The influence of service quality and patients' emotions on satisfaction.

PubMed

Vinagre, Maria Helena; Neves, José

2008-01-01

The purpose of this research is to develop and empirically test a model to examine the major factors affecting patients' satisfaction that depict and estimate the relationships between service quality, patient's emotions, expectations and involvement. The approach was tested using structural equation modeling, with a sample of 317 patients from six Portuguese public healthcare centres, using a revised SERVQUAL scale for service quality evaluation and an adapted DESII scale for assessing patient emotions. The scales used to evaluate service quality and emotional experience appears valid. The results support process complexity that leads to health service satisfaction, which involves diverse phenomena within the cognitive and emotional domain, revealing that all the predictors have a significant effect on satisfaction. The emotions inventory, although showing good internal consistency, might be enlarged to other typologies in further research--needed to confirm these findings. Patient's satisfaction mechanisms are important for improving service quality. The research shows empirical evidence about the effect of both patient's emotions and service quality on satisfaction with healthcare services. Findings also provide a model that includes valid and reliable measures.

Quality effort decision in service supply chain with quality preference based on quantum game

NASA Astrophysics Data System (ADS)

Zhang, Cuihua; Xing, Peng; Wang, Jianwei

2015-04-01

Service quality preference behaviors of both members are considered in service supply chain (SSC) including a service integrator and a service provider with stochastic demand. Through analysis of service quality cost and revenue, the utility functions are established on service quality effort degree and service quality preference level in integrated and decentralized SSC. Nash equilibrium and quantum game are used to optimize the models. By comparing the different solutions, the optimal strategies are obtained in SSC with quality preference. Then some numerical examples are studied and the changing trend of service quality effort is further analyzed by the influence of the entanglement operator and quality preferences.

Performance-Based Service Quality Model: An Empirical Study on Japanese Universities

ERIC Educational Resources Information Center

Sultan, Parves; Wong, Ho

2010-01-01

Purpose: This paper aims to develop and empirically test the performance-based higher education service quality model. Design/methodology/approach: The study develops 67-item instrument for measuring performance-based service quality with a particular focus on the higher education sector. Scale reliability is confirmed using the Cronbach's alpha.…

Quality of care and service trajectories for people with intellectual disabilities: defining the aspects of quality from the client's perspective.

PubMed

Barelds, Anna; van de Goor, Ien; van Heck, Guus; Schols, Jos

2010-03-01

Care and service trajectories for people with intellectual disabilities (i.e. people with mental retardations) are routes within the healthcare delivery system that consist of all the steps that people with intellectual disabilities and their families have to take in order to realise the needed care and services. This article aims to identify the quality aspects of trajectories that are considered important by people with intellectual disabilities and their parents/relatives. In addition, it examines how these aspects are related to quality determinants mentioned in the literature on integrated care and to authoritative models for quality assessment of care and service delivery. Quality aspects were collected during eight focus group discussions with people with intellectual disabilities or their parents/relatives. In addition, quality determinants of integrated care and authoritative models for quality assessment were selected by means of a thorough review of the literature. Finally, the quality aspects identified using focus groups were compared to the determinants and models found in the literature. The quality aspects presented by people with intellectual disabilities referred particularly to the immediate situation in receiving care and services, such as 'keeping appointments' and 'time and attention', whereas parents/relatives also referred to broader 'organisational issues', such as 'access to support' and 'problems with placement'. The quality aspects, however, are minimally related to the quality determinants of integrated care, probably because clients and their parents/relatives find it difficult to have an overview of the coherence between the various actions that have to be performed, when going through the trajectories. In contrast, the quality aspects seem to fit into the domains of the authoritative models for quality assessment, probably because of the minimal focus of the models on long-term aspects in care and service delivery.

Service Quality and Customer Satisfaction: An Assessment and Future Directions.

ERIC Educational Resources Information Center

Hernon, Peter; Nitecki, Danuta A.; Altman, Ellen

1999-01-01

Reviews the literature of library and information science to examine issues related to service quality and customer satisfaction in academic libraries. Discusses assessment, the application of a business model to higher education, a multiple constituency approach, decision areas regarding service quality, resistance to service quality, and future…

From service quality in organisations to self-determination at home.

PubMed

Martínez-Tur, V; Moliner, C; Peñarroja, V; Gracia, E; Peiró, J M

2015-10-01

In our proposed model, family members' perceptions of service quality in organisations improve communication about self-determination. In turn, family perceptions of communication openness have a positive relationship with self-determination attitudes of family members. Finally, these attitudes predict self-determination behaviours of individuals with intellectual disability, as reported by family members. We tested this model with a sample of 625 family members (196 using 'day care services' and 429 using 'occupational services'). Multi-sample structural equation modelling (SEM) supported the model. Communication and attitudes fully mediated the link from service quality to self-determination behaviours. Improving family members' perceptions of service quality and opening channels of communication between professionals and family members are useful strategies to facilitate parents' positive attitudes and increase the frequency of self-determination behaviours at home. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

A Systematic Process for Developing High Quality SaaS Cloud Services

NASA Astrophysics Data System (ADS)

La, Hyun Jung; Kim, Soo Dong

Software-as-a-Service (SaaS) is a type of cloud service which provides software functionality through Internet. Its benefits are well received in academia and industry. To fully utilize the benefits, there should be effective methodologies to support the development of SaaS services which provide high reusability and applicability. Conventional approaches such as object-oriented methods do not effectively support SaaS-specific engineering activities such as modeling common features, variability, and designing quality services. In this paper, we present a systematic process for developing high quality SaaS and highlight the essentiality of commonality and variability (C&V) modeling to maximize the reusability. We first define criteria for designing the process model and provide a theoretical foundation for SaaS; its meta-model and C&V model. We clarify the notion of commonality and variability in SaaS, and propose a SaaS development process which is accompanied with engineering instructions. Using the proposed process, SaaS services with high quality can be effectively developed.

Non-linear assessment and deficiency of linear relationship for healthcare industry

NASA Astrophysics Data System (ADS)

Nordin, N.; Abdullah, M. M. A. B.; Razak, R. C.

2017-09-01

This paper presents the development of the non-linear service satisfaction model that assumes patients are not necessarily satisfied or dissatisfied with good or poor service delivery. With that, compliment and compliant assessment is considered, simultaneously. Non-linear service satisfaction instrument called Kano-Q and Kano-SS is developed based on Kano model and Theory of Quality Attributes (TQA) to define the unexpected, hidden and unspoken patient satisfaction and dissatisfaction into service quality attribute. A new Kano-Q and Kano-SS algorithm for quality attribute assessment is developed based satisfaction impact theories and found instrumentally fit the reliability and validity test. The results were also validated based on standard Kano model procedure before Kano model and Quality Function Deployment (QFD) is integrated for patient attribute and service attribute prioritization. An algorithm of Kano-QFD matrix operation is developed to compose the prioritized complaint and compliment indexes. Finally, the results of prioritized service attributes are mapped to service delivery category to determine the most prioritized service delivery that need to be improved at the first place by healthcare service provider.

Service quality assessment of workers compensation health care delivery programs in New York using SERVQUAL.

PubMed

Arunasalam, Mark; Paulson, Albert; Wallace, William

2003-01-01

Preferred provider organizations (PPOs) provide healthcare services to an expanding proportion of the U.S. population. This paper presents a programmatic assessment of service quality in the workers' compensation environment using two different models: the PPO program model and the fee-for-service (FFS) payor model. The methodology used here will augment currently available research in workers' compensation, which has been lacking in measuring service quality determinants and assessing programmatic success/failure of managed care type programs. Results indicated that the SERVQUAL tool provided a reliable and valid clinical quality assessment tool that ascertained that PPO marketers should focus on promoting physician outreach (to show empathy) and accessibility (to show reliability) for injured workers.

The trust-commitment challenge in service quality-loyalty relationships.

PubMed

Moreira, Antonio Carrizo; Silva, Pedro Miguel

2015-01-01

The purpose of this paper is to develop and empirically test a model to examine service quality, satisfaction, trust and commitment as loyalty antecedents in a private healthcare service. The approach was tested using structural equation modelling, involving 175 patients from a private Portuguese healthcare unit, using a revised Service Quality Assessment Scale (SQAS) scale for service quality evaluation. The scale used to evaluate service quality is valid and meaningful. Service quality proved to be a multidimensional construct and relevant to build satisfaction. The path satisfaction→trust→loyalty was validated, whereas the path satisfaction→commitment→loyalty was not statistically supported. The revised SQAS scale showed good internal consistency in healthcare context. Further trust-commitment antecedents must be examined in a private healthcare landscape to generalise the findings. Healthcare quality managers must explore the service quality dimensions to generate satisfaction among their patients. Developing trust generates positive patient attitudes and loyalty. This study explores using the SQAS scale in a private healthcare context. The authors provide further evidence that service quality is an antecedent and different from satisfaction. All the measures used proved to be valid and reliable. Trust and commitment play different roles in their relationship with loyalty.

Evaluating Quality of Students' Support Services in Open Distance Learning

ERIC Educational Resources Information Center

Nsamba, Asteria; Makoe, Mpine

2017-01-01

Evaluating the quality of students' support services in distance education institutions is vital because by nature Open Distance Learning (ODL) is a high-involvement service industry, with multiple student support service encounters. Most quality evaluation models tend to view quality from the institutional perspective. As a result, little is…

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan

PubMed Central

Chang, Hsin Hsin; Chang, Ching Sheng

2008-01-01

Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. Methods This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. Results The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. Conclusion It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust. PMID:18419820

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan.

PubMed

Chang, Hsin Hsin; Chang, Ching Sheng

2008-04-17

Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust.

Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

PubMed

Killaspy, Helen; Marston, Louise; Omar, Rumana Z; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; King, Michael

2013-01-01

Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

Measuring Service Quality in a Tertiary Institution.

ERIC Educational Resources Information Center

Soutar, Geoffrey; McNeil, Margaret

1996-01-01

Measures service quality from the viewpoint of customers (students at an Australian university), using the SERVQUAL model. Obtains evaluations of academic and administrative aspects of the educational service. Makes significant negative evaluations of administrative service quality (resulting from communication problems). Satisfaction with the…

Measuring Service Quality in Higher Education: Development of a Hierarchical Model (HESQUAL)

ERIC Educational Resources Information Center

Teeroovengadum, Viraiyan; Kamalanabhan, T. J.; Seebaluck, Ashley Keshwar

2016-01-01

Purpose: This paper aims to develop and empirically test a hierarchical model for measuring service quality in higher education. Design/methodology/approach: The first phase of the study consisted of qualitative research methods and a comprehensive literature review, which allowed the development of a conceptual model comprising 53 service quality…

Total Quality Management of Information System for Quality Assessment of Pesantren Using Fuzzy-SERVQUAL

NASA Astrophysics Data System (ADS)

Faizah, Arbiati; Syafei, Wahyul Amien; Isnanto, R. Rizal

2018-02-01

This research proposed a model combining an approach of Total Quality Management (TQM) and Fuzzy method of Service Quality (SERVQUAL) to asses service quality. TQM implementation was as quality management orienting on customer's satisfaction by involving all stakeholders. SERVQUAL model was used to measure quality service based on five dimensions such as tangible, reliability, responsiveness, assurance, and empathy. Fuzzy set theory was to accommodate subjectivity and ambiguity of quality assessment. Input data consisted of indicator data and quality assessment aspect. Input data was, then, processed to be service quality assessment questionnaires of Pesantren by using Fuzzy method to get service quality score. This process consisted of some steps as follows : inputting dimension and questionnaire data to data base system, filling questionnaire through system, then, system calculated fuzzification, defuzzification, gap of quality expected and received by service receivers, and calculating each dimension rating showing quality refinement priority. Rating of each quality dimension was, then, displayed at dashboard system to enable users to see information. From system having been built, it could be known that tangible dimension had the highest gap, -0.399, thus it needs to be prioritized and gets evaluation and refinement action soon.

Urban Air Quality Modelling with AURORA: Prague and Bratislava

NASA Astrophysics Data System (ADS)

Veldeman, N.; Viaene, P.; De Ridder, K.; Peelaerts, W.; Lauwaet, D.; Muhammad, N.; Blyth, L.

2012-04-01

The European Commission, in its strategy to protect the health of the European citizens, states that in order to assess the impact of air pollution on public health, information on long-term exposure to air pollution should be available. Currently, indicators of air quality are often being generated using measured pollutant concentrations. While air quality monitoring stations data provide accurate time series information at specific locations, air quality models have the advantage of being able to assess the spatial variability of air quality (for different resolutions) and predict air quality in the future based on different scenarios. When running such air quality models at a high spatial and temporal resolution, one can simulate the actual situation as closely as possible, allowing for a detailed assessment of the risk of exposure to citizens from different pollutants. AURORA (Air quality modelling in Urban Regions using an Optimal Resolution Approach), a prognostic 3-dimensional Eulerian chemistry-transport model, is designed to simulate urban- to regional-scale atmospheric pollutant concentration and exposure fields. The AURORA model also allows to calculate the impact of changes in land use (e.g. planting of trees) or of emission reduction scenario's on air quality. AURORA is currently being applied within the ESA atmospheric GMES service, PASODOBLE (http://www.myair-eu.org), that delivers information on air quality, greenhouse gases, stratospheric ozone, … At present there are two operational AURORA services within PASODOBLE. Within the "Air quality forecast service" VITO delivers daily air quality forecasts for Belgium at a resolution of 5 km and for the major Belgian cities: Brussels, Ghent, Antwerp, Liege and Charleroi. Furthermore forecast services are provided for Prague, Czech Republic and Bratislava, Slovakia, both at a resolution of 1 km. The "Urban/regional air quality assessment service" provides urban- and regional-scale maps (hourly resolution) for air pollution and human exposure statistics for an entire year. So far we concentrated on Brussels, Belgium and the Rotterdam harbour area, The Netherlands. In this contribution we focus on the operational forecast services. Reference Lefebvre W. et al. (2011) Validation of the MIMOSA-AURORA-IFDM model chain for policy support: Modeling concentrations of elemental carbon in Flanders, Atmospheric Environment 45, 6705-6713

Breast cancer screening services: trade-offs in quality, capacity, outreach, and centralization.

PubMed

Güneş, Evrim D; Chick, Stephen E; Akşin, O Zeynep

2004-11-01

This work combines and extends previous work on breast cancer screening models by explicitly incorporating, for the first time, aspects of the dynamics of health care states, program outreach, and the screening volume-quality relationship in a service system model to examine the effect of public health policy and service capacity decisions on public health outcomes. We consider the impact of increasing standards for minimum reading volume to improve quality, expanding outreach with or without decentralization of service facilities, and the potential of queueing due to stochastic effects and limited capacity. The results indicate a strong relation between screening quality and the cost of screening and treatment, and emphasize the importance of accounting for service dynamics when assessing the performance of health care interventions. For breast cancer screening, increasing outreach without improving quality and maintaining capacity results in less benefit than predicted by standard models.

Analysis of psychological factors for quality assessment of interactive multimodal service

NASA Astrophysics Data System (ADS)

Yamagishi, Kazuhisa; Hayashi, Takanori

2005-03-01

We proposed a subjective quality assessment model for interactive multimodal services. First, psychological factors of an audiovisual communication service were extracted by using the semantic differential (SD) technique and factor analysis. Forty subjects participated in subjective tests and performed point-to-point conversational tasks on a PC-based TV phone that exhibits various network qualities. The subjects assessed those qualities on the basis of 25 pairs of adjectives. Two psychological factors, i.e., an aesthetic feeling and a feeling of activity, were extracted from the results. Then, quality impairment factors affecting these two psychological factors were analyzed. We found that the aesthetic feeling is mainly affected by IP packet loss and video coding bit rate, and the feeling of activity depends on delay time and video frame rate. We then proposed an opinion model derived from the relationships among quality impairment factors, psychological factors, and overall quality. The results indicated that the estimation error of the proposed model is almost equivalent to the statistical reliability of the subjective score. Finally, using the proposed model, we discuss guidelines for quality design of interactive audiovisual communication services.

A Conceptual Framework for Quality of Care

PubMed Central

Mosadeghrad, Ali Mohammad

2012-01-01

Despite extensive research on defining and measuring health care quality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel members to identify the healthcare service quality attributes and dimensions. Data analysis was carried out by content analysis, with the constant comparative method. Over 100 attributes of quality healthcare service were elicited and grouped into five categories. The dimensions were: efficacy, effectiveness, efficiency, empathy, and environment. Consequently, a comprehensive model of service quality was developed for health care context. The findings of the current study led to a conceptual framework of healthcare quality. This model leads to a better understanding of the different aspects of quality in health care and provides a better basis for defining, measuring and controlling quality of health care services. PMID:23922534

A new method based on fuzzy logic to evaluate the contract service provider performance.

PubMed

Miguel, C A; Barr, C; Moreno, M J L

2008-01-01

This paper puts forward a fuzzy inference system for evaluating the service quality performance of service contract providers. An application service provider (ASP) model for computerized maintenance management was used in establishing common performance indicators of the quality of service. This model was implemented in 10 separate hospitals. As a result, inference produced a service cost/acquisition cost (SC/AC) ratio reduction from 16.14% to 6.09%, an increase of 20.9% in availability, with a maintained repair quality (NRR) in the period of December 2001 to January 2003.

A Tentative Study on the Evaluation of Community Health Service Quality*

NASA Astrophysics Data System (ADS)

Ma, Zhi-qiang; Zhu, Yong-yue

Community health service is the key point of health reform in China. Based on pertinent studies, this paper constructed an indicator system for the community health service quality evaluation from such five perspectives as visible image, reliability, responsiveness, assurance and sympathy, according to service quality evaluation scale designed by Parasuraman, Zeithaml and Berry. A multilevel fuzzy synthetical evaluation model was constructed to evaluate community health service by fuzzy mathematics theory. The applicability and maneuverability of the evaluation indicator system and evaluation model were verified by empirical analysis.

Doctors or technicians: assessing quality of medical education

PubMed Central

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products. PMID:23745059

Doctors or technicians: assessing quality of medical education.

PubMed

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products.

An Artificial Intelligence System to Predict Quality of Service in Banking Organizations

PubMed Central

Popovič, Aleš

2016-01-01

Quality of service, that is, the waiting time that customers must endure in order to receive a service, is a critical performance aspect in private and public service organizations. Providing good service quality is particularly important in highly competitive sectors where similar services exist. In this paper, focusing on banking sector, we propose an artificial intelligence system for building a model for the prediction of service quality. While the traditional approach used for building analytical models relies on theories and assumptions about the problem at hand, we propose a novel approach for learning models from actual data. Thus, the proposed approach is not biased by the knowledge that experts may have about the problem, but it is completely based on the available data. The system is based on a recently defined variant of genetic programming that allows practitioners to include the concept of semantics in the search process. This will have beneficial effects on the search process and will produce analytical models that are based only on the data and not on domain-dependent knowledge. PMID:27313604

An Artificial Intelligence System to Predict Quality of Service in Banking Organizations.

PubMed

Castelli, Mauro; Manzoni, Luca; Popovič, Aleš

2016-01-01

Quality of service, that is, the waiting time that customers must endure in order to receive a service, is a critical performance aspect in private and public service organizations. Providing good service quality is particularly important in highly competitive sectors where similar services exist. In this paper, focusing on banking sector, we propose an artificial intelligence system for building a model for the prediction of service quality. While the traditional approach used for building analytical models relies on theories and assumptions about the problem at hand, we propose a novel approach for learning models from actual data. Thus, the proposed approach is not biased by the knowledge that experts may have about the problem, but it is completely based on the available data. The system is based on a recently defined variant of genetic programming that allows practitioners to include the concept of semantics in the search process. This will have beneficial effects on the search process and will produce analytical models that are based only on the data and not on domain-dependent knowledge.

[Patients and quality of primary health care services. Survey of practitioners at the Bahía de Cádiz and La Janda health centers].

PubMed

Hernán García, M; Gutiérrez Cuadra, J L; Lineros González, C; Ruiz Barbosa, C; Rabadán Asensio, A

2002-10-31

To report the opinions of practitioners at health centers on dimensions of quality that affect user satisfaction. Cross-sectional study of focus groups (FG). Bahía de Cádiz and La Janda health centers in southwestern Spain. We studied 4 FG whose participants were staff members of the two health centers: FG1, physicians; FG2, user satisfaction service staff; FG3, social workers; FG4, nurses. The groups were based on the different functions of staff at the two centers. The analysis was based on variables in the SERCAL model (an adaptation of the SERVQUAL model for the Spanish health care system) of opinions regarding service quality: access, comfort (tangibles), personalized service (courtesy), competence, and loyalty. The data were analyzed with version N-Vivo of the NUDIST program. All dimensions of the theoretical model were identified by practitioners as constructs of users' perceptions of service quality. Users' and practitioners' views contrasted with and complemented each other to generate a model that could be validated. Access, personalized service and problem-solving (responsiveness) were key variables. Practitioners' opinions provided information of use in improving the quality model. Differences in opinion between users and practitioners merit further study based on an understanding of these groups' values and interests, and on the care provision context. Practitioners identified access, personalized service and problem-solving as features that influenced users' opinions of the quality of the health center.

A novel client service quality measuring model and an eHealthcare mitigating approach.

PubMed

Cheng, L M; Choi, Wai Ping Choi; Wong, Anita Yiu Ming

2016-07-01

Facing population ageing in Hong Kong, the demand of long-term elderly health care services is increasing. The challenge is to support a good quality service under the constraints faced by recent shortage of nursing and care services professionals without redesigning the work flow operated in the existing elderly health care industries. the existing elderly health care industries. The Total QoS measure based on Finite Capacity Queuing Model is a reliable method and an effective measurement for Quality of services. The value is good for measuring the staffing level and offers a measurement for efficiency enhancement when incorporate new technologies like ICT. The implemented system has improved the Quality of Service by more than 14% and the extra released manpower resource will allow clinical care provider to offer further value added services without actually increasing head count. We have developed a novel Quality of Service measurement for Clinical Care services based on multi-queue using finite capacity queue model M/M/c/K/n and the measurement is useful for estimating the shortage of staff resource in a caring institution. It is essential for future integration with the existing widely used assessment model to develop reliable measuring limits which allow an effective measurement of public fund used in health care industries. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2016-01-01

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

Refinement, Validation and Benchmarking of a Model for E-Government Service Quality

NASA Astrophysics Data System (ADS)

Magoutas, Babis; Mentzas, Gregoris

This paper presents the refinement and validation of a model for Quality of e-Government Services (QeGS). We built upon our previous work where a conceptualized model was identified and put focus on the confirmatory phase of the model development process, in order to come up with a valid and reliable QeGS model. The validated model, which was benchmarked with very positive results with similar models found in the literature, can be used for measuring the QeGS in a reliable and valid manner. This will form the basis for a continuous quality improvement process, unleashing the full potential of e-government services for both citizens and public administrations.

A Multiple-Item Scale for Assessing E-Government Service Quality

NASA Astrophysics Data System (ADS)

Papadomichelaki, Xenia; Mentzas, Gregoris

A critical element in the evolution of e-governmental services is the development of sites that better serve the citizens’ needs. To deliver superior service quality, we must first understand how citizens perceive and evaluate online citizen service. This involves defining what e-government service quality is, identifying its underlying dimensions, and determining how it can be conceptualized and measured. In this article we conceptualise an e-government service quality model (e-GovQual) and then we develop, refine, validate, confirm and test a multiple-item scale for measuring e-government service quality for public administration sites where citizens seek either information or services.

Two-echelon logistics service supply chain decision game considering quality supervision

NASA Astrophysics Data System (ADS)

Shi, Jiaying

2017-10-01

Due to the increasing importance of supply chain logistics service, we established the Stackelberg game model between single integrator and single subcontractors under decentralized and centralized circumstances, and found that logistics services integrators as a leader prefer centralized decision-making but logistics service subcontractors tend to the decentralized decision-making. Then, we further analyzed why subcontractor chose to deceive and rebuilt a principal-agent game model to monitor the logistics services quality of them. Mixed Strategy Nash equilibrium and related parameters were discussed. The results show that strengthening the supervision and coordination can improve the quality level of logistics service supply chain.

Federal Workforce Quality: Measurement and Improvement

DTIC Science & Technology

1992-08-01

explicit standards of production and service quality . Assessment Tools 4 OPM should institutionalize its data collection program of longitudinal research...include data about quirements, should set explicit standards of various aspects of the model. That is, the production and service quality . effort...are the immediate consumers service quality are possible. of the products and services delivered, and still others in the larger society who have no

A systematic composite service design modeling method using graph-based theory.

PubMed

Elhag, Arafat Abdulgader Mohammed; Mohamad, Radziah; Aziz, Muhammad Waqar; Zeshan, Furkh

2015-01-01

The composite service design modeling is an essential process of the service-oriented software development life cycle, where the candidate services, composite services, operations and their dependencies are required to be identified and specified before their design. However, a systematic service-oriented design modeling method for composite services is still in its infancy as most of the existing approaches provide the modeling of atomic services only. For these reasons, a new method (ComSDM) is proposed in this work for modeling the concept of service-oriented design to increase the reusability and decrease the complexity of system while keeping the service composition considerations in mind. Furthermore, the ComSDM method provides the mathematical representation of the components of service-oriented design using the graph-based theoryto facilitate the design quality measurement. To demonstrate that the ComSDM method is also suitable for composite service design modeling of distributed embedded real-time systems along with enterprise software development, it is implemented in the case study of a smart home. The results of the case study not only check the applicability of ComSDM, but can also be used to validate the complexity and reusability of ComSDM. This also guides the future research towards the design quality measurement such as using the ComSDM method to measure the quality of composite service design in service-oriented software system.

A Systematic Composite Service Design Modeling Method Using Graph-Based Theory

PubMed Central

Elhag, Arafat Abdulgader Mohammed; Mohamad, Radziah; Aziz, Muhammad Waqar; Zeshan, Furkh

2015-01-01

The composite service design modeling is an essential process of the service-oriented software development life cycle, where the candidate services, composite services, operations and their dependencies are required to be identified and specified before their design. However, a systematic service-oriented design modeling method for composite services is still in its infancy as most of the existing approaches provide the modeling of atomic services only. For these reasons, a new method (ComSDM) is proposed in this work for modeling the concept of service-oriented design to increase the reusability and decrease the complexity of system while keeping the service composition considerations in mind. Furthermore, the ComSDM method provides the mathematical representation of the components of service-oriented design using the graph-based theoryto facilitate the design quality measurement. To demonstrate that the ComSDM method is also suitable for composite service design modeling of distributed embedded real-time systems along with enterprise software development, it is implemented in the case study of a smart home. The results of the case study not only check the applicability of ComSDM, but can also be used to validate the complexity and reusability of ComSDM. This also guides the future research towards the design quality measurement such as using the ComSDM method to measure the quality of composite service design in service-oriented software system. PMID:25928358

Private healthcare quality: applying a SERVQUAL model.

PubMed

Butt, Mohsin Muhammad; de Run, Ernest Cyril

2010-01-01

This paper seeks to develop and test the SERVQUAL model scale for measuring Malaysian private health service quality. The study consists of 340 randomly selected participants visiting a private healthcare facility during a three-month data collection period. Data were analyzed using means, correlations, principal component and confirmatory factor analysis to establish the modified SERVQUAL scale's reliability, underlying dimensionality and convergent, discriminant validity. Results indicate a moderate negative quality gap for overall Malaysian private healthcare service quality. Results also indicate a moderate negative quality gap on each service quality scale dimension. However, scale development analysis yielded excellent results, which can be used in wider healthcare policy and practice. Respondents were skewed towards a younger population, causing concern that the results might not represent all Malaysian age groups. The study's major contribution is that it offers a way to assess private healthcare service quality. Second, it successfully develops a scale that can be used to measure health service quality in Malaysian contexts.

Measuring Quality in Special Libraries: Lessons from Service Marketing.

ERIC Educational Resources Information Center

White, Marilyn Domas; Abels, Eileen G.

1995-01-01

Surveys the service marketing literature for models and data-gathering instruments measuring service quality, particularly the instruments SERVQUAL and SERVPERF, and assesses their applicability to special libraries and information centers. Topics include service characteristics and definitions of service; performance-minus-expectations and…

Models of Dynamic Relations Among Service Activities, System State and Service Quality on Computer and Network Systems

DTIC Science & Technology

2010-01-01

Service quality on computer and network systems has become increasingly important as many conventional service transactions are moved online. Service quality of computer and network services can be measured by the performance of the service process in throughput, delay, and so on. On a computer and network system, competing service requests of users and associated service activities change the state of limited system resources which in turn affects the achieved service ...relations of service activities, system state and service

Applying revised gap analysis model in measuring hotel service quality.

PubMed

Lee, Yu-Cheng; Wang, Yu-Che; Chien, Chih-Hung; Wu, Chia-Huei; Lu, Shu-Chiung; Tsai, Sang-Bing; Dong, Weiwei

2016-01-01

With the number of tourists coming to Taiwan growing by 10-20 % since 2010, the number has increased due to an increasing number of foreign tourists, particularly after deregulation allowed admitting tourist groups, followed later on by foreign individual tourists, from mainland China. The purpose of this study is to propose a revised gap model to evaluate and improve service quality in Taiwanese hotel industry. Thus, service quality could be clearly measured through gap analysis, which was more effective for offering direction in developing and improving service quality. The HOLSERV instrument was used to identify and analyze service gaps from the perceptions of internal and external customers. The sample for this study included three main categories of respondents: tourists, employees, and managers. The results show that five gaps influenced tourists' evaluations of service quality. In particular, the study revealed that Gap 1 (management perceptions vs. customer expectations) and Gap 9 (service provider perceptions of management perceptions vs. service delivery) were more critical than the others in affecting perceived service quality, making service delivery the main area of improvement. This study contributes toward an evaluation of the service quality of the Taiwanese hotel industry from the perspectives of customers, service providers, and managers, which is considerably valuable for hotel managers. It was the aim of this study to explore all of these together in order to better understand the possible gaps in the hotel industry in Taiwan.

Establishing a Cloud Computing Success Model for Hospitals in Taiwan.

PubMed

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services.

Establishing a Cloud Computing Success Model for Hospitals in Taiwan

PubMed Central

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services. PMID:28112020

Quality Services Management: A Consumer-Oriented Model for Systems Audit and Strategic Intervention.

ERIC Educational Resources Information Center

Baker, Pamela C.

The paper describes Quality Service Management (QSM) as applied to the provision of services to disabled and other special needs persons. QSM is defined as a systems approach to consumer relations based on the belief that quality care may be achieved only within the context of overall services management. Differences among "quality…

E-Services quality assessment framework for collaborative networks

NASA Astrophysics Data System (ADS)

Stegaru, Georgiana; Danila, Cristian; Sacala, Ioan Stefan; Moisescu, Mihnea; Mihai Stanescu, Aurelian

2015-08-01

In a globalised networked economy, collaborative networks (CNs) are formed to take advantage of new business opportunities. Collaboration involves shared resources and capabilities, such as e-Services that can be dynamically composed to automate CN participants' business processes. Quality is essential for the success of business process automation. Current approaches mostly focus on quality of service (QoS)-based service selection and ranking algorithms, overlooking the process of service composition which requires interoperable, adaptable and secure e-Services to ensure seamless collaboration, data confidentiality and integrity. Lack of assessment of these quality attributes can result in e-Service composition failure. The quality of e-Service composition relies on the quality of each e-Service and on the quality of the composition process. Therefore, there is the need for a framework that addresses quality from both views: product and process. We propose a quality of e-Service composition (QoESC) framework for quality assessment of e-Service composition for CNs which comprises of a quality model for e-Service evaluation and guidelines for quality of e-Service composition process. We implemented a prototype considering a simplified telemedicine use case which involves a CN in e-Healthcare domain. To validate the proposed quality-driven framework, we analysed service composition reliability with and without using the proposed framework.

Toward a food service quality management system for compliance with the Mediterranean dietary model.

PubMed

Grigoroudis, Evangelos; Psaroudaki, Antonia; Diakaki, Christina

2013-01-01

The traditional diet of Cretan people in the 1960s is the basis of the Mediterranean dietary model. This article investigates the potential of this model to inspire proposals of meals by food-serving businesses, and suggests a methodology for the development of a quality management system, which will certify the delivery of food service according to this dietary model. The proposed methodology is built upon the principles and structure of the ISO 9001:2008 quality standard to enable integration with other quality, environmental, and food safety management systems.

Relationship between Service Quality, Satisfaction, Motivation and Loyalty: A Multi-Dimensional Perspective

ERIC Educational Resources Information Center

Subrahmanyam, Annamdevula

2017-01-01

Purpose: This paper aims to identify and test four competing models with the interrelationships between students' perceived service quality, students' satisfaction, loyalty and motivation using structural equation modeling (SEM), and to select the best model using chi-square difference (??2) statistic test. Design/methodology/approach: The study…

E-Service Quality Evaluation on E-Government Website: Case Study BPJS Kesehatan Indonesia

NASA Astrophysics Data System (ADS)

Rasyid, A.; Alfina, I.

2017-01-01

This research intends to develop a model to evaluate the quality of e-services on e-government. The proposed model consists of seven dimensions: web design, reliability, responsiveness, privacy and security, personalization, information, and ease of use. The model is used to measure the quality of the e-registration of BPJS Kesehatan, an Indonesian government health insurance program. The validation and reliability testing show that of the seven dimensions proposed, only four that suitable for the case study. The result shows that the BPJS Kesehatan e-registration service is good in reliability and responsiveness dimensions, while from web design and ease of use dimensions the e-service still needs to be optimized.

Validity test and its consistency in the construction of patient loyalty model

NASA Astrophysics Data System (ADS)

Yanuar, Ferra

2016-04-01

The main objective of this present study is to demonstrate the estimation of validity values and its consistency based on structural equation model. The method of estimation was then implemented to an empirical data in case of the construction the patient loyalty model. In the hypothesis model, service quality, patient satisfaction and patient loyalty were determined simultaneously, each factor were measured by any indicator variables. The respondents involved in this study were the patients who ever got healthcare at Puskesmas in Padang, West Sumatera. All 394 respondents who had complete information were included in the analysis. This study found that each construct; service quality, patient satisfaction and patient loyalty were valid. It means that all hypothesized indicator variables were significant to measure their corresponding latent variable. Service quality is the most measured by tangible, patient satisfaction is the most mesured by satisfied on service and patient loyalty is the most measured by good service quality. Meanwhile in structural equation, this study found that patient loyalty was affected by patient satisfaction positively and directly. Service quality affected patient loyalty indirectly with patient satisfaction as mediator variable between both latent variables. Both structural equations were also valid. This study also proved that validity values which obtained here were also consistence based on simulation study using bootstrap approach.

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

PubMed

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

2014-06-01

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

QaaS (quality as a service) model for web services using big data technologies

NASA Astrophysics Data System (ADS)

Ahmad, Faisal; Sarkar, Anirban

2017-10-01

Quality of service (QoS) determines the service usability and utility and both of which influence the service selection process. The QoS varies from one service provider to other. Each web service has its own methodology for evaluating QoS. The lack of transparent QoS evaluation model makes the service selection challenging. Moreover, most QoS evaluation processes do not consider their historical data which not only helps in getting more accurate QoS but also helps for future prediction, recommendation and knowledge discovery. QoS driven service selection demands a model where QoS can be provided as a service to end users. This paper proposes a layered QaaS (quality as a service) model in the same line as PaaS and software as a service, where users can provide QoS attributes as inputs and the model returns services satisfying the user's QoS expectation. This paper covers all the key aspects in this context, like selection of data sources, its transformation, evaluation, classification and storage of QoS. The paper uses server log as the source for evaluating QoS values, common methodology for its evaluation and big data technologies for its transformation and analysis. This paper also establishes the fact that Spark outperforms the Pig with respect to evaluation of QoS from logs.

Applying Quality Function Deployment Model in Burn Unit Service Improvement.

PubMed

Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi

2016-01-01

Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives.

Assessing uncertain human exposure to ambient air pollution using environmental models in the Web

NASA Astrophysics Data System (ADS)

Gerharz, L. E.; Pebesma, E.; Denby, B.

2012-04-01

Ambient air quality can have significant impact on human health by causing respiratory and cardio-vascular diseases. Thereby, the pollutant concentration a person is exposed to can differ considerably between individuals depending on their daily routine and movement patterns. Using a straight forward approach this exposure can be estimated by integration of individual space-time paths and spatio-temporally resolved ambient air quality data. To allow a realistic exposure assessment, it is furthermore important to consider uncertainties due to input and model errors. In this work, we present a generic, web-based approach for estimating individual exposure by integration of uncertain position and air quality information implemented as a web service. Following the Model Web initiative envisioning an infrastructure for deploying, executing and chaining environmental models as services, existing models and data sources for e.g. air quality, can be used to assess exposure. Therefore, the service needs to deal with different formats, resolutions and uncertainty representations provided by model or data services. Potential mismatch can be accounted for by transformation of uncertainties and (dis-)aggregation of data under consideration of changes in the uncertainties using components developed in the UncertWeb project. In UncertWeb, the Model Web vision is extended to an Uncertainty-enabled Model Web, where services can process and communicate uncertainties in the data and models. The propagation of uncertainty to the exposure results is quantified using Monte Carlo simulation by combining different realisations of positions and ambient concentrations. Two case studies were used to evaluate the developed exposure assessment service. In a first study, GPS tracks with a positional uncertainty of a few meters, collected in the urban area of Münster, Germany were used to assess exposure to PM10 (particulate matter smaller 10 µm). Air quality data was provided by an uncertainty-enabled air quality model system which provided realisations of concentrations per hour on a 250 m x 250 m resolved grid over Münster. The second case study uses modelled human trajectories in Rotterdam, The Netherlands. The trajectories were provided as realisations in 15 min resolution per 4 digit postal code from an activity model. Air quality estimates were provided for different pollutants as ensembles by a coupled meteorology and air quality model system on a 1 km x 1 km grid with hourly resolution. Both case studies show the successful application of the service to different resolutions and uncertainty representations.

QoS measurement of workflow-based web service compositions using Colored Petri net.

PubMed

Nematzadeh, Hossein; Motameni, Homayun; Mohamad, Radziah; Nematzadeh, Zahra

2014-01-01

Workflow-based web service compositions (WB-WSCs) is one of the main composition categories in service oriented architecture (SOA). Eflow, polymorphic process model (PPM), and business process execution language (BPEL) are the main techniques of the category of WB-WSCs. Due to maturity of web services, measuring the quality of composite web services being developed by different techniques becomes one of the most important challenges in today's web environments. Business should try to provide good quality regarding the customers' requirements to a composed web service. Thus, quality of service (QoS) which refers to nonfunctional parameters is important to be measured since the quality degree of a certain web service composition could be achieved. This paper tried to find a deterministic analytical method for dependability and performance measurement using Colored Petri net (CPN) with explicit routing constructs and application of theory of probability. A computer tool called WSET was also developed for modeling and supporting QoS measurement through simulation.

Measuring patient-perceived hospital service quality: a conceptual framework.

PubMed

Pai, Yogesh P; Chary, Satyanarayana T

2016-04-18

Purpose - Although measuring healthcare service quality is not a new phenomenon, the instruments used to measure are timeworn. With the shift in focus to patient centric processes in hospitals and recognizing healthcare to be different compared to other services, service quality measurement needs to be tuned specifically to healthcare. The purpose of this paper is to design a conceptual framework for measuring patient perceived hospital service quality (HSQ), based on existing service quality literature. Design/methodology/approach - Using HSQ theories, expanding existing healthcare service models and literature, a conceptual framework is proposed to measure HSQ. The paper outlines patient perceived service quality dimensions. Findings - An instrument for measuring HSQ dimensions is developed and compared with other service quality measuring instruments. The latest dimensions are in line with previous studies, but a relationship dimension is added. Practical implications - The framework empowers managers to assess healthcare quality in corporate, public and teaching hospitals. Originality/value - The paper helps academics and practitioners to assess HSQ from a patient perspective.

Factors associated with quality of life and caregiver strain amongst frail older adults referred to a community rehabilitation service: implications for service delivery.

PubMed

Comans, Tracy A; Currin, Michelle L; Brauer, Sandra G; Haines, Terry P

2011-01-01

To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models. Analytical cross-sectional study arising from baseline assessments from 107 subjects drawn from a randomised controlled trial of community rehabilitation service delivery models. A community rehabilitation team based in Brisbane, Queensland, Australia. Primary outcome variables include quality of life (EQ-5D & VAS) and Carer Strain Index. Predictor variables include participation in functional activities, history of falls, number of medications, number of co-morbidities, depression, environmental hazards, physical function and nutrition. Association between variables assessed using linear regression. Major factors contributing to reduced quality of life were having reduced participation in daily activities, depression, and having poor vision. Having poor nutrition and no longer driving also contributed to poor quality of life. The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person. Community rehabilitation services working with older populations must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain.

A model of service quality perceptions and health care consumer behavior.

PubMed

O'Connor, S J; Shewchuk, R M; Bowers, M R

1991-01-01

Analysis of covariance structures (LISREL) was used to examine the influence of consumer held perceptions of service quality on consumer satisfaction and intentions to return. Results indicate that service quality is a significant predictor of consumer satisfaction which, in turn, predicts intention to return. Health care marketing implications are discussed.

Quality Assurance in University Guidance Services

ERIC Educational Resources Information Center

Simon, Alexandra

2014-01-01

In Europe there is no common quality assurance framework for the delivery of guidance in higher education. Using a case study approach in four university career guidance services in England, France and Spain, this article aims to study how quality is implemented in university career guidance services in terms of strategy, standards and models,…

Social franchising primary healthcare clinics--a model for South African National Health Insurance?

PubMed

Robinson, Andrew Ken Lacey

2015-09-21

This article describes the first government social franchise initiative in the world to deliver a 'brand' of quality primary healthcare (PHC) clinic services. Quality and standards of care are not uniformly and reliably delivered across government PHC clinics in North West Province, South Africa, despite government support, numerous policies, guidelines and in-service training sessions provided to staff. Currently the strongest predictor of good-quality service is the skill and dedication of the facility manager. A project utilising the social franchising business model, harvesting best practices, has been implemented with the aim of developing a system to ensure reliably excellent healthcare service provision in every facility in North West. The services of social franchising consultants have been procured to develop the business model to drive this initiative. Best practices have been benchmarked, and policies, guidelines and clinic support systems have been reviewed, evaluated and assessed, and incorporated into the business plan. A pilot clinic has been selected to refine and develop a working social franchise model. This will then be replicated in one clinic to confirm proof of concept before further scale-up. The social franchise business model can provide solutions to a reliable and recognisable 'brand' of quality universal coverage of healthcare services.

Service quality in community pharmacy: an exploration of determinants.

PubMed

White, Lesley; Klinner, Christiane

2012-01-01

Although various instruments have been developed to measure customer satisfaction with community pharmacy services, there is limited research regarding pharmacy staffs' understanding of service quality and its determinants. This study aimed to explore the perceptions of pharmacy staff regarding the factors that constitute a high level of service quality using the service quality determinants proposed by the Conceptual Model of Service Quality. Structured interviews were conducted with 27 pharmacy assistants and 6 pharmacists in 3 community pharmacies in Sydney. The interview questions focused on the participants' perceptions of consumer expectations, the translation of these perceptions into service quality specifications, the actual service delivery, and the communication to customers. From the pharmacy staff perspective, service quality is significantly limited by insufficient internal communication and control processes that impede role clarity and the resolution of conflicting role expectations among customer service personnel. Participants indicated that these problems could be alleviated through the implementation of more transparent, realistic, measurable, and accepted quality specifications by pharmacy management. The study indicates that the extent to which pharmacy management sets, maintains, and communicates service quality specifications to staff directly affects role clarity, role conflict, and organizational commitment among customer service staff, which in turn directly influence the level of service quality provided to the customers. Copyright © 2012 Elsevier Inc. All rights reserved.

Research on manufacturing service behavior modeling based on block chain theory

NASA Astrophysics Data System (ADS)

Zhao, Gang; Zhang, Guangli; Liu, Ming; Yu, Shuqin; Liu, Yali; Zhang, Xu

2018-04-01

According to the attribute characteristics of processing craft, the manufacturing service behavior is divided into service attribute, basic attribute, process attribute, resource attribute. The attribute information model of manufacturing service is established. The manufacturing service behavior information is successfully divided into public and private domain. Additionally, the block chain technology is introduced, and the information model of manufacturing service based on block chain principle is established, which solves the problem of sharing and secreting information of processing behavior, and ensures that data is not tampered with. Based on the key pairing verification relationship, the selective publishing mechanism for manufacturing information is established, achieving the traceability of product data, guarantying the quality of processing quality.

Franchising of health services in low-income countries.

PubMed

Montagu, Dominic

2002-06-01

Grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. This paper describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analyzing choices in the design and implementation of health-related social franchises in developing countries.

Mitigating Provider Uncertainty in Service Provision Contracts

NASA Astrophysics Data System (ADS)

Smith, Chris; van Moorsel, Aad

Uncertainty is an inherent property of open, distributed and multiparty systems. The viability of the mutually beneficial relationships which motivate these systems relies on rational decision-making by each constituent party under uncertainty. Service provision in distributed systems is one such relationship. Uncertainty is experienced by the service provider in his ability to deliver a service with selected quality level guarantees due to inherent non-determinism, such as load fluctuations and hardware failures. Statistical estimators utilized to model this non-determinism introduce additional uncertainty through sampling error. Inability of the provider to accurately model and analyze uncertainty in the quality level guarantees can result in the formation of sub-optimal service provision contracts. Emblematic consequences include loss of revenue, inefficient resource utilization and erosion of reputation and consumer trust. We propose a utility model for contract-based service provision to provide a systematic approach to optimal service provision contract formation under uncertainty. Performance prediction methods to enable the derivation of statistical estimators for quality level are introduced, with analysis of their resultant accuracy and cost.

Quality Management in Career Services, a la Deming.

ERIC Educational Resources Information Center

Korschgen, Ann J.; Rounds, Dan

1992-01-01

Describes career services program at University of Wisconsin-La Crosse that adapted material from W.E. Deming's quality control manual to the needs of its office. Discusses Deming's work and its implications for career services professionals, then describes application of Deming's model to the career services program. (NB)

Modeling the impact of watershed management policies on marine ecosystem services with application to Hood Canal, WA, USA

NASA Astrophysics Data System (ADS)

Sutherland, D. A.; Kim, C.; Marsik, M.; Spiridonov, G.; Toft, J.; Ruckelshaus, M.; Guerry, A.; Plummer, M.

2011-12-01

Humans obtain numerous benefits from marine ecosystems, including fish to eat; mitigation of storm damage; nutrient and water cycling and primary production; and cultural, aesthetic and recreational values. However, managing these benefits, or ecosystem services, in the marine world relies on an integrated approach that accounts for both marine and watershed activities. Here we present the results of a set of simple, physically-based, and spatially-explicit models that quantify the effects of terrestrial activities on marine ecosystem services. Specifically, we model the circulation and water quality of Hood Canal, WA, USA, a fjord system in Puget Sound where multiple human uses of the nearshore ecosystem (e.g., shellfish aquaculture, recreational Dungeness crab and shellfish harvest) can be compromised when water quality is poor (e.g., hypoxia, excessive non-point source pollution). Linked to the estuarine water quality model is a terrestrial hydrology model that simulates streamflow and nutrient loading, so land cover and climate changes in watersheds can be reflected in the marine environment. In addition, a shellfish aquaculture model is linked to the water quality model to test the sensitivity of the ecosystem service and its value to both terrestrial and marine activities. The modeling framework is general and will be publicly available, allowing easy comparisons of watershed impacts on marine ecosystem services across multiple scales and regions.

Service quality framework for clinical laboratories.

PubMed

Ramessur, Vinaysing; Hurreeram, Dinesh Kumar; Maistry, Kaylasson

2015-01-01

The purpose of this paper is to illustrate a service quality framework that enhances service delivery in clinical laboratories by gauging medical practitioner satisfaction and by providing avenues for continuous improvement. The case study method has been used for conducting the exploratory study, with focus on the Mauritian public clinical laboratory. A structured questionnaire based on the SERVQUAL service quality model was used for data collection, analysis and for the development of the service quality framework. The study confirms the pertinence of the following service quality dimensions within the context of clinical laboratories: tangibility, reliability, responsiveness, turnaround time, technology, test reports, communication and laboratory staff attitude and behaviour. The service quality framework developed, termed LabSERV, is vital for clinical laboratories in the search for improving service delivery to medical practitioners. This is a pioneering work carried out in the clinical laboratory sector in Mauritius. Medical practitioner expectations and perceptions have been simultaneously considered to generate a novel service quality framework for clinical laboratories.

Research on the Establishment and Evaluation of End - to - End Service Quality Index System

NASA Astrophysics Data System (ADS)

Wei, Chen; Jing, Tao; Ji, Yutong

2018-01-01

From the perspective of power data networks, put forward the index system model to measure the quality of service, covering user experience, business performance, network capacity support, etc., and gives the establishment and use of each layer index in the model.

