Time to improvement of pain and sleep quality in clinical trials of pregabalin for the treatment of fibromyalgia.

PubMed

Arnold, Lesley M; Emir, Birol; Pauer, Lynne; Resnick, Malca; Clair, Andrew

2015-01-01

To determine the time to immediate and sustained clinical improvement in pain and sleep quality with pregabalin in patients with fibromyalgia. A post hoc analysis of four 8- to 14-week phase 2-3, placebo-controlled trials of fixed-dose pregabalin (150-600 mg/day) for fibromyalgia, comprising 12 pregabalin and four placebo treatment arms. A total of 2,747 patients with fibromyalgia, aged 18-82 years. Pain and sleep quality scores, recorded daily on 11-point numeric rating scales (NRSs), were analyzed to determine time to immediate improvement with pregabalin, defined as the first of ≥2 consecutive days when the mean NRS score was significantly lower for pregabalin vs placebo in those treatment arms with a significant improvement at endpoint, and time to sustained clinical improvement with pregabalin, defined as a ≥1-point reduction of the baseline NRS score of patient responders who had a ≥30% improvement on the pain NRS, sleep NRS, or Fibromyalgia Impact Questionnaire (FIQ) from baseline to endpoint, or who reported "much improved" or "very much improved" on the Patient Global Impression of Change (PGIC) at endpoint. Significant improvements in pain and sleep quality scores at endpoint vs placebo were seen in 8/12 and 11/12 pregabalin treatment arms, respectively (P < 0.05). In these arms, time to immediate improvements in pain or sleep occurred by day 1 or 2. Time to sustained clinical improvement occurred significantly earlier in pain, sleep, PGIC, and FIQ responders (P < 0.02) with pregabalin vs placebo. Both immediate and sustained clinical improvements in pain and sleep quality occurred faster with pregabalin vs placebo. Wiley Periodicals, Inc.

Sustaining Reliability on Accountability Measures at The Johns Hopkins Hospital.

PubMed

Pronovost, Peter J; Holzmueller, Christine G; Callender, Tiffany; Demski, Renee; Winner, Laura; Day, Richard; Austin, J Matthew; Berenholtz, Sean M; Miller, Marlene R

2016-02-01

In 2012 Johns Hopkins Medicine leaders challenged their health system to reliably deliver best practice care linked to nationally vetted core measures and achieve The Joint Commission Top Performer on Key Quality Measures ®program recognition and the Delmarva Foundation award. Thus, the Armstrong Institute for Patient Safety and Quality implemented an initiative to ensure that ≥96% of patients received care linked to measures. Nine low-performing process measures were targeted for improvement-eight Joint Commission accountability measures and one Delmarva Foundation core measure. In the initial evaluation at The Johns Hopkins Hospital, all accountability measures for the Top Performer program reached the required ≥95% performance, gaining them recognition by The Joint Commission in 2013. Efforts were made to sustain performance of accountability measures at The Johns Hopkins Hospital. Improvements were sustained through 2014 using the following conceptual framework: declare and communicate goals, create an enabling infrastructure, engage clinicians and connect them in peer learning communities, report transparently, and create accountability systems. One part of the accountability system was for teams to create a sustainability plan, which they presented to senior leaders. To support sustained improvements, Armstrong Institute leaders added a project management office for all externally reported quality measures and concurrent reviewers to audit performance on care processes for certain measure sets. The Johns Hopkins Hospital sustained performance on all accountability measures, and now more than 96% of patients receive recommended care consistent with nationally vetted quality measures. The initiative methods enabled the transition of quality improvement from an isolated project to a way of leading an organization.

Quality of Cardiac Care in Canada: Recommendations for Building a Sustainable Future.

PubMed

Young, Courtney; Lambert, Laurie; Abel, James; O'Neill, Blair J

2018-06-01

Cardiovascular (CV) disease continues to present a significant disease and economic burden in Canada. To improve the quality of care and ensure sustainability of services, a national quality improvement initiative is required. The purpose of this analysis was to review the evidence for public reporting (PR) and external benchmarking (EB) to improve patient outcomes, and to recommend a strategy to improve CV care in Canada. To incorporate recent literature, the Canadian Cardiovascular Society (CCS) commissioned the Institute of Health Economics to provide a rapid update on the literature of PR and EB. The review showed that EB is more likely to promote positive effects, such as improved mortality, morbidity, and evidence-based clinical practice, and to limit negative effects, such as access restrictions or unintended provider behaviour associated with some forms of "top-down" PR. On the basis of these findings, this we recommend the following: (1) secure funding for the provincial collection of CV quality indicators and the creation of annual National CV Quality Reports; (2) enhance the culture of using CV quality indicator data for continuous quality improvement and opportunities for national or regional EB and sharing best practices; and (3) implement ongoing evaluation and revision of CCS clinical practice guidelines incorporating key quality indicators. This is already under way to a limited extent by the CCS with its Quality Project, but intentional, sustained support needs to be secured to enhance this ongoing effort and improve the quality of CV care for all Canadians. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Developing a Practical and Sustainable Faculty Development Program With a Focus on Teaching Quality Improvement and Patient Safety: An Alliance for Independent Academic Medical Centers National Initiative III Project.

PubMed

Rodrigue, Christopher; Seoane, Leonardo; Gala, Rajiv B; Piazza, Janice; Amedee, Ronald G

2012-01-01

Teaching the next generation of physicians requires more than traditional teaching models. The Accreditation Council for Graduate Medical Education's Next Accreditation System places considerable emphasis on developing a learning environment that fosters resident education in quality improvement and patient safety. The goal of this project was to develop a comprehensive and sustainable faculty development program with a focus on teaching quality improvement and patient safety. A multidisciplinary team representing all stakeholders in graduate medical education developed a validated survey to assess faculty and house officer baseline perceptions of their experience with faculty development opportunities, quality improvement tools and training, and resident participation in quality improvement and patient safety programs at our institution. We then developed a curriculum to address these 3 areas. Our pilot survey revealed a need for a comprehensive program to teach faculty and residents the art of teaching. Two other areas of need are (1) regular resident participation in quality improvement and patient safety efforts and (2) effective tools for developing skills and habits to analyze practices using quality improvement methods. Resident and faculty pairs in 17 Ochsner training programs developed and began quality improvement projects while completing the first learning module. Resident and faculty teams also have been working on the patient safety modules and incorporating aspects of patient safety into their individual work environments. Our team's goal is to develop a sustainable and manageable faculty development program that includes modules addressing quality improvement and patient safety in accordance with Accreditation Council for Graduate Medical Education accreditation requirements.

A quality improvement project sustainably decreased time to onset of active physical therapy intervention in patients with acute lung injury.

PubMed

Dinglas, Victor D; Parker, Ann M; Reddy, Dereddi Raja S; Colantuoni, Elizabeth; Zanni, Jennifer M; Turnbull, Alison E; Nelliot, Archana; Ciesla, Nancy; Needham, Dale M

2014-10-01

Rehabilitation started early during an intensive care unit (ICU) stay is associated with improved outcomes and is the basis for many quality improvement (QI) projects showing important changes in practice. However, little evidence exists regarding whether such changes are sustainable in real-world practice. To evaluate the sustained effect of a quality improvement project on the timing of initiation of active physical therapy intervention in patients with acute lung injury (ALI). This was a pre-post evaluation using prospectively collected data involving consecutive patients with ALI admitted pre-quality improvement (October 2004-April 2007, n = 120) versus post-quality improvement (July 2009-July 2012, n = 123) from a single medical ICU. The primary outcome was time to first active physical therapy intervention, defined as strengthening, mobility, or cycle ergometry exercises. Among ICU survivors, more patients in the post-quality improvement versus pre-quality improvement group received physical therapy in the ICU (89% vs. 24%, P < 0.001) and were able to stand, transfer, or ambulate during physical therapy in the ICU (64% vs. 7%, P < 0.001). Among all patients in the post-quality improvement versus pre-quality improvement group, there was a shorter median (interquartile range) time to first physical therapy (4 [2, 6] vs. 11 d [6, 29], P < 0.001) and a greater median (interquartile range) proportion of ICU days with physical therapy after initiation (50% [33, 67%] vs. 18% [4, 47%], P = 0.003). In multivariable regression analysis, the post-quality improvement period was associated with shorter time to physical therapy (adjusted hazard ratio [95% confidence interval], 8.38 [4.98, 14.11], P < 0.001), with this association significant for each of the 5 years during the post-quality improvement period. The following variables were independently associated with a longer time to physical therapy: higher Sequential Organ Failure Assessment score (0.93 [0.89, 0.97]), higher FiO2 (0.86 [0.75, 0.99] for each 10% increase), use of an opioid infusion (0.47 [0.25, 0.89]), and deep sedation (0.24 [0.12, 0.46]). In this single-site, pre-post analysis of patients with ALI, an early rehabilitation quality improvement project was independently associated with a substantial decrease in the time to initiation of active physical therapy intervention that was sustained over 5 years. Over the entire pre-post period, severity of illness and sedation were independently associated with a longer time to initiation of active physical therapy intervention in the ICU.

Sustainability of quality improvement following removal of pay-for-performance incentives.

PubMed

Benzer, Justin K; Young, Gary J; Burgess, James F; Baker, Errol; Mohr, David C; Charns, Martin P; Kaboli, Peter J

2014-01-01

Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed. To investigate sustainability of performance levels following removal of performance-based incentives. Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010. VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals. Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives. Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained. This is a quasi-experimental study without a comparison group; causal conclusions are limited. The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.

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

PubMed

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

2017-10-09

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

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

ERIC Educational Resources Information Center

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

2016-01-01

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

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

ERIC Educational Resources Information Center

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

2016-01-01

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

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

ERIC Educational Resources Information Center

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

2016-01-01

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

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

ERIC Educational Resources Information Center

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

2016-01-01

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

Indonesian Private University Lecturer Performance Improvement Model to Improve a Sustainable Organization Performance

ERIC Educational Resources Information Center

Suryaman

2018-01-01

Lecturer performance will affect the quality and carrying capacity of the sustainability of an organization, in this case the university. There are many models developed to measure the performance of teachers, but not much to discuss the influence of faculty performance itself towards sustainability of an organization. This study was conducted in…

Supporting Sustainable Rural Communities

EPA Pesticide Factsheets

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

A Quality Improvement Project Sustainably Decreased Time to Onset of Active Physical Therapy Intervention in Patients with Acute Lung Injury

PubMed Central

Dinglas, Victor D.; Reddy, Dereddi Raja S.; Colantuoni, Elizabeth; Zanni, Jennifer M.; Turnbull, Alison E.; Nelliot, Archana; Ciesla, Nancy; Needham, Dale M.

2014-01-01

Rationale: Rehabilitation started early during an intensive care unit (ICU) stay is associated with improved outcomes and is the basis for many quality improvement (QI) projects showing important changes in practice. However, little evidence exists regarding whether such changes are sustainable in real-world practice. Objectives: To evaluate the sustained effect of a quality improvement project on the timing of initiation of active physical therapy intervention in patients with acute lung injury (ALI). Methods: This was a pre–post evaluation using prospectively collected data involving consecutive patients with ALI admitted pre–quality improvement (October 2004–April 2007, n = 120) versus post–quality improvement (July 2009–July 2012, n = 123) from a single medical ICU. Measurements and Main Results: The primary outcome was time to first active physical therapy intervention, defined as strengthening, mobility, or cycle ergometry exercises. Among ICU survivors, more patients in the post–quality improvement versus pre–quality improvement group received physical therapy in the ICU (89% vs. 24%, P < 0.001) and were able to stand, transfer, or ambulate during physical therapy in the ICU (64% vs. 7%, P < 0.001). Among all patients in the post–quality improvement versus pre–quality improvement group, there was a shorter median (interquartile range) time to first physical therapy (4 [2, 6] vs. 11 d [6, 29], P < 0.001) and a greater median (interquartile range) proportion of ICU days with physical therapy after initiation (50% [33, 67%] vs. 18% [4, 47%], P = 0.003). In multivariable regression analysis, the post–quality improvement period was associated with shorter time to physical therapy (adjusted hazard ratio [95% confidence interval], 8.38 [4.98, 14.11], P < 0.001), with this association significant for each of the 5 years during the post–quality improvement period. The following variables were independently associated with a longer time to physical therapy: higher Sequential Organ Failure Assessment score (0.93 [0.89, 0.97]), higher FiO2 (0.86 [0.75, 0.99] for each 10% increase), use of an opioid infusion (0.47 [0.25, 0.89]), and deep sedation (0.24 [0.12, 0.46]). Conclusions: In this single-site, pre–post analysis of patients with ALI, an early rehabilitation quality improvement project was independently associated with a substantial decrease in the time to initiation of active physical therapy intervention that was sustained over 5 years. Over the entire pre–post period, severity of illness and sedation were independently associated with a longer time to initiation of active physical therapy intervention in the ICU. PMID:25167767

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative.

PubMed

Dückers, Michel La; Wagner, Cordula; Vos, Leti; Groenewegen, Peter P

2011-03-09

Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana

PubMed Central

Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F.

2015-01-01

Background Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients’ decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. Purpose To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. Methods This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman’s rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Results Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. Conclusion There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana’s healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes. PMID:26465935

Comparison of Perceived and Technical Healthcare Quality in Primary Health Facilities: Implications for a Sustainable National Health Insurance Scheme in Ghana.

PubMed

Alhassan, Robert Kaba; Duku, Stephen Opoku; Janssens, Wendy; Nketiah-Amponsah, Edward; Spieker, Nicole; van Ostenberg, Paul; Arhinful, Daniel Kojo; Pradhan, Menno; Rinke de Wit, Tobias F

2015-01-01

Quality care in health facilities is critical for a sustainable health insurance system because of its influence on clients' decisions to participate in health insurance and utilize health services. Exploration of the different dimensions of healthcare quality and their associations will help determine more effective quality improvement interventions and health insurance sustainability strategies, especially in resource constrained countries in Africa where universal access to good quality care remains a challenge. To examine the differences in perceptions of clients and health staff on quality healthcare and determine if these perceptions are associated with technical quality proxies in health facilities. Implications of the findings for a sustainable National Health Insurance Scheme (NHIS) in Ghana are also discussed. This is a cross-sectional study in two southern regions in Ghana involving 64 primary health facilities: 1,903 households and 324 health staff. Data collection lasted from March to June, 2012. A Wilcoxon-Mann-Whitney test was performed to determine differences in client and health staff perceptions of quality healthcare. Spearman's rank correlation test was used to ascertain associations between perceived and technical quality care proxies in health facilities, and ordered logistic regression employed to predict the determinants of client and staff-perceived quality healthcare. Negative association was found between technical quality and client-perceived quality care (coef. = -0.0991, p<0.0001). Significant staff-client perception differences were found in all healthcare quality proxies, suggesting some level of unbalanced commitment to quality improvement and potential information asymmetry between clients and service providers. Overall, the findings suggest that increased efforts towards technical quality care alone will not necessarily translate into better client-perceived quality care and willingness to utilize health services in NHIS-accredited health facilities. There is the need to intensify client education and balanced commitment to technical and perceived quality improvement efforts. This will help enhance client confidence in Ghana's healthcare system, stimulate active participation in the national health insurance, increase healthcare utilization and ultimately improve public health outcomes.

Patient safety reporting systems: sustained quality improvement using a multidisciplinary team and "good catch" awards.

PubMed

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

2012-08-01

Since 1999, hospitals have made substantial commitments to health care quality and patient safety through individual initiatives of executive leadership involvement in quality, investments in safety culture, education and training for medical students and residents in quality and safety, the creation of patient safety committees, and implementation of patient safety reporting systems. At the Weinberg Surgical Suite at The Johns Hopkins Hospital (Baltimore), a 16-operating-room inpatient/outpatient cancer center, a patient safety reporting process was developed to maximize the usefulness of the reports and the long-term sustainability of quality improvements arising from them. A six-phase framework was created incorporating UHC's Patient Safety Net (PSN): Identify, report, analyze, mitigate, reward, and follow up. Unique features of this process included a multidisciplinary team to review reports, mitigate hazards, educate and empower providers, recognize the identifying/reporting individuals or groups with "Good Catch" awards, and follow up to determine if quality improvements were sustained over time. Good Catch awards have been given in recognition of 29 patient safety hazards identified since 2008; in each of these cases, an initiative was developed to mitigate the original hazard. Twenty-five (86%) of the associated quality improvements have been sustained. Two Good Catch award-winning projects--vials of heparin with an unusually high concentration of the drug that posed a potential overdose hazard and a rapid infusion device that resisted practitioner control--are described in detail. A multidisciplinary team's analysis and mitigation of hazards identified in a patient safety reporting process entailed positive recognition with a Good Catch award, education of practitioners, and long-term follow-up.

Sustainable Living in Long-Term Care: For People with Dementia/Alzheimer's

ERIC Educational Resources Information Center

Simmons, Daniela

2011-01-01

Nonhome-based long-term care sustainable living arrangements for elderly people with Alzheimer's is presented. Characteristics contributing to sustainability are discussed. The ultimate goal in sustainable design for older adult communities is a people-centered model of care in environments that improve their quality of life. Without sustainable…

Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study.

PubMed

Stumbo, Scott P; Ford, James H; Green, Carla A

2017-11-01

A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007-2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results. We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1) finding alignment between business- and client-centered practices; (2) staff engagement early in QI process added legitimacy which facilitated sustainment; (3) commitment to integrating data into monitoring practices and the identification of a data champion; and (4) adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1) lack of evidence of impact on business practices led to discontinuation; (2) disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3) no data integration into overall business practices and no identified data champion; and (4) high staff turnover. In addition, we found that many agencies' current use of NIATx methods and tools suggested a legacy effect that might improve quality elsewhere, even absent overall sustainment of original study outcome goals. Available quantitative data on wait-time reduction demonstrated general concordance between agency perceptions of, and evidence for, sustainment 2 years following the end of the intervention. Additional quantitative data suggested that greater engagement during the intervention period showed some association with sustainment. Factors identified in QI frameworks as important for short-term sustainment-organizational capacity (e.g. staffing and leadership) and intervention characteristics (e.g. flexibility and fit)-are also important to long-term sustainment.

Tourism partnerships in protected areas: exploring contributions to sustainability.

PubMed

Pfueller, Sharron L; Lee, Diane; Laing, Jennifer

2011-10-01

Partnerships between natural-area managers and the tourism industry have been suggested to contribute to sustainability in protected areas. This article explores how important sustainability outcomes of partnerships are to their members, how well they are realised and the features of partnerships leading to their achievement. In 21 case studies in Australia, interviews (n = 97) and surveys (n = 100) showed that of 14 sustainability outcomes, improved understanding of protected areas values and improved biodiversity conservation were the most important. Other highly ranked outcomes were greater respect for culture, heritage, and/or traditions; improved quality of environmental conditions; social benefits to local communities; and improved economic viability of the protected area. Scores for satisfaction with outcomes were, like those for importance, all high but were less than those for importance for the majority, with improvement in quality of environmental conditions showing the largest gap. The satisfaction score exceeded that for importance only for increased competitiveness of the protected area as a tourist destination. "Brown" aspects of sustainability, i.e., decreased waste or energy use, were among the lowest-scoring outcomes for both importance and satisfaction. The most important factor enabling sustainability outcomes was provision of benefits to partnership members. Others were increased financial support, inclusiveness, supportive organisational and administrative arrangements, direct involvement of decision makers, partnership maturity, creation of new relationships, decreased conflict, and stimulation of innovation. Improving sustainability outcomes, therefore, requires maintaining these partnership attributes and also increasing emphasis on reducing waste and resource use.

Tourism Partnerships in Protected Areas: Exploring Contributions to Sustainability

NASA Astrophysics Data System (ADS)

Pfueller, Sharron L.; Lee, Diane; Laing, Jennifer

2011-10-01

Partnerships between natural-area managers and the tourism industry have been suggested to contribute to sustainability in protected areas. This article explores how important sustainability outcomes of partnerships are to their members, how well they are realised and the features of partnerships leading to their achievement. In 21 case studies in Australia, interviews ( n = 97) and surveys ( n = 100) showed that of 14 sustainability outcomes, improved understanding of protected areas values and improved biodiversity conservation were the most important. Other highly ranked outcomes were greater respect for culture, heritage, and/or traditions; improved quality of environmental conditions; social benefits to local communities; and improved economic viability of the protected area. Scores for satisfaction with outcomes were, like those for importance, all high but were less than those for importance for the majority, with improvement in quality of environmental conditions showing the largest gap. The satisfaction score exceeded that for importance only for increased competitiveness of the protected area as a tourist destination. "Brown" aspects of sustainability, i.e., decreased waste or energy use, were among the lowest-scoring outcomes for both importance and satisfaction. The most important factor enabling sustainability outcomes was provision of benefits to partnership members. Others were increased financial support, inclusiveness, supportive organisational and administrative arrangements, direct involvement of decision makers, partnership maturity, creation of new relationships, decreased conflict, and stimulation of innovation. Improving sustainability outcomes, therefore, requires maintaining these partnership attributes and also increasing emphasis on reducing waste and resource use.

Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability—An Emerging Framework

PubMed Central

Holve, Erin

2013-01-01

Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four “pillars” of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two “foundational considerations,” adaptive capacity and policy levers, are also discussed. PMID:25848557

AIRBORNE REMOTELY SENSED INFORMATION FOR PESTICIDAL TRANSGENIC CROPS: HOW SPECTRAL IMAGING MAY PLAY A ROLE

EPA Science Inventory

The importance of sustainability to Bt crops. Resistance management as a sustainability strategy. The importance of data quality to sustainability and regulation of Bt Crops. Where information improvement can be useful across the globe.

IMPROVING BIOMASS LOGISTICS COST WITHIN AGRONOMIC SUSTAINABILITY CONSTRAINTS AND BIOMASS QUALITY TARGETS

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

J. Richard Hess; Kevin L. Kenney; Christopher T. Wright

Equipment manufacturers have made rapid improvements in biomass harvesting and handling equipment. These improvements have increased transportation and handling efficiencies due to higher biomass densities and reduced losses. Improvements in grinder efficiencies and capacity have reduced biomass grinding costs. Biomass collection efficiencies (the ratio of biomass collected to the amount available in the field) as high as 75% for crop residues and greater than 90% for perennial energy crops have also been demonstrated. However, as collection rates increase, the fraction of entrained soil in the biomass increases, and high biomass residue removal rates can violate agronomic sustainability limits. Advancements inmore » quantifying multi-factor sustainability limits to increase removal rate as guided by sustainable residue removal plans, and mitigating soil contamination through targeted removal rates based on soil type and residue type/fraction is allowing the use of new high efficiency harvesting equipment and methods. As another consideration, single pass harvesting and other technologies that improve harvesting costs cause biomass storage moisture management challenges, which challenges are further perturbed by annual variability in biomass moisture content. Monitoring, sampling, simulation, and analysis provide basis for moisture, time, and quality relationships in storage, which has allowed the development of moisture tolerant storage systems and best management processes that combine moisture content and time to accommodate baled storage of wet material based upon “shelf-life.” The key to improving biomass supply logistics costs has been developing the associated agronomic sustainability and biomass quality technologies and processes that allow the implementation of equipment engineering solutions.« less

Improving and sustaining delivery of CPT for PTSD in mental health systems: a cluster randomized trial.

PubMed

Wiltsey Stirman, Shannon; Finley, Erin P; Shields, Norman; Cook, Joan; Haine-Schlagel, Rachel; Burgess, James F; Dimeff, Linda; Koerner, Kelly; Suvak, Michael; Gutner, Cassidy A; Gagnon, David; Masina, Tasoula; Beristianos, Matthew; Mallard, Kera; Ramirez, Vanessa; Monson, Candice

2017-03-06

Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavily in programs to implement EBPs, few eligible patients receive EBPs in routine care settings, and clinicians do not appear to deliver the full treatment protocol to many of their patients. Emerging evidence suggests that when CPT and other EBPs are delivered at low levels of fidelity, clinical outcomes are negatively impacted. Thus, identifying strategies to improve and sustain the delivery of CPT and other EBPs is critical. Existing literature has suggested two competing strategies to promote sustainability. One emphasizes fidelity to the treatment protocol through ongoing consultation and fidelity monitoring. The other focuses on improving the fit and effectiveness of these treatments through appropriate adaptations to the treatment or the clinical setting through a process of data-driven, continuous quality improvement. Neither has been evaluated in terms of impact on sustained implementation. To compare these approaches on the key sustainability outcomes and provide initial guidance on sustainability strategies, we propose a cluster randomized trial with mental health clinics (n = 32) in three diverse MHSs that have implemented CPT. Cohorts of clinicians and clinical managers will participate in 1 year of a fidelity oriented learning collaborative or 1 year of a continuous quality improvement-oriented learning collaborative. Patient-level PTSD symptom change, CPT fidelity and adaptation, penetration, and clinics' capacity to deliver EBP will be examined. Survey and interview data will also be collected to investigate multilevel influences on the success of the two learning collaborative strategies. This research will be conducted by a team of investigators with expertise in CPT implementation, mixed method research strategies, quality improvement, and implementation science, with input from stakeholders in each participating MHS. It will have broad implications for supporting ongoing delivery of EBPs in mental health and healthcare systems and settings. The resulting products have the potential to significantly improve efforts to ensure ongoing high quality implementation and consumer access to EBPs. NCT02449421 . Registered 02/09/2015.

Quality of life long-term after body contouring surgery following bariatric surgery: sustained improvement after 7 years.

PubMed

van der Beek, Eva S J; Geenen, Rinie; de Heer, Francine A G; van der Molen, Aebele B Mink; van Ramshorst, Bert

2012-11-01

Bariatric surgery for morbid obesity results in massive weight loss and improvement of health and quality of life. A downside of the major weight loss is the excess of overstretched skin, which may influence the patient's quality of life by causing functional and aesthetic problems. The purpose of the current study was to evaluate the patient's quality of life long-term after body contouring following bariatric surgery. Quality of life was measured with the Obesity Psychosocial State Questionnaire in 33 post-bariatric surgery patients 7.2 years (range, 3.2 to 13.3 years) after body contouring surgery. Data were compared with previous assessments 4.1 years (range, 0.7 to 9.2 years) after body contouring surgery of the quality of life at that time and before body contouring surgery. Compared with appraisals of quality of life before body contouring surgery, a significant, mostly moderate to large, sustained improvement of quality of life was observed in post-bariatric surgery patients 7.2 years after body contouring surgery in six of the seven psychosocial domains. A small deterioration occurred between 4.1- and 7.2-year follow-up on two of the seven domains except for the domain efficacy toward eating, which showed a significant improvement. At 7-year follow-up, 18 patients (55 percent) were satisfied with the result of body contouring surgery. This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery. This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity. Therapeutic, IV.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

PubMed Central

2011-01-01

Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects. PMID:21385467

Working toward quality in obstetric anesthesia: a business approach.

PubMed

Lynde, Grant C

2017-06-01

Physicians are increasingly required to demonstrate that they provide quality care. How does one define quality? A significant body of literature in industries outside of health care provides guidance on how to define appropriate metrics, create teams to troubleshoot problem areas, and sustain those improvements. The modern quality movement in the United States began in response to revolutionary gains in both quality and productivity in Japanese manufacturing in the 1980's. Applying these lessons to the healthcare setting has been slow. Hospitals are only now introducing tools such as failure mode and effect analysis, Lean and Six Sigma into their quality divisions and are seeing significant cost reductions and outcomes improvements. The review will discuss the process for creating an effective quality program for an obstetric anesthesia division. Sustainable improvements in delivered care need to be based on an evaluation of service line needs, defining appropriate metrics, understanding current process flows, changing and measuring those processes, and developing mechanisms to ensure the new processes are maintained.

Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.

PubMed

Cosimi, Lisa A; Dam, Huong V; Nguyen, Thai Q; Ho, Huyen T; Do, Phuong T; Duc, Duat N; Nguyen, Huong T; Gardner, Bridget; Libman, Howard; Pollack, Todd; Hirschhorn, Lisa R

2015-07-17

The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

Sustaining improvement? The 20-year Jönköping quality improvement program revisited.

PubMed

Staines, Anthony; Thor, Johan; Robert, Glenn

2015-01-01

There is scarce evidence of organization-wide and sustained impact of quality improvement (QI) programs in health care. For 20 years, the Jönköping County Council's (Sweden) ambitious program has attracted attention from practitioners and researchers alike. This is a follow-up case of a 2006 study of Jönköping's improvement program, triangulating data from 20 semi-structured interviews, observation and secondary analysis of internal performance data. In 2010, clinical outcomes had clearly improved in 2 departments (pediatrics, intensive care), while process improvements were evident in many departments. In an overall index of the 20 Swedish county councils' performance, Jönköping had improved its ranking since 2006 to lead in 2010. Five key issues shaped Jönköping's improvement program since 2006: a rigorously managed succession of chief executive officer; adept management of a changing external context; clear strategic direction relating to integration; a broadened conceptualization of "quality" (incorporating clinical effectiveness, patient safety, and patient experience); and continuing investment in QI education and research. Physician involvement in formal QI initiatives had increased since 2006 but remained a challenge in 2010. A new clinical information system was being deployed but had not yet met expectations. This study suggests that ambitious approaches can carry health care organizations beyond the sustainability threshold.

Strategies to sustain a quality improvement initiative in neonatal resuscitation

PubMed Central

van Heerden, Carlien; Janse van Rensburg, Elsie S.

2016-01-01

Background Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. Aim The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. Setting A maternity section of a district hospital in South Africa. Methods The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. Results The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. Conclusion These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s’ drive to attain the MDG4. PMID:27380840

Evaluating strategies for sustainable intensification of U.S. agriculture through the Long-Term Agroecosystem Research network

USDA-ARS?s Scientific Manuscript database

Sustainable intensification is an emerging model for agriculture designed to reconcile accelerating global demand for agricultural products with long-term environmental stewardship. Defined here as increasing agricultural production while maintaining or improving environmental quality, sustainable i...

[Improving patient safety through voluntary peer review].

PubMed

Kluge, S; Bause, H

2015-01-01

The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

Partnerships for Quality project: closing the gap in care of children with ADHD.

PubMed

Lannon, Carole; Dolins, Judith; Lazorick, Suzanne; Crowe, Virginia Leigh Hamilton; Butts-Dion, Sue; Schoettker, Pamela J

2007-12-01

The Partnerships for Quality project was designed to close the gap between knowledge and care for children with attention deficit hyperactivity disorder by fostering a partnership between a major medical specialty society, a professional certifying body, a national family-based advocacy organization, and a child health improvement organization. Ten American Academy of Pediatrics chapters conducted training workshops for practicing pediatricians and their office teams. Assistance was provided in the form of feedback of data, ongoing communication via conference calls, and a listserve. Two national workshops were conducted to disseminate learnings and promote sustainability. Participation in the intervention resulted in greater involvement in quality improvement activities by practice teams and improved care outcomes. The training workshops facilitated collaboration among providers, parents, and the educational, mental health, and legal systems. The partnership structure used demonstrated what professional societies can do to support improvement at the local level and what component chapters need to do to support improvement at the practice level. The integration of quality improvement infrastructure and policy changes at the national and local levels suggest that the quality efforts are likely to be sustained, providing long-term improvement in care and outcomes for children and families.

Do Health Reforms to Improve Quality Have Long-Term Effects? Results of a Follow-Up on a Randomized Policy Experiment in the Philippines.

PubMed

Quimbo, Stella; Wagner, Natascha; Florentino, Jhiedon; Solon, Orville; Peabody, John

2016-02-01

We tracked doctors who had previously participated in a randomized policy experiment in the Philippines. The original experiment involved 30 district hospitals divided equally into one control site and two intervention sites that increased insurance payments (full insurance support for children under 5 years old) or made bonus payments to hospital staff. During the 3 years of the intervention, quality-as measured by clinical performance and value vignettes-improved and was sustained in both intervention sites compared with controls. Five years after the interventions were discontinued, we remeasured the quality of care of the doctors. We found that the intervention sites continued to have significantly higher quality compared with the control sites. The previously documented quality improvement in intervention sites appears to be sustained; moreover, it was subject to a very low (less than 1% per year) rate of decay in quality scores. Copyright © 2015 John Wiley & Sons, Ltd.

Role of Institutions of Higher Learning in Enhancing Sustainable Development in Kenya

ERIC Educational Resources Information Center

Ekene, Osuji Gregory; Oluoch-Suleh, Everlyn

2015-01-01

Education brings about a change in the individual which promotes greater productivity and work efficiency. It remains a major component in the development of human resources and it accounts for much improvements in population quality and environmental resource management; hence, sustainable development. Improvement of human resources is not…

PAVING THE WAY TO A &LDQUO;GREENER&RDQUO; CAMPUS: ALTERNATIVE PAVING MATERIALS FOR POLLUTION CONTROL AND AESTHETIC APPEAL

EPA Science Inventory

There were two major areas of focus in this project: a) determination of potential water quality improvements using sustainable paving alternatives and b) determination of potential aesthetic improvement by the use of the sustainable alternatives. In order to address both obje...

Implementing Laboratory Quality Management Systems in Mozambique: The Becton Dickinson-US President's Emergency Plan for AIDS Relief Public-Private Partnership Initiative.

PubMed

Skaggs, Beth; Pinto, Isabel; Masamha, Jessina; Turgeon, David; Gudo, Eduardo Samo

2016-04-15

Mozambique's ministry of health (MOH) recognized the need to establish a national laboratory quality assurance (NLQA) program to improve the reliability and accuracy of laboratory testing. The Becton Dickinson-US President's Emergency Plan for AIDS Relief Public-Private Partnership (PPP) was used to garner MOH commitment and train a cadre of local auditors and managers to support sustainability and country ownership of a NLQA program. From January 2011 to April 2012, the World Health Organization Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist and the Strengthening Laboratory Management Towards Accreditation (SLMTA) curriculum were used in 6 MOH laboratories. PPP volunteers provided training and mentorship to build the capacity of local auditors and program managers to promote institutionalization and sustainability of the program within the MOH. SLIPTA was launched in 6 MOH laboratories, and final audits demonstrated improvements across the 13 quality system essentials, compared with baseline. Training and mentorship of MOH staff by PPP volunteers resulted in 18 qualified auditors and 28 managers/quality officers capacitated to manage the improvement process in their laboratories. SLIPTA helps laboratories improve the quality and reliability of their service even in the absence of full accreditation. Local capacity building ensures sustainability by creating country buy-in, reducing costs of audits, and institutionalizing program management. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Working toward a sustainable laboratory quality improvement programme through country ownership: Mozambique's SLMTA story.

PubMed

Masamha, Jessina; Skaggs, Beth; Pinto, Isabel; Mandlaze, Ana Paula; Simbine, Carolina; Chongo, Patrina; de Sousa, Leonardo; Kidane, Solon; Yao, Katy; Luman, Elizabeth T; Samogudo, Eduardo

2014-01-01

Launched in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has emerged as an innovative approach for the improvement of laboratory quality. In order to ensure sustainability, Mozambique embedded the SLMTA programme within the existing Ministry of Health (MOH) laboratory structure. This article outlines the steps followed to establish a national framework for quality improvement and embedding the SLMTA programme within existing MOH laboratory systems. The MOH adopted SLMTA as the national laboratory quality improvement strategy, hired a dedicated coordinator and established a national laboratory quality technical working group comprising mostly personnel from key MOH departments. The working group developed an implementation framework for advocacy, training, mentorship, supervision and audits. Emphasis was placed on building local capacity for programme activities. After receiving training, a team of 25 implementers (18 from the MOH and seven from partner organisations) conducted baseline audits (using the Stepwise Laboratory Quality Improvement Process Towards Accreditation [SLIPTA] checklist), workshops and site visits in six reference and two central hospital laboratories. Exit audits were conducted in six of the eight laboratories and their results are presented. The six laboratories demonstrated substantial improvement in audit scores; median scores increased from 35% at baseline to 57% at exit. It has been recommended that the National Tuberculosis Reference Laboratory apply for international accreditation. Successful implementation of SLMTA requires partnership between programme implementers, whilst effectiveness and long-term viability depend on country leadership, ownership and commitment. Integration of SLMTA into the existing MOH laboratory system will ensure durability beyond initial investments. The Mozambican model holds great promise that country leadership, ownership and institutionalisation can set the stage for programme success and sustainability.

Laboratory Innovation Towards Quality Program Sustainability.

PubMed

Abimiku, Alash'le; Timperi, Ralph; Blattner, William

2016-08-01

Laboratory innovation significantly affects program sustainability of HIV programs in low and middle income countries (LMICs) far beyond its immediate sphere of impact. Innovation in rapid development of diagnostic technologies, improved quality management systems, strengthened laboratory management, affordable external quality assurance and accreditation schemes, and building local capacity have reduced costs, brought quality improvement to point-of-care testing, increased access to testing services, reduced treatment and prevention costs and opened the door to the real possibility of ending the AIDS epidemic. However, for effectively implemented laboratory innovation to contribute to HIV quality program sustainability, it must be implemented within the overall context of the national strategic plan and HIV treatment programs. The high quality of HIV rapid diagnostic test was a breakthrough that made it possible for more persons to learn their HIV status, receive counseling, and if infected to receive treatment. Likewise, the use of dried blood spots made the shipment of samples easier for the assessment of different variables of HIV infection-molecular diagnosis, CD4+ cell counts, HIV antibodies, drug resistance surveillance, and even antiretroviral drug level measurements. Such advancement is critical for to reaching the UNAIDS target of 90-90-90 and for bringing the AIDS epidemic to an end, especially in LMICs.

Health benefits from improved outdoor air quality and intervention in China.

PubMed

Li, Shanshan; Williams, Gail; Guo, Yuming

2016-07-01

China is at its most critical stage of outdoor air quality management. In order to prevent further deterioration of air quality and to protect human health, the Chinese government has made a series of attempts to reduce ambient air pollution. Unlike previous literature reviews on the widespread hazards of air pollution on health, this review article firstly summarized the existing evidence of human health benefits from intermittently improved outdoor air quality and intervention in China. Contents of this paper provide concrete and direct clue that improvement in outdoor air quality generates various health benefits in China, and confirm from a new perspective that it is worthwhile for China to shift its development strategy from economic growth to environmental economic sustainability. Greater emphasis on sustainable environment design, consistently strict regulatory enforcement, and specific monitoring actions should be regarded in China to decrease the health risks and to avoid long-term environmental threats. Copyright © 2016 Elsevier Ltd. All rights reserved.

Microfinance investments in quality at private clinics in Uganda: a case-control study.

PubMed

Seiber, Eric E; Robinson, Amara L

2007-10-18

Small private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda. This study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics. The study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic. The results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets.

Guiding inpatient quality improvement: a systematic review of Lean and Six Sigma.