Quality of services and quality of life from service providers' perspectives: analysis with focus groups.

PubMed

Jenaro, C; Vega, V; Flores, N; Cruz, M

2013-06-01

Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this population. The current study aims to identify service providers' perceptions regarding the quality of life of their clients and the quality of services they provide. It also aims to identify similarities and differences of appraisals among professionals, and to identify associations between supports, quality of life and quality of services. Data were collected from 22 service providers who attended three focus groups (professionals, direct support staff, and managers) from whom 424 comments were analysed. Service providers were asked about the required support for users, the meaning of quality of life for those users, and about features that should characterise quality services. Thematic analysis was employed and transcripts of the sessions were coded according to the dimensions of models on supports, quality of life and quality of services. Chi-squared tests were utilised to test for potential differences among groups. Each professional group has its own priorities concerning required supports. Among the organisation different and potentially conflicting perceptions regarding the meaning of experiencing quality of life coexist. Concerning quality of services, only managers mentioned personal outcomes. Finally, institutionalisation has a negative impact on supports, quality of life and quality of services. It is necessary to move beyond a shared awareness of the negative impact of institutionalisation towards the transformation of services in search of personal quality outcomes. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

Research on Holographic Evaluation of Service Quality in Power Data Network

NASA Astrophysics Data System (ADS)

Wei, Chen; Jing, Tao; Ji, Yutong

2018-01-01

With the rapid development of power data network, the continuous development of the Power data application service system, more and more service systems are being put into operation. Following this, the higher requirements for network quality and service quality are raised, in the actual process for the network operation and maintenance. This paper describes the electricity network and data network services status. A holographic assessment model was presented to achieve a comprehensive intelligence assessment on the power data network and quality of service in the operation and maintenance on the power data network. This evaluation method avoids the problems caused by traditional means which performs a single assessment of network performance quality. This intelligent Evaluation method can improve the efficiency of network operation and maintenance guarantee the quality of real-time service in the power data network..

A fuzzy MCDM model with objective and subjective weights for evaluating service quality in hotel industries

NASA Astrophysics Data System (ADS)

Zoraghi, Nima; Amiri, Maghsoud; Talebi, Golnaz; Zowghi, Mahdi

2013-12-01

This paper presents a fuzzy multi-criteria decision-making (FMCDM) model by integrating both subjective and objective weights for ranking and evaluating the service quality in hotels. The objective method selects weights of criteria through mathematical calculation, while the subjective method uses judgments of decision makers. In this paper, we use a combination of weights obtained by both approaches in evaluating service quality in hotel industries. A real case study that considered ranking five hotels is illustrated. Examples are shown to indicate capabilities of the proposed method.

Implementation of occupational health service improvements through application of total quality management processes.

PubMed

Thomas, Elizabeth Anne

2011-06-01

The occupational health services department for a manufacturing division of a high-technology firm was redesigned from an outsourced model, in which most services were provided by an outside clinic vendor, to an in-house service model, in which services were provided by an on-site nurse practitioner. The redesign and implementation, accomplished by a cross-functional team using Total Quality Management processes, resulted in a comprehensive occupational health services department that realized significant cost reduction, increased compliance with regulatory and company requirements, and improved employee satisfaction. Implications of this project for occupational health nurses are discussed.

Dimensions of service quality in healthcare: a systematic review of literature.

PubMed

Fatima, Iram; Humayun, Ayesha; Iqbal, Usman; Shafiq, Muhammad

2018-06-13

Various dimensions of healthcare service quality were used and discussed in literature across the globe. This study presents an updated meaningful review of the extensive research that has been conducted on measuring dimensions of healthcare service quality. Systematic review method in current study is based on PRISMA guidelines. We searched for literature using databases such as Google, Google Scholar, PubMed and Social Science, Citation Index. In this study, we screened 1921 identified papers using search terms/phrases. Snowball strategies were adopted to extract published articles from January 1997 till December 2016. Two-hundred and fourteen papers were identified as relevant for data extraction; completed by two researchers, double checked by the other two to develop agreement in discrepancies. In total, 74 studies fulfilled our pre-defined inclusion and exclusion criteria for data analysis. Service quality is mainly measured as technical and functional, incorporating many sub-dimensions. We synthesized the information about dimensions of healthcare service quality with reference to developed and developing countries. 'Tangibility' is found to be the most common contributing factor whereas 'SERVQUAL' as the most commonly used model to measure healthcare service quality. There are core dimensions of healthcare service quality that are commonly found in all models used in current reviewed studies. We found a little difference in these core dimensions while focusing dimensions in both developed and developing countries, as mostly SERVQUAL is being used as the basic model to either generate a new one or to add further contextual dimensions. The current study ranked the contributing factors based on their frequency in literature. Based on these priorities, if factors are addressed irrespective of any context, may lead to contribute to improve healthcare quality and may provide an important information for evidence-informed decision-making.

The management of health care service quality. A physician perspective.

PubMed

Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L

2016-01-01

Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.

Measuring Student Course Evaluations: The Use of a Loglinear Model

ERIC Educational Resources Information Center

Ting, Ding Hooi; Abella, Mireya Sosa

2007-01-01

In this paper, the researchers attempt to incorporate the marketing theory (specifically the service quality model) into the education system. The service quality measurements have been employed to investigate its applicability in the education environment. Most of previous studies employ the regression-based analysis to test the effectiveness of…

Higher Education Quality Assessment Model: Towards Achieving Educational Quality Standard

ERIC Educational Resources Information Center

Noaman, Amin Y.; Ragab, Abdul Hamid M.; Madbouly, Ayman I.; Khedra, Ahmed M.; Fayoumi, Ayman G.

2017-01-01

This paper presents a developed higher education quality assessment model (HEQAM) that can be applied for enhancement of university services. This is because there is no universal unified quality standard model that can be used to assess the quality criteria of higher education institutes. The analytical hierarchy process is used to identify the…

Fox Valley Technical College Quality First Process Model.

ERIC Educational Resources Information Center

Fox Valley Technical Coll., Appleton, WI.

An overview is provided of the Quality First Process Model developed by Fox Valley Technical College (FVTC), Wisconsin, to provide guidelines for quality instruction and service consistent with the highest educational standards. The 16-step model involves activities that should be adaptable to any organization. The steps of the quality model are…

Citizen Perceptions of Government Service Quality: Evidence from Public Schools. Program on Education Policy and Governance Working Papers Series. PEPG 10-16

ERIC Educational Resources Information Center

Chingos, Matthew M.; Henderson, Michael; West, Martin R.

2010-01-01

Conventional models of democratic accountability hinge on citizens' ability to evaluate government performance accurately, yet there is little evidence on the degree to which citizen perceptions of the quality of government services correspond to actual service quality. Using nationally representative survey data, we find that citizens'…

Process service quality evaluation based on Dempster-Shafer theory and support vector machine.

PubMed

Pei, Feng-Que; Li, Dong-Bo; Tong, Yi-Fei; He, Fei

2017-01-01

Human involvement influences traditional service quality evaluations, which triggers an evaluation's low accuracy, poor reliability and less impressive predictability. This paper proposes a method by employing a support vector machine (SVM) and Dempster-Shafer evidence theory to evaluate the service quality of a production process by handling a high number of input features with a low sampling data set, which is called SVMs-DS. Features that can affect production quality are extracted by a large number of sensors. Preprocessing steps such as feature simplification and normalization are reduced. Based on three individual SVM models, the basic probability assignments (BPAs) are constructed, which can help the evaluation in a qualitative and quantitative way. The process service quality evaluation results are validated by the Dempster rules; the decision threshold to resolve conflicting results is generated from three SVM models. A case study is presented to demonstrate the effectiveness of the SVMs-DS method.

Using fuzzy gap analysis to measure service quality of medical tourism in Taiwan.

PubMed

Ho, Li-Hsing; Feng, Shu-Yun; Yen, Tieh-Min

2015-01-01

The purpose of this paper is intended to create a model to measure quality of service, using fuzzy linguistics to analyze the quality of service of medical tourism in Taiwan so as to find the direction for improvement of service quality in medical tourism. The study developed fuzzy questionnaires based on the characteristics of medical tourism quality of service in Taiwan. Questionnaires were delivered and recovered from February to April 2014, using random sampling according to the proportion of medical tourism companies in each region, and 150 effective samples were obtained. The critical quality of service level is found through the fuzzy gap analysis using questionnaires examining expectations and perceptions of customers, as the direction for continuous improvement. From the study, the primary five critical service items that improve the quality of service for medical tourism in Taiwan include, in order: the capability of the service provider to provide committed medical tourism services reliably and accurately, facility service providers in conjunction with the services provided, the cordial and polite attitude of the service provider eliciting a sense of trust from the customer, professional ability of medical (nursing) personnel in hospital and reliability of service provider. The contribution of this study is to create a fuzzy gap analysis to assess the performance of medical tourism service quality, identify key quality characteristics and provide a direction for improvement and development for medical tourism service quality in Taiwan.

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)

PubMed Central

Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

2014-01-01

Objective To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care. PMID:25005598

Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan.

PubMed

Alonge, O; Lin, S; Igusa, T; Peters, D H

2017-12-01

System dynamics methods were used to explore effective implementation pathways for improving health systems performance through pay-for-performance (P4P) schemes. A causal loop diagram was developed to delineate primary causal relationships for service delivery within primary health facilities. A quantitative stock-and-flow model was developed next. The stock-and-flow model was then used to simulate the impact of various P4P implementation scenarios on quality and volume of services. Data from the Afghanistan national facility survey in 2012 was used to calibrate the model. The models show that P4P bonuses could increase health workers' motivation leading to higher levels of quality and volume of services. Gaming could reduce or even reverse this desired effect, leading to levels of quality and volume of services that are below baseline levels. Implementation issues, such as delays in the disbursement of P4P bonuses and low levels of P4P bonuses, also reduce the desired effect of P4P on quality and volume, but they do not cause the outputs to fall below baseline levels. Optimal effect of P4P on quality and volume of services is obtained when P4P bonuses are distributed per the health workers' contributions to the services that triggered the payments. Other distribution algorithms such as equal allocation or allocations proportionate to salaries resulted in quality and volume levels that were substantially lower, sometimes below baseline. The system dynamics models served to inform, with quantitative results, the theory of change underlying P4P intervention. Specific implementation strategies, such as prompt disbursement of adequate levels of performance bonus distributed per health workers' contribution to service, increase the likelihood of P4P success. Poorly designed P4P schemes, such as those without an optimal algorithm for distributing performance bonuses and adequate safeguards for gaming, can have a negative overall impact on health service delivery systems. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

PubMed

Creanga, Andreea A; Gullo, Sara; Kuhlmann, Anne K Sebert; Msiska, Thumbiko W; Galavotti, Christine

2017-05-22

The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care. We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items. We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received. Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

A cost-constrained model of strategic service quality emphasis in nursing homes.

PubMed

Davis, M A; Provan, K G

1996-02-01

This study employed structural equation modeling to test the relationship between three aspects of the environmental context of nursing homes; Medicaid dependence, ownership status, and market demand, and two basic strategic orientations: low cost and differentiation based on service quality emphasis. Hypotheses were proposed and tested against data collected from a sample of nursing homes operating in a single state. Because of the overwhelming importance of cost control in the nursing home industry, a cost constrained strategy perspective was supported. Specifically, while the three contextual variables had no direct effect on service quality emphasis, the entire model was supported when cost control orientation was introduced as a mediating variable.

The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe.

PubMed

Mahdavi, Mahdi; Vissers, Jan; Elkhuizen, Sylvia; van Dijk, Mattees; Vanhala, Antero; Karampli, Eleftheria; Faubel, Raquel; Forte, Paul; Coroian, Elena; van de Klundert, Joris

2018-01-01

While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian's Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Data collection consisted of: a) systematic modelling of provider network's structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011-2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian's SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning.

The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe

PubMed Central

Elkhuizen, Sylvia; van Dijk, Mattees; Vanhala, Antero; Karampli, Eleftheria; Faubel, Raquel; Forte, Paul; Coroian, Elena

2018-01-01

Background While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning. PMID:29447220

Measuring Perceptual (In) Congruence between Information Service Providers and Users

ERIC Educational Resources Information Center

Boyce, Crystal

2017-01-01

Library quality is no longer evaluated solely on the value of its collections, as user perceptions of service quality play an increasingly important role in defining overall library value. This paper presents a retooling of the LibQUAL+ survey instrument, blending the gap measurement model with perceptual congruence model studies from information…

Developing a quality assurance program for online services.

PubMed Central

Humphries, A W; Naisawald, G V

1991-01-01

A quality assurance (QA) program provides not only a mechanism for establishing training and competency standards, but also a method for continuously monitoring current service practices to correct shortcomings. The typical QA cycle includes these basic steps: select subject for review, establish measurable standards, evaluate existing services using the standards, identify problems, implement solutions, and reevaluate services. The Claude Moore Health Sciences Library (CMHSL) developed a quality assurance program for online services designed to evaluate services against specific criteria identified by research studies as being important to customer satisfaction. These criteria include reliability, responsiveness, approachability, communication, and physical factors. The application of these criteria to the library's existing online services in the quality review process is discussed with specific examples of the problems identified in each service area, as well as the solutions implemented to correct deficiencies. The application of the QA cycle to an online services program serves as a model of possible interventions. The use of QA principles to enhance online service quality can be extended to other library service areas. PMID:1909197

Developing a quality assurance program for online services.

PubMed

Humphries, A W; Naisawald, G V

1991-07-01

A quality assurance (QA) program provides not only a mechanism for establishing training and competency standards, but also a method for continuously monitoring current service practices to correct shortcomings. The typical QA cycle includes these basic steps: select subject for review, establish measurable standards, evaluate existing services using the standards, identify problems, implement solutions, and reevaluate services. The Claude Moore Health Sciences Library (CMHSL) developed a quality assurance program for online services designed to evaluate services against specific criteria identified by research studies as being important to customer satisfaction. These criteria include reliability, responsiveness, approachability, communication, and physical factors. The application of these criteria to the library's existing online services in the quality review process is discussed with specific examples of the problems identified in each service area, as well as the solutions implemented to correct deficiencies. The application of the QA cycle to an online services program serves as a model of possible interventions. The use of QA principles to enhance online service quality can be extended to other library service areas.

Research on quality metrics of wireless adaptive video streaming

NASA Astrophysics Data System (ADS)

Li, Xuefei

2018-04-01

With the development of wireless networks and intelligent terminals, video traffic has increased dramatically. Adaptive video streaming has become one of the most promising video transmission technologies. For this type of service, a good QoS (Quality of Service) of wireless network does not always guarantee that all customers have good experience. Thus, new quality metrics have been widely studies recently. Taking this into account, the objective of this paper is to investigate the quality metrics of wireless adaptive video streaming. In this paper, a wireless video streaming simulation platform with DASH mechanism and multi-rate video generator is established. Based on this platform, PSNR model, SSIM model and Quality Level model are implemented. Quality Level Model considers the QoE (Quality of Experience) factors such as image quality, stalling and switching frequency while PSNR Model and SSIM Model mainly consider the quality of the video. To evaluate the performance of these QoE models, three performance metrics (SROCC, PLCC and RMSE) which are used to make a comparison of subjective and predicted MOS (Mean Opinion Score) are calculated. From these performance metrics, the monotonicity, linearity and accuracy of these quality metrics can be observed.

Bespoke program design for school-aged therapy disability service delivery.

PubMed

Weatherill, Pamela; Bahn, Susanne; Cooper, Trudi

2012-01-01

This article uses the evaluation of a school-aged therapy service for children with disabilities in Western Australia to investigate models of service delivery. The current literature on family-centered practice, multidisciplinary and transdisciplinary approaches, and 4 models of service are reviewed. The models include the life needs model, the relational goal-orientated model of optimal service delivery to children and families, the quality of life model, and the collaborative model of service delivery. Analysis of the data is presented together with a bespoke model of service delivery for children with disabilities, arguing that local contexts benefit from custom-made service design.

Level of quality management in the Municipal Sports Services, contrast trough EFQM Excellence Model.

PubMed

Martínez-Moreno, Alfonso; Díaz Suárez, Arturo

2016-01-01

The quality management in the Municipal Sports Services is embedded in the servuction provided to the citizens, which are their internal customers who determine the quality improvement ensuring competitiveness with excellence criteria. The Model of the European Foundation for Quality Management enables the evaluation of organization progress towards achieving quality goals, from a structured, measurable and comparable methodology. The aim is to carry out a diagnosis of the level of implementation of quality in the Municipal Sports Services of the Region of Murcia, Spain. The sample of 287 workers of 30 sports services gets a high level of reliability at all scales, with a coefficient of variation of .985 (range .810-.943). The score in the criteria of Policy and Strategy, People Management, Alliances and Resources, Processes and People Results were significantly higher (p < .05) in the Municipalities with more than 25,000 inhabitants when compared with those less than 10,000 and with those from 10,000 to 25,000 inhabitants obtaining global ratings of 571 points, those less than 10,000, 590 points those from 10,000 to 25,000 and those higher than 25,000 reach 636, having a good level of quality in relation to the scale that determines the model.

Patients' perceptions of service quality in China: An investigation using the SERVQUAL model.

PubMed

Fan, Li-Hua; Gao, Lei; Liu, Xin; Zhao, Shi-Hong; Mu, Hui-Tong; Li, Zhe; Shi, Lei; Wang, Ling-Ling; Jia, Xiao-Li; Ha, Min; Lou, Feng-Ge

2017-01-01

The doctor-patient relationship has been a major focus of society. Hospitals' efforts to improve the quality of their medical services have been to reduce the probability of doctor-patient conflicts. In this study, we aimed to determine the gap between expectations and perceptions of service quality according to patients to provide reference data for creating strategies to improve health care quality. Twenty-seven hospitals in 15 provinces (municipalities directly beneath the central government) were selected for our survey; we sent out 1,589 questionnaires, of which 1,520 were collected (response rate 95.65%) and 1,303 were valid (85.72% effective recovery rate). Paired t-tests were used to analyze whether there were significant differences between patients' expectations and perceived service quality. A binary logistic regression analysis was used to determine whether there were significant differences in the gap between expectation and perception of service quality according to patients' demographic characteristics. There was a significant difference between the expected and perceived service quality (p < 0.05) according to patients both before and after receiving medical services. Furthermore, the service quality gap of each service dimension was negative. Specifically, the gaps in service quality were as follows: economy, responsiveness, empathy, assurance, reliability, and tangibles. Overall, we can conclude that patients' perceptions of service quality are lower than their expectations. According to the study results, the quality of health care services as perceived by patients was lower than expected. Hospitals should make adjustments according to the actual situation and should strive to constantly improve the quality of medical services for patients.

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

PubMed

Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

2015-01-01

With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

The management of health care service quality. A physician perspective

PubMed Central

Bobocea, L; Gheorghe, IR; Spiridon, St; Gheorghe, CM; Purcarea, VL

2016-01-01

Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer’s perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician’s perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician’s perspective. PMID:27453745

Linking water quality and well-being for improved assessment and valuation of ecosystem services

PubMed Central

Keeler, Bonnie L.; Polasky, Stephen; Brauman, Kate A.; Johnson, Kris A.; Finlay, Jacques C.; O’Neill, Ann; Kovacs, Kent; Dalzell, Brent

2012-01-01

Despite broad recognition of the value of the goods and services provided by nature, existing tools for assessing and valuing ecosystem services often fall short of the needs and expectations of decision makers. Here we address one of the most important missing components in the current ecosystem services toolbox: a comprehensive and generalizable framework for describing and valuing water quality-related services. Water quality is often misrepresented as a final ecosystem service. We argue that it is actually an important contributor to many different services, from recreation to human health. We present a valuation approach for water quality-related services that is sensitive to different actions that affect water quality, identifies aquatic endpoints where the consequences of changing water quality on human well-being are realized, and recognizes the unique groups of beneficiaries affected by those changes. We describe the multiple biophysical and economic pathways that link actions to changes in water quality-related ecosystem goods and services and provide guidance to researchers interested in valuing these changes. Finally, we present a valuation template that integrates biophysical and economic models, links actions to changes in service provision and value estimates, and considers multiple sources of water quality-related ecosystem service values without double counting. PMID:23091018

Linking water quality and well-being for improved assessment and valuation of ecosystem services.

PubMed

Keeler, Bonnie L; Polasky, Stephen; Brauman, Kate A; Johnson, Kris A; Finlay, Jacques C; O'Neill, Ann; Kovacs, Kent; Dalzell, Brent

2012-11-06

Despite broad recognition of the value of the goods and services provided by nature, existing tools for assessing and valuing ecosystem services often fall short of the needs and expectations of decision makers. Here we address one of the most important missing components in the current ecosystem services toolbox: a comprehensive and generalizable framework for describing and valuing water quality-related services. Water quality is often misrepresented as a final ecosystem service. We argue that it is actually an important contributor to many different services, from recreation to human health. We present a valuation approach for water quality-related services that is sensitive to different actions that affect water quality, identifies aquatic endpoints where the consequences of changing water quality on human well-being are realized, and recognizes the unique groups of beneficiaries affected by those changes. We describe the multiple biophysical and economic pathways that link actions to changes in water quality-related ecosystem goods and services and provide guidance to researchers interested in valuing these changes. Finally, we present a valuation template that integrates biophysical and economic models, links actions to changes in service provision and value estimates, and considers multiple sources of water quality-related ecosystem service values without double counting.

Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service.

PubMed

van Meeuwen, Dorine Pd; van Walt Meijer, Quirine J; Simonse, Lianne Wl

2015-03-24

With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and credibility, availability, pleasantness, and social interaction. Based on the in-depth insights from the actor perspectives, the business model for online precare services is modeled with a visual design. A new care model of the online precare service is designed and compiled of building blocks for the business model. For the construction of a care model, actors, transactions, and value attributes are essential elements. The design of a care model structures these elements in a visual way. Guided by the business modeling toolkit, the care model design artifact is visualized in the context of an online precare service. Important building blocks include: provision of an online flow of information with regular interactions to the client stimulates self-management of personal health and service-dedicated health expert ensure an increase of the perceived quality of the eHealth service.

Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service

PubMed Central

2015-01-01

Background With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. Objective The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. Methods This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. Results We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and credibility, availability, pleasantness, and social interaction. Based on the in-depth insights from the actor perspectives, the business model for online precare services is modeled with a visual design. A new care model of the online precare service is designed and compiled of building blocks for the business model. Conclusions For the construction of a care model, actors, transactions, and value attributes are essential elements. The design of a care model structures these elements in a visual way. Guided by the business modeling toolkit, the care model design artifact is visualized in the context of an online precare service. Important building blocks include: provision of an online flow of information with regular interactions to the client stimulates self-management of personal health and service-dedicated health expert ensure an increase of the perceived quality of the eHealth service. PMID:25831094

Family and Community Perceptions of Quality in Juvenile Justice Programs

ERIC Educational Resources Information Center

Selber, Katherine; Streeter, Calvin

2004-01-01

The conceptualization and empirical assessment of service quality in juvenile justice remains limited. There are few reports on programmatic attempts to assess satisfaction in juvenile justice programs or attempts to include what constitutes quality of service from multiple customer perspectives. This article describes a potential model, the Gap…

Reliability prediction of ontology-based service compositions using Petri net and time series models.

PubMed

Li, Jia; Xia, Yunni; Luo, Xin

2014-01-01

OWL-S, one of the most important Semantic Web service ontologies proposed to date, provides a core ontological framework and guidelines for describing the properties and capabilities of their web services in an unambiguous, computer interpretable form. Predicting the reliability of composite service processes specified in OWL-S allows service users to decide whether the process meets the quantitative quality requirement. In this study, we consider the runtime quality of services to be fluctuating and introduce a dynamic framework to predict the runtime reliability of services specified in OWL-S, employing the Non-Markovian stochastic Petri net (NMSPN) and the time series model. The framework includes the following steps: obtaining the historical response times series of individual service components; fitting these series with a autoregressive-moving-average-model (ARMA for short) and predicting the future firing rates of service components; mapping the OWL-S process into a NMSPN model; employing the predicted firing rates as the model input of NMSPN and calculating the normal completion probability as the reliability estimate. In the case study, a comparison between the static model and our approach based on experimental data is presented and it is shown that our approach achieves higher prediction accuracy.

Healthcare service quality perception in Japan.

PubMed

Eleuch, Amira ep Koubaa

2011-01-01

This study aims to assess Japanese patients' healthcare service quality perceptions and to shed light on the most meaningful service features. It follows-up a study published in IJHCQA Vol. 21 No. 7. Through a non-linear approach, the study relied on the scatter model to detect healthcare service features' importance in forming overall quality judgment. Japanese patients perceive healthcare services through a linear compensatory process. Features related to technical quality and staff behavior compensate for each other to decide service quality. A limitation of the study is the limited sample size. Non-linear approaches could help researchers to better understand patients' healthcare service quality perceptions. The study highlights a need to adopt an evolution that enhances technical quality and medical practices in Japanese healthcare settings. The study relies on a non-linear approach to assess patient overall quality perceptions in order to enrich knowledge. Furthermore, the research is conducted in Japan where healthcare marketing studies are scarce owing to cultural and language barriers. Japanese culture and healthcare system characteristics are used to explain and interpret the results.

A Model of Quality of College Life (QCL) of Students in Korea

ERIC Educational Resources Information Center

Yu, Grace (Byung-Hee); Lee, Dong-Jin

2008-01-01

This study develops and tests a model of quality of college life (QCL) of students in Korea. In this study, QCL of students is conceptualized in terms of needs satisfaction and affect balance. It has been hypothesized that satisfaction with education services, administrative services, and facilities have a significant impact on QCL, which in turn…

Bandwidth Allocation to Interactive Users in DBS-Based Hybrid Internet

DTIC Science & Technology

1998-01-01

policies 12 3.1 Framework for queuing analysis: ON/OFF source traffic model . 13 3.2 Service quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14...minimizing the queuing delay. In consequence, we were interested in ob- taining improvements in the service quality , as perceived by the users. A...the service quality as per- ceived by users. The merit of this approach, first introduced in [8], is the ability to capture the characteristics of the

Routing UAVs to Co-Optimize Mission Effectiveness and Network Performance with Dynamic Programming

DTIC Science & Technology

2011-03-01

Heuristics on Hexagonal Connected Dominating Sets to Model Routing Dissemination," in Communication Theory, Reliability, and Quality of Service (CTRQ...24] Matthew Capt. USAF Compton, Improving the Quality of Service and Security of Military Networks with a Network Tasking Order Process, 2010. [25...Wesley, 2006. [32] James Haught, "Adaptive Quality of Service Engine with Dynamic Queue Control," Air Force Institute of Technology, Wright

Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

PubMed

Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren

2017-01-13

Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.

Is an advance care planning model feasible in community palliative care? A multi-site action research approach.

PubMed

Blackford, Jeanine; Street, Annette

2012-09-01

This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care. A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews (n = 9). Three community palliative care services: one regional and two metropolitan services in Victoria, Australia. The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the model. Changes to quality audit processes were essential to consolidate the model into routine palliative care practice. An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure. © 2011 Blackwell Publishing Ltd.

Improving sexual health services in the city: can the NHS learn from clients and the service industry

PubMed Central

Patel, Hitesh; Baeza, Juan; Patel, Mitesh; Greene, Linda; Theobald, Nick

2007-01-01

Abstract Objective  Genitourinary service providers are struggling to meet patient demand and have introduced changes in access structure to cope. In this study, we explored the perspectives of clients and providers upon the different models of access introduced and whether these maintained service quality using the SERQUAL model. Methods  Primary data were collected in May 2005 at two genitourinary medicine clinics, two Accident and Emergency Departments and from members of a university ‘gay’ society all of which were located in London. Forty‐four high‐risk clients and 11 health service providers underwent semi‐structured face‐to‐face interviews. Results  Both the walk‐in and appointment‐based access systems were appreciated by clients. Clients said that the most important issue was that they were not turned away when they presented. Health‐care providers had a variety of opinions about the two systems as they had different impacts on morale, training and service provision. Conclusions  Service quality can be maintained by using both walk‐in and appointment‐based systems. This is because our data, in line with Parasuraman's model of service quality, showed that ‘access’ is but one determinant of quality. Having different modes of access facilitates patient choice, which is paramount in a modern health‐care system. However, to provide a good service it is important to maintain a motivated staff, who can be affected by their working environment. PMID:17524007

Using technology to enhance the quality of home health care: three case studies of health information technology initiatives at the visiting nurse service of New York.

PubMed

Russell, David; Rosenfeld, Peri; Ames, Sylvia; Rosati, Robert J

2010-01-01

There is a growing recognition among health services researchers and policy makers that Health Information Technology (HIT) has the potential to address challenging issues that face patients and providers of healthcare. The Visiting Nurse Service of New York (VNSNY), a large not-for-profit home healthcare agency, has integrated technology applications into the service delivery model of several programs. Case studies, including the development and implementation, of three informatics initiatives at VNSNY are presented on: (1) Quality Scorecards that utilize process, outcomes, cost, and satisfaction measures to assess performance among clinical staff and programs; (2) a tool to identify patients at risk of being hospitalized, and (3) a predictive model that identifies patients who are eligible for physical rehabilitation services. Following a description of these initiatives, we discuss their impact on quality and process indicators, as well as the opportunities and challenges to implementation. © 2010 National Association for Healthcare Quality.

Measuring the Quality of the u-Learning Service Using the Zone of Tolerance SERVQUAL

NASA Astrophysics Data System (ADS)

Kim, Seong Jin; Park, Keon Chul; Seo, Hyun Sik; Lee, Bong Gyou

The purpose of this study is to analyze diverse factors that affect service quality of Digital textbook service. The ZOT(Zone of Tolerance) SERVQUAL has been applied to develop the research model. Users of the Digital textbook service were selected as subjects for the sample frame. A total of 115 surveys from over 112 schools were collected and used as data for analysis. Results of the survey by SPSS Win Ver. 12.0 showed that the perceived level of service quality in terms of reliability is particularly low, and is quite different from adequate quality. This paper suggests useful guidelines to education providers for improving their public u-Learning environment.

The quality of service in passenger transport terminals

NASA Astrophysics Data System (ADS)

Oprea, C.; Roşca, E.; Popa, M.; Ilie, A.; Dinu, O.; Roşca, M.

2016-11-01

The quality of service in transport terminals is differently perceived by engineers, economists, transport operators and sociologists. The traveler's perception is nevertheless decisive. The quality of service is well connected with the inside design of terminals, with the facilities in terminals and with the provided service standards. In order to provide a high level of service, the activities taking place in the public transport terminal and the maximum travelers flow size must be carefully analyzed and dimensioned. The purpose of modelling is to find the best route for each traveler from origin (entrance) to destination (exit) through all the intermediate service points, taking into consideration the instant network conditions. In developing the model we consider the walking, the waiting and the serving time. Using a simulation program written in ARENA we determine the waiting time. For validation, the model is used to evaluate the performance level in Bucharest Basarab station. By comparing the total walking distance for the possible routes and the utility function that describes the utility of all activities from entrance to exit we can find the optimal route.

Patients’ perceptions of service quality in China: An investigation using the SERVQUAL model

PubMed Central

Zhao, Shi-hong; Mu, Hui-tong; Li, Zhe; Shi, Lei; Wang, Ling-ling; Jia, Xiao-li; Ha, Min; Lou, Feng-ge

2017-01-01

Background and aim The doctor–patient relationship has been a major focus of society. Hospitals’ efforts to improve the quality of their medical services have been to reduce the probability of doctor–patient conflicts. In this study, we aimed to determine the gap between expectations and perceptions of service quality according to patients to provide reference data for creating strategies to improve health care quality. Methods Twenty–seven hospitals in 15 provinces (municipalities directly beneath the central government) were selected for our survey; we sent out 1,589 questionnaires, of which 1,520 were collected (response rate 95.65%) and 1,303 were valid (85.72% effective recovery rate). Paired t-tests were used to analyze whether there were significant differences between patients' expectations and perceived service quality. A binary logistic regression analysis was used to determine whether there were significant differences in the gap between expectation and perception of service quality according to patients' demographic characteristics. Results There was a significant difference between the expected and perceived service quality (p < 0.05) according to patients both before and after receiving medical services. Furthermore, the service quality gap of each service dimension was negative. Specifically, the gaps in service quality were as follows: economy, responsiveness, empathy, assurance, reliability, and tangibles. Overall, we can conclude that patients’ perceptions of service quality are lower than their expectations. Conclusions According to the study results, the quality of health care services as perceived by patients was lower than expected. Hospitals should make adjustments according to the actual situation and should strive to constantly improve the quality of medical services for patients. PMID:29272312

Quality First in Education... Why Not? Using Quality and Productivity Methods To Improve Schools.

ERIC Educational Resources Information Center

Spanbauer, Stanley J.; Hillman, Jo Ann

A description is provided of the implementation at Fox Valley Technical College (FVTC), Wisconsin, of the Quality First Process Model, which was adapted from a model commonly used in manufacturing and service industries. The model uses private sector quality and productivity procedures and new management styles to serve students more effectively,…

Health authority commissioning for quality in contraception services

PubMed Central

Newman, M.; Bardsley, M.; Morgan, D.; Jacobson, B.

1998-01-01

OBJECTIVE: To compare the commissioning of contraception services by London health authorities with accepted models of good practice. DESIGN: Combined interview and postal surveys of all health authorities and National Health Service (NHS) trusts responsible for running family planning clinics in the Greater London area. MAIN OUTCOME MEASURES: Health authority commissioning was assessed on the presence of four key elements of good practice--strategies, coordination, service specifications, and quality standards in contracts--by monitoring activity and quality. RESULTS: Less than half the health authorities surveyed had written strategies or service specifications for contraception services. Arrangements for coordination of services were limited and monitoring was underdeveloped. CONCLUSION: The process of commissioning services for contraception seems to be relatively underdeveloped despite the importance of health problems associated with unplanned pregnancy in London. These findings raise questions about the capacity of health authorities to improve the quality of these services through the commissioning process. PMID:10185140

Measuring Service Quality in Higher Education: A South African Case Study

ERIC Educational Resources Information Center

Green, Paul

2014-01-01

The goal of this paper is to report on the SERVQUAL gap which causes unsuccessful service delivery at a University of Technology in South Africa. Using a quantitative research design, the study adopts a SERVQUAL model adapted to a tertiary environment containing five dimensions of service quality (tangibles, responsiveness, empathy, assurance, and…

Healthcare professionals' perceptions related to the provision of clinical pharmacy services in the public health sector of Mexico: a case study.

PubMed

Díaz de León-Castañeda, Christian; Gutiérrez-Godínez, Jéssica; Colado-Velázquez, Juventino Iii; Toledano-Jaimes, Cairo

2018-04-22

In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services. To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision. A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti. Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision. The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision. Copyright © 2018 Elsevier Inc. All rights reserved.

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

PubMed

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

2013-05-01

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

The determinations of remote sensing satellite data delivery service quality: A positivistic case study in Chinese context

NASA Astrophysics Data System (ADS)

Jin, Jiahua; Yan, Xiangbin; Tan, Qiaoqiao; Li, Yijun

2014-03-01

With the development of remote sensing technology, remote-sensing satellite has been widely used in many aspects of national construction. Big data with different standards and massive users with different needs, make the satellite data delivery service to be a complex giant system. How to deliver remote-sensing satellite data efficiently and effectively is a big challenge. Based on customer service theory, this paper proposes a hierarchy conceptual model for examining the determinations of remote-sensing satellite data delivery service quality in the Chinese context. Three main dimensions: service expectation, service perception and service environment, and 8 sub-dimensions are included in the model. Large amount of first-hand data on the remote-sensing satellite data delivery service have been obtained through field research, semi-structured questionnaire and focused interview. A positivist case study is conducted to validate and develop the proposed model, as well as to investigate the service status and related influence mechanisms. Findings from the analysis demonstrate the explanatory validity of the model, and provide potentially helpful insights for future practice.

Does empowering resident families or nursing home employees in decision making improve service quality?

PubMed

Hamann, Darla J

2014-08-01

This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. © The Author(s) 2013.

Evolution of Reference: A New Service Model for Science and Engineering Libraries

ERIC Educational Resources Information Center

Bracke, Marianne Stowell; Chinnaswamy, Sainath; Kline, Elizabeth

2008-01-01

This article explores the different steps involved in adopting a new service model at the University of Arizona Science-Engineering Library. In a time of shrinking budgets and changing user behavior the library was forced to rethink it reference services to be cost effective and provide quality service at the same time. The new model required…

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).

PubMed

Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

2014-07-08

To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of 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.

Using Modeling and Simulation to Examine the Benefits of a Network Tasking Order

DTIC Science & Technology

2010-01-01

Without careful planning, the topolo- gies that form can suffer from poor Quality of Service (QoS). The networks could have bottlenecks, or worse, be... quality of service Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to...mission type include: • expected communications partners; • type of data transmitted; • bandwidth required (average, burst); • quality of service

Privatization of local public hospitals: effect on budget, medical service quality, and social welfare.

PubMed

Aiura, Hiroshi; Sanjo, Yasuo

2010-09-01

We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on medical quality, by using a Hotelling-type spatial competition model extended into a two-region model. We show that the rural public hospital provides excess quality for each unit of medical service as compared to the first-best quality, and the profits of the rural public hospital are lower than those of the urban public hospital because the provision of excess quality requires larger expenditure. In addition, we investigate the impact of the partial (or full) privatization of local public hospitals.

A Study Investigating the Perceived Service Quality Levels of Sport Center Members: A Kano Model Perspective

ERIC Educational Resources Information Center

Yildiz, Kadir; Polat, Ercan; Güzel, Pinar

2018-01-01

The purpose of this study is to investigate sport center members' perceived service quality levels with a view to Kano customer expectations and requirements model. To that end, a descriptive approach and a correlational research design featuring survey method is adopted. Research group consists of 680 (300 women, 380 men) sport center members who…

42 CFR § 510.300 - Determination of episode quality-adjusted target prices.

Code of Federal Regulations, 2010 CFR

2017-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.300 Determination of episode quality... hospitals for each performance year of the model as specified in this section. Episode quality-adjusted...

Perspectives on User Satisfaction Surveys.

ERIC Educational Resources Information Center

Cullen, Rowena

2001-01-01

Discusses academic libraries, digital environments, increasing competition, the relationship between service quality and user satisfaction, and user surveys. Describes the SERVQUAL model that measures service quality and user satisfaction in academic libraries; considers gaps between user expectations and managers' perceptions of user…

The behavioral consequences of service quality: an empirical study in the Chinese retail pharmacy industry.

PubMed

Chen, Yuwen; Fu, Frank Q

2015-01-01

This study focuses on the impacts of service quality and examines the mediating effects of customer satisfaction and customer loyalty on willingness to pay more. The authors collected survey data from 479 actual retail pharmacy customers in China and used the structural equation modeling approach to test the hypotheses. The results reveal six dimensions of service quality and the differential impact of these dimensions on customer satisfaction and behavioral intentions. This study contributes to the existing literature by exploring the dimensionality of the service quality construct and mediating effects of customer satisfaction and customer loyalty in a non-Western setting.

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters.

PubMed

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2013-01-16

Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients' perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients' overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a direct effect; and (B) service quality and patient trust are used as intervening variables to affect patient satisfaction, which represents an indirect effect. Due to differences in the scale, resources and costs among medical institutions of different levels, it is a most urgent and concerning issue of how to control customers' demands and preferences and adopt correct marketing concepts under the circumstances of intense competition in order to satisfy the public and build up a competitive edge for medical institutions.

Using internal marketing to improve organizational commitment and service quality.

PubMed

Tsai, Yafang; Wu, Shih-Wang

2011-12-01

The purpose of this article was to explore the structural relationships among internal marketing, organizational commitment and service quality and to practically apply the findings. Internal marketing is a way to assist hospitals in improving the quality of the services that they provide while executing highly labour-intensive tasks. Through internal marketing, a hospital can enhance the organizational commitment of its employees to attain higher service quality. This research uses a cross-sectional study to survey nursing staff perceptions about internal marketing, organizational commitment and service quality. The results of the survey are evaluated using equation models. The sample includes three regional hospitals in Taiwan. Three hundred and fifty questionnaires were distributed and 288 valid questionnaires were returned, yielding a response rate of 82.3%. The survey process lasted from 1 February to 9 March 2007. The data were analysed with SPSS 12.0, including descriptive statistics based on demographics. In addition, the influence of demographics on internal marketing, organizational commitment and service quality is examined using one-way anova. The findings reveal that internal marketing plays a critical role in explaining employee perceptions of organizational commitment and service quality. Organizational commitment is the mediator between internal marketing and service quality. The results indicate that internal marketing has an impact on both organizational commitment and service quality. Internal marketing should be emphasized to influence frontline nursing staff, thereby helping to create better organizational commitment and service quality. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Marketing to older patients: perceptions of service quality.

PubMed

Brand, R R; Cronin, J J; Routledge, J B

1997-01-01

Marketing has taken on increased importance in the United States' health care industry, especially with respect to Americans aged 55 and older. Given that health care costs account for 14 percent of the GNP of the U.S., and that older Americans represent nearly 25 percent of all health care expenditures, the ability of physicians to assess the perceptions of service quality, service value, and satisfaction and the effects of these variables on patient loyalty with respect to older patients is very important. A comprehensive model of patient behavior is introduced and tested. The results suggest the medical office staff and the expertise of the physician play particularly important roles in older patients' perceptions of service quality. In addition, strong relationships were found between (1) Service Quality and Satisfaction, (2) Satisfaction and Patient Behavior (repeated use of the physician), and (3) Service Quality and Patient Behavior. Conclusions and suggestions for future research are offered.

Factors affecting success of an integrated community-based telehealth system.

PubMed

Hsieh, Hui-Lung; Tsai, Chung-Hung; Chih, Wen-Hai; Lin, Huei-Hsieh

2015-01-01

The rise of chronic and degenerative diseases in developed countries has become one critical epidemiologic issue. Telehealth can provide one viable way to enhance health care, public health, and health education delivery and support. The study aims to empirically examine and evaluate the success factors of community-based telehealth system adoption. The valid 336 respondents are the residents of a rural community in Taiwan. The structural equation modeling (SEM) was used to assess the proposed model applied to telehealth. The findings showed the research model had good explanatory power and fitness. Also, the findings indicated that system quality exerted the strongest overall effect on intention to use. Furthermore, service quality exerted the strongest overall effect on user satisfaction. The findings also illustrated that the joint effects of three intrinsic qualities (system quality, information quality, and service quality) on use were mediated by user satisfaction and intention to use. The study implies that community-based telehealth service providers should improve three intrinsic qualities to enhance user satisfaction and intention to use, which in turn can lead to increase the usage of the telehealth equipment. The integrated community-based telehealth system may become an innovative and suitable way to deliver better care to the residents of communities.

Assessing Medical Tourism Services Quality Using SERVQUAL Model: A Patient's Perspective.

PubMed

Qolipour, Mohammad; Torabipour, Amin; Faraji Khiavi, Farzad; Saki Malehi, Amal

2018-01-01

Continuous quality improvement of the hospital services is a basic requirement of medical tourism industry. The different dimensions of hospital services quality are assessed constantly to improve the service of medical tourism. The aim of this study was to determine the services quality of medical tourism in private and public hospitals. In this cross-sectional study, the quality of hospital services were assessed in view of 250 Iraqi tourists referred to Ahvaz private and public hospitals in 2015. Data were collected using a valid medical tourism SERVQUAL questionnaire (MTSQ). This questionnaire includes 8 main dimensions with 31 items. Finally, Mann-Whitney, Kruskal-Wallis and Wilcoxon tests were used to analyze the data. The mean of age of patients was 39±2.2 yr. The mean of hospital length of stay was 3.87±1.36 days. The most patients were admitted to Orthopedics, Otorhinolaryngology, Obstetrics, and Gynecology departments, respectively. There was a negative gap in all of the dimensions of service quality in the studied hospitals ( P >0.001). The highest and lowest quality gap was seen in the "exchange and travel facilities" (-2.63) and the "tangibles" (-0.68) dimension, respectively. There was a negative gap in all of the dimensions of service quality in the studied hospitals. Therefore, the hospital services quality is improved to attract the foreign patients.

Assessing Medical Tourism Services Quality Using SERVQUAL Model: A Patient’s Perspective

PubMed Central

QOLIPOUR, Mohammad; TORABIPOUR, Amin; FARAJI KHIAVI, Farzad; SAKI MALEHI, Amal

2018-01-01

Background: Continuous quality improvement of the hospital services is a basic requirement of medical tourism industry. The different dimensions of hospital services quality are assessed constantly to improve the service of medical tourism. The aim of this study was to determine the services quality of medical tourism in private and public hospitals. Methods: In this cross-sectional study, the quality of hospital services were assessed in view of 250 Iraqi tourists referred to Ahvaz private and public hospitals in 2015. Data were collected using a valid medical tourism SERVQUAL questionnaire (MTSQ). This questionnaire includes 8 main dimensions with 31 items. Finally, Mann-Whitney, Kruskal-Wallis and Wilcoxon tests were used to analyze the data. Results: The mean of age of patients was 39±2.2 yr. The mean of hospital length of stay was 3.87±1.36 days. The most patients were admitted to Orthopedics, Otorhinolaryngology, Obstetrics, and Gynecology departments, respectively. There was a negative gap in all of the dimensions of service quality in the studied hospitals (P>0.001). The highest and lowest quality gap was seen in the “exchange and travel facilities” (−2.63) and the “tangibles” (−0.68) dimension, respectively. Conclusion: There was a negative gap in all of the dimensions of service quality in the studied hospitals. Therefore, the hospital services quality is improved to attract the foreign patients. PMID:29318124

Development, Implementation, and Evaluation of the Apollo Model of Pediatric Rehabilitation Service Delivery

ERIC Educational Resources Information Center

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

2013-01-01

This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical…

Through a Different Lens: Bridging the Expectation-Perception (Quality) Divide in Higher Education

ERIC Educational Resources Information Center

Yeo, Roland K.; Marquardt, Michael J.

2011-01-01

The paper draws on the underpinnings of SERVQUAL (a Service Quality measurement model) and explores three key aspects of service standards as adopted by an Engineering School in Singapore: customer orientation, course design/delivery and support services. Qualitative methodology was employed and data were collected by means of structured in-depth…

A Study of the Interrelationships among Service Recovery, Relationship Quality, and Brand Image in Higher Education Industries

ERIC Educational Resources Information Center

Chen, Yu-Chuan

2015-01-01

This study aims to investigate the direction and strength of the relationships among service recovery, relationship quality, and brand image in higher education industries. This research provides a framework for school managers to understand service recovery from an operations perspective. Structural equation models were used to test the proposed…

Measuring the Effect of Tourism Services on Travelers' Quality of Life: Further Validation.

ERIC Educational Resources Information Center

Neal, Janet D.; Sirgy, M. Joseph; Uysal, Muzaffer

2004-01-01

lication and extension study provided additional validational support of the original tourism services satisfaction measure in relation to QOL-related measures.Neal, Sirgy and Uysal (1999) developed a model and a measure to capture the effect of tourism services on travelers' quality of life (QOL). They hypothesized that travelers' overall life…

Reliability Prediction of Ontology-Based Service Compositions Using Petri Net and Time Series Models

PubMed Central

Li, Jia; Xia, Yunni; Luo, Xin

2014-01-01

OWL-S, one of the most important Semantic Web service ontologies proposed to date, provides a core ontological framework and guidelines for describing the properties and capabilities of their web services in an unambiguous, computer interpretable form. Predicting the reliability of composite service processes specified in OWL-S allows service users to decide whether the process meets the quantitative quality requirement. In this study, we consider the runtime quality of services to be fluctuating and introduce a dynamic framework to predict the runtime reliability of services specified in OWL-S, employing the Non-Markovian stochastic Petri net (NMSPN) and the time series model. The framework includes the following steps: obtaining the historical response times series of individual service components; fitting these series with a autoregressive-moving-average-model (ARMA for short) and predicting the future firing rates of service components; mapping the OWL-S process into a NMSPN model; employing the predicted firing rates as the model input of NMSPN and calculating the normal completion probability as the reliability estimate. In the case study, a comparison between the static model and our approach based on experimental data is presented and it is shown that our approach achieves higher prediction accuracy. PMID:24688429

Water Quality Is a Poor Predictor of Recreational Hotspots in England

PubMed Central

Mullin, Karen; Boeuf, Blandine; Fincham, William; Taylor, Nigel; Villalobos-Jiménez, Giovanna; von Vittorelli, Laura; Wolf, Christine; Fritsch, Oliver; Strauch, Michael; Seppelt, Ralf; Volk, Martin; Beckmann, Michael

2016-01-01

Maintaining and improving water quality is key to the protection and restoration of aquatic ecosystems, which provide important benefits to society. In Europe, the Water Framework Directive (WFD) defines water quality based on a set of biological, hydro-morphological and chemical targets, and aims to reach good quality conditions in all river bodies by the year 2027. While recently it has been argued that achieving these goals will deliver and enhance ecosystem services, in particular recreational services, there is little empirical evidence demonstrating so. Here we test the hypothesis that good water quality is associated with increased utilization of recreational services, combining four surveys covering walking, boating, fishing and swimming visits, together with water quality data for all water bodies in eight River Basin Districts (RBDs) in England. We compared the percentage of visits in areas of good water quality to a set of null models accounting for population density, income, age distribution, travel distance, public access, and substitutability. We expect such association to be positive, at least for fishing (which relies on fish stocks) and swimming (with direct contact to water). We also test if these services have stronger association with water quality relative to boating and walking alongside rivers, canals or lakeshores. In only two of eight RBDs (Northumbria and Anglian) were both criteria met (positive association, strongest for fishing and swimming) when comparing to at least one of the null models. This conclusion is robust to variations in dataset size. Our study suggests that achieving the WFD water quality goals may not enhance recreational ecosystem services, and calls for further empirical research on the connection between water quality and ecosystem services. PMID:27875562

A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination.

PubMed

Joshi, Chandni; Russell, Grant; Cheng, I-Hao; Kay, Margaret; Pottie, Kevin; Alston, Margaret; Smith, Mitchell; Chan, Bibiana; Vasi, Shiva; Lo, Winston; Wahidi, Sayed Shukrullah; Harris, Mark F

2013-11-07

Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service - Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.

A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination

PubMed Central

2013-01-01

Introduction Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. Methods A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service – Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Results Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. Conclusion The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training. PMID:24199588

A fuzzy inference system to evaluate contract service provider performance.

PubMed

Cruz, Antonio Miguel; Denis, Ernesto Rodriguez

2005-01-01

This paper puts forward a fuzzy inference system for evaluating the quality performance of service contract providers. An Application Service Provider was designed and put online, featuring surveys to establish the most useful indicators to evaluate the quality of the service. This model was implemented in 10 separate hospitals. As a result, the service cost-acquisition cost ratio in these cases was reduced from 16.14% to 6.09% in the period 2001-January 2003.

[Service quality in health care: the application of the results of marketing research].

PubMed

Verheggen, F W; Harteloh, P P

1993-01-01

This paper deals with quality assurance in health care and its relation to quality assurance in trade and industry. We present the service quality model--a model of quality from marketing research--and discuss how it can be applied to health care. Traditional quality assurance appears to have serious flaws. It lacks a general theory of the sources of hazards in the complex process of patient care and tends to stagnate, for no real improvement takes place. Departing from this criticism, modern quality assurance in health care is marked by: defining quality in a preferential sense as "fitness for use"; the use of theories and models of trade and industry (process-control); an emphasis on analyzing the process, instead of merely inspecting it; use of the Deming problem solving technique (plan, do, check, act); improvement of the process of care by altering perceptions of parties involved. We present an experience of application and utilization of this method in the University Hospital Maastricht, The Netherlands. The successful application of this model requires a favorable corporate culture and motivation of the health care workers. This model provides a useful framework to uplift the traditional approach to quality assurance in health care.

Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

PubMed

Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

2012-07-01

The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one HMO that aims to transition from fee-for-service to a pay-for-performance and quality reporting for reimbursement for chiropractic care. This model is theoretically based on the combination of a fee-for-service payment, pay for participation (NCQA Back Pain Recognition Program payment), meaningful use of electronic health record payment, and pay for reporting (PQRS-BPMG payment). Evaluation of this model needs to be implemented to determine if it will achieve its intended goals. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Identifying models of delivery, care domains and quality indicators relevant to palliative day services: a scoping review protocol.

PubMed

O'Connor, Seán R; Dempster, Martin; McCorry, Noleen K

2017-05-16

With an ageing population and increasing numbers of people with life-limiting illness, there is a growing demand for palliative day services. There is a need to measure and demonstrate the quality of these services, but there is currently little agreement on which aspects of care should be used to do this. The aim of the scoping review will be to map the extent, range and nature of the evidence around models of delivery, care domains and existing quality indicators used to evaluate palliative day services. Electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials) will be searched for evidence using consensus development methods; randomised or quasi-randomised controlled trials; mixed methods; and prospective, longitudinal or retrospective case-control studies to develop or test quality indicators for evaluating palliative care within non-residential settings, including day hospices and community or primary care settings. At least two researchers will independently conduct all searches, study selection and data abstraction procedures. Meta-analyses and statistical methods of synthesis are not planned as part of the review. Results will be reported using numerical counts, including number of indicators in each care domain and by using qualitative approach to describe important indicator characteristics. A conceptual model will also be developed to summarise the impact of different aspects of quality in a palliative day service context. Methodological quality relating to indicator development will be assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) tool. Overall strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Final decisions on quality assessment will be made via consensus between review authors. Identifying, developing and implementing evidence-based quality indicators is critical to the evaluation and continued improvement of palliative care. Review findings will be used to support clinicians and policymakers make decisions on which quality indicators are most appropriate for evaluating day services at the patient and service level, and to identify areas for further research.

Evaluating the Service Quality of the Hotel Establishments in Sports Tourism with Regard to the Athletes

ERIC Educational Resources Information Center

Osmanoglu, Hasan; Üzüm, Hanifi

2018-01-01

The purpose of this study was to evaluate the service quality of the hotels which are provided sport tourism by athletes according to some variables. The research was conducted with cross-sectional research method as one of the general survey models and relational screening model. Target group of the study also constituted the sample group. This…

How the Kano model contributes to Kansei engineering in services.

PubMed

Hartono, Markus; Chuan, Tan Kay

2011-11-01

Recent studies show that products and services hold great appeal if they are attractively designed to elicit emotional feelings from customers. Kansei engineering (KE) has good potential to provide a competitive advantage to those able to read and translate customer affect and emotion in actual product and services. This study introduces an integrative framework of the Kano model and KE, applied to services. The Kano model was used and inserted into KE to exhibit the relationship between service attribute performance and customer emotional response. Essentially, the Kano model categorises service attribute quality into three major groups (must-be [M], one-dimensional [O] and attractive [A]). The findings of a case study that involved 100 tourists who stayed in luxury 4- and 5-star hotels are presented. As a practical matter, this research provides insight on which service attributes deserve more attention with regard to their significant impact on customer emotional needs. STATEMENT OF RELEVANCE: Apart from cognitive evaluation, emotions and hedonism play a big role in service encounters. Through a focus on delighting qualities of service attributes, this research enables service providers and managers to establish the extent to which they prioritise their improvement efforts and to always satisfy their customer emotions beyond expectation.

Performance Evaluation of Resource Management in Cloud Computing Environments.

PubMed

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price.

Performance Evaluation of Resource Management in Cloud Computing Environments

PubMed Central

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price. PMID:26555730

Mapping Ecosystem Services in the Jordan Valley, Jordan

NASA Astrophysics Data System (ADS)

Luz, Ana; Marques, Ana; Ribeiro, Inês; Alho, Maria; Catarina Afonso, Ana; Almeida, Erika; Branquinho, Cristina; Talozi, Samer; Pinho, Pedro

2016-04-01

In the last decade researchers started using ecosystem services as a new framework to understand the relationships between environment and society. Habitat quality and water quality are related with ecosystem services regulation and maintenance, or even provision. According to the Common International Classification of Ecosystem Services (CICES) both habitat quality and water quality are associated with lifecycle maintenance, habitat and gene pool protection, and water conditions, among others. As there is increased pressure on habitats and rivers especially for agricultural development, mapping and evaluating habitat and water quality has important implications for resource management and conservation, as well as for rural development. Here, we model and map habitat and water quality in the Jordan Valley, Jordan. In this study, we aim to identify and analyse ecosystem services both through 1) habitat quality and 2) water quality modelling using InVest, an integrated valuation of ecosystem services and tradeoffs. The data used in this study mainly includes the LULC, Jordan River watershed and main threats and pollutants in the study area, such as agriculture, industry, fish farms and urbanization. Results suggest a higher pressure on natural habitats in the Northern region of the Jordan Valley, where industry is dominant. Agriculture is present along the Jordan Valley and limits the few natural forested areas. Further, water pollution is mainly concentrated in disposal sites due to the low flow of the Jordan River. Our results can help to identify areas where natural resources and water resource management is most needed in the Jordan Valley. Acknowledgements: Transbasin FP7 project

An overview of service quality of continuous positive airway pressure services in Australian pharmacies.

PubMed

Hanes, Carissa A; Wong, Keith K H; Saini, Bandana

2014-01-01

Little is known about CPAP services offered in the Australian primary care pharmacy setting, despite the potential influence of service quality on patient adherence. The objective of this study was to provide an overview on a nationwide scale of the range and quality of CPAP and sleep apnoea-related services in Australian pharmacies. A paper-based questionnaire was developed and mailed to all pharmacies in Australia that currently provide CPAP services (as identified by manufacturer's distributor lists or Internet search). A point system was devised to score participants on the quality of their CPAP service. Pharmacies were rated against a list of 23 criteria that were determined by consensus, with one point allocated for each criterion met, allowing for a maximum score of 23. The study response rate was 55% (110/199), and representation was obtained from all eight Australian states and territories. The mean number of criteria met (total score) for pharmacies was 15.7 ± 3.4 (15.7/23 = 68.3%; score range 2-22). Variability was evident in the range of services offered. Eighty-seven per cent of respondents believed that pharmacies supplying CPAP should adhere to a formalized set of professional guidelines. The accessibility of pharmacies may make them a valuable venue for CPAP service provision. However, models of care to guide practice and standardize the variability in services are required. Implementation of such models could improve patient access to quality treatment in the primary care setting. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

The Impact of Visit Frequency on the Relationship between Service Quality and Outpatient Satisfaction: A South Korean Study

PubMed Central

Cho, Woo Hyun; Lee, Hanjoon; Kim, Chankon; Lee, Sunhee; Choi, Kui-Son

2004-01-01

Objective To examine the relative impact of four service quality dimensions on outpatient satisfaction and to test the invariance of the structural relationships between the service quality dimensions and satisfaction across three patient groups of varying numbers of prior visits to the same hospital as outpatients. Data Sources/Study Setting Survey of 557 outpatients using a self-administered questionnaire over a 10-day period at a general hospital in Sungnam, South Korea. Data Collection Patients answered questions related to two main constructs, patient satisfaction and health care service quality. The health care service quality measures (30 items) were developed based on the results of three focus group interviews and the SERVQUAL scale, while satisfaction (3 items) was measured using a previously validated scale. Study Design Confirmatory factor analysis was used to assess the construct validity of the service quality scale by testing convergent and divergent validity. A structural equation model specifying the four service quality dimensions as exogenous variables and patient satisfaction as an endogenous variable was estimated to assess the relative impact of each of the service quality dimensions on satisfaction. This was followed by a multigroup LISREL analysis that tested the invariance of structural coefficients across three groups with different frequencies of outpatient visits to the hospital. Principal Findings Findings support the causal relationship between service quality and satisfaction in the context of the South Korean health care environment. The four service quality dimensions showed varying patterns of impact on patient satisfaction across the three different outpatient groups. Conclusion The hospital management needs to be aware of the relative importance of each of the service quality dimensions in satisfaction formation of outpatients, which varies across different hospital utilization groups, and use this in strategic considerations. PMID:14965075

[Theoretical grounds of a structural and functional model for quality assurance of radiation diagnostics under conditions of development of the modern health care system in Ukraine].

PubMed

Korop, Oleg A; Lenskykh, Sergiy V

2018-01-01

Introduction: Modern changes in the health care system of Ukraine are focused on financial support in providing medical and diagnostic care to the population and are based on deep and consistent structural and functional transformations. They are aimed at providing adequate quality care, which is the main target function and a principal criterion for operation of health care system. The urgency of this problem is increasing in the context of reforming the health care system and global changes in the governmental financial guarantees for the provision of medical services to the population. The aim of the work is to provide theoretical grounds for a structural and functional model of quality assurance of radiation diagnostics at all levels of medical care given to the population under the current health care reform in Ukraine. Materials and methods: The object of the study is organizing the operation of the radiation diagnostic service; the information is based on the actual data on the characteristics of radiation diagnosis at different levels of medical care provision. Methods of systematic approach, system analysis and structural and functional analysis of the operating system of radiation diagnostics are used. Review: The basis of the quality assurance model is the cyclical process, which includes the stages of the problem identifition, planning of its solution, organization of the system for implementation of decisions, monitoring the quality management process of the radiation diagnostics, and factors influencing the quality of the radiation diagnostics service. These factors include the quality of the structure, process, results, organization of management and control of current processes and the results of radiation diagnostics management. Conclusions: The advantages of the proposed model for ensuring the quality of the radiation diagnostics service are its systemacy and complexity, elimination of identified defects and deficiencies, and achievement of profitability through modern redistribution and use of existing resources of the health care system. The results of adequate service quality management activities in radiation diagnostics are the improvement of organizational and economic principles along with legislative regulation, the implementation of a modern system of radiation diagnostics in the state health care at the national and regional levels, the increase of the accessibility, quality and efficiency of the radiation diagnostics service.

The structure of service quality perceptions for multiple-encounter services.

PubMed

Andaleeb, Syed Saad; Kara, Ali

2013-01-01

The objective of this study was to examine a complex service environment-hospitals-to suggest how service quality could be reframed and measured for multiple-encounter service situations more effectively. In this cross-sectional study, a sample of 371 patients completed the survey instrument. Service quality measures were guided by the literature but allowed to flow from the respondents at the preliminary stage. Confirmatory factor analysis, along with structural equation modeling, was used to test the hypothesized relationships among key actors' performance metrics (KAPMs). Patient satisfaction is significantly influenced by perceived service quality based on KAPMs. For multiple-encounter services, service quality dimensions and measures ought to be tied to KAPMs. Primary actors-ie, doctors-need knowledge and skills about patient psychology, negotiation, handling difficult patients, and, importantly, "putting the customer first." Sensitivity training on such matters should be provided. The secondary actors are the nurses who have more frequent contact with the patients. Nurses need to be perceived as "patient advocates." Effective advocacy begins with prompt and caring services to build trust. The tertiary actors in their support role also ought to be integrated into becoming vital part of the service provided.

Tourism guide cloud service quality: What actually delights customers?

PubMed

Lin, Shu-Ping; Yang, Chen-Lung; Pi, Han-Chung; Ho, Thao-Minh

2016-01-01

The emergence of advanced IT and cloud services has beneficially supported the information-intensive tourism industry, simultaneously caused extreme competitions in attracting customers through building efficient service platforms. On response, numerous nations have implemented cloud platforms to provide value-added sightseeing information and personal intelligent service experiences. Despite these efforts, customers' actual perspectives have yet been sufficiently understood. To bridge the gap, this study attempts to investigate what aspects of tourism cloud services actually delight customers' satisfaction and loyalty. 336 valid survey questionnaire answers were analyzed using structural equation modeling method. The results prove positive impacts of function quality, enjoyment, multiple visual aids, and information quality on customers' satisfaction as well as of enjoyment and satisfaction on use loyalty. The findings hope to provide helpful references of customer use behaviors for enhancing cloud service quality in order to achieve better organizational competitiveness.

How Do Patients Perceive and Expect Quality of Surgery, Diagnostics, and Emergency Services in Tertiary Care Hospitals? An Evidence of Gap Analysis From Pakistan.

PubMed

Fatima, Iram; Humayun, Ayesha; Anwar, Muhammad Imran; Iftikhar, Adil; Aslam, Muhammad; Shafiq, Muhammad

2017-07-01

Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients' perspective. A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality) instrument was administered to determine patient's expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant ( p < 0.003; p < 0.037, respectively) as well as in perception of communication ( p < 0.026). Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness ( p < 0.005), but the perception of each dimension was significantly different in different educational categories (assurance: p < 0.001; empathy: p < 0.001; reliability: p < 0.001; tangibility: p < 0.001; responsiveness: p < 0.001; communication: p < 0.001; and for overall service quality: p < 0.001). Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals. Tertiary care hospitals failed to meet patients' expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy.

Developing a Holistic Model for Quality in Higher Education.

ERIC Educational Resources Information Center

Srikanthan, G.; Dalrymple, John F.

2002-01-01

Proposes a holistic model for quality management in higher education which incorporates both service and academic functions. Discusses the crucial role played by organizational culture in implementation of any quality strategy, and asserts that ideal organizational behavior embodies the "learning communities" concept. (EV)

An investigation on the quality of midwifery services from the viewpoint of the clients in Isfahan through SERVQUAL model.

PubMed

Oliaee, Zohreh; Jabbari, Alireza; Ehsanpour, Soheila

2016-01-01

Quality of care is of great importance in health services as these services have the important mission to preserve health, and to give care to the society. The present study aimed to investigate the quality of midwifery services from the viewpoint of the clients, under coverage of health care centers in Isfahan, through SERVQUAL model. This descriptive and analytical study was conducted on 218 subjects in 2014. Study population comprised the women referring to midwifery services clinics in health care centers in Isfahan. Data of the subjects (n = 218) were collected by SERVQUAL model containing the dimensions of tangibles, reliability, responsiveness, assurance, and empathy. Data were analyzed by paired t-test, Spearman and Pearson correlation coefficients, and independent t-test through SPSS 20. There was a negative gap in all five relevant dimensions of giving services. The widest gap was in the mean of dimension of tangibles (-1.5), and the narrowest gap was in the dimension of assurance (-0.9). There was no significant association between the scores of expectations and perceptions, and age, education level, occupation, and marital status. The obtained negative gap showed that the level of service receivers' perception from existing condition was far from their expectation, and there was a wide gap between attaining their satisfaction with midwifery services and their expectation and reaching their appropriate level of services.

Dynamic selection mechanism for quality of service aware web services

NASA Astrophysics Data System (ADS)

D'Mello, Demian Antony; Ananthanarayana, V. S.

2010-02-01

A web service is an interface of the software component that can be accessed by standard Internet protocols. The web service technology enables an application to application communication and interoperability. The increasing number of web service providers throughout the globe have produced numerous web services providing the same or similar functionality. This necessitates the use of tools and techniques to search the suitable services available over the Web. UDDI (universal description, discovery and integration) is the first initiative to find the suitable web services based on the requester's functional demands. However, the requester's requirements may also include non-functional aspects like quality of service (QoS). In this paper, the authors define a QoS model for QoS aware and business driven web service publishing and selection. The authors propose a QoS requirement format for the requesters, to specify their complex demands on QoS for the web service selection. The authors define a tree structure called quality constraint tree (QCT) to represent the requester's variety of requirements on QoS properties having varied preferences. The paper proposes a QoS broker based architecture for web service selection, which facilitates the requesters to specify their QoS requirements to select qualitatively optimal web service. A web service selection algorithm is presented, which ranks the functionally similar web services based on the degree of satisfaction of the requester's QoS requirements and preferences. The paper defines web service provider qualities to distinguish qualitatively competitive web services. The paper also presents the modelling and selection mechanism for the requester's alternative constraints defined on the QoS. The authors implement the QoS broker based system to prove the correctness of the proposed web service selection mechanism.

Evaluating clinical librarian services: a systematic review.

PubMed

Brettle, Alison; Maden-Jenkins, Michelle; Anderson, Lucy; McNally, Rosalind; Pratchett, Tracey; Tancock, Jenny; Thornton, Debra; Webb, Anne

2011-03-01

  Previous systematic reviews have indicated limited evidence and poor quality evaluations of clinical librarian (CL) services. Rigorous evaluations should demonstrate the value of CL services, but guidance is needed before this can be achieved.   To undertake a systematic review which examines models of CL services, quality, methods and perspectives of clinical librarian service evaluations.   Systematic review methodology and synthesis of evidence, undertaken collaboratively by a group of 8 librarians to develop research and critical appraisal skills.   There are four clear models of clinical library service provision. Clinical librarians are effective in saving health professionals time, providing relevant, useful information and high quality services. Clinical librarians have a positive effect on clinical decision making by contributing to better informed decisions, diagnosis and choice of drug or therapy. The quality of CL studies is improving, but more work is needed on reducing bias and providing evidence of specific impacts on patient care. The Critical Incident Technique as part of a mixed method approach appears to offer a useful approach to demonstrating impact.   This systematic review provides practical guidance regarding the evaluation of CL services. It also provides updated evidence regarding the effectiveness and impact of CL services. The approach used was successful in developing research and critical appraisal skills in a group of librarians. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

Users' Continuance Intention of Virtual Learning Community Services: The Moderating Role of Usage Experience

ERIC Educational Resources Information Center

Zhang, Min; Liu, Yupei; Yan, Weiwei; Zhang, Yan

2017-01-01

Users' continuance intention plays a significant role in the process of information system (IS) service, especially virtual learning community (VLC) services. Following the IS success model and IS post-acceptance model, this study explores the determinants of users' intention to continue using VLCs' service from the perspective of quality,…

42 CFR § 512.413 - Quality measures and reporting for SHFFT model.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL... 42 Public Health 5 2017-10-01 2017-10-01 false Quality measures and reporting for SHFFT model. Â... reporting for SHFFT model. (a) Required measures. (1) Hospital-Level Risk-Standardized Complication Rate...

Supporting Collaborative Model and Data Service Development and Deployment with DevOps

NASA Astrophysics Data System (ADS)

David, O.

2016-12-01

Adopting DevOps practices for model service development and deployment enables a community to engage in service-oriented modeling and data management. The Cloud Services Integration Platform (CSIP) developed the last 5 years at Colorado State University provides for collaborative integration of environmental models into scalable model and data services as a micro-services platform with API and deployment infrastructure. Originally developed to support USDA natural resource applications, it proved suitable for a wider range of applications in the environmental modeling domain. While extending its scope and visibility it became apparent community integration and adequate work flow support through the full model development and application cycle drove successful outcomes.DevOps provide best practices, tools, and organizational structures to optimize the transition from model service development to deployment by minimizing the (i) operational burden and (ii) turnaround time for modelers. We have developed and implemented a methodology to fully automate a suite of applications for application lifecycle management, version control, continuous integration, container management, and container scaling to enable model and data service developers in various institutions to collaboratively build, run, deploy, test, and scale services within minutes.To date more than 160 model and data services are available for applications in hydrology (PRMS, Hydrotools, CFA, ESP), water and wind erosion prediction (WEPP, WEPS, RUSLE2), soil quality trends (SCI, STIR), water quality analysis (SWAT-CP, WQM, CFA, AgES-W), stream degradation assessment (SWAT-DEG), hydraulics (cross-section), and grazing management (GRAS). In addition, supporting data services include soil (SSURGO), ecological site (ESIS), climate (CLIGEN, WINDGEN), land management and crop rotations (LMOD), and pesticides (WQM), developed using this workflow automation and decentralized governance.

42 CFR § 512.400 - Quality measures and reporting-general.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Quality Measures... EPM participant is eligible for reconciliation payments under § 512.305(d)(1)(iii), and for assigning...

Trends in extramural consultation: comparison between subspecialized and general surgical pathology service models.

PubMed

Liu, Yong-Jun; Kessler, Meghan; Zander, Dani S; Karamchandani, Dipti M

2016-10-01

Academic and community hospital pathology groups are increasingly adopting subspecialized service models for surgical pathology (SP) practice. Reasons cited include improvements in sign-out efficiency, quality and accuracy, enhancement of clinician-pathologist communications, and augmentation of resident training quality. However, there is a paucity of published quantitative data regarding the outcomes of transitioning from general to subspecialized SP service coverage. Retrospective assessment of the frequencies and outcomes of SP extramural consultations requested by faculty at our institution was performed, encompassing 2 consecutive years each of subspecialized and general SP service models. The frequencies of extramural consultations between the 2 practice models were not significantly different (0.25% vs 0.21%, P = .142). Although more pathology cases were sent out in gastrointestinal (0.29% vs 0.14%, P = .007), gynecologic (0.16% vs 0.02%, P = .009), and pulmonary (1.73% vs 0.28%, P = .008) services during the "subspecialization" era, fewer pediatric cases were sent out (0.48% vs 1.69%, P = .008). Importantly, the transition to the subspecialized model was associated with a marked reduction in the frequency of major disagreements between the original diagnosis and the consultant's diagnosis (1.8% vs 9.3%, P = .018). Our study supports the value of the subspecialized SP sign-out model for increasing diagnostic accuracy and enhancing the quality of patient care. Copyright © 2016 Elsevier Inc. All rights reserved.

The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

PubMed

Jennings, Natasha; Clifford, Stuart; Fox, Amanda R; O'Connell, Jane; Gardner, Glenn

2015-01-01

To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in evidence based health service planning. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

PubMed

Jeon, Hangoo; Seo, Kwang-Kyu

2015-01-01

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

A Framework and Improvements of the Korea Cloud Services Certification System

PubMed Central

Jeon, Hangoo

2015-01-01

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

The Quality of Educational Services from Students' Viewpoint in Iran: A Systematic Review and Meta-analysis.

PubMed

Moosavi, Ahmad; Mohseni, Mohammad; Ziaiifar, Hajar; Azami-Aghdash, Saber; Gharasi Manshadi, Mahdi; Rezapour, Aziz

2017-04-01

Students' view is an important factor in assessing the quality of universities. Servqual pattern is regarded as the most prominent for services quality measurement. This study aimed to review systematically studies that investigated the quality of educational services. A systematic review and meta-analysis of studies evaluating students' viewpoint about quality of educational services were conducted. Required data were collected from PubMed, Embase, Scopus, Science Direct, Google Scholar, SID, Magiran, and Iranmedex, without time restriction. Computer software CMA, ver. 2 was applied to estimate the total mean score of students' perception and expectation of services quality and the gap between them. The 18 eligible studies were entered into study. The studies were conducted between 2004 and 2014. Based on the random effect model, the total mean score of students' perception, students' expectation and the gap between them were estimated 2.92 (95% CI, 2.75 - 3.09), 4.18 (95% CI, 3.98 - 4.38), respectively and -1.30 (95% CI= -1.56, -1.04). The studied students' expectation level is higher than the current quality of educational services. There is a tangible difference between their expectations and the current quality, which requires officials' efforts to improve quality in all dimensions and effective steps can be taken towards improving the quality of educational services through appropriate training planning and training for empowering employees in colleges and universities.

COMPUTATIONAL ASPECTS OF THE AIR QUALITY FORECASTING VERSION OF CMAQ (CMAQ-F)

EPA Science Inventory

The air quality forecast version of the Community Modeling Air Quality (CMAQ) model (CMAQ-F) was developed from the public release version of CMAQ (available from http://www.cmascenter.org), and is running operationally at the National Weather Service's National Centers for Envir...

Defining Quality of Life in the Children of Parents with Severe Mental Illness: A Preliminary Stakeholder-Led Model

PubMed Central

Bee, Penny; Berzins, Kathryn; Calam, Rachel; Pryjmachuk, Steven; Abel, Kathryn M.

2013-01-01

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13–18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key ‘meta-themes’. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to address fully the quality of life priorities of these vulnerable families. PMID:24040050

Defining quality of life in the children of parents with severe mental illness: a preliminary stakeholder-led model.

PubMed

Bee, Penny; Berzins, Kathryn; Calam, Rachel; Pryjmachuk, Steven; Abel, Kathryn M

2013-01-01

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13-18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key 'meta-themes'. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to address fully the quality of life priorities of these vulnerable families.

Understanding patients' behavioral intentions: evidence from Iran's private hospitals industry.

PubMed

Zarei, Ehsan; Arab, Mohammad; Tabatabaei, Seyed Mahmoud Ghazi; Rashidian, Arash; Forushani, Abbas Rahimi; Khabiri, Roghayeh

2014-01-01

In the ever-increasing competitive market of private hospital industry, creating a strong relationship with the customers that shapes patients' loyalty has been considered a key factor in obtaining market share. The purpose of this paper is to test a model of customer loyalty among patients of private hospitals in Iran. This cross-sectional study was carried out in Tehran, the capital of the Islamic Republic of Iran in 2010. The study samples composed of 969 patients who were consecutively selected from eight private hospitals. The survey instrument was designed based on a review of the related literature and included 36 items. Data analysis was performed using structural equation modeling. For the service quality construct, three dimensions extracted: Process, interaction, and environment. Both process and interaction quality had significant effects on perceived value. Perceived value along with the process and interaction quality were the most important antecedents of patient overall satisfaction. The direct effect of the process and interaction quality on behavioral intentions was insignificant. Perceived value and patient overall satisfaction were the direct antecedents of patient behavioral intentions and the mediators between service quality and behavioral intentions. Environment quality of service delivery had no significant effect on perceived value, overall satisfaction, and behavioral intentions. Contrary to previous similar studies, the role of service quality was investigated not in a general sense, but in the form of three types of qualities including quality of environment, quality of process, and quality of interaction.

Is patient satisfaction and perceived service quality with musculoskeletal rehabilitation determined by patient experiences?

PubMed

Medina-Mirapeix, Francesc; Jimeno-Serrano, Francisco J; Escolar-Reina, Pilar; Del Baño-Aledo, M Elena

2013-06-01

To assess the relationships between patient experiences and two overall evaluations - satisfaction and service quality - in outpatient rehabilitation settings. A cross-sectional, self-reported survey carried out in the year 2009. Three outpatient rehabilitation units belonging to Spanish hospitals located in Barcelona, Madrid and Seville. Four hundred and sixty-five outpatients (response rate 90%) mean age 39.4 (SD = 11.9) years. Self-reported experiences on aspects of care, participants' perception of service quality, satisfaction with care, socio-demographic and health characteristics. Satisfaction and service quality were highly correlated (rho = 0.72, P< 0.001). Two multivariate logistic regression models using satisfaction and service quality (with adjusted R(2) 31.5% and 37.1%, respectively) indicated that patients' experiences and global rating of health improvement have more effect on those evaluations than socio-demographic characteristics. Mean satisfaction was 8.9 (SD = 1.2), and 88% of respondents described high service quality. However, nearly 25% of the respondents who reported high-quality evaluations also indicated a problem score of more than 50% in almost all aspects of care studied. Satisfaction and service quality provide a poor indicator of patients' experiences. Both are two proxies but distinct constructs in rehabilitation care. Besides, not all problems encountered by patients are equally important to them.

42 CFR § 512.725 - Data sharing for FFS-CR participants.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants Provisions for Ffs-Cr Participants § 512... quality. (3) Enhance efficiencies in the delivery of care. (4) Otherwise achieve the goals of the model...

Value for money of changing healthcare services? Economic evaluation of quality improvement

PubMed Central

Severens, J

2003-01-01



 There are many instances of perceived or real inefficiencies in health service delivery. Both healthcare providers and policy makers need to know the impact and cost of applying strategies to change the behaviour of individuals or organisations. Quality improvement or implementation research is concerned with evaluating the methods of behavioural change. Addressing inefficiencies in healthcare services raises a series of issues, beginning with how inefficiency itself should be defined. The basic concepts of cost analysis and economic evaluations are explained and a model for working through the economic issues of quality improvement is discussed. This model combines the costs and benefits of corrected inefficiency with the costs and degree of behavioural change achieved by a quality improvement method in the policy maker's locality. It shows why it may not always be cost effective for policy makers to address suboptimal behaviour. Both the interpretation of quality improvement research findings and their local application need careful consideration. The limited availability of applicable quality improvement research may make it difficult to provide robust advice on the value for money of many behavioural quality improvement strategies. PMID:14532369

42 CFR § 414.1330 - Quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1330 Quality... comprise: (1) 60 percent of a MIPS eligible clinician's final score for MIPS payment year 2019. (2) 50...

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

PubMed

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2012-11-21

No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems.

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

PubMed Central

2013-01-01

Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a direct effect; and (B) service quality and patient trust are used as intervening variables to affect patient satisfaction, which represents an indirect effect. Due to differences in the scale, resources and costs among medical institutions of different levels, it is a most urgent and concerning issue of how to control customers’ demands and preferences and adopt correct marketing concepts under the circumstances of intense competition in order to satisfy the public and build up a competitive edge for medical institutions. PMID:23320786

Differentiated strategies for improving streaming service quality

NASA Astrophysics Data System (ADS)

An, Hui; Chen, Xin-Meng

2005-02-01

With the explosive growth of streaming services, users are becoming more and more sensitive to its quality of service. To handle these problems, the research community focuses of the application of caching and replication techniques. But most approaches try to find specific strategies of caching of replication that suit for streaming service characteristics and to design some kind of universal policy to deal with all streaming objects. This paper explores the combination of caching and replication for improving streaming service quality and demonstrates that it makes sense to incorporate two technologies. It provides a system model and discusses some related issues of how to determining a refreshable streaming object and which refreshment policies a refreshable object should use.

A Kind of Transformation of Information Service--Science and Technology Novelty Search in Chinese University Libraries

ERIC Educational Resources Information Center

Aiguo, Li

2007-01-01

Science and Technology Novelty Search (S&TNS) is a special information consultation service developed as part of the Chinese Sci-Tech system. The author introduces the concept of S&TNS, and explains its role, and the role of the university library in the process. A quality control model to improve the quality of service of the S&TNS at…

Service models and realization of differentiated services networks

NASA Astrophysics Data System (ADS)

Elizondo, Antonio J.; Garcia Osma, Maria L.; Einsiedler, Hans J.; Roth, Rudolf; Smirnov, Michael I.; Bartoli, Maurizio; Castelli, Paolo; Varga, Balazs; Krampell, Magnus

2001-07-01

Internet Service Providers need to offer Quality of Service (QoS) to fulfil the requirements of applications of their customers. Moreover, in a competitive market environment costs must be low. The selected service model must be effective and low in complexity, but it should still provide high quality and service differentiation, that the current Internet is not yet capable to support. The Differentiated Services (DiffServ) Architecture has been proposed for enabling a range of different Classes of Service (CoS). In the EURESCOM project P1006 several European service providers co-operated to examine various aspects involved in the introduction of service differentiation using the DiffServ approach. The project explored a set of service models for Expedited Forwarding (EF) and Assured Forwarding (AF) and identified requirements for network nodes. Besides, we addressed also measurement issues, charging and accounting issues. Special attention has been devoted to requirements of elastic traffic that adapts its sending rate to congestion state and available bandwidth. QoS mechanisms must prove Transmission Control Protocol (TCP) friendliness. TCP performance degrades under multiple losses. Since RED based queue management may still cause multiple discards, a modified marking scheme called Capped Leaky Bucket is proposed to improve the performance of elastic applications.

42 CFR § 512.411 - Quality measures and reporting for AMI model.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL... 42 Public Health 5 2017-10-01 2017-10-01 false Quality measures and reporting for AMI model. Â... reporting for AMI model. (a) Required measures. (1) Hospital 30-Day, All-Cause, Risk-Standardized Mortality...

42 CFR § 512.412 - Quality measures and reporting for CABG model.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL... 42 Public Health 5 2017-10-01 2017-10-01 false Quality measures and reporting for CABG model. Â... reporting for CABG model. (a) Required measures. (1) Hospital 30-Day, All-Cause, Risk-Standardized Mortality...

White Paper Report of the 2011 RAD-AID Conference on International Radiology for Developing Countries: Integrating Multidisciplinary Strategies for Imaging Services in the Developing World

PubMed Central

Mazal, Jonathan; Lexa, Frank; Starikovsky, Anna; Jimenez, Pablo; Jain, Sanjay; DeStigter, Kristen K.; Nathan, Robert; Krebs, Elizabeth; Noble, Vicki; Marks, William; Hirsh, Richard N.; Short, Brad; Sydnor, Ryan; Timmreck-Jackson, Emily; Lungren, Matthew P.; Maxfield, Charles; Azene, Ezana M.; Garra, Brian S.; Choi, Brian G.; Lewin, Jonathan S.; Mollura, Daniel J.

2016-01-01

The 2011 RAD-AID Conference on International Radiology for Developing Countries discussed data, experiences and models pertaining to radiology in the developing world, where widespread shortages of imaging services significantly reduce health care quality and increase health care disparity. This white paper from the 2011 RAD-AID Conference represents consensus advocacy of multidisciplinary strategies to improve planning, accessibility and quality of imaging services in the developing world. Conference presenters and participants discussed numerous solutions to imaging and healthcare disparities including: (1) economic development for radiology service planning, (2) public health mechanisms to address disease and prevention at the population and community levels, (3) comparative clinical models to implement various clinical and workflow strategies adapted to unique developing world community contexts, (4) education to improve training and optimize service quality, and (5) technology innovation to bring new technical capabilities to limited-resource regions. PMID:22748790

White paper report of the 2011 RAD-AID Conference on International Radiology for Developing Countries: integrating multidisciplinary strategies for imaging services in the developing world.

PubMed

Everton, Kathryn L; Mazal, Jonathan; Mollura, Daniel J

2012-07-01

The 2011 RAD-AID Conference on International Radiology for Developing Countries discussed data, experiences, and models pertaining to radiology in the developing world, where widespread shortages of imaging services significantly reduce health care quality and increase health care disparities. This white paper from the 2011 RAD-AID conference represents consensus advocacy of multidisciplinary strategies to improve the planning, accessibility, and quality of imaging services in the developing world. Conference presenters and participants discussed numerous solutions to imaging and health care disparities, including (1) economic development for radiologic service planning, (2) public health mechanisms to address disease and prevention at the population and community levels, (3) comparative clinical models to implement various clinical and workflow strategies adapted to unique developing world community contexts, (4) education to improve training and optimize service quality, and (5) technology innovation to bring new technical capabilities to limited-resource regions. Published by Elsevier Inc.

[A cross-level analysis of the links between service quality and disconfirmation of expectations and customer satisfaction].

PubMed

Sánchez-Hernández, Rosa M; Martínez-Tur, Vicente; González-Morales, M Gloria; Ramos, José; Peiró, José M

2009-08-01

This article examines links between disconfirmation of expectations and functional and relational service quality perceived by employees and customer satisfaction. A total of 156 employees, who were working in 52 work units, participated in the research study. In addition, 517 customers who were assisted by these work units were surveyed. Using a cross-level approach, we used a random coefficient model to test the aforementioned relationships. A strong relationship between disconfirmation of expectations and customer satisfaction was observed. Also, the results confirmed that functional service quality maintains an additional and significant association with customer satisfaction. In contrast, there were no significant relationships between relational service quality and customer satisfaction. The article concludes with a discussion of these results.

Developing a long-term condition's information service in collaboration with third sector organisations.

PubMed

McShane, Lesley; Greenwell, Kate; Corbett, Sally; Walker, Richard

2014-06-01

People with long-term conditions need to be signposted to high quality information and advice to understand and manage their condition. Information seeking tools combined with third sector information could help address their information needs. To describe the development and implementation of an information service for people living with long-term conditions at one NHS acute trust in the Northeast of England. An information service was trialled using bespoke information models for three long-term conditions in collaboration with third sector organisations. These guided people to relevant, timely and reliable information. Both clinician and service user questionnaires were used to evaluate satisfaction with the service. Appropriately designed information models can be used interchangeably across all services. Between 75% and 91% of users agreed that they were satisfied with various aspects of the service. Generally, users received relevant, understandable and high quality information at the right time. Nearly all health professionals (94-100%) felt the service was accessible, provided high quality information and did not significantly impact on their consultation time. The developed information service was well received by service users and health professionals. Specifically, the use of information prescriptions and menus facilitated access to information for people with long-term conditions. © 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group.

Practice and payment preferences of newly practising family physicians in British Columbia

PubMed Central

Brcic, Vanessa; McGregor, Margaret J.; Kaczorowski, Janusz; Dharamsi, Shafik; Verma, Serena

2012-01-01

Abstract Objective To examine the remuneration model preferences of newly practising family physicians. Design Mixed-methods study comprising a cross-sectional, Web-based survey, as well as qualitative content analysis of answers to open-ended questions. Setting British Columbia. Participants University of British Columbia family practice residents who graduated between 2000 and 2009. Main outcome measures Preferred remuneration models of newly practising physicians. Results The survey response rate was 31% (133 of 430). Of respondents, 71% (93 of 132) preferred non–fee-for-service practice models and 86% (110 of 132) identified the payment model as very or somewhat important in their choice of future practice. Three principal themes were identified from content analysis of respondents’ open-ended comments: frustrations with fee-for-service billing, which encompassed issues related to aggravations with “the business side of things” and was seen as impeding “the freedom to focus on medicine”; quality of patient care, which embraced the importance of a payment model that supported “comprehensive patient care” and “quality rather than quantity”; and freedom to choose, which supported the plurality of practice preferences among providers who strived to provide quality care for patients, “whatever model you happen to be working in.” Conclusion Newly practising physicians in British Columbia preferred alternatives to fee-for-service payment models, which were perceived as contributing to fewer frustrations with billing systems, improved quality of work life, and better quality of patient care. PMID:22586205

Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders.

PubMed

Roux, Paul; Passerieux, Christine; Fleury, Marie-Josée

2016-12-01

Needs and service performance assessment are key components in improving recovery among individuals with mental disorders. To test the role of service performance as a mediating factor between severity of patients' needs and outcomes. A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling. The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes. Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life. © The Royal College of Psychiatrists 2016.

The Copernicus Atmosphere Monitoring Service: facilitating the prediction of air quality from global to local scales

NASA Astrophysics Data System (ADS)

Engelen, R. J.; Peuch, V. H.

2017-12-01

The European Copernicus Atmosphere Monitoring Service (CAMS) operationally provides daily forecasts of global atmospheric composition and regional air quality. The global forecasting system is using ECMWF's Integrated Forecasting System (IFS), which is used for numerical weather prediction and which has been extended with modules for atmospheric chemistry, aerosols and greenhouse gases. The regional forecasts are produced by an ensemble of seven operational European air quality models that take their boundary conditions from the global system and provide an ensemble median with ensemble spread as their main output. Both the global and regional forecasting systems are feeding their output into air quality models on a variety of scales in various parts of the world. We will introduce the CAMS service chain and provide illustrations of its use in downstream applications. Both the usage of the daily forecasts and the usage of global and regional reanalyses will be addressed.

PubMed Central

2012-01-01

The Walt Disney Company has never lost sight of its founder's edict: “Give the public everything you can give them.” From this simple statement, everyone at Disney strives to exceed customer expectations every day. For more than 80 years this singular pursuit of excellence in delivering consistent quality service has earned the Disney organization a world-renowned reputation and ongoing business success. Uncover some of the secrets behind the Disney service culture and processes. In this session, you will examine the time-tested model for delivering world-class Guest service and discover how attention to detail creates a consistent, successful environment for both employees and customers. You can then use these ideas to transform and improve your own organization's delivery of quality service. You will learn how to: Develop an organizational culture that supports consistent delivery of quality service.Evaluate the Disney approach and tailor it to your business.Design quality service standards and processes to raise the level of customer satisfaction.Create metrics to gauge the needs, perceptions and expectations of your customers.Enable employees, settings and processes to convey your quality service commitment.Implement a strategic plan for monitoring the delivery of seamless customer experiences.

Constructing a consumption model of fine dining from the perspective of behavioral economics

PubMed Central

Tsai, Sang-Bing

2018-01-01

Numerous factors affect how people choose a fine dining restaurant, including food quality, service quality, food safety, and hedonic value. A conceptual framework for evaluating restaurant selection behavior has not yet been developed. This study surveyed 150 individuals with fine dining experience and proposed the use of mental accounting and axiomatic design to construct a consumer economic behavior model. Linear and logistic regressions were employed to determine model correlations and the probability of each factor affecting behavior. The most crucial factor was food quality, followed by service and dining motivation, particularly regarding family dining. Safe ingredients, high cooking standards, and menu innovation all increased the likelihood of consumers choosing fine dining restaurants. PMID:29641554

Constructing a consumption model of fine dining from the perspective of behavioral economics.

PubMed

Hsu, Sheng-Hsun; Hsiao, Cheng-Fu; Tsai, Sang-Bing

2018-01-01

Numerous factors affect how people choose a fine dining restaurant, including food quality, service quality, food safety, and hedonic value. A conceptual framework for evaluating restaurant selection behavior has not yet been developed. This study surveyed 150 individuals with fine dining experience and proposed the use of mental accounting and axiomatic design to construct a consumer economic behavior model. Linear and logistic regressions were employed to determine model correlations and the probability of each factor affecting behavior. The most crucial factor was food quality, followed by service and dining motivation, particularly regarding family dining. Safe ingredients, high cooking standards, and menu innovation all increased the likelihood of consumers choosing fine dining restaurants.

A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service.

PubMed

Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard

2014-09-01

To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.

Multi-Agent Architecture with Support to Quality of Service and Quality of Control

NASA Astrophysics Data System (ADS)

Poza-Luján, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, Jose-Enrique

Multi Agent Systems (MAS) are one of the most suitable frameworks for the implementation of intelligent distributed control system. Agents provide suitable flexibility to give support to implied heterogeneity in cyber-physical systems. Quality of Service (QoS) and Quality of Control (QoC) parameters are commonly utilized to evaluate the efficiency of the communications and the control loop. Agents can use the quality measures to take a wide range of decisions, like suitable placement on the control node or to change the workload to save energy. This article describes the architecture of a multi agent system that provides support to QoS and QoC parameters to optimize de system. The architecture uses a Publish-Subscriber model, based on Data Distribution Service (DDS) to send the control messages. Due to the nature of the Publish-Subscribe model, the architecture is suitable to implement event-based control (EBC) systems. The architecture has been called FSACtrl.

How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

PubMed

Pelone, Ferruccio; Kringos, Dionne S; Spreeuwenberg, Peter; De Belvis, Antonio G; Groenewegen, Peter P

2013-09-01

To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. PC systems in 22 European countries in 2009/2010. Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

An investigation on the quality of midwifery services from the viewpoint of the clients in Isfahan through SERVQUAL model

PubMed Central

Oliaee, Zohreh; Jabbari, Alireza; Ehsanpour, Soheila

2016-01-01

Background: Quality of care is of great importance in health services as these services have the important mission to preserve health, and to give care to the society. The present study aimed to investigate the quality of midwifery services from the viewpoint of the clients, under coverage of health care centers in Isfahan, through SERVQUAL model. Materials and Methods: This descriptive and analytical study was conducted on 218 subjects in 2014. Study population comprised the women referring to midwifery services clinics in health care centers in Isfahan. Data of the subjects (n = 218) were collected by SERVQUAL model containing the dimensions of tangibles, reliability, responsiveness, assurance, and empathy. Data were analyzed by paired t-test, Spearman and Pearson correlation coefficients, and independent t-test through SPSS 20. Results: There was a negative gap in all five relevant dimensions of giving services. The widest gap was in the mean of dimension of tangibles (−1.5), and the narrowest gap was in the dimension of assurance (−0.9). There was no significant association between the scores of expectations and perceptions, and age, education level, occupation, and marital status. Conclusions: The obtained negative gap showed that the level of service receivers' perception from existing condition was far from their expectation, and there was a wide gap between attaining their satisfaction with midwifery services and their expectation and reaching their appropriate level of services. PMID:27186207

The quality of health care and patient satisfaction: an exploratory investigation of the 5Qs model at some Egyptian and Jordanian medical clinics.

PubMed

Zineldin, Mosad

2006-01-01

To examine the major factors affecting patients' perception of cumulative satisfaction and to address the question whether patients in Egypt and Jordan evaluate quality of health care similarly or differently. A conceptual model including behavioural dimensions of patient-physician relationships and patient satisfaction has been developed. As the empirical research setting, this study concerns three hospitals in Egypt and Jordan. The survey instrument in a questionnaire form was designed to achieve the research objectives. A total of 48 items (attributes) of the newly developed five quality dimensions were identified to be the most relevant. A total of 224 complete and usable questionnaires were received from the in-patients. Hospital C has above-average total and dimensional qualities and patients are the most satisfied in accordance with all dimensions of services. Hospitals A and B have under-average total qualities as the majority of patients are not satisfied with services. Comparing hospitals A and B, in the majority of dimensions (with the exception of Q5), the quality in hospital B is higher than in hospital A. Patients' satisfaction with different service quality dimensions is correlated with their willingness to recommend the hospital to others. A cure to improve the quality for health-care services can be an application of total relationship management and the 5Qs model together with customer orientation strategy. The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health-care quality strategies. In this research a study is described involving a new instrument and a new method which assure a reasonable level of relevance, validity and reliability, while being explicitly change-oriented. This study argues that a patient's satisfaction is a cumulative construct, summing satisfaction with five different qualities (5Qs) of the hospital: quality of object, processes, infrastructure, interaction, and atmosphere.

An integrative review and evidence-based conceptual model of the essential components of pre-service education.