PubMed

Glasgow, Justin M; Scott-Caziewell, Jill R; Kaboli, Peter J

2010-12-01

Two popular quality improvement (QI) approaches in health care are Lean and Six Sigma. Hospitals continue to adopt these QI approaches-or the hybrid Lean Sigma approach-with little knowledge on how well they produce sustainable improvements. A systematic literature review was conducted to determine whether Lean, Six Sigma, or Lean Sigma have been effectively used to create and sustain improvements in the acute care setting. Databases were searched for articles published in the health care, business, and engineering literatures. Study inclusion criteria required identification of a Six Sigma, Lean, or Lean Sigma project; QI efforts focused on hospitalized patients; descriptions of project improvements; and reported results. Depending on the quality of data reported, articles were classified as summary reports, pre-post observational studies, or time-series reports. Database searches identified 539 potential articles. After review of titles, abstracts, and full text, 47 articles met inclusion criteria--10 articles summarized multiple projects, 12 reported Lean projects, 20 reported Six Sigma projects, and 5 reported Lean Sigma projects. Generally, the studies provided limited data, with only 15 articles providing any sort of follow-up data; of the 15, only 3 report a follow-up period greater than two years. Lean, Six Sigma, and Lean Sigma as QI approaches can aid institutions in tackling a wide variety of problems encountered in acute care. However, the true impact of these approaches is difficult to judge, given that the lack of rigorous evaluation or clearly sustained improvements provides little evidence supporting broad adoption. There is still a need for future work that will improve the evidence base for understanding more about QI approaches and how to achieve sustainable improvement.

42 CFR 486.348 - Condition: Quality assessment and performance improvement (QAPI).

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS FOR COVERAGE OF... result in performance improvements and track performance to ensure that improvements are sustained. (b...

Can endurance training improve physical capacity and quality of life in young Fontan patients?

PubMed

Hedlund, Eva R; Lundell, Bo; Söderström, Liselott; Sjöberg, Gunnar

2018-03-01

Children after Fontan palliation have reduced exercise capacity and quality of life. Our aim was to study whether endurance training could improve physical capacity and quality of life in Fontan patients. Fontan patients (n=30) and healthy age- and gender-matched control subjects (n=25) performed a 6-minute walk test at submaximal capacity and a maximal cycle ergometer test. Quality of life was assessed with Pediatric Quality of Life Inventory Version 4.0 questionnaires for children and parents. All tests were repeated after a 12-week endurance training programme and after 1 year. Patients had decreased submaximal and maximal exercise capacity (maximal oxygen uptake 35.0±5.1 ml/minute per·kg versus 43.7±8.4 ml/minute·per·kg, p<0.001) and reported a lower quality of life score (70.9±9.9 versus 85.7±8.0, p<0.001) than controls. After training, patients improved their submaximal exercise capacity in a 6-minute walk test (from 590.7±65.5 m to 611.8±70.9 m, p<0.05) and reported a higher quality of life (p<0.01), but did not improve maximal exercise capacity. At follow-up, submaximal exercise capacity had increased further and improved quality of life was sustained. The controls improved their maximal exercise capacity (p<0.05), but not submaximal exercise capacity or quality of life after training. At follow-up, improvement of maximal exercise capacity was sustained. We believe that an individualised endurance training programme for Fontan patients improves submaximal exercise capacity and quality of life in Fontan patients and the effect on quality of life appears to be long-lasting.

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

NASA Astrophysics Data System (ADS)

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

2017-11-01

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

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol.

PubMed

Perkins, Gavin D; Davies, Robin P; Quinton, Sarah; Woolley, Sarah; Gao, Fang; Abella, Ben; Stallard, Nigel; Cooke, Matthew W

2011-10-18

Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest. The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites. This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing. ISRCTN56583860.

Sustainability analysis of bioenergy based land use change under climate change and variability

NASA Astrophysics Data System (ADS)

Raj, C.; Chaubey, I.; Brouder, S. M.; Bowling, L. C.; Cherkauer, K. A.; Frankenberger, J.; Goforth, R. R.; Gramig, B. M.; Volenec, J. J.

2014-12-01

Sustainability analyses of futuristic plausible land use and climate change scenarios are critical in making watershed-scale decisions for simultaneous improvement of food, energy and water management. Bioenergy production targets for the US are anticipated to impact farming practices through the introduction of fast growing and high yielding perennial grasses/trees, and use of crop residues as bioenergy feedstocks. These land use/land management changes raise concern over potential environmental impacts of bioenergy crop production scenarios, both in terms of water availability and water quality; impacts that may be exacerbated by climate variability and change. The objective of the study was to assess environmental, economic and biodiversity sustainability of plausible bioenergy scenarios for two watersheds in Midwest US under changing climate scenarios. The study considers fourteen sustainability indicators under nine climate change scenarios from World Climate Research Programme's (WCRP's) Coupled Model Intercomparison Project phase 3 (CMIP3). The distributed hydrological model SWAT (Soil and Water Assessment Tool) was used to simulate perennial bioenergy crops such as Miscanthus and switchgrass, and corn stover removal at various removal rates and their impacts on hydrology and water quality. Species Distribution Models (SDMs) developed to evaluate stream fish response to hydrology and water quality changes associated with land use change were used to quantify biodiversity sustainability of various bioenergy scenarios. The watershed-scale sustainability analysis was done in the St. Joseph River watershed located in Indiana, Michigan, and Ohio; and the Wildcat Creek watershed, located in Indiana. The results indicate streamflow reduction at watershed outlet with increased evapotranspiration demands for high-yielding perennial grasses. Bioenergy crops in general improved in-stream water quality compared to conventional cropping systems (maize-soybean). Water quality benefits due to land use change were generally greater than the effects of climate change variability.

Quality improvement and emerging global health priorities

PubMed Central

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

2018-01-01

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

Developing an Effective Assessment Process To Support Institutional Effectiveness Efforts.

ERIC Educational Resources Information Center

Albert, Angela R.; Pet-Armacost, Julia

This paper describes a process and an organizational structure in which Institutional Effectiveness (IE) can thrive. When such a system is implemented, continuous quality improvement can be sustained for the long term. Key concepts and philosophies found in the literature regarding continuous quality improvement and assessment in higher education…

Facility uses Six Sigma to improve quality.

PubMed

2006-09-01

Initiative demonstrates a 23% improvement in first bed assignment to a private isolation room. Keys to improvement found in enhanced communication and staff training. Staff develop reporting mechanism to sustain and institutionalize project results.

A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.

PubMed

Williams, Linda; Daggett, Virginia; Slaven, James E; Yu, Zhangsheng; Sager, Danielle; Myers, Jennifer; Plue, Laurie; Woodward-Hagg, Heather; Damush, Teresa M

2016-04-01

Quality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators. We conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables. Patients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, p<0.001), but did not differ in post-I period. Dysphagia screening improved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period. Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time. 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/

Safe, High-Performance, Sustainable Precast School Design

ERIC Educational Resources Information Center

Finsen, Peter I.

2011-01-01

School design utilizing integrated architectural and structural precast and prestressed concrete components has gained greater acceptance recently for numerous reasons, including increasingly sophisticated owners and improved learning environments based on material benefits such as: sustainability, energy efficiency, indoor air quality, storm…

Prospective relationships of physical activity with quality of life among colorectal cancer survivors

USDA-ARS?s Scientific Manuscript database

Physical activity can enhance quality of life for cancer survivors. However, few longitudinal studies have examined whether physical activity has a sustained effect on improvements in quality of life. The present study aims to examine the relationships between physical activity and quality of life o...

Overcoming systemic roadblocks to sustainability: The evolutionary redesign of worldviews, institutions, and technologies

PubMed Central

Beddoe, Rachael; Costanza, Robert; Farley, Joshua; Garza, Eric; Kent, Jennifer; Kubiszewski, Ida; Martinez, Luz; McCowen, Tracy; Murphy, Kathleen; Myers, Norman; Ogden, Zach; Stapleton, Kevin; Woodward, John

2009-01-01

A high and sustainable quality of life is a central goal for humanity. Our current socio-ecological regime and its set of interconnected worldviews, institutions, and technologies all support the goal of unlimited growth of material production and consumption as a proxy for quality of life. However, abundant evidence shows that, beyond a certain threshold, further material growth no longer significantly contributes to improvement in quality of life. Not only does further material growth not meet humanity's central goal, there is mounting evidence that it creates significant roadblocks to sustainability through increasing resource constraints (i.e., peak oil, water limitations) and sink constraints (i.e., climate disruption). Overcoming these roadblocks and creating a sustainable and desirable future will require an integrated, systems level redesign of our socio-ecological regime focused explicitly and directly on the goal of sustainable quality of life rather than the proxy of unlimited material growth. This transition, like all cultural transitions, will occur through an evolutionary process, but one that we, to a certain extent, can control and direct. We suggest an integrated set of worldviews, institutions, and technologies to stimulate and seed this evolutionary redesign of the current socio-ecological regime to achieve global sustainability. PMID:19240221

Green Campus initiative and its impacts on quality of life of stakeholders in Green and Non-Green Campus universities.

PubMed

Tiyarattanachai, Ronnachai; Hollmann, Nicholas M

2016-01-01

In 2010, Universitas Indonesia (UI) developed the UI GreenMetric World University Ranking for universities to share information about their sustainability practices. This ranking system was well aligned with the basis of Sustainability for Higher Education. The scoring system can also be used as a guideline for universities to achieve sustainability in their campuses. Since its first launch, more universities around the world have increasingly participated in the ranking system including many universities in Thailand. This study compared perception of stakeholders in Green Campus and Non-Green Campus universities in Thailand regarding stakeholders' satisfaction on sustainability practices and perceived quality of life at their campuses. The results showed that stakeholders at the studied Green Campus University were more satisfied and had significantly better perceived quality of life compared to stakeholders from the studied Non-Green Campus university. The results suggested that universities should adopt the criteria set in the UI GreenMetric World University Ranking to achieve better sustainability in their campuses and improve quality of life of their stakeholders.

Impact of a competency based curriculum on quality improvement among internal medicine residents.

PubMed

Fok, Mark C; Wong, Roger Y

2014-11-28

Teaching quality improvement (QI) principles during residency is an important component of promoting patient safety and improving quality of care. The literature on QI curricula for internal medicine residents is limited. We sought to evaluate the impact of a competency based curriculum on QI among internal medicine residents. This was a prospective, cohort study over four years (2007-2011) using pre-post curriculum comparison design in an internal medicine residency program in Canada. Overall 175 post-graduate year one internal medicine residents participated. A two-phase, competency based curriculum on QI was developed with didactic workshops and longitudinal, team-based QI projects. The main outcome measures included self-assessment, objective assessment using the Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess QI knowledge, and performance-based assessment via presentation of longitudinal QI projects. Overall 175 residents participated, with a response rate of 160/175 (91%) post-curriculum and 114/175 (65%) after conducting their longitudinal QI project. Residents' self-reported confidence in making changes to improve health increased and was sustained at twelve months post-curriculum. Self-assessment scores of QI skills improved significantly from pre-curriculum (53.4 to 69.2 percent post-curriculum [p-value 0.002]) and scores were sustained at twelve months after conducting their longitudinal QI projects (53.4 to 72.2 percent [p-value 0.005]). Objective scores using the QIKAT increased post-curriculum from 8.3 to 10.1 out of 15 (p-value for difference <0.001) and this change was sustained at twelve months post-project with average individual scores of 10.7 out of 15 (p-value for difference from pre-curriculum <0.001). Performance-based assessment occurred via presentation of all projects at the annual QI Project Podium Presentation Day. The competency based curriculum on QI improved residents' QI knowledge and skills during residency training. Importantly, residents perceived that their QI knowledge improved after the curriculum and this also correlated to improved QIKAT scores. Experiential QI project work appeared to contribute to sustaining QI knowledge at twelve months.

Creating quality improvement culture in public health agencies.

PubMed

Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

Quality improvement "201": context-relevant quality improvement leadership training for the busy clinician-educator.

PubMed

Stille, Christopher J; Savageau, Judith A; McBride, Jeanne; Alper, Eric J

2012-01-01

Development of quality improvement (QI) skills and leadership for busy clinician-educators in academic medical centers is increasingly necessary, although it is challenging given limited resources. In response, the authors developed the Quality Scholars program for primary care teaching faculty. They conducted a needs assessment, evaluated existing internal and national resources, and developed a 9-month, 20-session project-based curriculum that combines didactic and hands-on techniques with facilitated project discussion. They also conducted pre-post tests of knowledge and attitudes, and evaluations of each session, scholars' projects, and program sustainability and costs. In all, 10 scholars from all 3 generalist disciplines comprised the first class. A wide spectrum of previous experiences enhanced collaboration. QI knowledge increased slightly, and reported self-readiness to lead QI projects increased markedly. Protected time for project work and group discussion of QI topics was seen as essential. All 10 scholars completed projects and presented results. Institutional leadership agreed to sustain the program using institutional funds.

Academic Developers as Change Agents Improving Quality in a Large Interprofessional Undergraduate Subject

ERIC Educational Resources Information Center

Cordiner, Moira

2014-01-01

Much has been written about academic developers as change agents but not in an interprofessional education (IPE) context. IPE involves teaching students in different health professions how to work effectively in teams across professional boundaries to improve the quality of patient care. Extensive evidence reveals that implementing sustainable IPE…

Environmental Kuznets Curve Hypothesis: A Perspective of Sustainable Development in Indonesia

NASA Astrophysics Data System (ADS)

Nuansa, Citrasmara Galuh; Widodo, Wahyu

2018-02-01

Sustainable development with three main pillars, namely environmental, economic, and social, is the concept of country's development to achieve inclusive economic growth, good environmental quality, and improvement of people's welfare. However, the dominance of economic factors cause various environmental problem. This phenomenon occurs in most of developing countries, including in Indonesia. The relationship between economic activity and environmental quality has been widely discussed and empirically tested by scholars. This descriptive research analysed the hypothesis called Environmental Kuznets Curve (EKC) from a perspective of sustainable development in Indonesia. EKC hypothesis illustrates the relationship between economic growth and environmental degradation forming an inverted U-curve, indicating that at the beginning of development, environmental quality will decrease along with increasing economic growth, and then reached a certain point the environmental quality will gradually improve. In this paper will be discussed how the relationship between environmental quality and economic growth in Indonesia was investigated. The preliminary results show that most of the empirical studies use the conventional approach, in which the CO2 emission used as the proxy of environmental degradation. The existence of inverted U-curve is also inconclusive. Therefore, the extension research on the relationship between economic growth and environmental quality in Indonesia using the EKC hypothesis is required.

Association of Implementation of Practice Standards for Electrocardiographic Monitoring With Nurses' Knowledge, Quality of Care, and Patient Outcomes: Findings From the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial.

PubMed

Funk, Marjorie; Fennie, Kristopher P; Stephens, Kimberly E; May, Jeanine L; Winkler, Catherine G; Drew, Barbara J

2017-02-01

Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses' knowledge, quality of care, and patient outcomes. The PULSE (Practical Use of the Latest Standards of Electrocardiography) Trial was a 6-year multisite randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, time 2 after group 1 hospitals received the intervention, and time 3 after group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses' knowledge (N=3013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest; N=95 884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses' knowledge improved significantly immediately after the intervention in both groups but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention and was sustained. Online ECG monitoring education and strategies to change practice can lead to improved nurses' knowledge, quality of care, and patient outcomes. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01269736. © 2017 American Heart Association, Inc.

Association of Implementation of Practice Standards for Electrocardiographic Monitoring with Nurses’ Knowledge, Quality of Care, and Patient Outcomes: Findings from the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial

PubMed Central

Funk, Marjorie; Fennie, Kristopher P.; Stephens, Kimberly E.; May, Jeanine L.; Winkler, Catherine G.; Drew, Barbara J.

2017-01-01

Background Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. Methods and Results The PULSE Trial was a 6-year multi-site randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, Time 2 after Group 1 hospitals received the intervention, and Time 3 after Group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses’ knowledge (N=3,013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4,587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest) (N=95,884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses’ knowledge improved significantly immediately following the intervention in both groups, but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention, and was sustained. Conclusions Online ECG monitoring education and strategies to change practice can lead to improved nurses’ knowledge, quality of care, and patient outcomes. PMID:28174175

Preventing Heel Pressure Ulcers: Sustained Quality Improvement Initiative in a Canadian Acute Care Facility.

PubMed

Hanna-Bull, Debbie

2016-01-01

The setting for this quality improvement initiative designed to reduce the prevalence of facility-acquired heel pressure ulcers was a regional, acute-care, 490-bed facility in Ontario, Canada, responsible for dialysis, vascular, and orthopedic surgery. An interdisciplinary skin and wound care team designed an evidence-based quality improvement initiative based on a systematic literature review and standardization of heel offloading methods. The prevalence of heel pressure ulcers was measured at baseline (immediately prior to implementation of initiative) and at 1 and 4 years following implementation. The prevalence of facility-acquired heel pressure ulcers was 5.8% when measured before project implementation. It was 4.2% at 1 year following implementation and 1.6% when measured at the end of the 4-year initiative. Outcomes demonstrate that the initiative resulted in a continuous and sustained reduction in facility-acquired heel pressure ulcer incidence over a 4-year period.

Relationship of health-related quality of life to treatment adherence and sustained response in chronic hepatitis C patients.

PubMed

Bernstein, David; Kleinman, Leah; Barker, Chris M; Revicki, Dennis A; Green, Jesse

2002-03-01

Interferon therapy may exacerbate health-related quality of life (HRQL) deficits associated with hepatitis C virus (HCV) early in the course of therapy. Treatment with polyethylene glycol-modified interferon (peginterferon) alfa-2a (40 kd) provides improved sustained response over interferon alfa-2a, but its effect on HRQL is unknown. The objective of this study was to (1) evaluate the effect of sustained virologic response on HRQL in patients with HCV and (2) determine whether impairment of HRQL during treatment contributes to early treatment discontinuation. Data consisted of a pooled secondary analysis of patients (n = 1,441) across 3 international, multicenter, open-label, randomized studies that compared peginterferon alfa-2a (40 kd) with interferon alfa-2a. ANCOVA was used to examine the effect of sustained virologic response on HRQL. Repeated-measures mixed-models ANCOVA was used to compare Fatigue Severity Scale (FSS) and SF-36 scores during treatment by treatment group. Logistic regression analysis was used to examine the association between changes at baseline in on-treatment HRQL and early treatment discontinuation. Sustained virologic response was associated with marked improvements from baseline to end of follow-up in all subjects, including patients with cirrhosis. During treatment, patients receiving peginterferon alfa-2a (40 kd) had statistically significantly better scores on both the SF-36 and FSS. Baseline to 24-week changes in fatigue and SF-36 mental and physical summary scores significantly predicted treatment discontinuation. In conclusion, sustained virologic response is associated with improvements in quality of life in patients with or without advanced liver disease. This parameter may be an important consideration in maximizing treatment adherence.

Creating the Urban Village: Teaching Pre-Service Teachers about Sustainable Design in Architecture and Community Planning

ERIC Educational Resources Information Center

Vande Zande, Robin

2010-01-01

Sustainable design is a philosophy adopted by people concerned with the health of society and the natural environment. The practice of sustainable design works toward the improvement of the quality of the built environment, while reducing or eradicating the negative impact on the natural environment (McLennan 2004). It is a philosophical approach…

Microfinance investments in quality at private clinics in Uganda: a case-control study

PubMed Central

Seiber, Eric E; Robinson, Amara L

2007-01-01

Background Small private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda. Methods This study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics. Results The study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic. Conclusion The results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets. PMID:17945024

Improving Uptake of Key Perinatal Interventions Using Statewide Quality Collaboratives.

PubMed

Pai, Vidya V; Lee, Henry C; Profit, Jochen

2018-06-01

Regional and statewide quality improvement collaboratives have been instrumental in implementing evidence-based practices and facilitating quality improvement initiatives within neonatology. Statewide collaboratives emerged from larger collaborative organizations, like the Vermont Oxford Network, and play an increasing role in collecting and interpreting data, setting priorities for improvement, disseminating evidence-based clinical practice guidelines, and creating regional networks for synergistic learning. In this review, we highlight examples of successful statewide collaborative initiatives, as well as challenges that exist in initiating and sustaining collaborative efforts. Copyright © 2018 Elsevier Inc. All rights reserved.

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

ERIC Educational Resources Information Center

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

2017-01-01

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

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

PubMed Central

2011-01-01

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

Quality, Safety and Patient Centered Care--A Dream Come True in the Mountains of Northern Pakistan. An Award winning project of "2015 Quality, Safety & Patient Centered Care Award" at, Chicago USA.

PubMed

Jassani, Kashif; Essani, Rozina Roshan; Abbas, Syed Nadeem Husain

2016-01-01

Northern Pakistan remains very challenging terrain due to harsh weather all year round presenting an infrastructura, human resource and supply chain challenge of its own. Many times the facility had to move to different locations on emergency and ad hoc basis due to landslides, earthquakes affecting continuity of care. Providing quality healthcare to often resource constraint hard-to-reach areas has always been AKHS,P's unique forte. Breaking barriers for catchment population to access quality healthcare, AKHS,P embarked on an initiative of implementing, achieving and sustaining ISO 9001:2008 Quality Management System international standards certification. This article shares the unique experience of AKHS,P in achieving and sustaining ISO 9001:2008 International Quality Management System Certification. After untiring efforts and the hard work of ground staff; AKHS,P achieved ISO 9001:2008 International Quality Management System Certification as well as 1st Surveillance Audit which itself proved that AKHS,P sustained quality systems and ensured continuous quality improvement in the Mountains of Northern Pakistan.

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

DOT National Transportation Integrated Search

2014-08-31

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

Sustainability of partnership projects: a conceptual framework and checklist.

PubMed

Edwards, Janine C; Feldman, Penny Hollander; Sangl, Judy; Polakoff, David; Stern, Glen; Casey, Don

2007-12-01

There is growing recognition that the health care delivery system in the United States must make major changes. Intervention projects focusing on quality and patient safety offer the potential for reshaping the future of medicine. Sustainability of the Partnerships for Quality (PFQ) projects and other patient safety and quality improvement projects that provide evidence of effectiveness is essential if progress is to be made. For the purposes of these projects, a conceptual framework and a checklist for sustainability were developed. The framework consists of two dimensions: (1) the goals--what is to be sustained--and (2) elements for sustainability--infrastructure, incentives, incremental opportunities for involvement, and integration. The checklist is designed to trigger planning for sustainability early in a project's design. Specific questions about each of the elements can cue planners and project leaders to build in the goals for sustainability and change processes. A pilot test showed that the framework and checklist are relevant and helpful across a variety of projects. Two extended examples of planning and action for sustainability from the PFQ projects are described. It is too early to claim sustainability for these project. However, continued monitoring for at least three years with the checklist could result in valuable national data with which to design and implement future projects.

Emblems of Quality in Higher Education. Developing and Sustaining High-Quality Programs.

ERIC Educational Resources Information Center

Haworth, Jennifer Grant; Conrad, Clifton F.

This book proposes an "engagement" theory of program quality to evaluate and improve higher education programs at all degree levels. Based on interviews with 781 participants in a national study of Masters degree programs, it focuses on the interactive roles of students, faculty, and administrators in developing high-quality programs…

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the...

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the...

A framework and a measurement instrument for sustainability of work practices in long-term care

PubMed Central

2011-01-01

Background In health care, many organizations are working on quality improvement and/or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization. Methods The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N teams = 63, N individual = 112). Data were collected not until at least one year had passed after implementation. Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach's alpha coefficient. A long and a short version of the instrument are proposed. Results The χ2- difference test of the -2 Log Likelihood estimates demonstrated that the hierarchical two factor model with routinization and institutionalization as separate constructs showed a better fit than the one factor model (p < .01). Secondly, construct validity of the instrument was strong as indicated by the high factor loadings of the items. Finally, the internal consistency of the subscales was good. Conclusions The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the subscales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects. PMID:22087884

Sustaining a quality improvement culture in local health departments applying for accreditation.

PubMed

Verma, Pooja; Moran, John W

2014-01-01

This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI. To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs. Quantitative data from a self-reporting survey and qualitative data from telephone interviews. Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews. QI lead staff at LHDs that are advanced in accreditation preparation and QI. Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives. Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI. When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.

Small physician practices in new york needed sustained help to realize gains in quality from use of electronic health records.

PubMed

Ryan, Andrew M; Bishop, Tara F; Shih, Sarah; Casalino, Lawrence P

2013-01-01

The 2009 American Recovery and Reinvestment Act spurred adoption of electronic health records (EHRs) in the United States, through such measures as financial incentives to providers through Medicare and Medicaid and regional extension centers, which provide ongoing technical assistance to practices. Yet the relationship between EHR adoption and quality of care remains poorly understood. We evaluated the early effects on quality of the Primary Care Information Project, which provides subsidized EHRs and technical assistance to primary care practices in underserved neighborhoods in New York City, using the regional extension center model. We found that just general participation in, or exposure to, the project was not enough to improve quality of care. It took sustained exposure on the part of these practices and technical assistance to them before they demonstrated improvement on measures of care most likely to be affected by the use of electronic health records, such as cancer screenings and care for patients with diabetes. Participating in the Primary Care Information Project for nine or more months was associated with significantly improved quality, but only for this limited group of quality measures and only for physicians receiving extensive technical assistance.

The congestion mitigation and air quality improvement program

DOT National Transportation Integrated Search

2000-01-01

Clean air is an important part of a healthy environment. Unfortunately, many industrial and transportation activities that sustain our economy can also produce air pollutant emissions as by-products, degrading our air quality. Safeguarding our air fr...

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: A cohort study: trial protocol

PubMed Central

2011-01-01

Background Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest. Methods/design The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. Methods: All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites. Conclusion This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing. Trial registration ISRCTN56583860 PMID:22008636

SANTPEN's SoTL Journey: Building and Using a SoTL Approach across Institutions

ERIC Educational Resources Information Center

West, Deborah; Stephenson, Helen

2016-01-01

In the current higher education environment, providing high quality teaching and learning experiences to students has moved beyond desirable to essential. Quality improvement takes many forms, but one core aspect to ensure sustainable improvement is the development of a culture of scholarship of teaching and learning (SoTL). Developing such an…

Sustaining Excellence.

ERIC Educational Resources Information Center

Moorse, Rosemary; Reisenberger, Anna

This publication outlines prerequisites for success, critical factors in achieving excellence, and strategies for sustaining excellence once high levels of performance have been achieved. It considers how quality and improvement models might be used to support colleges in this work and draws on the work of 10 colleges in the United Kingdom that…

Texas Sustainable School Design Guideline.

ERIC Educational Resources Information Center

Nicklas, Michael; Bailey, Gary; Padia, Harshad D.; Malin, Nadav

This guide offers a detailed listing of the key practices and technologies that can help create a sustainable school. The document includes hundreds of cost-effective recommendations that can improve the energy performance and environmental quality of school designs. Each design and construction phase is addressed, from site selection through…

Creating Quality Improvement Culture in Public Health Agencies

PubMed Central

Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

Quality maternity care for every woman, everywhere: a call to action.

PubMed

Koblinsky, Marjorie; Moyer, Cheryl A; Calvert, Clara; Campbell, James; Campbell, Oona M R; Feigl, Andrea B; Graham, Wendy J; Hatt, Laurel; Hodgins, Steve; Matthews, Zoe; McDougall, Lori; Moran, Allisyn C; Nandakumar, Allyala K; Langer, Ana

2016-11-05

To improve maternal health requires action to ensure quality maternal health care for all women and girls, and to guarantee access to care for those outside the system. In this paper, we highlight some of the most pressing issues in maternal health and ask: what steps can be taken in the next 5 years to catalyse action toward achieving the Sustainable Development Goal target of less than 70 maternal deaths per 100 000 livebirths by 2030, with no single country exceeding 140? What steps can be taken to ensure that high-quality maternal health care is prioritised for every woman and girl everywhere? We call on all stakeholders to work together in securing a healthy, prosperous future for all women. National and local governments must be supported by development partners, civil society, and the private sector in leading efforts to improve maternal-perinatal health. This effort means dedicating needed policies and resources, and sustaining implementation to address the many factors influencing maternal health-care provision and use. Five priority actions emerge for all partners: prioritise quality maternal health services that respond to the local specificities of need, and meet emerging challenges; promote equity through universal coverage of quality maternal health services, including for the most vulnerable women; increase the resilience and strength of health systems by optimising the health workforce, and improve facility capability; guarantee sustainable finances for maternal-perinatal health; and accelerate progress through evidence, advocacy, and accountability. Copyright © 2016 Elsevier Ltd. All rights reserved.

Teacher Quality: Sustained Coordination among Key Federal Education Programs Could Enhance State Efforts to Improve Teacher Quality. Report to the Chairman of the Subcommittee on Higher Education, Lifelong Learning, and Competitiveness, Committee on Education and Labor, House of Representatives. GAO-09-593

ERIC Educational Resources Information Center

US Government Accountability Office, 2009

2009-01-01

Policymakers and researchers have focused on improving the quality of our nation's 3 million teachers to raise the achievement of students in key academic areas, such as reading and mathematics. Given the importance of teacher quality to student achievement and the key role federal and state governments play in supporting teacher quality, GAO's…

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the Director...

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the Director...

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the Director...

Quality engineering as a discipline of study.

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

Kolb, Rachel R.; Hoover, Marcey L.

2012-12-01

The current framework for quality scholarship in the United States ranges from the training and education of future quality engineers, managers, and professionals to focused and sustained research initiatives that, through academic institutions and other organizations, aim to improve the knowledge and application of quality across a variety of sectors. Numerous quality journals also provide a forum for professional dissemination of information.

A research agenda to advance quality measurement and improvement.

PubMed

Leatherman, Sheila T; Hibbard, Judith H; McGlynn, Elizabeth A

2003-01-01

In developing a conceptual framework for the design of a national quality measurement and reporting system (NQMRS), the Strategic Framework Board (SFB) recommends that such a system be built on a strong evidence base. To identify critical gaps in the evidence needed for a fully functional NQMRS and to recommend a starting point for the development of a research agenda. Selective review of literature in quality of care measurement and reporting and identification of strategic issues that must be addressed. There is some limited evidence that measurement and reporting can improve quality. Substantial advances have been made in the science of measurement and reporting but important gaps remain, specifically in (1) measurement methods and tools, (2) uses of quality performance data, (3) organizational and cultural factors, (4) information and informatics, and (5) impact evaluation/research. To achieve a sustainable research agenda, three strategic issues will have to be addressed: (1) the policy rationale for the research agenda, (2) adequate levels of public-sector funding, and (3) sustainability in a rapidly changing environment.

Good to Great: Quality-Improvement Initiative Increases and Sustains Pediatric Health Care Worker Hand Hygiene Compliance.

PubMed

McLean, Heather S; Carriker, Charlene; Bordley, William Clay

2017-04-01

The Joint Commission, the Centers for Disease Control and Prevention, and the World Health Organization challenge hospitals to achieve and sustain compliance with effective hand hygiene (HH) practice; however, many inpatient units fail to achieve a high level of reliability. The aim of the project was to increase and sustain health care worker (HCW) compliance with HH protocols from 87% (level of reliability [LOR] 1) to ≥95% (LOR 2) within 9 months on 2 pediatric inpatient units in an academic children's hospital. This study was a time-series, quality-improvement project. Interventions were tested through multiple plan-do-study-act cycles on 2 pediatric inpatient units. HH compliance audits of HCWs on these units were performed randomly each week by the hospital infection prevention program. Control charts of percentages of HCW HH compliance were constructed with 3-σ (data within 3 SDs from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Charts were annotated with interventions including (1) increasing awareness, (2) providing timely feedback, (3) empowering patients and families to participate in mitigation, (4) providing focused education, and (5) developing interdisciplinary HH champions. HH compliance rates improved from an average of 87% (LOR 1) to ≥95% (LOR 2) within 9 months, and this improvement has been sustained for >2 years on both pediatric inpatient units. Significant and sustained gains in HH compliance rates of ≥95% (LOR 2) can be achieved by applying high-reliability human-factor interventions. Copyright © 2017 by the American Academy of Pediatrics.

Sustainable Infrastructures for Life Science Communication: Workshop Summary

ERIC Educational Resources Information Center

Brown, Elizabeth Stallman; Yeung, Laurence; Sawyer, Keegan

2014-01-01

Advances in the life sciences--from the human genome to biotechnology to personalized medicine and sustainable communities--have profound implications for the well-being of society and the natural world. Improved public understanding of such scientific advances has the potential to benefit both individuals and society through enhanced quality of…

Developing an Interdisciplinary, Team-Based Quality Improvement Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program.

PubMed

Rao, Sandhya K; Carballo, Victoria; Cummings, Brian M; Millham, Frederick; Jacobson, Joseph O

Although there has been tremendous progress in quality improvement (QI) education for students and trainees in recent years, much less has been published regarding the training of active clinicians in QI. The Partners Clinical Process Improvement Leadership Program (CPIP) is a 6-day experiential program. Interdisciplinary teams complete a QI project framed by didactic sessions, interactive exercises, case-based problem sessions, and a final presentation. A total of 239 teams composed of 516 individuals have graduated CPIP. On completion, participant satisfaction scores average 4.52 (scale 1-5) and self-reported understanding of QI concepts improved. At 6 months after graduation, 66% of survey respondents reported sustained QI activity. Three opportunities to improve the program have been identified: (1) increasing faculty participation through online and tiered course offerings, (2) integrating the faculty-focused program with the trainee curriculum, and (3) developing a postgraduate curriculum to address the challenges of sustained improvement.

The Psychology of Sustainability and Sustainable Development for Well-Being in Organizations.

PubMed

Di Fabio, Annamaria

2017-01-01

This article discusses the contribution of the psychology of sustainability and sustainable development to well-being in organizations from a primary prevention perspective. It deals with sustainability not only in terms of the ecological, economic, and social environment but also in terms of improving the quality of life of every human being. The psychology of sustainability and sustainable development is seen as a primary prevention perspective that can foster well-being in organizations at all the different levels going from the worker, to the group, to the organization, and also to inter-organizational processes. The possibilities for further research and interventions are also discussed.

The Psychology of Sustainability and Sustainable Development for Well-Being in Organizations

PubMed Central

Di Fabio, Annamaria

2017-01-01

This article discusses the contribution of the psychology of sustainability and sustainable development to well-being in organizations from a primary prevention perspective. It deals with sustainability not only in terms of the ecological, economic, and social environment but also in terms of improving the quality of life of every human being. The psychology of sustainability and sustainable development is seen as a primary prevention perspective that can foster well-being in organizations at all the different levels going from the worker, to the group, to the organization, and also to inter-organizational processes. The possibilities for further research and interventions are also discussed. PMID:28974935

Enabling nutrient security and sustainability through systems research.

PubMed

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

2015-05-01

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

International quality improvement initiatives.

PubMed

Hickey, Patricia A; Connor, Jean A; Cherian, Kotturathu M; Jenkins, Kathy; Doherty, Kaitlin; Zhang, Haibo; Gaies, Michael; Pasquali, Sara; Tabbutt, Sarah; St Louis, James D; Sarris, George E; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Tchervenkov, Christo I; Jacobs, Jeffery P; Stellin, Giovanni; Kirklin, James K; Garg, Rajnish; Vener, David F

2017-12-01

Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.

Towards Quality Technical Vocational Education and Training (Tvet) Programmes in Nigeria: Challenges and Improvement Strategies

ERIC Educational Resources Information Center

Ayonmike, Chinyere Shirley; Okwelle, P. Chijioke; Okeke, Benjamin Chukwumaijem

2015-01-01

Technical Vocational Education and Training (TVET) is widely recognized as a vital driving force for the socio-economic growth and technological development of nations. In achieving the goals and objectives of TVET in Nigeria, the quality of the programme needs to be improved and sustained. The purpose of this study is to ascertain the challenges…

Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department.

PubMed

Chartier, Lucas B; Cheng, Amy H Y; Stang, Antonia S; Vaillancourt, Samuel

2018-01-01

Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses-Ishikawa diagrams, Pareto charts and process mapping-and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.

A Case Review: Integrating Lewin’s Theory with Lean’s System Approach for Change

PubMed

Wojciechowski, Elizabeth; Pearsall, Tabitha; Murphy, Patricia; French, Eileen

2016-05-31

The complexity of healthcare calls for interprofessional collaboration to improve and sustain the best outcomes for safe and high quality patient care. Historically, rehabilitation nursing has been an area that relies heavily on interprofessional relationships. Professionals from various disciplines often subscribe to different change management theories for continuous quality improvement. Through a case review, authors describe how a large, Midwestern, rehabilitation hospital used the crosswalk methodology to facilitate interprofessional collaboration and develop an intervention model for implementing and sustaining bedside shift reporting. The authors provide project background and offer a brief overview of the two common frameworks used in this project, Lewin’s Three-Step Model for Change and the Lean Systems Approach. The description of the bedside shift report project methods demonstrates that multiple disciplines are able to utilize a common framework for leading and sustaining change to support outcomes of high quality and safe care, and capitalize on the opportunities of multiple views and discipline-specific approaches. The conclusion discusses outcomes, future initiatives, and implications for nursing practice.

PROMOTING AIR QUALITY THROUGH ENVIRONMENTAL TECHNOLOGY VERIFICATION

EPA Science Inventory

The paper discusses the promotion of improved air quality through environmental technology verifications (ETVs). In 1995, the U.S. EPA's Office of Research and Development began the ETV Program in response to President Clinton's "Bridge to a Sustainable Future" and Vice Presiden...

Plants for Sustainable Improvement of Indoor Air Quality.

PubMed

Brilli, Federico; Fares, Silvano; Ghirardo, Andrea; de Visser, Pieter; Calatayud, Vicent; Muñoz, Amalia; Annesi-Maesano, Isabella; Sebastiani, Federico; Alivernini, Alessandro; Varriale, Vincenzo; Menghini, Flavio

2018-06-01

Indoor pollution poses a serious threat to human health. Plants represent a sustainable but underexploited solution to enhance indoor air quality. However, the current selection of plants suitable for indoors fails to consider the physiological processes and mechanisms involved in phytoremediation. Therefore, the capacity of plants to remove indoor air pollutants through stomatal uptake (absorption) and non-stomatal deposition (adsorption) remains largely unknown. Moreover, the effects of the indoor plant-associated microbiome still need to be fully analyzed. Here, we discuss how a combination of the enhanced phytoremediation capacity of plants together with cutting-edge air-cleaning and smart sensor technologies can improve indoor life while reducing energy consumption. Copyright © 2018 Elsevier Ltd. All rights reserved.

Development of a culture of sustainability in health care organizations.

PubMed

Ramirez, Bernardo; West, Daniel J; Costell, Michael M

2013-01-01

This paper aims to examine the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to implant a culture of sustainability. Competencies and management development strategies needed to engrain this corporate culture of sustainability are analyzed in this document. This paper draws on the experience of the authors as health care executives and educators developing managerial competencies with interdisciplinary and international groups of executives in the last 25 years, using direct observation, interviews, discussions and bibliographic evidence. With a holistic framework for sustainability, health care managers can implement strategies for multidisciplinary teams to respond to the constant change, fine-tune operations and successfully manage quality of care. Managers can mentor students and provide in-service learning experiences that integrate knowledge, skills, and abilities. Further empirical research needs to be conducted on these interrelated innovative topics. Health care organizations around the world are under stakeholders' pressure to provide high quality, cost-effective, accessible and sustainable services. Professional organizations and health care providers can collaborate with university graduate health management education programs to prepare competent managers in all the dimensions of sustainability. The newly designated accountable care organizations represent an opportunity for managers to address the need for sustainability. Sustainability of health care organizations with the holistic approach discussed in this paper is an innovative and practical approach to quality improvement that merits further development.

Economic valuation for sustainable development in the Swedish coastal zone.

PubMed

Söderqvist, Tore; Eggert, Håkan; Olsson, Björn; Soutukorva, Asa

2005-03-01

The Swedish coastal zone is a scene of conflicting interests about various goods and services provided by nature. Open-access conditions and the public nature of many services increase the difficulty in resolving these conflicts. "Sustainability" is a vague but widely accepted guideline for finding reasonable trade-offs between different interests. The UN view of sustainable development suggests that coastal zone management should aim at a sustainable ecological, economic, and social-cultural development. Looking closer at economic sustainability, it is observed that economic analyses about whether changes in society imply a gain or a loss should take into account the economic value of the environment. Methods used for making such economic valuation in the context of the Swedish coastal zone are briefly reviewed. It is noted that the property rights context matters for the results of a valuation study. This general background is followed by a concise presentation of the design and results of four valuation studies on Swedish coastal zone issues. One study is on the economic value of an improved bathing water quality in the Stockholm archipelago. The other studies are a travel cost study about the economic value of improved recreational fisheries in the Stockholm archipelago, a replacement cost study on the value of restoring habitats for sea trout, and a choice experiment study on the economic value of improved water quality along the Swedish westcoast.

Total quality management practices in Malaysia healthcare industry

NASA Astrophysics Data System (ADS)

Ahmad, Md Fauzi; Nee, Phoi Soo; Nor, Nik Hisyamudin Muhd; Wei, Chan Shiau; Hassan, Mohd Fahrul; Hamid, Nor Aziati Abdul

2017-10-01

The aim of total quality management (TQM) is to achieve customer satisfaction. Healthcare industry is very important in Malaysia for providing good healthcare services to public. However, failure to improve quality and efficiency is a big challenge in a healthcare industry in order to increase quality healthcare services. The objectives of this research are to identify the extent level of TQM implementation; and to determine the impact of TQM implementation on business sustainable in healthcare industry. Quantitative approach has been chosen as the methodology of this study. The survey respondents targeted in this research are staffs in Malaysia private clinic. 70 respondents have participated in this research. Data were analysed by Statistical Package Social Science (SPSS). Analysis result showed that there was a positive significant relationship between TQM practices and business sustainable (r=0.774, P<0.05). All TQM factors have significant relationship with business sustainable factors. The findings of this research will help healthcare industry to understand a better and deeper valuable information on the impact of TQM implementation towards business sustainable in Malaysia healthcare industry.

Relationship between food waste, diet quality, and environmental sustainability

PubMed Central

Niles, Meredith T.; Neher, Deborah A.; Roy, Eric D.; Tichenor, Nicole E.; Jahns, Lisa

2018-01-01

Improving diet quality while simultaneously reducing environmental impact is a critical focus globally. Metrics linking diet quality and sustainability have typically focused on a limited suite of indicators, and have not included food waste. To address this important research gap, we examine the relationship between food waste, diet quality, nutrient waste, and multiple measures of sustainability: use of cropland, irrigation water, pesticides, and fertilizers. Data on food intake, food waste, and application rates of agricultural amendments were collected from diverse US government sources. Diet quality was assessed using the Healthy Eating Index-2015. A biophysical simulation model was used to estimate the amount of cropland associated with wasted food. This analysis finds that US consumers wasted 422g of food per person daily, with 30 million acres of cropland used to produce this food every year. This accounts for 30% of daily calories available for consumption, one-quarter of daily food (by weight) available for consumption, and 7% of annual cropland acreage. Higher quality diets were associated with greater amounts of food waste and greater amounts of wasted irrigation water and pesticides, but less cropland waste. This is largely due to fruits and vegetables, which are health-promoting and require small amounts of cropland, but require substantial amounts of agricultural inputs. These results suggest that simultaneous efforts to improve diet quality and reduce food waste are necessary. Increasing consumers’ knowledge about how to prepare and store fruits and vegetables will be one of the practical solutions to reducing food waste. PMID:29668732

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

ERIC Educational Resources Information Center

Ng, Mee Kam

2005-01-01

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

A targeted conservation approach for improving environmental quality: Multiple benefits and expanded opportunities

USDA-ARS?s Scientific Manuscript database

We all benefit from maintaining the quality of our water supplies, the productivity of our soils, and the quality of our outdoors for recreation. In areas of the country where agriculture is a key industry, sustaining these resources requires that we maintain healthy working landscapes and vibrant a...

Community-based primary care: improving and assessing diabetes management.

PubMed

Gannon, Meghan; Qaseem, Amir; Snow, Vincenza

2010-01-01

Morbidity and mortality associated with diabetes make it a prime target for quality improvement research. Quality gaps and racial/gender disparities persist throughout this population of patients necessitating a sustainable improvement in the clinical management of diabetes. The authors of this study sought (1) to provide a population perspective on diabetes management, and (2) to reinforce evidence-based clinical guidelines through a Web-based educational module.The project also aimed to gain insight into working remotely with a community of rural physicians. This longitudinal pre-post intervention study involved 18 internal medicine physicians and included 3 points of medical record data abstraction over 24 months. A Web-based educational module was introduced after the baseline data abstraction. This module contained chapters on clinical education, practice tools, and self-assessment. The results showed a sustained improvement in most clinical outcomes and demonstrated the effectiveness of using Web-based mediums to reinforce clinical guidelines and change physician behavior.

Professional Learning Communities That Initiate Improvement in Student Achievement

ERIC Educational Resources Information Center

Royer, Suzanne M.

2012-01-01

Quality teaching requires a strong practice of collaboration, an essential building block for educators to improve student achievement. Researchers have theorized that the implementation of a professional learning community (PLC) with resultant collaborative practices among teachers sustains academic improvement. The problem addressed specifically…

Genomic exploitation of genetic variation for crop improvement

USDA-ARS?s Scientific Manuscript database

Crop plants produce food, fiber, and fuel that are essential to human civilization and mainstays of economic prosperity. Our society continues to cultivate and improve the crop plants for better quality and productivity with sustainable environments. The process of crop genetic improvement has bee...

Environmental indicators for sustainable production of algal biofuels

DOE PAGES

Efroymson, Rebecca A.; Dale, Virginia H.

2014-10-01

For analyzing sustainability of algal biofuels, we identify 16 environmental indicators that fall into six categories: soil quality, water quality and quantity, air quality, greenhouse gas emissions, biodiversity, and productivity. Indicators are selected to be practical, widely applicable, predictable in response, anticipatory of future changes, independent of scale, and responsive to management. Major differences between algae and terrestrial plant feedstocks, as well as their supply chains for biofuel, are highlighted, for they influence the choice of appropriate sustainability indicators. Algae strain selection characteristics do not generally affect which indicators are selected. The use of water instead of soil as themore » growth medium for algae determines the higher priority of water- over soil-related indicators. The proposed set of environmental indicators provides an initial checklist for measures of biofuel sustainability but may need to be modified for particular contexts depending on data availability, goals of the stakeholders, and financial constraints. Ultimately, use of these indicators entails defining sustainability goals and targets in relation to stakeholder values in a particular context and can lead to improved management practices.« less

Quality Improvement Initiatives in Inflammatory Bowel Disease.

PubMed

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

2017-08-01

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

SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach.

PubMed

Cranley, Lisa A; Hoben, Matthias; Yeung, Jasper; Estabrooks, Carole A; Norton, Peter G; Wagg, Adrian

2018-03-12

Interventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success. This study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis. In total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of the seven facilities up to 18 months following the intervention and demonstrated the need for continued staff and leadership engagement. Sustainability of a QI project which empowers and engages care aides is possible and achievable, but requires ongoing staff and leadership engagement.

Improving residents' handovers through just-in-time training for structured communication.

PubMed

Rourke, Liam; Amin, Aditi; Boyington, Curtiss; Ao, Peter; Frolova, Natalia

2016-01-01

In a recent quality assurance project we learned that nearly half of the handovers we examined were characterized as unsatisfactory by our residents, who provided examples in which their anxiety had been piqued and patient care had been affected. These reports substantiated a growing body of literature on the relationship between the quality of handover and the quality of patient care, so we sought to improve the quality and consistency of the in-hosptial handovers undertaken by our internal medicine residents. Senior residents attended morning report for three consecutive month long blocks and evaluated the quality of the handovers using an observational protocol comprised of 16 aspects of effective handover. During the first block, the resident observed a median of eight of the 16 practices occurring across the 46 handovers, and a large amount of variability. At the beginning of the subsequent block we presented a concise introduction to a structured handover procedure (SBARR). The median quality of the subsequent 33 handovers rose to 11, and the variability decreased considerably. In the next block we refined the SBARR orientation to focus on the errors observed in the previous blocks, and the improvement in the quality and variability was sustained. The minor change, which requires few resources to sustain, had a favourable impact on the quality of our residents' in-hospital handovers.

Use of Natural Diversity and Biotechnology to Increase the Quality and Nutritional Content of Tomato and Grape

PubMed Central

Gascuel, Quentin; Diretto, Gianfranco; Monforte, Antonio J.; Fortes, Ana M.; Granell, Antonio

2017-01-01

Improving fruit quality has become a major goal in plant breeding. Direct approaches to tackling fruit quality traits specifically linked to consumer preferences and environmental friendliness, such as improved flavor, nutraceutical compounds, and sustainability, have slowly been added to a breeder priority list that already includes traits like productivity, efficiency, and, especially, pest and disease control. Breeders already use molecular genetic tools to improve fruit quality although most advances have been made in producer and industrial quality standards. Furthermore, progress has largely been limited to simple agronomic traits easy-to-observe, whereas the vast majority of quality attributes, specifically those relating to flavor and nutrition, are complex and have mostly been neglected. Fortunately, wild germplasm, which is used for resistance against/tolerance of environmental stresses (including pathogens), is still available and harbors significant genetic variation for taste and health-promoting traits. Similarly, heirloom/traditional varieties could be used to identify which genes contribute to flavor and health quality and, at the same time, serve as a good source of the best alleles for organoleptic quality improvement. Grape (Vitis vinifera L.) and tomato (Solanum lycopersicum L.) produce fleshy, berry-type fruits, among the most consumed in the world. Both have undergone important domestication and selection processes, that have dramatically reduced their genetic variability, and strongly standardized fruit traits. Moreover, more and more consumers are asking for sustainable production, incompatible with the wide range of chemical inputs. In the present paper, we review the genetic resources available to tomato/grape breeders, and the recent technological progresses that facilitate the identification of genes/alleles of interest within the natural or generated variability gene pool. These technologies include omics, high-throughput phenotyping/phenomics, and biotech approaches. Our review also covers a range of technologies used to transfer to tomato and grape those alleles considered of interest for fruit quality. These include traditional breeding, TILLING (Targeting Induced Local Lesions in Genomes), genetic engineering, or NPBT (New Plant Breeding Technologies). Altogether, the combined exploitation of genetic variability and innovative biotechnological tools may facilitate breeders to improve fruit quality tacking more into account the consumer standards and the needs to move forward into more sustainable farming practices. PMID:28553296

Sustainable freight infrastructure to meet climate and air quality goals.

DOT National Transportation Integrated Search

2012-02-01

This report examines the potential for freight modal shift from truck-to-rail in the upper Midwestern U.S. : to improve air quality and reduce CO2 emissions. Two scenarios were generated, one focusing on : intra-regional freight movements within the ...

Soil agroecosystem health: current challenges and future opportunities

USDA-ARS?s Scientific Manuscript database

Soil health is a broad concept that emphasizes the ecological importance of soils, including sustained plant and animal productivity, human health, and environmental quality. In the United States, soil degradation and associated water quality problems have been widely documented. Improvement and mai...

NITRATE AND FECAL COLIFORM CONCENTRATIONS IN SILVOPASTURE AND PASTURE LEACHATES

USDA-ARS?s Scientific Manuscript database

A major limitation to efficient forage-based livestock production in Appalachia is asynchrony of forage availability and quality with nutritional requirements of the grazer. Silvopasture is being studied to improve the seasonal distribution and persistence of high quality herbage, sustainability an...

Soil quality impacts of perennial bioenergy crops on marginally-productive lands

USDA-ARS?s Scientific Manuscript database

Dedicated perennial energy crops grown on marginally-productive croplands can provide a sustainable supply of bioenergy feedstock while improving soil quality and enhancing ecosystem services. Because marginally-productive croplands typically are at higher risk of degradation, growing highly produc...

Crop residue is key for sustaining maximum food production and for conservation of our biosphere

USDA-ARS?s Scientific Manuscript database

Crop residue is key in our efforts to move towards agricultural sustainability. This paper provides a quick overview of some selected references and looks at some of the newest advances related to cover crops. Several authors have described in detail the benefits derived from improving soil quality ...

Smogbusters: Grassroots Action for Clean Air and Sustainable Transport in Australia

ERIC Educational Resources Information Center

Manners, Eric; Wake, David; Carlisle, Rachel

2009-01-01

Smogbusters was a national, community-based, government-funded community education program promoting clean air and sustainable transport in Australia from 1994 to 2002. Smogbusters aimed to improve air quality primarily by raising awareness about motor vehicle transport and its negative impacts on health, the environment and communities, and by…

Biomass Logistics

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

J. Richard Hess; Kevin L. Kenney; William A. Smith

Equipment manufacturers have made rapid improvements in biomass harvesting and handling equipment. These improvements have increased transportation and handling efficiencies due to higher biomass densities and reduced losses. Improvements in grinder efficiencies and capacity have reduced biomass grinding costs. Biomass collection efficiencies (the ratio of biomass collected to the amount available in the field) as high as 75% for crop residues and greater than 90% for perennial energy crops have also been demonstrated. However, as collection rates increase, the fraction of entrained soil in the biomass increases, and high biomass residue removal rates can violate agronomic sustainability limits. Advancements inmore » quantifying multi-factor sustainability limits to increase removal rate as guided by sustainable residue removal plans, and mitigating soil contamination through targeted removal rates based on soil type and residue type/fraction is allowing the use of new high efficiency harvesting equipment and methods. As another consideration, single pass harvesting and other technologies that improve harvesting costs cause biomass storage moisture management challenges, which challenges are further perturbed by annual variability in biomass moisture content. Monitoring, sampling, simulation, and analysis provide basis for moisture, time, and quality relationships in storage, which has allowed the development of moisture tolerant storage systems and best management processes that combine moisture content and time to accommodate baled storage of wet material based upon “shelf-life.” The key to improving biomass supply logistics costs has been developing the associated agronomic sustainability and biomass quality technologies and processes that allow the implementation of equipment engineering solutions.« less

Sustainability Efforts of One Oil Company in Niger Delta of Nigeria

NASA Astrophysics Data System (ADS)

Anosike, Charles Afam

Environmental degradation and socioeconomic dilemma continue to stigmatize oil production in the Niger Delta of Nigeria. Sustainability programs of oil companies often determine the improvement of living conditions in the region. This explanatory qualitative case study, guided by systems thinking theory and sustainable value framework, explored practitioners' perceptions of sustainability programs to identify its impact on business and the host communities. The research question was designed to address how sustainability efforts of a single oil company in the Niger Delta contributed to the business performance and the livelihood of the local people. Research data were gathered from a sample of 20 experienced sustainability practitioners of the oil company, partnering nonprofit organizations, and community leaders through face-to-face semistructured interviews. Data were segmented and categorized. The data analysis process revealed several themes regarding the challenges and shortfalls of sustainability programs in the region. The oil company's understanding of sustainability as programs and projects focused on preserving resources for future generations was not evident in practice. Findings from the study suggested the need for improved inclusiveness of people in driving sustainability projects. Inclusive sustainability should enhance the oil company's contemplation mechanism to ensure eco-saving thinking and processes, which could result in improved quality of life and business performance in the region. The research findings underscore the need for oil multinational corporations (MNCs) to use a business lens in viewing sustainability to achieve sustainable value.

A Cultural Assessment of Tripler Regional Medical Center.

DTIC Science & Technology

1997-05-15

add value to the beneficiaries. The path Tripler Regional Medical Center has chosen to achieve the level of service quality required to sustain or grow...employing TQM management methods. The goals of this training include improvement in management, service quality , and in employee satisfaction, among

A European Sustainable Tourism Labels proposal using a composite indicator

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

Blancas, Francisco Javier, E-mail: fjblaper@upo.es; Lozano-Oyola, Macarena, E-mail: mlozoyo@upo.es; González, Mercedes, E-mail: m_gonzalez@uma.es

The tourism sector in Europe faces important challenges which it must deal with to promote its future development. In this context, the European Commission considers that two key issues must be addressed. On the one hand, a better base of socio-economic knowledge about tourism and its relationship with the environment is needed, and, on the other hand, it is necessary to improve the image of European areas as quality sustainable tourism destinations. In this paper we present analytical tools that cover these needs. Specifically, we define a system of sustainable tourism indicators and we obtain a composite indicator incorporating weightsmore » quantified using a panel of experts. Employing the values of this global indicator as a basis, we define a Sustainable Tourism Country-Brand Ranking which assesses the perception of each country-brand depending on its degree of sustainability, and a system of sustainable tourism labels which reward the management carried out. - Highlights: • We define a system of indicators to improve the knowledge about sustainable tourism. • We obtain composite indicators based on expert knowledge. • The Sustainable Tourism Country-Brand Ranking would improve the image of destinations. • We define a Sustainable Tourism Labels System to assess country-brands. • The conclusions of the empirical analysis can be extrapolated to other tourist areas.« less

Sustainable waste management through end-of-waste criteria development.

PubMed

Zorpas, Antonis A

2016-04-01

The Waste Framework Directive 2000/98 (WFD) contains specific requirements to define end-of-waste criteria (EWC). The main goal of EWC is to remove and eliminate the administrative loads of waste legislation for safe and high-quality waste materials, thereby facilitating and assisting recycling. The target is to produce effective with high quality of recyclables materials, promoting product standardization and quality and safety assurance, and improving harmonization and legal certainty in the recyclable material markets. At the same time, those objectives aim to develop a plan in order to improve the development and wider use of environmental technologies, which reduce pressure on environment and at the same time address the three dimensions of the Lisbon strategy: growth, jobs and environment. This paper presents the importance of EWC, and the approach of setting EWC as EWC affect several management systems as well as sustainable and clean technologies.

Commentary: A call to leadership: the role of the academic medical center in driving sustainable health system improvement through performance measurement.

PubMed

Nedza, Susan M

2009-12-01

As the government attempts to address the high cost of health care in the United States, the issues being confronted include variations in the quality of care administered and the inconsistent application of scientifically proven treatments. To improve quality, methods of measurement and reporting with rewards or, eventually, penalties based on performance, must be developed. To date, well-intentioned national policy initiatives, such as value-based purchasing, have focused primarily on the measurement of discrete events and on attempts to construct incentives. While important, the current approach alone cannot improve quality, ensure equitability, decrease variability, and optimize value. Additional thought-leadership is required, both theoretical and applied. Academic medical centers' (AMCs') scholarly and practical participation is needed. Although quality cannot be sustainably improved without measurement, the existing measures alone do not ensure quality. There is not enough evidence to support strong measure development and, further, not enough insight regarding whether the existing measures have their intended effect of enhancing health care delivery that results in quality outcomes for patients. Perhaps the only way that the United States health care system will achieve a standard of quality care is through the strong embrace, effective engagement, intellectual insights, educational contributions, and practical applications in AMCs. Quality will never be achieved through public policies or national initiatives alone but instead through the commitment of the academic community to forward the science of performance measurement and to ensure that measurement leads to better health outcomes for our nation.

Reducing queues: demand and capacity variations.

PubMed

Eriksson, Henrik; Bergbrant, Ing-Marie; Berrum, Ingela; Mörck, Boel

2011-01-01

The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting-times. Cases were selected according to successful and sustained queue reduction. The approach in this study is action research. Accessibility improved as out-patient waiting lists for two clinics were reduced. The main success was working towards matching demand and capacity. It has been possible to sustain the improvements. Results should be viewed cautiously. Transferring and generalizing outcomes from this study is for readers to consider. However, accessible healthcare may be possible by paying more attention to existing solutions. The study indicates that queue reduction activities should include acquiring knowledge about theories and methods to improve accessibility, finding ways to monitor varying demand and capacity, and to improve patient processing by reducing variations. Accessibility is considered an important dimension when measuring service quality. However, there are few articles on how clinic staff sustain reduces waiting lists. This paper contributes accessible knowledge to the field.

Four simple recommendations to encourage best practices in research software

PubMed Central

Jiménez, Rafael C.; Kuzak, Mateusz; Alhamdoosh, Monther; Barker, Michelle; Batut, Bérénice; Borg, Mikael; Capella-Gutierrez, Salvador; Chue Hong, Neil; Cook, Martin; Corpas, Manuel; Flannery, Madison; Garcia, Leyla; Gelpí, Josep Ll.; Gladman, Simon; Goble, Carole; González Ferreiro, Montserrat; Gonzalez-Beltran, Alejandra; Griffin, Philippa C.; Grüning, Björn; Hagberg, Jonas; Holub, Petr; Hooft, Rob; Ison, Jon; Katz, Daniel S.; Leskošek, Brane; López Gómez, Federico; Oliveira, Luis J.; Mellor, David; Mosbergen, Rowland; Mulder, Nicola; Perez-Riverol, Yasset; Pergl, Robert; Pichler, Horst; Pope, Bernard; Sanz, Ferran; Schneider, Maria V.; Stodden, Victoria; Suchecki, Radosław; Svobodová Vařeková, Radka; Talvik, Harry-Anton; Todorov, Ilian; Treloar, Andrew; Tyagi, Sonika; van Gompel, Maarten; Vaughan, Daniel; Via, Allegra; Wang, Xiaochuan; Watson-Haigh, Nathan S.; Crouch, Steve

2017-01-01

Scientific research relies on computer software, yet software is not always developed following practices that ensure its quality and sustainability. This manuscript does not aim to propose new software development best practices, but rather to provide simple recommendations that encourage the adoption of existing best practices. Software development best practices promote better quality software, and better quality software improves the reproducibility and reusability of research. These recommendations are designed around Open Source values, and provide practical suggestions that contribute to making research software and its source code more discoverable, reusable and transparent. This manuscript is aimed at developers, but also at organisations, projects, journals and funders that can increase the quality and sustainability of research software by encouraging the adoption of these recommendations. PMID:28751965

Four simple recommendations to encourage best practices in research software.

PubMed

Jiménez, Rafael C; Kuzak, Mateusz; Alhamdoosh, Monther; Barker, Michelle; Batut, Bérénice; Borg, Mikael; Capella-Gutierrez, Salvador; Chue Hong, Neil; Cook, Martin; Corpas, Manuel; Flannery, Madison; Garcia, Leyla; Gelpí, Josep Ll; Gladman, Simon; Goble, Carole; González Ferreiro, Montserrat; Gonzalez-Beltran, Alejandra; Griffin, Philippa C; Grüning, Björn; Hagberg, Jonas; Holub, Petr; Hooft, Rob; Ison, Jon; Katz, Daniel S; Leskošek, Brane; López Gómez, Federico; Oliveira, Luis J; Mellor, David; Mosbergen, Rowland; Mulder, Nicola; Perez-Riverol, Yasset; Pergl, Robert; Pichler, Horst; Pope, Bernard; Sanz, Ferran; Schneider, Maria V; Stodden, Victoria; Suchecki, Radosław; Svobodová Vařeková, Radka; Talvik, Harry-Anton; Todorov, Ilian; Treloar, Andrew; Tyagi, Sonika; van Gompel, Maarten; Vaughan, Daniel; Via, Allegra; Wang, Xiaochuan; Watson-Haigh, Nathan S; Crouch, Steve

2017-01-01

Scientific research relies on computer software, yet software is not always developed following practices that ensure its quality and sustainability. This manuscript does not aim to propose new software development best practices, but rather to provide simple recommendations that encourage the adoption of existing best practices. Software development best practices promote better quality software, and better quality software improves the reproducibility and reusability of research. These recommendations are designed around Open Source values, and provide practical suggestions that contribute to making research software and its source code more discoverable, reusable and transparent. This manuscript is aimed at developers, but also at organisations, projects, journals and funders that can increase the quality and sustainability of research software by encouraging the adoption of these recommendations.

Telehealth and Indian healthcare: moving to scale and sustainability.

PubMed

Carroll, Mark; Horton, Mark B

2013-05-01

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

Linking ecology and aesthetics in sustainable agricultural landscapes: Lessons from the Palouse region of Washington, U.S.A

Treesearch

Linda R. Klein; William G. Hendrix; Virginia I. Lohr; Jolie B. Kaytes; Rodney D. Sayler; Mark E. Swanson; William J. Elliot; John P. Reganold

2015-01-01

Inspired by international escalation in agricultural sustainability debates, we explored the promise of landscape-scale conservation buffers to mitigate environmental damage, improve ecological function, and enhance scenic quality. Although the ecological benefits of buffer vegetation are well established by plot- and field-scale research, buffer adoption by farmers is...

Are We Educating Engineers for Sustainability?: Comparison between Obtained Competences and Swedish Industry's Needs

ERIC Educational Resources Information Center

Hanning, Andreas; Abelsson, Anna Priem; Lundqvist, Ulrika; Svanstrom, Magdalena

2012-01-01

Purpose: The aim of this study is to contribute to the quality improvement and long-term strategic development of education for sustainable development (ESD) in engineering education curricula. Design/methodology/approach: The content in 70 courses in environment and SD were characterized and quantified using course document text analysis.…

The Equity Challenge in China's Higher Education Finance Policy

ERIC Educational Resources Information Center

Sun, Fengshou; Barrientos, Armando

2009-01-01

Sustaining China's rapid economic growth in the future will come to depend in large part on the quantity and quality of the human resources it can mobilize. The paper considers the prospects for higher education financing, and highlights the importance of improving equity in access to higher education as a precondition for a sustainable expansion…

Lean management: innovative tools for engaging teams in continuous quality improvement.

PubMed

Perreault, Lucille; Vaillancourt, Lise; Filion, Catherine; Hadj, Camélia

2014-01-01

Lean management has proven to be a sustainable method to ensure a high level of patient care through innovation and teamwork. It involves a set of six tools that allow for visual management shared among team members. The team focuses their efforts on the improvement of organizational indicators in a standardized and engaging way, resulting in the sustainability of improvements. This article outlines the program's rollout at Montfort Hospital (l'Hôpital Montfort). In only a few months, two pilot units accomplished close to 50 improvements each. In addition, the organizational employee satisfaction questionnaire showed very positive results. Copyright © 2014 Longwoods Publishing.

Small steps to health: building sustainable partnerships in pediatric obesity care.

PubMed

Pomietto, Mo; Docter, Alicia Dixon; Van Borkulo, Nicole; Alfonsi, Lorrie; Krieger, James; Liu, Lenna L

2009-06-01

Given the prevalence of childhood obesity and the limited support for preventing and managing obesity in primary care settings, the Seattle Children's Hospital's Children's Obesity Action Team has partnered with Steps to Health King County to develop a pediatric obesity quality-improvement project. Primary care clinics joined year-long quality-improvement collaboratives to integrate obesity prevention and management into the clinic setting by using the chronic-disease model. Sustainability was enhanced through integration at multiple levels by emphasizing small, consistent behavior changes and self-regulation of eating/feeding practices with children, teenagers, and families; building local community partnerships; and encouraging broader advocacy and policy change. Cultural competency and attention to disparities were integrated into quality-improvement efforts. . Participating clinics were able to increase BMI measurement and weight classification; integrate management of overweight/obese children and family and self-management support; and grow community collaborations. Over the course of 4 years, this project grew from a local effort involving 3 clinics to a statewide program recently adopted by the Washington State Department of Health. This model can be used by other states/regions to develop pediatric obesity quality-improvement programs to support the assessment, prevention, and management of childhood obesity. Furthermore, these health care efforts can be integrated into broader community-wide childhood-obesity action plans.

Considerations that will determine if competency-based assessment is a sustainable innovation.

PubMed

Dauphinee, W Dale; Boulet, John R; Norcini, John J

2018-05-18

Educational assessment for the health professions has seen a major attempt to introduce competency based frameworks. As high level policy developments, the changes were intended to improve outcomes by supporting learning and skills development. However, we argue that previous experiences with major innovations in assessment offer an important road map for developing and refining assessment innovations, including careful piloting and analyses of their measurement qualities and impacts. Based on the literature, numerous assessment workshops, personal interactions with potential users, and our 40 years of experience in implementing assessment change, we lament the lack of a coordinated approach to clarify and improve measurement qualities and functionality of competency based assessment (CBA). To address this worrisome situation, we offer two roadmaps to guide CBA's further development. Initially, reframe and address CBA as a measurement development opportunity. Secondly, using a roadmap adapted from the management literature on sustainable innovation, the medical assessment community needs to initiate an integrated plan to implement CBA as a sustainable innovation within existing educational programs and self-regulatory enterprises. Further examples of down-stream opportunities to refocus CBA at the implementation level within faculties and within the regulatory framework of the profession are offered. In closing, we challenge the broader assessment community in medicine to step forward and own the challenge and opportunities to reframe CBA as an innovation to improve the quality of the clinical educational experience. The goal is to optimize assessment in health education and ultimately improve the public's health.

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

PubMed

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

2006-01-01

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

Triple Aim in Canada: developing capacity to lead to better health, care and cost

PubMed Central

Farmanova, Elina; Kirvan, Christine; Verma, Jennifer; Mukerji, Geetha; Akunov, Nurdin; Phillips, Kaye; Samis, Stephen

2016-01-01

Abstract Quality problem Many modern health systems strive for ‘Triple Aim’ (TA)—better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not. Initial assessment Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems. Choice of solution To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community. Implementation Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale. Evaluation A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI. Lessons learned Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector. PMID:28423164

Triple Aim in Canada: developing capacity to lead to better health, care and cost.

PubMed

Farmanova, Elina; Kirvan, Christine; Verma, Jennifer; Mukerji, Geetha; Akunov, Nurdin; Phillips, Kaye; Samis, Stephen

2016-12-01

Many modern health systems strive for 'Triple Aim' (TA)-better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not. Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems. To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community. Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale. A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI. Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Impact of telemonitoring approaches on integrated HIV and TB diagnosis and treatment interventions in sub-Saharan Africa: a scoping review.

PubMed

Yah, Clarence S; Tambo, Ernest; Khayeka-Wandabwa, Christopher; Ngogang, Jeanne Y

2017-01-01

Background: This paper explores telemonitoring/mhealth approaches as a promising real time and contextual strategy in overhauling HIV and TB interventions quality access and uptake, retention,adherence and coverage impact in endemic and prone-epidemic prevention and control in sub-Sahara Africa. Methods: The scoping review method was applied in acknowledged journals indexing platforms including Medline, Embase, Global Health, PubMed, MeSH PsycInfo, Scopus and Google Scholar to identify relevant articles pertaining to telemonitoring as a proxy surrogate method in reinforcing sustainability of HIV/TB prevention/treatment interventions in sub-Saharan Africa. Full papers were assessed and those selected that fosters evidence on telemonitoring/mhealth diagnosis, treatment approaches and strategies in HIV and TB prevention and control were synthesized and analyzed. Results: We found telemonitoring/mhealth approach as a more efficient and sustained proxy in HIV and TB risk reduction strategies for early diagnosis and prompt quality clinical outcomes. It can significantly contribute to decreasing health systems/patients cost, long waiting time in clinics, hospital visits, travels and time off/on from work. Improved integrated HIV and TB telemonitoring systems sustainability hold great promise in health systems strengthening including patient centered early diagnosis and care delivery systems, uptake and retention to medications/services and improving patients' survival and quality of life. Conclusion: Telemonitoring/mhealth (electronic phone text/video/materials messaging)acceptability, access and uptake are crucial in monitoring and improving uptake, retention,adherence and coverage in both local and national integrated HIV and TB programs and interventions. Moreover, telemonitoring is crucial in patient-providers-health professional partnership, real-time quality care and service delivery, antiretroviral and anti-tuberculous drugs improvement, susceptibility monitoring and prescription choice, reinforcing cost effective HIV and TB integrated therapy model and survival rate.

A New Alliance: Continuous Quality and Classroom Effectiveness. ASHE-ERIC Higher Education Report No. 6.

ERIC Educational Resources Information Center

Wolverton, Mimi

This report presents seven case studies and discusses the role of continuous quality improvement (CQI) in college classroom effectiveness efforts, particularly specific institutions where sustained CQI programs have affected college classroom practice, their common features, and lingering doubts about CQI. An introduction discusses general…

Implementing Innovations in Global Women's, Children's, and Adolescents' Health: Realizing the Potential for Implementation Science.

PubMed

Peterson, Herbert B; Haidar, Joumana; Fixsen, Dean; Ramaswamy, Rohit; Weiner, Bryan J; Leatherman, Sheila

2018-03-01

The launch of the United Nations Sustainable Development Goals and the new Secretary General's Global Strategy for Women's, Children's, and Adolescents' Health are a window of opportunity for improving the health and well-being of women, children, and adolescents in the United States and around the world. Realizing the full potential of this historic moment will require that we improve our ability to successfully implement life-saving and life-enhancing innovations, particularly in low-resource settings. Implementation science, a new and rapidly evolving field that addresses the "how-to" component of providing sustainable quality services at scale, can make an important contribution on this front. A synthesis of the implementation science evidence indicates that three interrelated factors are required for successful, sustainable outcomes at scale: 1) effective innovations, 2) effective implementation, and 3) enabling contexts. Implementation science addresses the interaction among these factors to help make innovations more usable, to build ongoing capacity to assure the effective implementation of these innovations, and to ensure enabling contexts to sustain their full and effective use in practice. Improving access to quality services will require transforming health care systems and, therefore, much of the focus of implementation science in global health is on improving the ability of health systems to serve as enabling contexts. The field of implementation science is inherently interdisciplinary and academe will need to respond by facilitating collaboration among scientists from relevant disciplines, including evaluation, improvement, and systems sciences. Platforms and programs to facilitate collaborations among researchers, practitioners, policymakers, and funders are likewise essential.

Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial.

PubMed

Kutner, Jean S; Smith, Marlaine C; Corbin, Lisa; Hemphill, Linnea; Benton, Kathryn; Mellis, B Karen; Beaty, Brenda; Felton, Sue; Yamashita, Traci E; Bryant, Lucinda L; Fairclough, Diane L

2008-09-16

Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms. To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer. Multisite, randomized clinical trial. Population-based Palliative Care Research Network. 380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice. Six 30-minute massage or simple-touch sessions over 2 weeks. Primary outcomes were immediate (Memorial Pain Assessment Card, 0- to 10-point scale) and sustained (Brief Pain Inventory [BPI], 0- to 10-point scale) change in pain. Secondary outcomes were immediate change in mood (Memorial Pain Assessment Card) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, 0- to 10-point scale), symptom distress (Memorial Symptom Assessment Scale, 0- to 4-point scale), and analgesic medication use (parenteral morphine equivalents [mg/d]). Immediate outcomes were obtained just before and after each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks. 298 persons were included in the immediate outcome analysis and 348 in the sustained outcome analysis. A total of 82 persons did not receive any allocated study treatments (37 massage patients, 45 control participants). Both groups demonstrated immediate improvement in pain (massage, -1.87 points [95% CI, -2.07 to -1.67 points]; control, -0.97 point [CI, -1.18 to -0.76 points]) and mood (massage, 1.58 points [CI, 1.40 to 1.76 points]; control, 0.97 point [CI, 0.78 to 1.16 points]). Massage was superior for both immediate pain and mood (mean difference, 0.90 and 0.61 points, respectively; P < 0.001). No between-group mean differences occurred over time in sustained pain (BPI mean pain, 0.07 point [CI, -0.23 to 0.37 points]; BPI worst pain, -0.14 point [CI, -0.59 to 0.31 points]), quality of life (McGill Quality of Life Questionnaire overall, 0.08 point [CI, -0.37 to 0.53 points]), symptom distress (Memorial Symptom Assessment Scale global distress index, -0.002 point [CI, -0.12 to 0.12 points]), or analgesic medication use (parenteral morphine equivalents, -0.10 mg/d [CI, -0.25 to 0.05 mg/d]). The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group. Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.

Social sustainability in healthcare facilities: a rating tool for analysing and improving social aspects in environments of care.

PubMed

Capolongo, Stefano; Gola, Marco; di Noia, Michela; Nickolova, Maria; Nachiero, Dario; Rebecchi, Andrea; Settimo, Gaetano; Vittori, Gail; Buffoli, Maddalena

2016-01-01

Nowadays several rating systems exist for the evaluation of the sustainability of buildings, but often their focus is limited to environmental and efficiency aspects. Hospitals are complex constructions in which many variables affect hospital processes. Therefore, a research group has developed a tool for the evaluation of sustainability in healthcare facilities. The paper analyses social sustainability issues through a tool which evaluates users' perception from a the quality and well-being perspective. It presents a hierarchical structure composed of a criteria and indicators system which is organised through a weighing system calculated by using the Analytic Network Process. The output is the definition of a tool which evaluates how Humanisation, Comfort and Distribution criteria can affect the social sustainability of a building. Starting from its application, it is evident that the instrument enables the improvement of healthcare facilities through several design and organisational suggestions for achieving healing and sustainable architectures.

Tablet Nuff but Life Still Rough: Technology for Early Childhood Sustainable Development in Jamaica

ERIC Educational Resources Information Center

Kelly-Williams, Suzette; Berson, Ilene R.; Berson, Michael J.