PubMed

Johnson, Peter; Fogarty, Linda; Fullerton, Judith; Bluestone, Julia; Drake, Mary

2013-08-28

With decreasing global resources, a pervasive critical shortage of skilled health workers, and a growing disease burden in many countries, the need to maximize the effectiveness and efficiency of pre-service education in low-and middle-income countries has never been greater. We performed an integrative review of the literature to analyse factors contributing to quality pre-service education and created a conceptual model that shows the links between essential elements of quality pre-service education and desired outcomes. The literature contains a rich discussion of factors that contribute to quality pre-service education, including the following: (1) targeted recruitment of qualified students from rural and low-resource settings appears to be a particularly effective strategy for retaining students in vulnerable communities after graduation; (2) evidence supports a competency-based curriculum, but there is no clear evidence supporting specific curricular models such as problem-based learning; (3) the health workforce must be well prepared to address national health priorities; (4) the role of the preceptor and preceptors' skills in clinical teaching, identifying student learning needs, assessing student learning, and prioritizing and time management are particularly important; (5) modern, Internet-enabled medical libraries, skills and simulation laboratories, and computer laboratories to support computer-aided instruction are elements of infrastructure meriting strong consideration; and (6) all students must receive sufficient clinical practice opportunities in high-quality clinical learning environments in order to graduate with the competencies required for effective practice. Few studies make a link between PSE and impact on the health system. Nevertheless, it is logical that the production of a trained and competent staff through high-quality pre-service education and continuing professional development activities is the foundation required to achieve the desired health outcomes. Professional regulation, deployment practices, workplace environment upon graduation and other service delivery contextual factors were analysed as influencing factors that affect educational outcomes and health impact. Our model for pre-service education reflects the investments that must be made by countries into programmes capable of leading to graduates who are competent for the health occupations and professions at the time of their entry into the workforce.

Quality of medical service, patient satisfaction and loyalty with a focus on interpersonal-based medical service encounters and treatment effectiveness: a cross-sectional multicenter study of complementary and alternative medicine (CAM) hospitals.

PubMed

Kim, Chang Eun; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Choi, Areum; Park, Ki Byung; Lee, Ho-Joo; Ha, In-Hyuk

2017-03-28

Treatment effectiveness holds considerable importance in the association between service quality and satisfaction in medical service studies. While complementary and alternative medicine (CAM) use grows more prominent, comprehensive evaluations of the quality of medical service at CAM-oriented hospitals are scarce. This study assesses the quality of medical services provided at a CAM-oriented hospital of Korean medicine using the service encounter system approach and analyzes the influence of treatment effectiveness on patient loyalty. A survey study using one-on-one interviews was conducted using a cross-sectional design in outpatients visiting one of fifteen Korean medicine facilities located throughout Korea. A total of 880 surveys were completed from June to July, 2014, and 728 surveys were included in the final analysis after excluding incomplete or incorrect questionnaires. The reliability and validity of the surveys was confirmed using Cronbach's alpha coefficient and confirmatory factor analysis, and a structural equation modeling analysis was performed to verify causality and association between factors (quality of medical service, treatment effectiveness, patient satisfaction, and intent to revisit). The measured factors of physician performance and quality of service procedures had a positive effect on treatment effectiveness. The impression of the facilities and environment directly impacted satisfaction rates for interpersonal-based medical service encounters, while treatment effectiveness positively affected satisfaction regarding quality of medical service. However, treatment effectiveness had a more significant effect on satisfaction compared to facilities and environment, and it indirectly affected satisfaction and directly influenced intent to revisit. Treatment effectiveness and satisfaction both positively influenced intent to revisit. The importance of treatment effectiveness should be recognized when examining quality of medical services, and we hope that these findings may contribute to future studies.

Interacting coastal based ecosystem services: recreation and water quality in Puget Sound, WA

USGS Publications Warehouse

Kreitler, Jason; Papenfus, Michael; Byrd, Kristin; Labiosa, William

2013-01-01

Coastal recreation and water quality are major contributors to human well-being in coastal regions. They can also interact, creating opportunities for ecosystem based management, ecological restoration, and water quality improvement that can positively affect people and the environment. Yet the effect of environmental quality on human behavior is often poorly quantified, but commonly assumed in coastal ecosystem service studies. To clarify this effect we investigate a water quality dataset for evidence that environmental condition partially explains variation in recreational visitation, our indicator of human behavior. In Puget Sound, WA, we investigate variation in visitation in both visitation rate and fixed effects (FE) models. The visitation rate model relates the differences in annual recreational visitation among parks to environmental conditions, park characteristics, travel cost, and recreational demand. In our FE model we control for all time-invariant unobserved variables and compare monthly variation at the park level to determine how water quality affects visitation during the summer season. The results of our first model illustrate how visitation relates to various amenities and costs. In the FE analysis, monthly visitation was negatively related to water quality while controlling for monthly visitation trends. This indicates people are responding to changes in water quality, and an improvement would yield an increase in the value of recreation. Together, these results could help in prioritizing water quality improvements, could assist the creation of new parks or the modification of existing recreational infrastructure, and provide quantitative estimates for the expected benefits from potential changes in recreational visitation and water quality improvements. Our results also provide an example of how recreational visitation can be quantified and used in ecosystem service assessments.

Interacting Coastal Based Ecosystem Services: Recreation and Water Quality in Puget Sound, WA

PubMed Central

Kreitler, Jason; Papenfus, Michael; Byrd, Kristin; Labiosa, William

2013-01-01

Coastal recreation and water quality are major contributors to human well-being in coastal regions. They can also interact, creating opportunities for ecosystem based management, ecological restoration, and water quality improvement that can positively affect people and the environment. Yet the effect of environmental quality on human behavior is often poorly quantified, but commonly assumed in coastal ecosystem service studies. To clarify this effect we investigate a water quality dataset for evidence that environmental condition partially explains variation in recreational visitation, our indicator of human behavior. In Puget Sound, WA, we investigate variation in visitation in both visitation rate and fixed effects (FE) models. The visitation rate model relates the differences in annual recreational visitation among parks to environmental conditions, park characteristics, travel cost, and recreational demand. In our FE model we control for all time-invariant unobserved variables and compare monthly variation at the park level to determine how water quality affects visitation during the summer season. The results of our first model illustrate how visitation relates to various amenities and costs. In the FE analysis, monthly visitation was negatively related to water quality while controlling for monthly visitation trends. This indicates people are responding to changes in water quality, and an improvement would yield an increase in the value of recreation. Together, these results could help in prioritizing water quality improvements, could assist the creation of new parks or the modification of existing recreational infrastructure, and provide quantitative estimates for the expected benefits from potential changes in recreational visitation and water quality improvements. Our results also provide an example of how recreational visitation can be quantified and used in ecosystem service assessments. PMID:23451067

The Mental Health Recovery Measure Can Be Used to Assess Aspects of Both Customer-Based and Service-Based Recovery in the Context of Severe Mental Illness.

PubMed

Oliveira-Maia, Albino J; Mendonça, Carina; Pessoa, Maria J; Camacho, Marta; Gago, Joaquim

2016-01-01

Within clinical psychiatry, recovery from severe mental illness (SMI) has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here, we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and quality of life. The study was conducted in 101 patients suffering from SMI, recruited from a rural community mental health setting in Portugal. Customer-based recovery and function-related service-based recovery were assessed, respectively, using a shortened version of the Mental Health Recovery Measure (MHRM-20) and the Global Assessment of Functioning score. The Camberwell Assessment of Need scale was used to objectively assess needs, while subjective quality of life was measured with the TL-30s scale. Using multiple linear regression models, we found that the Global Assessment of Functioning score was incrementally predictive of the MHRM-20 score, when added to a model including only clinical and demographic factors, and that this model was further incremented by the score for quality of life. However, in an alternate model using the Global Assessment of Functioning score as the dependent variable, while the MHRM-20 score contributed significantly to the model when added to clinical and demographic factors, the model was not incremented by the score for quality of life. These results suggest that, while a more global concept of recovery from SMI may be assessed using measures for service-based and customer-based recovery, the latter, namely the MHRM-20, also provides information about subjective well-being. Pending confirmation of these findings in other populations, this instrument could thus be useful for comprehensive assessment of recovery and subjective well-being in patients suffering from SMI.

The Mental Health Recovery Measure Can Be Used to Assess Aspects of Both Customer-Based and Service-Based Recovery in the Context of Severe Mental Illness

PubMed Central

Oliveira-Maia, Albino J.; Mendonça, Carina; Pessoa, Maria J.; Camacho, Marta; Gago, Joaquim

2016-01-01

Within clinical psychiatry, recovery from severe mental illness (SMI) has classically been defined according to symptoms and function (service-based recovery). However, service-users have argued that recovery should be defined as the process of overcoming mental illness, regaining self-control and establishing a meaningful life (customer-based recovery). Here, we aimed to compare customer-based and service-based recovery and clarify their differential relationship with other constructs, namely needs and quality of life. The study was conducted in 101 patients suffering from SMI, recruited from a rural community mental health setting in Portugal. Customer-based recovery and function-related service-based recovery were assessed, respectively, using a shortened version of the Mental Health Recovery Measure (MHRM-20) and the Global Assessment of Functioning score. The Camberwell Assessment of Need scale was used to objectively assess needs, while subjective quality of life was measured with the TL-30s scale. Using multiple linear regression models, we found that the Global Assessment of Functioning score was incrementally predictive of the MHRM-20 score, when added to a model including only clinical and demographic factors, and that this model was further incremented by the score for quality of life. However, in an alternate model using the Global Assessment of Functioning score as the dependent variable, while the MHRM-20 score contributed significantly to the model when added to clinical and demographic factors, the model was not incremented by the score for quality of life. These results suggest that, while a more global concept of recovery from SMI may be assessed using measures for service-based and customer-based recovery, the latter, namely the MHRM-20, also provides information about subjective well-being. Pending confirmation of these findings in other populations, this instrument could thus be useful for comprehensive assessment of recovery and subjective well-being in patients suffering from SMI. PMID:27857698

Service Quality Of Diagnostic Fine Needle Aspiration Cytology In A Tertiary Care Hospital Of Lahore (Process Measure As Patient's Perspective).

PubMed

Rizvi, Zainab; Usmani, Rabia Arshed; Rizvi, Amna; Wazir, Salim; Zahra, Taskeen; Rasool, Hafza

2017-01-01

Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas <60% was 'poor quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value <0.05). Out of the 4 dimensions of service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (p<.05). The study suggests that service quality of therapeutic and diagnostic procedures in public hospitals should be routinely monitored from the patients' point of view as most aspects of service quality in public hospitals of Pakistan, require improvements. In this manner patient's satisfaction regarding use of services in public hospitals can be made better.

Objective Video Quality Assessment Based on Machine Learning for Underwater Scientific Applications

PubMed Central

Moreno-Roldán, José-Miguel; Luque-Nieto, Miguel-Ángel; Poncela, Javier; Otero, Pablo

2017-01-01

Video services are meant to be a fundamental tool in the development of oceanic research. The current technology for underwater networks (UWNs) imposes strong constraints in the transmission capacity since only a severely limited bitrate is available. However, previous studies have shown that the quality of experience (QoE) is enough for ocean scientists to consider the service useful, although the perceived quality can change significantly for small ranges of variation of video parameters. In this context, objective video quality assessment (VQA) methods become essential in network planning and real time quality adaptation fields. This paper presents two specialized models for objective VQA, designed to match the special requirements of UWNs. The models are built upon machine learning techniques and trained with actual user data gathered from subjective tests. Our performance analysis shows how both of them can successfully estimate quality as a mean opinion score (MOS) value and, for the second model, even compute a distribution function for user scores. PMID:28333123

Forging a novel provider and payer partnership in Wisconsin to compensate pharmacists for quality-driven pharmacy and medication therapy management services.

PubMed

Trapskin, Kari; Johnson, Curtis; Cory, Patrick; Sorum, Sarah; Decker, Chris

2009-01-01

To describe the Wisconsin Pharmacy Quality Collaborative (WPQC), a quality-based network of pharmacies and payers with the common goals of improving medication use and safety, reducing health care costs for payers and patients, and increasing professional recognition and compensation for pharmacist-provided services. Wisconsin between 2006 and 2009. Community (independent, chain, and health-system) pharmacies and private and public health care payers/purchasers with support from the McKesson Corporation. This initiative aligns incentives for pharmacies and payers through implementation of 12 quality-based pharmacy requirements as conditions of pharmacy participation in a practice-advancement pilot. Payers compensate network pharmacies that meet the quality-based requirements for two levels of pharmacy professional services (level 1, intervention-based services; level 2, comprehensive medication review and assessment services). The pilot project is designed to measure the following outcomes: medication-use quality improvements, frequency and types of services provided, drug therapy problems, patient safety, cost savings, identification of factors that facilitate pharmacist participation, and patient satisfaction. The Pharmacy Society of Wisconsin created the WPQC network, which consists of 53 pharmacies, 106 trained pharmacists, 45 student pharmacists, 6 pharmacy technicians, and 2 initial payers. A quality assurance process is followed approximately quarterly to audit the 12 network quality requirements. An evaluation of this collaboration is being conducted. This program demonstrates that collaboration among payers and pharmacists is possible and can result in the development of an incentive-aligned program that stresses quality patient care, standardized services, and professional service compensation for pharmacists. This combination of a quality-based credentialing process with a professional services reimbursement schedule is unique and has the promise to enhance the ambulatory pharmacy practice model.

How Do Patients Perceive and Expect Quality of Surgery, Diagnostics, and Emergency Services in Tertiary Care Hospitals? An Evidence of Gap Analysis From Pakistan

PubMed Central

Fatima, Iram; Humayun, Ayesha; Anwar, Muhammad Imran; Iftikhar, Adil; Aslam, Muhammad; Shafiq, Muhammad

2017-01-01

Objectives Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients’ perspective. Methods A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality) instrument was administered to determine patient’s expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. Results Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant (p < 0.003; p < 0.037, respectively) as well as in perception of communication (p < 0.026). Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness (p < 0.005), but the perception of each dimension was significantly different in different educational categories (assurance: p < 0.001; empathy: p < 0.001; reliability: p < 0.001; tangibility: p < 0.001; responsiveness: p < 0.001; communication: p < 0.001; and for overall service quality: p < 0.001). Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals. Conclusions Tertiary care hospitals failed to meet patients’ expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy. PMID:28804582

Information sharing model in supporting implementation of e-procurement service: Case of Bandung city

NASA Astrophysics Data System (ADS)

Ramantoko, Gadang; Irawan, Herry

2017-10-01

This research examines the factors influencing the Information Sharing Model in Supporting Implementation of e-Procurement Services: Case of Bandung City in its early maturity stage. The early maturity of information sharing stage was determined using e-Government Maturity Stage Conceptual Framework from Estevez. Bandung City e-Procurement Information Sharing system was categorized at stage 1 in Estevez' model where the concern was mainly on assessing the benefit and risk of implementing the system. The Authors were using DeLone & McLean (D&M) Information System Success model to study benefit and risk of implementing the system in Bandung city. The model was then empirically tested by employing survey data that was collected from the available 40 listed supplier firms. D&M's model adjusted by Klischewski's description was introducing Information Quality, System Quality, and Service Quality as independent variable; Usability and User Satisfaction as intermediate dependent variable; and Perceived Net Benefit as final dependent variable. The findings suggested that, all of the predictors in D&M's model significantly influenced the net perceived benefit of implementing the e-Procurement system in the early maturity stage. The theoretical contribution of this research suggested that D&M's model might find useful in modeling complex information technology successfulness such as the one used in e-Procurement service. This research could also have implications for policy makers (LPSE) and system providers (LKPP) following the introduction of the service. However, the small number of respondent might be considered limitation of the study. The model needs to be further tested using larger number of respondents by involving the population of the firms in extended boundary/municipality area around Bandung.

Using Modified-ISS Model to Evaluate Medication Administration Safety During Bar Code Medication Administration Implementation in Taiwan Regional Teaching Hospital.

PubMed

Ma, Pei-Luen; Jheng, Yan-Wun; Jheng, Bi-Wei; Hou, I-Ching

2017-01-01

Bar code medication administration (BCMA) could reduce medical errors and promote patient safety. This research uses modified information systems success model (M-ISS model) to evaluate nurses' acceptance to BCMA. The result showed moderate correlation between medication administration safety (MAS) to system quality, information quality, service quality, user satisfaction, and limited satisfaction.

Evaluation of a Digital Library by Means of Quality Function Deployment (QFD) and the Kano Model

ERIC Educational Resources Information Center

Garibay, Cecilia; Gutierrez, Humberto; Figueroa, Arturo

2010-01-01

This paper proposes utilizing a combination of the Quality Function Deployment (QFD)-Kano model as a useful tool to evaluate service quality. The digital library of the University of Guadalajara (Mexico) is presented as a case study. Data to feed the QFD-Kano model was gathered by an online questionnaire that was made available to users on the…

Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model.

PubMed

Sandoval, Brian E; Bell, Jennifer; Khatri, Parinda; Robinson, Patricia J

2018-06-01

Primary care continues to be at the center of health care transformation. The Primary Care Behavioral Health (PCBH) model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. This article reviews the link between the PCBH model of service delivery and health care services quality improvement, and provides guidance for initiating PCBH model clinical pathways for patients facing depression, chronic pain, alcohol misuse, obesity, insomnia, and social barriers to health.

An Electronic Service Quality Reference Model for Designing E-Commerce Websites Which Maximizes Customer Satisfaction

ERIC Educational Resources Information Center

Shaheen, Amer N.

2011-01-01

This research investigated Electronic Service Quality (E-SQ) features that contribute to customer satisfaction in an online environment. The aim was to develop an approach which improves E-CRM processes and enhances online customer satisfaction. The research design adopted mixed methods involving qualitative and quantitative methods to…

Measuring Service Quality in a Nontraditional Institution Using Importance-Performance Gap Analysis

ERIC Educational Resources Information Center

Mugdh, Mrinal

2004-01-01

nd wants of these students, nontraditional colleges have adopted research strategies that take into account both student expectations as well as their perception of satisfaction to assess service quality at their institutions. As one of the model adult learner focused institutions, Empire State College used Noel-Levitz Adult Learner Inventory in…

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

PubMed Central

2012-01-01

Background No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. Methods The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. Results The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. Conclusions It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems. PMID:23171394

Assessing Satisfaction with Selected Student Services Using SERVQUAL, a Market-Driven Model of Service Quality.

ERIC Educational Resources Information Center

Ruby, Carl A.

1998-01-01

Demonstrates how the use of SERVQUAL, a market-driven assessment model adapted from business, can be used to study student satisfaction with four areas of support services hypothetically related to enrollment management. The sample included 748 students enrolled in general education courses at ten different private institutions. (Contains 27…

Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures

PubMed Central

Obure, Carol Dayo; Jacobs, Rowena; Guinness, Lorna; Mayhew, Susannah; Vassall, Anna

2016-01-01

Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings. This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach. The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency. The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality. PMID:26803655

Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures.

PubMed

Obure, Carol Dayo; Jacobs, Rowena; Guinness, Lorna; Mayhew, Susannah; Vassall, Anna

2016-02-01

Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings. This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach. The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency. The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

DataFed: A Federated Data System for Visualization and Analysis of Spatio-Temporal Air Quality Data

NASA Astrophysics Data System (ADS)

Husar, R. B.; Hoijarvi, K.

2017-12-01

DataFed is a distributed web-services-based computing environment for accessing, processing, and visualizing atmospheric data in support of air quality science and management. The flexible, adaptive environment facilitates the access and flow of atmospheric data from provider to users by enabling the creation of user-driven data processing/visualization applications. DataFed `wrapper' components, non-intrusively wrap heterogeneous, distributed datasets for access by standards-based GIS web services. The mediator components (also web services) map the heterogeneous data into a spatio-temporal data model. Chained web services provide homogeneous data views (e.g., geospatial, time views) using a global multi-dimensional data model. In addition to data access and rendering, the data processing component services can be programmed for filtering, aggregation, and fusion of multidimensional data. A complete application software is written in a custom made data flow language. Currently, the federated data pool consists of over 50 datasets originating from globally distributed data providers delivering surface-based air quality measurements, satellite observations, emissions data as well as regional and global-scale air quality models. The web browser-based user interface allows point and click navigation and browsing the XYZT multi-dimensional data space. The key applications of DataFed are for exploring spatial pattern of pollutants, seasonal, weekly, diurnal cycles and frequency distributions for exploratory air quality research. Since 2008, DataFed has been used to support EPA in the implementation of the Exceptional Event Rule. The data system is also used at universities in the US, Europe and Asia.

Service quality in healthcare institutions: establishing the gaps for policy action.

PubMed

Abuosi, Aaron A; Atinga, Roger A

2013-01-01

The authors seek to examine two key issues: to assess patients' hospital service quality perceptions and expectation using SERVQUAL; and to outline the distinct concepts used to assess patient perceptions. Questionnaires were administered to 250 patients on admission and follow-up visits. The 22 paired SERVQUAL expectation and perception items were adopted. Repeated t-measures and factor analysis with Varimax rotation were used to analyse data. Results showed that patient expectations were not being met during medical treatment. Perceived service quality was rated lower than expectations for all variables. The mean difference between perceptions and expectations was statistically significant. Contrary to the SERVQUAL five-factor model, four service-quality factors were identified in the study. Findings have practical implications for hospital managers who should consider stepping up staffing levels backed by client-centred training programmes to help clinicians deliver care to patients' expectations. Limited studies are tailored towards patients' service-quality perception and expectation in Ghanaian hospitals. The findings therefore provide valuable information for policy and practice.

An examination of the role of perceived support and employee commitment in employee-customer encounters.

PubMed

Vandenberghe, Christian; Bentein, Kathleen; Michon, Richard; Chebat, Jean-Charles; Tremblay, Michel; Fils, Jean-François

2007-07-01

The authors examined the relationships between perceived organizational support, organizational commitment, commitment to customers, and service quality in a fast-food firm. The research design matched customer responses with individual employees' attitudes, making this study a true test of the service provider-customer encounter. On the basis of a sample of matched employee-customer data (N = 133), hierarchical linear modeling analyses revealed that perceived organizational support had both a unit-level and an employee-level effect on 1 dimension of service quality: helping behavior. Contrary to affective organizational commitment, affective commitment to customers enhanced service quality. The 2 sub-dimensions of continuance commitment to the organization--perceived high sacrifice and perceived lack of alternatives--exerted effects opposite in sign: The former fostered service quality, whereas the latter reduced it. The implications of these findings are discussed within the context of research on employee-customer encounters.

Pre-Service Physics Teachers' Argumentation in a Model Rocketry Physics Experience

ERIC Educational Resources Information Center

Gürel, Cem; Süzük, Erol

2017-01-01

This study investigates the quality of argumentation developed by a group of pre-service physics teachers' (PSPT) as an indicator of subject matter knowledge on model rocketry physics. The structure of arguments and scientific credibility model was used as a design framework in the study. The inquiry of model rocketry physics was employed in…

Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

Real-time GIS data model and sensor web service platform for environmental data management.

PubMed

Gong, Jianya; Geng, Jing; Chen, Zeqiang

2015-01-09

Effective environmental data management is meaningful for human health. In the past, environmental data management involved developing a specific environmental data management system, but this method often lacks real-time data retrieving and sharing/interoperating capability. With the development of information technology, a Geospatial Service Web method is proposed that can be employed for environmental data management. The purpose of this study is to determine a method to realize environmental data management under the Geospatial Service Web framework. A real-time GIS (Geographic Information System) data model and a Sensor Web service platform to realize environmental data management under the Geospatial Service Web framework are proposed in this study. The real-time GIS data model manages real-time data. The Sensor Web service platform is applied to support the realization of the real-time GIS data model based on the Sensor Web technologies. To support the realization of the proposed real-time GIS data model, a Sensor Web service platform is implemented. Real-time environmental data, such as meteorological data, air quality data, soil moisture data, soil temperature data, and landslide data, are managed in the Sensor Web service platform. In addition, two use cases of real-time air quality monitoring and real-time soil moisture monitoring based on the real-time GIS data model in the Sensor Web service platform are realized and demonstrated. The total time efficiency of the two experiments is 3.7 s and 9.2 s. The experimental results show that the method integrating real-time GIS data model and Sensor Web Service Platform is an effective way to manage environmental data under the Geospatial Service Web framework.

Service quality benchmarking via a novel approach based on fuzzy ELECTRE III and IPA: an empirical case involving the Italian public healthcare context.

PubMed

La Fata, Concetta Manuela; Lupo, Toni; Piazza, Tommaso

2017-11-21

A novel fuzzy-based approach which combines ELECTRE III along with the Importance-Performance Analysis (IPA) is proposed in the present work to comparatively evaluate the service quality in the public healthcare context. Specifically, ELECTRE III is firstly considered to compare the service performance of examined hospitals in a noncompensatory manner. Afterwards, IPA is employed to support the service quality management to point out improvement needs and their priorities. The proposed approach also incorporates features of the Fuzzy Set Theory so as to address the possible uncertainty, subjectivity and vagueness of involved experts in evaluating the service quality. The model is applied to five major Sicilian public hospitals, and strengths and criticalities of the delivered service are finally highlighted and discussed. Although several approaches combining multi-criteria methods have already been proposed in the literature to evaluate the service performance in the healthcare field, to the best of the authors' knowledge the present work represents the first attempt at comparing service performance of alternatives in a noncompensatory manner in the investigated context.

Patient satisfaction in Japan.

PubMed

Elleuch, Amira

2008-01-01

To extend existing knowledge about health care quality and patient satisfaction by exploring Japanese context having a different health care system and a different culture from the USA and Europe. A structural equation model is used to explore links between quality perception and patient satisfaction as well as between patient satisfaction and intentional behavior relying on 159 Japanese outpatient replies. Japanese healthcare service quality is evaluated using its process characteristics (patient-provider interaction) and physical attributes (settings and appearance). Process quality attributes were found to be patient satisfaction antecedents. Satisfaction in turn predicts patient intentional behavior (to return and to recommend). Japanese society cultural specificity seems to be an interesting background to understand Japanese evaluation when patients assess health service quality. The sample investigated is relatively small. The study relied on a linear approach to assess patient satisfaction and intentional behavior. However, the non-linear model should yield a better reality fit. To improve Japanese patient satisfaction, cultural values such as courtesy, empathy and harmony should be emphasized when delivering medical services. Satisfied consumers are an important asset for the healthcare provider as they intend to reuse the service and to recommend it to their families and friends. Both foreign and Japanese providers should adopt a consumer perspective to enhance the service quality and then to maintain long-term relationships with their customers. The study used structural equation analysis to assess patient satisfaction in a scarcely investigated context. Moreover, the study relies on Japanese society's cultural characteristics to explain and understand results.

Identifying positive deviants in healthcare quality and safety: a mixed methods study.

PubMed

O'Hara, Jane K; Grasic, Katja; Gutacker, Nils; Street, Andrew; Foy, Robbie; Thompson, Carl; Wright, John; Lawton, Rebecca

2018-01-01

Objective Solutions to quality and safety problems exist within healthcare organisations, but to maximise the learning from these positive deviants, we first need to identify them. This study explores using routinely collected, publicly available data in England to identify positively deviant services in one region of the country. Design A mixed methods study undertaken July 2014 to February 2015, employing expert discussion, consensus and statistical modelling to identify indicators of quality and safety, establish a set of criteria to inform decisions about which indicators were robust and useful measures, and whether these could be used to identify positive deviants. Setting Yorkshire and Humber, England. Participants None - analysis based on routinely collected, administrative English hospital data. Main outcome measures We identified 49 indicators of quality and safety from acute care settings across eight data sources. Twenty-six indicators did not allow comparison of quality at the sub-hospital level. Of the 23 remaining indicators, 12 met all criteria and were possible candidates for identifying positive deviants. Results Four indicators (readmission and patient reported outcomes for hip and knee surgery) offered indicators of the same service. These were selected by an expert group as the basis for statistical modelling, which supported identification of one service in Yorkshire and Humber showing a 50% positive deviation from the national average. Conclusion Relatively few indicators of quality and safety relate to a service level, making meaningful comparisons and local improvement based on the measures difficult. It was possible, however, to identify a set of indicators that provided robust measurement of the quality and safety of services providing hip and knee surgery.

Citizens' role in health services: satisfaction behavior: Kano's model, Part 1.

PubMed

Corbella Jané, Antoni; Maturana Domínguez, Salvador

2003-01-01

When it comes to consumer satisfaction, there is a lack of consensus over the importance of the role of consumers in connection with the quality of services. Widely different points of view exist, ranging from a defense of consumer satisfaction as the ultimate measure of service quality, to its treatment as a commercial issue or as one that merely has to do with image. This first article (part 1 of 2, also in this issue) describes and illustrates Kano's explicative model of how consumer satisfaction behaves and briefly analyzes the main characteristics, advantages, and limitations of the different methods used to assess consumer satisfaction.

Development Design Model of Academic Quality Assurance at Private Islamic University Jakarta Indonesia

ERIC Educational Resources Information Center

Suprihatin, Krebet; Bin Mohamad Yusof, Hj. Abdul Raheem

2015-01-01

This study aims to evaluate the practice of academic quality assurance in design model based on seven aspects of quality are: curriculum design, teaching and learning, student assessment, student selection, support services, learning resources, and continuous improvement. The design study was conducted in two stages. The first stage is to obtain…

Household's willingness to pay for heterogeneous attributes of drinking water quality and services improvement: an application of choice experiment

NASA Astrophysics Data System (ADS)

Dauda, Suleiman Alhaji; Yacob, Mohd Rusli; Radam, Alias

2015-09-01

The service of providing good quality of drinking water can greatly improve the lives of the community and maintain a normal health standard. For a large number of population in the world, specifically in the developing countries, the availability of safe water for daily sustenance is none. Damaturu is the capital of Yobe State, Nigeria. It hosts a population of more than two hundred thousand, yet only 45 % of the households are connected to the network of Yobe State Water Corporation's pipe borne water services; this has led people to source for water from any available source and thus, exposed them to the danger of contracting waterborne diseases. In order to address the problem, Yobe State Government has embarked on the construction of a water treatment plant with a capacity and facility to improve the water quality and connect the town with water services network. The objectives of this study are to assess the households' demand preferences of the heterogeneous water attributes in Damaturu, and to estimate their marginal willingness to pay, using mixed logit model in comparison with conditional logit model. A survey of 300 households randomly sampled indicated that higher education greatly influenced the households' WTP decisions. The most significant variable from both of the models is TWQ, which is MRS that rates the water quality from the level of satisfactory to very good. 219 % in simple model is CLM, while 126 % is for the interaction model. As for MLM, 685 % is for the simple model and 572 % is for the interaction model. Estimate of MLM has more explanatory powers than CLM. Essentially, this finding can help the government in designing cost-effective management and efficient tariff structure.

The role of hydrological and water quality models in the application of the ecosystem services framework for the EU Water Framework Directive

NASA Astrophysics Data System (ADS)

Hallouin, Thibault; Bruen, Michael; Feeley, Hugh B.; Christie, Michael; Bullock, Craig; Kelly, Fiona; Kelly-Quinn, Mary

2017-04-01

The hydrological cycle is intimately linked with environmental processes that are essential for human welfare in many regards including, among others, the provision of safe water from surface and subsurface waterbodies, rain-fed agricultural production, or the provision of aquatic-sourced food. As well as being a receiver of these natural benefits, the human population is also a manager of the water and other natural resources and, as such, can affect their future sustainable provision. With global population growth and climate change, both the dependence of the human population on water resources and the threat they pose to these resources are likely to intensify so that the sustainability of the coupled natural and human system is threatened. In the European Union, the Water Framework Directive is driving policy and encouraging member states to manage their water resources wisely in order to maintain or restore ecological quality. To this end, the ecosystem services framework can be a useful tool to link the requirements in terms of ecological status into more tangible descriptors, that is the ecosystem services. In the ESManage Project, existing environmental system models such as hydrological models and water quality models are used as the basis to quantify the provision of many hydrological and aquatic ecosystem services by constructing indicators for the ecosystem services from the modelled environmental variables. By allowing different management options and policies to be compared, these models can be a valuable source of information for policy makers when they are used for climate and land use scenario analyses. Not all hydrological models developed for flood forecasting are suitable for this application and inappropriate models can lead to questionable conclusions. This paper demonstrates the readily available capabilities of a specially developed catchment hydrological model coupled with a water quality model to quantify a wide range of biophysically quantifiable water-related ecosystem services such as water provision (river flows, groundwater recharge and vegetation transpiration), flood regulation or nutrient and sediment retention. This combination of models will be used to carry out scenario analyses on IPCC climate change scenarios as well as various land use scenarios. Results will be presented for a test catchment in the Republic of Ireland.

Economic models for prevention: making a system work for patients

PubMed Central

2015-01-01

The purpose of this article is to describe alternative means of providing patient centered, preventive based, services using an alternative non-profit, economic model. Hard to reach, vulnerable groups, including children, adults and elders, often have difficulties accessing traditional dental services for a number of reasons, including economic barriers. By partnering with community organizations that serve these groups, collaborative services and new opportunities for access are provided. The concept of a dental home is well accepted as a means of providing care, and, for these groups, provision of such services within community settings provides a sustainable means of delivery. Dental homes provided through community partnerships can deliver evidence based dental care, focused on a preventive model to achieve and maintain oral health. By using a non-profit model, the entire dental team is provided with incentives to deliver measurable quality improvements in care, rather than a more traditional focus on volume of activity alone. Examples are provided that demonstrate how integrated oral health services can deliver improved health outcomes with the potential to reduce total costs while improving quality. PMID:26391814

Designing and implementing a trust-wide quality assurance programme.

PubMed

Coope, Sally-Ann

2018-04-02

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

Measurement of Productivity and Quality in Non-Marketable Services: With Application to Schools

ERIC Educational Resources Information Center

Fare, R.; Grosskopf, S.; Forsund, F. R.; Hayes, K.; Heshmati, A.

2006-01-01

Purpose: This paper seeks to model and compute productivity, including a measure of quality, of a service which does not have marketable outputs--namely public education at the micro level. This application is a case study for Sweden public schools. Design/methodology/approach: A Malmquist productivity index is employed which allows for multiple…

Perceptions of Services and Resources as Mediators of Depression among Parents of Children with Developmental Disabilities.

ERIC Educational Resources Information Center

Herman, Sandra E.; Marcenko, Maureen O.

1997-01-01

This study examined effects of resource perceptions and respite use in a theoretical model of adaptation with 72 parents of children with developmental disabilities. Amount and quality of respite services indirectly affected parental depression. Both quality and respite use were related to helpfulness of the parent's social network. The strongest…

Structure of Perceptions of Service Quality in Libraries: A LibQUAL+ Study.

ERIC Educational Resources Information Center

Thompson, Bruce; Cook, Colleen; Heath, Fred

2003-01-01

Used confirmatory factor analysis to evaluate the score integrity of LibQUALl+, an instrument to measure perceptions of library service quality. Results for 60,027 graduate and undergraduate students suggest that the model implied by LibQUAL is reasonable and invariant across independent samples and fits all three major subgroups of library users.…

Quality management in home care: models for today's practice.

PubMed

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.

An optimization modeling approach to awarding large fire support wildfire helicopter contracts from the US Forest Service

Treesearch

Stephanie A. Snyder; Keith D. Stockmann; Gaylord E. Morris

2012-01-01

The US Forest Service used contracted helicopter services as part of its wildfire suppression strategy. An optimization decision-modeling system was developed to assist in the contract selection process. Three contract award selection criteria were considered: cost per pound of delivered water, total contract cost, and quality ratings of the aircraft and vendors....

Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

PubMed

Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

2015-03-01

Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

Determinants of user satisfaction with a Clinical Information System.

PubMed

Palm, Jean-Marc; Colombet, Isabelle; Sicotte, Claude; Degoulet, Patrice

2006-01-01

Clinical Information Systems (CIS) implementation has faced user resistance. Consequently, we aimed to assess the acceptability of an integrated CIS. We designed an electronic survey instrument from two theoretical models (Delone and McLean, and Technology Acceptance Model). Dimensions hypothesized to be determinant of user satisfaction were: user characteristics, CIS use, quality, usefulness, and service quality. The questionnaire was administered to physicians, nurses and medical secretaries of the Georges Pompidou university Hospital (HEGP) in Paris. Answers were obtained from 324 users (93 physicians, 174 nurses, and 57 secretaries). Cronbach's alpha coefficients showed a correct reliability within each dimension. Secretaries and nurses were more satisfied with the CIS than physicians. Except for CIS use, after adjustment for confounders, female gender, perceived CIS quality, usefulness, and service quality were strongly correlated with user satisfaction. This study reinforces the necessity of several models and dimensions to evaluate the acceptability of a complex CIS, with a specific approach for different user profiles.

A Diffusion Model for Two-sided Service Systems

NASA Astrophysics Data System (ADS)

Homma, Koichi; Yano, Koujin; Funabashi, Motohisa

A diffusion model is proposed for two-sided service systems. ‘Two-sided’ refers to the existence of an economic network effect between two different and interrelated groups, e.g., card holders and merchants in an electronic money service. The service benefit for a member of one side depends on the number and quality of the members on the other side. A mathematical model by J. H. Rohlfs explains the network (or bandwagon) effect of communications services. In Rohlfs' model, only the users' group exists and the model is one-sided. This paper extends Rohlfs' model to a two-sided model. We propose, first, a micro model that explains individual behavior in regard to service subscription of both sides and a computational method that drives the proposed model. Second, we develop macro models with two diffusion-rate variables by simplifying the micro model. As a case study, we apply the models to an electronic money service and discuss the simulation results and actual statistics.

Reexamining competitive priorities: Empirical study in service sector

NASA Astrophysics Data System (ADS)

Idris, Fazli; Mohammad, Jihad

2015-02-01

The general objective of this study is to validate the multi-level concept of competitive priorities using reflective-formative model at a higher order for service industries. An empirical study of 228 firms from 9 different service industries is conducted to answer the objective of this study. Partial least square analysis with SmartPLS 2.0 was used to perform the analysis. Finding revealed six priorities: cost, flexibility, delivery, quality talent management, quality tangibility, and innovativeness. It emerges that quality are expanded into two types; one is related to managing talent for process improvement and the second one is the physical appearance and tangibility of the service quality. This study has confirmed competitive priorities as formative second-order hierarchical latent construct by using rigorous empirical evidence. Implications, limitation and suggestion for future research are accordingly discussed in this paper.

The adoption of Firm-Hosted Online Communities: an empirical investigation into the role of service quality and social interactions

NASA Astrophysics Data System (ADS)

Corkindale, David; Ram, Jiwat; Chen, Howard

2018-02-01

Online communities are a powerful device for collaborative creativity and innovation. Developments in Web 2.0 technologies have given rise to such interactions through firm-hosted online communities (FHOCs) - firm-run online information services that also provide self-help to a community. We devise a model that seeks to explain the factors that encourage people to become members of a FHOC and test the model using structural equation modelling based on data collected from 511 users of a FHOC. The study finds that: (a) an understanding of Perceived Usefulness (PU) plays a mediating role between Behavioural Intention (BI) to adopt FHOC and Trust, as well as Interface design; b) Networking among users has an indirect effect on BI; and c) design of the Interface has a direct influence on BI. A managerial implication is that Networking plays a role in the way supplementary services, including blogs and discussion forums, are perceived. Theoretically, when service quality is decomposed into components such as core services and supplementary services, it also positively influences PU.

Clinical governance is "ACE"--using the EFQM excellence model to support baseline assessment.

PubMed

Holland, K; Fennell, S

2000-01-01

The introduction of clinical governance in the "new NHS" means that National Health Service (NHS) organisations are now accountable for the quality of the services they provide to their local communities. As part of the implementation of clinical governance in the NHS, Trusts and health authorities had to complete a baseline assessment of their capability and capacity by September 1999. Describes one Trust's approach to developing and implementing its baseline assessment tool, based upon its existing use of the European Foundation for Quality Management (EFQM) Excellence Model. An initial review of the process suggests that the model provides an adaptable framework for the development of a comprehensive and practical assessment tool and that self-assessment ensures ownership of action plans at service level.

Measuring the performance of maintenance service outsourcing.

PubMed

Cruz, Antonio Miguel; Rincon, Adriana Maria Rios; Haugan, Gregory L

2013-01-01

The aims of this paper are (1) to identify the characteristics of maintenance service providers that directly impact maintenance service quality, using 18 independent covariables; (2) to quantify the change in risk these covariables present to service quality, measured in terms of equipment turnaround time (TAT). A survey was applied to every maintenance service provider (n = 19) for characterization purposes. The equipment inventory was characterized, and the TAT variable recorded and monitored for every work order of each service provider (N = 1,025). Finally, the research team conducted a statistical analysis to accomplish the research objectives. The results of this study offer strong empirical evidence that the most influential variables affecting the quality of maintenance service performance are the following: type of maintenance, availability of spare parts in the country, user training, technological complexity of the equipment, distance between the company and the hospital, and the number of maintenance visits performed by the company. The strength of the results obtained by the Cox model built are supported by the measure of the Rp,e(2) = 0.57 with a value of Rp,e= 0.75. Thus, the model explained 57% of the variation in equipment TAT, with moderate high positive correlation between the dependent variable (TAT) and independent variables.

A Service Delivery Model for Children with DCD Based on Principles of Best Practice.

PubMed

Camden, Chantal; Léger, France; Morel, Julie; Missiuna, Cheryl

2015-01-01

In this perspective article, we propose the Apollo model as an example of an innovative interdisciplinary, community-based service delivery model for children with Developmental Coordination Disorder (DCD) characterized by the use of graduated levels of intensity and evidence-based interventions that focus on function and participation. We describe the context that led to the creation of the Apollo model, describe the approach to service delivery and the services offered. The Apollo model has 5 components: first contact, service delivery coordination, community-, group-, and individual-interventions. This model guided the development of a streamlined set of services offered to children with DCD, including early-intake to share educational information with families, community interventions, inter-disciplinary and occupational therapy groups, and individual interventions. Following implementation of the Apollo model, wait-times decreased and the number of children receiving services increased, without compromising service quality. Lessons learned are shared to facilitate development of other practice models to support children with DCD.

Health care competition, strategic mission, and patient satisfaction: research model and propositions.

PubMed

Rivers, Patrick A; Glover, Saundra H

2008-01-01

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry. A literature review was conducted. A total of 50 items of literature related to the subject were reviewed. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. Empirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment. The authors develop a research model which included propositions to examine the complex issues of competition in the health care industry.

GPCRM: a homology modeling web service with triple membrane-fitted quality assessment of GPCR models.

PubMed

Miszta, Przemyslaw; Pasznik, Pawel; Jakowiecki, Jakub; Sztyler, Agnieszka; Latek, Dorota; Filipek, Slawomir

2018-05-21

Due to the involvement of G protein-coupled receptors (GPCRs) in most of the physiological and pathological processes in humans they have been attracting a lot of attention from pharmaceutical industry as well as from scientific community. Therefore, the need for new, high quality structures of GPCRs is enormous. The updated homology modeling service GPCRM (http://gpcrm.biomodellab.eu/) meets those expectations by greatly reducing the execution time of submissions (from days to hours/minutes) with nearly the same average quality of obtained models. Additionally, due to three different scoring functions (Rosetta, Rosetta-MP, BCL::Score) it is possible to select accurate models for the required purposes: the structure of the binding site, the transmembrane domain or the overall shape of the receptor. Currently, no other web service for GPCR modeling provides this possibility. GPCRM is continually upgraded in a semi-automatic way and the number of template structures has increased from 20 in 2013 to over 90 including structures the same receptor with different ligands which can influence the structure not only in the on/off manner. Two types of protein viewers can be used for visual inspection of obtained models. The extended sortable tables with available templates provide links to external databases and display ligand-receptor interactions in visual form.

The relationship between advertising, price, and nursing home quality.

PubMed

Kash, Bita A; Miller, Thomas R

2009-01-01

Theoretically, nursing homes should engage in advertising for the following two reasons: (a) to improve awareness of the services offered in a particular market and (b) to signal high-quality services. In this study, we build upon results from prior studies of nursing home advertising activity, market competition, and quality. The purpose of this study was to examine the association between advertising expenses, price, and quality. We focused on answering the question: Do nursing homes use advertising and price to signal superior quality? The Texas Nursing Facilities Medicaid Cost Report, the Texas Quality Reporting System, and the Area Resource File were merged for the year 2003. We used three alternative measures of quality to improve the robustness of this exploratory analysis. Quality measures were examined using Bonferroni correlation coefficient analysis. Associations between advertising expenses and quality were evaluated using three regression models predicting quality. We also examined the association of the price of a private bed per day with quality. Advertising expenses were not associated with better nursing home quality as measured by three quality scales. The average price customers pay for one private bed per day was associated with better quality only in one of the three quality regression models. The price of nursing home care might be a better indicator of quality and necessary to increase as quality of care is improved in the nursing homes sector. Because more advertising expenditures are not necessarily associated with better quality, consumers could be mislead by advertisements and choose poor quality nursing homes. Nursing home administrators should focus on customer relationship management tools instead of expensive advertising. Relationship management tools are proven marketing techniques for the health services sector, usually less expensive than advertising, and help with staff retention and quality outcomes.

An Evaluation of Service Quality in Higher Education: Marmara and Nigde Omer Halisdemir Universities' Department of Education Students

ERIC Educational Resources Information Center

Ada, Sefer; Baysal, Z. Nurdan; Erkan, Senem Seda Sahenk

2017-01-01

The purpose of this research is to evaluate the quality service in higher education in Marmara and Nigde Omer Halisdemir Universities' department of education students. This study was prepared using a screening model from quantitative research methods. The sample of this research comprised 886 university students attending the higher education…

Antecedents and Consequences of Service Quality in a Higher Education Context: A Qualitative Research Approach

ERIC Educational Resources Information Center

Sultan, Parves; Wong, Ho Yin

2013-01-01

Purpose: The purpose of the paper is to report on the perception of students in regard to critical antecedents, dimensions and consequences of service quality with an aim to develop a theoretical model in the context of a university in Australia. Design/methodology/approach: This research used focus group discussions with 19 students who had been…

The impact of complaint management and service quality on organizational image: A case study at the Malaysian public university library

NASA Astrophysics Data System (ADS)

Tan, Pei Kian; Mohd Suradi, Nur Riza; Saludin, Mohamad Nasir

2013-04-01

Service failure frequently occurs. This affects customer expectations which lead to complaint. However, not all dissatisfied customers actually complain. Without customer feedback, it would be impossible for a company to know whether they needed a change for improvement. Thus, complaint management brings a learning experience to organization in order to provide better service. Therefore, it is important to identify customer dissatisfaction through a systematic complaint handling or management. The study proposes a model of systematic complaint management which applied to academic library as a tool of service recovery. As such, the main purpose of this study is to investigate the critical success factors of complaint management towards service quality, customer satisfaction, customer loyalty and the impact to organizational image at academic library. Three academic libraries have been identified and selected for this project, the Library of Tun Sri Lanang, UKM, UTeM and UNIMAS. Using the justice theory, this study investigates the perception of customers on complaint management in terms of outcomes they receive, procedures used by organization and interpersonal treatment. In this study, there are five factors of complaint management identified, which includes speed of recovery, management system, empowerment, culture and psychology and tangible compensation. A questionnaire was designed and used as the data gathering instrument. A total of 600 respondents participated in this study. Ten hypotheses were used to test the relationships between complaint management, service quality, customer satisfaction, customer loyalty and organizational image. To measure the construct relationships, Structural Equation Model (SEM) approach was used. The results show that management system (b = 0.210; p < 0.05) exerts the highest positive impact on service quality. It followed by psychology and culture (b = 0.188; p < 0.05), empowerment (b = 0.179; p < 0.05) and tangible compensation (b = 0.175; p < 0.05). However, the empirical results suggest that speed of recovery (b = -0.009; p > 0.05) do not influence service quality. The second part of this study uses confirmatory factor analysis (CFA) to analyze and confirm the conceptual model proposed in this research. The result shows that all the values obtained in this study fits the data reasonably well.

Agent-Based Framework for Personalized Service Provisioning in Converged IP Networks

NASA Astrophysics Data System (ADS)

Podobnik, Vedran; Matijasevic, Maja; Lovrek, Ignac; Skorin-Kapov, Lea; Desic, Sasa

In a global multi-service and multi-provider market, the Internet Service Providers will increasingly need to differentiate in the service quality they offer and base their operation on new, consumer-centric business models. In this paper, we propose an agent-based framework for the Business-to-Consumer (B2C) electronic market, comprising the Consumer Agents, Broker Agents and Content Agents, which enable Internet consumers to select a content provider in an automated manner. We also discuss how to dynamically allocate network resources to provide end-to-end Quality of Service (QoS) for a given consumer and content provider.

Ecosystem Services Modeling as a Tool for Defining Priority Areas for Conservation.