2017-01-01

Early childhood education has a role to play in constructing a sustainable society. In particular, increasing global attention has focused on how early childhood may help alleviate poverty among children and their families and promote economic growth. Part of this discourse involves the use of technology as a means to improve the quality of early…

Life-Cycle Thinking in Inquiry-Based Sustainability Education--Effects on Students' Attitudes towards Chemistry and Environmental Literacy

ERIC Educational Resources Information Center

Juntunen, Marianne; Aksela, Maija

2013-01-01

The aim of the present study is to improve the quality of students' environmental literacy and sustainability education in chemistry teaching by combining the socio-scientific issue of life-cycle thinking with inquiry-based learning approaches. This case study presents results from an inquiry-based life-cycle thinking project: an interdisciplinary…

Linking Environmental Sustainability, Health, and Safety Data in Health Care: A Research Roadmap.

PubMed

Kaplan, Susan B; Forst, Linda

2017-08-01

Limited but growing evidence demonstrates that environmental sustainability in the health-care sector can improve worker and patient health and safety. Yet these connections are not appreciated or understood by decision makers in health-care organizations or oversight agencies. Several studies demonstrate improvements in quality of care, staff satisfaction, and work productivity related to environmental improvements in the health-care sector. A pilot study conducted by the authors found that already-collected data could be used to evaluate impacts of environmental sustainability initiatives on worker and patient health and safety, yet few hospitals do so. Future research should include a policy analysis of laws that could drive efforts to integrate these areas, elucidation of organizational models that promote sharing of environmental and health and safety data, and development of tools and methods to enable systematic linkage and evaluation of these data to expand the evidence base and improve the hospital environment.

Using Lean Six Sigma Methodology to Improve Quality of the Anesthesia Supply Chain in a Pediatric Hospital.

PubMed

Roberts, Renée J; Wilson, Ashley E; Quezado, Zenaide

2017-03-01

Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign). We showed improvement in the metrics after those interventions were implemented, and those improvements were sustained and thus controlled 1 year after implementation.

Annual Reports

EPA Pesticide Factsheets

tools,data, and models that are: improving air quality; helping communities become more resilient; reducing emissions of carbon and other pollutants; ushering in new generations of safer, more sustainable chemicals, advancing safe drinking water resources

A slow fashion design model for bluejeans using house of quality approach

NASA Astrophysics Data System (ADS)

Nergis, B.; Candan, C.; Sarısaltık, S.; Seneloglu, N.; Bozuk, R.; Amzayev, K.

2017-10-01

The purpose of this study was to develop a slow fashion design model using the house of quality model (HOQ) to provide fashion designers a tool to improve the overall sustainability of denim jeans for Y generation consumers in Turkish market. In doing so, a survey was conducted to collect data on the design & performance expectations as well as the perception of slow fashion in design process of denim jeans of the targeted consumer group. The results showed that Y generation in the market gave the most importance to the sustainable production techniques when identifying slow fashion.

An Interactive Strategy for Solving Multi-Criteria Decision Making of Sustainable Land Revitalization Planning Problem

NASA Astrophysics Data System (ADS)

Mayasari, Ruth; Mawengkang, Herman; Gomar Purba, Ronal

2018-02-01

Land revitalization refers to comprehensive renovation of farmland, waterways, roads, forest or villages to improve the quality of plantation, raise the productivity of the plantation area and improve agricultural production conditions and the environment. The objective of sustainable land revitalization planning is to facilitate environmentally, socially, and economically viable land use. Therefore it is reasonable to use participatory approach to fullfil the plan. This paper addresses a multicriteria decision aid to model such planning problem, then we develop an interactive approach for solving the problem.

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

NASA Astrophysics Data System (ADS)

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

2018-06-01

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

Using Quality Enhancement Processes to Achieve Sustainable Development and Support for Sessional Staff

ERIC Educational Resources Information Center

Lekkas, D.; Winning, T. A.

2017-01-01

Consistent with quality enhancement, we report on how we used a continuous improvement cycle to formalise and embed an academic development and support programme for our School's sessional staff. Key factors in establishing and maintaining the programme included: local change agents supported initially by institutional project funding; School…

Green Infrastructure

EPA Pesticide Factsheets

To promote the benefits of green infrastructure, help communities overcome barriers to using GI, and encourage the use of GI to create sustainable and resilient water infrastructure that improves water quality and supports and revitalizes communities.

External Technical Support for School Improvement: Critical Issues from the Chilean Experience

ERIC Educational Resources Information Center

Osses, Alejandra; Bellei, Cristián; Valenzuela, Juan Pablo

2015-01-01

To what extent school improvement processes can be initiated and sustained from the outside has been a relevant question for policy-makers seeking to increase quality in education. Since 2008, the Chilean Government is strongly promoting the use of external technical support (ETS) services to support school improvement processes, as part of the…

Improving performance on core processes of care.

PubMed

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

NASA Excellence Award for Quality and Productivity 1989 highlights. The 1989 recipient: Lockheed Engineering and Sciences Company

NASA Technical Reports Server (NTRS)

1990-01-01

The NASA Excellence Award for Productivity and Quality is the result of NASA's desire to encourage superior quality and the continuous improvement philosophy in the aerospace industry. It is awarded to NASA contractors, subcontractors, and suppliers who have demonstrated sustained excellence, customer orientation, and outstanding achievements in a total quality management (TQM) environment. The 'highlights' booklet is intended to transfer successful techniques demonstrated by the performance and quality of major NASA contractors.

Species Composition, Tree Quality and Wood Properties of Southern Pine Stands Under Ecosystemm Management on National Forests in the Peidmont and Coastal Plain

Treesearch

Alexander Clark; James W. McMinn

1999-01-01

National Forests in the United States are under sustainable ecosystem management to conserve biodiversity, achieve sustainable conditions and improve the balance among forest values. This paper reports on a study established to identify the implications of ecosystem management strategies on natural stands in the Piedmont and Coastal Plain. The impact of partial...

Municipal Technical Assistance Program: An EPA/ME DEP ...

EPA Pesticide Factsheets

2018-06-01

The Urban Environmental Program's mission is to improve the environment and enhance the quality of life for urban residents throughout New England by building community capacity to assess and resolve environmental problems, achieving measurable and sustainable improvements in urban communities, and restoring and revitalizing neighborhoods for urban residents.

Urban Environmental Program in New England | US EPA

EPA Pesticide Factsheets

2017-04-10

The Urban Environmental Program's mission is to improve the environment and enhance the quality of life for urban residents throughout New England by building community capacity to assess and resolve environmental problems, achieving measurable and sustainable improvements in urban communities, and restoring and revitalizing neighborhoods for urban residents.

How the SmartWay Partnership Works

EPA Pesticide Factsheets

This page describes how the SmartWay program and the SmartWay Transport Partnership work for carriers, shippers, and logistics companies to track air quality, reduce fuel consumption, improve freight supply chain sustainability.

Applying PCI in Combination Swivel Head Wrench

NASA Astrophysics Data System (ADS)

Chen, Tsang-Chiang; Yang, Chun-Ming; Hsu, Chang-Hsien; Hung, Hsiang-Wen

2017-09-01

Taiwan’s traditional industries are subject to competition in the era of globalization and environmental change, the industry is facing economic pressure and shock, and now sustainable business can only continue to improve production efficiency and quality of technology, in order to stabilize the market, to obtain high occupancy. The use of process capability indices to monitor the quality of the ratchet wrench to find the key function of the dual-use ratchet wrench, the actual measurement data, The use of process capability Cpk index analysis, and draw Process Capability Analysis Chart model. Finally, this study explores the current situation of this case and proposes a lack of improvement and improvement methods to improve the overall quality and thereby enhance the overall industry.

The effects of gardening on quality of life in people with stroke.

PubMed

Ho, Sui-Hua; Lin, Chiuhsiang Joe; Kuo, Fen-Ling

2016-06-27

Compared with traditional rehabilitation, gardening has been viewed as a more occupation-based intervention to help patients improve functional performance. However, there is still a need for evidence-based research into what factors interact to create the beneficial effects of gardening for people who have sustained a cerebral vascular accident (CVA). To explore how plant, gender, and the time after stroke onset influenced improvements in the quality of life of patients in a gardening program. One treatment of tending short-term plants, and another treatment of tending long-term plants were compared. Quality of life improvement was evaluated according to three factors: plant, gender, and the time after stroke onset. The data were analyzed with 2k replicated factorial designs. The 2k factorial design with replication indicated significant effects on both the social role and the family role. For the social role, the interaction of plant and gender difference was significant. For the family role, the significant effects were found on interaction of plant with both gender and the time after stroke onset. Tending plants with different life cycles has varied effects on the quality of life of people who have sustained a CVA. Factors related to gender and the time after stroke onset influenced role competency in this sample.

Innovative Competencies of Mining engineers in Transition to the Sustainable Development

NASA Astrophysics Data System (ADS)

Krechetov, Andrey; Khoreshok, Alexey; Blumenstein, Valery

2017-11-01

The transition to the sustainable development posed new challenges to the system of mining higher education. They are determined by the acceleration of scientific and technological progress and widespread introduction of innovations, convergence of technologies from various industries. On the one hand, globalization and rapid technology development are constantly increasing quality requirements for the labor resources of the mineral and raw materials complex and constant improvement of their skills. On the other hand, the transition to the sustainable development provides the necessity for rational use of raw materials and environmental protection. This requires the improvement of staff support system for mining operations and the interaction of enterprises with universities training mining engineers, aimed at the innovative competencies development of future miners.

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

PubMed

Ellis, Beverley

2011-01-01

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

Innovation sustainability in challenging health-care contexts: embedding clinically led change in routine practice

PubMed Central

Martin, Graham P; Weaver, Simon; Currie, Graeme; Finn, Rachael; McDonald, Ruth

2012-01-01

The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities. PMID:23554445

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

PubMed

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

2015-07-01

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

Testing the Community-Based Learning Collaborative (CBLC) implementation model: a study protocol.

PubMed

Hanson, Rochelle F; Schoenwald, Sonja; Saunders, Benjamin E; Chapman, Jason; Palinkas, Lawrence A; Moreland, Angela D; Dopp, Alex

2016-01-01

High rates of youth exposure to violence, either through direct victimization or witnessing, result in significant health/mental health consequences and high associated lifetime costs. Evidence-based treatments (EBTs), such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), can prevent and/or reduce these negative effects, yet these treatments are not standard practice for therapists working with children identified by child welfare or mental health systems as needing services. While research indicates that collaboration among child welfare and mental health services sectors improves availability and sustainment of EBTs for children, few implementation strategies designed specifically to promote and sustain inter-professional collaboration (IC) and inter-organizational relationships (IOR) have undergone empirical investigation. A potential candidate for evaluation is the Community-Based Learning Collaborative (CBLC) implementation model, an adaptation of the Learning Collaborative which includes strategies designed to develop and strengthen inter-professional relationships between brokers and providers of mental health services to promote IC and IOR and achieve sustained implementation of EBTs for children within a community. This non-experimental, mixed methods study involves two phases: (1) analysis of existing prospective quantitative and qualitative quality improvement and project evaluation data collected pre and post, weekly, and monthly from 998 participants in one of seven CBLCs conducted as part of a statewide initiative; and (2) Phase 2 collection of new quantitative and qualitative (key informant interviews) data during the funded study period to evaluate changes in relations among IC, IOR, social networks and the penetration and sustainment of TF-CBT in targeted communities. Recruitment for Phase 2 is from the pool of 998 CBLC participants to achieve a targeted enrollment of n = 150. Study aims include: (1) Use existing quality improvement (weekly/monthly online surveys; pre-post surveys; interviews) and newly collected quantitative (monthly surveys) and qualitative (key informant interviews) data and social network analysis to test whether CBLC strategies are associated with penetration and sustainment of TF-CBT; and (2) Use existing quantitative quality improvement (weekly/monthly on-line surveys; pre/post surveys) and newly collected qualitative (key informant interviews) data and social network analysis to test whether CBLC strategies are associated with increased IOR and IC intensity. The proposed research leverages an on-going, statewide implementation initiative to generate evidence about implementation strategies needed to make trauma-focused EBTs more accessible to children. This study also provides feasibility data to inform an effectiveness trial that will utilize a time-series design to rigorously evaluate the CBLC model as a mechanism to improve access and sustained use of EBTs for children.

Farmer Heroes Manage Nutrients On Farm

EPA Pesticide Factsheets

These featured farmers have been identified by the National Association of Conservation Districts and EPA for implementing specific best management practices to reduce pollution while also improving or sustaining their profits, soil quality or yields.

Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program.

PubMed

Lutz, Mark F; Haines, Stuart T; Lesch, Christine A; Szumita, Paul M

2016-10-01

Results of the MENTORED QUALITY IMPROVEMENT IMPACT PROGRAM℠ (MQIIP) on Ensuring Insulin Pen Safety in Hospitals, which was part of an ASHP educational initiative aimed at ensuring the safe use of insulin pens in hospitals, are described. During this ASHP initiative, which also included continuing-education activities and Web-based resources, distance mentoring by pharmacists with expertise in the safe use of insulin pens was provided to interprofessional teams at 14 hospitals between September 2014 and May 2015. The results of baseline assessments of nursing staff knowledge of insulin pen use, insulin pen storage and labeling audits, and insulin pen injection observations conducted in September and October 2014 were the basis for insulin pen quality-improvement plans. Postintervention data were collected in April and May 2015. Compared with the baseline period, significant improvements in nurses' knowledge of insulin pen use, insulin pen labeling and storage, and insulin pen administration were observed in the postintervention period despite the relatively short time frame for implementation of quality-improvement plans. Program participants are committed to sustaining and building on improvements achieved during the program. The outcome measures described in this report could be adapted by other health systems to identify opportunities to improve the safety of insulin pen use. Focused attention on insulin pen safety through an interprofessional team approach during the MQIIP enabled participating sites to detect potential safety issues based on collected data, develop targeted process changes, document improvements, and identify areas requiring further intervention. A sustained organizational commitment is required to ensure the safe use of insulin pen devices in hospitals. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Using Economic Evaluation to Illustrate Value of Care for Improving Patient Safety and Quality: Choosing the Right Method.

PubMed

Padula, William V; Lee, Ken K H; Pronovost, Peter J

2017-08-03

To scale and sustain successful quality improvement (QI) interventions, it is recommended for health system leaders to calculate the economic and financial sustainability of the intervention. Many methods of economic evaluation exist, and the type of method depends on the audience: providers, researchers, and hospital executives. This is a primer to introduce cost-effectiveness analysis, budget impact analysis, and return on investment calculation as 3 distinct methods for each stakeholder needing a measurement of the value of QI at the health system level. Using cases for the QI of hospital-acquired condition rates (e.g., pressure injuries), this primer proceeds stepwise through each method beginning from the same starting point of constructing a model so that the repetition of steps is minimized and thereby capturing the attention of all intended audiences.

Quality-based financial incentives in health care: can we improve quality by paying for it?

PubMed

Conrad, Douglas A; Perry, Lisa

2009-01-01

This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.

Improving visit cycle time using patient flow analysis in a high-volume inner-city hospital-based ambulatory clinic serving minority New Yorkers.

PubMed

Dhar, Sanjay; Michel, Raquel; Kanna, Balavenkatesh

2011-01-01

Patient waiting time and waiting room congestion are quality indicators that are related to efficiency of ambulatory care systems and patient satisfaction. Our main purpose was to test a program to decrease patient visit cycle time, while maintaining high-quality healthcare in a high-volume inner-city hospital-based clinic in New York City. Use of patient flow analysis and the creation of patient care teams proved useful in identifying areas for improvement, target, and measure effectiveness of interventions. The end result is reduced visit cycle time, improved provider team performance, and sustained patient care outcomes. © 2010 National Association for Healthcare Quality.

Capacity and readiness for quality improvement among home and community-based service providers.

PubMed

Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

2016-01-01

The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

Pain Assessment and Management After a Knowledge Translation Booster Intervention.

PubMed

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Barwick, Melanie; Pinard, Marie

2016-10-01

Inadequate pain treatment leaves hospitalized children vulnerable to immediate and long-term sequelae. A multidimensional knowledge translation intervention (ie, the Evidence-based Practice for Improving Quality [EPIQ]) improved pain assessment, management, and intensity outcomes in 16 units at 8 Canadian pediatric hospitals. The sustained effectiveness of EPIQ over time is unknown, however. The goals of this study were to determine the following: (1) sustainability of the impact of EPIQ on pain assessment, management, and intensity outcomes 12, 24, and 36 months after EPIQ; (2) effectiveness of a pain practice change booster (Booster) intervention to sustain EPIQ outcomes over time; and (3) influence of context on sustainability. A prospective, repeated measures, cluster randomized controlled trial was undertaken in the 16 EPIQ units, 12 months after EPIQ completion, to determine the effectiveness of a practice change booster (Booster) to sustain EPIQ outcomes. Generalized estimating equation models examined outcomes controlling for child and unit contextual factors. Outcomes achieved during EPIQ were sustained in the use of any pain assessment measure (P = .01) and a validated pain assessment measure in the EPIQ units (P = .02) up to 36 months after EPIQ. Statistically significant improvements in pain management practices persisted in EPIQ units; results varied across time. There were no significant differences in outcomes after implementation of the Booster between the Booster and Nonbooster groups. Improved pain assessment and management practices were sustained after EPIQ; however, the Booster did not seem to provide additional impact. Copyright © 2016 by the American Academy of Pediatrics.

Land-based production of animal protein: impacts, efficiency, and sustainability.

PubMed

Wu, Guoyao; Bazer, Fuller W; Cross, H Russell

2014-11-01

Land-based production of high-quality protein by livestock and poultry plays an important role in improving human nutrition, growth, and health, as well as economical and social developments worldwide. With exponential growth of the global population and marked rises in meat consumption per capita, demands for animal-source protein are expected to increase by 72% between 2013 and 2050. This raises concerns about the sustainability and environmental impacts of animal agriculture. An attractive solution to meeting the increasing needs for animal products and mitigating undesired effects of agricultural practices is to enhance the efficiency of animal growth, reproduction, and lactation. Breeding techniques may help achieve this goal, but have only met with limited success. A promising, mechanism-based approach is to optimize the proportion and amounts of amino acids in diets for maximizing whole-body protein synthesis and feed efficiency. Improvements in farm animal productivity will not only decrease the contamination of soils, groundwater, and air by excessive manure, but will also help sustain animal agriculture to produce high-quality protein for the expanding population in the face of diminishing resources. © 2014 New York Academy of Sciences.

Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability.

PubMed

Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H

2016-07-01

Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol.

PubMed

Robert, Glenn B; Anderson, Janet E; Burnett, Susan J; Aase, Karina; Andersson-Gare, Boel; Bal, Roland; Calltorp, Johan; Nunes, Francisco; Weggelaar, Anne-Marie; Vincent, Charles A; Fulop, Naomi J

2011-10-26

although there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-to-day implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients. in-depth multi-level (macro, meso and micro-system) analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features: • a working definition of quality comprising three components: clinical effectiveness, patient safety and patient experience • a conceptualisation of quality as a human, social, technical and organisational accomplishment • an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy makers in the European Union. Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims). the protocol is based on the premise that future research, policy and practice need to address the sociology of improvement in equal measure to the science and technique of improvement, or at least expand the discipline of improvement to include these critical organisational and cultural processes. We define the 'organisational and cultural characteristics associated with better quality of care' in a broad sense that encompasses all the features of a hospital that might be hypothesised to impact upon clinical effectiveness, patient safety and/or patient experience.

Lime and phosphogypsum impacts on soil organic matter pools in a tropical Oxisol under long-term no-till conditions

USDA-ARS?s Scientific Manuscript database

Improving soil organic matter (SOM) quality in tropical acid soils is important for increasing the sustainability of agricultural ecosystems. This research evaluated the effect of the surface application of lime and phosphogypsum on the quality and amount of SOM in a long-term crop rotation under no...

The transition of a large-scale quality improvement initiative: a bibliometric analysis of the Productive Ward: Releasing Time to Care programme.

PubMed

White, Mark; Wells, John S G; Butterworth, Tony

2014-09-01

To examine the literature related to a large-scale quality improvement initiative, the 'Productive Ward: Releasing Time to Care', providing a bibliometric profile that tracks the level of interest and scale of roll-out and adoption, discussing the implications for sustainability. Productive Ward: Releasing Time to Care (aka Productive Ward) is probably one of the most ambitious quality improvement efforts engaged by the UK-NHS. Politically and financially supported, its main driver was the NHS Institute for Innovation and Improvement. The NHS institute closed in early 2013 leaving a void of resources, knowledge and expertise. UK roll-out of the initiative is well established and has arguably peaked. International interest in the initiative however continues to develop. A comprehensive literature review was undertaken to identify the literature related to the Productive Ward and its implementation (January 2006-June 2013). A bibliometric analysis examined/reviewed the trends and identified/measured interest, spread and uptake. Overall distribution patterns identify a declining trend of interest, with reduced numbers of grey literature and evaluation publications. However, detailed examination of the data shows no reduction in peer-reviewed outputs. There is some evidence that international uptake of the initiative continues to generate publications and create interest. Sustaining this initiative in the UK will require re-energising, a new focus and financing. The transition period created by the closure of its creator may well contribute to further reduced levels of interest and publication outputs in the UK. However, international implementation, evaluation and associated publications could serve to attract professional/academic interest in this well-established, positively reported, quality improvement initiative. This paper provides nurses and ward teams involved in quality improvement programmes with a detailed, current-state, examination and analysis of the Productive Ward literature, highlighting the bibliometric patterns of this large-scale, international, quality improvement programme. It serves to disseminate updated publication information to those in clinical practice who are involved in Productive Ward or a similar quality improvement initiative. © 2014 John Wiley & Sons Ltd.

Saline sewage treatment and source separation of urine for more sustainable urban water management.

PubMed

Ekama, G A; Wilsenach, J A; Chen, G H

2011-01-01

While energy consumption and its associated carbon emission should be minimized in wastewater treatment, it has a much lower priority than human and environmental health, which are both closely related to efficient water quality management. So conservation of surface water quality and quantity are more important for sustainable development than green house gas (GHG) emissions per se. In this paper, two urban water management strategies to conserve fresh water quality and quantity are considered: (1) source separation of urine for improved water quality and (2) saline (e.g. sea) water toilet flushing for reduced fresh water consumption in coastal and mining cities. The former holds promise for simpler and shorter sludge age activated sludge wastewater treatment plants (no nitrification and denitrification), nutrient (Mg, K, P) recovery and improved effluent quality (reduced endocrine disruptor and environmental oestrogen concentrations) and the latter for significantly reduced fresh water consumption, sludge production and oxygen demand (through using anaerobic bioprocesses) and hence energy consumption. Combining source separation of urine and saline water toilet flushing can reduce sewer crown corrosion and reduce effluent P concentrations. To realize the advantages of these two approaches will require significant urban water management changes in that both need dual (fresh and saline) water distribution and (yellow and grey/brown) wastewater collection systems. While considerable work is still required to evaluate these new approaches and quantify their advantages and disadvantages, it would appear that the investment for dual water distribution and wastewater collection systems may be worth making to unlock their benefits for more sustainable urban development.

Improving Employees' Safety Awareness in Healthcare Organizations Using the DMAIC Quality Improvement Approach.

PubMed

Momani, Amer; Hirzallah, Muʼath; Mumani, Ahmad

Occupational injuries and illnesses in healthcare can cause great human suffering, incur high cost, and have an adverse impact on the quality of patient care. One of the most effective solutions for addressing health and safety issues and improving decisions at the point of care rests in raising employees' safety awareness to recognize, avoid, or respond to potential problems before they arise. In this article, the DMAIC Six Sigma model (Define, Measure, Analyze, Improve, Control) is used as a systematic program to measure, improve, and sustain employees' safety awareness in healthcare organizations. We report on a case study using the model, which was implemented and validated at a local hospital. First, the occupational health and safety knowledge that each job requires was identified. Next, the degree of competence of jobholders to meet these requirements was assessed. Based on the assessment, different awareness-raising efforts were proposed and implemented. The results showed significant improvement in the overall safety awareness compliance assessed: from 74.2% to 84.4% (p < .001) after the intervention. The proposed model ensures that the organization's awareness-raising efforts serve its actual needs and produce optimized and sustained results that eventually lead to safer healthcare service.

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

PubMed

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

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

The financial performance of labor and delivery units.

PubMed

von Gruenigen, Vivian E; Powell, Diane M; Sorboro, Susan; McCarroll, Michelle L; Kim, Unhee

2013-07-01

Hospitals and health care systems are already seeing the effect of health care reform with declining dollars. Hospital services, which had narrow financial margins in the past, will have further challenges. This article will review definitions, challenges, and potential financial solutions for labor and delivery units. Improving quality, efficiency, and cost requires substantial physician cooperation in the changing paradigm from physician-centric care to the transparent safety of teams. The financial contribution margin should increase the net revenue, but significant volumes are also needed. The challenge of this model for obstetrics is the slowing birth rate with the ultimate limitation for growth. Therefore, cost containment is imperative for sustainability. Standardization of hospital policies and procedures can improve quality and cost-savings with new incentive models. Examples include decreasing expensive pharmaceuticals, minimizing elective inductions of labor, and encouraging breast-feeding. As providers of health care to women, we all must engage in the triple aim of (1) improving the experience of care, (2) improving the health of populations, and (3) reducing per capita costs of health care. Although accountable care organizations presently are focused on Medicare populations for cost containment, all health care providers and institutions must be vigilant on both quality cost-effective care for sustainability, especially in obstetrics. Copyright © 2013 Mosby, Inc. All rights reserved.

Lean thinking in emergency departments: concepts and tools for quality improvement.

PubMed

Bruno, Frances

2017-10-12

The lean approach is a viable framework for reducing costs and enhancing the quality of patient care in emergency departments (EDs). Reports on lean-inspired quality improvement initiatives are rapidly growing but there is little emphasis on the philosophy behind the processes, which is the essential ingredient in sustaining transformation. This article describes lean philosophy, also referred to as lean, lean thinking and lean healthcare, and its main concepts, to enrich the knowledge and vocabulary of nurses involved or interested in quality improvement in EDs. The article includes examples of lean strategies to illustrate their practical application in EDs. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

The Coaching on Lifestyle (CooL) Intervention for Overweight and Obesity: A Longitudinal Study into Participants’ Lifestyle Changes

PubMed Central

Gerards, Sanne; Rutten, Geert; Philippens, Nicole; Janssen, Ester; Winkens, Bjorn; van de Goor, Ien; Kremers, Stef

2018-01-01

Combined lifestyle interventions (CLIs) can be effective in reducing weight and improving lifestyle-related behaviours but it is unclear how CLIs can best be implemented in practice in order to achieve sustained lifestyle changes. The Coaching on Lifestyle programme (CooL) is a CLI in the Netherlands, in which professional lifestyle coaches counsel adults and children (and/or their parents) who are obese or at high risk of obesity to achieve a sustained healthier lifestyle. The CooL intervention consists of group and individual sessions addressing the topics of physical activity, dietary behaviours, sleep and stress. Our longitudinal one-group pre-post study aimed to identify lifestyle changes among participants (adults, children and their parents) at 8 and 18 months after initiation. We assessed constructs ranging from motivation and behaviour-specific cognitions to behaviours and health outcomes. Positive and sustained changes among adults were found regarding perceived autonomy, motivation, perceived barriers, lifestyle behaviours, quality of life and weight. Among children and their parents, few improvements were found regarding behaviours and quality of life. CooL has been successful in coaching adult participants towards sustained behavioural change during the intervention period. Mixed results and smaller effect sizes were found for children and their parents. PMID:29617337

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

PubMed

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

2016-05-01

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

Deployment of lean six sigma in care coordination: an improved discharge process.

PubMed

Breslin, Susan Ellen; Hamilton, Karen Marie; Paynter, Jacquelyn

2014-01-01

This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post-acute care, utilizing Lean Six Sigma methodology. Inpatient acute care hospital. A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions. Implications for The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge..

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

PubMed

Palmersheim, T M

1999-12-01

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

An answer to chronicity in the Basque Country: primary care-based population health management.

PubMed

Nuño-Solinís, Roberto; Orueta, Juan F; Mateos, Maider

2012-01-01

Chronic conditions have an impact on individuals since they represent a restraint on quality of life, functional status, and productivity of people who suffer from them but they also compromise the sustainability of health systems. In 2010, the Strategy for Tackling the Challenge of Chronicity in the Basque Country was published. It contains policies and projects aimed at reinventing the health delivery model with the purpose of improving the quality of care for chronic patients and advancing toward a more sustainable, proactive, and integrated model. We present 3 projects here: population stratification, integrated care initiatives, and innovation from health care staff.

Strengthening national health laboratories in sub-Saharan Africa: a decade of remarkable progress

PubMed Central

Alemnji, G. A.; Zeh, C.; Yao, K.; Fonjungo, P. N.

2016-01-01

OBJECTIVES Efforts to combat the HIV/AIDS pandemic have underscored the fragile and neglected nature of some national health laboratories in Africa. In response, national and international partners and various governments have worked collaboratively over the last several years to build sustainable laboratory capacities within the continent. Key accomplishments reflecting this successful partnership include the establishment of the African-based World Health Organization Regional Office for Africa (WHO-AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA); development of the Strengthening Laboratory Management Toward Accreditation (SLMTA) training programme; and launching of a Pan African-based institution, the African Society for Laboratory Medicine (ASLM). These platforms continue to serve as the foundations for national health laboratory infrastructure enhancement, capacity development and overall quality system improvement. Further targeted interventions should encourage countries to aim at integrated tiered referral networks, promote quality system improvement and accreditation, develop laboratory policies and strategic plans, enhance training and laboratory workforce development and a retention strategy, create career paths for laboratory professionals and establish public–private partnerships. Maintaining the gains and ensuring sustainability will require concerted action by all stakeholders with strong leadership and funding from African governments and from the African Union. PMID:24506521

Effective integrated frameworks for assessing mining sustainability.

PubMed

Virgone, K M; Ramirez-Andreotta, M; Mainhagu, J; Brusseau, M L

2018-05-28

The objectives of this research are to review existing methods used for assessing mining sustainability, analyze the limited prior research that has evaluated the methods, and identify key characteristics that would constitute an enhanced sustainability framework that would serve to improve sustainability reporting in the mining industry. Five of the most relevant frameworks were selected for comparison in this analysis, and the results show that there are many commonalities among the five, as well as some disparities. In addition, relevant components are missing from all five. An enhanced evaluation system and framework were created to provide a more holistic, comprehensive method for sustainability assessment and reporting. The proposed framework has five components that build from and encompass the twelve evaluation characteristics used in the analysis. The components include Foundation, Focus, Breadth, Quality Assurance, and Relevance. The enhanced framework promotes a comprehensive, location-specific reporting approach with a concise set of well-defined indicators. Built into the framework is quality assurance, as well as a defined method to use information from sustainability reports to inform decisions. The framework incorporates human health and socioeconomic aspects via initiatives such as community-engaged research, economic valuations, and community-initiated environmental monitoring.

Exploring the Potential for Sustainable Future Bioenergy Production in the Arkansas-White-Red River Basin

NASA Astrophysics Data System (ADS)

Baskaran, L.; Jager, H.; Kreig, J.

2016-12-01

Bioenergy production in the US has been projected to increase in the next few years and this has raised concerns over environmentally sustainable production. Specifically, there are concerns that managing lands to produce bioenergy feedstocks in the Mississippi-Atchafalaya River Basin (MARB) may have impacts over the water quality in the streams draining these lands and hamper with efforts to reduce the size of the Gulf of Mexico's "Dead Zone" (hypoxic waters). However, with appropriate choice of feedstocks and good conservation practices, bioenergy production systems can be environmentally and economically sustainable. We evaluated opportunities for producing 2nd generation cellulosic feedstocks that are economically sustainable and improve water quality in the Arkansas-White-Red (AWR) river basin, which is major part of the MARB. We generated a future bioenergy landscape by downscaling county-scale projections of bioenergy crop production produced by an economic model, POLYSYS, at a market price of $60 per dry ton and a 1% annual yield increase. Our future bioenergy landscape includes perennial grasses (switchgrass and miscanthus), short-rotated woody crops (poplar and willow) and annual crops (high yield sorghum, sorghum stubble, corn stover and wheat straw). Using the Soil and Water Assessment Tool (SWAT) we analyzed changes in water quality and quantity by simulating a baseline scenario with the current landscape (2014 land cover) and a future scenario with the bioenergy landscape. Our results over the AWR indicate decreases in median nutrient and sediment loadings from the baseline scenario. We also explored methods to evaluate if conservation practices (such as reducing fertilizer applications, incorporating filter strips, planting cover crops and moving to a no-till system) can improve water quality, while maintaining biomass yield. We created a series of SWAT simulations with varying levels of conservation practices by crop and present our methods towards identifying future scenarios that may minimize water quality and maximize biomass yields.

49 CFR 268.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... used in this part— CMAQ means Congestion Mitigation and Air Quality Improvement Program (23 U.S.C. 149...—as a completely self-sustaining entity; and (2) The total benefits of a Maglev corridor must equal or...

49 CFR 268.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... used in this part— CMAQ means Congestion Mitigation and Air Quality Improvement Program (23 U.S.C. 149...—as a completely self-sustaining entity; and (2) The total benefits of a Maglev corridor must equal or...

49 CFR 268.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... used in this part— CMAQ means Congestion Mitigation and Air Quality Improvement Program (23 U.S.C. 149...—as a completely self-sustaining entity; and (2) The total benefits of a Maglev corridor must equal or...

The challenges of sustainable access to safe drinking water in rural areas of developing countries: case of Zawtar El-Charkieh, Southern Lebanon.

PubMed

Massoud, May A; Al-Abady, Abdolmonim; Jurdi, Mey; Nuwayhid, Iman

2010-06-01

Adequate and safe water is important for human health and well-being, economic production, and sustainable development. Failure to ensure the safety of drinking water may expose the community to the risk of outbreaks of waterborne and infectious diseases. Although drinking water is a basic human right, many people do not have access to safe and adequate drinking water or proper sanitation facilities. The authors conducted a study to assess the quantity, cost, continuity, coverage, and quality of drinking water in the village of Zawtar El-Charkieh, Lebanon. Their aim was to identify the challenges of sustainable access to safe drinking water in order to determine the short-term management actions and long-term strategies to improve water quality. Results revealed that contamination of the source, absence of any disinfection method or insufficient dose, poor maintenance operations, and aging of the networks are significant factors contributing to water contamination during the storage and distribution process. Establishing a comprehensive drinking water system that integrates water supply, quality, and management as well as associated educational programs in order to ensure the safety and sustainability of drinking water supplies is essential.

Repair of symptomatic paraesophageal hernias in elderly (>70 years) patients results in sustained quality of life at 5 years and beyond.

PubMed

Merzlikin, Oleg V; Louie, Brian E; Farivar, Alexander S; Shultz, Dale; Aye, Ralph W

2017-10-01

Paraesophageal hernias (PEHs) involve herniation of stomach and/or other viscera into the mediastinum. These commonly occur in the elderly and can severely limit quality of life. Short term outcomes of repaired PEH demonstrated low morbidity and significant improvement in quality of life, but long-term data for all patients, especially the elderly, are lacking. Retrospective chart review of a prospectively collected database of patients aged 70 or greater with a symptomatic PEH repaired 5+ years ago. Quality of life data were assessed preoperatively, at 12-24 months, and at 5+ years using QOLRAD, GERD-HRQL, and DSS. We identified 137 patients who met the age criteria, with 69 patients undergoing surgery 5+ years ago. With ten patients were lost to follow-up, 59 patients were analyzed, including 24 males and 35 females. Median age at repair was 77 years. There were two 90-day mortalities, with one occurring within 30 days of surgery. Patients alive at evaluation had a median age of 74 years and were followed a median 7.4 years. From baseline, QOLRAD improved from 4 to 6.5, GERD-HRQL improved from 11 to 5, and swallowing improved from 11 to 38. During follow-up, 21 patients died. Deceased patients lived a median of 4 years after repair, with a median age at repair of 80 years. At a median time follow-up of 2 years, this group's QOLRAD improved from 5.1 to 7, GERD-HRQL improved from 16 to 4, and swallowing improved from 14.5 to 35. In elderly patients with symptomatic PEH undergoing surgical repair more than 5 years ago, there was sustained improvement in quality of life. This justifies surgical repair of symptomatic PEH in elderly patients.

Advancing health system integration through supply chain improvement.

PubMed

Rosser, Mike

2006-01-01

Collaboration is a key element to success in the provision of sustainable and integrated healthcare services. Among the many initiatives undertaken to improve service quality and reduce costs, collaboration among hospitals in Ontario has been difficult to achieve; however, voluntary collaboration is vital to achieving transformation of the magnitude envisioned by system leaders.

Sustaining self-management in diabetes mellitus.

PubMed

Mitchell-Brown, Fay

2014-01-01

Successful management of diabetes depends on the individual's ability to manage and control symptoms. Self-management of diabetes is believed to play a significant role in achieving positive outcomes for patients. Adherence to self-management behaviors supports high-quality care, which reduces and delays disease complications, resulting in improved quality of life. Because self-management is so important to diabetes management and involves a lifelong commitment for all patients, health care providers should actively promote ways to maintain and sustain behavior change that support adherence to self-management. A social ecological model of behavior change (McLeroy, Bibeau, Steckler, & Glanz, 1988) helps practitioners provide evidence-based care and optimizes patients' clinical outcomes. This model supports self-management behaviors through multiple interacting interventions that can help sustain behavior change. Diabetes is a complex chronic disease; successful management must use multiple-level interventions.

Sustainable management for the eastern Mediterranean coast of Turkey.

PubMed

Berberoglu, Süha

2003-03-01

The objective of this article is to propose a program for the integrated coastal zone management that is required to stimulate and guide sustainable development of the Mediterranean coastal zone of Turkey. Improved data collection, quality control, analysis, and data management will provide a firm basis for future scientific understanding of the East Mediterranean coast of Turkey and will support long-term management. Various innovative procedures were proposed for a promising ecosystem-based approach to manage coastal wetlands in the Mediterranean: remote data acquisition with new technologies; environmental quality monitoring program that will provide a baseline for monitoring; linking a Geographic Information System (GIS) with natural resource management decision routines in the context of operational wetlands, fisheries, tourism management system; environmental sensitivity analysis to ensure that permitted developments are environmentally sustainable; and use of natural species to restore the wetlands and coastal dunes and sustain the system processes. The proposed management scheme will benefit the scientific community in the Mediterranean and the management/planning community in Eastern Turkey.

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

PubMed

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

2007-01-01

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

Assessing the Total Economic Value of Improving Water Quality to Inform Water Resources Management: Evidence and Challenges from Southeast Asia

NASA Astrophysics Data System (ADS)

Jalilov, S.; Fukushi, K.

2016-12-01

Population growth, high rates of economic development and rapid urbanization in the developing countries of Southeast Asia (SEA) have resulted in degradation and depletion of natural resources, including water resources and related ecosystem services. Many urban rivers in the region are highly polluted with domestic, industrial and agricultural wastes. Policymakers are often aware of the direct value of water resources for domestic and industrial consumption, but they often underestimate the indirect value of these functions, since they are not exchanged in the market and do not appear in national income accounts. Underestimation of pollution and over-exploitation of water resources result in a loss of these benefits and have adverse impacts on nearby residents, threatening the long-term sustainable development of natural resources in the region. Behind these constraints lies a lack of knowledge (ignorance) from governments that a clean water environment could bring significant economic benefits. This study has been initiated to tackle this issue and to foster a more rational approach for sustainable urban development in Metro Manila in the Philippines. We applied a Contingent Valuation Method (CVM) based on Computer-Assisted Personal Interviewing (CAPI) technique. Results show that users are willing to pay up to PHP 102.42 (2.18) monthly to improve quality of urban waterbodies whereas nonusers are willing to pay up to PHP 366.53 (7.80) as one-time payment towards water quality improvement. The estimated monetary value of water quality improvements would be a useful variable in cost-benefit analyses of various water quality-related policies, in both public and private sectors in Metro Manila. This survey design could serve as a useful template for similar water quality studies in other SEA countries.

To the problem of ensuring stability of activities of construction companies engaged in high-rise building construction

NASA Astrophysics Data System (ADS)

Ivanov, Nikolay; Safe Aldeen, Ahmed

2018-03-01

Recently, more and more attention in scientific literature has been drawn to improving the sustainability of organization. The growth in the volume of high-rise construction in Russia makes the task of assessing and ensuring the sustainability of organizations and enterprises leading this type of construction very relevant. The article considers the approach to assessing the sustainability of the organization's activities in the context of functioning of quality management system (QMS). It puts forward the hypothesis that assessment of sustainability of an organization that has a real and efficient functioning quality management system can be based on the results of assessing the effectiveness of the QMS. The article describes in sufficient detail the sequence of actions to form a list of criteria for assessing the effectiveness of the QMS and sustainability of the organization, and to evaluate both characteristics on the basis of these criteria. For a clear interpretation of the results obtained, the authors use so-called petal diagrams. It suggests an original approach to their creation and analysis. Based on the results of the study, the authors conclude that in order to assess the sustainability of enterprises and organizations analysis of the dynamics of changes in the basic sustainability factors is mandatory.

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

PubMed

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

2016-06-01

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

Comparative analysis of the outflow water quality of two sustainable linear drainage systems.

PubMed

Andrés-Valeri, V C; Castro-Fresno, D; Sañudo-Fontaneda, L A; Rodriguez-Hernandez, J

2014-01-01

Three different drainage systems were built in a roadside car park located on the outskirts of Oviedo (Spain): two sustainable urban drainage systems (SUDS), a swale and a filter drain; and one conventional drainage system, a concrete ditch, which is representative of the most frequently used roadside drainage system in Spain. The concentrations of pollutants were analyzed in the outflow of all three systems in order to compare their capacity to improve water quality. Physicochemical water quality parameters such as dissolved oxygen, total suspended solids, pH, electrical conductivity, turbidity and total petroleum hydrocarbons were monitored and analyzed for 25 months. Results are presented in detail showing significantly smaller amounts of outflow pollutants in SUDS than in conventional drainage systems, especially in the filter drain which provided the best performance.

An Architecture for Continuous Data Quality Monitoring in Medical Centers.

PubMed

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

2015-01-01

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

Global quality imaging: improvement actions.

PubMed

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

2011-05-01

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

Modeled Impacts of Cover Crops and Vegetative Barriers on Corn Stover Availability and Soil Quality

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

Ian J. Bonner; David J. Muth Jr.; Joshua B. Koch

2014-06-01

Environmentally benign, economically viable, and socially acceptable agronomic strategies are needed to launch a sustainable lignocellulosic biofuel industry. Our objective was to demonstrate a landscape planning process that can ensure adequate supplies of corn (Zea mays L.) stover feedstock while protecting and improving soil quality. The Landscape Environmental Assessment Framework (LEAF) was used to develop land use strategies that were then scaled up for five U.S. Corn Belt states (Nebraska, Iowa, Illinois, Indiana, and Minnesota) to illustrate the impact that could be achieved. Our results show an annual sustainable stover supply of 194 million Mg without exceeding soil erosion Tmore » values or depleting soil organic carbon [i.e., soil conditioning index (SCI)?>?0] when no-till, winter cover crop, and vegetative barriers were incorporated into the landscape. A second, more rigorous conservation target was set to enhance soil quality while sustainably harvesting stover. By requiring erosion to be <1/2 T and the SCI-organic matter (OM) subfactor to be >?0, the annual sustainable quantity of harvestable stover dropped to148 million Mg. Examining removal rates by state and soil resource showed that soil capability class and slope generally determined the effectiveness of the three conservation practices and the resulting sustainable harvest rate. This emphasizes that sustainable biomass harvest must be based on subfield management decisions to ensure soil resources are conserved or enhanced, while providing sufficient biomass feedstock to support the economic growth of bioenergy enterprises.« less

Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT.

PubMed

McCall, W Vaughn; Reboussin, David; Prudic, Joan; Haskett, Roger F; Isenberg, Keith; Olfson, Mark; Rosenquist, Peter B; Sackeim, Harold A

2013-05-01

Health-related quality of life (HRQOL) is diminished in depressed adult outpatients and especially impaired among depressed patients referred for ECT. We compare pretreatment HRQOL in ECT and non-ECT depressed patients from two large samples, and examined whether sustained remission in depressive symptoms after ECT is associated with normalization of HRQOL. HRQOL was measured with the Medical Outcomes Study Short Form 36 (SF36) before ECT and 6 months after ECT in an effectiveness (n=286) and an efficacy (n=243) clinical trial. ECT patients had very low baseline SF36 scores. With one exception, SF36 subscale scores in both trials were significantly lower than those of depressed outpatients. A minority of patients in both trials entered and sustained remission over the 24 week timeframe. Among sustained remitters, average SF36 scores were no different from normative scores of the general adult population, except that in the effectiveness study ECT patients reported less Bodily Pain (p<0.05) and better Mental Health (p<0.05), while in the efficacy study ECT patients reported more difficulty with Role-Emotional (p<0.01). Only a modest number of patients were observed in sustained remission. HRQOL is very poor in patients referred for ECT. Depressed patients who experience sustained remission after ECT, however, can expect improvement in their quality of life that leaves many in a position indistinguishable from the general adult population. Copyright © 2013 Elsevier B.V. All rights reserved.

Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT

PubMed Central

McCall, W. Vaughn; Reboussin, David; Prudic, Joan; Haskett, Roger F.; Isenberg, Keith; Olfson, Mark; Rosenquist, Peter B.; Sackeim, Harold A

2012-01-01

Background Health-related quality of life (HRQOL) is diminished in depressed adult outpatients and especially impaired among depressed patients referred for ECT. We compare pretreatment HRQOL in ECT and non-ECT depressed patients from two large samples, and examined whether sustained remission in depressive symptoms after ECT is associated with normalization of HRQOL. Methods HRQOL was measured with the Medical Outcomes Study Short Form 36 (SF36) before ECT and 6 months after ECT in an effectiveness (n=286) and an efficacy (n=243) clinical trial. Results ECT patients had very low baseline SF36 scores. With one exception, SF36 subscale scores in both trials were significantly lower than those of depressed outpatients. A minority of patients in both trials entered and sustained remission over the 24 week timeframe. Among sustained remitters, average SF36 scores were no different from normative scores of the general adult population, except that in the effectiveness study ECT patients reported less Bodily Pain (p<0.05) and better Mental Health (p<0.05), while in the efficacy study ECT patients reported more difficulty with Role-Emotional. (p<0.01) Limitations Only a modest number of patients were observed in sustained remission. Conclusions HRQOL is very poor in patients referred for ECT. Depressed patients who experience sustained remission after ECT, however, can expect improvement in their quality of life that leaves many in a position indistinguishable from the general adult population. PMID:23158959

Production and supply of high-quality food protein for human consumption: sustainability, challenges, and innovations.

PubMed

Wu, Guoyao; Fanzo, Jessica; Miller, Dennis D; Pingali, Prabhu; Post, Mark; Steiner, Jean L; Thalacker-Mercer, Anna E

2014-08-01

The Food and Agriculture Organization of the United Nations estimates that 843 million people worldwide are hungry and a greater number suffer from nutrient deficiencies. Approximately one billion people have inadequate protein intake. The challenge of preventing hunger and malnutrition will become even greater as the global population grows from the current 7.2 billion people to 9.6 billion by 2050. With increases in income, population, and demand for more nutrient-dense foods, global meat production is projected to increase by 206 million tons per year during the next 35 years. These changes in population and dietary practices have led to a tremendous rise in the demand for food protein, especially animal-source protein. Consuming the required amounts of protein is fundamental to human growth and health. Protein needs can be met through intakes of animal and plant-source foods. Increased consumption of food proteins is associated with increased greenhouse gas emissions and overutilization of water. Consequently, concerns exist regarding impacts of agricultural production, processing and distribution of food protein on the environment, ecosystem, and sustainability. To address these challenging issues, the New York Academy of Sciences organized the conference "Frontiers in Agricultural Sustainability: Studying the Protein Supply Chain to Improve Dietary Quality" to explore sustainable innovations in food science and programming aimed at producing the required quality and quantity of protein through improved supply chains worldwide. This report provides an extensive discussion of these issues and summaries of the presentations from the conference. © 2014 New York Academy of Sciences.

Cost-effectiveness of a pressure ulcer quality collaborative.

PubMed

Makai, Peter; Koopmanschap, Marc; Bal, Roland; Nieboer, Anna P

2010-06-01

A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained. Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by euro2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

Promoting and Sustaining High Quality Physical Education and School Sport through School Sport Partnerships

ERIC Educational Resources Information Center

Flintoff, Anne; Foster, Rebecca; Wystawnoha, Simon

2011-01-01

School sport partnerships (SSPs) have been at the centre of a national strategy for Physical Education and School Sport (PESS) in England for the last seven years, aiming to improve both the range and quality of opportunities for young people to be physically active. While annual surveys show significantly increased opportunities for young people…

Supporting Excellence: A Framework for Developing, Implementing, and Sustaining a High-Quality District Curriculum. First Edition

ERIC Educational Resources Information Center

Council of the Great City Schools, 2017

2017-01-01

In the ongoing effort to improve instructional standards in our nation's urban public schools, the Council of the Great City Schools has released resources to help districts determine the quality and alignment of instructional materials at each grade level; to ensure that materials for English language learners are rigorous and aligned to district…

2015 National Agenda for Digital Stewardship

DTIC Science & Technology

2014-09-01

tool and framework that explores the aspects of “benefit,” “risk,” “value,”’ “ quality ,” and “sustainability.” It is analyzing previous work on cost...evidence of the value of digital stewardship activities is needed. Improved and sharable metrics about the quality and success of digital stewardship...Significant Properties .................................. 38 5.3.4 Policy Research on Trust Frameworks

Impact of cover crop, irrigation and season on nutrient and sediment in the runoff water measured at the edge-of-fields in northeast Arkansas

USDA-ARS?s Scientific Manuscript database

Improved understanding of water quality at the edge-of-field (EOF) from production-size fields is needed to better inform agriculture and resource managers regarding sustainable farming practices and environmental stewardship. We measured runoff water quality at EOF of paired commercial fields in Mi...

Managing Quality Improvement of eLearning in a Large, Campus-Based University

ERIC Educational Resources Information Center

Ellis, Robert A.; Jarkey, Nerida; Mahony, Mary Jane; Peat, Mary; Sheely, Stephen

2007-01-01

Purpose: This paper seeks to discuss the characteristics that shape a model to manage eLearning in a large, predominantly campus-based university. It focuses on how such a model can provide a sustainable approach to supporting eLearning for more than 40,000 students while still managing basic quality assurance for the University executive and the…

Nurturing Quality of Higher Education through National Ranking: A Potential Empowerment Model for Developing Countries

ERIC Educational Resources Information Center

Kusumastuti, Dyah; Idrus, Nirwan

2017-01-01

This paper reviews the recently introduced National Higher Education ranking system in Indonesia in order to evaluate its potential as a sustainable model to improve the quality of higher education in the country. It is a scaffold towards an established world-universities ranking system that may prove formidable for a developing country. This…

Critical points of Brazil nuts: a beginning for food safety, quality control and Amazon sustainability.

PubMed

Lima, Andriele M; Gonçalves, Evonnildo C; Andrade, Soraya S; Barbosa, Maria S R; Barroso, Karla F P; de Sousa, Mayara B; Borges, Larissa; Vieira, Jozé L F; Teixeira, Francisco M

2013-03-15

One difficulty of self-sustainability is the quality assurance of native products. This research was designed to study the risks and critical control points in the collection, handling and marketing of Brazil nuts from native forests and urban fairs in the Brazilian Amazon by characterisation of morphological aspects of fungi and posterior identification by molecular biology and determination of aflatoxins by high-performance liquid chromatography. Several corrective actions to improve product quality were found to be necessary in both sites. Growth of fungi was observed in 95% of fragments of Brazil nuts from both sites during the between-harvest period. Aflatoxin levels indicated that, although fungal growth was observed in both sites, only Brazil nuts from the native forest showed a high risk to human health (total aflatoxin level of 471.69 µg kg(-1)). This study has shown the main issues related to the process design of Brazil nuts, supporting the necessity for research on new strategies to improve the quality of nuts. Also, the habit of eating Brazil nuts stored throughout the year may represent a risk to farmers. © 2012 Society of Chemical Industry.

Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis.

PubMed

Scott, John W; Nyinawankusi, Jeanne D'Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha

2017-07-01

Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (p<0.05 for all), and all five achieved a post-CQI average of at least 90% completion. The monthly composite STQ scores ranged from 76.5 to 97.9 pre-CQI, but tightened to 86.1-98.7 during the post-CQI period. Interrupted time series analysis of the STQ score showed that CQI programme led to both an immediate improvement of +6.1% (p=0.017) and sustained monthly improvements in care delivery-improving at a rate of 0.7% per month (p=0.028). The SAMU experience demonstrates the utility of a responsive, data-driven quality improvement programme to yield significant immediate and sustained improvements in pre-hospital care for trauma in Rwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2015-01-01

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

Quality of life, binge eating and sexual function in participants treated for obesity with sustained release naltrexone/bupropion.

PubMed

Halseth, A; Shan, K; Gilder, K; Malone, M; Acevedo, L; Fujioka, K

2018-04-01

This multicenter, randomized, controlled, open-label trial examined weight-related quality of life, control over eating behaviour and sexual function after 26 weeks of treatment with either 32 mg naltrexone sustained release (SR)/360 mg bupropion SR plus a comprehensive lifestyle intervention program (NB + CLI, N = 153) or usual care (UC, N = 89), which included minimal lifestyle intervention. Impact of Weight on Quality of Life-Lite, Binge Eating Scale and Arizona Sexual Experiences Scale were assessed at baseline (BL) and weeks 16 and 26. NB + CLI and UC participants lost 9.46 and 0.94% respectively of initial body weight at week 26 (P < 0.0001). NB + CLI participants had greater improvements in Impact of Weight on Quality of Life-Lite total score than UC participants (P < 0.0001). In participants with moderate/severe Binge Eating Scale scores at BL, 91% of NB + CLI and 18% of UC participants experienced categorical improvements. In participants with Arizona Sexual Experiences Scale-defined sexual dysfunction at BL, 58% of NB + CLI and 19% of UC participants no longer met dysfunction criteria at week 26. The most frequent adverse events leading to discontinuation before week 26 in NB + CLI included nausea (10.5%); anxiety (3.3%); and headache, hypertension, insomnia and palpitations (1.3% each). Compared with UC, participants treated with NB + CLI experienced greater improvements in weight-related quality of life, control over eating behaviour, and sexual function.

Sustainable Development and Protection of the Environment: Two Management Strategies Not Always Compatible

NASA Astrophysics Data System (ADS)

Athanassakis, Artemios M.

2010-01-01

The definition of Sustainable Development has received intense criticism and contestations with the result, that International Union for the Conservation of Natural Resources (I.U.C.N.), and the World Wide Fund for Nature (W.W.F.) clarified that sustainable development means the improvement of life quality, inside the limits of clarified capacity of ecosystems. According to its critics, is considered as a general concept, indefinite and contradictory. Those disputes put the accent on the close relation between the Sustainable Development and the values of the today's global market. This relationship transforms the Sustainable Development to an one dimensional economical growth with the "ecological ornaments" of sustainability and protection of environment. Therefore this paper looks for, whether the sustainable development consists one more device, focuses on the world financial system, or establishes one optimistic developmental perspective, which might harmonize the economical activities with the natural function of our planetic ecosystems.

Using quality experts from manufacturing to transform primary care.

PubMed

Steiner, Rose M; Walsworth, David T

2010-01-01

Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality and process improvement. Michigan uses quality experts from the manufacturing industry who are educated regarding the health care environment, which enables them to perform as quality-improvement coaches (QICs) in primary-care practices. In this case study, ninety-six quality experts were trained to coach primary-care practices, with 53 currently assigned to offices, and others assisting as needed. Practice teams and QICs identify gaps in care and office practices with the use of assorted quality-improvement tools. Reports are made monthly to describe clinical and process measures and methods used. Michigan has 33 practices engaged, involving 205 physicians and 40 midlevel providers. The teaming of quality experts from the manufacturing industry with primary-care office providers and staff resulted in office efficiency, improved care provided, and progress toward attainment of a patient-centered medical home (PCMH). Quality experts from manufacturing volunteered to coach for improvements in primary care. The efforts of QICs have been successful. Because the QICs are volunteers, sustainability of the Michigan Improving Performance in Practice program is a challenge.

Tracking and sustaining improvement initiatives: leveraging quality dashboards to lead change in a neurosurgical department.

PubMed

McLaughlin, Nancy; Afsar-Manesh, Nasim; Ragland, Victoria; Buxey, Farzad; Martin, Neil A

2014-03-01

Increasingly, hospitals and physicians are becoming acquainted with business intelligence strategies and tools to improve quality of care. In 2007, the University of California Los Angeles (UCLA) Department of Neurosurgery created a quality dashboard to help manage process measures and outcomes and ultimately to enhance clinical performance and patient care. At that time, the dashboard was in a platform that required data to be entered manually. It was then reviewed monthly to allow the department to make informed decisions. In 2009, the department leadership worked with the UCLA Medical Center to align mutual quality-improvement priorities. The content of the dashboard was redesigned to include 3 areas of priorities: quality and safety, patient satisfaction, and efficiency and use. Throughout time, the neurosurgery quality dashboard has been recognized for its clarity and its success in helping management direct improvement strategies and monitor impact. We describe the creation and design of the neurosurgery quality dashboard at UCLA, summarize the evolution of its assembly process, and illustrate how it can be used as a powerful tool of improvement and change. The potential challenges and future directions of this business intelligence tool are also discussed.

Evaluating the Economic and Social Benefits of Nutrient ...

EPA Pesticide Factsheets

New England’s coastal social-ecological systems are subject to chronic environmental problems, including water quality degradation. Researchers at EPA’s Office of Research and Development (ORD) Atlantic Ecology Division (AED) are piloting an effort to further understand how reduced water quality due to nutrient enrichment is affecting and may affect the economic prosperity, social capacity, and ecological integrity of coastal New England communities. This research is part of task 4.61 of ORD’s Sustainable and Healthy Communities Research Program (Integrated Solutions for Sustainable Communities: Social-Ecological Systems for Resilience and Adaptive Management in Communities - A Cape Cod Case Study). Concurrent with this effort, AED researchers are participating in EPA’s three-office effort (Office of Research and Development, Office of Policy, and Office of Water) to quantify and monetize the benefits of water quality improvements across the Nation. AED’s effort is a case study of changes in recreation demand and values due to changes in nutrients in Northeastern estuaries and freshwater ponds. This work is part of task 3.04A of the Safe and Sustainable Waters Research Program (National Water Quality Benefits: Economic Case Studies of Water Quality Benefits). Because of the complementarity between the two projects, this Supporting Statement describes and requests hours for focus groups and interviews for both of these research efforts. Our initial

New Professionalism in Austere Times: The Employment Experiences of Early Career Teachers in Scotland

ERIC Educational Resources Information Center

Hulme, Moira; Menter, Ian

2014-01-01

International concern to raise educational standards and improve teacher quality has directed attention to the need to sustain career-long professional learning. Teacher induction and early professional learning (during years 2-6) have been associated with patterns of attrition and improved pupil outcomes. As the economic crisis impacts on public…

Improving the Quality of Radiographs in Neonatal Intensive Care Unit Utilizing Educational Interventions.

PubMed

Gupta, Ashish O; Rorke, Jeanne; Abubakar, Kabir

2015-08-01

We aimed to develop an educational tool to improve the radiograph quality, sustain this improvement overtime, and reduce the number of repeat radiographs. A three phase quality control study was conducted at a tertiary care NICU. A retrospective data collection (phase1) revealed suboptimal radiograph quality and led to an educational intervention and development of X-ray preparation checklist (primary intervention), followed by a prospective data collection for 4 months (phase 2). At the end of phase 2, interim analysis revealed a gradual decline in radiograph quality, which prompted a more comprehensive educational session with constructive feedback to the NICU staff (secondary intervention), followed by another data collection for 6 months (phase 3). There was a significant improvement in the quality of radiographs obtained after primary educational intervention (phase 2) compared with phase 1 (p < 0.001). During interim analysis after phase 2, radiograph quality declined but still remained significantly better than phase 1. Secondary intervention resulted in significant improvement in radiograph quality to > 95% in all domains of image quality. No radiographs were repeated in phase 3, compared with 5.8% (16/277) in phase 1. A structured, collaborated educational intervention successfully improves the radiograph quality and decreases the need for repeat radiographs and radiation exposure in the neonates. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Performance measurement for ambulatory care: moving towards a new agenda.

PubMed

Roski, J; Gregory, R

2001-12-01

Despite a shift in care delivery from inpatient to ambulatory care, performance measurement efforts for the different levels in ambulatory care settings such as individual physicians, individual clinics and physician organizations have not been widely instituted in the United States (U.S.). The Health Plan Employer Data and Information Set (HEDIS), the most widely used performance measurement set in the U.S., includes a number of measures that evaluate preventive and chronic care provided in ambulatory care facilities. While HEDIS has made important contributions to the tracking of ambulatory care quality, it is becoming increasingly apparent that the measurement set could be improved by providing quality of care information at the levels of greatest interest to consumers and purchasers of care, namely for individual physicians, clinics and physician organizations. This article focuses on the improvement opportunities for quality performance measurement systems in ambulatory care. Specific challenges to creating a sustainable performance measurement system at the level of physician organizations, such as defining the purpose of the system, the accountability logic, information and reporting needs and mechanisms for sustainable implementation, are discussed.

A geographic information system screening tool to tackle diffuse pollution through the use of sustainable drainage systems.

PubMed

Todorovic, Zorica; Breton, Neil P

2014-01-01

Sustainable drainage systems (SUDS) offer many benefits that traditional solutions do not. Traditional approaches are unable to offer a solution to problems of flood management and water quality. Holistic consideration of the wide range of benefits from SUDS can result in advantages such as improved flood resilience and water quality enhancement through consideration of diffuse pollution sources. Using a geographical information system (GIS) approach, diffuse pollutant sources and opportunities for SUDS are easily identified. Consideration of potential SUDS locations results in source, site and regional controls, leading to improved water quality (to meet Water Framework Directive targets). The paper will discuss two different applications of the tool, the first of which is where the pollutant of interest is known. In this case the outputs of the tool highlight and isolate the areas contributing the pollutants and suggest the adequate SUDS measures to meet the required criteria. The second application is where the tool identifies likely pollutants at a receiving location, and SUDS measures are proposed to reduce pollution with assessed efficiencies.

Sustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative.

PubMed

Dandoy, Christopher E; Hariharan, Selena; Weiss, Brian; Demmel, Kathy; Timm, Nathan; Chiarenzelli, Janis; Dewald, Mary Katherine; Kennebeck, Stephanie; Langworthy, Shawna; Pomales, Jennifer; Rineair, Sylvia; Sandfoss, Erin; Volz-Noe, Pamela; Nagarajan, Rajaram; Alessandrini, Evaline

2016-02-01

Timely delivery of antibiotics to febrile immunocompromised (F&I) paediatric patients in the emergency department (ED) and outpatient clinic reduces morbidity and mortality. The aim of this quality improvement initiative was to increase the percentage of F&I patients who received antibiotics within goal in the clinic and ED from 25% to 90%. Using the Model of Improvement, we performed Plan-Do-Study-Act cycles to design, test and implement high-reliability interventions to decrease time to antibiotics. Pre-arrival interventions were tested and implemented, followed by post-arrival interventions in the ED. Many processes were spread successfully to the outpatient clinic. The Chronic Care Model was used, in addition to active family engagement, to inform and improve processes. The study period was from January 2010 to January 2015. Pre-arrival planning improved our F&I time to antibiotics in the ED from 137 to 88 min. This was sustained until October 2012, when further interventions including a pre-arrival huddle decreased the median time to <50 min. Implementation of the various processes to the clinic delivery system increased the mean percentage of patients receiving antibiotics within 60 min to >90%. In September 2014, we implemented a rapid response team to improve reliable venous access in the ED, which increased our mean percentage of patients receiving timely antibiotics to its highest rate (95%). This stepwise approach with pre-arrival planning using the Chronic Care Model, followed by standardisation of processes, created a sustainable improvement of timely antibiotic delivery in F&I patients. 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/

Methylotrophic bacteria in sustainable agriculture.

PubMed

Kumar, Manish; Tomar, Rajesh Singh; Lade, Harshad; Paul, Diby

2016-07-01

Excessive use of chemical fertilizers to increase production from available land has resulted in deterioration of soil quality. To prevent further soil deterioration, the use of methylotrophic bacteria that have the ability to colonize different habitats, including soil, sediment, water, and both epiphytes and endophytes as host plants, has been suggested for sustainable agriculture. Methylotrophic bacteria are known to play a significant role in the biogeochemical cycle in soil ecosystems, ultimately fortifying plants and sustaining agriculture. Methylotrophs also improve air quality by using volatile organic compounds such as dichloromethane, formaldehyde, methanol, and formic acid. Additionally, methylotrophs are involved in phosphorous, nitrogen, and carbon cycling and can help reduce global warming. In this review, different aspects of the interaction between methylotrophs and host plants are discussed, including the role of methylotrophs in phosphorus acquisition, nitrogen fixation, phytohormone production, iron chelation, and plant growth promotion, and co-inoculation of these bacteria as biofertilizers for viable agriculture practices.

Green Open Space: Awareness for Health or Sustainability?

NASA Astrophysics Data System (ADS)

Dewi, O. C.; Chairunnisa, I.; Hidayat, T.; Anggraini, M.; Napitupulu, A.

2018-03-01

Universitas Indonesia in cooperation with American Red Cross and Indonesian Red Cross have been assisting green open space revitalisation program in 7 locations in Bogor Regency (2016-2017). The program was held under The Urban Disaster Risk Reduction Greater Jakarta Project; an initiative program from American Red Cross Indonesia. This project was not only improving the existing green open space quality, but also creating one adapted from public land. The revitalization project figures what happened on daily basis on the existing land, proposing new programming facilities, community-based construction, monitoring and handing over. This paper discovers the meaning of a green space for the community, whether the community aware of its benefit on human health or environmental sustainability. The research question is does the community aware of green open space benefit for human health or environmental sustainability? Or both? The original data from the community was gathered and grouped based on its relevance with environmental quality and public health.

[Current status and sustainable development countermeasures of Anoectochilus roxburghii].

PubMed

Hong, Lin; Shao, Qing-Song; Zhou, Ai-Cun; Wang, Hong-Zhen; Zhang, Ai-Lian; Xu, Jian-Wei; Huang, Yu-Qiu

2016-02-01

The current status of the domestic manufacturing and sales markets of Anoectochilus roxburghii were investigated and analyzed in the study. Some problems in the A. roxburghii industry were revealed and a variety of sustainable development countermeasures were also proposed. The main problems of A. roxburghii industry are the lack of protection for wild resources, the lag in the speed of variety breeding, the insufficient research on the quality systems, the low level of industry and product innovation capability, as well as the relatively low market cognition and brand competence. Therefore, strengthening the protection for breeding resources, establishing a dynamic monitoring system, promoting the variety breeding, constructing a propagation system for improved varieties, enhancing the quality of medicinal herbs, accelerating the adjustment of product structure, upgrading the industry technology, strengthening brand competence and expanding the market, will be the effective methods to realize the sustainable development of A. roxburghii industry. Copyright© by the Chinese Pharmaceutical Association.

Development of framework for sustainable Lean implementation: an ISM approach

NASA Astrophysics Data System (ADS)

Jadhav, Jagdish Rajaram; Mantha, S. S.; Rane, Santosh B.

2014-07-01

The survival of any organization depends upon its competitive edge. Even though Lean is one of the most powerful quality improvement methodologies, nearly two-thirds of the Lean implementations results in failures and less than one-fifth of those implemented have sustained results. One of the most significant tasks of top management is to identify, understand and deploy the significant Lean practices like quality circle, Kanban, Just-in-time purchasing, etc. The term `bundle' is used to make groups of inter-related and internally consistent Lean practices. Eight significant Lean practice bundles have been identified based on literature reviewed and opinion of the experts. The order of execution of Lean practice bundles is very important. Lean practitioners must be able to understand the interrelationship between these practice bundles. The objective of this paper is to develop framework for sustainable Lean implementation using interpretive structural modelling approach.

Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study.

PubMed

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Interactional Resources for Quality Improvement: Learning from Participants through a Qualitative Study

PubMed Central

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

2017-01-01

BACKGROUND Implementing quality improvement in hospitals requires a multi-faceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: 1) a critical outside perspective on their implementation progress; 2) opportunities to learn from peers, especially around clinical innovations; and 3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs. PMID:28375951

Organizational management practices for achieving software process improvement

NASA Technical Reports Server (NTRS)

Kandt, Ronald Kirk

2004-01-01

The crisis in developing software has been known for over thirty years. Problems that existed in developing software in the early days of computing still exist today. These problems include the delivery of low-quality products, actual development costs that exceed expected development costs, and actual development time that exceeds expected development time. Several solutions have been offered to overcome out inability to deliver high-quality software, on-time and within budget. One of these solutions involves software process improvement. However, such efforts often fail because of organizational management issues. This paper discusses business practices that organizations should follow to improve their chances of initiating and sustaining successful software process improvement efforts.

A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculum.

PubMed

Tomolo, A M; Lawrence, R H; Aron, D C

2009-10-01

In 2002, the Accreditation Council for Graduate Medical Education (ACGME) introduced a new requirement: residents must demonstrate competency in Practice-Based Learning and Improvement (PBLI). Training in this domain is still not consistently integrated into programmes, with few, if any, adequately going beyond knowledge of basic content and addressing all components of the requirement. To summarise the implementation of a PBLI curriculum designed to address all components of the requirement and to evaluate the impact on the practice system. A case-study approach was used for identifying and evaluating the steps for delivering the curriculum, along with the Model for Improvement's successive Plan-Do-Study-Act (PDSA) cycles (July 2004-May 2006). Notes from curriculum development meetings, notes and presentation slides made by teams about their projects, resident curriculum exit evaluations curriculum and interviews. Residents reported high levels of comfort by applying PBLI-related knowledge and skills and that the curriculum improved their ability to do various PBLI tasks. The involvement of multiple stakeholders increased. Twelve of the 15 teams' suggestions with practical systems-relevant outcomes were implemented and sustained beyond residents' project periods. While using the traditional PDSA cycles was helpful, there were limitations. A PBLI curriculum that is centred around practice-based quality improvement projects can fulfil the objectives of this ACGME competency while accomplishing sustained outcomes in quality improvement. A comprehensive curriculum is an investment but offers organisational rewards. We propose a more realistic and informative representation of rapid PDSA cycle changes.

A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculum.

PubMed

Tomolo, A M; Lawrence, R H; Aron, D C

2009-06-01

In 2002, the Accreditation Council for Graduate Medical Education (ACGME) introduced a new requirement: residents must demonstrate competency in Practice-Based Learning and Improvement (PBLI). Training in this domain is still not consistently integrated into programmes, with few, if any, adequately going beyond knowledge of basic content and addressing all components of the requirement. To summarise the implementation of a PBLI curriculum designed to address all components of the requirement and to evaluate the impact on the practice system. A case-study approach was used for identifying and evaluating the steps for delivering the curriculum, along with the Model for Improvement's successive Plan-Do-Study-Act (PDSA) cycles (July 2004-May 2006). Notes from curriculum development meetings, notes and presentation slides made by teams about their projects, resident curriculum exit evaluations curriculum and interviews. Residents reported high levels of comfort by applying PBLI-related knowledge and skills and that the curriculum improved their ability to do various PBLI tasks. The involvement of multiple stakeholders increased. Twelve of the 15 teams' suggestions with practical systems-relevant outcomes were implemented and sustained beyond residents' project periods. While using the traditional PDSA cycles was helpful, there were limitations. A PBLI curriculum that is centred around practice-based quality improvement projects can fulfil the objectives of this ACGME competency while accomplishing sustained outcomes in quality improvement. A comprehensive curriculum is an investment but offers organisational rewards. We propose a more realistic and informative representation of rapid PDSA cycle changes.

Developing Quality Improvement capacity and capability across the Children in Fife partnership.

PubMed

Morris, Craig; Alexander, Ingrid

2016-01-01

A Project Manager from the Fife Early Years Collaborative facilitated a large-scale Quality Improvement (herein QI) project to build organisational capacity and capability across the Children in Fife partnership through three separate, eight month training cohorts. This 18 month QI project enabled 32 practitioners to increase their skills, knowledge, and experiences in a variety of QI tools including the Model for Improvement which then supported the delivery of high quality improvement projects and improved outcomes for children and families. Essentially growing the confidence and capability of practitioners to deliver sustainable QI. 27 respective improvement projects were delivered, some leading to service redesign, reduced waiting times, increased uptake of health entitlements, and improved accessibility to front-line health services. 13 improvement projects spread or scaled beyond the initial site and informal QI mentoring took place with peers in respective agencies. Multiple PDSA cycles were conducted testing the most efficient and effective support mechanisms during and post training, maintaining regular contact, and utilising social media to share progress and achievements.

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

PubMed

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

2011-12-01

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

SEASAT economic assessment. Volume 5: Coastal zones case study and generalization. [economic benefits of weather forecasting by SEASAT satellites to the coastal plains of the United States

NASA Technical Reports Server (NTRS)

1975-01-01

The economic losses sustained in the U.S. coastal zones were studied for the purpose of quantitatively establishing economic benefits as a consequence of improving the predictive quality of destructive phenomena in U.S. coastal zones. Improved prediction of hurricane landfall and improved experimental knowledge of hurricane seeding are discussed.

CrossTalk: The Journal of Defense Software Engineering. Volume 22, Number 6, September/October 2009

DTIC Science & Technology

2009-10-01

software to improve the reliability, sustainability, and responsiveness of our warfighting capability. Subscriptions: Send correspondence concerning...endorsed by, the U.S. government, the DoD, the co-sponsors, or the STSC.All product names referenced in this issue are trademarks of their companies...Authors will use this section to share evidence of a demonstrative return on investment, process improvement , quality improvement , reductions to schedule

The perceived importance and the presence of creative potential in the health professional's work environment.

PubMed

Lukersmith, Sue; Burgess-Limerick, Robin

2013-01-01

The value of creative employees to an organisation's growth and innovative development, productivity, quality and sustainability is well established. This study examined the perceived relationship between creativity and work environment factors of 361 practicing health professionals, and whether these factors were present (realised) in their work environment. Job design (challenges, team work, task rotation, autonomy) and leadership (coaching supervisor, time for thinking, creative goals, recognition and incentives for creative ideas and results) were perceived as the most important factors for stimulating creativity. There was room for improvement of these in the work environment. Many aspects of the physical work environment were less important. Public health sector employers and organisations should adopt sustainable strategies which target the important work environment factors to support employee creativity and so enhance service quality, productivity, performance and growth. Implications of the results for ergonomists and workplace managers are discussed with a participatory ergonomics approach recommended. Creative employees are important to an organisation's innovation, productivity and sustainability. The survey identified health professionals perceive a need to improve job design and leadership factors at work to enhance and support employee creativity. There are implications for organisations and ergonomists to investigate the creative potential of work environments.

Energy, Transportation, Air Quality, Climate Change, Health Nexus: Sustainable Energy is Good for Our Health.

PubMed

Erickson, Larry E; Jennings, Merrisa

2017-01-01

The Paris Agreement on Climate Change has the potential to improve air quality and human health by encouraging the electrification of transportation and a transition from coal to sustainable energy. There will be human health benefits from reducing combustion emissions in all parts of the world. Solar powered charging infrastructure for electric vehicles adds renewable energy to generate electricity, shaded parking, and a needed charging infrastructure for electric vehicles that will reduce range anxiety. The costs of wind power, solar panels, and batteries are falling because of technological progress, magnitude of commercial activity, production experience, and competition associated with new trillion dollar markets. These energy and transportation transitions can have a very positive impact on health. The energy, transportation, air quality, climate change, health nexus may benefit from additional progress in developing solar powered charging infrastructure.

An Ecological Assessment of the United States Mid-Atlantic Region: A Landscape Atlas

Treesearch

K. Bruce Jones; Kurt H. Riitters; James D. Wickham; Roger D. Tankersley; Robert V. O' Neill; Deborah J. Chaloud; Elizabeth R. Smith; Anne C. Neale

1997-01-01

Environmental quality affects our health, our quality of life, the sustainability of our economies, and the futures of our children. Yet pressures from an increasing population coupled with the need for economic development and an improved standard of living often have multiple effects on our natural resources. So just as a person with a less-than-healthy lifestyle is...

The Kinzua Quality Deer Cooperative: can adaptive management and local stakeholder engagement sustain reduced impact of ungulate browsers in forest systems?

Treesearch

Susan L. Stout; Alejandro A. Royo; David S. deCalesta; Kevin McAleese; James C. Finley

2013-01-01

The Kinzua Quality Deer Cooperative (KQDC) was established in 2000 to test new approaches to stewardship of white-tailed deer and forest habitat on a 30 000 hectare landscape in northwest Pennsylvania, USA. Partners included land managers, scientists, educators, tourism promoters,and hunters. KQDC goals were adaptive management of the deer herd, improved habitat...