PubMed

Duarte, Gabriela Teixeira; Ribeiro, Milton Cezar; Paglia, Adriano Pereira

2016-01-01

Conservationists often have difficulty obtaining financial and social support for protected areas that do not demonstrate their benefits for society. Therefore, ecosystem services have gained importance in conservation science in the last decade, as these services provide further justification for appropriate management and conservation of natural systems. We used InVEST software and a set of GIS procedures to quantify, spatialize and evaluated the overlap between ecosystem services-carbon stock and sediment retention-and a biodiversity proxy-habitat quality. In addition, we proposed a method that serves as an initial approach of a priority areas selection process. The method considers the synergism between ecosystem services and biodiversity conservation. Our study region is the Iron Quadrangle, an important Brazilian mining province and a conservation priority area located in the interface of two biodiversity hotspots, the Cerrado and Atlantic Forest biomes. The resultant priority area for the maintenance of the highest values of ecosystem services and habitat quality was about 13% of the study area. Among those priority areas, 30% are already within established strictly protected areas, and 12% are in sustainable use protected areas. Following the transparent and highly replicable method we proposed in this study, conservation planners can better determine which areas fulfill multiple goals and can locate the trade-offs in the landscape. We also gave a step towards the improvement of the habitat quality model with a topography parameter. In areas of very rugged topography, we have to consider geomorfometric barriers for anthropogenic impacts and for species movement and we must think beyond the linear distances. Moreover, we used a model that considers the tree mortality caused by edge effects in the estimation of carbon stock. We found low spatial congruence among the modeled services, mostly because of the pattern of sediment retention distribution.

The Role of Psychological Capital and Intragroup Conflict on Employees' Burnout and Quality of Service: A Multilevel Approach

PubMed Central

Leon-Perez, Jose M.; Antino, Mirko; Leon-Rubio, Jose M.

2016-01-01

Previous studies have found a negative association between intragroup conflict and both employees' health and performance, including the quality of service that employees provide. However, some authors have indicated that such negative effects of intragroup conflict depend on how conflict is managed. In addition, at individual level, research is increasingly emphasizing the role of psychological strengths (i.e., psychological capital) as predictors of health and performance. Thus, this research addresses both a main effect at individual level (psychological capital on burnout/quality of service) and a moderated cross-level model (2-2-1: intragroup conflict, conflict management climate and burnout/quality of service) in a cross-sectional survey study (N = 798 workers nested in 55 units/facilities). Results revealed a main effect of psychological capital on both burnout (r = −0.50) and quality of service (r = 0.28). Also, there was an association between intragroup relationship conflict and burnout (r = 0.33). Finally, there was an interaction effect in which conflict management climate buffers the negative association between intragroup conflict and quality of service. Practical implications of these results for developing positive and healthy organizations that prevent potential psychosocial risks at group level while promote individual strengths are discussed. PMID:27895601

The Role of Psychological Capital and Intragroup Conflict on Employees' Burnout and Quality of Service: A Multilevel Approach.

PubMed

Leon-Perez, Jose M; Antino, Mirko; Leon-Rubio, Jose M

2016-01-01

Previous studies have found a negative association between intragroup conflict and both employees' health and performance, including the quality of service that employees provide. However, some authors have indicated that such negative effects of intragroup conflict depend on how conflict is managed. In addition, at individual level, research is increasingly emphasizing the role of psychological strengths (i.e., psychological capital) as predictors of health and performance. Thus, this research addresses both a main effect at individual level (psychological capital on burnout/quality of service) and a moderated cross-level model (2-2-1: intragroup conflict, conflict management climate and burnout/quality of service) in a cross-sectional survey study ( N = 798 workers nested in 55 units/facilities). Results revealed a main effect of psychological capital on both burnout ( r = -0.50) and quality of service ( r = 0.28). Also, there was an association between intragroup relationship conflict and burnout ( r = 0.33). Finally, there was an interaction effect in which conflict management climate buffers the negative association between intragroup conflict and quality of service. Practical implications of these results for developing positive and healthy organizations that prevent potential psychosocial risks at group level while promote individual strengths are discussed.

A research model of health-care competition and customer satisfaction.

PubMed

Asoh, Derek A; Rivers, Patrick A

2007-11-01

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.

Using SERVQUAL and Kano research techniques in a patient service quality survey.

PubMed

Christoglou, Konstantinos; Vassiliadis, Chris; Sigalas, Ioakim

2006-01-01

This article presents the results of a service quality study. After an introduction to the SERVQUAL and the Kano research techniques, a Kano analysis of 75 patients from the General Hospital of Katerini in Greece is presented. The service quality criterion used satisfaction and dissatisfaction indices. The Kano statistical analysis process results strengthened the hypothesis of previous research regarding the importance of personal knowledge, the courtesy of the hospital employees and their ability to convey trust and confidence (assurance dimension). Managerial suggestions are made regarding the best way of acting and approaching hospital patients based on the basic SERVQUAL model.

Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service.

PubMed

Gaynor, Martin; Propper, Carol; Seiler, Stephan

2016-11-01

Choice in public services is controversial. We exploit a reform in the English National Health Service to assess the effect of removing constraints on patient choice. We estimate a demand model that explicitly captures the removal of the choice constraints imposed on patients. We find that, post-removal, patients became more responsive to clinical quality. This led to a modest reduction in mortality and a substantial increase in patient welfare. The elasticity of demand faced by hospitals increased substantially post- reform and we find evidence that hospitals responded to the enhanced incentives by improving quality. This suggests greater choice can raise quality.

42 CFR 82.2 - What are the basics of dose reconstruction?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 82.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OCCUPATIONAL... conditions and the type, quality, and completeness of data available to characterize the environment. (a) If... information to analytically develop an exposure model. For internal exposures, this model includes such...

An Integrated Ecological Modeling System for Assessing Impacts of Multiple Stressors on Stream and Riverine Ecosystem Services Within River Basins

EPA Science Inventory

We demonstrate a novel, spatially explicit assessment of the current condition of aquatic ecosystem services, with limited sensitivity analysis for the atmospheric contaminant mercury. The Integrated Ecological Modeling System (IEMS) forecasts water quality and quantity, habitat ...

Service Quality Assessment of Hospitals in Asian Context: An Empirical Evidence From Pakistan

PubMed Central

Shafiq, Muhammad; Naeem, Muhammad Azhar; Munawar, Zartasha; Fatima, Iram

2017-01-01

Hospitals vary from one another in terms of their specialty, services offered, and resource availability. Their services are widely measured with scales that gauge patients’ perspective. Therefore, there is a need for research to develop a scale that measures hospital service quality in Asian hospitals, regardless of their nature or ownership. To address this research need, this study adapted the SERVQUAL instrument to develop a service quality measurement scale. Data were collected from inpatients and outpatients at 9 different hospitals, and the scale was developed using structural equation modeling. The developed scale was then validated by identifying service quality gaps and ranking the areas that require managerial effort. The findings indicated that all 5 dimensions of SERVQUAL are valid in Asian countries such as Pakistan, with 13 items retained. Reliability, tangibility, responsiveness, empathy, and assurance were ranked first, second, third, fourth, and fifth, respectively, in terms of the size of the quality gap. The gaps were statistically significant, with values ≤.05; therefore, hospital administrators must focus on each of these areas. By focusing on the identified areas of improvement, health care authorities, managers, practitioners, and decision makers can bring substantial change within hospitals. PMID:28660771

Service Quality Assessment of Hospitals in Asian Context: An Empirical Evidence From Pakistan.

PubMed

Shafiq, Muhammad; Naeem, Muhammad Azhar; Munawar, Zartasha; Fatima, Iram

2017-01-01

Hospitals vary from one another in terms of their specialty, services offered, and resource availability. Their services are widely measured with scales that gauge patients' perspective. Therefore, there is a need for research to develop a scale that measures hospital service quality in Asian hospitals, regardless of their nature or ownership. To address this research need, this study adapted the SERVQUAL instrument to develop a service quality measurement scale. Data were collected from inpatients and outpatients at 9 different hospitals, and the scale was developed using structural equation modeling. The developed scale was then validated by identifying service quality gaps and ranking the areas that require managerial effort. The findings indicated that all 5 dimensions of SERVQUAL are valid in Asian countries such as Pakistan, with 13 items retained. Reliability, tangibility, responsiveness, empathy, and assurance were ranked first, second, third, fourth, and fifth, respectively, in terms of the size of the quality gap. The gaps were statistically significant, with values ≤.05; therefore, hospital administrators must focus on each of these areas. By focusing on the identified areas of improvement, health care authorities, managers, practitioners, and decision makers can bring substantial change within hospitals.

A model for consolidation of clinical microbiology laboratory services within a multihospital health-care system.

PubMed

Carter, Elliot; Stubbs, James R; Bennett, Betsy

2004-01-01

To determine the cost-effectiveness of consolidating clinical microbiology services in a three-hospital health-care network while maintaining high-quality laboratory services, a retrospective review of the total costs of maintaining separate clinical microbiology laboratories within our health-care system was compared to the cost of providing these services after consolidation. Turnaround times before and after consolidation were compared to assess efficiency of the consolidated services. Input of clinicians was also solicited to ensure that quality of services and customer satisfaction remained high. The results of the consolidation project show that the net fiscal saving because of consolidation of clinical microbiology services within our health-care system will be approximately 100,000 dollars per fiscal year. This value includes increased courier charges as well as personnel savings. Although fiscal savings are an integral part of any laboratory consolidation plan, the financial considerations must be balanced by quality of service. The response to consolidation from clinicians was decidedly mixed before implementation of the plan because of fear of increased turnaround times and limited access to laboratory information. The consolidation process, however, was smooth with few physician complaints. The consolidation of our clinical microbiology services illustrates that significant financial savings can be achieved without compromise of efficiency or quality of service.

From data to wisdom: quality improvement strategies supporting large-scale implementation of evidence-based services.

PubMed

Daleiden, Eric L; Chorpita, Bruce F

2005-04-01

The Hawaii Department of Health Child and Adolescent Mental Health Division has explored various strategies to promote widespread use of empirical evidence to improve the quality of services and outcomes for youth. This article describes a core set of clinical decisions and how several general and local evidence bases may inform those decisions. Multiple quality improvement strategies are illustrated in the context of a model that outlines four phases of evidence: data, information, knowledge, and wisdom.

Operational monitoring and forecasting of bathing water quality through exploiting satellite Earth observation and models: The AlgaRisk demonstration service

NASA Astrophysics Data System (ADS)

Shutler, J. D.; Warren, M. A.; Miller, P. I.; Barciela, R.; Mahdon, R.; Land, P. E.; Edwards, K.; Wither, A.; Jonas, P.; Murdoch, N.; Roast, S. D.; Clements, O.; Kurekin, A.

2015-04-01

Coastal zones and shelf-seas are important for tourism, commercial fishing and aquaculture. As a result the importance of good water quality within these regions to support life is recognised worldwide and a number of international directives for monitoring them now exist. This paper describes the AlgaRisk water quality monitoring demonstration service that was developed and operated for the UK Environment Agency in response to the microbiological monitoring needs within the revised European Union Bathing Waters Directive. The AlgaRisk approach used satellite Earth observation to provide a near-real time monitoring of microbiological water quality and a series of nested operational models (atmospheric and hydrodynamic-ecosystem) provided a forecast capability. For the period of the demonstration service (2008-2013) all monitoring and forecast datasets were processed in near-real time on a daily basis and disseminated through a dedicated web portal, with extracted data automatically emailed to agency staff. Near-real time data processing was achieved using a series of supercomputers and an Open Grid approach. The novel web portal and java-based viewer enabled users to visualise and interrogate current and historical data. The system description, the algorithms employed and example results focussing on a case study of an incidence of the harmful algal bloom Karenia mikimotoi are presented. Recommendations and the potential exploitation of web services for future water quality monitoring services are discussed.

The Mediating Effect of Innovation between Total Quality Management (TQM) and Business Performance

NASA Astrophysics Data System (ADS)

Shan, Ang Wei; Fauzi Ahmad, Mohd; Hisyamudin Muhd Nor, Nik

2016-11-01

Both TQM and Innovation are the competitive key factors that intensely embedded into organizational products, service and process. In order to achieve higher business performance, organizations are needed to adopt both quality and innovation. Therefore, the main objective of this paper is to identify the relationship between TQM and business performance with a mediator's effect of Innovation. After detailed review the extensive literature, a new TQM model is presented. The proposed model integrates the TQM practices and different type of innovation attempt to develop a theoretical knowledge to help academician and manufacturer to understand the relationship that design quality in product and service and engaging innovation in the activities. To this end, the SEM-PLS (Structural Equation Modelling - Partial Least Squares Structural) is used to identify and evaluate the relationship among TQM, Innovation and business performance in establishing a new TQM model.

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed Central

2013-01-01

Background As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Methods Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Results Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Conclusions Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations. PMID:24341530

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed

Dahrouge, Simone; Hogg, William; Ward, Natalie; Tuna, Meltem; Devlin, Rose Anne; Kristjansson, Elizabeth; Tugwell, Peter; Pottie, Kevin

2013-12-17

As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations.

The Development of Learning Services Assessment Instrument Model of Islamic Higher Education

ERIC Educational Resources Information Center

Zurqoni

2017-01-01

The Islamic higher educations have an important role in producing the qualified graduates. Therefore, the organization of the Islamic higher educations must be coupled with the quality of learning services. Some institutes and universities are optimizing their learning services, while the others tend to choose different service patterns since…

Successful outsourcing: improving quality of life through integrated support services.

PubMed

Bates, Jason; Sharratt, Martin; King, John

2014-01-01

This article examines the way that non-clinical support services are provided in healthcare settings through outsourcing partnerships. The integrated support services model and benefits to patient experience and safety as well as organizational efficiency and effectiveness are explored through an examination of services at a busy urban community hospital.

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory

PubMed Central

Mousavi, Ali; Clarkson, P. John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation. PMID:27170899

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory.

PubMed

Komashie, Alexander; Mousavi, Ali; Clarkson, P John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation.

Assessing the effects of regional payment for watershed services program on water quality using an intervention analysis model.

PubMed

Lu, Yan; He, Tian

2014-09-15

Much attention has been recently paid to ex-post assessments of socioeconomic and environmental benefits of payment for ecosystem services (PES) programs on poverty reduction, water quality, and forest protection. To evaluate the effects of a regional PES program on water quality, we selected chemical oxygen demand (COD) and ammonia-nitrogen (NH3-N) as indicators of water quality. Statistical methods and an intervention analysis model were employed to assess whether the PES program produced substantial changes in water quality at 10 water-quality sampling stations in the Shaying River watershed, China during 2006-2011. Statistical results from paired-sample t-tests and box plots of COD and NH3-N concentrations at the 10 stations showed that the PES program has played a positive role in improving water quality and reducing trans-boundary water pollution in the Shaying River watershed. Using the intervention analysis model, we quantitatively evaluated the effects of the intervention policy, i.e., the watershed PES program, on water quality at the 10 stations. The results suggest that this method could be used to assess the environmental benefits of watershed or water-related PES programs, such as improvements in water quality, seasonal flow regulation, erosion and sedimentation, and aquatic habitat. Copyright © 2014 Elsevier B.V. All rights reserved.

Faculty Sufficiency and AACSB Accreditation Compliance within a Global University: A Mathematical Modeling Approach

ERIC Educational Resources Information Center

Boronico, Jess; Murdy, Jim; Kong, Xinlu

2014-01-01

This manuscript proposes a mathematical model to address faculty sufficiency requirements towards assuring overall high quality management education at a global university. Constraining elements include full-time faculty coverage by discipline, location, and program, across multiple campus locations subject to stated service quality standards of…

ASSESSMENT OF ETA-CMAQ FORECASTS OF PARTICULATE MATTER DISTRIBUTIONS THROUGH COMPARISONS WITH SURFACE NETWORK AND SPECIALIZED MEASUREMENTS

EPA Science Inventory

An air-quality forecasting (AQF) system based on the National Weather Service (NWS) National Centers for Environmental Prediction's (NCEP's) Eta model and the U.S. EPA's Community Multiscale Air Quality (CMAQ) Modeling System is used to simulate the distributions of tropospheric ...

Modified HWBI Model(s) Linking Service Flows to Well-Being Endpoints: Accounting for Environmental Quality

EPA Science Inventory

This report describes an approach for modifying ORD’s Human Well-Being Index (HWBI) to increase its utility by introducing a composite index developed independently of the HWBI effort. Using ORD’s Environmental Quality Index (EQI), this research examines the potential...

Analysis, requirements and development of a collaborative social and medical services data model.

PubMed

Bobroff, R B; Petermann, C A; Beck, J R; Buffone, G J

1994-01-01

In any medical and social service setting, patient data must be readily shared among multiple providers for delivery of expeditious, quality care. This paper describes the development and implementation of a generalized social and medical services data model for an ambulatory population. The model, part of the Collaborative Social and Medical Services System Project, is based on the data needs of the Baylor College of Medicine Teen Health Clinics and follows the guidelines of the ANSI HISPP/MSDS JWG for a Common Data Model. Design details were determined by informal staff interviews, operational observations, and examination of clinic guidelines and forms. The social and medical services data model is implemented using object-oriented data modeling techniques and will be implemented in C++ using an Object-Oriented Database Management System.

Voices of Strong Democracy: Concepts and Models for Service-Learning in Communication Studies. AAHE's Series on Service-Learning in the Disciplines.

ERIC Educational Resources Information Center

Droge, David, Ed.; Murphy, Bren Ortega, Ed.

This volume is part of a series of 18 monographs on service learning and the academic disciplines. These essays demonstrate some "best practices" for service-learning, providing rigorous learning experiences for students and high-quality service to the community. A Preface by James L. Applegate and Sherwyn P. Morreale, "Service-Learning in…

E-service learning: A pedagogic innovation for healthcare management education.

PubMed

Malvey, Donna M; Hamby, Eileen F; Fottler, Myron D

2006-01-01

This paper proposes an innovation in service learning that we identify as e-service learning. By adding the "e" to service learning, we create a service learning model that is dynamic, mediated by technology, and delivered online. This paper begins by examining service learning, which is a distinct learning concept. Service learning furnishes students with opportunities for applied learning through participation in projects and activities in community organizations. The authors then define and conceptualize e-service learning, including the anticipated outcomes of implementation such as enhanced access, quality, and cost effectiveness of healthcare management education. Because e-service learning is mediated by technology, we identify state of the art technologies that support e-service learning activities. In addition, possible e-service learning projects and activities that may be included in healthcare management courses such as finance, human resources, quality, service management/marketing and strategy are identified. Finally, opportunities for future research are suggested.

A Socio-technical assessment of the success of picture archiving and communication systems: the radiology technologist’s perspective

PubMed Central

2013-01-01

Background With the increasing prevalence of Picture Archiving and Communication Systems (PACS) in healthcare institutions, there is a growing need to measure their success. However, there is a lack of published literature emphasizing the technical and social factors underlying a successful PACS. Methods An updated Information Systems Success Model was utilized by radiology technologists (RTs) to evaluate the success of PACS at a large medical center in Taiwan. A survey, consisting of 109 questionnaires, was analyzed by Structural Equation Modeling. Results Socio-technical factors (including system quality, information quality, service quality, perceived usefulness, user satisfaction, and PACS dependence) were proven to be effective measures of PACS success. Although the relationship between service quality and perceived usefulness was not significant, other proposed relationships amongst the six measurement parameters of success were all confirmed. Conclusions Managers have an obligation to improve the attributes of PACS. At the onset of its deployment, RTs will have formed their own subjective opinions with regards to its quality (system quality, information quality, and service quality). As these personal concepts are either refuted or reinforced based on personal experiences, RTs will become either satisfied or dissatisfied with PACS, based on their perception of its usefulness or lack of usefulness. A satisfied RT may play a pivotal role in the implementation of PACS in the future. PMID:24053458

Quality and customer satisfaction: A case study in Brazil

NASA Astrophysics Data System (ADS)

Barcellos, Paulo Fernando Pinto

The dissertation deals with the case of CEEE-Companhia Estadual de Energia Eletrica, an electric power utility located in Rio Grande do Sul, the southernmost state of Brazil. Customer satisfaction with the services provided by CEEE is investigated within three groups of consumers: residential, commercial, and industrial. The purpose of the dissertation is to find answers to the following research questions: (1) What is service quality in public utilities, and particularly in an electric power company? (2) What service quality dimensions do customers want to be provided and favor the most? (3) How does the market measure service quality? (4) What should be done by companies, and particularly by an electric utility monopoly, to increase the performance of the rendered service? (5) How does this impact customer satisfaction, retention, and intention to recommend? and (6) How do we start a company-wide quality program provided that the resources are scarce and therefore priorities should be set forth? To investigate the posed questions, the study begins with an exploratory survey of CEEE's Board. The survey is followed by qualitative research of the three customer groups. After qualitative analysis of the data is concluded, questionnaires for the quantitative research, as well as hypothetical models, are developed. Dillman's "Total Design Method" is used to design the questionnaires. The basic ACSI (American Customer Satisfaction Model) is used to approach customer satisfaction. Data are processed by PLS (Partial Least Squares) which follows the procedure developed at the National Quality Research Center of the University of Michigan Business School. In summary, commercial customers are the most dissatisfied with the services provided by CEEE, while residential customers are the most satisfied. To improve quality, priority should be placed on commercial customers and include efforts to improve productivity gains throughout the company. Also, CEEE's image should be improved through a better communication process with the market and an intensive and extensive training of personnel. A special marketing campaign could help build a better image by explaining CEEE's goals to improve quality. Finally, a bottom line of satisfaction scores (as quality indicators) should be set for the entire company.

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long-term care institution residents.

PubMed

Lin, Jesun; Hsiao, Chih-Tung; Glen, Robert; Pai, Jar-Yuan; Zeng, Sin-Huei

2014-06-01

To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long-term care institutions. The five-point Likert scale questionnaire administered through facetoface interviews. Fourteen long-term care institutions located in central and southern Taiwan stratified according to services and accommodation population. One hundred and eighty long-term institutional care residents. Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Student's t-test on institutional location shows a significant difference between overall satisfaction for central and southern institution long-term care recipients. The correlation test revealed that the higher a resident's level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index-of-model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long-term care institutions, is also an important factor in residents' overall satisfaction. The primary goal of long-term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost-effective but high-quality care. On the basis of the results of in-depth interviews with long-term institutional care residents, this study suggests long-term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. © 2012 John Wiley & Sons Ltd.

Preliminary Guidelines for Installation Product Line Land Management Suite (LMS) Product Developers

DTIC Science & Technology

2005-01-01

land use patterns might call a storm simulation model available as a CDF service to evaluate the ability of the pattern to maintain water quality ...Analysis GIS data Server Internal DIAS objects External DIAS objects External CDF services Fort Future DIAS Model GUI Figure 10. A Fort Future DIAS...31 iv ERDC/CERL TR-05-1 Are Programs that Analyze Data Being Developed as CDF Services

Mapping a Careflow Network to assess the connectedness of Connected Health.

PubMed

Carroll, Noel; Richardson, Ita

2017-04-01

Connected Health is an emerging and rapidly developing field which has the potential to transform healthcare service systems by increasing its safety, quality and overall efficiency. From a healthcare perspective, process improvement models have mainly focused on the static workflow viewpoint. The objective of this article is to study and model the dynamic nature of healthcare delivery, allowing us to identify where potential issues exist within the service system and to examine how Connected Health technological solutions may support service efficiencies. We explore the application of social network analysis (SNA) as a modelling technique which captures the dynamic nature of a healthcare service. We demonstrate how it can be used to map the 'Careflow Network' and guide Connected Health innovators to examine specific opportunities within the healthcare service. Our results indicate that healthcare technology must be correctly identified and implemented within the Careflow Network to enjoy improvements in service delivery. Oftentimes, prior to making the transformation to Connected Health, researchers use various modelling techniques that fail to identify where Connected Health innovation is best placed in a healthcare service network. Using SNA allows us to develop an understanding of the current operation of healthcare system within which they can effect change. It is important to identify and model the resource exchanges to ensure that the quality and safety of care are enhanced, efficiencies are increased and the overall healthcare service system is improved. We have shown that dynamic models allow us to study the exchange of resources. These are often intertwined within a socio-technical context in an informal manner and not accounted for in static models, yet capture a truer insight on the operations of a Careflow Network.

Team-Based Models for End-of-Life Care: An Evidence-Based Analysis

PubMed Central

2014-01-01

Background End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Objectives Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. Data Sources A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Review Methods Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Results Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: hospital, direct contact home, direct contact home, indirect contact comprehensive, indirect contact comprehensive, direct contact comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees the patient. A “comprehensive” model is one that provides continuity of service across inpatient and outpatient settings, e.g., in hospital and then at home. All teams consisted of a nurse and physician at minimum, at least one of whom had a specialty in end-of-life health care. More than 50% of the teams offered services that included symptom management, psychosocial care, development of patient care plans, end-of-life care planning, and coordination of care. We found moderate-quality evidence that the use of a comprehensive direct contact model initiated up to 9 months before death improved informal caregiver satisfaction and the odds of having a home death, and decreased the odds of dying in a nursing home. We found moderate-quality evidence that the use of a comprehensive, direct, and early (up to 24 months before death) contact model improved patient quality of life, symptom management, and patient satisfaction. We did not find that using a comprehensive team-based model had an impact on hospital admissions or length of stay. We found low-quality evidence that the use of a home team-based model increased the odds of having a home death. Limitations Heterogeneity in data reporting across studies limited the ability to complete a meta-analysis on many of the outcome measures. Missing data was not managed well within the studies. Conclusions Moderate-quality evidence shows that a comprehensive, direct-contact, team-based model of care provides the following benefits for end-of-life patients with an estimated survival of up to 9 months: it improves caregiver satisfaction and increases the odds of dying at home while decreasing the odds of dying in a nursing home. Moderate-quality evidence also shows that improvement in patient quality of life, symptom management, and patient satisfaction occur when end-of-life care via this model is provided early (up to 24 months before death). However, using this model to deliver end-of-life care does not impact hospital admissions or hospital length of stay. Team membership includes at minimum a physician and nurse, with at least one having specialist training and/or experience in end-of-life care. Team services include symptom management, psychosocial care, development of patient care plans, end-of-life care planning, and coordination of care. PMID:26356140

Providing High-Quality Support Services to Home-Based Child Care: A Conceptual Model and Literature Review

ERIC Educational Resources Information Center

Bromer, Juliet; Korfmacher, Jon

2017-01-01

Research Findings: Home-based child care accounts for a significant proportion of nonparental child care arrangements for young children in the United States. Yet the early care and education field lacks clear models or pathways for how to improve quality in these settings. The conceptual model presented here articulates the components of…

Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

PubMed

Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

2015-12-21

Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

PubMed

Bhattacharyya, Onil; Khor, Sara; McGahan, Anita; Dunne, David; Daar, Abdallah S; Singer, Peter A

2010-07-15

The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services. A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation that have led to effective provision of care for the poor. An environmental scan of peer-reviewed and grey literature was conducted to select exemplars of innovation. A case series of organizations was then purposively sampled to maximize variation. These cases were examined using content analysis and constant comparison to characterize their strategies, focusing on business processes. After an initial sample of 46 studies, 10 case studies of exemplars were developed spanning different geography, disease areas and health service delivery models. These ten organizations had innovations in their marketing, financing, and operating strategies. These included approaches such a social marketing, cross-subsidy, high-volume, low cost models, and process reengineering. They tended to have a narrow clinical focus, which facilitates standardizing processes of care, and experimentation with novel delivery models. Despite being well-known, information on the social impact of these organizations was variable, with more data on availability and affordability and less on quality of care. These private sector organizations demonstrate a range of innovations in health service delivery that have the potential to better serve the poor's health needs and be replicated. There is a growing interest in investing in social enterprises, like the ones profiled here. However, more rigorous evaluations are needed to investigate the impact and quality of the health services provided and determine the effectiveness of particular strategies.

Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

PubMed Central

2010-01-01

Background The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services. A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation that have led to effective provision of care for the poor. Methods An environmental scan of peer-reviewed and grey literature was conducted to select exemplars of innovation. A case series of organizations was then purposively sampled to maximize variation. These cases were examined using content analysis and constant comparison to characterize their strategies, focusing on business processes. Results After an initial sample of 46 studies, 10 case studies of exemplars were developed spanning different geography, disease areas and health service delivery models. These ten organizations had innovations in their marketing, financing, and operating strategies. These included approaches such a social marketing, cross-subsidy, high-volume, low cost models, and process reengineering. They tended to have a narrow clinical focus, which facilitates standardizing processes of care, and experimentation with novel delivery models. Despite being well-known, information on the social impact of these organizations was variable, with more data on availability and affordability and less on quality of care. Conclusions These private sector organizations demonstrate a range of innovations in health service delivery that have the potential to better serve the poor's health needs and be replicated. There is a growing interest in investing in social enterprises, like the ones profiled here. However, more rigorous evaluations are needed to investigate the impact and quality of the health services provided and determine the effectiveness of particular strategies. PMID:20630108

Hierarchy Bayesian model based services awareness of high-speed optical access networks

NASA Astrophysics Data System (ADS)

Bai, Hui-feng

2018-03-01

As the speed of optical access networks soars with ever increasing multiple services, the service-supporting ability of optical access networks suffers greatly from the shortage of service awareness. Aiming to solve this problem, a hierarchy Bayesian model based services awareness mechanism is proposed for high-speed optical access networks. This approach builds a so-called hierarchy Bayesian model, according to the structure of typical optical access networks. Moreover, the proposed scheme is able to conduct simple services awareness operation in each optical network unit (ONU) and to perform complex services awareness from the whole view of system in optical line terminal (OLT). Simulation results show that the proposed scheme is able to achieve better quality of services (QoS), in terms of packet loss rate and time delay.

The Disabled Student Experience: Does the SERVQUAL Scale Measure Up?

ERIC Educational Resources Information Center

Vaughan, Elizabeth; Woodruffe-Burton, Helen

2011-01-01

Purpose: The purpose of this paper is to empirically test a new disabled service user-specific service quality model ARCHSECRET against a modified SERVQUAL model in the context of disabled students within higher education. Design/methodology/approach: The application of SERVQUAL in the voluntary sector had raised serious issues on its portability…

Employing the Five-Factor Mentoring Instrument: Analysing Mentoring Practices for Teaching Primary Science

ERIC Educational Resources Information Center

Hudson, Peter; Usak, Muhammet; Savran-Gencer, Ayse

2009-01-01

Primary science education is a concern around the world and quality mentoring within schools can develop pre-service teachers' practices. A five-factor model for mentoring has been identified, namely, personal attributes, system requirements, pedagogical knowledge, modelling, and feedback. Final-year pre-service teachers (mentees, n = 211) from…

Pollux: Enhancing the Quality of Service of the Global Information Grid (GIG)

DTIC Science & Technology

2009-06-01

and throughput of standard-based and/or COTS-based QoS-enabled pub/sub technologies, including DDS, JMS, Web Services, and CORBA. 2. The DDS QoS...of ser- vice pICKER (QUICKER) model-driven engineering ( MDE ) toolchain shown in Figure 8. QUICKER extends the Platform-Independent Component Modeling

A landscape based, systems dynamic model for assessing impacts of urban development on water quality for sustainable seagrass growth in Tampa Bay, Florida

EPA Science Inventory

We present an integrated assessment model to predict potential unintended consequences of urban development on the sustainability of seagrasses and preservation of ecosystem services, such as catchable fish, in Tampa Bay. Ecosystem services are those ecological functions and pro...

Using GIS Models to Identify Relative Nitrogen Attenuation by Riparian Buffers in the Coastal Plain of North Carolina

EPA Science Inventory

Riparian areas have demonstrated the ability to attenuate nutrients and provide water quality services at the field scale, but services of riparian buffers for downstream users should be assessed at watershed scales. GIS-based riparian models have been developed to connect ripari...

Modeling Adaptable Business Service for Enterprise Collaboration

NASA Astrophysics Data System (ADS)

Boukadi, Khouloud; Vincent, Lucien; Burlat, Patrick

Nowadays, a Service Oriented Architecture (SOA) seems to be one of the most promising paradigms for leveraging enterprise information systems. SOA creates opportunities for enterprises to provide value added service tailored for on demand enterprise collaboration. With the emergence and rapid development of Web services technologies, SOA is being paid increasing attention and has become widespread. In spite of the popularity of SOA, a standardized framework for modeling and implementing business services are still in progress. For the purpose of supporting these service-oriented solutions, we adopt a model driven development approach. This paper outlines the Contextual Service Oriented Modeling and Analysis (CSOMA) methodology and presents UML profiles for the PIM level service-oriented architectural modeling, as well as its corresponding meta-models. The proposed PIM (Platform Independent Model) describes the business SOA at a high level of abstraction regardless of techniques involved in the application employment. In addition, all essential service-specific concerns required for delivering quality and context-aware service are covered. Some of the advantages of this approach are that it is generic and thus not closely allied with Web service technology as well as specifically treating the service adaptability during the design stage.

"Mindless Medicals".

PubMed

Michell, Karen Elizabeth; Rispel, Laetitia C

2017-03-01

This article explores stakeholders' perceptions of the quality of occupational health service (OHS) delivery in South Africa. Using a purposive sampling technique, 11 focus group discussions (FGDs) were conducted in three provinces. Focus group participants ( n = 69) were recruited through professional organizations of occupational physicians and occupational health nurses as well as employer representatives of major industries in South Africa. Transcriptions of FGDs were analyzed using thematic content analysis. South Africa has diverse models of OHS delivery with varying quality. Focus group participants criticized the outsourced model of service delivery and the excessive focus on physical examinations to achieve legal compliance. These problems are exacerbated by a perceived lack of employer emphasis on occupational health, insufficient human and financial resources, and lack of specific quality of care standards for occupational health. Improvement in the quality of OHS delivery is essential to realize South Africa's quest for universal health coverage.

Developing a framework to assess the water quality and quantity impacts of climate change, shifting land use, and urbanization in a Midwestern agricultural landscape

NASA Astrophysics Data System (ADS)

Loheide, S. P.; Booth, E. G.; Kucharik, C. J.; Carpenter, S. R.; Gries, C.; Katt-Reinders, E.; Rissman, A. R.; Turner, M. G.

2011-12-01

Dynamic hydrological processes play a critical role in the structure and functioning of agricultural watersheds undergoing urbanization. Developing a predictive understanding of the complex interaction between agricultural productivity, ecosystem health, water quality, urban development, and public policy requires an interdisciplinary effort that investigates the important biophysical and social processes of the system. Our research group has initiated such a framework that includes a coordinated program of integrated scenarios, model experiments to assess the effects of changing drivers on a broad set of ecosystem services, evaluations of governance and leverage points, outreach and public engagement, and information management. Our geographic focus is the Yahara River watershed in south-central Wisconsin, which is an exemplar of water-related issues in the Upper Midwest. This research addresses three specific questions. 1) How do different patterns of land use, land cover, land management, and water resources engineering practices affect the resilience and sensitivity of ecosystem services under a changing climate? 2) How can regional governance systems for water and land use be made more resilient and adaptive to meet diverse human needs? 3) In what ways are regional human-environment systems resilient and in what ways are they vulnerable to potential changes in climate and water resources? A comprehensive program of model experiments and biophysical measurements will be utilized to evaluate changes in five freshwater ecosystem services (flood regulation, groundwater recharge, surface water quality, groundwater quality, and lake recreation) and five related ecosystem services (food crop yields, bioenergy crop yields, carbon storage in soil, albedo, and terrestrial recreation). Novel additions to existing biophysical models will allow us to simulate all components of the hydrological cycle as well as agricultural productivity, nitrogen and phosphorus transport, and lake water quality. The integrated model will be validated using a comprehensive observational database that includes soil moisture, evapotranspiration, stomatal conductance, streamflow, stream and lake water quality, and crop yields and productivity. Integrated scenarios will be developed to synthesize decision-maker perspectives, alternative approaches to resource governance, plausible trends in demographic and economic drivers, and model projections under alternate climate and land use regimes to understand future conditions of the watershed and its ecosystem services. The quantitative data and integrated scenarios will then be linked to evaluate governance of water and land use.

US EPA 2012 Air Quality Fused Surface for the Conterminous U.S. Map Service

EPA Pesticide Factsheets

This web service contains a polygon layer that depicts fused air quality predictions for 2012 for census tracts in the conterminous United States. Fused air quality predictions (for ozone and PM2.5) are modeled using a Bayesian space-time downscaling fusion model approach described in a series of three published journal papers: 1) (Berrocal, V., Gelfand, A. E. and Holland, D. M. (2012). Space-time fusion under error in computer model output: an application to modeling air quality. Biometrics 68, 837-848; 2) Berrocal, V., Gelfand, A. E. and Holland, D. M. (2010). A bivariate space-time downscaler under space and time misalignment. The Annals of Applied Statistics 4, 1942-1975; and 3) Berrocal, V., Gelfand, A. E., and Holland, D. M. (2010). A spatio-temporal downscaler for output from numerical models. J. of Agricultural, Biological,and Environmental Statistics 15, 176-197) is used to provide daily, predictive PM2.5 (daily average) and O3 (daily 8-hr maximum) surfaces for 2012. Summer (O3) and annual (PM2.5) means calculated and published. The downscaling fusion model uses both air quality monitoring data from the National Air Monitoring Stations/State and Local Air Monitoring Stations (NAMS/SLAMS) and numerical output from the Models-3/Community Multiscale Air Quality (CMAQ). Currently, predictions at the US census tract centroid locations within the 12 km CMAQ domain are archived. Predictions at the CMAQ grid cell centroids, or any desired set of locations co

[A measure of the efficiency of primary care in Barcelona (Spain) incorporating quality indicators].

PubMed

Romano, José; Choi, Álvaro

2016-01-01

To demonstrate the impact of the incorporation of quality indicators in assessing the technical efficiency of primary healthcare teams. The processes through which primary healthcare resources have been allocated since the onset of the financial crisis in 2008 have focussed on quantitative rather than qualitative indicators. This study applies data envelopment analysis (DEA) techniques to 58 primary healthcare teams from three different primary healthcare services from the province of Barcelona (Spain). We combine publicly available information from the regional government of Catalonia with data requested from the Catalan Health System Observatory. The analysis compares the results of three models, thereby allowing shifts in the efficiency of primary healthcare teams to be identified in terms of the (lack of) consideration for healthcare quality indicators. Only 16% of the primary healthcare teams were found to be efficient according to the baseline models, which only incorporated input and output quantity indicators. However, once proxies for healthcare quality are included in the analysis, this percentage increases to 58.6%. No meaningful differences in primary healthcare team efficiency were found between public and privately owned centres, between regional primary care services and organisational models, or between rural and urban teams. The results suggest the need to incorporate healthcare quality indicators as outputs when considering criteria for the streamlining of primary healthcare services. Failure to incorporate quality indicators is associated with various primary healthcare concepts. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Identifying organisational principles and management practices important to the quality of health care services for chronic conditions.

PubMed

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 effect of financial incentives and public performance reporting on the behaviour of professionals and quality of care. Using secondary data, KP and the Danish health care system were compared in terms of six central dimensions: population, health care professionals, health care organisations, utilization patterns, quality measurements, and costs. Differences existed between the two systems on all dimensions, complicating the interpretation of findings. For instance, observed differences might be due to similar tendencies in the two health care systems that were observed at different times, rather than true structural differences. The expenses in the two health care systems were corrected for differences in the populations served and the purchasing power of currencies. However, no validated methods existed to correct for observed differences in case-mixes of chronic conditions. Data from a population of about half a million patients with diabetes in a large U.S. integrated health care delivery system affiliated with 41 medical centers employing 15 different CCM management practices was the basis for identifying effective management practices. Through the use of statistical modelling, the management practice of provider alerts was identified as most effective for promoting screening for hemoglobin A1c and lipid profile. The CCM was used as a framework for implementing four rehabilitation programs. The model promoted continuity of care and quality of health care services. New management practices were developed in the study, and known practices were further developed. However, the observational nature of the study limited the generalisability of the findings. In a structured literature survey focusing on the effect of financial incentives and public performance reporting on the quality of health care services, few studies documenting an effect were identified. The results varied, and important program aspects or contextual variables were often omitted. A model describing the effects of the two incentives on the conduct of health care professionals and their interaction with the organisations in which they serve was developed. On the macro-level, organisational differences between KP and the Danish health care system related to the primary care sectors, utilization patterns, and the quality of health care services, supporting a hypothesis that KP's focus on primary care is a beneficial form of organisation. On the meso-level, use of the CCM improved quality of health care services, but the effect is complicated and context dependent. The CCM was found to be useful in the Danish health care system, and the model was also further developed in a Danish setting. On the micro-level, quality was improved by financial incentives and disclosure in a complex interplay with other central factors in the work environment of health care professionals.

Optimum Landscape Allocation of Conservation Practices for Water Quality and Ecosystem Service Valuation

NASA Astrophysics Data System (ADS)

Dalzell, B. J.; Pennington, D.; Nelson, E.; Mulla, D.; Polasky, S.; Taff, S.

2012-12-01

This study links a spatially-explicit biophysical model (SWAT) with an economic model (InVEST) to identify the economically optimum allocation of conservation practices on the landscape. Combining biophysical and economic analysis allows assessment of the benefits and costs of alternative policy choices through consideration of direct costs and benefits as measured by market transactions as well as non-market benefits and costs from changes in environmental conditions that lead to changes in the provision of ecosystem services. When applied to an agricultural watershed located in South-Central Minnesota, this approach showed that: (1) some modest gains (20% improvement, relative to baseline conditions) in water quality can be achieved without diminishing current economic returns, but that (2) more dramatic reductions in sediment and phosphorus required to meet water quality goals (50% reductions in loadings) will require transitioning land from row crops into perennial vegetation. This shift in land cover will result in a reduction in economic returns unless non-market ecosystem services are also valued. Further results showed that traditional best management practices such as conservation tillage and reduced fertilizer application rates are not sufficient to achieve water quality goals by themselves. Finally, if crop prices drop to pre-2007 levels or valuation of ecosystem services increases, then achieving water quality goals can occur with less of an economic impact to the watershed.

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

PubMed

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

2013-08-01

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

Land use impact on water quality: valuing forest services in terms of the water supply sector.

PubMed

Fiquepron, Julien; Garcia, Serge; Stenger, Anne

2013-09-15

The aim of this paper is to quantify the impact of the forest on raw water quality within the framework of other land uses. On the basis of measurements of quality parameters that were identified as being the most problematic (i.e., pesticides and nitrates), we modeled how water quality is influenced by land uses. In order to assess the benefits provided by the forest in terms of improved water quality, we used variations of drinking water prices that were determined by the operating costs of water supply services (WSS). Given the variability of links between forests and water quality, we chose to cover all of France using data observed in each administrative department (France is divided into 95 départements), including a description of WSS and information on land uses. We designed a model that describes the impact of land uses on water quality, as well as the operation of WSS and prices. This bioeconomic model was estimated by the generalized method of moments (GMM) to account for endogeneity and heteroscedasticity issues. We showed that the forest has a positive effect on raw water quality compared to other land uses, with an indirect impact on water prices, making them lower for consumers. Copyright © 2013 Elsevier Ltd. All rights reserved.

The effects of integrated care: a systematic review of UK and international evidence.

PubMed

Baxter, Susan; Johnson, Maxine; Chambers, Duncan; Sutton, Anthea; Goyder, Elizabeth; Booth, Andrew

2018-05-10

Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. Prospero registration number: 42016037725 .

Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being.

PubMed

Martinussen, Monica; Kaiser, Sabine; Adolfsen, Frode; Patras, Joshua; Richardsen, Astrid M

2017-07-01

This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers' experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T 1 ) and after (T 2 , T 3 ) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T 1 to T 2 . No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T 3 ) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.

Data Envelopment Analysis (DEA) Model in Operation Management

NASA Astrophysics Data System (ADS)

Malik, Meilisa; Efendi, Syahril; Zarlis, Muhammad

2018-01-01

Quality management is an effective system in operation management to develops, maintains, and improves quality from groups of companies that allow marketing, production, and service at the most economycal level as well as ensuring customer satisfication. Many companies are practicing quality management to improve their bussiness performance. One of performance measurement is through measurement of efficiency. One of the tools can be used to assess efficiency of companies performance is Data Envelopment Analysis (DEA). The aim of this paper is using Data Envelopment Analysis (DEA) model to assess efficiency of quality management. In this paper will be explained CCR, BCC, and SBM models to assess efficiency of quality management.

42 CFR § 414.1335 - Data submission criteria for the quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive...

Quality and provider choice: a multinomial logit-least-squares model with selectivity.

PubMed Central

Haas-Wilson, D; Savoca, E

1990-01-01

A Federal Trade Commission survey of contact lens wearers is used to estimate a multinomial logit-least-squares model of the joint determination of provider choice and quality of care in the contact lens industry. The effect of personal and industry characteristics on a consumer's choice among three types of providers--opticians, ophthalmologists, and optometrists--is estimated via multinomial logit. The regression model of the quality of care has two features that distinguish it from previous work in the area. First, it uses an outcome rather than a structural or process measure of quality. Quality is measured as an index of the presence of seven potentially pathological eye conditions caused by poorly fitted lenses. Second, the model controls for possible selection bias that may arise from the fact that the sample observations on quality are generated by consumers' nonrandom choices of providers. The multinomial logit estimates of provider choice indicate that professional regulations limiting the commercial practices of optometrists shift demand for contact lens services away from optometrists toward ophthalmologists. Further, consumers are more likely to have their lenses fitted by opticians in states that require the licensing of opticians. The regression analysis of variations in quality across provider types shows a strong positive selection bias in the estimate of the quality of care received by consumers of ophthalmologists' services. Failure to control for this selection bias results in an overestimate of the quality of care provided by ophthalmologists. PMID:2312308

Health care competition, strategic mission, and patient satisfaction: research model and propositions

PubMed Central

Rivers, Patrick A.; Glover, Saundra H.

2010-01-01

Purpose In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry. Design/methodology/approach A literature review was conducted. A total of 50 items of literature related to the subject were reviewed.. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examined Findings A model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. Practical implications Empirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment. Originality/value The authors develop a research model which included propositions to examine the complex issues of competition in the health care industry. PMID:19579575

Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

PubMed

Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, José Miguel; Cardoso, Graça; King, Michael

2012-01-01

The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users' autonomy.

Perinatal staff perceptions of safety and quality in their service.

PubMed

Sinni, Suzanne V; Wallace, Euan M; Cross, Wendy M

2014-11-28

Ensuring safe and appropriate service delivery is central to a high quality maternity service. With this in mind, over recent years much attention has been given to the development of evidence-based clinical guidelines, staff education and risk reporting systems. Less attention has been given to assessing staff perceptions of a service's safety and quality and what factors may influence that. In this study we set out to assess staff perceptions of safety and quality of a maternity service and to explore potential influences on service safety. The study was undertaken within a new low risk metropolitan maternity service in Victoria, Australia with a staffing profile comprising midwives (including students), neonatal nurses, specialist obstetricians, junior medical staff and clerical staff. In depth open-ended interviews using a semi-structured questionnaire were conducted with 23 staff involved in the delivery of perinatal care, including doctors, midwives, nurses, nursing and midwifery students, and clerical staff. Data were analyzed using naturalistic interpretive inquiry to identify emergent themes. Staff unanimously reported that there were robust systems and processes in place to maintain safety and quality. Three major themes were apparent: (1) clinical governance, (2) dominance of midwives, (3) inter-professional relationships. Overall, there was a strong sense that, at least in this midwifery-led service, midwives had the greatest opportunity to be an influence, both positively and negatively, on the safe delivery of perinatal care. The importance of understanding team dynamics, particularly mutual respect, trust and staff cohesion, were identified as key issues for potential future service improvement. Senior staff, particularly midwives and neonatal nurses, play central roles in shaping team behaviors and attitudes that may affect the safety and quality of service delivery. We suggest that strategies targeting senior staff to enhance their performance in their roles, particularly in the training and teamwork role-modeling of the transitory junior workforce, are important for the development and maintenance of a high quality and safe maternity service.

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

PubMed Central

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-01-01

Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. PMID:25231492

The Role of Distance and Quality on Facility Selection for Maternal and Child Health Services in Urban Kenya.

PubMed

Escamilla, Veronica; Calhoun, Lisa; Winston, Jennifer; Speizer, Ilene S

2018-02-01

Universal access to health care requires service availability and accessibility for those most in need of maternal and child health services. Women often bypass facilities closest to home due to poor quality. Few studies have directly linked individuals to facilities where they sought maternal and child health services and examined the role of distance and quality on this facility choice. Using endline data from a longitudinal survey from a sample of women in five cities in Kenya, we examine the role of distance and quality on facility selection for women using delivery, facility-based contraceptives, and child health services. A survey of public and private facilities offering reproductive health services was also conducted. Distances were measured between household cluster location and both the nearest facility and facility where women sought care. A quality index score representing facility infrastructure, staff, and supply characteristics was assigned to each facility. We use descriptive statistics to compare distance and quality between the nearest available facility and visited facility among women who bypassed the nearest facility. Facility distance and quality comparisons were also stratified by poverty status. Logistic regression models were used to measure associations between the quality and distance to the nearest facility and bypassing for each outcome. The majority of women bypassed the nearest facility regardless of service sought. Women bypassing for delivery traveled the furthest and had the fewest facility options near their residential cluster. Poor women bypassing for delivery traveled 4.5 km further than non-poor women. Among women who bypassed, two thirds seeking delivery and approximately 46% seeking facility-based contraception or child health services bypassed to a public hospital. Both poor and non-poor women bypassed to higher quality facilities. Our findings suggest that women in five cities in Kenya prefer public hospitals and are willing to travel further to obtain services at public hospitals, possibly related to free service availability. Over time, it will be important to examine service quality and availability in public sector facilities with reduced or eliminated user fees, and whether it lends itself to a continuum of care where women can visit one facility for multiple services reducing travel burden.

Ecosystem Services Modeling as a Tool for Defining Priority Areas for Conservation

PubMed Central

Duarte, Gabriela Teixeira; Ribeiro, Milton Cezar; Paglia, Adriano Pereira

2016-01-01

Conservationists often have difficulty obtaining financial and social support for protected areas that do not demonstrate their benefits for society. Therefore, ecosystem services have gained importance in conservation science in the last decade, as these services provide further justification for appropriate management and conservation of natural systems. We used InVEST software and a set of GIS procedures to quantify, spatialize and evaluated the overlap between ecosystem services—carbon stock and sediment retention—and a biodiversity proxy–habitat quality. In addition, we proposed a method that serves as an initial approach of a priority areas selection process. The method considers the synergism between ecosystem services and biodiversity conservation. Our study region is the Iron Quadrangle, an important Brazilian mining province and a conservation priority area located in the interface of two biodiversity hotspots, the Cerrado and Atlantic Forest biomes. The resultant priority area for the maintenance of the highest values of ecosystem services and habitat quality was about 13% of the study area. Among those priority areas, 30% are already within established strictly protected areas, and 12% are in sustainable use protected areas. Following the transparent and highly replicable method we proposed in this study, conservation planners can better determine which areas fulfill multiple goals and can locate the trade-offs in the landscape. We also gave a step towards the improvement of the habitat quality model with a topography parameter. In areas of very rugged topography, we have to consider geomorfometric barriers for anthropogenic impacts and for species movement and we must think beyond the linear distances. Moreover, we used a model that considers the tree mortality caused by edge effects in the estimation of carbon stock. We found low spatial congruence among the modeled services, mostly because of the pattern of sediment retention distribution. PMID:27145031

The effect of social franchising on access to and quality of health services in low- and middle-income countries.

PubMed

Koehlmoos, Tracey Perez; Gazi, Rukhsana; Hossain, S Shahed; Zaman, K

2009-01-21

Social franchising has developed as a possible means of improving provision of health services through engaging the non-state sector in low- and middle-income countries. To examine the evidence that social franchising has on access to and quality of health services in low- and middle-income countries. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (up to October 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, Ovid (1950 to September Week 3 2007), EMBASE, Ovid (1980 to 2007 Week 38), CINAHL, Ovid (1982 to September Week 3 2007), EconLit, WebSPIRS (1969 to Sept 2007), LILACS, Science Citation Index Expanded and Social Sciences Citation Index (1975 to March 2008), Sociological Abstracts, CSA Illumnia (1952 September 2007), WHOLIS (1948 November 2007). Randomized controlled trials, non-randomized controlled trials, controlled before and after studies and interrupted time series comparing social franchising models with other models of health service delivery, other social franchising models or absence of health services. Two review authors independently applied the criteria for inclusion and exclusion of studies to scan 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 develop rigorous studies to evaluate the effects of social franchising on access to and quality of health services in low- and middle-income countries. Such studies should be informed by the wider literature to identify models of social franchising that have a sound theoretical basis and empirical research addressing their reach, acceptability, feasibility, maintenance and measurability.

Factors affecting satisfaction level with the food services in a military hospital.

PubMed

Sahin, Bayram; Demir, Cesim; Celik, Yusuf; Teke, A Kadir

2006-10-01

To determine the factors affecting general satisfaction level of patients with the food services in a military hospital in Turkey. The study was carried out in a military hospital providing tertiary health care services with the capacity of 1000 hospital bed. A questionnaire was used as data collection tool on measuring satisfaction of the patients with the food services. The results showed that of 374 patients 51.3% evaluated food service quality adequate, 32.4% said that the food quality was inadequate, and 16.3% stated that they were uncertain. A logistic regression model was estimated in determining the most important and statistically significant factors affecting patient satisfaction with hospital foods and food services. The results showed that patient-specific demographic characteristics were insignificant in explaining satisfaction level with food services, but the variables of taste (OR = 9.853, p = 0.000) and appearance (OR = 2.687, p = 0.014) of the food were statistically significant and important determinants of patient satisfaction with the foods served at the hospital. The results of this study would be helpful in making decision on increasing the level of satisfaction of patients with the food services for hospital managers and the food (nutrition) departments. On the other hand, the results can also be used in benchmarking the hospital's food services quality with other hospitals, and in monitoring improvements in food services quality in the future.

Patient expectations of dental services. Image affects expectations, and expectations affect perceived service quality.

PubMed

Clow, K E; Fischer, A K; O'Bryan, D

1995-01-01

The authors construct a theoretical model of the antecedents of expectations for dental services by analyzing survey responses from 240 dental patients. The patients' image of the dentist, tangible cues, situational factors, and patient satisfaction with prior service encounters have the greatest influence on expectations of service, whereas marketing variables, such as price and advertising, appear to have no effect.

Assessing quality of health services with the SERVQUAL model in Iran. A systematic review and meta-analysis.

PubMed

Teshnizi, Saeed Hosseini; Aghamolaei, Teamur; Kahnouji, Kobra; Teshnizi, Seyyed Mehrdad Hosseini; Ghani, Jalil

2018-03-01

The five-dimension service quality (SERVQUAL) scale is one of the most common tools for evaluating gaps between clients' perceptions and expectations. This study aimed to assess the quality of health services in Iran through a meta-analysis of all Iranian studies which used the SERVQUAL tool. A systematic literature review has been performed in Web of Science, PubMed, Scopus, Google Scholar, Iran Medex, Magiran and Scientific Information Database. All relevant English or Persian studies published between January 2009 and April 2016 were have been selected. Papers were considered if they regarded all five dimensions of the SERVQUAL tool for assessing the quality of health care services. Two reviewer independently extracted mean and standard deviation of five dimensions and characteristics of studies. The quality of studies included in meta-analysis using STROBE checklist. Of 315 studies initially identified, 12 were included in our meta-analysis. All analyses were performed in Stata MP v. 14. Patients' perceptions were lower than their expectations (gap = -1.64). Responsibility (-1.22) and reliability (-1.15) had the lowest gaps, and tangibility and empathy (-1.03) had the largest gaps. Except gender, other variables had no significant associations with gaps. Patients in the cities of Arak (-3.47) and Shiraz (-3.02) had the largest gaps. All dimensions of service quality were negative, which implies that the quality of health services in Iran has not been satisfying to patients and needs to be improved.

Exploring nursing e-learning systems success based on information system success model.

PubMed

Chang, Hui-Chuan; Liu, Chung-Feng; Hwang, Hsin-Ginn

2011-12-01

E-learning is thought of as an innovative approach to enhance nurses' care service knowledge. Extensive research has provided rich information toward system development, courses design, and nurses' satisfaction with an e-learning system. However, a comprehensive view in understanding nursing e-learning system success is an important but less focused-on topic. The purpose of this research was to explore net benefits of nursing e-learning systems based on the updated DeLone and McLean's Information System Success Model. The study used a self-administered questionnaire to collected 208 valid nurses' responses from 21 of Taiwan's medium- and large-scale hospitals that have implemented nursing e-learning systems. The result confirms that the model is sufficient to explore the nurses' use of e-learning systems in terms of intention to use, user satisfaction, and net benefits. However, while the three exogenous quality factors (system quality, information quality, and service quality) were all found to be critical factors affecting user satisfaction, only information quality showed a direct effect on the intention to use. This study provides useful insights for evaluating nursing e-learning system qualities as well as an understanding of nurses' intentions and satisfaction related to performance benefits.

Analysis of Gap in Service Quality in Drug Addiction Treatment Centers of Kerman, Iran, Using SERVQUAL Model.

PubMed

Naqavi, Mohammad Reza; Refaiee, Raheleh; Baneshi, Mohammad Reza; Nakhaee, Nouzar

2014-01-01

Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). There was a gap between the clients' expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients' views regarding service quality in addiction treatment clinics.

CITYZER - Services for effective decision making and environmental resilience

NASA Astrophysics Data System (ADS)

Harri, Ari-Matti; Turtiainen, Heikki; Turpeinen, Jani; Viitala, Erkki; Janka, Kauko; Palonen, Henry; Rönkkö, Topi; Laiho, Tiina; Laitinen, Teija; Haukka, Harri; Schmidt, Walter; Nousiainen, Timo

2016-04-01

The CITYZER project develops new digital services and products to support decision making processes related to weather and air quality in cities. This includes, e.g., early warnings and forecasts (0-24 h), which allow for avoiding weather-related accidents, mitigate human distress and costs from weather-related damage and bad air quality, and generally improve the resilience and safety of the society. The project takes advantage of the latest scientific know-how and directly exploits the expertise obtained from, e.g., Tekes-funded (MMEA [1], RAVAKE) and EU-funded (HAREN, EDHIT [2]) projects. Central to the project is the Observation Network Manager NM10 [3] developed by Vaisala Oyj within the Tekes/MMEA project, on which CITYZER defines and builds new commercial services and connects new sensor networks (e.g., air quality). The target groups of the services and products (e.g., public sector, real estate and energy companies, and distributors) and related business models will be analyzed and developed in collaboration with local player (e.g., Asia, South America) taking advantage of the pre-existing contacts by the Haaga-Helia, Vaisala Oyj and CLIC Innovation. Service models are designed to account for and adapt to the special needs of different areas and customers. The developed services will be scalable (most common platforms) and responsive. CITYZER project partners include Vaisala Oyj (observation instrumentation, systems and products), Sasken Ltd (mobile products), Emtele Ltd (Portable IoT ICT Service Operation Center/Environment and remote intelligent cabinet for sensor network-GW and connections), HSY (urban services), Haaga-Helia University of Applied Sciences (service business models including digital services), Finnish Meteorological Institute (implementation of and scientific research on meteorological & air quality products), and the Tampere University of Technology (definition of and scientific research on air quality products), Pegasor Ltd (support for air quality instrumentation and products), INNO-W Ltd (providing business services support), as well as the CLIC Innovation Ltd as a subcontractor for arranging cooperation with international partners and project information dissemination, as well as composing the consortium agreement and other legal issues. Additional project partners are welcomed to join the project and current consortium encourage all potential partners to contact project management for further details. The business impact of this project to existing markets is estimated to be substantial and it will also create totally new markets especially for weather information related services. The existing whole target market size at this point is estimated to be several billion USD and the size of the market is growing steadily. The key CITYZER outcomes are the piloted services and products with envisaged great commercial and export potential. Development of the services will be managed by Sasken, Emtele, Pegasor and Vaisala and supported by INNO-W. The user profiling and market assessment, including the most potential market area either from Asia or South America, will be led by Haaga-Helia and supported by industrial partners. FMI, Vaisala and Pegasor will use their expertise and current business relations to those foreign markets to speed up and guide the user and market evaluation. Essential potential players are local actors in e.g. Brazil, China and India that will be subcontracted to bring in local expertise in the user profiling and market assessment processes. This three year project is scheduled such that, overall, the first two years focus on implementing the technical basis as well as customer and market analyses. Throughout the course of the project a CityzerDemo test bed environment will be developed in the Helsinki metropolitan area, demonstrating the observational and modeling system and services built on them. In addition, the services and business models will be evaluated. Acknowledgements The project has received funding from TEKES, the Finnish Funding Agency for Innovation. References [1] http://mmea.fi/ [2] http://edhit.eu/ [3] http://www.vaisala.com/en/products/metdatamanagementsystems/Pages/NM10.aspx

CITYZER - Services for effective decision making and environmental resilience

NASA Astrophysics Data System (ADS)

Haukka, Harri; Turtiainen, Heikki; Janka, Kauko; Palonen, Henry; Turpeinen, Jani; Viitala, Erkki; Rönkkö, Topi; Laiho, Tiina; Laitinen, Teija; Harri, Ari-Matti; Schmidt, Walter; Nousiainen, Timo; Niemi, Jarkko

2017-04-01

The CITYZER project develops new digital services and products to support decision making processes related to weather and air quality in cities. This includes, e.g., early warnings and forecasts (0-24 h), which allow for avoiding weather-related accidents, mitigate human distress and costs from weather-related damage and bad air quality, and generally improve the resilience and safety of the society. The project takes advantage of the latest scientific know-how and directly exploits the expertise obtained from, e.g., Tekes-funded (MMEA [1], RAVAKE) and EU-funded (HAREN, EDHIT [2]) projects. Central to the project is the Observation Network Manager NM10 [3] developed by Vaisala within the Tekes/MMEA project, on which CITYZER defines and builds new commercial services and connects new sensor networks (e.g., air quality). The target groups of the services and products (e.g., public sector, real estate and energy companies, and distributors) and related business models will be analyzed and developed in collaboration with local players (e.g., India, South America, China) taking advantage of the pre-existing contacts by the Haaga-Helia, Vaisala Ltd and CLIC Innovation. Service models are designed to account for and adapt to the special needs of different areas and customers. The developed services will be scalable (most common platforms) and responsive. CITYZER project partners include Vaisala Ltd (weather observation instrumentation and products), Sasken Ltd (mobile products), Emtele Ltd (Portable IoT ICT Service Operation Center/Environment and remote intelligent cabinet for sensor network-GW and connections), HSY (urban services), Haaga-Helia University of Applied Sciences (service business models including digital services), Finnish Meteorological Institute (implementation of and scientific research on meteorological & air quality products), and the Tampere University of Technology (definition of and scientific research on air quality products), Pegasor Ltd (support for air quality instrumentation and products), INNO-W Ltd (business services support), as well as the CLIC Innovation Ltd as a subcontractor for arranging cooperation with international partners and project information dissemination, as well as composing the consortium agreement and other legal issues. The business impact of this project to existing markets is estimated to be substantial and it will also create totally new markets especially for weather information related services. The existing whole target market size at this point is estimated to be several billion USD and the size of the market is growing steadily. The key CITYZER outcomes are the piloted services and products with envisaged great commercial and export potential. Development of the services will be managed by INNO-W supported by Sasken, Emtele, Pegasor and Vaisala. The user profiling and market assessment, including Asia and South America, will be led by Haaga-Helia supported by INNO-W and Sasken. FMI, Vaisala and Pegasor will use their expertise and current business relations to those foreign markets to speed up and guide the user and market evaluation. Essential potential players are local business school teams in Brazil and India that will be subcontracted to bring in local expertise in the user profiling and market assessment processes. This three year project is scheduled such that, overall, the first two years focus on implementing the technical basis as well as customer and market analyses. Throughout the course of the project a CityzerDemo environment will be developed in the Helsinki metropolitan area, demonstrating the observational and modeling system and services built on them. In addition, the services and business models will be evaluated. Acknowledgements The project has received funding from TEKES, the Finnish Funding Agency for Innovation. References [1] http://mmea.fi/ [2] http://edhit.eu/ [3] http://www.vaisala.com/en/products/metdatamanagementsystems/Pages/NM10.aspx

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients' Perspective.

PubMed

Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid

2016-03-01

The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (-0.88) and responsiveness (-0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. There were gaps between the patients' perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time.

Quality models for audiovisual streaming

NASA Astrophysics Data System (ADS)

Thang, Truong Cong; Kim, Young Suk; Kim, Cheon Seog; Ro, Yong Man

2006-01-01

Quality is an essential factor in multimedia communication, especially in compression and adaptation. Quality metrics can be divided into three categories: within-modality quality, cross-modality quality, and multi-modality quality. Most research has so far focused on within-modality quality. Moreover, quality is normally just considered from the perceptual perspective. In practice, content may be drastically adapted, even converted to another modality. In this case, we should consider the quality from semantic perspective as well. In this work, we investigate the multi-modality quality from the semantic perspective. To model the semantic quality, we apply the concept of "conceptual graph", which consists of semantic nodes and relations between the nodes. As an typical of multi-modality example, we focus on audiovisual streaming service. Specifically, we evaluate the amount of information conveyed by a audiovisual content where both video and audio channels may be strongly degraded, even audio are converted to text. In the experiments, we also consider the perceptual quality model of audiovisual content, so as to see the difference with semantic quality model.

Measuring nursing home resident satisfaction with food and food service: initial testing of the FoodEx-LTC.

PubMed

Crogan, Neva L; Evans, Bronwynne; Velasquez, Donna

2004-04-01

Malnutrition impacts the quality of life and general health of many older persons living in our nation's 20,000 nursing homes (1). Despite the urgency of this issue, no instrument that measures resident satisfaction with food and food service was found in an extensive literature search. The purpose of this article is to describe the development and initial testing of a resident satisfaction with food and food service questionnaire (FoodEx-LTC) in the context of the Quality Nutrition Outcomes-Long-Term Care Model. This pilot study was conducted in two phases. During phase one the instrument was developed, peer-reviewed, and pretested. Phase two further tested the instrument using a correlational design, measuring both intermediate and long-term outcomes found on the Quality Nutrition Outcomes-Long-Term Care Model. Hypothesis testing was used to measure construct validity. 4 of 5 FoodEx-LTC domains were significantly correlated with depression, 2 of 5 with serum albumin. The FoodEx-LTC demonstrates acceptable reliability for a new instrument. The coefficient alpha scores ranged from.69-.87 and test-retest correlations ranged from.55-.89, dependent upon domain. FoodEx-LTC appears to be a valid and reliable measure of resident food and food service satisfaction in nursing homes. This line of inquiry is of great importance because perceived quality of food and food service are strongly related to quality of life for residents in nursing homes, and adequate food intake is integral to maintaining weight and preventing protein-calorie malnutrition among elderly residents.

Contribution of ecosystem services to air quality and climate change mitigation policies: the case of urban forests in Barcelona, Spain.

PubMed

Baró, Francesc; Chaparro, Lydia; Gómez-Baggethun, Erik; Langemeyer, Johannes; Nowak, David J; Terradas, Jaume

2014-05-01

Mounting research highlights the contribution of ecosystem services provided by urban forests to quality of life in cities, yet these services are rarely explicitly considered in environmental policy targets. We quantify regulating services provided by urban forests and evaluate their contribution to comply with policy targets of air quality and climate change mitigation in the municipality of Barcelona, Spain. We apply the i-Tree Eco model to quantify in biophysical and monetary terms the ecosystem services "air purification," "global climate regulation," and the ecosystem disservice "air pollution" associated with biogenic emissions. Our results show that the contribution of urban forests regulating services to abate pollution is substantial in absolute terms, yet modest when compared to overall city levels of air pollution and GHG emissions. We conclude that in order to be effective, green infrastructure-based efforts to offset urban pollution at the municipal level have to be coordinated with territorial policies at broader spatial scales.

Improving the quality of care for mild to moderate dementia: an evaluation of the Croydon Memory Service Model.

PubMed

Banerjee, Sube; Willis, Rosalind; Matthews, David; Contell, Faith; Chan, Jeni; Murray, Joanna

2007-08-01

The large majority of people with dementia receive nothing in the way of specialist assessment and care at any stage of their illness. There is a particular lack of services focussed on early identification and intervention in dementia where there is the possibility of long-term harm reduction for people with dementia and their family carers. We have developed a model of care that is complementary to local systems of health and social care (The Croydon Memory Service Model [CMSM]). This is a low-cost, high-throughput, generic service to enable early identification and intervention in dementia. It is a multi-agency approach with joint ownership by health services, social services and the voluntary sector with embedded specifically-tailored approaches to primary care and minority ethnic communities. We completed a service evaluation of the introduction of the CMSM in a single borough in South London. Six predefined service goals were set: high acceptability; high appropriate referral rate; successful engagement with people from minority ethnic groups; successful engagement with people with young onset dementia; focus on engagement with mild cases to enable early intervention; and an increase in the overall number of new cases of dementia seen. Mixed qualitative and quantitative methodologies were used including a description and 6-month follow-up of a cohort of 290 consecutive referrals. All key predefined service goals were met: 95% acceptability; 94% appropriate referrals; successful engagement with minority ethnic groups (two-fold greater number compared with that expected from general population demographic data); 17% of referrals under 65 years of age; 68% referrals with mild or minimal dementia severity; and an estimated 63% increase in the number of new cases of dementia seen in Croydon. At 6-month follow up, those referred to the service had decreased behavioural disturbance and increased quality of life compared with baseline. Specific services for early dementia, which deliver diagnosis and care, can be established. These services can increase the numbers of people with early dementia identified and provided with care. Those receiving such services appear to improve in terms of quality of life and behavioural and psychological symptoms of dementia. Next steps should include the establishment of such services in other representative areas and evaluation of their effectiveness in comparison with other models of care.

The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study.

PubMed

Roche, Tina E; Gardner, Glenn; Jack, Leanne

2017-06-27

Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities. This study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care. The median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models. There was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations. Australian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).

Using creative problem solving (TRIZ) in improving the quality of hospital services.

PubMed

LariSemnani, Behrouz; Mohebbi Far, Rafat; Shalipoor, Elham; Mohseni, Mohammad

2014-08-14

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients' expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients' satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ' needs.

The Lindsay Leg Club: supporting the NHS to provide leg ulcer care.

PubMed

McKenzie, Morag

2013-06-01

Public health services will need to cope with additional demands due to an ageing society and the increasing prevalence of chronic conditions. Lower-limb ulceration is a long-term, life-changing condition and leg ulcer management can be challenging for nursing staff. The Lindsay Leg Club model is a unique partnership between community nurses, members and the local community, which provides quality of care and empowerment for patients with leg ulcers, while also supporting and educating nursing staff. The Leg Club model works in accord with core themes of Government and NHS policy. Patient feedback on the Leg Club model is positive and the Leg Clubs provide a service to members which is well accepted by patients, yet is more economically efficient than the traditional district nursing practice of home visits. Lindsay Leg Clubs provide a valuable support service to the NHS in delivering improved quality of care while improving efficiency.

Monitoring Quality Across Home Visiting Models: A Field Test of Michigan's Home Visiting Quality Assurance System.

PubMed

Heany, Julia; Torres, Jennifer; Zagar, Cynthia; Kostelec, Tiffany

2018-06-05

Introduction In order to achieve the positive outcomes with parents and children demonstrated by many home visiting models, home visiting services must be well implemented. The Michigan Home Visiting Initiative developed a tool and procedure for monitoring implementation quality across models referred to as Michigan's Home Visiting Quality Assurance System (MHVQAS). This study field tested the MHVQAS. This article focuses on one of the study's evaluation questions: Can the MHVQAS be applied across models? Methods Eight local implementing agencies (LIAs) from four home visiting models (Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Maternal Infant Health Program) and five reviewers participated in the study by completing site visits, tracking their time and costs, and completing surveys about the process. LIAs also submitted their most recent review by their model developer. The researchers conducted participant observation of the review process. Results Ratings on the MHVQAS were not significantly different between models. There were some differences in interrater reliability and perceived reliability between models. There were no significant differences between models in perceived validity, satisfaction with the review process, or cost to participate. Observational data suggested that cross-model applicability could be improved by assisting sites in relating the requirements of the tool to the specifics of their model. Discussion The MHVQAS shows promise as a tool and process to monitor implementation quality of home visiting services across models. The results of the study will be used to make improvements before the MHVQAS is used in practice.

APOLLO: a quality assessment service for single and multiple protein models.

PubMed

Wang, Zheng; Eickholt, Jesse; Cheng, Jianlin

2011-06-15

We built a web server named APOLLO, which can evaluate the absolute global and local qualities of a single protein model using machine learning methods or the global and local qualities of a pool of models using a pair-wise comparison approach. Based on our evaluations on 107 CASP9 (Critical Assessment of Techniques for Protein Structure Prediction) targets, the predicted quality scores generated from our machine learning and pair-wise methods have an average per-target correlation of 0.671 and 0.917, respectively, with the true model quality scores. Based on our test on 92 CASP9 targets, our predicted absolute local qualities have an average difference of 2.60 Å with the actual distances to native structure. http://sysbio.rnet.missouri.edu/apollo/. Single and pair-wise global quality assessment software is also available at the site.

Officer Career Development: A Review of the Civilian and Military Research Literature on Turnover and Retention

DTIC Science & Technology

1991-09-01

balance of costs associated with turnover and the costs associated with retaining employees. Under this approach, the optimal level of aggregate turnover...behavior psychiatric technicians psychological attachment push/pull models quality of life quality of service quality of worklife questionnaires race

ISO 9000 Quality Systems: Application to Higher Education.

ERIC Educational Resources Information Center

Clery, Roger G.

This paper describes and explains the 20 elements of the International Organization for Standards 9000 (ISO 9000) series, a model for quality assurance in the business processes of design/development, production, installation and servicing. The standards were designed in 1987 to provide a common denominator for business quality particularly to…

Examining visitors' behavioral intentions and behaviors in a Taiwan National Park

Treesearch

Chieh-Lu Li; Garry E. Chick

2011-01-01

In 2007-2008, some visitors to Taroko National Park in Taiwan were surveyed to allow testing of a behavioral prediction model in the context of national park recreation. This model includes three constructs: values (a cultural anthropology factor), perceptions of service quality (service marketing factors), and perceptions of crowding (a national park recreation factor...

External quality assurance for HIV point-of-care testing in Africa: A collaborative country-partner approach to strengthen diagnostic services

PubMed Central

2016-01-01

It is important to consider the role of diagnostics and the critical need for quality diagnostics services in resource-limited settings. Accurate diagnostic tests play a key role in patient management and the prevention and control of most infectious diseases. As countries plan for implementation of HIV early infant diagnosis and viral load point-of-care testing, the London School of Hygiene & Tropical Medicine has worked with countries and partners with an interest in external quality assurance to support quality point-of-care testing on the continent. Through a series of collaborative consultations and workshops, the London School of Hygiene & Tropical Medicine has gathered lessons learned, tools, and resources and developed quality assurance models that will support point-of-care testing. The London School of Hygiene & Tropical Medicine is committed to the continued advancement of laboratory diagnostics in Africa and quality laboratory services and point-of-care testing. PMID:28879132

Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

PubMed

McLawhorn, Alexander S; Buller, Leonard T

2017-09-01

The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

Remote sensing, geographical information systems, and spatial modeling for analyzing public transit services

NASA Astrophysics Data System (ADS)

Wu, Changshan

Public transit service is a promising transportation mode because of its potential to address urban sustainability. Current ridership of public transit, however, is very low in most urban regions, particularly those in the United States. This woeful transit ridership can be attributed to many factors, among which poor service quality is key. Given this, there is a need for transit planning and analysis to improve service quality. Traditionally, spatially aggregate data are utilized in transit analysis and planning. Examples include data associated with the census, zip codes, states, etc. Few studies, however, address the influences of spatially aggregate data on transit planning results. In this research, previous studies in transit planning that use spatially aggregate data are reviewed. Next, problems associated with the utilization of aggregate data, the so-called modifiable areal unit problem (MAUP), are detailed and the need for fine resolution data to support public transit planning is argued. Fine resolution data is generated using intelligent interpolation techniques with the help of remote sensing imagery. In particular, impervious surface fraction, an important socio-economic indicator, is estimated through a fully constrained linear spectral mixture model using Landsat Enhanced Thematic Mapper Plus (ETM+) data within the metropolitan area of Columbus, Ohio in the United States. Four endmembers, low albedo, high albedo, vegetation, and soil are selected to model heterogeneous urban land cover. Impervious surface fraction is estimated by analyzing low and high albedo endmembers. With the derived impervious surface fraction, three spatial interpolation methods, spatial regression, dasymetric mapping, and cokriging, are developed to interpolate detailed population density. Results suggest that cokriging applied to impervious surface is a better alternative for estimating fine resolution population density. With the derived fine resolution data, a multiple route maximal covering/shortest path (MRMCSP) model is proposed to address the tradeoff between public transit service quality and access coverage in an established bus-based transit system. Results show that it is possible to improve current transit service quality by eliminating redundant or underutilized service stops. This research illustrates that fine resolution data can be efficiently generated to support urban planning, management and analysis. Further, this detailed data may necessitate the development of new spatial optimization models for use in analysis.

Quality assessment of Isfahan Medical Faculty web site electronic services and prioritizing solutions using analytic hierarchy process approach

PubMed Central

Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Hajrahimi, Nargess; Sarmadi, Sima

2014-01-01

Context: Implementing information technology in the best possible way can bring many advantages such as applying electronic services and facilitating tasks. Therefore, assessment of service providing systems is a way to improve the quality and elevate these systems including e-commerce, e-government, e-banking, and e-learning. Aims: This study was aimed to evaluate the electronic services in the website of Isfahan University of Medical Sciences in order to propose solutions to improve them. Furthermore, we aim to rank the solutions based on the factors that enhance the quality of electronic services by using analytic hierarchy process (AHP) method. Materials and Methods: Non-parametric test was used to assess the quality of electronic services. The assessment of propositions was based on Aqual model and they were prioritized using AHP approach. The AHP approach was used because it directly applies experts’ deductions in the model, and lead to more objective results in the analysis and prioritizing the risks. After evaluating the quality of the electronic services, a multi-criteria decision making frame-work was used to prioritize the proposed solutions. Statistical Analysis Used: Non-parametric tests and AHP approach using Expert Choice software. Results: The results showed that students were satisfied in most of the indicators. Only a few indicators received low satisfaction from students including, design attractiveness, the amount of explanation and details of information, honesty and responsiveness of authorities, and the role of e-services in the user's relationship with university. After interviewing with Information and Communications Technology (ICT) experts at the university, measurement criteria, and solutions to improve the quality were collected. The best solutions were selected by EC software. According to the results, the solution “controlling and improving the process in handling users complaints” is of the utmost importance and authorities have to have it on the website and place great importance on updating this process. Conclusions: Although, 4 out of the 22 indicators used in the test hypothesis were not confirmed, the results show that these assumptions are accepted at 95% confidence level. To improve the quality of electronic services, special attention should be paid to “services interaction.” As the results showed having “controlling and improving the process in handling users complaints” on the website is the first and most important one and the process of “changing brand/factory name/address in the text of the factory license/renewal or modification of manufacturing license/changing the formula” is the least important one. PMID:25540790

Quality assessment of Isfahan Medical Faculty web site electronic services and prioritizing solutions using analytic hierarchy process approach.

PubMed

Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Hajrahimi, Nargess; Sarmadi, Sima

2014-01-01

Implementing information technology in the best possible way can bring many advantages such as applying electronic services and facilitating tasks. Therefore, assessment of service providing systems is a way to improve the quality and elevate these systems including e-commerce, e-government, e-banking, and e-learning. This study was aimed to evaluate the electronic services in the website of Isfahan University of Medical Sciences in order to propose solutions to improve them. Furthermore, we aim to rank the solutions based on the factors that enhance the quality of electronic services by using analytic hierarchy process (AHP) method. Non-parametric test was used to assess the quality of electronic services. The assessment of propositions was based on Aqual model and they were prioritized using AHP approach. The AHP approach was used because it directly applies experts' deductions in the model, and lead to more objective results in the analysis and prioritizing the risks. After evaluating the quality of the electronic services, a multi-criteria decision making frame-work was used to prioritize the proposed solutions. Non-parametric tests and AHP approach using Expert Choice software. The results showed that students were satisfied in most of the indicators. Only a few indicators received low satisfaction from students including, design attractiveness, the amount of explanation and details of information, honesty and responsiveness of authorities, and the role of e-services in the user's relationship with university. After interviewing with Information and Communications Technology (ICT) experts at the university, measurement criteria, and solutions to improve the quality were collected. The best solutions were selected by EC software. According to the results, the solution "controlling and improving the process in handling users complaints" is of the utmost importance and authorities have to have it on the website and place great importance on updating this process. Although, 4 out of the 22 indicators used in the test hypothesis were not confirmed, the results show that these assumptions are accepted at 95% confidence level. To improve the quality of electronic services, special attention should be paid to "services interaction." As the results showed having "controlling and improving the process in handling users complaints" on the website is the first and most important one and the process of "changing brand/factory name/address in the text of the factory license/renewal or modification of manufacturing license/changing the formula" is the least important one.

Information system success model for customer relationship management system in health promotion centers.

PubMed

Choi, Wona; Rho, Mi Jung; Park, Jiyun; Kim, Kwang-Jum; Kwon, Young Dae; Choi, In Young

2013-06-01

Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model. THE EVALUATION AREAS OF THE CRM SYSTEM INCLUDES THREE AREAS: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible. Information quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance. This study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems.

Information System Success Model for Customer Relationship Management System in Health Promotion Centers

PubMed Central

Choi, Wona; Rho, Mi Jung; Park, Jiyun; Kim, Kwang-Jum; Kwon, Young Dae

2013-01-01

Objectives Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model. Methods The evaluation areas of the CRM system includes three areas: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible. Results Information quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance. Conclusions This study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems. PMID:23882416

Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long‐term care institution residents

PubMed Central

Lin, Jesun; Hsiao, Chih‐Tung; Glen, Robert; Pai, Jar‐Yuan; Zeng, Sin‐Huei

2012-01-01

Abstract Objective  To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long‐term care institutions. Design  The five‐point Likert scale questionnaire administered through facetoface interviews. Setting  Fourteen long‐term care institutions located in central and southern Taiwan stratified according to services and accommodation population. Participants  One hundred and eighty long‐term institutional care residents. Main outcome measures  Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). Results  Student’s t‐test on institutional location shows a significant difference between overall satisfaction for central and southern institution long‐term care recipients. The correlation test revealed that the higher a resident’s level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index‐of‐model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long‐term care institutions, is also an important factor in residents’ overall satisfaction. Conclusion  The primary goal of long‐term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost‐effective but high‐quality care. On the basis of the results of in‐depth interviews with long‐term institutional care residents, this study suggests long‐term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents. PMID:22429448

The Oregon Quality Education Model Applied to Schools Characterized by Low Student Enrollment, Sparse Distribution of Students, and Remote Settings with Findings Relating to Equity of Services. White Paper.

ERIC Educational Resources Information Center

Hill, Jonathan

The Oregon Quality Education Model (QEM) was developed by the state to identify the fundamental requirements and costs for a quality education that meets Oregon's academic standards. It will determine the funding of Oregon schools. Among the assumptions upon which the QEM is built were that elementary school enrollment is 340 students, middle…

Modelling home televisiting services using systems dynamic theory.

PubMed

Valero, M A; Arredondo, M T; del Nogal, F; Gallar, P; Insausti, J; Del Pozo, F

2001-01-01

A quantitative model was developed to study the provision of a home televisiting service. Systems dynamic theory was used to describe the relationships between quality of care, accessibility and cost-effectiveness. Input information was gathered from the telemedicine literature, as well as from over 75 sessions of a televisiting service provided by the Severo Ochoa Hospital to 18 housebound patients from three different medical specialties. The model allowed the Severo Ochoa Hospital to estimate the equipment needed to support increased medical contacts for intensive cardiac and other patients.

Scenarios reveal pathways to sustain future ecosystem services in an agricultural landscape.

PubMed

Qiu, Jiangxiao; Carpenter, Stephen R; Booth, Eric G; Motew, Melissa; Zipper, Samuel C; Kucharik, Christopher J; Chen, Xi; Loheide, Steven P; Seifert, Jenny; Turner, Monica G

2018-01-01

Sustaining food production, water quality, soil retention, flood, and climate regulation in agricultural landscapes is a pressing global challenge given accelerating environmental changes. Scenarios are stories about plausible futures, and scenarios can be integrated with biophysical simulation models to explore quantitatively how the future might unfold. However, few studies have incorporated a wide range of drivers (e.g., climate, land-use, management, population, human diet) in spatially explicit, process-based models to investigate spatial-temporal dynamics and relationships of a portfolio of ecosystem services. Here, we simulated nine ecosystem services (three provisioning and six regulating services) at 220 × 220 m from 2010 to 2070 under four contrasting scenarios in the 1,345-km 2 Yahara Watershed (Wisconsin, USA) using Agro-IBIS, a dynamic model of terrestrial ecosystem processes, biogeochemistry, water, and energy balance. We asked (1) How does ecosystem service supply vary among alternative future scenarios? (2) Where on the landscape is the provision of ecosystem services most susceptible to future social-ecological changes? (3) Among alternative future scenarios, are relationships (i.e., trade-offs, synergies) among food production, water, and biogeochemical services consistent over time? Our results showed that food production varied substantially with future land-use choices and management, and its trade-offs with water quality and soil retention persisted under most scenarios. However, pathways to mitigate or even reverse such trade-offs through technological advances and sustainable agricultural practices were apparent. Consistent relationships among regulating services were identified across scenarios (e.g., trade-offs of freshwater supply vs. flood and climate regulation, and synergies among water quality, soil retention, and climate regulation), suggesting opportunities and challenges to sustaining these services. In particular, proactive land-use changes and management may buffer water quality against undesirable future climate changes, but changing climate may overwhelm management efforts to sustain freshwater supply and flood regulation. Spatially, changes in ecosystem services were heterogeneous across the landscape, underscoring the power of local actions and fine-scale management. Our research highlights the value of embracing spatial and temporal perspectives in managing ecosystem services and their complex interactions, and provides a system-level understanding for achieving sustainability of the food-water-climate nexus in agricultural landscapes. © 2017 by the Ecological Society of America.

Differentiated optical services: a quality of optical service model for WDM networks

NASA Astrophysics Data System (ADS)

Ndousse, Thomas D.; Golmie, Nada

1999-08-01

This paper addresses the issues of guaranteed and scalable end-to-end QoS in Metropolitan DWDM networks serving as transit networks for IP access networks. DWDM offering few wavelengths have in the past been deployed in backbone networks to upgrade point-to-point transmission where sharing is based on coarse granularity. This type of DWDM backbone networks, offering few lightpaths, provides no support for QoS services traversing the network. As DWDM networks with larger numbers of wavelengths penetrate the data-centric Metro environment, specific IP service requirements such as priority restoration, scalability, dynamic provisioning of capacity and routes, and support for coarse-grain QoS capabilities will have to be addressed in the optical domain in order to support end-to-end Service- Level Agreements. In this paper, we focus on the support of QoS in the optical domain in order to achieve end-to-end QoS over a DWDM network. We propose a QoS service model in the optical domain called Differentiated Optical Services (DOS). Service classification in DOS is based on a set of optical parameters that captures the quality and reliability of the optical lightpath.

How to Improve Quality If You're Not in Manufacturing.

ERIC Educational Resources Information Center

Johnson, Gary K.; Dumas, Roland A.

1992-01-01

Discusses the problems of applying quality methods to jobs that are not directly involved with manufacturing such as sales, merchandising, law, health care, accounting, and food service. Presents a model for nonmanufacturing organizations. (JOW)

The Quality Adaptation Model: Adaptation and Adoption of the Quality Standard ISO/IEC 19796-1 for Learning, Education, and Training

ERIC Educational Resources Information Center

Pawlowski, Jan M.

2007-01-01

In 2005, the new quality standard for learning, education, and training, ISO/IEC 19796-1, was published. Its purpose is to help educational organizations to develop quality systems and to improve the quality of their processes, products, and services. In this article, the standard is presented and compared to existing approaches, showing the…

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

PubMed

Wheeler, Claire; Lloyd-Evans, Brynmor; Churchard, Alasdair; Fitzgerald, Caroline; Fullarton, Kate; Mosse, Liberty; Paterson, Bethan; Zugaro, Clementina Galli; Johnson, Sonia

2015-04-08

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs. A systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders' views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies. Sixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs' ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training. We cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders' views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable. Prospero CRD42013006415 .

Plate versus bulk trolley food service in a hospital: comparison of patients' satisfaction.

PubMed

Hartwell, Heather J; Edwards, John S A; Beavis, John

2007-03-01

The aim of this research was to compare plate with bulk trolley food service in hospitals in terms of patient satisfaction. Key factors distinguishing satisfaction with each system would also be identified. A consumer opinion card (n = 180), concentrating on the quality indicators of core foods, was used to measure patient satisfaction and compare two systems of delivery, plate and trolley. Binary logistic regression analysis was used to build a model that would predict food service style on the basis of the food attributes measured. Further investigation used multinomial logistic regression to predict opinion for the assessment of each food attribute within food service style. Results showed that the bulk trolley method of food distribution enables all foods to have a more acceptable texture, and for some foods (potato, P = 0.007; poached fish, P = 0.001; and minced beef, P < or = 0.0005) temperature, and for other foods (broccoli, P < or = 0.0005; carrots, P < or = 0.0005; and poached fish, P = 0.001) flavor, than the plate system of delivery, where flavor is associated with bad opinion or dissatisfaction. A model was built indicating patient satisfaction with the two service systems. This research confirms that patient satisfaction is enhanced by choice at the point of consumption (trolley system); however, portion size was not the controlling dimension. Temperature and texture were the most important attributes that measure patient satisfaction with food, thus defining the focus for hospital food service managers. To date, a model predicting patient satisfaction with the quality of food as served has not been proposed, and as such this work adds to the body of knowledge in this field. This report brings new information about the service style of dishes for improving the quality of food and thus enhancing patient satisfaction.

Manpower Mix for Health Services

PubMed Central

Shuman, Larry J.; Young, John P.; Naddor, Eliezer

1971-01-01

A model is formulated to determine the mix of manpower and technology needed to provide health services of acceptable quality at a minimum total cost to the community. Total costs include both the direct costs associated with providing the services and with developing additional manpower and the indirect costs (shortage costs) resulting from not providing needed services. The model is applied to a hypothetical neighborhood health center, and its sensitivity to alternative policies is investigated by cost-benefit analyses. Possible extensions of the model to include dynamic elements in health delivery systems are discussed, as is its adaptation for use in hospital planning, with a changed objective function. PMID:5095652

Importance of relationship quality and communication on foodservice for the elderly.

PubMed

Seo, Sunhee; Back, Ki Joon; Shanklin, Carol W

2011-02-01

In order to promote foodservice for the elderly, foodservice managers in Continuing Care Retirement Communities (CCRCs) must identify the main factors to enhance the satisfaction and behavioral intentions with food service. The purpose of this study was to investigate the relationships between relationship quality (consisting of trust, commitment, and satisfaction) and communication in the formation of elderly's behavioral intentions with food services at CCRCs. A survey was administered to residents in two CCRCs and a total of 327 residents participated. A tested structural equation model exhibited good model fit and explanatory power of the study construct. Satisfaction directly influenced word-of-mouth and service quality has an influence on commitment. Commitment was a significant determinant of behavioral intentions to eat more often in the dining room. Also, communication showed positive association with trust. The results provided strong evidence for the importance of satisfaction and communication as a consequence of relationship marketing efforts. Suggestions for future research to better understand the elderly' behavioral intention judgments were given.

Importance of relationship quality and communication on foodservice for the elderly

PubMed Central

Back, Ki Joon; Shanklin, Carol W.

2011-01-01

In order to promote foodservice for the elderly, foodservice managers in Continuing Care Retirement Communities (CCRCs) must identify the main factors to enhance the satisfaction and behavioral intentions with food service. The purpose of this study was to investigate the relationships between relationship quality (consisting of trust, commitment, and satisfaction) and communication in the formation of elderly's behavioral intentions with food services at CCRCs. A survey was administered to residents in two CCRCs and a total of 327 residents participated. A tested structural equation model exhibited good model fit and explanatory power of the study construct. Satisfaction directly influenced word-of-mouth and service quality has an influence on commitment. Commitment was a significant determinant of behavioral intentions to eat more often in the dining room. Also, communication showed positive association with trust. The results provided strong evidence for the importance of satisfaction and communication as a consequence of relationship marketing efforts. Suggestions for future research to better understand the elderly' behavioral intention judgments were given. PMID:21487500

Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

PubMed

Bansal, Manjit K

2004-01-01

Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

Improving Aboriginal maternal and infant health services in the 'Top End' of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change.

PubMed

Barclay, Lesley; Kruske, Sue; Bar-Zeev, Sarah; Steenkamp, Malinda; Josif, Cathryn; Narjic, Concepta Wulili; Wardaguga, Molly; Belton, Suzanne; Gao, Yu; Dunbar, Terry; Kildea, Sue

2014-06-02

Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of 'out of hospital' or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the required skills for providing care for infants, and an 'outpatient' model of care. Services were also characterised by absent Aboriginal leadership and inadequate coordination between remote and tertiary services that is essential to improve quality of care and reduce 'system-introduced' risk. Evidence-informed redesign of maternity services and delivery of care has improved clinical effectiveness and quality for women. However, more work is needed to address substandard care provided for infants and their parents.

Rehabilitation service models for people with physical and/or mental disability living in low- and middle-income countries: A systematic review.

PubMed

Furlan, Andréa D; Irvin, Emma; Munhall, Claire; Giraldo-Prieto, Mario; Fullerton, Laura; McMaster, Robert; Danak, Shivang; Costante, Alicia; Pitzul, Kristen B; Bhide, Rohit P; Marchenko, Stanislav; Mahood, Quenby; David, Judy A; Flannery, John F; Bayley, Mark

2018-04-03

To compare models of rehabilitation services for people with mental and/or physical disability in order to determine optimal models for therapy and interventions in low- to middle-income countries. CINAHL, EMBASE, MEDLINE, CENTRAL, PsycINFO, Business Source Premier, HINARI, CEBHA and PubMed. Systematic reviews, randomized control trials and observational studies comparing >2 models of rehabilitation care in any language. Date extraction: Standardized forms were used. Methodological quality was assessed using AMSTAR and quality of evidence was assessed using GRADE. Twenty-four systematic reviews which included 578 studies and 202,307 participants were selected. In addition, four primary studies were included to complement the gaps in the systematic reviews. The studies were all done at various countries. Moderate- to high-quality evidence supports the following models of rehabilitation services: psychological intervention in primary care settings for people with major depression, admission into an inpatient, multidisciplinary, specialized rehabilitation unit for those with recent onset of a severe disabling condition; outpatient rehabilitation with multidisciplinary care in the community, hospital or home is recommended for less severe conditions; However, a model of rehabilitation service that includes early discharge is not recommended for elderly patients with severe stroke, chronic obstructive pulmonary disease, hip fracture and total joints. Models of rehabilitation care in inpatient, multidisciplinary and specialized rehabilitation units are recommended for the treatment of severe conditions with recent onset, as they reduce mortality and the need for institutionalized care, especially among elderly patients, stroke patients, or those with chronic back pain. Results are expected to be generalizable for brain/spinal cord injury and complex fractures.

Modeling work of the dispatching service of high-rise building as queuing system

NASA Astrophysics Data System (ADS)

Dement'eva, Marina; Dement'eva, Anastasiya

2018-03-01

The article presents the results of calculating the performance indicators of the dispatcher service of a high-rise building as a queuing system with an unlimited queue. The calculation was carried out for three models: with a single control room and brigade of service, with a single control room and a specialized service, with several dispatch centers and specialized services. The aim of the work was to investigate the influence of the structural scheme of the organization of the dispatcher service of a high-rise building on the amount of operating costs and the time of processing and fulfilling applications. The problems of high-rise construction and their impact on the complication of exploitation are analyzed. The composition of exploitation activities of high-rise buildings is analyzed. The relevance of the study is justified by the need to review the role of dispatch services in the structure of management of the quality of buildings. Dispatching service from the lower level of management of individual engineering systems becomes the main link in the centralized automated management of the exploitation of high-rise buildings. With the transition to market relations, the criterion of profitability at the organization of the dispatching service becomes one of the main parameters of the effectiveness of its work. A mathematical model for assessing the efficiency of the dispatching service on a set of quality of service indicators is proposed. The structure of operating costs is presented. The algorithm of decision-making is given when choosing the optimal structural scheme of the dispatching service of a high-rise building.

An integrative fuzzy Kansei engineering and Kano model for logistics services

NASA Astrophysics Data System (ADS)

Hartono, M.; Chuan, T. K.; Prayogo, D. N.; Santoso, A.

2017-11-01

Nowadays, customer emotional needs (known as Kansei) in product and especially in services become a major concern. One of the emerging services is the logistics services. In obtaining a global competitive advantage, logistics services should understand and satisfy their customer affective impressions (Kansei). How to capture, model and analyze the customer emotions has been well structured by Kansei Engineering, equipped with Kano model to strengthen its methodology. However, its methodology lacks of the dynamics of customer perception. More specifically, there is a criticism of perceived scores on user preferences, in both perceived service quality and Kansei response, whether they represent an exact numerical value. Thus, this paper is proposed to discuss an approach of fuzzy Kansei in logistics service experiences. A case study in IT-based logistics services involving 100 subjects has been conducted. Its findings including the service gaps accompanied with prioritized improvement initiatives are discussed.

Technology Transfer of the Air Quality Assessment Model.