Designing, testing, and implementing a sustainable nurse home visiting program: right@home.

PubMed

Goldfeld, Sharon; Price, Anna; Kemp, Lynn

2018-05-01

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.

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

PubMed

Nix, Kathryn A; O'Shea, John S

2015-06-01

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

The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India.

PubMed

Kara, Nabihah; Firestone, Rebecca; Kalita, Tapan; Gawande, Atul A; Kumar, Vishwajeet; Kodkany, Bhala; Saurastri, Rajiv; Pratap Singh, Vinay; Maji, Pinki; Karlage, Ami; Hirschhorn, Lisa R; Semrau, Katherine Ea

2017-06-27

Shifting childbirth into facilities has not improved health outcomes for mothers and newborns as significantly as hoped. Improving the quality and safety of care provided during facility-based childbirth requires helping providers to adhere to essential birth practices-evidence-based behaviors that reduce harm to and save lives of mothers and newborns. To achieve this goal, we developed the BetterBirth Program, which we tested in a matched-pair, cluster-randomized controlled trial in Uttar Pradesh, India. The goal of this intervention was to improve adoption and sustained use of the World Health Organization Safe Childbirth Checklist (SCC), an organized collection of 28 essential birth practices that are known to improve the quality of facility-based childbirth care. Here, we describe the BetterBirth Program in detail, including its 4 main features: implementation tools, an implementation strategy of coaching, an implementation pathway (Engage-Launch-Support), and a sustainability plan. This coaching-based implementation of the SCC motivates and empowers care providers to identify, understand, and resolve the barriers they face in using the SCC with the resources already available. We describe important lessons learned from our experience with the BetterBirth Program as it was tested in the BetterBirth Trial. For example, the emphasis on relationship building and respect led to trust between coaches and birth attendants and helped influence change. In addition, the cloud-based data collection and feedback system proved a valuable asset in the coaching process. More research on coaching-based interventions is required to refine our understanding of what works best to improve quality and safety of care in various settings.Note: At the time of publication of this article, the results of evaluation of the impact of the BetterBirth Program were pending publication in another journal. After the impact findings have been published, we will update this article with a reference to the impact findings. © Kara et al.

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

PubMed

Barnas, Kim

2011-09-01

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

[In-house team seminars: working together as a team--from data and statistics to quality development].

PubMed

Berlage, Silvia; Wenzlaff, Paul; Damm, Gabriele; Sens, Brigitte

2010-01-01

The concept of the "ZQ In-house Seminars" provided by external trainers/experts pursues the specific aim to enable all healthcare staff members of hospital departments to analyse statistical data--especially from external quality measurements--and to initiate in-hospital measures of quality improvement based on structured team work. The results of an evaluation in Lower Saxony for the period between 2004 and 2008 demonstrate a sustainable increase in outcome quality of care and a strengthening of team and process orientation in clinical care.

Education in Quality Improvement for Pediatric Practice: an online program to teach clinicians QI.

PubMed

Bundy, David G; Morawski, Lori F; Lazorick, Suzanne; Bradbury, Scott; Kamachi, Karen; Suresh, Gautham K

2014-01-01

Education in Quality Improvement for Pediatric Practice (EQIPP) is an online program designed to improve evidence-based care delivery by teaching front-line clinicians quality improvement (QI) skills. Our objective was to evaluate EQIPP data to characterize 1) participant enrollment, use patterns, and demographics; 2) changes in performance in clinical QI measures from baseline to follow-up measurement; and 3) participant experience. We conducted an observational study of EQIPP participants utilizing 1 of 3 modules (asthma, immunizations, gastroesophageal reflux disease) from 2009 to 2013. Enrollment and use, demographic, and quality measure data were extracted directly from the EQIPP system; participant experience was assessed via an optional online survey. Study participants (n = 3501) were diverse in their gender, age, and race; most were board certified. Significant quality gaps were observed across many of the quality measures at baseline; sizable improvements were observed across most quality measures at follow-up. Participants were generally satisfied with their experience. The most influential module elements were collecting and analyzing data, creating and implementing aim statements and improvement plans, and completing "QI Basics." Online educational programs, such as EQIPP, hold promise for front-line clinicians to learn QI. The sustainability of the observed improvements in care processes and their linkage to improvements in health outcomes are unknown and are an essential topic for future study. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets

PubMed Central

Perignon, Marlène; Vieux, Florent; Soler, Louis-Georges; Masset, Gabriel

2017-01-01

The Food and Agriculture Organization defines sustainable diets as nutritionally adequate, safe, healthy, culturally acceptable, economically affordable diets that have little environmental impact. This review summarizes the studies assessing, at the individual level, both the environmental impact and the nutritional quality or healthiness of self-selected diets. Reductions in meat consumption and energy intake were identified as primary factors for reducing diet-related greenhouse gas emissions. The choice of foods to replace meat, however, was crucial, with some isocaloric substitutions possibly increasing total diet greenhouse gas emissions. Moreover, nutritional adequacy was rarely or only partially assessed, thereby compromising the assessment of diet sustainability. Furthermore, high nutritional quality was not necessarily associated with affordability or lower environmental impact. Hence, when identifying sustainable diets, each dimension needs to be assessed by relevant indicators. Finally, some nonvegetarian self-selected diets consumed by a substantial fraction of the population showed good compatibility with the nutritional, environmental, affordability, and acceptability dimensions. Altogether, the reviewed studies revealed the scarcity of standardized nationally representative data for food prices and environmental indicators and suggest that diet sustainability might be increased without drastic dietary changes. PMID:27974596

Air, Climate, and Energy Strategic Research Action Plan, 2012 - 2016

EPA Pesticide Factsheets

As the U.S. Environmental Protection Agency (EPA) moves forward, it is necessary to more fully understand the interplay between air, climate change, and the changing energy landscape to develop innovative and sustainable solutions to improve air quality

Improving global environmental management with standard corporate reporting.

PubMed

Kareiva, Peter M; McNally, Brynn W; McCormick, Steve; Miller, Tom; Ruckelshaus, Mary

2015-06-16

Multinational corporations play a prominent role in shaping the environmental trajectory of the planet. The integration of environmental costs and benefits into corporate decision-making has enormous, but as yet unfulfilled, potential to promote sustainable development. To help steer business decisions toward better environmental outcomes, corporate reporting frameworks need to develop scientifically informed standards that consistently consider land use and land conversion, clean air (including greenhouse gas emissions), availability and quality of freshwater, degradation of coastal and marine habitats, and sustainable use of renewable resources such as soil, timber, and fisheries. Standardization by itself will not be enough--also required are advances in ecosystem modeling and in our understanding of critical ecological thresholds. With improving ecosystem science, the opportunity for realizing a major breakthrough in reporting corporate environmental impacts and dependencies has never been greater. Now is the time for ecologists to take advantage of an explosion of sustainability commitments from business leaders and expanding pressure for sustainable practices from shareholders, financial institutions, and consumers.

Improving global environmental management with standard corporate reporting

PubMed Central

Kareiva, Peter M.; McNally, Brynn W.; McCormick, Steve; Miller, Tom; Ruckelshaus, Mary

2015-01-01

Multinational corporations play a prominent role in shaping the environmental trajectory of the planet. The integration of environmental costs and benefits into corporate decision-making has enormous, but as yet unfulfilled, potential to promote sustainable development. To help steer business decisions toward better environmental outcomes, corporate reporting frameworks need to develop scientifically informed standards that consistently consider land use and land conversion, clean air (including greenhouse gas emissions), availability and quality of freshwater, degradation of coastal and marine habitats, and sustainable use of renewable resources such as soil, timber, and fisheries. Standardization by itself will not be enough—also required are advances in ecosystem modeling and in our understanding of critical ecological thresholds. With improving ecosystem science, the opportunity for realizing a major breakthrough in reporting corporate environmental impacts and dependencies has never been greater. Now is the time for ecologists to take advantage of an explosion of sustainability commitments from business leaders and expanding pressure for sustainable practices from shareholders, financial institutions, and consumers. PMID:26082543

From Science, Engineering and Innovation to Sustainable Development: The Path Forward

NASA Astrophysics Data System (ADS)

Turekian, Vaughan

2017-01-01

In September 2015, world leaders committed to a new 2030 Agenda for Sustainable Development, with 17 Sustainable Development Goals (SDGs) aimed at ending poverty, hunger and inequality, taking action on the environment and climate change, and improving access to health and education. Science, technology and innovation (STI) underpin the achievement of all of the SDGs, whether it is expanding access to health services and quality education; improving food security; and access to clean water and sanitation; building transparent, accountable, and stable institutions; empowering women and minorities; or promoting the sustainable management and use of renewable energy and natural resources. The goals speak to a broad range of directions the world needs to go to promote economic, environmental, and social well-being. The goals are interdependent and achieving one will only be possible by achieving all. We have an obligation to take necessary steps that integrate all the different stakeholders and constant advances in innovation, science, and technology.

Developing and sustaining leadership in public health nursing: findings from one British Columbia health authority.

PubMed

Mills, Leslie; Wong, Sabrina T; Bhagat, Radhika; Quail, Donna; Triolet, Kathy; Weber, Tannis

2012-12-01

To develop clinical leadership among front-line public health nurses (PHNs). This paper describes a quality improvement process to develop clinical leadership among front-line PHNs. Three activities were undertaken by a working group consisting mainly of front-line staff: engaging PHNs in an online change-readiness questionnaire, administering a survey to clients who had ever used public health services delivered by one Vancouver Community Infant, Child and Youth (ICY) program team and conducting three group interviews with public health providers. The group interviews asked about PHN practice. They were analyzed using thematic content analysis. This quality improvement project suggests that PHNs (n=70) strongly believed in opportunities for system improvement. Client surveys (n=429) and community partner surveys (n=79) revealed the importance of the PHN role. Group interview data yielded three themes: PHNs were the "hub" of community care; PHNs lacked a common language to describe their work; PHNs envisioned their future practice encompassing their full scope of competencies. PHNs developed the "ICY Public Health Nursing Model," which articulates 14 public health interventions and identifies the scope of their work. Developing and sustaining clinical leadership in front-line PHNs was accomplished through these various quality assurance activities. Copyright © 2013 Longwoods Publishing.

Strengthening national health laboratories in sub-Saharan Africa: a decade of remarkable progress.

PubMed

Alemnji, G A; Zeh, C; Yao, K; Fonjungo, P N

2014-04-01

Efforts to combat the HIV/AIDS pandemic have underscored the fragile and neglected nature of some national health laboratories in Africa. In response, national and international partners and various governments have worked collaboratively over the last several years to build sustainable laboratory capacities within the continent. Key accomplishments reflecting this successful partnership include the establishment of the African-based World Health Organization Regional Office for Africa (WHO-AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA); development of the Strengthening Laboratory Management Toward Accreditation (SLMTA) training programme; and launching of a Pan African-based institution, the African Society for Laboratory Medicine (ASLM). These platforms continue to serve as the foundations for national health laboratory infrastructure enhancement, capacity development and overall quality system improvement. Further targeted interventions should encourage countries to aim at integrated tiered referral networks, promote quality system improvement and accreditation, develop laboratory policies and strategic plans, enhance training and laboratory workforce development and a retention strategy, create career paths for laboratory professionals and establish public-private partnerships. Maintaining the gains and ensuring sustainability will require concerted action by all stakeholders with strong leadership and funding from African governments and from the African Union. Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

International Watershed Technology: Improving Water Quality and Quantity at the Local, Basin, and Regional Scales

USGS Publications Warehouse

Tollner, Ernest W.; Douglas-Mankin, Kyle R.

2017-01-01

This article introduces the five papers in the “International Watershed Technology” collection. These papers were selected from 60 technical presentations at the fifth biennial ASABE 21st Century Watershed Technology Conference and Workshop: Improving the Quality of Water Resources at Local, Basin, and Regional Scales, held in Quito, Ecuador, on 3-9 December 2016. The conference focused on solving spatial and temporal water quality and quantity problems and addressed topics such as watershed management in developing countries, aquatic ecology and ecohydrology, ecosystem services, climate change mitigation strategies, flood forecasting, remote sensing, and water resource policy and management. While diverse, the presentation topics reflected the continuing evolution of the “data mining” and “big data” themes of past conferences related to geospatial data applications, with increasing emphasis on practical solutions. The papers selected for this collection represent applications of spatial data analyses toward practical ends with a theme of “tools and techniques for sustainability.” The papers address a range of topics, including the matching of crops with water availability, and assessing the environmental impacts of agricultural production. The papers identify some of the latest tools and techniques for improving sustainability in watershed resource management that are relevant to both developing and developed countries.

Quality, risk management and patient safety: the challenge of effective integration.

PubMed

França, Margarida

2008-01-01

Nowadays we observe the development of three waves of intervention and change within healthcare services: quality management, risk management and patient safety. The Patient Safety movement has been launched at international level as a consequence of the Institute of Medicine's report--To Err is Human, and today patient safety constitutes one basic dimension of health quality subjected to the direct intervention of supranational entities (WHO, EU) and Member States' Governments. The objective of this paper is to raise awareness about the value of quality improvement (QI) methodologies and tools to sustainable healthcare quality outcomes.

Water Quality and Sustainable Environmental Health

NASA Astrophysics Data System (ADS)

Setegn, S. G.

2014-12-01

Lack of adequate safe water, the pollution of the aquatic environment and the mismanagement of resources are major causes of ill-health and mortality, particularly in the developing countries. In order to accommodate more growth, sustainable fresh water resource management will need to be included in future development plans. One of the major environmental issues of concern to policy-makers is the increased vulnerability of ground water quality. The main challenge for the sustainability of water resources is the control of water pollution. To understand the sustainability of the water resources, one needs to understand the impact of future land use and climate changes on the natural resources. Providing safe water and basic sanitation to meet the Millennium Development Goals will require substantial economic resources, sustainable technological solutions and courageous political will. A balanced approach to water resources exploitation for development, on the one hand, and controls for the protection of health, on the other, is required if the benefits of both are to be realized without avoidable detrimental effects manifesting themselves. Meeting the millennium development goals for water and sanitation in the next decade will require substantial economic resources, sustainable technological solutions and courageous political will. In addition to providing "improved" water and "basic" sanitation services, we must ensure that these services provide: safe drinking water, adequate quantities of water for health, hygiene, agriculture and development and sustainable sanitation approaches to protect health and the environment.

Systematic Sustainability Assessment (SSA) Tool for Hydroelectric Project in Malaysia

NASA Astrophysics Data System (ADS)

Turan, Faiz Mohd; Johan, Kartina

2017-08-01

Sustainably developed and managed hydropower has enormous potential to contribute to global sustainability goals. It is known that hydroelectricity contributing small amounts to greenhouse gas emissions and other atmospheric pollutants. However, developing the remaining hydroelectric potential offers many challenges, and public pressure and expectations on the environmental and social performance of hydroelectric tend to increase over time. This paper aims to develop Systematic Sustainability Assessment (SSA) Tool that promotes and guides more sustainable hydroelectric projects in the context of Malaysia. The proposed SSA tool which not only provide a quality and quantitative report of sustainability performance but also act as Self-Assessment Report (SAR) to provide roadmap to achieve greater level of sustainability in project management for continuous improvement. It is expected to provide a common language that allow government, civil society, financial institutions and the hydroelectric sector to talk about and evaluate sustainability issues. The advantage of SSA tool is it can be used at any stage of hydroelectric development, from the earliest planning stages right through to operation.

How collaborative governance can facilitate quality learning for sustainability in cities: A comparative case study of Bristol, Kitakyushu and Tongyeong

NASA Astrophysics Data System (ADS)

Ofei-Manu, Paul; Didham, Robert J.; Byun, Won Jung; Phillips, Rebecca; Dickella Gamaralalage, Premakumara Jagath; Rees, Sian

2017-09-01

Quality learning for sustainability can have a transformative effect in terms of promoting empowerment, leadership and wise investments in individual and collective lives and regenerating the local economies of cities, making them more inclusive, safe, resilient and sustainable. It can also help cities move towards achieving the United Nations Sustainable Development Goals (SDGs). Effecting the transformation of cities into Learning Cities, however, requires changes in the structure of governance. Drawing on interviews with key informants as well as secondary data, this article examines how collaborative governance has facilitated quality learning for sustainability in Bristol (United Kingdom), Kitakyushu (Japan) and Tongyeong (Republic of Korea). Focusing on a conceptual framework and practical application of learning initiatives, this comparative study reveals how these cities' governance mechanisms and institutional structures supported initiatives premised on cooperative learning relationships. While recognising differences in the scope and depth of the learning initiatives and the need for further improvements, the authors found evidence of general support for the governance structures and mechanisms for learning in these cities. The authors conclude by recommending that (1) to implement the Learning Cities concept based on UNESCO's Key Features of Learning Cities, recognition should be given to existing sustainability-related learning initiatives in cities; (2) collaborative governance of the Learning Cities concept at both local and international levels should be streamlined; and (3) UNESCO's Global Network of Learning Cities could serve as a hub for sharing education/learning resources and experiences for other international city-related programmes as an important contribution to the implementation of the SDGs.

Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial.

PubMed

Ross, Stephen; Bossis, Anthony; Guss, Jeffrey; Agin-Liebes, Gabrielle; Malone, Tara; Cohen, Barry; Mennenga, Sarah E; Belser, Alexander; Kalliontzi, Krystallia; Babb, James; Su, Zhe; Corby, Patricia; Schmidt, Brian L

2016-12-01

Clinically significant anxiety and depression are common in patients with cancer, and are associated with poor psychiatric and medical outcomes. Historical and recent research suggests a role for psilocybin to treat cancer-related anxiety and depression. In this double-blind, placebo-controlled, crossover trial, 29 patients with cancer-related anxiety and depression were randomly assigned and received treatment with single-dose psilocybin (0.3 mg/kg) or niacin, both in conjunction with psychotherapy. The primary outcomes were anxiety and depression assessed between groups prior to the crossover at 7 weeks. Prior to the crossover, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life. At the 6.5-month follow-up, psilocybin was associated with enduring anxiolytic and anti-depressant effects (approximately 60-80% of participants continued with clinically significant reductions in depression or anxiety), sustained benefits in existential distress and quality of life, as well as improved attitudes towards death. The psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression. In conjunction with psychotherapy, single moderate-dose psilocybin produced rapid, robust and enduring anxiolytic and anti-depressant effects in patients with cancer-related psychological distress. ClinicalTrials.gov Identifier: NCT00957359. © The Author(s) 2016.

Stormwater Management Effects on Ecosystem Services: A Literature Review

NASA Astrophysics Data System (ADS)

Prudencio, L.; Null, S. E.

2016-12-01

Managing stormwater provides benefits for enhancing water supplies while reducing urban runoff. Yet, there has been little research focused on understanding how stormwater management affects ecosystem services, the benefits that ecosystems provide to humans. Garnering more knowledge of the changes to ecosystem services from stormwater management will ultimately improve management and decision-making. The objective of this research is to review and synthesize published literature on 1) ecosystem services and stormwater management and 2) changes in ecosystem services from anthropogenic impacts and climate warming, to establish a foundation for research at the intersection of ecosystems services, stormwater management, and global environmental change. We outline four research areas for ecosystem services and stormwater management that should be further explored. These four areas, named after the four types of ecosystem services, highlight context-specific research questions and human and climate change effects. We conclude that effective and sustainable stormwater management requires incorporating engineering, social, and environmental criteria to quantify benefits of provisioning, regulating, cultural, and supporting ecosystem services. Lastly, improved current and potential stormwater management policy may better support sustainable stormwater methods at the institutional level. Stormwater quality and monitoring could be improved through the use of the Clean Water Act (e.g. Total Maximum Daily Loads), the Endangered Species Act, and public health measures. Additional policies regulating groundwater quantity and quality have been and may continue to be implemented by states, encouraging sustainable and cleaner stormwater practices.

Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial

PubMed Central

Ross, Stephen; Bossis, Anthony; Guss, Jeffrey; Agin-Liebes, Gabrielle; Malone, Tara; Cohen, Barry; Mennenga, Sarah E; Belser, Alexander; Kalliontzi, Krystallia; Babb, James; Su, Zhe; Corby, Patricia; Schmidt, Brian L

2016-01-01

Background: Clinically significant anxiety and depression are common in patients with cancer, and are associated with poor psychiatric and medical outcomes. Historical and recent research suggests a role for psilocybin to treat cancer-related anxiety and depression. Methods: In this double-blind, placebo-controlled, crossover trial, 29 patients with cancer-related anxiety and depression were randomly assigned and received treatment with single-dose psilocybin (0.3 mg/kg) or niacin, both in conjunction with psychotherapy. The primary outcomes were anxiety and depression assessed between groups prior to the crossover at 7 weeks. Results: Prior to the crossover, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life. At the 6.5-month follow-up, psilocybin was associated with enduring anxiolytic and anti-depressant effects (approximately 60–80% of participants continued with clinically significant reductions in depression or anxiety), sustained benefits in existential distress and quality of life, as well as improved attitudes towards death. The psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression. Conclusions: In conjunction with psychotherapy, single moderate-dose psilocybin produced rapid, robust and enduring anxiolytic and anti-depressant effects in patients with cancer-related psychological distress. Trial Registration: ClinicalTrials.gov Identifier: NCT00957359 PMID:27909164

Nursing's leadership in positioning human health at the core of urban sustainability.

PubMed

St Pierre Schneider, Barbara; Menzel, Nancy; Clark, Michele; York, Nancy; Candela, Lori; Xu, Yu

2009-01-01

The United Nations predicts that by 2050 nearly three fourths of the world's population will live in urban areas, including cities. People are attracted to cities because these urban areas offer diverse opportunities, including the availability of goods and services and a higher quality of life. Cities, however, may not be sustainable with this population boom. To address sustainability, urban developers and engineers are building green structures, and businesses are creating products that are safe for the environment. Additionally, efforts are needed to place human health at the core of urban sustainability. Without human health, cities will not survive for future generations. Nursing is the discipline that can place human health in this position. Nursing's initiatives throughout history are efforts of sustainability-improving human health within the physical, economic, and social environments. Therefore, nursing must take a leadership role to ensure that human health is at the core of urban sustainability.

Increased nutritional value in food crops.

PubMed

Goicoechea, Nieves; Antolín, M Carmen

2017-09-01

Modern agriculture and horticulture must combine two objectives that seem to be almost mutually exclusive: to satisfy the nutritional needs of an increasing human population and to minimize the negative impact on the environment. These two objectives are included in the Goal 2 of the 2030 Agenda for Sustainable Development of the United Nations: 'End hunger, achieve food security and improved nutrition and promote sustainable agriculture'. Enhancing the nutritional levels of vegetables would improve nutrient intake without requiring an increase in consumption. In this context, the use of beneficial rhizospheric microorganisms for improving, not only growth and yield, but also the nutrient quality of crops represents a promising tool that may respond to the challenges for modern agriculture and horticulture and represents an alternative to the genetic engineering of crops. This paper summarizes the state of the art, the current difficulties associated to the use of rhizospheric microorganisms as enhancers of the nutritional quality of food crops as well as the future prospects. © 2017 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

Technology for Improving Early Reading in Multi-Lingual Settings: Evidence from Rural South Africa

ERIC Educational Resources Information Center

Castillo, Nathan M.

2017-01-01

In September 2015, the United Nations ratified 17 Sustainable Development Goals (SDGs), including a central goal to improve the quality of learning, and attain universal literacy. As part of this effort, the UN and other funding agencies see technology as a major enabling tool for achievement of the SDGs. However, little evidence exists concerning…

Merging Education and Business Models to Create and Sustain Transformational Change

ERIC Educational Resources Information Center

Isenberg, Susan

2010-01-01

In 2004, a large Midwest hospital was losing money, patients, employees, and physicians. A business consultant was hired to engage key employees in a process to improve the quality and efficiency of patient care. The improvement was negligible after the first year, so a 3-man consultancy was added in 2005 to engage all employees in an educational…

Using baldrige performance excellence program approaches in the pursuit of radiation oncology quality care, patient satisfaction, and workforce commitment.

PubMed

Sternick, Edward S

2011-01-01

The Malcolm Baldrige National Quality Improvement Act was signed into law in 1987 to advance US business competitiveness and economic growth. Administered by the National Institute of Standards and Technology, the Act created the Baldrige National Quality Program, recently renamed the Baldrige Performance Excellence Program. The comprehensive analytical approaches referred to as the Baldrige Healthcare Criteria, are very well-suited for the evaluation and sustainable improvement of radiation oncology management and operations. A multidisciplinary self-assessment approach is used for radiotherapy program evaluation and development in order to generate a fact-based, knowledge-driven system for improving quality of care, increasing patient satisfaction, enhancing leadership effectiveness, building employee engagement, and boosting organizational innovation. This methodology also provides a valuable framework for benchmarking an individual radiation oncology practice's operations and results against guidelines defined by accreditation and professional organizations and regulatory agencies.

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

PubMed

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

2015-04-21

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

Sustainability and transformation plans: translating the perspectives.

PubMed

Thakrar, Sonali V; Bell, Diane

2017-10-02

Each local health economy has been tasked with producing a sustainability and transformation plan. A health economy is a system that controls and contributes to health-care resource and the effects of health services on its population. This includes commissioners, acute providers, primary care providers, community services, public health and the voluntary sector. Sustainability and transformation plans represent a shift in the way health care is planned for in England. The aim of each sustainability and transformation plan is to deliver care within existing resource limits by improving quality of care, developing new models of care and improving efficiency of care provision. The tight timescales for production of sustainability and transformation plans mean that in most cases there has been limited clinical engagement; as a result many clinicians have limited sight, understanding or ownership of the proposals within sustainability and transformation plans. As sustainability and transformation plans move into the implementation phase, this article explores the role of the clinician in the ongoing design and delivery of the local sustainability and transformation plans. By finding the common ground between the perspectives of the clinician, the commissioner and system leaders, the motivation of clinicians can be aligned with the ambitions of the sustainability and transformation plan. The common goal of a sustainability and transformation plan and the necessary collaboration required to make it successful is discussed. Ultimately, such translation is essential: clinicians are intelligent, adaptive and motivated individuals who must have a lead role in constructing and implementing plans that transform health and social care.

Videotape review leads to rapid and sustained learning.

PubMed

Scherer, Lynette A; Chang, Michael C; Meredith, J Wayne; Battistella, Felix D

2003-06-01

Performance review using videotapes is a strategy employed to improve future performance. We postulated that videotape review of trauma resuscitations would improve compliance with a treatment algorithm. Trauma resuscitations were taped and reviewed during a 6-month period. For 3 months, team members were given verbal feedback regarding performance. During the next 3 months, new teams attended videotape reviews of their performance. Data on targeted behaviors were compared between the two groups. Behavior did not change after 3 months of verbal feedback; however, behavior improved after 1 month of videotape feedback (P <0.05) and total time to disposition was reduced by 50% (P <0.01). This response was sustained for the remainder of the study. Videotape review can be an important learning tool as it was more effective than verbal feedback in achieving behavioral changes and algorithm compliance. Videotape review can be an important quality assurance adjunct, as improved algorithm compliance should be associated with improved patient care.

The ReACH Collaborative--improving quality home care.

PubMed

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

2007-08-01

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

Using phytotechnologies to remediate brownfields, landfills, and other urban areas

Treesearch

R.S. Zalesny Jr.; Jill Zalesny

2010-01-01

Urban areas requiring remedial work has prompted the use of phytotechnologies to improve water quality, soil health, and biodiversity, as well as to achieve sustainable social and economic goals. Phytotechnologies directly use plants to clean up contaminated groundwater, soil, and sediment.

Secukinumab sustains early patient-reported outcome benefits through 1 year: Results from 2 phase III randomized placebo-controlled clinical trials comparing secukinumab with etanercept.

PubMed

Strober, Bruce; Gottlieb, Alice B; Sherif, Bintu; Mollon, Patrick; Gilloteau, Isabelle; McLeod, Lori; Fox, Todd; Mordin, Margaret; Gnanasakthy, Ari; Papavassilis, Charis; Lebwohl, Mark G

2017-04-01

Psoriasis is a chronic condition with negative impact on patients' quality of life that most often requires lifelong effective and safe treatment. This analysis focused on the effect of secukinumab treatment on patient-reported health-related quality of life as assessed by the Dermatology Life Quality Index (DLQI) in patients with moderate to severe psoriasis. The proportion of subjects achieving DLQI score 0/1 response at week 24, time to DLQI score 0/1 response, and sustained DLQI score 0/1 response up to week 52 were compared between secukinumab and etanercept. Of 1470 subjects, 1144 received secukinumab and 326 received etanercept. DLQI score 0/1 response rates were significantly higher for secukinumab than for etanercept at week 24. The median time to DLQI score 0/1 response was significantly shorter for secukinumab versus etanercept (12 vs 24 weeks; P < .01). The majority of secukinumab-treated subjects achieved DLQI score 0/1 response at week 24 and sustained it through week 52 along with a 90% to 100% reduction in the Psoriasis Area and Severity Index total score response. Placebo comparisons are limited during the maintenance period because of rerandomization at week 12. Secukinumab treatment provided faster and greater sustained improvements in quality of life than etanercept over 52 weeks, consistent with greater clinical response. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Quality of life, binge eating and sexual function in participants treated for obesity with sustained release naltrexone/bupropion

PubMed Central

Shan, K.; Gilder, K.; Malone, M.; Acevedo, L.; Fujioka, K.

2018-01-01

Summary Objective This multicenter, randomized, controlled, open‐label trial examined weight‐related quality of life, control over eating behaviour and sexual function after 26 weeks of treatment with either 32 mg naltrexone sustained release (SR)/360 mg bupropion SR plus a comprehensive lifestyle intervention program (NB + CLI, N = 153) or usual care (UC, N = 89), which included minimal lifestyle intervention. Methods Impact of Weight on Quality of Life‐Lite, Binge Eating Scale and Arizona Sexual Experiences Scale were assessed at baseline (BL) and weeks 16 and 26. Results NB + CLI and UC participants lost 9.46 and 0.94% respectively of initial body weight at week 26 (P < 0.0001). NB + CLI participants had greater improvements in Impact of Weight on Quality of Life‐Lite total score than UC participants (P < 0.0001). In participants with moderate/severe Binge Eating Scale scores at BL, 91% of NB + CLI and 18% of UC participants experienced categorical improvements. In participants with Arizona Sexual Experiences Scale‐defined sexual dysfunction at BL, 58% of NB + CLI and 19% of UC participants no longer met dysfunction criteria at week 26. The most frequent adverse events leading to discontinuation before week 26 in NB + CLI included nausea (10.5%); anxiety (3.3%); and headache, hypertension, insomnia and palpitations (1.3% each). Conclusion Compared with UC, participants treated with NB + CLI experienced greater improvements in weight‐related quality of life, control over eating behaviour, and sexual function. PMID:29670752

Assessing the microbial quality of improved drinking water sources: results from the Dominican Republic.

PubMed

Baum, Rachel; Kayser, Georgia; Stauber, Christine; Sobsey, Mark

2014-01-01

Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water), was celebrated as achieved in 2012. However, new studies show that we may be prematurely celebrating. Access to safe drinking water may be overestimated if microbial water quality is considered. The objective of this study was to examine the relationship between microbial drinking water quality and drinking water source in the Puerto Plata region of the Dominican Republic. This study analyzed microbial drinking water quality data from 409 households in 33 communities. Results showed that 47% of improved drinking water sources were of high to very-high risk water quality, and therefore unsafe for drinking. This study provides evidence that the current estimate of safe water access may be overly optimistic, and microbial water quality data are needed to reliably assess the safety of drinking water.

Assessing the Microbial Quality of Improved Drinking Water Sources: Results from the Dominican Republic

PubMed Central

Baum, Rachel; Kayser, Georgia; Stauber, Christine; Sobsey, Mark

2014-01-01

Millennium Development Goal Target 7c (to halve between 1990 and 2015 the proportion of the global population without sustainable access to safe drinking water), was celebrated as achieved in 2012. However, new studies show that we may be prematurely celebrating. Access to safe drinking water may be overestimated if microbial water quality is considered. The objective of this study was to examine the relationship between microbial drinking water quality and drinking water source in the Puerto Plata region of the Dominican Republic. This study analyzed microbial drinking water quality data from 409 households in 33 communities. Results showed that 47% of improved drinking water sources were of high to very-high risk water quality, and therefore unsafe for drinking. This study provides evidence that the current estimate of safe water access may be overly optimistic, and microbial water quality data are needed to reliably assess the safety of drinking water. PMID:24218411

The Development of a Service-Learning Program for First-Year Students Based on the Hallmarks of High Quality Service-Learning and Rigorous Program Evaluation

ERIC Educational Resources Information Center

Smith, Bradley H.; Gahagan, James; McQuillin, Samuel; Haywood, Benjamin; Cole, Caroline Pender; Bolton, Clay; Wampler, Mary Katherine

2011-01-01

We describe six hallmarks of high quality service-learning and explain how these considerations guided the development of a Transitional Coaching Program (TCP) during the first three years of implementation. We have demonstrated that the TCP is acceptable, feasible, and sustainable. Improvements have been seen in the degree of impact on learning…

Biofuel Induced Land Use Change effects on Watershed Hydrology and Water Quality

NASA Astrophysics Data System (ADS)

Chaubey, I.; Cibin, R.; Frankenberger, J.; Cherkauer, K. A.; Volenec, J. J.; Brouder, S. M.

2015-12-01

High yielding perennial grasses such as Miscanthus and switchgrass, and crop residues such as corn stover are expected to play a significant role in meeting US biofuel production targets. We have evaluated the potential impacts of biofuel induced land use changes on hydrology, water quality, and ecosystem services. The bioenergy production scenarios, included: production of Miscanthus × giganteus and switchgrass on highly erodible landscape positions, agricultural marginal land areas, and pastures; removal of corn stover at various rates; and combinations of these scenarios. The hydrology and water quality impacts of land use change scenarios were estimated for two watersheds in Midwest USA (1) Wildcat Creek watershed (drainage area of 2,083 km2) located in north-central Indiana and (2) St. Joseph River watershed (drainage area of 2,809 km2) located in Indiana, Ohio, and Michigan. We have also simulated the impacts of climate change and variability on environmental sustainability and have compared climate change impacts with land use change impacts. The study results indicated improved water quality with perennial grass scenarios compared to current row crop production impacts. Erosion reduction with perennial energy crop production scenarios ranged between 0.2% and 59%. Stream flow at the watershed outlet were reduced between 0.2 and 8% among various bioenergy crop production scenarios. Stover removal scenarios indicated increased erosion compared to baseline condition due reduced soil cover after stover harvest. Stream flow and nitrate loading were reduced with stover removal due to increased soil evaporation and reduced mineralization. A comparison of land use and climate change impacts indicates that land use changes will have considerably larger impacts on hydrology, water quality and environmental sustainability compared to climate change and variability. Our results indicate that production of biofuel crops can be optimized at the landscape level to provide adequate supply of biomass while improving water quality and environmental sustainability.

Ethnopedology and soil quality of bamboo (Bambusa sp.) based agroforestry system.

PubMed

Arun Jyoti, Nath; Lal, Rattan; Das, Ashesh Kumar

2015-07-15

It is widely recognized that farmers' hold important knowledge of folk soil classification for agricultural land for its uses, yet little has been studied for traditional agroforestry systems. This article explores the ethnopedology of bamboo (Bambusa sp.) based agroforestry system in North East India, and establishes the relationship of soil quality index (SQI) with bamboo productivity. The study revealed four basic folk soil (mati) types: kalo (black soil), lal (red soil), pathal (stony soil) and balu (sandy soil). Of these, lal mati soil was the most predominant soil type (~ 40%) in bamboo-based agroforestry system. Soil physio-chemical parameters were studied to validate the farmers' soil hierarchal classification and also to correlate with productivity of the bamboo stand. Farmers' hierarchal folk soil classification was consistent with the laboratory scientific analysis. Culm production (i.e. measure of productivity of bamboo) was the highest (27culmsclump(-1)) in kalo mati (black soil) and the lowest (19culmsclump(-1)) in balu mati (sandy soil). Linear correlation of individual soil quality parameter with bamboo productivity explained 16 to 49% of the variability. A multiple correlation of the best fitted linear soil quality parameter (soil organic carbon or SOC, water holding capacity or WHC, total nitrogen) with productivity improved explanatory power to 53%. Development of SQI from ten relevant soil quality parameters and its correlation with bamboo productivity explained the 64% of the variation and therefore, suggest SQI as the best determinant of bamboo yield. Data presented indicate that the kalo mati (black soil) is sustainable or sustainable with high input. However, the other three folk soil types (red, stony and sandy soil) are also sustainable but for other land uses. Therefore, ethnopedological studies may move beyond routine laboratory analysis and incorporate SQI for assessing the sustainability of land uses managed by the farmers'. Additional research is required to incorporate principal component analysis for improving the SQI and site potential assessment. It is also important to evaluate the minimum data set (MDS) required for SQI and productivity assessment in agroforestry systems. Copyright © 2015 Elsevier B.V. All rights reserved.

Transvenous stimulation of the phrenic nerve for the treatment of central sleep apnoea: 12 months' experience with the remedē® System.

PubMed

Jagielski, Dariusz; Ponikowski, Piotr; Augostini, Ralph; Kolodziej, Adam; Khayat, Rami; Abraham, William T

2016-11-01

Patients with central sleep apnoea (CSA) often have poor quality of life and are at increased risk of morbidity and mortality. This study sought to evaluate the 12-month clinical outcomes of patients with CSA treated with unilateral transvenous phrenic nerve stimulation in the prospective, multicentre, non-randomized remedē ® System pilot study. Forty-seven patients with CSA were treated with the remedē ® System (Respicardia Inc., Minnetonka, MN, USA) for a minimum of 3 months. Sleep-disordered breathing parameters were evaluated by polysomnography (PSG) at 3, 6, and 12-month follow-up. Sleep symptoms and quality of life were also evaluated. Forty-one patients completed all follow-up PSGs and were included in the analysis. At 12 months, there was sustained improvement compared with baseline in the apnoea-hypopnoea index (49.9 ± 15.1 vs. 27.5 ± 18.3 events/h, P < 0.001) and central apnoea index (28.2 ± 15.0 vs. 6.0 ± 9.2 events/h, P < 0.001). Sustained improvement in the oxygen desaturation index (46.1 ± 19.1 vs. 26.9 ± 18.0 events/h, P < 0.001), rapid eye movement sleep (11.4 ± 6.1% vs. 17.1 ± 8.0%, P < 0.001), and sleep efficiency (69.3 ± 16.9% vs. 75.6 ± 17.1%, P = 0.024) were also observed. There were also continued favourable effects on sleepiness and quality of life. Three deaths unrelated to remedē ® System therapy and five serious adverse events occurred over 12 months of follow-up. The present study demonstrates that in patients with CSA, unilateral transvenous phrenic nerve stimulation is associated with sustained improvement in key sleep parameters, sleep symptoms, and quality of life over 12 months of follow-up. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

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

PubMed

Keyser, Donna J; Pincus, Harold Alan

2010-01-01

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

Levers supporting tariff growth for water services: evidence from a contingent valuation analysis.