DTIC Science & Technology

1984-02-01

i T I, _______ ENGINEERING & SERVICES LABORATORY AIR FORCE ENGINEERING & SERVICES CENTER TYNOALL AIR FORCE BASE. FLORIDA 32403 OTIC FILE CO84 03...30 015 NOTICE PLEASE DO NOT REQUEST COPIES OF THIS REPORT FRO(M HQ AFESC./RD ( ENGINEERING AND SERVICES LABORATORY). ADDITONAL COPIES MAY BE PURCHASED...report was prepared by the Air Force Engineering and Services Center, Engineering and Services Laboratory, (AFESC/ RDV) Tyndall AFB, FL. This report

A quality function deployment framework for the service quality of health information websites.

PubMed

Chang, Hyejung; Kim, Dohoon

2010-03-01

This research was conducted to identify both the users' service requirements on health information websites (HIWs) and the key functional elements for running HIWs. With the quality function deployment framework, the derived service attributes (SAs) are mapped into the suppliers' functional characteristics (FCs) to derive the most critical FCs for the users' satisfaction. Using the survey data from 228 respondents, the SAs, FCs and their relationships were analyzed using various multivariate statistical methods such as principal component factor analysis, discriminant analysis, correlation analysis, etc. Simple and compound FC priorities were derived by matrix calculation. Nine factors of SAs and five key features of FCs were identified, and these served as the basis for the house of quality model. Based on the compound FC priorities, the functional elements pertaining to security and privacy, and usage support should receive top priority in the course of enhancing HIWs. The quality function deployment framework can improve the FCs of the HIWs in an effective, structured manner, and it can also be utilized for critical success factors together with their strategic implications for enhancing the service quality of HIWs. Therefore, website managers could efficiently improve website operations by considering this study's results.

The impact of primary care reform on health system performance in Canada: a systematic review.

PubMed

Carter, Renee; Riverin, Bruno; Levesque, Jean-Frédéric; Gariepy, Geneviève; Quesnel-Vallée, Amélie

2016-07-30

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

Comparing consumer-directed and agency models for providing supportive services at home.

PubMed

Benjamin, A E; Matthias, R; Franke, T M

2000-04-01

To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. A survey of a random sample of 1,095 clients, age 18 and over, who receive services in California's In-Home Supportive Services (IHSS) program funded primarily by Medicaid. Other data were obtained from the California Management and Payrolling System (CMIPS). The sample was stratified by service model (agency-directed or consumer-directed), client age (over or under age 65), and severity. Data were collected on client demographics, condition/functional status, and supportive service experience. Outcome measures were developed in three areas: safety, unmet need, and service satisfaction. Factor analysis was used to reduce multiple outcome measures to nine dimensions. Multiple regression analysis was used to assess the effect of service model on each outcome dimension, taking into account the client-provider relationship, client demographics, and case mix. Recipients of IHSS services as of mid-1996 were interviewed by telephone. The survey was conducted in late 1996 and early 1997. On various outcomes, recipients in the consumer-directed model report more positive outcomes than those in the agency model, or they report no difference. Statistically significant differences emerge on recipient safety, unmet needs, and service satisfaction. A family member present as a paid provider is also associated with more positive reported outcomes within the consumer-directed model, but model differences persist even when this is taken into account. Although both models have strengths and weaknesses, from a recipient perspective the consumer-directed model is associated with more positive outcomes. Although health professionals have expressed concerns about the capacity of consumer direction to assure quality, particularly with respect to safety, meeting unmet needs, and technical quality, our findings suggest that the consumer-directed service model is a viable alternative to the agency model. Because public programs are under growing pressure to address the long-term care needs of low-income people of all ages with disabilities, the Medicaid personal assistance benefit needs to be reassessed in light of these findings. Consumer-directed models may offer a less elaborate and possibly less costly option for organizing supportive services at home. Study limitations may limit the generalizability of these findings. This was a natural experiment, in which only some counties offered both service models and counties assigned recipients to a service model. The use of a telephone survey excluded important recipient subsets, notably people with severe cognitive impairments. A more definitive study would include direct observations as well as survey approaches.

Model parameters for representative wetland plant functional groups

USDA-ARS?s Scientific Manuscript database

Wetlands provide a wide variety of ecosystem services including water quality remediation, biodiversity refugia, groundwater recharge, and floodwater storage. Realistic estimation of ecosystem service benefits associated with wetlands requires reasonable simulation of the hydrology of each site and...

Context-aware workflow management of mobile health applications.

PubMed

Salden, Alfons; Poortinga, Remco

2006-01-01

We propose a medical application management architecture that allows medical (IT) experts readily designing, developing and deploying context-aware mobile health (m-health) applications or services. In particular, we elaborate on how our application workflow management architecture enables chaining, coordinating, composing, and adapting context-sensitive medical application components such that critical Quality of Service (QoS) and Quality of Context (QoC) requirements typical for m-health applications or services can be met. This functional architectural support requires learning modules for distilling application-critical selection of attention and anticipation models. These models will help medical experts constructing and adjusting on-the-fly m-health application workflows and workflow strategies. We illustrate our context-aware workflow management paradigm for a m-health data delivery problem, in which optimal communication network configurations have to be determined.

The fee-for-service shift to bundled payments: financial considerations for hospitals.

PubMed

Scamperle, Keely

2013-01-01

Skyrocketing health care costs are forcing payers to demand delivery efficiencies that preserve and promote quality care while reducing costs. Hospitals are challenged to meet the pressure from payers to deliver value and outcome-based health care while preserving sufficient financial margins. The fee-for-service (FFS) model with its perverse incentives to incur high-volume services is no longer, if ever, sufficient to ensure quality, cost-efficient health care. In response, payers have sought to force the issue through accelerated efforts to bundle payments to providers. It is theorized that by tying together providers throughout the continuum or episode of care for a patient, efficiencies in delivery inclusive of cost reductions will be obtained. This article examines the bundled payment models and the financial considerations for hospital facility providers.

A Consumer's Guide To Outcomes in Early Childhood Intervention.

ERIC Educational Resources Information Center

Accreditation Council on Services for People with Disabilities, Landover, MD.

This collection of 21 suggested outcome measures for early childhood intervention services is designed to assist families in evaluating the quality of early intervention services they receive. The measures apply to all types of service and support program models for children with various developmental delays and/or disabilities and their families.…

Predictors of Service Utilization among Youth Diagnosed with Mood Disorders

ERIC Educational Resources Information Center

Mendenhall, Amy N.

2012-01-01

In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the…

Paying for reproductive health services in Bangladesh: intersections between cost, quality and culture.

PubMed

Schuler, Sidney Ruth; Bates, Lisa M; Islam, Md Khairul

2002-09-01

In 1997 a consortium of non-governmental organizations (NGOs) in Bangladesh began to implement health sector reform measures intended to expand access to and improve the quality of family planning and other basic health services. The new service delivery model entails higher costs for clients and requires that they take greater initiative. Clients have to travel further to get certain services, and they have to pay more for them than they did under the previous door-to-door family planning model. This paper is based on findings from a qualitative study looking at client and community reactions to the programme changes. It examines a number of barriers to access and constraints to cost recovery, including gender, class and ideas about entitlements, the role of government and obligations among people. The NGOs want to maximize cost recovery while making the basic services they offer accessible to most people. The findings suggest that this requires more than the establishment of an appropriate pricing structure. Attitudes related to charging and paying for services must also change, along with the institutional policies and practices that support them.

The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam.

PubMed

Ngo, Anh D; Alden, Dana L; Pham, Van; Phan, Ha

2010-02-28

Service franchising is a business model that involves building a network of outlets (franchisees) that are locally owned, but act in coordinated manner with the guidance of a central headquarters (franchisor). The franchisor maintains quality standards, provides managerial training, conducts centralized purchasing and promotes a common brand. Research indicates that franchising private reproductive health and family planning (RHFP) services in developing countries improves quality and utilization. However, there is very little evidence that franchising improves RHFP services delivered through community-based public health clinics. This study evaluates behavioral outcomes associated with a new approach - the Government Social Franchise (GSF) model - developed to improve RHFP service quality and capacity in Vietnam's commune health stations (CHSs). The project involved networking and branding 36 commune health station (CHS) clinics in two central provinces of Da Nang and Khanh Hoa, Vietnam. A quasi-experimental design with 36 control CHSs assessed GSF model effects on client use as measured by: 1) clinic-reported client volume; 2) the proportion of self-reported RHFP service users at participating CHS clinics over the total sample of respondents; and 3) self-reported RHFP service use frequency. Monthly clinic records were analyzed. In addition, household surveys of 1,181 CHS users and potential users were conducted prior to launch and then 6 and 12 months after implementing the GSF network. Regression analyses controlled for baseline differences between intervention and control groups. CHS franchise membership was significantly associated with a 40% plus increase in clinic-reported client volumes for both reproductive and general health services. A 45% increase in clinic-reported family planning service clients related to GSF membership was marginally significant (p = 0.05). Self-reported frequency of RHFP service use increased by 20% from the baseline survey to the 12 month post-launch survey (p < 0.05). However, changes in self-reported usage rate were not significantly associated with franchise membership (p = 0.15). This study provides preliminary evidence regarding the ability of the Government Social Franchise model to increase use of reproductive health and family planning service in smaller public sector clinics. Further investigations, including assessment of health outcomes associated with increased use of GSF services and cost-effectiveness of the model, are required to better delineate the effectiveness and limitations of franchising RHFP services in the public health system in Vietnam and other developing countries.

The impact of social franchising on the use of reproductive health and family planning services at public commune health stations in Vietnam

PubMed Central

2010-01-01

Background Service franchising is a business model that involves building a network of outlets (franchisees) that are locally owned, but act in coordinated manner with the guidance of a central headquarters (franchisor). The franchisor maintains quality standards, provides managerial training, conducts centralized purchasing and promotes a common brand. Research indicates that franchising private reproductive health and family planning (RHFP) services in developing countries improves quality and utilization. However, there is very little evidence that franchising improves RHFP services delivered through community-based public health clinics. This study evaluates behavioral outcomes associated with a new approach - the Government Social Franchise (GSF) model - developed to improve RHFP service quality and capacity in Vietnam's commune health stations (CHSs). Methods The project involved networking and branding 36 commune health station (CHS) clinics in two central provinces of Da Nang and Khanh Hoa, Vietnam. A quasi-experimental design with 36 control CHSs assessed GSF model effects on client use as measured by: 1) clinic-reported client volume; 2) the proportion of self-reported RHFP service users at participating CHS clinics over the total sample of respondents; and 3) self-reported RHFP service use frequency. Monthly clinic records were analyzed. In addition, household surveys of 1,181 CHS users and potential users were conducted prior to launch and then 6 and 12 months after implementing the GSF network. Regression analyses controlled for baseline differences between intervention and control groups. Results CHS franchise membership was significantly associated with a 40% plus increase in clinic-reported client volumes for both reproductive and general health services. A 45% increase in clinic-reported family planning service clients related to GSF membership was marginally significant (p = 0.05). Self-reported frequency of RHFP service use increased by 20% from the baseline survey to the 12 month post-launch survey (p < 0.05). However, changes in self-reported usage rate were not significantly associated with franchise membership (p = 0.15). Conclusions This study provides preliminary evidence regarding the ability of the Government Social Franchise model to increase use of reproductive health and family planning service in smaller public sector clinics. Further investigations, including assessment of health outcomes associated with increased use of GSF services and cost-effectiveness of the model, are required to better delineate the effectiveness and limitations of franchising RHFP services in the public health system in Vietnam and other developing countries. PMID:20187974

Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

PubMed

Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

2017-07-01

The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology community and provide insight to others considering the development of episode-based payment models in the commercial or government sectors.

Using a relational database to improve mortality and length of stay for a department of surgery: a comparative review of 5200 patients.

PubMed

Ang, Darwin N; Behrns, Kevin E

2013-07-01

The emphasis on high-quality care has spawned the development of quality programs, most of which focus on broad outcome measures across a diverse group of providers. Our aim was to investigate the clinical outcomes for a department of surgery with multiple service lines of patient care using a relational database. Mortality, length of stay (LOS), patient safety indicators (PSIs), and hospital-acquired conditions were examined for each service line. Expected values for mortality and LOS were derived from University HealthSystem Consortium regression models, whereas expected values for PSIs were derived from Agency for Healthcare Research and Quality regression models. Overall, 5200 patients were evaluated from the months of January through May of both 2011 (n = 2550) and 2012 (n = 2650). The overall observed-to-expected (O/E) ratio of mortality improved from 1.03 to 0.92. The overall O/E ratio for LOS improved from 0.92 to 0.89. PSIs that predicted mortality included postoperative sepsis (O/E:1.89), postoperative respiratory failure (O/E:1.83), postoperative metabolic derangement (O/E:1.81), and postoperative deep vein thrombosis or pulmonary embolus (O/E:1.8). Mortality and LOS can be improved by using a relational database with outcomes reported to specific service lines. Service line quality can be influenced by distribution of frequent reports, group meetings, and service line-directed interventions.

New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS

PubMed Central

Baron, Richard J.

2012-01-01

Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. PMID:22412007

Comparative study: TQ and Lean Production ownership models in health services

PubMed Central

Eiro, Natalia Yuri; Torres-Junior, Alvair Silveira

2015-01-01

Objective: compare the application of Total Quality (TQ) models used in processes of a health service, cases of lean healthcare and literature from another institution that has also applied this model. Method: this is a qualitative research that was conducted through a descriptive case study. Results: through critical analysis of the institutions studied it was possible to make a comparison between the traditional quality approach checked in one case and the theoretical and practice lean production approach used in another case and the specifications are described below. Conclusion: the research identified that the lean model was better suited for people that work systemically and generate the flow. It also pointed towards some potential challenges in the introduction and implementation of lean methods in health. PMID:26487134

Will the "Fixes" Fall Flat? Prospects for Quality Measures and Payment Incentives to Control Healthcare Spending.

PubMed

Hauswald, Erik; Sklar, David

2017-04-01

Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system of rewards and penalties. We describe the history of the US healthcare payment system, focusing on Medicare and the efforts to control spending through the Sustainable Growth Rate. We describe the latest evolution of the payment system, which emphasizes quality measurement and alternative payment models. We conclude with suggestions for how to influence physician behavior through education and payment reform so that their behavior aligns with alternative care models to control spending in the future.

Reforming funding for chronic illness: Medicare-CDM.

PubMed

Swerissen, Hal; Taylor, Michael J

2008-02-01

Chronic diseases are a major challenge for the Australian health care system in terms of both the provision of quality care and expenditure, and these challenges will only increase in the future. Various programs have been instituted under the Medicare system to provide increased funding for chronic care, but essentially these programs still follow the traditional fee-for-service model. This paper proposes a realignment and extension of current Medicare chronic disease management programs into a framework that provides general practitioners and other health professionals with the necessary "tools" for high quality care planning and ongoing management, and incorporating international models of outcome-linked funding. The integration of social support services with the Medicare system is also a necessary step in providing high quality care for patients with complex needs requiring additional support.

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

PubMed

Kochar, Aveena; Chisty, Alia

2017-11-01

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

Development of a questionnaire to measure consumers' perceptions of service quality in Australian community pharmacies.

PubMed

Mirzaei, Ardalan; Carter, Stephen R; Chen, Jenny Yimin; Rittsteuer, Claudia; Schneider, Carl R

2018-06-11

Recent changes within community pharmacy have seen a shift towards some pharmacies providing "value-added" services. However, providing high levels of service is resource intensive yet revenues from dispensing are declining. Of significance therefore, is how consumers perceive service quality (SQ). However, at present there are no validated and reliable instruments to measure consumers' perceptions of SQ in Australian community pharmacies. The aim of this study was to build a theory-grounded model of service quality (SQ) in community pharmacies and to create a valid survey instrument to measure consumers' perceptions of service quality. Stage 1 dealt with item generation using theory, prior research and qualitative interviews with pharmacy consumers. Selected items were then subjected to content validity and face validity. Stages 2 and 3 included psychometric testing among English-speaking adult consumers of Australian pharmacies. Exploratory factor analysis was used for item reduction and to explain the domains of SQ. In stage 1, item generation for SQ initially generated 113 items which were then refined, through content and face validity, down to 61 items. In stage 2, after subjecting the questionnaire to psychometric testing on the data from the first pharmacy (n = 374), the use of the primary dimensions of SQ was abandoned leaving 32 items representing 5 domains of SQ. In stage 3, the questionnaire was subject to further testing and item reduction in 3 other pharmacies (n = 320). SQ was best described using 23 items representing 6 domains: 'health and medicines advice', 'relationship quality', 'technical quality', 'environmental quality', 'non-prescription service', and 'health outcomes'. This research presents a theoretically-grounded and robust measurement scale developed for consumer perceptions of SQ in a community pharmacy. Copyright © 2018. Published by Elsevier Inc.

30 CFR 285.659 - What requirements must I include in my SAP, COP, or GAP regarding air quality?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., or GAP regarding air quality? 285.659 Section 285.659 Mineral Resources MINERALS MANAGEMENT SERVICE... must I include in my SAP, COP, or GAP regarding air quality? (a) You must comply with the Clean Air Act...) For air quality modeling that you perform in support of the activities proposed in your plan, you...

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

ERIC Educational Resources Information Center

Spanbauer, Stanley J.; Hillman, Jo

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

Competition and quality in a physiotherapy market with fixed prices.

PubMed

Pekola, Piia; Linnosmaa, Ismo; Mikkola, Hennamari

2017-01-01

Our study focuses on competition and quality in physiotherapy organized and regulated by the Social Insurance Institution of Finland (Kela). We first derive a hypothesis with a theoretical model and then perform empirical analyses of the data. Within the physiotherapy market, prices are regulated by Kela, and after registration eligible firms are accepted to join a pool of firms from which patients choose service providers based on their individual preferences. By using 2SLS estimation techniques, we analyzed the relationship among quality, competition and regulated price. According to the results, competition has a statistically significant (yet weak) negative effect (p = 0.019) on quality. The outcome for quality is likely caused by imperfect information. It seems that Kela has provided too little information for patients about the quality of the service.

Multigroup Path Analysis of the Influence of Healthcare Quality, by Different Health Insurance Types.

PubMed

Hong, Yong-Rock; Holcomb, Derek; Ballard, Michael; Schwartz, Laurel

Winds of change have been blowing in the U.S. healthcare system since passage of the Affordable Care Act. Examining differences between individuals covered by different types of insurance is essential if healthcare executives are to develop new strategies in response to the emerging health insurance market. In this study, we used multigroup path analysis models to examine the moderating effects of health insurance on direct and indirect associations with general health status, satisfaction with received care, financial burden, and perceived value of the healthcare system. Data were obtained from the 2012 Medical Expenditure Panel Survey and analyzed according to the types of insurance: private, public, and military. With the satisfactory fit of the model (χ = 2,532.644, df = 96, p < .001; normed fit index = 0.943; incremental fit index = 0.945; comparative fit index = 0.957; root mean squared error of approximation = 0.044), higher healthcare quality was positively associated with better health status, greater satisfaction, and greater perceived value of the healthcare system in the three insurance groups. In addition, although all direct paths between health service quality and financial burden were not statistically significant, indirect effects were significant in all models through health status. Being married and earning higher incomes were also found to be strong predictors of better health status and health service quality. Efforts to improve the quality of health services are needed, which could contribute to a reduction in health disparities among insurance beneficiaries and result in less healthcare spending.

The Association between Freedom of Choice and Effectiveness of Home Care Services.

PubMed

Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

2016-03-31

The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.

The Association between Freedom of Choice and Effectiveness of Home Care Services

PubMed Central

Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

2016-01-01

Objectives: The aim of this paper is to study home care clients’ freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. Methods: A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients’ subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. Results: As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Conclusion: Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients’ opinions and to thereby improve the effectiveness of home care services. PMID:27616949

Hospice Value-Based Purchasing Program: A Model Design.

PubMed

Nowak, Bryan P

2016-12-01

With the implementation of the Affordable Care Act, the U.S. government committed to a transition in payment policy for health care services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal, the Department of Health and Human Services is designing and implementing new payment models intended to improve the quality of health care while reducing its cost. Collectively, these novel payment models and programs have been characterized under the moniker of value-based purchasing (VBP), and although many of these models retain a fundamental fee-for-service (FFS) structure, they are seen as essential tools in the evolution away from volume-based health care financing toward a health system that provides "better care, smarter spending, and healthier people." In 2014, approximately 20% of Medicare provider FFS payments were linked to a VBP program. The Department of Health and Human Services has committed to a four-year plan to link 90% of Medicare provider FFS payments to value-based purchasing by 2018. To achieve this goal, all items and services currently reimbursed under Medicare FFS programs will need to be evaluated in the context of VBP. To this end, the Medicare Hospice benefit appears to be appropriate for inclusion in a model of VBP. This policy analysis proposes an adaptable model for a VBP program for the Medicare Hospice benefit linking payment to quality and efficiency in a manner consistent with statutory requirements established in the Affordable Care Act. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Data Quality Screening Service

NASA Technical Reports Server (NTRS)

Strub, Richard; Lynnes, Christopher; Hearty, Thomas; Won, Young-In; Fox, Peter; Zednik, Stephan

2013-01-01

A report describes the Data Quality Screening Service (DQSS), which is designed to help automate the filtering of remote sensing data on behalf of science users. Whereas this process often involves much research through quality documents followed by laborious coding, the DQSS is a Web Service that provides data users with data pre-filtered to their particular criteria, while at the same time guiding the user with filtering recommendations of the cognizant data experts. The DQSS design is based on a formal semantic Web ontology that describes data fields and the quality fields for applying quality control within a data product. The accompanying code base handles several remote sensing datasets and quality control schemes for data products stored in Hierarchical Data Format (HDF), a common format for NASA remote sensing data. Together, the ontology and code support a variety of quality control schemes through the implementation of the Boolean expression with simple, reusable conditional expressions as operands. Additional datasets are added to the DQSS simply by registering instances in the ontology if they follow a quality scheme that is already modeled in the ontology. New quality schemes are added by extending the ontology and adding code for each new scheme.

Evaluation of the influence of economic groups on the efficiency and quality of service of water companies: an empirical approach for Chile.

PubMed

Molinos-Senante, María; Farías, Rodrigo

2018-06-04

The privatization of water and sewerage services (WSS) has led to the foundation of water economic groups, which integrate several water companies and have gained notable importance at the global level. In the framework of benchmarking studies, there are no prior studies exploring the impact that economic groups have on the efficiency and quality of service provided by water companies. This study investigates, for the first time, whether the membership of water companies in an economic group influences their performance. Quantity- and quality-adjusted efficiency scores were computed using data envelopment analysis models. An empirical application was developed for the Chilean water industry since most of their water companies are private and belong to an economic group. The results show that independent water companies provide WSS with better quality than do water companies that belong to an economic group. From a statistical point of view, it was evident that membership in an economic group impacts both the quantity- and quality-adjusted efficiency scores of water companies. The results of this study illustrate that applying the model-firm regulation to the Chilean water industry has significant drawbacks that should be addressed by the water regulator to promote the long-term sustainability of the water industry.

The Airport Performance Model

DOT National Transportation Integrated Search

1976-04-01

This report describes the development of a model and companion data base for evaluating levels and qualities of service provided to the public by Air Carrier Airports. The model is designed to translate changes in airport capabilities into public ser...

Predicting effects of environmental change on river inflows to ...

EPA Pesticide Factsheets

Estuarine river watersheds provide valued ecosystem services to their surrounding communities including drinking water, fish habitat, and regulation of estuarine water quality. However, the provisioning of these services can be affected by changes in the quantity and quality of river water, such as those caused by altered landscapes or shifting temperatures or precipitation. We used the ecohydrology model, VELMA, in the Trask River watershed to simulate the effects of environmental change scenarios on estuarine river inputs to Tillamook Bay (OR) estuary. The Trask River watershed is 453 km2 and contains extensive agriculture, silviculture, urban, and wetland areas. VELMA was parameterized using existing spatial datasets of elevation, soil type, land use, air temperature, precipitation, river flow, and water quality. Simulated land use change scenarios included alterations in the distribution of the nitrogen-fixing tree species Alnus rubra, and comparisons of varying timber harvest plans. Scenarios involving spatial and temporal shifts in air temperature and precipitation trends were also simulated. Our research demonstrates the utility of ecohydrology models such as VELMA to aid in watershed management decision-making. Model outputs of river water flow, temperature, and nutrient concentrations can be used to predict effects on drinking water quality, salmonid populations, and estuarine water quality. This modeling effort is part of a larger framework of

Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool.

PubMed

Javaid, M K; Kyer, C; Mitchell, P J; Chana, J; Moss, C; Edwards, M H; McLellan, A R; Stenmark, J; Pierroz, D D; Schneider, M C; Kanis, J A; Akesson, K; Cooper, C

2015-11-01

Fracture Liaison Services are the best model to prevent secondary fractures. The International Osteoporosis Foundation developed a Best Practice Framework to provide a quality benchmark. After a year of implementation, we confirmed that a single framework with set criteria is able to benchmark services across healthcare systems worldwide. Despite evidence for the clinical effectiveness of secondary fracture prevention, translation in the real-world setting remains disappointing. Where implemented, a wide variety of service models are used to deliver effective secondary fracture prevention. To support use of effective models of care across the globe, the International Osteoporosis Foundation's Capture the Fracture® programme developed a Best Practice Framework (BPF) tool of criteria and standards to provide a quality benchmark. We now report findings after the first 12 months of implementation. A questionnaire for the BPF was created and made available to institutions on the Capture the Fracture website. Responses from institutions were used to assign gold, silver, bronze or black (insufficient) level of achievements mapped across five domains. Through an interactive process with the institution, a final score was determined and published on the Capture the Fracture website Fracture Liaison Service (FLS) map. Sixty hospitals across six continents submitted their questionnaires. The hospitals served populations from 20,000 to 15 million and were a mix of private and publicly funded. Each FLS managed 146 to 6200 fragility fracture patients per year with a total of 55,160 patients across all sites. Overall, 27 hospitals scored gold, 23 silver and 10 bronze. The pathway for the hip fracture patients had the highest proportion of gold grading while vertebral fracture the lowest. In the first 12 months, we have successfully tested the BPF tool in a range of health settings across the globe. Initial findings confirm a significant heterogeneity in service provision and highlight the importance of a global approach to ensure high quality secondary fracture prevention services.

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals.

PubMed

Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

2017-03-01

Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach's alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals.

Meeting the Health Care Needs of a Rural Hispanic Migrant Population With Diabetes

ERIC Educational Resources Information Center

Heuer, Loretta; Hess, Carla W.; Klug, Marilyn G.

2004-01-01

There is a need for models of health care that provide accessible, culturally appropriate, quality services to the population of Hispanic migrant farmworkers at risk for or diagnosed with diabetes. The purposes of this study were to describe the Migrant Health Service, Inc (MHSI), Diabetes Program, the conceptual model on which it is based, and 4…

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

ERIC Educational Resources Information Center

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

2013-01-01

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

Automatic Earth observation data service based on reusable geo-processing workflow

NASA Astrophysics Data System (ADS)

Chen, Nengcheng; Di, Liping; Gong, Jianya; Yu, Genong; Min, Min

2008-12-01

A common Sensor Web data service framework for Geo-Processing Workflow (GPW) is presented as part of the NASA Sensor Web project. This framework consists of a data service node, a data processing node, a data presentation node, a Catalogue Service node and BPEL engine. An abstract model designer is used to design the top level GPW model, model instantiation service is used to generate the concrete BPEL, and the BPEL execution engine is adopted. The framework is used to generate several kinds of data: raw data from live sensors, coverage or feature data, geospatial products, or sensor maps. A scenario for an EO-1 Sensor Web data service for fire classification is used to test the feasibility of the proposed framework. The execution time and influences of the service framework are evaluated. The experiments show that this framework can improve the quality of services for sensor data retrieval and processing.

Using Creative Problem Solving (TRIZ) in Improving the Quality of Hospital Services

PubMed Central

LariSemnani, Behrouz; Far, Rafat Mohebbi; Shalipoor, Elham; Mohseni, Mohammad

2015-01-01

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients’ expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients’ satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ’ needs. PMID:25560360

A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial.

PubMed

Cardoso, Graça; Papoila, Ana; Tomé, Gina; Killaspy, Helen; King, Michael; Caldas-de-Almeida, José Miguel

2017-11-01

This study aimed to assess the efficacy of a staff-training intervention to improve service users' engagement in activities and quality of care, by means of a cluster randomised controlled trial. All residential units with at least 12-h a day staff support (n = 23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit's manager. Half the units (n = 12) were randomly assigned to continue providing treatment as usual, and half (n = 11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users' level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users' quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). Knowledge acquired by the staff during the initial workshops increased significantly (p ≤ 0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. The intervention increased the level of knowledge of staff without leading to an improvement in service users' engagement in activities, quality of life, or quality of care in the units.

Quality of life, autonomy, satisfaction, and costs associated with mental health supported accommodation services in England: a national survey.

PubMed

Killaspy, Helen; Priebe, Stefan; Bremner, Stephen; McCrone, Paul; Dowling, Sarah; Harrison, Isobel; Krotofil, Joanna; McPherson, Peter; Sandhu, Sima; Arbuthnott, Maurice; Curtis, Sarah; Leavey, Gerard; Shepherd, Geoff; Eldridge, Sandra; King, Michael

2016-12-01

Little research has been done into the effectiveness of mental health supported accommodation services. We did a national survey to investigate provision and costs of services and assess service user quality of life and outcomes across England. We randomly sampled three types of services from 14 nationally representative regions-residential care, supported housing, and floating outreach-and recruited up to ten service users per service. Service quality and costs and service users' quality of life, autonomy, and satisfaction with care were assessed in a standardised manner with validated tools and compared by multilevel modelling. 619 service users were recruited from 22 residential care, 35 supported housing, and 30 floating outreach services. Those in residential care and supported housing had more severe mental health problems than those in floating outreach. 348 (57%) were assessed as being at risk of severe self-neglect and 229 (37%) as being vulnerable to exploitation in the previous 2 years. Residential care was most expensive but provided for people with the greatest needs. The mean annual budget was £466 687 for residential care (range £276 000-777 920), compared with £365 452 for supported housing (£174 877-818 000), and £172 114 for floating outreach (£17 126-491 692). Quality of care was best in supported housing. People in supported housing and floating outreach were more socially included but experienced more crime than those in residential care. After adjustment for service quality and service user sociodemographic and clinical factors, quality of life was similar for service users in residential care and supported housing (mean difference -0·138, 95% CI -0·402 to 0·126, p=0·306) and lower for those in floating outreach than in residential care (-0·424, -0·734 to -0·114, p=0·007). However, autonomy was greater for those in supported housing than for those in residential care (0·145, 0·010 to 0·279, p=0.035). Satisfaction with care was similar across services. Supported housing might be cost-effective, but the benefits need to be weighed against the risks associated with increased autonomy. National Institute for Health Research. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predicting the Use of Public Transportation: A Case Study from Putrajaya, Malaysia

PubMed Central

Borhan, Muhamad Nazri; Mohd Akhir, Norliza; Mat Yazid, Muhamad Razuhanafi; Ismail, Amiruddin; Rahmat, Riza Atiq

2014-01-01

Putrajaya is a new federal administrative capital of Malaysia which has been set to achieve a 70% share of all travels by public transport in the city area. However, the current modal split between the public transport and private transport is 15 : 85. In order to understand travelers' willingness to use the public transport, a conceptual model has been developed to determine the factors that affect them to use the public transport instead of travelling in their own cars. Various variables such as service quality, environmental impact, attitude, and behavior intention were analyzed and tested using structural equation model (SEM). Results indicate that the service quality and attitude are found to have positive effects on the behavioral intention of taking the public transport. Other than this, this study also shows that the service quality and environmental impact have some positive influences on the attitude to using the public transport. However, environmental impact has no significant, positive, and direct effect on behavioral intention. The results of this study demonstrate that the model that was developed is useful in predicting the public transport and it could provide a more complete understanding of behavioral intention towards public transport use. PMID:25110744

Predicting the use of public transportation: a case study from Putrajaya, Malaysia.

PubMed

Borhan, Muhamad Nazri; Syamsunur, Deprizon; Akhir, Norliza Mohd; Yazid, Muhamad Razuhanafi Mat; Ismail, Amiruddin; Rahmat, Riza Atiq

2014-01-01

Putrajaya is a new federal administrative capital of Malaysia which has been set to achieve a 70% share of all travels by public transport in the city area. However, the current modal split between the public transport and private transport is 15:85. In order to understand travelers' willingness to use the public transport, a conceptual model has been developed to determine the factors that affect them to use the public transport instead of travelling in their own cars. Various variables such as service quality, environmental impact, attitude, and behavior intention were analyzed and tested using structural equation model (SEM). Results indicate that the service quality and attitude are found to have positive effects on the behavioral intention of taking the public transport. Other than this, this study also shows that the service quality and environmental impact have some positive influences on the attitude to using the public transport. However, environmental impact has no significant, positive, and direct effect on behavioral intention. The results of this study demonstrate that the model that was developed is useful in predicting the public transport and it could provide a more complete understanding of behavioral intention towards public transport use.

Analysis of Gap in Service Quality in Drug Addiction Treatment Centers of Kerman, Iran, Using SERVQUAL Model

PubMed Central

Naqavi, Mohammad Reza; Refaiee, Raheleh; Baneshi, Mohammad Reza; Nakhaee, Nouzar

2014-01-01

Background Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Methods Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Findings Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). Conclusion There was a gap between the clients’ expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients’ views regarding service quality in addiction treatment clinics. PMID:25984274

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients’ Perspective

PubMed Central

Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid

2016-01-01

Introduction The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. Methods In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. Results There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (−0.88) and responsiveness (−0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. Conclusion There were gaps between the patients’ perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time. PMID:27123218

Testing a pharmacist-patient relationship quality model among older persons with diabetes.

PubMed

Worley, Marcia M

2006-03-01

Considering recent changes to the Medicare program, pharmacists will have unique opportunities to be reimbursed for providing Medication Therapy Management Services to older persons with diabetes. A high-quality pharmacist-patient relationship can lay the foundation for effective provision of Medication Therapy Management Services and improved care in this cohort. To test a pharmacist-patient relationship quality model in a group of older persons with diabetes from the patient's perspective. Antecedents to relationship quality were pharmacist participative behavior/patient-centeredness of relationship, patient participative behavior, and pharmacist-patient interpersonal communication. Pharmacist-patient relationship commitment was the outcome of relationship quality studied. Data were collected via mailed questionnaire from a random sample of 600 community-dwelling adults in the United States who (1) were 65 years of age and older, (2) had type 1 or type 2 diabetes, (3) used at least one prescription medication to treat their diabetes, and (4) used some type of nonmail order pharmacy as their primary source of obtaining prescription medications. Model relationships were tested using path analysis. The adjusted response rate was 41.6% (221/531). The models explained 47% and 49% of the variance in relationship quality and relationship commitment, respectively. In the relationship quality model, pharmacist participative behavior/patient-centeredness of relationship (beta=.51, P<.001) and pharmacist-patient interpersonal communication (beta=.17, P=.008) had direct effects on relationship quality. In the relationship commitment model, relationship quality had a direct effect on relationship commitment (beta=.60, P<.001). Pharmacist participative behavior/patient-centeredness and pharmacist-patient interpersonal communication had indirect effects on relationship commitment through their effects on relationship quality, which is a mediator in the model. Results affirm findings from previous research showing that patients' perceptions of pharmacist participative behavior/patient-centeredness of relationship and pharmacist-patient interpersonal communication are positively related to perceptions of relationship quality. Also, relationship quality is a strong mediator between pharmacist participative behavior/patient-centeredness of relationship and relationship commitment, as well as between pharmacist-patient interpersonal communication and relationship commitment.

Using SERVQUAL to evaluate quality disconfirmation of nursing service in Taiwan.

PubMed

Chou, Shieu-Ming; Chen, Thai-Form; Woodard, Beth; Yen, Miao-Fen

2005-06-01

The purpose of this study was to determine the extent of disconfirmation of the perceived quality of nursing services, and its relationship to patient's satisfaction, intent to return, and intent to recommend to others. The service dimensions were tangibles, reliability, responsiveness, assurance, and empathy, which were adopted from the Gap model of Parasuraman, Zeithaml and Berry (1985). A total of 186 subjects was tested by a modified SERVQUAL (service quality) instrument. These subjects were from 15 randomly selected medical-surgical units in a medical center in Taipei, Taiwan, Republic of China. The response rate was 92%. Descriptive statistics and multiple regression were used to analyze subjects' responses. A number of the demographic variables served as covariates in data analysis. Responsiveness was highly significant in predicting overall satisfaction with hospital service (p = .0003). Reliability was significant in predicting overall satisfaction with nursing care (p < .00005) and intent to return. Empathy was a highly significant predictor of intent to recommend.

Self-management model in the scheduling of successive appointments in rheumatology.

PubMed

Castro Corredor, David; Cuadra Díaz, José Luis; Mateos Rodríguez, Javier José; Anino Fernández, Joaquín; Mínguez Sánchez, María Dolores; de Lara Simón, Isabel María; Tébar, María Ángeles; Añó, Encarnación; Sanz, María Dolores; Ballester, María Nieves

2018-01-08

The rheumatology service of Ciudad Real Hospital, located in an autonomous community of that same name that is nearly in the center of Spain, implemented a self-management model of successive appointments more than 10 years ago. Since then, the physicians of the department schedule follow-up visits for their patients depending on the disease, its course and ancillary tests. The purpose of this study is to evaluate and compare the self-management model for successive appointments in the rheumatology service of Ciudad Real Hospital versus the model of external appointment management implemented in 8 of the hospital's 15 medical services. A comparative and multivariate analysis was performed to identify variables with statistically significant differences, in terms of activity and/or performance indicators and quality perceived by users. The comparison involved the self-management model for successive appointments employed in the rheumatology service of Ciudad Real Hospital and the model for external appointment management used in 8 hospital medical services between January 1 and May 31, 2016. In a database with more than 100,000 records of appointments involving the set of services included in the study, the mean waiting time and the numbers of non-appearances and rescheduling of follow-up visits in the rheumatology department were significantly lower than in the other services. The number of individuals treated in outpatient rheumatology services was 7,768, and a total of 280 patients were surveyed (response rate 63.21%). They showed great overall satisfaction, and the incidence rate of claims was low. Our results show that the self-management model of scheduling appointments has better results in terms of activity indicators and in quality perceived by users, despite the intense activity. Thus, this study could be fundamental for decision making in the management of health care organizations. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

The transprofessional model: blending intents in terminal care of AIDS.

PubMed

Cherin, D A; Simmons, W J; Hillary, K

1998-01-01

Current terminal care services present dying patients and their families with a dichotomy in service delivery and the intent care between curative treatments and palliative treatments. This arbitrary dichotomy reduces patients' quality of life in many cases and robs patients and families of benefiting from the psychosocial aspects of treatment until the last few weeks of life. This article presents a blended model of care, the Transprofessional Model, in which patients receive both curative and palliative service throughout their care process. The blended intent model differs from traditional home care in that services are provided by a care coordination team composed of nurses and social workers; the traditional model of care is often case managed by a single, registered nurse. The combination of the multi-disciplinary approach to care coordination and training in both curative and palliative services in the Transprofessional Model demonstrates that this blended model of care produces a bio-psychosocial focus to terminal care as compared to a primary focus on curative services present in the traditional model of home care.

Assessing and changing organizational social contexts for effective mental health services.

PubMed

Glisson, Charles; Williams, Nathaniel J

2015-03-18

Culture and climate are critical dimensions of a mental health service organization's social context that affect the quality and outcomes of the services it provides and the implementation of innovations such as evidence-based treatments (EBTs). We describe a measure of culture and climate labeled Organizational Social Context (OSC), which has been associated with innovation, service quality, and outcomes in national samples and randomized controlled trials (RCTs) of mental health and social service organizations. The article also describes an empirically supported organizational intervention model labeled Availability, Responsiveness, and Continuity (ARC), which has improved organizational social context, innovation, and effectiveness in five RCTs. Finally, the article outlines a research agenda for developing more efficient and scalable organizational strategies to improve mental health services by identifying the mechanisms that link organizational interventions and social context to individual-level service provider intentions and behaviors associated with innovation and effectiveness.

Patient satisfaction and perceived quality of care: evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia.

PubMed

Dansereau, Emily; Masiye, Felix; Gakidou, Emmanuela; Masters, Samuel H; Burstein, Roy; Kumar, Santosh

2015-12-30

To examine the associations between perceived quality of care and patient satisfaction among HIV and non-HIV patients in Zambia. Patient exit survey conducted at 104 primary, secondary and tertiary health clinics across 16 Zambian districts. 2789 exiting patients. Five dimensions of perceived quality of care (health personnel practice and conduct, adequacy of resources and services, healthcare delivery, accessibility of care, and cost of care). Respondent, visit-related, and facility characteristics. Patient satisfaction measured on a 1-10 scale. Indices of perceived quality of care were modelled using principal component analysis. Statistical associations between perceived quality of care and patient satisfaction were examined using random-effect ordered logistic regression models, adjusting for demographic, socioeconomic, visit and facility characteristics. Average satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV services. Favourable perceptions of health personnel conduct were associated with higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33) and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of resources and services were also associated with higher odds of satisfaction for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81 to 12.10) visits. Two additional dimensions of perceived quality of care--healthcare delivery and accessibility of care--were positively associated with higher satisfaction for non-HIV patients. The odds of overall satisfaction were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to 0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients, the odds of satisfaction were greater in hospitals compared with health centres/posts (OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly-managed facilities (OR=0.41, 95% CI=0.27 to 0.64). Perceived quality of care is an important driver of patient satisfaction with health service delivery in Zambia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Manufacturing Bms/Iso System Review

NASA Technical Reports Server (NTRS)

Gomez, Yazmin

2004-01-01

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

Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community.

PubMed

Tosh, Jonathan; Kearns, Ben; Brennan, Alan; Parry, Glenys; Ricketts, Thomas; Saxon, David; Kilgarriff-Foster, Alexis; Thake, Anna; Chambers, Eleni; Hutten, Rebecca

2013-04-26

The purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression. Modelling methods were used to develop a conceptual and health economic model of the current configuration of services in Sheffield, England for people with longer-term depression. Data and assumptions were synthesised to estimate cost per Quality Adjusted Life Years (QALYs). Three service changes were developed and resulted in increased QALYs at increased cost. Versus current care, the incremental cost-effectiveness ratio (ICER) for a self-referral service was £11,378 per QALY. The ICER was £2,227 per QALY for the dropout reduction service and £223 per QALY for an increase in non-therapy services. These results were robust when compared to current cost-effectiveness thresholds and accounting for uncertainty. Cost-effective service improvements for longer-term depression have been identified. Also identified were limitations of the current evidence for the long term impact of services.

Case Management: Service or Symptom?

ERIC Educational Resources Information Center

Netting, F. Ellen

1992-01-01

Provides overview of case management, its history, and contemporary models. Examines challenges that case management poses for social work profession: covering up issue that health and human services delivery system is nonsystem; maintaining client-centered perspective in cost-obsessed environment; dealing with quality control; coping with…

Policy Research Challenges in Comparing Care Models for Dual-Eligible Beneficiaries.

PubMed

Van Cleave, Janet H; Egleston, Brian L; Brosch, Sarah; Wirth, Elizabeth; Lawson, Molly; Sullivan-Marx, Eileen M; Naylor, Mary D

2017-05-01

Providing affordable, high-quality care for the 10 million persons who are dual-eligible beneficiaries of Medicare and Medicaid is an ongoing health-care policy challenge in the United States. However, the workforce and the care provided to dual-eligible beneficiaries are understudied. The purpose of this article is to provide a narrative of the challenges and lessons learned from an exploratory study in the use of clinical and administrative data to compare the workforce of two care models that deliver home- and community-based services to dual-eligible beneficiaries. The research challenges that the study team encountered were as follows: (a) comparing different care models, (b) standardizing data across care models, and (c) comparing patterns of health-care utilization. The methods used to meet these challenges included expert opinion to classify data and summative content analysis to compare and count data. Using descriptive statistics, a summary comparison of the two care models suggested that the coordinated care model workforce provided significantly greater hours of care per recipient than the integrated care model workforce. This likely represented the coordinated care model's focus on providing in-home services for one recipient, whereas the integrated care model focused on providing services in a day center with group activities. The lesson learned from this exploratory study is the need for standardized quality measures across home- and community-based services agencies to determine the workforce that best meets the needs of dual-eligible beneficiaries.

Quality of maternity care and its determinants along the continuum in Kenya: A structural equation modeling analysis

PubMed Central

Mendez, Bomar Rojas

2017-01-01

Background Improving access to delivery services does not guarantee access to quality obstetric care and better survival, and therefore, concerns for quality of maternal and newborn care in low- and middle-income countries have been raised. Our study explored characteristics associated with the quality of initial assessment, intrapartum, and immediate postpartum and newborn care, and further assessed the relationships along the continuum of care. Methods The 2010 Service Provision Assessment data of Kenya for 627 routine deliveries of women aged 15–49 were used. Quality of care measures were assessed using recently validated quality of care measures during initial assessment, intrapartum, and postpartum periods. Data were analyzed with negative binomial regression and structural equation modeling technique. Results The negative binomial regression results identified a number of determinants of quality, such as the level of health facilities, managing authority, presence of delivery fee, central electricity supply and clinical guideline for maternal and neonatal care. Our structural equation modeling (SEM) further demonstrated that facility characteristics were important determinants of quality for initial assessment and postpartum care, while characteristics at the provider level became more important in shaping the quality of intrapartum care. Furthermore we also noted that quality of initial assessment had a positive association with quality of intrapartum care (β = 0.71, p < 0.001), which in turn was positively associated with the quality of newborn and immediate postpartum care (β = 1.29, p = 0.004). Conclusions A continued focus on quality of care along the continuum of maternity care is important not only to mothers but also their newborns. Policymakers should therefore ensure that required resources, as well as adequate supervision and emphasis on the quality of obstetric care, are available. PMID:28520771

Conceptual Model for Quality of Life among Adults With Congenital or Early Deafness

PubMed Central

Kushalnagar, P; McKee, M; Smith, SR; Hopper, M; Kavin, D; Atcherson, SR

2015-01-01

Background A conceptual model of health-related quality of life (QoL) is needed to describe key themes that impact perceived QoL in adults with congenital or early deafness. Objective: To revise University of Washington Center for Disability Policy and Research's conceptual model of health promotion and QoL, with suggestions for applying the model to improving programs or services that target deaf adults with early deafness. Methods Purposive and theoretical sampling of 35 adults who were born or became deaf early was planned in a 1-year study. In-depth semi-structured interviews probed deaf adult participants' perceptions about quality of life as a deaf individual. Data saturation was reached at the 17th interview with 2 additional interviews for validation, resulting in a total sample of 19 deaf adults. Coding and thematic analysis were conducted to develop the conceptual model. Results Our conceptual model delineates the relationships between health status (self-acceptance, coping with limitations), intrinsic (functional communication skills, navigating barriers/self-advocacy, resilience) and extrinsic (acceptance by others, access to information, educating others) factors in their influence on deaf adult quality of life outcomes at home, college, work, and in the community. Conclusions Findings demonstrate the need for the programs and services to consider not only factors intrinsic to the deaf individual but also extrinsic factors in enhancing perceived quality of life outcomes among people with a range of functional hearing and language preferences, including American Sign Language. PMID:24947577

Conceptual model for quality of life among adults with congenital or early deafness.

PubMed

Kushalnagar, Poorna; McKee, Michael; Smith, Scott R; Hopper, Melinda; Kavin, Denise; Atcherson, Samuel R

2014-07-01

A conceptual model of health-related quality of life (QoL) is needed to describe key themes that impact perceived QoL in adults with congenital or early deafness. To revise University of Washington Center for Disability Policy and Research's conceptual model of health promotion and QoL, with suggestions for applying the model to improving programs or services that target deaf adults with early deafness. Purposive and theoretical sampling of 35 adults who were born or became deaf early was planned in a 1-year study. In-depth semi-structured interviews probed deaf adult participants' perceptions about quality of life as a deaf individual. Data saturation was reached at the 17th interview with 2 additional interviews for validation, resulting in a total sample of 19 deaf adults. Coding and thematic analysis were conducted to develop the conceptual model. Our conceptual model delineates the relationships between health status (self-acceptance, coping with limitations), intrinsic (functional communication skills, navigating barriers/self-advocacy, resilience) and extrinsic (acceptance by others, access to information, educating others) factors in their influence on deaf adult quality of life outcomes at home, college, work, and in the community. Findings demonstrate the need for the programs and services to consider not only factors intrinsic to the deaf individual but also extrinsic factors in enhancing perceived quality of life outcomes among people with a range of functional hearing and language preferences, including American Sign Language. Copyright © 2014 Elsevier Inc. All rights reserved.