PubMed

Guerrini, Andrea; Vigolo, Vania; Romano, Giulia; Testa, Federico

2018-02-01

The backwardness of the water utilities sector necessitates urgent investment in infrastructure to improve water quality and efficiency in water supply networks. A policy of tariff growth represents the main source to sustain such investments. Therefore, customer engagement in the form of willingness to pay (WTP) is highly desirable by water utilities to obtain social legitimization and support. This study examines the determinants of consumers' WTP for improvement programs for three drinking water issues: quality of water sources, renewal of water mains, and building of new wastewater treatment plants. The study is based on a survey conducted among a sample of 587 customers of a water utility located in the province of Verona in the north of Italy. The contingence valuation method is used to measure WTP. Specifically, an ordinal logistic regression model yields the following significant determinants of WTP: quality of water and services provided, preference for privatization of the water utility, sustainable consumption of water, and some socio-demographic variables. The findings provide interesting insights into the drivers of WTP as well as managerial recommendations for water utilities. In particular, the findings show that water utilities need to improve service and water quality to increase customers' acceptance of tariff growth. In addition, utilities should invest in customer education and communication activities focusing on specific age groups (e.g., older customers) to enhance their WTP. Finally, communication strategies should reinforce the possible role of liberalization and privatization in supporting infrastructure investments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Energy, Transportation, Air Quality, Climate Change, Health Nexus: Sustainable Energy is Good for Our Health

PubMed Central

Erickson, Larry E.; Jennings, Merrisa

2017-01-01

The Paris Agreement on Climate Change has the potential to improve air quality and human health by encouraging the electrification of transportation and a transition from coal to sustainable energy. There will be human health benefits from reducing combustion emissions in all parts of the world. Solar powered charging infrastructure for electric vehicles adds renewable energy to generate electricity, shaded parking, and a needed charging infrastructure for electric vehicles that will reduce range anxiety. The costs of wind power, solar panels, and batteries are falling because of technological progress, magnitude of commercial activity, production experience, and competition associated with new trillion dollar markets. These energy and transportation transitions can have a very positive impact on health. The energy, transportation, air quality, climate change, health nexus may benefit from additional progress in developing solar powered charging infrastructure. PMID:29922702

Decreasing Postanesthesia Care Unit to Floor Transfer Times to Facilitate Short Stay Total Joint Replacements.

PubMed

Sibia, Udai S; Grover, Jennifer; Turcotte, Justin J; Seanger, Michelle L; England, Kimberly A; King, Jennifer L; King, Paul J

2018-04-01

We describe a process for studying and improving baseline postanesthesia care unit (PACU)-to-floor transfer times after total joint replacements. Quality improvement project using lean methodology. Phase I of the investigational process involved collection of baseline data. Phase II involved developing targeted solutions to improve throughput. Phase III involved measured project sustainability. Phase I investigations revealed that patients spent an additional 62 minutes waiting in the PACU after being designated ready for transfer. Five to 16 telephone calls were needed between the PACU and the unit to facilitate each patient transfer. The most common reason for delay was unavailability of the unit nurse who was attending to another patient (58%). Phase II interventions resulted in transfer times decreasing to 13 minutes (79% reduction, P < .001). Phase III recorded sustained transfer times at 30 minutes, a net 52% reduction (P < .001) from baseline. Lean methodology resulted in the immediate decrease of PACU-to-floor transfer times by 79%, with a 52% sustained improvement. Our methods can also be used to improve efficiencies of care at other institutions. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

A full value-chain Water Footprint Assessment to help informed decision in corporate sustainability strategies

NASA Astrophysics Data System (ADS)

Zhang, Guoping; Chico Zamanilo, Daniel; Bai, Xue; Ren, Xiajing; Chen, Rong; Qin, Jun

2017-04-01

This study evaluated the water footprint (WF) of five production facilities along Muyuan Foodstuff Co. Ltd's (Muyuan) value chain, and assessed the sustainability and impact of their water footprints at the river catchment level. Muyuan, a large-scale, integrated pig breeder and producer in China, is keen to fulfil its corporate social responsibilities and committed to ensuring food quality and security, promoting environmental protection, and participating in catchment water resources management. Formulating corporate water related sustainability strategies, however, has been challenging. This study carried out a comprehensive Water Footprint Assessment (WFA) for Muyuan's full value chain to assist in formulating such strategies and setting up action plans with water footprint reduction targets. The study showed that that the water footprint of the supply chain, resulting from crops and crop products used in Muyuan's feed production facility is a major contributor to Muyuan's facilities' water footprint. From the perspective of the direct WF at the facilities, addressing the impact on water quality from effluents (i.e. the grey water footprint) at hog farms is a critical component of any water sustainability strategy. From the blue WF perspective, there are opportunities to reduce blue water consumption at hog farms through improved technology and implementation of best practices. The water footprint sustainability assessment in this study indicated that Muyuan operates in a catchment which is already under water stress and is a hotspot in terms of both blue water scarcity and water pollution level. The study helped identify potential water-related risks and opportunities for improving Muyuan's water use efficiency as well as ways Muyuan could contribute to sustainable water resources management in the catchment within which it operates. This is an innovative application of WFA in the livestock sector and supports the development of Muyuan's corporate water sustainability strategy. The results of the study were also used in the development of the national water footprint standard for organisations.

A new framework for sustainable hydropower development project

NASA Astrophysics Data System (ADS)

Johan, Kartina; Turan, Faiz Mohd; Gani, Nur Syazwani Abdul

2018-03-01

This project studies on the establishment of a new framework for sustainable hydropower development. A hydropower development is listed as one of the prescribed activities under the Environmental Quality Order 1987. Thus, Environmental Impact Assessment (EIA) guidelines must be referred to comply with the Department of Environment (DoE) requirements. In order to execute EIA, an assessment tool that will be utilized in the final evaluation phase must be determined. The selected assessment tool that will be used is Systematic Sustainability Assessment(SSA) which is a new integrated tool to evaluate the sustainability performance. A pilot run is conducted in five different departments within the Energy Company to validate the efficiency of the SSA tool. The parameters to be evaluated are constructed aligned with the Sustainable Development Goals (SDG) to maintain the sustainability features. Consequently, the performance level of the sustainability with respect to People, Planet and Profit (3P’s) is able to be discovered during evaluation phase in the hydropower development for continuous improvement.

Hyper-Realistic, Team-Centered Fleet Surgical Team Training Provides Sustained Improvements in Performance.

PubMed

Hoang, Tuan N; Kang, Jeff; Siriratsivawong, Kris; LaPorta, Anthony; Heck, Amber; Ferraro, Jessica; Robinson, Douglas; Walsh, Jonathan

2016-01-01

The high-stress, fast-paced environment of combat casualty care relies on effective teamwork and communication which translates into quality patient care. A training course was developed for U.S. Navy Fleet Surgical Teams to address these aspects of patient care by emphasizing efficiency and appropriate patient care. An effective training course provides knowledge and skills to pass the course evaluation and sustain the knowledge and skills acquired over time. The course included classroom didactic hours, and hands-on simulation sessions. A pretest was administered before the course, a posttest upon completion, and a sustainment test 5 months following course completion. The evaluation process measured changes in patient time to disposition and critical errors made during patient care. Naval Base San Diego, with resuscitation and surgical simulations carried out within the shipboard medical spaces. United States Navy medical personnel including physicians of various specialties, corpsmen, nurses, and nurse anesthetists deploying aboard ships. Time to disposition improved significantly, 11 ± 3 minutes, from pretest to posttest, and critical errors improved by 4 ± 1 errors per encounter. From posttest to sustainment test, time to disposition increased by 3 ± 1, and critical errors decreased by 1 ± 1. This course showed value in improving teamwork and communication skills of participants, immediately upon completion of the course, and after 5 months had passed. Therefore, with ongoing sustainment activities within 6 months, this course can substantially improve trauma care provided by shipboard deployed Navy medical personnel to wounded service members. Published by Elsevier Inc.

Let Us Use LET: A Quality Improvement Initiative.

PubMed

Sherman, Joshua M; Sheppard, Patrick; Hoppa, Eric; Krief, William; Avarello, Jahn

2016-07-01

Well-managed pain is associated with faster recovery, fewer complications, and decreased use of resources. In children, pain relief is also associated with higher patient and parent satisfaction. Studies have shown that there are deficiencies in pediatric pain management. LET gel (lidocaine 4%, epinephrine 0.1%, and tetracaine 0.5%) is a topical anesthetic that is routinely used before laceration repair. The aim of this study was to determine if educational initiatives as part of a quality improvement initiative lead to increased rates of early topical anesthetic usage in a large urban pediatric emergency department. The initiative consisted of an educational session and a triage booth poster. We then reviewed the charts of patients with facial and scalp lacerations for the month before the initiative, the month after the initiative, and 1 year after the initiative. We assessed if LET gel usage and time to administration improved and were sustainable. We reviewed 138 charts. Before the initiative, only 57.4% received LET gel before facial laceration repair with a mean time to application of 58.3 minutes. One month after the initiative, there was an increase in LET gel application by 20.1% with a reduction in time to application by 35.9 minutes (P < 0.05). In addition, these improvements were significantly sustainable. One year after the interventions, 82.4% received LET before facial laceration repair, and the time to LET application was 27.8 minutes. Simple educational initiatives can improve the use of topical anesthetics. By using educational tools as part of a quality improvement initiative, we were able to significantly improve the rates of LET gel application for facial lacerations in children and decrease the time to administration.

Lessons from the application of genomic selection to rainbow trout aquaculture

USDA-ARS?s Scientific Manuscript database

Selective breeding programs to improve performance in economically important traits such as growth, disease resistance, slaughter traits and flesh quality are key to the success and sustainability of maturing aquaculture industries. The rate of genetic progress per generation has traditionally been...

The ten years (2004-2014): Progress in peanut genetics and genomics

USDA-ARS?s Scientific Manuscript database

Plant breeding, genetics, and genomics play a critical role in sustainable agriculture specifically in improving crop productivity, quality, and resistance to pests and diseases. The germplasm collections have been treasures of crop genetic resources. Utilization of the collections of wild peanut sp...

Biking in fresh air: consideration of exposure to traffic-related air pollution in bicycle route planning.

DOT National Transportation Integrated Search

2017-03-01

Active transportation modes such as walking and biking are key elements of sustainable : transportation systems. In order to promote biking as an alternative form of transportation, a : holistic approach to improving the quality of the biking experie...

Current perspectives in contaminant hydrology and water resources sustainability

USGS Publications Warehouse

Bradley, Paul M.

2013-01-01

Human society depends on liquid freshwater resources to meet drinking, sanitation and hygiene, agriculture, and industry needs. Improved resource monitoring and better understanding of the anthropogenic threats to freshwater environments are critical to efficient management of freshwater resources and ultimately to the survival and quality of life of the global human population. This book helps address the need for improved freshwater resource monitoring and threat assessment by presenting current reviews and case studies focused on the fate and transport of contaminants in the environment and on the sustainability of groundwater and surface-water resources around the world. It is intended for students and professionals working in hydrology and water resources management.

Introducing a quality improvement programme to primary healthcare teams

PubMed Central

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

1998-01-01

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

Sustainability in a state comprehensive cancer control coalition: lessons learned.

PubMed

Desmond, Renee A; Chapman, Kathryn; Graf, Gavin; Stanfield, Bret; Waterbor, John W

2014-03-01

The Alabama Comprehensive Cancer Control Coalition (ACCCC) has developed an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality, and to improving the quality of life for cancer survivors, their families, and their caregivers. The ACCCC is currently in a maintenance phase and a formal plan for sustainability of the coalition was needed to keep the members engaged and productive. A training session in coalition sustainability conducted in 2013 identified the following elements as essential to success: (1) increased marketing of the coalition by simplifying its mission; (2) improved networking including flexibility in coalition meeting location and attendance; (3) increased membership satisfaction through transformational leadership; (4) revision of the working structure of committees and improved accountability; and (5) enhancement of partner satisfaction with coalition activities designed to recruit and retain new partners. A self-administered membership satisfaction survey was given to assess coalition mission, meeting logistics, organization, capacity building, and coalition goals. Results indicated that the subcategories of communication, mission, and meeting logistics were rated satisfied to very satisfied on a five-point scale. Although the ACCCC had clearly written goals, improvement could be made in leadership participation and new member orientation could be improved. Most members rated their parent organization as highly involved with the ACCCC and many offered suggestions on capacity building. Results of the sustainability training have clarified the ACCCC's plans to ensure coalition viability and improve strategies to inform stakeholders of the benefits of participation in the coalition.

Performance management of Clostridium difficile infection in hospitals - The carrot or stick approach?

PubMed

Fitzpatrick, Fidelma; Riordan, Mary O

2016-02-01

Public and political pressure for healthcare quality indicator monitoring, specifically healthcare-associated infection (HAI) has intensified the debate regarding the merits of public reporting and target setting as policy approaches. This paper reviews the evidence for these approaches with a focus on HAI, including Clostridium difficile infection (CDI). Healthcare key performance indicators (KPIs) and associated targets have been used widely with little evaluation. While targets are associated with some HAI reductions including CDI, as their control is multi-factorial, it is likely that reductions are due to numerous, concurrent control measures. Targets may help tackle organizational-wide issues that require high level management engagement and have contributed to the increased access and influence of infection control teams. HAI public reporting has also gained traction and is mandatory in many countries despite little scientific evaluation. CDI is one of the KPIs used but there is little consensus as to the best KPI for public reporting. Countries without public reporting have also seen improvements. Using indicator-based strategies rather than evidence-based ones risk improving the KPI but not necessarily quality of care. 'Bottom-up' approaches focussing on quality improvement and innovation generated by front line staff are seen as a lever for sustainable change. Positive deviance, where the resourcefulness and problem solving abilities of staff is harnessed, enables 'bottom-up' changes with process and outcome improvements. As implementation of best practice in healthcare is dependent on behavioural and cultural change, it is most likely that a combination of 'top-down' and 'bottom-up' approaches are required for sustainable improvement. This combined approach was used to improve staff influenza vaccination rates. Regulation may initially direct the spot-light onto infection control needs but true sustainable HAI reduction will only be fostered with concurrent cultural and behavioural shifts in practice and ownership of the HAI burden across clinical, policy and management domains. It will be interesting if this approach will be increasingly used by policy makers, however, irrespective it is clear that there is a need for rigorous evaluation of our HAI policy approaches from this point forward. Copyright © 2015 Elsevier Ltd. All rights reserved.

Implementing the Mother-Baby Model of Nursing Care Using Models and Quality Improvement Tools.

PubMed

Brockman, Vicki

As family-centered care has become the expected standard, many facilities follow the mother-baby model, in which care is provided to both a woman and her newborn in the same room by the same nurse. My facility employed a traditional model of nursing care, which was not evidence-based or financially sustainable. After implementing the mother-baby model, we experienced an increase in exclusive breastfeeding rates at hospital discharge, increased patient satisfaction, improved staff productivity and decreased salary costs, all while the number of births increased. Our change was successful because it was guided by the use of quality improvement tools, change theory and evidence-based practice models. © 2015 AWHONN.

Sustainability study of domestic communal wastewater treatment plant in Surabaya City

NASA Astrophysics Data System (ADS)

Bahar, E.; Sudarno; Zaman, B.

2017-06-01

Sanitation is one of the critical infrastructure sectors in order to improve community health status. The Ministry of Public Works of the Republic of Indonesia to define that word sanitation include: domestic waste water management, solid waste management, rain water management (drainage management) as well as the provision of clean water. Surabaya city as the capital of East Java province and Indonesia’s second largest city with a population of 2,853,661 inhabitants in 2014 (the second largest after Jakarta), but the people who have been served by the sanitation infrastructure systems were expected at 176,105 families or about 26.95 % of the population of the city is already using sanitation facilities. In the White Book Sanitation of Surabaya City in 2010, Surabaya City sanitation development mission is to realize the wastewater management of settlements in a sustainable and affordable by the community. This study aims to assess the sustainability of the wastewater treatment plant (WWTP) domestic communal in the city of Surabaya. The method in this research is quantitative method through observation, structured interviews and laboratory testing of the variables analyzed. Analyses were performed using a technique Multidisciplinary rapid appraisal (Rap-fish) to determine the level of sustainability of the management of communal WWTP based on a number of attributes that easy scored. Attributes of each dimension includes the technical, environmental quality, institutional, economic, and social. The results of this study are sustainability index of environmental quality dimension at 84.32 with highly sustainable status, technical dimension at 62.61 with fairly sustainable status, social dimension at 57.98 with fairly sustainable status, economic dimension at 43.24 with less sustainable status, and institutional dimension at 39.67 with less sustainable status.

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

Challenges ahead: social and institutional factors influencing sustainable urban stormwater management in Australia.

PubMed

Brown, R R; Farrelly, M A

2009-01-01

In a time of climate uncertainty and drought in Australia, improved urban stormwater quality management practices are required not only for protecting waterway health, but also as a fit-for-purpose supply source. To conceive of urban stormwater as an environmental threat as well as a water supply source requires a substantial shift in our traditional linear supply and wastewater structures towards more hybrid and complex infrastructure systems. To understand what drives and limits treatment technology adoption for stormwater management, over 800 urban water professionals in three Australian capital cities completed an online questionnaire survey in November 2006. Using the conceptual framework of receptivity assessment, the results revealed the professional community to be highly associated with the importance of improving stormwater quality for receiving waterway health, yet they do not consider that politicians share this perspective by placing a substantially lower level of importance on stormwater quality management. Significant acquisition barriers within each city, including institutional arrangements, costs, responsibilities, and regulations and approvals processes were all identified as constraining more sustainable practices. Capacity building programs, fostering greater socio-political capital and developing key demonstration projects with training events are recommended as useful policy interventions for addressing current institutional impediments.

An Application of Six Sigma to Reduce Supplier Quality Cost

NASA Astrophysics Data System (ADS)

Gaikwad, Lokpriya Mohanrao; Teli, Shivagond Nagappa; Majali, Vijay Shashikant; Bhushi, Umesh Mahadevappa

2016-01-01

This article presents an application of Six Sigma to reduce supplier quality cost in manufacturing industry. Although there is a wider acceptance of Six Sigma in many organizations today, there is still a lack of in-depth case study of Six Sigma. For the present research the case study methodology was used. The company decided to reduce quality cost and improve selected processes using Six Sigma methodologies. Regarding the fact that there is a lack of case studies dealing with Six Sigma especially in individual manufacturing organization this article could be of great importance also for the practitioners. This paper discusses the quality and productivity improvement in a supplier enterprise through a case study. The paper deals with an application of Six Sigma define-measure-analyze-improve-control methodology in an industry which provides a framework to identify, quantify and eliminate sources of variation in an operational process in question, to optimize the operation variables, improve and sustain performance viz. process yield with well-executed control plans. Six Sigma improves the process performance (process yield) of the critical operational process, leading to better utilization of resources, decreases variations and maintains consistent quality of the process output.

Strengthening monitoring and evaluation (M&E) and building sustainable health information systems in resource limited countries: lessons learned from an M&E task-shifting initiative in Botswana.

PubMed

Mpofu, Mulamuli; Semo, Bazghina-Werq; Grignon, Jessica; Lebelonyane, Refeletswe; Ludick, Steven; Matshediso, Ellah; Sento, Baraedi; Ledikwe, Jenny H

2014-10-03

The demand for quality data and the interest in health information systems has increased due to the need for country-level progress reporting towards attainment of the United Nations Millennium Development Goals and global health initiatives. To improve monitoring and evaluation (M&E) of health programs in Botswana, 51 recent university graduates with no experience in M&E were recruited and provided with on-the-job training and mentoring to develop a new cadre of health worker: the district M&E officer. Three years after establishment of the cadre, an assessment was conducted to document achievements and lessons learnt. This qualitative assessment included in-depth interviews at the national level (n = 12) with officers from government institutions, donor agencies, and technical organizations; and six focus group discussions separately with district M&E officers, district managers, and program officers coordinating different district health programs. Reported achievements of the cadre included improved health worker capacity to monitor and evaluate programs within the districts; improved data quality, management, and reporting; increased use of health data for disease surveillance, operational research, and planning purposes; and increased availability of time for nurses and other health workers to concentrate on core clinical duties. Lessons learnt from the assessment included: the importance of clarifying roles for newly established cadres, aligning resources and equipment to expectations, importance of stakeholder collaboration in implementation of sustainable programs, and ensuring retention of new cadres. The development of a dedicated M&E cadre at the district level contributed positively to health information systems in Botswana by helping build M&E capacity and improving data quality, management, and data use. This assessment has shown that such cadres can be developed sustainably if the initiative is country-led, focusing on recruitment and capacity-development of local counterparts, with a clear government retention plan.

Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

PubMed

Lacey, Susan R; Goodyear-Bruch, Caryl; Olney, Adrienne; Hanson, Dave; Altman, Marian S; Varn-Davis, Natasha S; Brinker, Debbie; Lavandero, Ramón; Cox, Karen S

2017-08-01

Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes. ©2017 American Association of Critical-Care Nurses.

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

PubMed

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

2013-09-01

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

Aspirational characteristics for effective leadership of improvement teams.

PubMed

Donnelly, Lane F

2017-01-01

Working on quality improvement has become an innate part of managing a pediatric radiology service. To help radiologists effectively lead improvement teams, eight aspirational characteristics are discussed. These are: 1) Be a good listener, 2) Effectively communicate around an accountability cycle, 3) Stress simplicity: Prioritization and pace, 4) Expend energy to optimize people development, 5) Lead with optimism, 6) Create a culture of wellness and sustainability, 7) Have a progressive attitude toward failure and 8) Project humility over arrogance.

Evaluation of the sustainability of contrasted pig farming systems: development of a market conformity tool for pork products based on technological quality traits.

PubMed

Gonzàlez, J; Gispert, M; Gil, M; Hviid, M; Dourmad, J Y; de Greef, K H; Zimmer, C; Fàbrega, E

2014-12-01

A market conformity tool, based on technological meat quality parameters, was developed within the Q-PorkChains project, to be included in a global sustainability evaluation of pig farming systems. The specific objective of the market conformity tool was to define a scoring system based on the suitability of meat to elaborate the main pork products, according to their market shares based on industry requirements, in different pig farming systems. The tool was based on carcass and meat quality parameters that are commonly used for the assessment of technological quality, which provide representative and repeatable data and are easily measurable. They were the following: cold carcass weight; lean meat percentage; minimum subcutaneous back fat depth at m. gluteus medius level, 45 postmortem and ultimate pH (measured at 24-h postmortem) in m. longissimus lumborum and semimembranosus; meat colour; drip losses and intramuscular fat content in a m. longissimus sample. Five categories of pork products produced at large scale in Europe were considered in the study: fresh meat, cooked products, dry products, specialties and other meat products. For each of the studied farming systems, the technological meat quality requirements, as well as the market shares for each product category within farming system, were obtained from the literature and personal communications from experts. The tool resulted in an overall conformity score that enabled to discriminate among systems according to the degree of matching of the achieved carcass and meat quality with the requirements of the targeted market. In order to improve feasibility, the tool was simplified by selecting ultimate pH at m. longissimus or semimembranosus, minimum fat thickness measured at the left half carcass over m. gluteus medius and intramuscular fat content in a m. longissimus sample as iceberg indicators. The overall suitability scores calculated by using both the complete and the reduced tools presented good correlation and the results obtained were similar. The tool could be considered as robust enough to discriminate among different systems, since it was tested in a wide range of them. It also can be used to detect improvement opportunities to enhance sustainability of pig farming systems. The final objective of the study was achieved, since the market suitability tool could be used in an integrated sustainability analysis of pig farming systems.

Who will have Sustainable Employment After a Back Injury? The Development of a Clinical Prediction Model in a Cohort of Injured Workers.

PubMed

Shearer, Heather M; Côté, Pierre; Boyle, Eleanor; Hayden, Jill A; Frank, John; Johnson, William G

2017-09-01

Purpose Our objective was to develop a clinical prediction model to identify workers with sustainable employment following an episode of work-related low back pain (LBP). Methods We used data from a cohort study of injured workers with incident LBP claims in the USA to predict employment patterns 1 and 6 months following a workers' compensation claim. We developed three sequential models to determine the contribution of three domains of variables: (1) basic demographic/clinical variables; (2) health-related variables; and (3) work-related factors. Multivariable logistic regression was used to develop the predictive models. We constructed receiver operator curves and used the c-index to measure predictive accuracy. Results Seventy-nine percent and 77 % of workers had sustainable employment at 1 and 6 months, respectively. Sustainable employment at 1 month was predicted by initial back pain intensity, mental health-related quality of life, claim litigation and employer type (c-index = 0.77). At 6 months, sustainable employment was predicted by physical and mental health-related quality of life, claim litigation and employer type (c-index = 0.77). Adding health-related and work-related variables to models improved predictive accuracy by 8.5 and 10 % at 1 and 6 months respectively. Conclusion We developed clinically-relevant models to predict sustainable employment in injured workers who made a workers' compensation claim for LBP. Inquiring about back pain intensity, physical and mental health-related quality of life, claim litigation and employer type may be beneficial in developing programs of care. Our models need to be validated in other populations.

Increasing recruitment rates in an inpatient clinical research study using quality improvement methods.

PubMed

Sauers, Hadley S; Beck, Andrew F; Kahn, Robert S; Simmons, Jeffrey M

2014-11-01

One important benefit of successful patient recruitment is increased generalizability of findings. We sought to optimize enrollment of children admitted with asthma as part of a population-based, prospective, observational cohort study with the goal of enrolling at least 60% of all eligible and staffed patients. Quality improvement methods were used to improve cohort recruitment. Weekly meetings with study staff and study leadership were held to plan and discuss how to maximize recruitment rates. Significant initial variability in recruitment success prompted the team to use small-scale tests of change to increase recruitment numbers. A number of tests were trialed, focusing primarily on reducing patient refusals and improving recruitment process efficiency. Recruitment rates were calculated by dividing eligible by enrolled patients and displayed using annotated Shewhart control charts. Control charts were used to illustrate week-to-week variability while also enabling differentiation of common-cause and special-cause variation. The study enrolled 774 patients, representing 54% of all eligible and 59% of those eligible for whom staff were available to enroll. Our mean weekly recruitment rate increased from 55% during the first 3 months of the study to a statistically significant sustained rate of 61%. This was sustained given numerous obstacles, such as departing and hiring of staff and adding a second recruitment location. Implementing quality improvement methods within a larger research study led to an increase in the rate of recruitment as well as the stability in recruitment rates from week-to-week. Copyright © 2014 by the American Academy of Pediatrics.

The Creation of a Pediatric Hospital Medicine Dashboard: Performance Assessment for Improvement.

PubMed

Fox, Lindsay Anne; Walsh, Kathleen E; Schainker, Elisabeth G

2016-07-01

Leaders of pediatric hospital medicine (PHM) recommended a clinical dashboard to monitor clinical practice and make improvements. To date, however, no programs report implementing a dashboard including the proposed broad range of metrics across multiple sites. We sought to (1) develop and populate a clinical dashboard to demonstrate productivity, quality, group sustainability, and value added for an academic division of PHM across 4 inpatient sites; (2) share dashboard data with division members and administrations to improve performance and guide program development; and (3) revise the dashboard to optimize its utility. Division members proposed a dashboard based on PHM recommendations. We assessed feasibility of data collection and defined and modified metrics to enable collection of comparable data across sites. We gathered data and shared the results with division members and administrations. We collected quarterly and annual data from October 2011 to September 2013. We found comparable metrics across all sites for descriptive, productivity, group sustainability, and value-added domains; only 72% of all quality metrics were tracked in a comparable fashion. After sharing the data, we saw increased timeliness of nursery discharges and an increase in hospital committee participation and grant funding. PHM dashboards have the potential to guide program development, mobilize faculty to improve care, and demonstrate program value to stakeholders. Dashboard implementation at other institutions and data sharing across sites may help to better define and strengthen the field of PHM by creating benchmarks and help improve the quality of pediatric hospital care. Copyright © 2016 by the American Academy of Pediatrics.

The Joint CEDEFOP/ETF Project on 'Scenarios and Strategies for Vocational Training and Lifelong Learning in Europe': A Contribution to the Debate on the Future of Europe.

ERIC Educational Resources Information Center

Sellin, Burkart

A project in Europe is working to improve the quality of work, promote equal opportunities, combat exclusion and poverty; promote lasting economic growth and a European Union economic policy; and promote sustainable development and quality of life. In order to achieve these goals, three main objectives for vocational education and training (VET)…

Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets.

PubMed

Perignon, Marlène; Vieux, Florent; Soler, Louis-Georges; Masset, Gabriel; Darmon, Nicole

2017-01-01

The Food and Agriculture Organization defines sustainable diets as nutritionally adequate, safe, healthy, culturally acceptable, economically affordable diets that have little environmental impact. This review summarizes the studies assessing, at the individual level, both the environmental impact and the nutritional quality or healthiness of self-selected diets. Reductions in meat consumption and energy intake were identified as primary factors for reducing diet-related greenhouse gas emissions. The choice of foods to replace meat, however, was crucial, with some isocaloric substitutions possibly increasing total diet greenhouse gas emissions. Moreover, nutritional adequacy was rarely or only partially assessed, thereby compromising the assessment of diet sustainability. Furthermore, high nutritional quality was not necessarily associated with affordability or lower environmental impact. Hence, when identifying sustainable diets, each dimension needs to be assessed by relevant indicators. Finally, some nonvegetarian self-selected diets consumed by a substantial fraction of the population showed good compatibility with the nutritional, environmental, affordability, and acceptability dimensions. Altogether, the reviewed studies revealed the scarcity of standardized nationally representative data for food prices and environmental indicators and suggest that diet sustainability might be increased without drastic dietary changes. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute.

Impact of Advocacy Initiatives on Nurses' Motivation to Sustain Momentum in Public Policy Advocacy.

PubMed

Taylor, Melissa R S

2016-01-01

The purpose of this study is to elicit insight from the public policy leaders of 2 regional professional nursing organizations on key qualities of their current advocacy initiatives that motivate nurses to sustain momentum in public policy advocacy beyond a single episode. The goal is to inform quality improvement in the development of future advocacy initiatives to increase sustained engagement of nurses. Social cognitive theory was used as the rationale for this qualitative, descriptive study. A purposive convenience sample of executive leadership and board committee members from 2 regional professional nursing organizations were recruited to complete an initial Web-based electronic survey, followed by separate semistructured interview focus groups. One organization was composed primarily of advanced practice registered nurses, and the other group composed of diverse, multispecialty nursing members with varied educational levels. Nine themes emerged, categorized as facilitators or challenges to the positive impact of advocacy initiatives on nurses' motivation. Highlighting and marketing facilitators to the positive impact of advocacy initiatives on nurses' motivation to sustain momentum in public policy advocacy, while designing and testing new initiatives that address the challenges, may increase the number of nurses who sustain engagement in the policy advocacy process. Copyright © 2016 Elsevier Inc. All rights reserved.

Maternal and neonatal implementation for equitable systems. A study design paper.

PubMed

Ekirapa-Kiracho, Elizabeth; Tetui, Moses; Bua, John; Muhumuza Kananura, Rornald; Waiswa, Peter; Makumbi, Fred; Atuyambe, Lynn; Ajeani, Judith; George, Asha; Mutebi, Aloysuis; Kakaire, Ayub; Namazzi, Gertrude; Paina, Ligia; Namusoke Kiwanuka, Suzanne

2017-08-01

Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach.  The  study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory  approach.

Nanotechnology in Sustainable Agriculture: Recent Developments, Challenges, and Perspectives

PubMed Central

Prasad, Ram; Bhattacharyya, Atanu; Nguyen, Quang D.

2017-01-01

Nanotechnology monitors a leading agricultural controlling process, especially by its miniature dimension. Additionally, many potential benefits such as enhancement of food quality and safety, reduction of agricultural inputs, enrichment of absorbing nanoscale nutrients from the soil, etc. allow the application of nanotechnology to be resonant encumbrance. Agriculture, food, and natural resources are a part of those challenges like sustainability, susceptibility, human health, and healthy life. The ambition of nanomaterials in agriculture is to reduce the amount of spread chemicals, minimize nutrient losses in fertilization and increased yield through pest and nutrient management. Nanotechnology has the prospective to improve the agriculture and food industry with novel nanotools for the controlling of rapid disease diagnostic, enhancing the capacity of plants to absorb nutrients among others. The significant interests of using nanotechnology in agriculture includes specific applications like nanofertilizers and nanopesticides to trail products and nutrients levels to increase the productivity without decontamination of soils, waters, and protection against several insect pest and microbial diseases. Nanotechnology may act as sensors for monitoring soil quality of agricultural field and thus it maintain the health of agricultural plants. This review covers the current challenges of sustainability, food security and climate change that are exploring by the researchers in the area of nanotechnology in the improvement of agriculture. PMID:28676790

Nanotechnology in Sustainable Agriculture: Recent Developments, Challenges, and Perspectives.

PubMed

Prasad, Ram; Bhattacharyya, Atanu; Nguyen, Quang D

2017-01-01

Nanotechnology monitors a leading agricultural controlling process, especially by its miniature dimension. Additionally, many potential benefits such as enhancement of food quality and safety, reduction of agricultural inputs, enrichment of absorbing nanoscale nutrients from the soil, etc. allow the application of nanotechnology to be resonant encumbrance. Agriculture, food, and natural resources are a part of those challenges like sustainability, susceptibility, human health, and healthy life. The ambition of nanomaterials in agriculture is to reduce the amount of spread chemicals, minimize nutrient losses in fertilization and increased yield through pest and nutrient management. Nanotechnology has the prospective to improve the agriculture and food industry with novel nanotools for the controlling of rapid disease diagnostic, enhancing the capacity of plants to absorb nutrients among others. The significant interests of using nanotechnology in agriculture includes specific applications like nanofertilizers and nanopesticides to trail products and nutrients levels to increase the productivity without decontamination of soils, waters, and protection against several insect pest and microbial diseases. Nanotechnology may act as sensors for monitoring soil quality of agricultural field and thus it maintain the health of agricultural plants. This review covers the current challenges of sustainability, food security and climate change that are exploring by the researchers in the area of nanotechnology in the improvement of agriculture.

The Use of Life Cycle Tools to Support Decision Making for Sustainable Nanotechnologies

EPA Science Inventory

Nanotechnology is a broad-impact technology with applications ranging from materials and electronics to analytical methods and metrology. The many benefits that can be realized through the utilization of nanotechnology are intended to lead to an improved quality of life. However,...

USE OF FERRATE IN SMALL DRINKING WATER TREATMENT SYSTEMS

EPA Science Inventory

The proposed project will result in a document providing guidance for the beneficial use of ferrate in small systems. We will highlight the ways it can be used to improve water quality, lower cost and provide a more sustainable treatment alternative to other technologies. W...

Vantage point - Prudent health care.

PubMed

Ellis, Gemma

2014-09-25

DESPITE PRODUCTIVITY improvement programmes in the NHS, the Nuffield Trust warns us that the NHS in Wales is likely to face a funding gap of £2.5 billion by 2025. Obviously then, we need to keep searching for ways to ensure long-term sustainability that does not compromise quality.

Going Green: Eco-Friendly Schools

ERIC Educational Resources Information Center

Whelan, Debra Lau

2007-01-01

A growing number of studies show that a school's physical condition--especially its lighting and indoor air quality--directly affect student performance. A 2005 Turner Construction survey of green buildings found that 70 percent of districts with sustainable schools reported improved student performance. It also makes perfect sense that…

Unpacking Community Participation: A Gendered Perspective

ERIC Educational Resources Information Center

Rouhani, Leva

2017-01-01

In recent years heightened attention has been directed towards the connections between schooling and local communities in sub-Saharan Africa. While community participation in school management has been emphasized as a strategy to promote sustainable development and improve quality education in sub-Saharan Africa, in practice this strategy has…

Catalyzing Institutional Transformation: Insights from the AAU STEM Initiative

ERIC Educational Resources Information Center

Miller, Emily R.; Fairweather, James S.; Slakey, Linda; Smith, Tobin; King, Tara

2017-01-01

In 2011, the Association of American Universities (AAU) embarked on an ambitious effort to improve the instructional quality and effectiveness of undergraduate introductory Science, Technology, Engineering, and Mathematics (STEM) courses. The primary focus was on sustainable implementation of evidence-based methods of instruction in courses that…

Sustainable uses of FGD gypsum in agricultural systems

USDA-ARS?s Scientific Manuscript database

Interest in using gypsum as a management tool to improve crop yields and soil/water quality has recently increased. Abundant supply and availability of flue gas desulfurization (FGD) gypsum, a by-product of scrubbing sulfur (S) from combustion gases at coal-fired power plants, in major agricultural...

Technology for Improving Production, Economic Efficiency, Quality, and Sustainability in Peanut Production and Handling

USDA-ARS?s Scientific Manuscript database

USDA ARS National Peanut Research Laboratory has a very diverse scientific staff conducting research to address the needs of the United States peanut industry. Research is conducted in the fields of mycology, chemistry, biochemistry, molecular biology, breeding, agronomy, economics, and engineering....

Technology for Improving Production, Economic Efficiency, Quality and Sustainability in Peanut Production and Handling

USDA-ARS?s Scientific Manuscript database

USDA ARS National Peanut Research Laboratory has a very diverse scientific staff conducting research to address the needs of the United States peanut industry. Research is conducted in the fields of mycology, chemistry, biochemistry, molecular biology, breeding, agronomy, economics, and engineering....

Technology for improving production, economic efficiency, quality, and sustainability in peanut production and handling

USDA-ARS?s Scientific Manuscript database

USDA ARS National Peanut Research Laboratory has a very diverse scientific staff conducting research to address the needs of the United States peanut industry. Research is conducted in the fields of mycology, chemistry, biochemistry, molecular biology, breeding, agronomy, economics, and engineering....

Tourism Development Based on Geopark in Bakkara Caldera Toba, Indonesia

NASA Astrophysics Data System (ADS)

Ginting, N.; Vinky Rahman, N.; Sembiring, G.