Assessing care-givers' satisfaction with child immunisation services in Zambia: Evidence from a national survey.

PubMed

Chama-Chiliba, Chitalu Miriam; Masiye, Felix; Mphuka, Chrispin

2017-10-09

The main aim of this study was to assess care-giver satisfaction with vaccination services in public health facilities in Zambia, and examine its determinants. This study used data from a recent population-based household survey, conducted from May to August 2015. Respondent satisfaction with vaccination services received during the last visit was measured on a five point Likert scale ranging from 1 to 5. We used an ordered logistic regression model to analyse the significance of perceived quality of vaccination services, immunisation delivery mode and a range of individual characteristics in predicting care-giver satisfaction. Findings show that one in five care givers were unsatisfied with the vaccination services that they had received, with rural populations showing a significantly higher level of satisfaction. Poor quality of care, defined by long waiting times, poor quality of communication between health staff and care givers, long distance to vaccination sites, mode of delivery, and personal characteristics were among major factors driving care-giver satisfaction ratings. We also find that receiving a vaccination at outreach mode of delivery was associated with higher odds of greater satisfaction compared to on-facility vaccination services. The odds of satisfaction were lower for respondents living further away from a health facility, which emphasizes the importance of access in seeking vaccination services. These findings suggest that major improvements in quality of vaccination and service organisation will be needed to increase client satisfaction and service utilisation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Context aware adaptive security service model

NASA Astrophysics Data System (ADS)

Tunia, Marcin A.

2015-09-01

Present systems and devices are usually protected against different threats concerning digital data processing. The protection mechanisms consume resources, which are either highly limited or intensively utilized by many entities. The optimization of these resources usage is advantageous. The resources that are saved performing optimization may be utilized by other mechanisms or may be sufficient for longer time. It is usually assumed that protection has to provide specific quality and attack resistance. By interpreting context situation of business services - users and services themselves, it is possible to adapt security services parameters to countermeasure threats associated with current situation. This approach leads to optimization of used resources and maintains sufficient security level. This paper presents architecture of adaptive security service, which is context-aware and exploits quality of context data issue.

Nurse managed occupational health services: a primary care model in practice.

PubMed

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.

Nurses' Satisfaction With Using Nursing Information Systems From Technology Acceptance Model and Information Systems Success Model Perspectives: A Reductionist Approach.

PubMed

Lin, Hsien-Cheng

2017-02-01

Nursing information systems can enhance nursing practice and the efficiency and quality of administrative affairs within the nursing department and thus have been widely considered for implementation. Close alignment of human-computer interaction can advance optimal clinical performance with the use of information systems. However, a lack of introduction of the concept of alignment between users' perceptions and technological functionality has caused dissatisfaction, as shown in the existing literature. This study provides insight into the alignment between nurses' perceptions and how technological functionality affects their satisfaction with Nursing Information System use through a reductionist perspective of alignment. This cross-sectional study collected data from 531 registered nurses in Taiwan. The results indicated that "perceived usefulness in system quality alignment," "perceived usefulness in information quality alignment," "perceived ease of use in system quality alignment," "perceived ease of use in information quality alignment," and "perceived ease of use in service quality alignment" have significantly affected nurses' satisfaction with Nursing Information System use. However, "perceived usefulness in service quality alignment" had no significant effect on nurses' satisfaction. This study also provides some meaningful implications for theoretical and practical aspects of design.

Models of commissioning health services in the British National Health Service: a literature review.

PubMed

Chappel, D; Miller, P; Parkin, D; Thomson, R

1999-06-01

The commissioning of health services is an under-researched area and yet it is critical to the way services meet health needs and to the quality of care. Recent emphasis in the United Kingdom and elsewhere has been on a 'primary care led National Health Service', particularly on locality commissioning through primary care groups. However, there are other models of commissioning using 'programmes of care' (focused on diseases or patient groups rather than geography) which may offer greater benefits. There is little research comparing the benefits and costs of these models, and most are not even clearly enough described to be replicated. There will always be a political dimension to models of commissioning, dependent, for example, on the balance of power in the decision-making process. None the less, a broader knowledge of possible models and a willingness to evaluate rigorously are needed if commissioning of health services is to result in better patient care.

SU-B-BRF-01: Professional Council Symposium: The Evolving US Healthcare Delivery Model, How Will the Medical Physics Profession Be Impacted and How Should We Respond?

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

Halvorsen, P; Shine, K; White, G

The United States' healthcare delivery model is undergoing significant change. Insurance and reimbursement models are rapidly evolving, federal allocations are shifting from specialty services to preventive and generalpractice services, and Accountable Care Organizations are gaining in prominence. One area of focus is on the perceived over-utilization of expensive services such as advanced imaging and, in some cases, radiation therapy. Reimbursement incentives are increasingly aimed at quality metrics, leading to an increased interest in the core concepts of High Reliability Organizations. With the shift in federal resources away from specialty services and the increasing prominence of Accountable Care Organizations, we willmore » likely be challenged to re-assess our traditional model for delivering medical physics services. Medical physicists have a unique combination of education and training in physics principles, radiation physics applications in medicine, human anatomy, as well as safety analysis and quality control methods. An effective medical physicist recognizes that to advance the institution's mission, the medical physicist must join other professional leaders within the institution to provide clear direction and perspective for the entire team. To do that, we must first recognize the macro changes in our healthcare delivery system and candidly assess how the medical physics practice model can evolve in a prudent way to support the institution's objectives while maintaining the traditionally high level of quality and safety. This year's Professional Council Symposium will explore the many facets of the changing healthcare system and its potential impact on medical physics. Dr. Shine will provide an overview of the developing healthcare delivery and reimbursement models, with a focus on how the physician community has adapted to the changing objectives. Mr. White will describe recent changes in the reimbursement patterns for both imaging and radiation therapy services, the underlying imperatives that will influence additional changes in the near-term future, and the broader changes in the medical physics workforce that may arise due to many (often conflicting) directives and incentives both internal and external to the profession. Maintaining the integrity of the medical physics profession and the high quality of medical physics services will require a shared understanding of the changing practice environment and a firm commitment to protecting the key priorities of clinical medical physics as the healthcare system transitions to a new and very different model. To be effective as medical physicists, we must learn how to provide leadership in our respective institutions. Learning Objectives: Understand the macro changes occurring in the US healthcare delivery system. Understand the likely near-term, and possible longer-term, impact on the medical physics profession. Understand some strategies for providing leadership during this period of significant change.« less

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients-innovation in the commissioning of primary dental care service delivery and organisation in the UK.

PubMed

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-09-17

In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards 'blended contracts' that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. 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.

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

PubMed

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

2013-01-01

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

[Financing, organization, costs and services performance of the Argentinean health sub-systems.

PubMed

Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

2016-01-01

To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services.

PubMed

Ngangue, Patrice; Gagnon, Marie-Pierre; Bedard, Emmanuelle

2017-04-08

The Cameroon government has made HIV testing and counselling (HTC) a priority in its HIV/AIDS strategic plan. However, there is a dearth of literature on the perspectives of providers on the quality of HTC services. The aim of this study was to explore challenges in the provision of HTC services and their implications on quality of HTC services in Douala's district hospitals. Two primary data collection methods supported by the Donabedian's model of healthcare were used to explain the challenges in the provision of HTC services and their implications on quality of HTC services. This consisted of semi-structured individual interviews with 6 nurses and 16 lay counsellors and a non-participant observation of the physical environment for HTC by site. The study sites were the prevention and voluntary testing and counselling centre (PVTCC) of the six district hospitals of the city of Douala. The study reveals concerns about confidentiality and privacy during the counselling sessions due to inadequate and limited space. An absence of consent, even verbal, was reported in one PVTCC. There is no specific accredited training curriculum that leads to a formal registration as a PVTCC staff, and some lay counsellors work without training. Lay counsellors carry the burden of HIV counselling, but the majority of them work for many years without remuneration and recognition. Another quality challenge is the high workload in the district hospitals' lab, which leads to long waiting times for HIV test results, thus contributing to failure to return for results. The findings of this study highlighted some issues such as lack of adequate space and equipment for HIV testing and counselling that hinder the quality of HTC services and should challenge the health authorities of Cameroon on the need to reorganize HTC services and create a national HIV quality assurance program.

Pricing the Services in Dynamic Environment: Agent Pricing Model

NASA Astrophysics Data System (ADS)

Žagar, Drago; Rupčić, Slavko; Rimac-Drlje, Snježana

New Internet applications and services as well as new user demands open many new issues concerning dynamic management of quality of service and price for received service, respectively. The main goals of Internet service providers are to maximize profit and maintain a negotiated quality of service. From the users' perspective the main goal is to maximize ratio of received QoS and costs of service. However, achieving these objectives could become very complex if we know that Internet service users might during the session become highly dynamic and proactive. This connotes changes in user profile or network provider/s profile caused by high level of user mobility or variable level of user demands. This paper proposes a new agent based pricing architecture for serving the highly dynamic customers in context of dynamic user/network environment. The proposed architecture comprises main aspects and basic parameters that will enable objective and transparent assessment of the costs for the service those Internet users receive while dynamically change QoS demands and cost profile.

Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study

PubMed Central

van der Eem, Lisette; Nyanza, Elias C.; van Pelt, Sandra; Ndaki, Pendo; Basinda, Namanya; Sundby, Johanne

2017-01-01

Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client’s wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria. PMID:29236699

A Quality Function Deployment Framework for the Service Quality of Health Information Websites

PubMed Central

Kim, Dohoon

2010-01-01

Objectives This research was conducted to identify both the users' service requirements on health information websites (HIWs) and the key functional elements for running HIWs. With the quality function deployment framework, the derived service attributes (SAs) are mapped into the suppliers' functional characteristics (FCs) to derive the most critical FCs for the users' satisfaction. Methods Using the survey data from 228 respondents, the SAs, FCs and their relationships were analyzed using various multivariate statistical methods such as principal component factor analysis, discriminant analysis, correlation analysis, etc. Simple and compound FC priorities were derived by matrix calculation. Results Nine factors of SAs and five key features of FCs were identified, and these served as the basis for the house of quality model. Based on the compound FC priorities, the functional elements pertaining to security and privacy, and usage support should receive top priority in the course of enhancing HIWs. Conclusions The quality function deployment framework can improve the FCs of the HIWs in an effective, structured manner, and it can also be utilized for critical success factors together with their strategic implications for enhancing the service quality of HIWs. Therefore, website managers could efficiently improve website operations by considering this study's results. PMID:21818418

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

PubMed Central

Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

Assessing the quality of reproductive health services in Egypt via exit interviews.

PubMed

Zaky, Hassan H M; Khattab, Hind A S; Galal, Dina

2007-05-01

This study assesses the quality of reproductive health services using client satisfaction exit interviews among three groups of primary health care units run by the Ministry of Health and Population of Egypt. Each group applied a different model of intervention. The Ministry will use the results in assessing its reproductive health component in the health sector reform program, and benefits from the strengths of other models of intervention. The sample was selected in two stages. First, a stratified random sampling procedure was used to select the health units. Then the sample of female clients in each health unit was selected using the systematic random approach, whereby one in every two women visiting the unit was approached. All women in the sample coming for reproductive health services were included in the analysis. The results showed that reproductive health beneficiaries at the units implementing the new health sector reform program were more satisfied with the quality of services. Still there were various areas where clients showed significant dissatisfaction, such as waiting time, interior furnishings, cleanliness of the units and consultation time. The study showed that the staff of these units did not provide a conductive social environment as other interventions did. A significant proportion of women expressed their intention to go to private physicians owing to their flexible working hours and variety specializations. Beneficiaries were generally more satisfied with the quality of health services after attending the reformed units than the other types of units, but the generalization did not fully apply. Areas of weakness are identified.

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency.

PubMed

Hanna, Timothy P; Kangolle, Alfred C T

2010-10-13

Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) PROCESS: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) OUTCOME: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important.

Guiding Principles and Checklist for Population-Based Quality Metrics

PubMed Central

Brunelli, Steven M.; Maddux, Franklin W.; Parker, Thomas F.; Johnson, Douglas; Nissenson, Allen R.; Collins, Allan; Lacson, Eduardo

2014-01-01

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. PMID:24558050

GP Practices as a One-Stop Shop: How Do Patients Perceive the Quality of Care? A Cross-Sectional Study in Thirty-Four Countries.

PubMed

Schäfer, Willemijn L A; Boerma, Wienke G W; Schellevis, François G; Groenewegen, Peter P

2017-12-29

To contribute to the current knowledge on how a broad range of services offered by general practitioners (GPs) may contribute to the patient perceived quality and, hence, the potential benefits of primary care. Between 2011 and 2013, primary care data were collected among GPs and their patients in 31 European countries, plus Australia, Canada, and New Zealand. In these countries, GPs are the main providers of primary care, mostly specialized in family medicine and working in the ambulatory setting. In this cross-sectional study, questionnaires were completed by 7,183 GPs and 61,931 visiting patients. Moreover, 7,270 patients answered questions about what they find important (their values). In the analyses of patient experiences, we adjusted for patients' values in each country to measure patient perceived quality. Perceived quality was measured regarding five areas: accessibility and continuity of care, doctor-patient communication, patient involvement in decision making, and comprehensiveness of care. The range of GP services was measured in relation to four areas: (1) to what extent they are the first contact to the health care system for patients in need of care, (2) their involvement in treatment and follow-up of acute and chronic conditions, in other words treatment of diseases, (3) their involvement in minor technical procedures, and (4) their involvement in preventive treatments. Data of the patients were linked to the data of the GPs. Multilevel modeling was used to construct scale scores for the experiences of patients in the five areas of quality and the range of services of GPs. In these four-level models, items were nested within patients, nested in GP practices, nested in countries. The relationship between the range of services and the experiences of patients was analyzed in three-level multilevel models, also taking into account the values of patients. In countries where GPs offer a broader range of services patients perceive better accessibility, continuity, and comprehensiveness of care, and more involvement in decision making. No associations were found between the range of services and the patient perceived communication with their GP. The range of GP services mostly explained the variation between countries in the areas of patient perceived accessibility and continuity of care. This study showed that in countries where GP practices serve as a "one-stop shop," patients perceive better quality of care, especially in the areas of accessibility and continuity of care. Therefore, primary care in a country is expected to benefit from investments in a broader range of services of GPs or other primary care physicians. © Health Research and Educational Trust.

An integrated model to measure service management and physical constraints' effect on food consumption in assisted-living facilities.

PubMed

Huang, Hui-Chun; Shanklin, Carol W

2008-05-01

The United States is experiencing remarkable growth in the elderly population, which provides both opportunities and challenges for assisted-living facilities. The objective of this study was to explore how service management influences residents' actual food consumption in assisted-living facilities. Physical factors influencing residents' service evaluation and food consumption also were investigated. A total of 394 questionnaires were distributed to assisted-living residents in seven randomly selected facilities. The questionnaire was developed based on an in-depth literature review and pilot study. Residents' perceived quality evaluations, satisfaction, and physical constraints were measured. Residents' actual food consumption was measured using a plate waste technique. A total of 118 residents in five facilities completed both questionnaires and food consumption assessments. Descriptive, multivariate analyses and structural equation modeling techniques were employed. Service management, including food and service quality and customer satisfaction, was found to significantly influence residents' food consumption. Physical constraints associated with aging, including a decline in health status, chewing problems, sensory loss, and functional disability, also significantly influenced residents' food consumption. A significant relationship was found between physical constraints and customer satisfaction. Foodservice that provides good food and service quality increases customer satisfaction and affects residents' actual food consumption. Physical constraints also influence residents' food consumption directly, or indirectly through satisfaction. The findings suggest that food and nutrition professionals in assisted-living should consider the physical profiles of their residents to enhance residents' satisfaction and nutrient intake. Recommendations for exploring residents' perspectives are discussed.

Quebec's Child Care Services: What Are the Mechanisms Influencing Children's Behaviors across Quantity, Type, and Quality of Care Experienced?

ERIC Educational Resources Information Center

Lemay, Lise; Bigras, Nathalie; Bouchard, Caroline

2015-01-01

The objective of this study was to examine how quantity, type, and quality of care interact in predicting externalizing and internalizing behaviors of 36-month-old children attending Quebec's educational child care from their first years of life. To do so, the authors examined two hypothesized models: (1) a mediation model where quantity, type,…

The development of a healing model of care for an Indigenous drug and alcohol residential rehabilitation service: a community-based participatory research approach.

PubMed

Munro, Alice; Shakeshaft, Anthony; Clifford, Anton

2017-12-04

Given the well-established evidence of disproportionately high rates of substance-related morbidity and mortality after release from incarceration for Indigenous Australians, access to comprehensive, effective and culturally safe residential rehabilitation treatment will likely assist in reducing recidivism to both prison and substance dependence for this population. In the absence of methodologically rigorous evidence, the delivery of Indigenous drug and alcohol residential rehabilitation services vary widely, and divergent views exist regarding the appropriateness and efficacy of different potential treatment components. One way to increase the methodological quality of evaluations of Indigenous residential rehabilitation services is to develop partnerships with researchers to better align models of care with the client's, and the community's, needs. An emerging research paradigm to guide the development of high quality evidence through a number of sequential steps that equitably involves services, stakeholders and researchers is community-based participatory research (CBPR). The purpose of this study is to articulate an Indigenous drug and alcohol residential rehabilitation service model of care, developed in collaboration between clients, service providers and researchers using a CBPR approach. This research adopted a mixed methods CBPR approach to triangulate collected data to inform the development of a model of care for a remote Indigenous drug and alcohol residential rehabilitation service. Four iterative CBPR steps of research activity were recorded during the 3-year research partnership. As a direct outcome of the CBPR framework, the service and researchers co-designed a Healing Model of Care that comprises six core treatment components, three core organisational components and is articulated in two program logics. The program logics were designed to specifically align each component and outcome with the mechanism of change for the client or organisation to improve data collection and program evaluation. The description of the CBPR process and the Healing Model of Care provides one possible solution about how to provide better care for the large and growing population of Indigenous people with substance.

Implementing two nurse practitioner models of service at an Australian male prison: A quality assurance study.

PubMed

Wong, Ides; Wright, Eryn; Santomauro, Damian; How, Raquel; Leary, Christopher; Harris, Meredith

2018-01-01

To examine the quality and safety of nurse practitioner services of two newly implemented nurse practitioner models of care at a correctional facility. Nurse practitioners could help to meet the physical and mental health needs of Australia's growing prison population; however, the nurse practitioner role has not previously been evaluated in this context. A quality assurance study conducted in an Australian prison where a primary health nurse practitioner and a mental health nurse practitioner were incorporated into an existing primary healthcare service. The study was guided by Donabedian's structure, processes and outcomes framework. Routinely collected information included surveys of staff attitudes to the implementation of the nurse practitioner models (n = 21 staff), consultation records describing clinical processes and time use (n = 289 consultations), and a patient satisfaction survey (n = 29 patients). Data were analysed descriptively and compared to external benchmarks where available. Over the two-month period, the nurse practitioners provided 289 consultations to 208 prisoners. The presenting problems treated indicated that most referrals were appropriate. A significant proportion of consultations involved medication review and management. Both nurse practitioners spent more than half of their time on individual patient-related care. Overall, multidisciplinary team staff agreed that the nurse practitioner services were necessary, safe, met patient need and reduced treatment delays. Findings suggest that the implementation of nurse practitioners into Australian correctional facilities is acceptable and feasible and has the potential to improve prisoners' access to health services. Structural factors (e.g., room availability and limited access to prisoners) may have reduced the efficiency of the nurse practitioners' clinical processes and service implementation. Results suggest that nurse practitioner models can be successfully integrated into a prison setting and could provide a nursing career pathway. © 2017 John Wiley & Sons Ltd.

Specialty Payment Model Opportunities and Assessment

PubMed Central

Mulcahy, Andrew W.; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J.; Kofner, Aaron; Liu, Jodi L.; Lovejoy, Susan L.; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model. PMID:28083363

Behavioral and quality-of-life outcomes in different service models for methadone maintenance treatment in Vietnam.

PubMed

Tran, Bach Xuan; Nguyen, Long Hoang; Nong, Vuong Minh; Nguyen, Cuong Tat; Phan, Huong Thu Thi; Latkin, Carl A

2016-02-02

Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90% response rate). Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3% on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3%). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8%), anxiety/depression (43.1%), and mobility (13.3%). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients. Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.

Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care.

PubMed

Kolarczyk, Lavinia M; Arora, Harendra; Manning, Michael W; Zvara, David A; Isaak, Robert S

2018-02-01

Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. All rights reserved.

Episodes of care: is emergency medicine ready?

PubMed

Wiler, Jennifer L; Beck, Dennis; Asplin, Brent R; Granovsky, Michael; Moorhead, John; Pilgrim, Randy; Schuur, Jeremiah D

2012-05-01

Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting. Copyright © 2011. Published by Mosby, Inc.

Do prominent quality measurement surveys capture the concerns of persons with disability?

PubMed

Iezzoni, Lisa I; Marsella, Sarah A; Lopinsky, Tiffany; Heaphy, Dennis; Warsett, Kimberley S

2017-04-01

Demonstration programs nationwide aim to control costs and improve care for people dually-eligible for Medicare and Medicaid, including many persons with disability. Ensuring these initiatives maintain or improve care quality requires comprehensive evaluation of quality of care. To examine whether the common quality measures being used to evaluate the Massachusetts One Care duals demonstration program comprehensively address the concerns of persons with disability. Drawing upon existing conceptual frameworks, we developed a model of interrelationships of personal, health care, and environmental factors for achieving wellness for persons with disability. Based on this model, we specified a scheme to code individual quality measurement items and coded the items contained in 12 measures being used to assess Massachusetts One Care, which exclusively enrolls non-elderly adults with disability. Across these 12 measures, we assigned 376 codes to 302 items; some items received two codes. Taken together, the 12 measures contain items addressing most factors in our conceptual model that affect health care quality for persons with disability, including long-term services and supports. Some important gaps exist. No items examine sexual or reproductive health care, peer support, housing security, disability stigmatization, and specific services obtained outside the home like adult day care. Certain key concepts are covered only by a single or several of the 12 quality measures. Common quality metrics cover most - although not all-health care quality concerns of persons with disability. However, multiple different quality measures are required for this comprehensive coverage, raising questions about respondent burden. Copyright © 2017 Elsevier Inc. All rights reserved.

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals

PubMed Central

Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

2017-01-01

Introduction Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. Methods To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. Results The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach’s alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. Conclusion The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals. PMID:28461863

Service quality and parents' willingness to get adolescents HPV vaccine from pharmacists.

PubMed

Shah, Parth D; Calo, William A; Marciniak, Macary W; Golin, Carol E; Sleath, Betsy L; Brewer, Noel T

2018-04-01

We sought to examine whether pharmacy service quality was associated with parents' willingness to have immunizing pharmacists administer human papillomavirus (HPV) vaccine to their adolescent children. Participants were a national sample of 1504 US parents of adolescents ages 11 to 17 who completed an online survey in 2014. Analyses used structural equation modeling. Parents rated service quality and feelings of satisfaction with their pharmacies as moderate to high. Many (44%) were willing to get HPV vaccine from immunizing pharmacists for their adolescent children. Compared with parents who went to chain pharmacies, parents who went to independent pharmacies gave higher ratings of service quality (professionalism, confidentiality, milieu, all p < .001). Parents who went to clinic pharmacies, compared with parents who went to chain pharmacies gave lower ratings for milieu (p < .01). Parents who went to independent pharmacies had lower willingness to get HPV vaccine from pharmacists compared to parents who went to chain pharmacies (p = .001), but there was no difference in willingness for parents who went to clinic versus chain pharmacies. Service quality and satisfaction partially mediated the effect between independent pharmacies compared to chain pharmacies and willingness (p < .05). Parents who knew their pharmacists or expressed more confidence in HPV vaccine also had higher willingness to get their children HPV vaccine from pharmacist. Many parents were willing to go to immunizing pharmacists for their children's HPV vaccination. Pharmacies that are considering offering HPV vaccine may be able to improve vaccine uptake by increasing perception of service quality. Copyright © 2018 Elsevier Inc. All rights reserved.

Physician outcome measurement: review and proposed model.

PubMed

Siha, S

1998-01-01

As health care moves from a free-for-service environment to a capitated arena, outcome measurements must change. ABC Children's Medical Center is challenged with developing comprehensive outcome measures for an employed physician group. An extensive literature review validates that physician outcomes must move beyond revenue production and measure all aspects of care delivery. The proposed measurement model for this physician group is a trilogy model. It includes measures of cost, quality, and service. While these measures can be examined separately, it is imperative to understand their integration in determining an organization's competitive advantage. The recommended measurements for the physician group must be consistent with the overall organizational goals. The long-term impact will be better utilization of resources. This will result in the most cost effective, quality care for the health care consumer.

Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change

PubMed Central

2014-01-01

Background Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. Methods A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of ‘out of hospital’ or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Results Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the required skills for providing care for infants, and an ‘outpatient’ model of care. Services were also characterised by absent Aboriginal leadership and inadequate coordination between remote and tertiary services that is essential to improve quality of care and reduce ‘system-introduced’ risk. Conclusion Evidence-informed redesign of maternity services and delivery of care has improved clinical effectiveness and quality for women. However, more work is needed to address substandard care provided for infants and their parents. PMID:24890910

Implementation of Medicaid Managed Long-Term Services and Supports for Adults with Intellectual And/Or Developmental Disabilities in Kansas

ERIC Educational Resources Information Center

Williamson, Heather J.; Perkins, Elizabeth A.; Levin, Bruce L.; Baldwin, Julie A.; Lulinski, Amie; Armstrong, Mary I.; Massey, Oliver T.

2017-01-01

Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is…

Delivering Integrated Services. Models for Facilitating Change in Small and Mid-Sized Firms. Business Assistance Tools.

ERIC Educational Resources Information Center

Mitchell, Stephen M.

This guide draws on case studies to identify lessons for small and midsized firms who wish to improve the quality of their services and facilitate change. Following an introduction, section 2 describes the context in which the research was undertaken after a needs analysis was conducted of small and midsized businesses and service providers, and…

People Management. Final Report of the People Management Committee

DTIC Science & Technology

1975-04-25

Objective Memorandum Planning, Programming, C Budgeting System Personnel Priority Model Projected Requisitioning Authority Prior ServIce Quality ...April 1975 PREPARED FOR - G THE DEPARTMENT OF ARMY OFFICE OF THE DEPUTY CHIEF OF STAFF FOR PERSONNEL NATIONAL TECHNICAL INFORMATION SERVICE US... service accessions and reenllstees. (3) Manage the DEP. (4) Bolster systems discipline. d. RecommendetIons; (1) That manpower objectives

Developing inclusive partnerships: user-defined outcomes, networking and knowledge--a case study.

PubMed

Beresford, Peter; Branfield, Fran

2006-09-01

Two major developments have been associated with the reorientation of United Kingdom health and social care policy and provision in recent years, placing a new emphasis on: quality and 'outcome' measures; and service user (and public and patient) involvement. These issues have become central to health and social care, representing expressions of the shift in political and ideological interest in public policy. However, these two strands of development have tended to be treated as discrete discourses and have developed separately in policy. Nevertheless, it can hardly be assumed that what policy makers, service planners, providers and purchasers would value and prioritise as good quality would necessarily coincide with what service users would want. Developing effective partnership working needs to go beyond considerations of organisations and professional groupings, and fully involve service users as one of the key stakeholders. This paper describes the findings of three projects undertaken by Shaping Our Lives. These studies confirmed that service-user concepts of outcomes and quality may differ significantly from those currently employed; moreover, service users are able to offer a complex and sophisticated model of what outcome measures might look like if they were centrally involved in their definition and application. Nevertheless, service users currently have little impact in defining and influencing quality outcomes. The projects also highlight the importance of networking and knowledge sharing for service users and user organisations in their ability to influence policy definitions of quality, and a number of the barriers and obstacles which undermine this process. The paper concludes with two proposals which, considered together, offer the basis for taking forward effective and inclusive partnerships and developing measures for quality consistent with the rights and preferences of service users themselves. They are an essential complement to broader efforts and strategies to develop effective partnerships in health and social care.

The Oncology Care Model: Perspectives From the Centers for Medicare & Medicaid Services and Participating Oncology Practices in Academia and the Community.

PubMed

Kline, Ron; Adelson, Kerin; Kirshner, Jeffrey J; Strawbridge, Larissa M; Devita, Marsha; Sinanis, Naralys; Conway, Patrick H; Basch, Ethan

2017-01-01

Cancer care delivery in the United States is often fragmented and inefficient, imposing substantial burdens on patients. Costs of cancer care are rising more rapidly than other specialties, with substantial regional differences in quality and cost. The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMIS) recently launched the Oncology Care Model (OCM), which uses payment incentives and practice redesign requirements toward the goal of improving quality while controlling costs. As of March 2017, 190 practices were participating, with approximately 3,200 oncologists providing care for approximately 150,000 unique beneficiaries per year (approximately 20% of the Medicare Fee-for-Service population receiving chemotherapy for cancer). This article provides an overview of the program from the CMS perspective, as well as perspectives from two practices implementing OCM: an academic health system (Yale Cancer Center) and a community practice (Hematology Oncology Associates of Central New York). Requirements of OCM, as well as implementation successes, challenges, financial implications, impact on quality, and future visions, are provided from each perspective.

Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services.

PubMed

Cason, Jana; Behl, Diane; Ringwalt, Sharon

2012-01-01

Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states' IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1-2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part C programming included security issues (40%; n=11); privacy issues (44%; n=12); concerns about quality of services delivered via telehealth (40%; n=11); and lack of evidence to support the effectiveness of a telehealth service delivery model within IDEA Part C programming (3%; n=1). Reimbursement policy and billing processes and technology infrastructure were also identified as barriers impacting the implementation of telehealth programming. Provider shortages impact the quantity and quality of services available for children with disabilities and developmental delay, particularly in rural areas. While many states are incorporating telehealth within their Early Intervention (IDEA Part C) services in order to improve access and overcome personnel shortages, barriers persist. Policy development, education of stakeholders, research, utilization of secure and private delivery platforms, and advocacy may facilitate more widespread adoption of telehealth within IDEA Part C programs across the country.

Overview of States’ Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services

PubMed Central

Cason, Jana; Behl, Diane; Ringwalt, Sharon

2012-01-01

Background: Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. Method: A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states’ IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Results: Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1–2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part C programming included security issues (40%; n=11); privacy issues (44%; n=12); concerns about quality of services delivered via telehealth (40%; n=11); and lack of evidence to support the effectiveness of a telehealth service delivery model within IDEA Part C programming (3%; n=1). Reimbursement policy and billing processes and technology infrastructure were also identified as barriers impacting the implementation of telehealth programming. Conclusions: Provider shortages impact the quantity and quality of services available for children with disabilities and developmental delay, particularly in rural areas. While many states are incorporating telehealth within their Early Intervention (IDEA Part C) services in order to improve access and overcome personnel shortages, barriers persist. Policy development, education of stakeholders, research, utilization of secure and private delivery platforms, and advocacy may facilitate more widespread adoption of telehealth within IDEA Part C programs across the country. PMID:25945202

7 CFR 225.7 - Program monitoring and assistance.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., food service management company representatives, auditors, and health inspectors who will participate... adequately for the Program. (c) Food specifications and meal quality standards. With the assistance of the... and model meal quality standards which shall become part of all contracts between vended sponsors and...

Achieving the integrated and smart health and wellbeing paradigm: a call for policy research and action on governance and business models.

PubMed

Stroetmann, Karl A

2013-04-01

To assure sustainability of our health systems and improve quality, implementing integrated wellness, health and social care service models have been proposed. They will need the enabling power of Health ICT facilitated systems and applications. Such solutions support the efficient coordination of service provision across provider and jurisdictional boundaries, the sharing of data, information and knowledge, and the streamlining as well as individualisation of care. Achieving such change in health systems with limited resources requires refocusing the trend of medico-technical progress. Health ICT innovations must be scrutinised for their potential to indeed contribute not only to decreasing costs, but - at the same time - improving the quality of life and ability to cope with challenges like the increasing prevalence of certain chronic diseases or new expectations from healthy people and patients alike. This paper argues that decision-oriented governance models leading to focused policy interventions are needed at several levels: Governments should provide for comprehensive Health ICT infrastructures to enable provider market success. At the individual actor level, sustainable business models reflecting in their value propositions the expectations of their clients (patients and funders) need to be developed. Health policy should design intelligent reimbursement systems providing incentives to indeed optimise services. Smart health innovations should only be implemented where they help achieve the goal of increasing the productivity of health value chains and the quality of overall service delivery value systems. To assure allocational efficiency, regulatory impact analyses (RIA) can support evidence based policy making. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report.

PubMed

Mulcahy, Andrew W; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J; Kofner, Aaron; Liu, Jodi L; Lovejoy, Susan L; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model.

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

PubMed

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

2004-03-01

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

The challenge of documenting water quality benefits of conservation practices: a review of USDA-ARS's conservation effects assessment project watershed studies.

PubMed

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.

Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation.

PubMed

Wollscheid, Sabine; Eriksen, John; Hallvik, Jørgen

2013-06-01

This study explores the provision of home care services (home nursing and domiciliary help) for the elderly in Norwegian municipalities with purchaser-provider split model. The study draws on the assumption that flexibility in adjusting services to the care receivers' needs, and cooperation between provider and purchasers are indicators of good quality of care. Data were collected through semi-structured telephone interviews with 22 team leaders of provider units in nine municipalities. Data were collected in 2008-2009. The study has been approved by the Norwegian Social Science Data Services. We identified four different ways of organising home care services under a purchaser-provider split model: Provider empowerment, New Public Management, Vague instructions and undermining the rules. High flexibility in providing care and cooperation with the purchaser unit were identified by the team leaders as characteristics for good care. Our findings suggest that the care providers use individual strategies that allow flexibility and cooperation rather than rigidly abiding to the regulations the purchaser-provider split models implies. Ironically, in provider units where the 'rules were undermined', the informants (team leaders of provider units) seemed to be most satisfied with the quality of home care that they delivered. © 2012 Nordic College of Caring Science.

Quality control in linen and laundry service at a tertiary care teaching hospital in India.

PubMed

Singh, Dara; Qadri, Gj; Kotwal, Monica; Syed, At; Jan, Farooq

2009-01-01

The clean bedding and clean clothes installs psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Being an important Component in the management of the patients, a study was carried out to find out the current quality status and its conformity with the known standards and identify the areas of intervention in order to further increase the patient and staff satisfaction regarding the services provided by linen and laundry department Quality control practised in the Linen and Laundry Service was studied by conducting a prospective study on the concept of Donabedian model of structure, process and outcome. Study was done by pre-designed Proforma along with observation / Interviews / Questionnaire and study of records. The input studied included physical facilities, manpower, materials, equipments and environmental factors. The various elements of manpower studied consisted of number of staff working, their qualification, training, promotion avenues, motivation and job satisfaction. Process was studied by carrying out observations in linen and laundry service through a predesigned flow chart which was supplemented by interviews with different category of staff. Patient satisfaction, staff satisfaction and microbial count of laundered linen (quality dimensions) were studied in the outcome. The current study found that in spite of certain deficiencies in the equipment, manpower and process, the linen and laundry service is providing a satisfactory service to its users. However the services can be further improved by removing the present deficiencies both at structure and process level.

75 FR 63834 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-18

... facilities and controls used for, the manufacture, preproduction design validation (including a process to... requirements governing the design, manufacture, packing, labeling, storage, installation, and servicing of all... Model for Quality Assurance in Design/Development, Production, Installation, and Servicing.'' The CGMP...

Promoting excellence in end-of-life care: a report on innovative models of palliative care.

PubMed

Byock, Ira; Twohig, Jeanne Sheils; Merriman, Melanie; Collins, Karyn

2006-02-01

Promoting Excellence in End-of Life Care, a national program of The Robert Wood Johnson Foundation, funded 22 demonstration projects representing a wide range of health care settings and patient populations to develop innovative models for delivering palliative care that addressed documented deficiencies in the care of patients and families facing the final stage of life. To determine the practicality (feasibility of development and operation as well as acceptance by stakeholders) of new models of care and to determine the impact of the models on access to, quality of and financing for palliative care. The program cannot report scientifically rigorous outcomes, but the grant-funded projects used a variety of methods and measures to assess acceptance of new models and their impact from the perspectives of various stakeholders, including patients and their families, clinicians, administrators and payers. While it is not possible to aggregate data across projects, the data reported to the Promoting Excellence national program office were used to describe program impact with respect to the practicality of palliative care service integration into existing clinical care settings (feasibility and acceptance by stakeholders), the availability and use of palliative care services (access), quality of care (conformance to patient expectations and accepted clinical standards) and costs of care. The 22 projects provided services in urban as well as rural settings, in integrated health systems, hospitals, outpatient clinics, cancer centers, nursing homes, renal dialysis clinics, inner city public health and safety net systems and prisons. Populations served included prison inmates, military veterans, renal dialysis patients, Native Americans, Native Alaskans, and African American patients, inner-city medically underserved patients, pediatric patients, and persons with serious mental illness patients. Hosting or adopting institutions sustained or expanded twenty of the 22 models, and feedback from all stakeholders was positive. Project sites developed and utilized new palliative care services and addressed quality through implementation of new standards and clinical protocols. Costs of care, where they could be assessed, were unaffected or decreased for project patients versus historical or concurrent controls. The 22 Promoting Excellence in End-of Life Care projects demonstrated that by individualizing patient and family assessment, effectively employing existing resources and aligning services with specific patient and family needs, it is possible to expand access to palliative services and improve quality of care in ways that are financially feasible and acceptable to patients, families, clinicians, administrators, and payers.

Health insurance coverage, income distribution and healthcare quality in local healthcare markets.

PubMed

Damianov, Damian S; Pagán, José A

2013-08-01

We develop a theoretical model of a local healthcare system in which consumers, health insurance companies, and healthcare providers interact with each other in markets for health insurance and healthcare services. When income and health status are heterogeneous, and healthcare quality is associated with fixed costs, the market equilibrium level of healthcare quality will be underprovided. Thus, healthcare reform provisions and proposals to cover the uninsured can be interpreted as an attempt to correct this market failure. We illustrate with a numerical example that if consumers at the local level clearly understand the linkages between health insurance coverage and the quality of local healthcare services, health insurance coverage proposals are more likely to enjoy public support. Copyright © 2012 John Wiley & Sons, Ltd.

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

PubMed

Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya

PubMed Central

Mutemwa, Richard; Mayhew, Susannah H; Warren, Charlotte E; Abuya, Timothy; Ndwiga, Charity; Kivunaga, Jackline

2017-01-01

Abstract The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client–provider consultation sessions. The cross-sectional study observed 366 client–provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63–0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07–14.21), adequate infrastructure (5.29; 95% CI: 2.89–7.69) and reagents (1.48; 95% CI: 1.02–1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92–4.36), job satisfaction (2.02; 95% CI: 1.21–2.83) and supervision (1.01; 95% CI: 0.35–1.68), while workload (−0.88; 95% CI: −1.75 to − 0.01) was negatively associated. Technical quality of the client–provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client–provider consultation sessions as measured by both health facility structural and provider factors. PMID:29194543

Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya.

PubMed

Mutemwa, Richard; Mayhew, Susannah H; Warren, Charlotte E; Abuya, Timothy; Ndwiga, Charity; Kivunaga, Jackline

2017-11-01

The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client-provider consultation sessions. The cross-sectional study observed 366 client-provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63-0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07-14.21), adequate infrastructure (5.29; 95% CI: 2.89-7.69) and reagents (1.48; 95% CI: 1.02-1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92-4.36), job satisfaction (2.02; 95% CI: 1.21-2.83) and supervision (1.01; 95% CI: 0.35-1.68), while workload (-0.88; 95% CI: -1.75 to - 0.01) was negatively associated. Technical quality of the client-provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client-provider consultation sessions as measured by both health facility structural and provider factors. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Profile and predictors of service needs for families of children with autism spectrum disorders

PubMed Central

Zwaigenbaum, Lonnie; Nicholas, David

2015-01-01

Purpose: Increasing demand for autism services is straining service systems. Tailoring services to best meet families’ needs could improve their quality of life and decrease burden on the system. We explored overall, best, and worst met service needs, and predictors of those needs, for families of children with autism spectrum disorders. Methods: Parents of 143 children with autism spectrum disorders (2–18 years) completed a survey including demographic and descriptive information, the Family Needs Survey–Revised, and an open-ended question about service needs. Descriptive statistics characterize the sample and determine the degree to which items were identified and met as needs. Predictors of total and unmet needs were modeled with regression or generalized linear model. Qualitative responses were thematically analyzed. Results: The most frequently identified overall and unmet service needs were information on services, family support, and respite care. The funding and quality of professional support available were viewed positively. Decreased child’s age and income and being an older mother predicted more total needs. Having an older child or mother, lower income, and disruptive behaviors predicted more total unmet needs, yet only disruptive behaviors predicted proportional unmet need. Child’s language or intellectual abilities did not predict needs. Conclusion: Findings can help professionals, funders, and policy-makers tailor services to best meet families’ needs. PMID:25073749

Comparison of three models of ownership of community health centres in China: a qualitative study.

PubMed

Wei, Xiaolin; Yang, Nan; Gao, Yang; Wong, Samuel Y S; Wong, Martin C S; Wang, Jiaji; Wang, Harry H X; Li, Donald K T; Tang, Jinling; Griffiths, Sian M

2015-07-01

Community health centres are the main form of provision of primary care in China. There are three models: government managed, hospital managed and private. Our aim was to describe and compare primary care under the three ownership models. Four aspects of primary care were studied: services, organization, financing and human resources. Interviews were undertaken with 60 managerial and professional staff in 13 community health centres in the Pearl River Delta region in 2010. Three community health centres were selected in the capital city and two were selected from each of the other five cities. Thematic framework analysis was conducted. Government-managed community health centres received the largest public funding, followed by hospital-managed community health centres, while private community health centres received the least. Private community health centres were the smallest in scale and provided lower quality public health services compared with the other two models. Patient out-of-pocket costs accounted for the majority of the revenue in all models of community health centres despite improved government funding for preventive services. General challenges such as the shortage of public funding, the exclusion of migrants in the funding for preventive services, low capacity in human resources and the separation of clinical and preventive care in community health centres were identified in all three models of community health centres. The ownership and management of a community health centre greatly influence the service it provides. Private community health centres are in a disadvantaged position to deliver high quality clinical and preventive care. © The Author(s) 2015.

Consumer and case manager perspectives of service empowerment: relationship to mental health recovery.

PubMed

Crane-Ross, Dushka; Lutz, Wilma J; Roth, Dee

2006-04-01

This study examines the relationship between service empowerment and recovery. Service empowerment is defined as the extent to which consumers participate in service decisions and the level of reciprocity and respect within the relationship with their case managers. Assessments were made from two perspectives: consumers and their case managers. Structural equation models were developed to examine the direct and indirect effects of service empowerment on four recovery outcomes: Quality of Life, Level of Functioning, Consumer-Reported Symptomatology, and Case Manager-Reported Symptomatology. Consumers' perceptions of service empowerment were the most powerful predictor of recovery outcomes across the four models. Consumers' and case managers' perceptions were related but the magnitude of the relationship was small, indicating that considerable differences exist between their perceptions of service empowerment.

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

PubMed

Sanders, Julie; Fitzpatrick, Joanne M

2017-01-01

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

A Control-Theoretic Approach for the Combined Management of Quality-of-Service and Energy in Service Centers

NASA Astrophysics Data System (ADS)

Poussot-Vassal, Charles; Tanelli, Mara; Lovera, Marco

The complexity of Information Technology (IT) systems is steadily increasing and system complexity has been recognised as the main obstacle to further advancements of IT. This fact has recently raised energy management issues. Control techniques have been proposed and successfully applied to design Autonomic Computing systems, trading-off system performance with energy saving goals. As users behaviour is highly time varying and workload conditions can change substantially within the same business day, the Linear Parametrically Varying (LPV) framework is particularly promising for modeling such systems. In this chapter, a control-theoretic method to investigate the trade-off between Quality of Service (QoS) requirements and energy saving objectives in the case of admission control in Web service systems is proposed, considering as control variables the server CPU frequency and the admission probability. To quantitatively evaluate the trade-off, a dynamic model of the admission control dynamics is estimated via LPV identification techniques. Based on this model, an optimisation problem within the Model Predictive Control (MPC) framework is setup, by means of which it is possible to investigate the optimal trade-off policy to manage QoS and energy saving objectives at design time and taking into explicit account the system dynamics.

Bundled payment and enhanced recovery after surgery.

PubMed

Huang, Jeffrey

2015-01-01

Medicare's fee-for-service (FFS) payment model may contribute to unsustainable spending growth. Payers are turning to alternative payment methods. The leading alternative payment model to the FFS problem is bundled payment. The Centers for Medicare & Medicaid Services (CMS) is taking another step to improve healthcare quality at lower cost. The CMS's Center for Medicare and Medicaid Innovation developed four models of bundled payments and 48 discrete clinical condition episodes. Many surgical care procedures are included in the 48 different clinical condition episodes.

Commitment to Quality Education Services through ISO 9000: A Case Study of Romania

ERIC Educational Resources Information Center

Paunescu, Carmen; Fok, Wing

2005-01-01

The paper discusses a model of quality management system for higher education. One of the main objectives of this paper is to highlight the challenges facing the school during implementation of the ISO 9001 standard and the benefits of successfully implementing such a quality system can bring to higher education. Based on the experience of a…

Compendium of Quality Rating Systems and Evaluations: The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Tout, Kathryn; Starr, Rebecca; Soli, Margaret; Moodie, Shannon; Kirby, Gretchen; Boller, Kimberly

2010-01-01

Quality Rating Systems (QRS) are currently operating, under development, or being piloted in over 25 states or local areas. As the QRS model becomes integrated into the landscape of child care and education service delivery, policy, and the decisions parents make about child care across the United States, there is an increasing need for…

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings

PubMed Central

Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-01-01

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals’ quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers. PMID:27800337

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings.

PubMed

Saccares, Stefano; Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-04-17

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals' quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers.

Significant components of service brand equity in healthcare sector.

PubMed

Chahal, Hardeep; Bala, Madhu

2012-01-01

The purpose of the study is to examine three significant components of service brand equity--i.e. perceived service quality, brand loyalty, and brand image--and analyze relationships among the components of brand equity and also their relationship with brand equity, which is still to be theorized and developed in the healthcare literature. Effective responses were received from 206 respondents, selected conveniently from the localities of Jammu city. After scale item analysis, the data were analyzed using factor analysis, correlations, t-tests, multiple regression analysis and path modeling using SEM. The findings of the study support that service brand equity in the healthcare sector is greatly influenced by brand loyalty and perceived quality. However, brand image has an indirect effect on service brand equity through brand loyalty (mediating variable). The research can be criticized on the ground that data were selected conveniently from respondents residing in the city of Jammu, India. But at the same time the respondents were appropriate for the study as they have adequate knowledge about the hospitals, and were associated with the selected hospital for more than four years. Furthermore, the validity and reliability of the data are strong enough to take care of the limitations of the convenience sampling selection method. The study has unique value addition to the service marketing vis-à-vis healthcare literature, from both theoretical and managerial perspectives. The study establishes a direct and significant relationship between service brand equity and its two components, i.e. perceived service quality and brand loyalty in the healthcare sector. It also provides directions to healthcare service providers in creating, enhancing, and maintaining service brand equity through service quality and brand loyalty, to sustain competitive advantage.

Do consumer reports of health plan quality affect health plan selection?

PubMed Central

Spranca, M; Kanouse, D E; Elliott, M; Short, P F; Farley, D O; Hays, R D

2000-01-01

OBJECTIVE: To learn whether consumer reports of health plan quality can affect health plan selection. DATA SOURCES: A sample of 311 privately insured adults from Los Angeles County. STUDY DESIGN: The design was a fractional factorial experiment. Consumers reviewed materials on four hypothetical health plans and selected one. The health plans varied as to cost, coverage, type of plan, ability to keep one's doctor, and quality, as measured by the Consumer Assessment of Health Plans Study (CAHPS) survey. DATA ANALYSIS: We used multinomial logistic regression to model each consumer's choice among health plans. PRINCIPAL FINDINGS: In the absence of CAHPS information, 86 percent of consumers preferred plans that covered more services, even though they cost more. When CAHPS information was provided, consumers shifted to less expensive plans covering fewer services if CAHPS ratings identified those plans as higher quality (59 percent of consumers preferred plans covering more services). Consumer choices were unaffected when CAHPS ratings identified the more expensive plans covering more services as higher quality (89 percent of consumers preferred plans covering more services). CONCLUSIONS: This study establishes that, under certain realistic conditions, CAHPS ratings could affect consumer selection of health plans and ultimately contain costs. Other studies are needed to learn how to enhance exposure and use of CAHPS information in the real world as well as to identify other conditions in which CAHPS ratings could make a difference. PMID:11130805