2017-03-01

Bakkara Caldera Toba is an outstanding product of natural phenomena of Toba Supervolcano which has fascinating nature and culture. Bakkara has a great potential to develop world tourism further. It requires a model of sustainable planning Geopark to develop Bakkara. This sustainable concept helps to improve the local community and tourist’s quality of life and also still maintain the quality of the environment. through field observation and depth interview. The Collected data with a triangulation method. Development tourism destination such as attractions and environment; facilities and services; accessibility; image; and price to consume. It associated based on Geopark aspects there are; geological heritage; geo-conservation activities; sustainable tourism activities; educational; activities; community involvement products; strong management structure; and secure basis, infrastructure, and activities. The results of this study indicate that the Bakkara has the potential to become a tourist destination by applying the concept of Geotourism which accentuate its natural side, by optimizing the management of its destination attractions, its facilities and services, and its accessibilities.

Improvements in the delivery of resuscitation and newborn care after Helping Babies Breathe training.

PubMed

Kamath-Rayne, B D; Josyula, S; Rule, A R L; Vasquez, J C

2017-10-01

To evaluate changes in neonatal resuscitation and postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. We hypothesized that HBB training would improve resuscitation and essential newborn care interventions. Direct observation and video recording of delivery room care spanned before and after an initial HBB workshop held in August 2013. Rates of essential newborn care interventions were compared in resuscitations performed by individuals who had and had not received HBB training, and run charts recording performance of newborn care practices over time were developed. Ten percent of deliveries (N=250) were observed over the study period, with 156 newborn resuscitations performed by individuals without HBB training, compared to 94 resuscitations performed by HBB trainees. After HBB training, significant improvements were seen in skin-to-skin care, breastfeeding within 60 min of age, and delayed cord clamping after 1 min (all P<0.01). More babies cared for by HBB trainees received basic neonatal resuscitation such as drying and stimulation. Run charts tracking these practices over time showed significant improvements after HBB training that were sustained during the study period, but remained below ideal goals. With improvement in drying/stimulation practices, fewer babies required bag/mask ventilation. In a rural Honduran community hospital, improvements in basic neonatal resuscitation and postnatal essential newborn care practices can be seen after HBB training. Further improvements in newborn care practices may require focused quality improvement initiatives for hospitals to sustain high quality care.

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

PubMed

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

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

Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution.

PubMed

Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S

2016-01-01

Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond.

Effects on Environmental and Socioeconomic Sustainability of Producing Ethanol from Perennial Grasses

NASA Astrophysics Data System (ADS)

Dale, V. H.; Parish, E. S.

2016-12-01

Using perennial grasses to produce ethanol can enhance progress toward sustainability. A suite of 35 environmental and socioeconomic sustainability indicators was considered in a holistic sustainability assessment of a five-year switchgrass-to-ethanol production experiment centered on a demonstration-scale biorefinery in Vonore, Tennessee. By combining field measurements, literature review and expert opinion, the team was able to rate 28 of the 35 recommended sustainability indicators. The team combined these ratings within a multi-attribute decision support system tool and used this information to compare the sustainability of producing 2118 hectares of no-till switchgrass relative to two alternative business-as-usual scenarios of unmanaged pasture and tilled corn production. The results suggest that East Tennessee switchgrass production improves environmental quality overall and can be beneficial to the counties surrounding the biorefinery in terms of dollars earned and jobs created. The timing of switchgrass production also provides an opportunity to use inactive equipment and laborers. By incorporating a landscape design approach, the opportunities, constraints and most reasonable paths forward for growing bioenergy feedstock in specific context can be assessed in a way that adapts and improves local practices. Lessons learned from this case study are being incorporated into sustainability assessments of corn stover in Iowa and a variety of bioenergy feedstocks in diverse settings. The overall goal is to develop sound management practices that can address the multiple and sometimes competing demands of stakeholders.

The Quality Imperative for Palliative Care

PubMed Central

Kamal, Arif H.; Hanson, Laura C.; Casarett, David J.; Dy, Sydney M.; Pantilat, Steven Z.; Lupu, Dale; Abernethy, Amy P.

2015-01-01

Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the United States shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), “here is what we do,” and increase the focus on “this is how well we do it” and “let’s see how we can do it better.” It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987

Incorporating discrete event simulation into quality improvement efforts in health care systems.

PubMed

Rutberg, Matthew Harris; Wenczel, Sharon; Devaney, John; Goldlust, Eric Jonathan; Day, Theodore Eugene

2015-01-01

Quality improvement (QI) efforts are an indispensable aspect of health care delivery, particularly in an environment of increasing financial and regulatory pressures. The ability to test predictions of proposed changes to flow, policy, staffing, and other process-level changes using discrete event simulation (DES) has shown significant promise and is well reported in the literature. This article describes how to incorporate DES into QI departments and programs in order to support QI efforts, develop high-fidelity simulation models, conduct experiments, make recommendations, and support adoption of results. The authors describe how DES-enabled QI teams can partner with clinical services and administration to plan, conduct, and sustain QI investigations. © 2013 by the American College of Medical Quality.

Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial.

PubMed

Innes, Kim E; Selfe, Terry Kit; Khalsa, Dharma Singh; Kandati, Sahiti

2016-04-08

Older adults with subjective cognitive decline (SCD) are at increased risk not only for Alzheimer's disease, but for poor mental health, impaired sleep, and diminished quality of life (QOL), which in turn, contribute to further cognitive decline, highlighting the need for early intervention. In this randomized controlled trial, we assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML), on perceived stress, sleep, mood, and health-related QOL in older adults with SCD. Sixty community-dwelling older adults with SCD were randomized to a KK or ML program and asked to practice 12 minutes daily for 12 weeks, then at their discretion for the following 3 months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological well-being, sleep quality, and health-related QOL were measured using well-validated instruments. Fifty-three participants (88%) completed the 6-month study. Participants in both groups showed significant improvement at 12 weeks in psychological well-being and in multiple domains of mood and sleep quality (p's≤0.05). Relative to ML, those assigned to KK showed greater gains in perceived stress, mood, psychological well-being, and QOL-Mental Health (p's≤0.09). Observed gains were sustained or improved at 6 months, with both groups showing marked and significant improvement in all outcomes. Changes were unrelated to treatment expectancies. Findings suggest that practice of a simple meditation or ML program may improve stress, mood, well-being, sleep, and QOL in adults with SCD, with benefits sustained at 6 months and gains that were particularly pronounced in the KK group.

Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial

PubMed Central

Innes, Kim E.; Selfe, Terry Kit; Khalsa, Dharma Singh; Kandati, Sahiti

2017-01-01

Background Older adults with subjective cognitive decline (SCD) are at increased risk not only for Alzheimer’s disease, but for poor mental health, impaired sleep, and diminished quality of life (QOL), which in turn, contribute to further cognitive decline, highlighting the need for early intervention. Objective In this randomized controlled trial, we assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML), on perceived stress, sleep, mood, and health-related QOL in older adults with SCD. Methods Sixty community-dwelling older adults with SCD were randomized to a KK or ML program and asked to practice 12 minutes daily for 12 weeks, then at their discretion for the following 3 months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological well-being, sleep quality, and health-related QOL were measured using well-validated instruments. Results Fifty-three participants (88%) completed the 6-month study. Participants in both groups showed significant improvement at 12 weeks in psychological well-being and in multiple domains of mood and sleep quality (p’s ≤ 0.05). Relative to ML, those assigned to KK showed greater gains in perceived stress, mood, psychological well-being, and QOL-Mental Health (p’s ≤ 0.09). Observed gains were sustained or improved at 6 months, with both groups showing marked and significant improvement in all outcomes. Changes were unrelated to treatment expectancies. Conclusions Findings suggest that practice of a simple meditation or ML program may improve stress, mood, well-being, sleep, and QOL in adults with SCD, with benefits sustained at 6 months and gains that were particularly pronounced in the KK group. PMID:27079708

An interval-possibilistic basic-flexible programming method for air quality management of municipal energy system through introducing electric vehicles.

PubMed

Yu, L; Li, Y P; Huang, G H; Shan, B G

2017-09-01

Contradictions of sustainable transportation development and environmental issues have been aggravated significantly and been one of the major concerns for energy systems planning and management. A heavy emphasis is placed on stimulation of electric vehicles (EVs) to handle these problems associated with various complexities and uncertainties in municipal energy system (MES). In this study, an interval-possibilistic basic-flexible programming (IPBFP) method is proposed for planning MES of Qingdao, where uncertainties expressed as interval-flexible variables and interval-possibilistic parameters can be effectively reflected. Support vector regression (SVR) is used for predicting electricity demand of the city under various scenarios. Solutions of EVs stimulation levels and satisfaction levels in association with flexible constraints and predetermined necessity degrees are analyzed, which can help identify the optimized energy-supply patterns that could plunk for improvement of air quality and hedge against violation of soft constraints. Results disclose that largely developing EVs can help facilitate the city's energy system with an environment-effective way. However, compared to the rapid growth of transportation, the EVs' contribution of improving the city's air quality is limited. It is desired that, to achieve an environmentally sustainable MES, more concerns should be focused on the integration of increasing renewable energy resources, stimulating EVs as well as improving energy transmission, transport and storage. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluating sustainable water quality management in the U.S.: Urban, Agricultural, and Environmental Protection Practices

NASA Astrophysics Data System (ADS)

van Oel, P. R.; Alfredo, K. A.; Russo, T. A.

2015-12-01

Sustainable water management typically emphasizes water resource quantity, with focus directed at availability and use practices. When attention is placed on sustainable water quality management, the holistic, cross-sector perspective inherent to sustainability is often lost. Proper water quality management is a critical component of sustainable development practices. However, sustainable development definitions and metrics related to water quality resilience and management are often not well defined; water quality is often buried in large indicator sets used for analysis, and the policy regulating management practices create sector specific burdens for ensuring adequate water quality. In this research, we investigated the methods by which water quality is evaluated through internationally applied indicators and incorporated into the larger idea of "sustainability." We also dissect policy's role in the distribution of responsibility with regard to water quality management in the United States through evaluation of three broad sectors: urban, agriculture, and environmental water quality. Our research concludes that despite a growing intention to use a single system approach for urban, agricultural, and environmental water quality management, one does not yet exist and is even hindered by our current policies and regulations. As policy continues to lead in determining water quality and defining contamination limits, new regulation must reconcile the disparity in requirements for the contaminators and those performing end-of-pipe treatment. Just as the sustainable development indicators we researched tried to integrate environmental, economic, and social aspects without skewing focus to one of these three categories, policy cannot continue to regulate a single sector of society without considering impacts to the entire watershed and/or region. Unequal distribution of the water pollution burden creates disjointed economic growth, infrastructure development, and policy enactment across the sectors preventing a holistic approach to water quality management and, thus, rendering our system unsustainable.

The importance of an alternative for sustainability of agriculture around the periphery of the Amazon rainforest.

PubMed

Moura, Emanoel G; Sena, Virley G L; Corrêa, Mariana S; Aguiar, Alana das C F

2013-04-01

The unsustainable use of the soil of the deforested area at the Amazonian border is one of the greatest threats to the rainforest, because it is the predominant cause of shifting cultivation in the region. The sustainable management of soils with low natural fertility is a major challenge for smallholder agriculture in the humid tropics. In the periphery of Brazilian Amazonia, agricultural practices that are recommended for the Brazilian savannah, such as saturating soils with soluble nutrients do not ensure the sustainability of agroecosystems. Improvements in the tilled topsoil cannot be maintained if deterioration of the porous soil structure is not prevented and nutrient losses in the root zone are not curtailed. The information gleaned from experiments affirms that in the management of humid tropical agrosystems, the processes resulting from the interaction between climatic factors and indicators of soil quality must be taken into consideration. It must be remembered that these interactions manifest themselves in ways that cannot be predicted from the paradigm established in the other region like the southeast of Brazil, which is based only on improving the chemical indicators of soil quality. The physical indicators play important role in the sustainable management of the agrosystems of the region and for these reasons must be considered. Therefore, alley cropping is a potential substitute for slash and burn agriculture in the humid tropics with both environmental and agronomic advantages, due to its ability to produce a large amount of residues on the soil surface and its effect on the increase of economic crop productivity in the long term. The article presents some promising patents on the importance of an alternative for sustainability of agriculture.

Quality Education: Cultural Competence and a Sustainability Worldview

ERIC Educational Resources Information Center

Nolet, Victor

2017-01-01

The United Nations Sustainable Development Goals tie together equity, justice, and a more inclusive society with ecological sustainability. This article offers teaching strategies for integrating the goal of quality education for sustainability and multicultural education.

Systems metabolic engineering as an enabling technology in accomplishing sustainable development goals.

PubMed

Yang, Dongsoo; Cho, Jae Sung; Choi, Kyeong Rok; Kim, Hyun Uk; Lee, Sang Yup

2017-09-01

With pressing issues arising in recent years, the United Nations proposed 17 Sustainable Development Goals (SDGs) as an agenda urging international cooperations for sustainable development. In this perspective, we examine the roles of systems metabolic engineering (SysME) and its contribution to improving the quality of life and protecting our environment, presenting how this field of study offers resolutions to the SDGs with relevant examples. We conclude with offering our opinion on the current state of SysME and the direction it should move forward in the generations to come, explicitly focusing on addressing the SDGs. © 2017 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care.

PubMed

Asplund, Kjell; Hulter Åsberg, Kerstin; Appelros, Peter; Bjarne, Daniela; Eriksson, Marie; Johansson, Asa; Jonsson, Fredrik; Norrving, Bo; Stegmayr, Birgitta; Terént, Andreas; Wallin, Sari; Wester, Per-Olov

2011-04-01

Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Annually, approximately 25,000 patients are included. In 2009, approximately 320,000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation.

PubMed

Eboreime, Ejemai Amaize; Nxumalo, Nonhlanhla; Ramaswamy, Rohit; Eyles, John

2018-05-08

Quality improvement models have been applied across various levels of health systems with varying success leading to scepticisms about effectiveness. Health systems are complex, influenced by contexts and characterized by numerous interests. Thus, a shift in focus from examining whether improvement models work, to understanding why, when and where they work most effectively is essential. Nigeria introduced DIVA (Diagnose-Intervene-Verify-Adjust) as a model to strengthen decentralized PHC planning. However, implementation has been poorly sustained. This article explores the role of actors and context in implementation and sustainability of DIVA in two local government areas (LGAs) in Nigeria. We employed an integrated mixed method approach in which qualitative data was used in conjunction with quantitative to understand effects of actors and contexts on implementation outcomes. We analysed policy documents and conducted interviews with PHC managers. Then using the Model for Understanding Success in Quality (MUSIQ), we measured contextual factors affecting implementation of DIVA in the selected LGAs. The LGAs scored 117.42 and 104.67 out of 168 points on the MUSIQ scale, respectively, indicating contextual barriers exist. Both have strong DIVA team attributes, but these could not independently ensure quality implementation. Although external support accounted for the greatest contextual disparities, the utmost implementation challenges relate to subnational government leadership, management, financial and technical support. Although higher levels of government may set visionary goals for PHC, interventions are potentially skewed towards donor interests at lower (implementation) levels. Thus, subnational political will is a key determinant of quality implementation. Consequently, advocacy for responsible and accountable political governance is essential in comparable decentralized contexts.

The EuPA Biobank Initiative: Meeting the future challenges of biobanking in proteomics & systems medicine.

PubMed

Wheelock, Åsa M; Paulson, Linda; Litton, Jan-Eric

2015-09-08

In this News & Reviews Discussion, the recently launched EuPA (European Proteomics Association) Biobank Initiative is introduced in the context of current and future challenges in biobanking. The purpose of the initiative is to provide a forumand knowledge platform for integrating the extensive experiences collected by the EuPA community, and link it to the European and international biobanking communities at large. The specific impact of providing a forum and easy access to this type of information to the EuPA community is the potential of improving the quality of future sample collections and biobanks, the quality of the research produced from these sample collections, as well as the output and productivity from existing biobanks. The underutilization of biobanks has recently been identified as an emerging issue of biobankingworldwide. Measures to improve our ability to locate and access appropriate sample collections for a wide range of research purposes may enhance both the scientific quality and biobank sustainability, thereby contributing to the important task of moving our research beyond basic findings and mere publications, into clinical practice. This manuscript is intended as a Discussion piece, and represents a recollection of the presentation under the “EuPA Initiative” session at HUPO/EuPA 2014 in Madrid. The launch of the EuPA (European Proteomics Association) Biobank Initiative in the context of current and future challenges in biobanking is discussed. The purpose of the initiative is to provide a forum and knowledge base for integrating the extensive experiences collected by the EuPA community, and link it to the European and international biobanking communities at large. The specific impact of providing a forumand easy access to this type of information to the EuPA community is the potential of improving the quality of future sample collections and biobanks, the quality of the research produced from these sample collections, aswell as the output and productivity fromexisting biobanks. The underutilization of biobanks has recently been identified as a challenge to the well-being and economic sustainability of biobanking worldwide. Measures to improve our ability to localize and access appropriate sample collections for validation studies and other research purposes is thus of benefit bothto scientific quality and biobank sustainability, thereby contributing to the important task of moving our research beyond basic findings and mere publications, into clinical practice. This article is part of a Special Issue entitled: HUPO 2014.

Cost containment: strategies and responsibilities of the laboratory manager.

PubMed

Martin, B G

1985-12-01

In these difficult times we must not lose the sense of purpose and the personal drive that makes it possible to achieve excellence. We can be exasperated with reduced funding, burdened with excuses, debilitated with confusion about budgetary cuts, and even be stubborn about alternatives, but we must be serious about excellence and quality. It is natural that during these times we will face those with conflicting views, negative ideas, and erratic long-term goals, but that in itself should rouse us, as professionals, toward the pursuit of quality health care services. With better scheduling of tests and procedure, improved discharge planning, more careful review of the need for patient hospitalization, and a more careful examination of the number, mix, and quality of services furnished during a patient's hospital stay, we, as a health care team, can and will reduce unnecessary utilization of all services. Well-managed laboratories must operate around a return on investment threshold, from which all products, services, and expenditures are ranked. On this basis, management decisions will be made to add to service, reduce service, improve or sustain quality, change technology, or discontinue the business altogether. Given the mandate embodied in the DRG regulations, laboratories have become cost centers. New ideas, new technology, and creative efforts must now be used to improve laboratory productivity while sustaining quality health care services. It is argued philosophically that the DRGs or other major measures to reduce funding adversely affect quality of service. This may be true under the traditional definition of services, but there must be "a new order of things." Today's complex problems indicate that orthodox solutions no longer apply, and in our quest to answer who should pay versus who should receive, and how much is enough, we must ensure quality of all services offered. This new order of doing things could result in far greater savings than has previously been predicted. The patient's length of stay in the hospital has already been reduced. There will continue to be decreases in laboratory utilization and consumption of resources necessary to provide laboratory services. Cost competitiveness coupled with the laboratory's need for increased productivity will further expand savings. To summarize, the laboratory manager in the mid-1980's will have the following goals. To provide quality, cost-efficient, and timely laboratory services. To sustain and nurture the growth of the clinical laboratory profession as dictated by the needs of society and new scientific trends and discoveries.(ABSTRACT TRUNCATED AT 400 WORDS)

End of Life: An Overview

ERIC Educational Resources Information Center

Toner, Mary Ann; Shadden, Barbara B.

2012-01-01

Speech-language pathologists (SLPs) provide services to patients confronting the end of life (EOL) in a variety of settings. Instead of targeting improvement of health or sustaining life, EOL services focus primarily on quality of life. Although SLPs may not consider themselves core members of the health care team providing EOL services, the…

Consequences of Climate Change, Eutrophication, and Other Anthropogenic Impacts to Coastal Salt Marshes: Multiple Stressors Reduce Resiliency and Sustainability

EPA Science Inventory

Coastal salt marshes provide a wide variety of ecosystem services, including habitat for protected vertebrates and ecologically valuable invertebrate fauna, flood protection, and improvements in water quality for adjacent marine and estuarine environments. Here, we consider the ...

Training Teachers to Think Historically: Applying Recent Research to Professional Development

ERIC Educational Resources Information Center

Neumann, David

2012-01-01

In this paper, the author argues that sustained, discipline-specific professional development provides the key to transferring research knowledge base to the classroom, where it can lead to significant improvements in the quality of history instruction. To be successful, such professional development must--like good classroom instruction--begin…

Participatory Action Research for Development of Prospective Teachers' Professionality during Their Pedagogical Practice

ERIC Educational Resources Information Center

Strode, Aina

2015-01-01

Implementation of participatory action research during pedagogical practice facilitates sustainable education because its objective is to understand professional practice, enrich the capacity of involved participants and an opportunity to make inquiries for the improvement of quality. In the research of professional practice, subjects explore…

Improved understanding and testing for salinity tolerance in cool-season turfgrasses

USDA-ARS?s Scientific Manuscript database

Water is a critical issue for sustainability of golf courses in urban areas. Rapid population growth and climate change have increased the necesssity for golf courses to be efficient users of water, and sometimes users of low quality, high salinity water. Our research has focused on determining wh...

Creating and Sustaining Learning Communities.

ERIC Educational Resources Information Center

Groff, Warren H.

According to this paper, the ultimate purpose of graduate and postgraduate education is to design programs to promote improvement in the quality of services that are provided in a variety of different contexts and systems--health and human services, business and industry, government and public service, and education and training. Nova Southeastern…

Business as Partners in Development: Building the Public Contribution of Private Enterprise.

ERIC Educational Resources Information Center

Nelson, Jane

1998-01-01

Outlines ways in which businesses can contribute to sustainable development through core business activities, social investment, and participation in public policy debates. Describes corporate efforts in Latin America and the Caribbean to promote child-friendly companies, provide community access to technology, improve educational quality and…

IMPROVING THE QUALITY, AVAILABILITY AND SUSTAINABILITY OF DRINKING WATER SUPPLIES THROUGH ANTIFOULING AND ANTISCALING DESALINATION MEMBRANES

EPA Science Inventory

Surface modification with the selected polymers is expected to reduce the fouling and scaling propensity of desalination membranes by strongly binding water at the membrane surface. Foulants will interact with this bound water layer and not with the membrane surface itself....

Meta-Analysis of Lost Ecosystem Attributes in Urban Streams and the Effectiveness of Out-of-Channel Management Practices

EPA Science Inventory

Watershed development is a leading cause of stream impairment, and it increasingly threatens the availability, quality, and sustainability of freshwater resources as human populations continue to grow and migrate. Most efforts have focused on trying to improve ecological conditio...

The Classroom in Your Pocket?

ERIC Educational Resources Information Center

Power, Tom; Thomas, Rhodri

2007-01-01

Research exploring the ways in which information communication technologies (ICTs) could improve access to, and the quality of, teacher education in the global south (Leach et al., 2006) showed that when teachers were given sustained training, support and access to laptop and handheld computers, they found the handheld and laptop computers equally…

LCACCESS: MAKING LIFE CYCLE DATA AVAILABLE VIA THE INTERNET(SYSTEMS ANLAYSIS BRANCH, SUSTAINABLE TECHNOLOGY DIVISION, NRMRL)

EPA Science Inventory

The lack of readily available, quality environmental life cycle inventory (LCI) data is often a barrier to manufacturers, among others, for incorporating life cycle considerations into their decision-making process. While much progress has been made on standardizing and improving...

The Revolving Door of the Principalship. Implications from UCEA

ERIC Educational Resources Information Center

Fuller, Ed; Terry Orr, Margaret; Young, Michelle D.

2008-01-01

Selecting and retaining quality principals is critical to improving and sustaining school success. With better understanding of the prevalence and consequences of principal turnover rates and disparities across contexts, districts and states can implement policies and programs that will increase principal retention and success. Data drawn from…

Connecting soil microbial communities to soil functioning and soil health

USDA-ARS?s Scientific Manuscript database

One of the most important functions soils perform, is the capacity to buffer anthropogenic disturbances to sustain productivity while improving water and air quality. At the core of a healthy soil is a biological active and diverse community that provides internal nutrient cycling and is resilient t...

Microbial quality of improved drinking water sources: evidence from western Kenya and southern Vietnam.

PubMed

Grady, Caitlin A; Kipkorir, Emmanuel C; Nguyen, Kien; Blatchley, E R

2015-06-01

In recent decades, more than 2 billion people have gained access to improved drinking water sources thanks to extensive effort from governments, and public and private sector entities. Despite this progress, many water sector development interventions do not provide access to safe water or fail to be sustained for long-term use. The authors examined drinking water quality of previously implemented water improvement projects in three communities in western Kenya and three communities in southern Vietnam. The cross-sectional study of 219 households included measurements of viable Escherichia coli. High rates of E. coli prevalence in these improved water sources were found in many of the samples. These findings suggest that measures above and beyond the traditional 'improved source' definition may be necessary to ensure truly safe water throughout these regions.

Improving the availability of clinical history accompanying radiographic examinations in a large pediatric radiology department.

PubMed

Hawkins, C Matthew; Anton, Christopher G; Bankes, Wendy M; Leach, Alan D; Zeno, Michael J; Pryor, Rebecca M; Larson, David B

2014-04-01

The purpose of this quality improvement initiative was to improve the consistency with which radiologists are provided a complete clinical history when interpreting radiography examinations performed in the outpatient and emergency department settings. The clinical history was considered complete if it contained three elements: nature of the symptoms, description of injury, or cause for clinical concern; duration of symptoms or time of injury; and focal site of pain or abnormality, if applicable. This was reduced to three elements: "what-when-where." A goal was established that 95% of the clinical histories should contain all three elements. To achieve this goal, technologists supplemented referring clinicians' history. The project was divided into four phases: launch, support, transition to sustainability, and maintenance. During the support phase, results of automated weekly audits automatically populated group-level performance reports. During the transition to the sustainability phase, audit results populated individual-level performance reports. During the maintenance phase, quarterly audit results were incorporated into technologists' employee performance goals. Before initiation of the project, 38% (76/200) of radiography examinations were accompanied by a complete clinical history. This increased to 92% (928/1006) by the end of the 15-week improvement phase. Performance was sustained at 96% (1168/1213) 7 months later [corrected]. By clearly defining expectations for an appropriate clinical history and establishing system and organizational mechanisms to facilitate verifiable compliance, we were able to successfully and sustainably improve the consistency with which radiography examinations were accompanied by a complete clinical history.

Improving patient care by making small sustainable changes: a cardiac telemetry unit's experience.

PubMed

Braaten, Jane S; Bellhouse, Dorothy E

2007-01-01

With the introduction of each new drug, technology, and regulation, the processes of care become more complicated, creating an elaborate set of procedures connecting various hospital units and departments. Using methods of Adaptive Design and the Toyota Production System, a nursing unit redesigned work systems to achieve sustainable improvements in productivity, staff and patient satisfaction, and quality outcomes. The first hurdle of redesign was identifying problems, to which staff had become so accustomed with various work arounds that they had trouble seeing the process bottlenecks. Once the staff identified problems, they assumed they could solve the problem because they assumed they knew the causes. Utilizing root cause analysis, asking, "why, why, why," was essential to unearthing the true cause of a problem. Similarly, identifying solutions that were simple and low cost was an essential step in problem solving. Adopting new procedures and sustaining the commitment to identify and signal problems was a last and critical step toward realizing improvement, requiring a manager to function as "teacher/coach" rather than "fixer/firefighter".

Solar powered oxygen systems in remote health centers in Papua New Guinea: a large scale implementation effectiveness trial.

PubMed

Duke, Trevor; Hwaihwanje, Ilomo; Kaupa, Magdalynn; Karubi, Jonah; Panauwe, Doreen; Sa'avu, Martin; Pulsan, Francis; Prasad, Peter; Maru, Freddy; Tenambo, Henry; Kwaramb, Ambrose; Neal, Eleanor; Graham, Hamish; Izadnegahdar, Rasa

2017-06-01

Pneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses. These hospitals are hampered by lack of reliable power, staff training and other basic services. We report the methodology of a large implementation effectiveness trial involving sustainable and renewable oxygen and power systems in 36 health facilities in remote rural areas of PNG. The methodology is a before-and after evaluation involving continuous quality improvement, and a health systems approach. We describe this model of implementation as the considerations and steps involved have wider implications in health systems in other countries. The implementation steps include: defining the criteria for where such an intervention is appropriate, assessment of power supplies and power requirements, the optimal design of a solar power system, specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, installation logistics in remote settings, the role of oxygen analyzers in monitoring oxygen concentrator performance, the engineering capacity required to sustain a program at scale, clinical guidelines and training on oxygen equipment and the treatment of children with severe respiratory infection and other critical illnesses, program costs, and measurement of processes and outcomes to support continuous quality improvement. This study will evaluate the feasibility and sustainability issues in improving oxygen systems and providing reliable power on a large scale in remote rural settings in PNG, and the impact of this on child mortality from pneumonia over 3 years post-intervention. Taking a continuous quality improvement approach can be transformational for remote health services.

The BetterBirth Program: Pursuing Effective Adoption and Sustained Use of the WHO Safe Childbirth Checklist Through Coaching-Based Implementation in Uttar Pradesh, India

PubMed Central

Kara, Nabihah; Firestone, Rebecca; Kalita, Tapan; Gawande, Atul A; Kumar, Vishwajeet; Kodkany, Bhala; Saurastri, Rajiv; Pratap Singh, Vinay; Maji, Pinki; Karlage, Ami; Hirschhorn, Lisa R; Semrau, Katherine EA

2017-01-01

Shifting childbirth into facilities has not improved health outcomes for mothers and newborns as significantly as hoped. Improving the quality and safety of care provided during facility-based childbirth requires helping providers to adhere to essential birth practices—evidence-based behaviors that reduce harm to and save lives of mothers and newborns. To achieve this goal, we developed the BetterBirth Program, which we tested in a matched-pair, cluster-randomized controlled trial in Uttar Pradesh, India. The goal of this intervention was to improve adoption and sustained use of the World Health Organization Safe Childbirth Checklist (SCC), an organized collection of 28 essential birth practices that are known to improve the quality of facility-based childbirth care. Here, we describe the BetterBirth Program in detail, including its 4 main features: implementation tools, an implementation strategy of coaching, an implementation pathway (Engage-Launch-Support), and a sustainability plan. This coaching-based implementation of the SCC motivates and empowers care providers to identify, understand, and resolve the barriers they face in using the SCC with the resources already available. We describe important lessons learned from our experience with the BetterBirth Program as it was tested in the BetterBirth Trial. For example, the emphasis on relationship building and respect led to trust between coaches and birth attendants and helped influence change. In addition, the cloud-based data collection and feedback system proved a valuable asset in the coaching process. More research on coaching-based interventions is required to refine our understanding of what works best to improve quality and safety of care in various settings. (After publication of this article, the impact results of the BetterBirth intervention were published in the New England Journal of Medicine [volume 377, pages 2313-2324, doi: 10.1056/NEJMoa1701075]. The results showed that the intervention had no significant effect on maternal or perinatal mortality or maternal morbidity, despite having positive effects on essential birth practices.) PMID:28655801

Riverbank filtration for the treatment of highly turbid Colombian rivers

NASA Astrophysics Data System (ADS)

Gutiérrez, Juan Pablo; van Halem, Doris; Rietveld, Luuk

2017-05-01

The poor quality of many Colombian surface waters forces us to seek alternative, sustainable treatment solutions with the ability to manage peak pollution events and to guarantee the uninterrupted provision of safe drinking water to the population. This review assesses the potential of using riverbank filtration (RBF) for the highly turbid and contaminated waters in Colombia, emphasizing water quality improvement and the influence of clogging by suspended solids. The suspended sediments may be favorable for the improvement of the water quality, but they may also reduce the production yield capacity. The cake layer must be balanced by scouring in order for an RBF system to be sustainable. The infiltration rate must remain high enough throughout the river-aquifer interface to provide the water quantity needed, and the residence time of the contaminants must be sufficient to ensure adequate water quality. In general, RBF seems to be a technology appropriate for use in highly turbid and contaminated surface rivers in Colombia, where improvements are expected due to the removal of turbidity, pathogens and to a lesser extent inorganics, organic matter and micro-pollutants. RBF has the potential to mitigate shock loads, thus leading to the prevention of shutdowns of surface water treatment plants. In addition, RBF, as an alternative pretreatment step, may provide an important reduction in chemical consumption, considerably simplifying the operation of the existing treatment processes. However, clogging and self-cleansing issues must be studied deeper in the context of these highly turbid waters to evaluate the potential loss of abstraction capacity yield as well as the development of different redox zones for efficient contaminant removal.

Improvement in the yield and quality of kalmegh (Andrographis paniculata Nees) under the sustainable production system.

PubMed

Verma, Rajesh Kumar; Verma, Sanjeet K; Pankaj, Umesh; Gupta, Anand K; Khan, Khushboo; Shankar, Karuna

2015-02-01

Andrographis paniculata Nees is an annual erect herb with wide medicinal and pharmacological applications due to the presence of andrographolide and other active chemical constituents. The large-scale cultivation of the kalmegh is not in practice. The aim of this study was to establish sustainable production systems of A. paniculata cv CIM-Megha with the application of different bioinoculants and chemical fertilisers. A. paniculata herb and andrographolide yield in the dried leaves was found to be highest (218% and 61.3%, respectively) in treatment T3 (NPK+Bacillus sp.) compared with T1 (control). The soil organic carbon, soil microbial respiration, soil enzymes activity and available nutrients improved significantly with combined application of bioinoculants and chemical fertilisers.

Curbing variations in packaging process through Six Sigma way in a large-scale food-processing industry

NASA Astrophysics Data System (ADS)

Desai, Darshak A.; Kotadiya, Parth; Makwana, Nikheel; Patel, Sonalinkumar

2015-03-01

Indian industries need overall operational excellence for sustainable profitability and growth in the present age of global competitiveness. Among different quality and productivity improvement techniques, Six Sigma has emerged as one of the most effective breakthrough improvement strategies. Though Indian industries are exploring this improvement methodology to their advantage and reaping the benefits, not much has been presented and published regarding experience of Six Sigma in the food-processing industries. This paper is an effort to exemplify the application of Six Sigma quality improvement drive to one of the large-scale food-processing sectors in India. The paper discusses the phase wiz implementation of define, measure, analyze, improve, and control (DMAIC) on one of the chronic problems, variations in the weight of milk powder pouch. The paper wraps up with the improvements achieved and projected bottom-line gain to the unit by application of Six Sigma methodology.

Quality of Life Changes Following Surgery for Hyperhidrosis.

PubMed

de Campos, José Ribas Milanez; da Fonseca, Hugo Veiga Sampaio; Wolosker, Nelson

2016-11-01

The best way to evaluate the impact of primary hyperhidrosis on quality of life (QL) is through specific questionnaires, avoiding generic models that do not appropriately evaluate individuals. QL improves significantly in the short term after sympathectomy. In the longer term, a sustained and stable improvement is seen, although there is a small decline in the numbers; after 5 and even at 10 years of follow-up it shows virtually the same numerical distribution. Compensatory hyperhidrosis is a major side effect and the main aggravating factor in postoperative QL, requiring attention to its management and prevention. Copyright © 2016 Elsevier Inc. All rights reserved.

Research on station management in subway operation safety

NASA Astrophysics Data System (ADS)

Li, Yiman

2017-10-01

The management of subway station is an important part of the safe operation of urban subway. In order to ensure the safety of subway operation, it is necessary to study the relevant factors that affect station management. In the protection of subway safety operations on the basis of improving the quality of service, to promote the sustained and healthy development of subway stations. This paper discusses the influencing factors of subway operation accident and station management, and analyzes the specific contents of station management security for subway operation, and develops effective suppression measures. It is desirable to improve the operational quality and safety factor for subway operations.

Improving sustainability in the remediation of contaminated soils by the use of compost and energy valorization by Paulownia fortunei.

PubMed

Madejón, Paula; Domínguez, María Teresa; Díaz, Manuel Jesús; Madejón, Engracia

2016-01-01

The plantation of fast growing trees in contaminated sites, in combination with the use of organic wastes, could partially solve a dual environmental problem: the disposal of these wastes and the improvement of soil quality in these degraded soils. This study evaluated the effects of two compost on the quantity and quality of Paulownia fortunei biomass and on syngas production by biomass gasification, produced by plants growing on trace elements contaminated soils. Compost increased biomass production to values similar to those produced in non-contaminated soils, due to the improvement in plant nutritional status. Moreover, biomass quality for gasification was increased by compost addition. Trace element accumulation in the biomass was relatively low and not related to biomass production or the gas quality obtained through gasification. Thus, P. fortunei plantations could pose an opportunity to improve the economic balance of the revegetation of contaminated soils, given that other commercial uses such as food or fodder crop production is not recommended in these soils. Copyright © 2015 Elsevier B.V. All rights reserved.

Improving hand hygiene in a paediatric hospital: a multimodal quality improvement approach.

PubMed

Jamal, Ahmed; O'Grady, G; Harnett, E; Dalton, D; Andresen, D

2012-02-01

Effective hand hygiene has long been recognised as an important way to reduce the transmission of bacterial and viral pathogens in healthcare settings. However, many studies have shown that adherence to hand hygiene remains low, and improvement efforts have often not delivered sustainable results. The Children's Hospital at Westmead is the largest tertiary paediatric hospital in Sydney, Australia. The hospital participated in a state-wide 'Clean hands save lives' campaign which was initiated in 2006. Strong leadership, good stakeholder engagement, readily accessible alcohol-based hand rub at the point of patient care, a multifaceted education programme, monitoring of staff, adherence to recommended hand hygiene practices and contemporaneous feedback of performance data have significantly improved and maintained compliance with hand hygiene. Hand hygiene compliance has increased from 23% in 2006 to 87% in 2011 (p<0.001). Sustained improvement in compliance with hand hygiene has been evident in the last 4 years. A decline in a set of hospital-acquired infections (including rotavirus, multiresistant organism transmission, and nosocomial bacteraemia) has also been noted as hand hygiene rates have improved. Monthly usage of alcohol-based hand rub has increased from 16 litres/1000 bed days to 51 litres/1000 bed days during this same period. This project has delivered sustained improvement in hand hygiene compliance by establishing a framework of multimodal evidence-based strategies.

Achieving Hand Hygiene Success With a Partnership Between Graduate Medical Education, Hospital Leadership, and Physicians.

PubMed

Rosenbluth, Glenn; Garritson, Susan; Green, Adrienne L; Milev, Dimiter; Vidyarthi, Arpana R; Auerbach, Andrew D; Baron, Robert B

2016-11-01

Engaging physicians in hand hygiene programs is a challenge faced by many academic medical centers. Partnerships between education and academic leaders present opportunities for effective collaboration and improvement. The authors developed a robust hand hygiene quality improvement program, with attention to rapid-cycle improvements, including all levels of staff and health care providers. The program included a defined governance structure, clear data collection process, educational interventions, rapid-cycle improvements, and financial incentive for staff and physicians (including residents and fellows). Outcomes were measured on patients in all clinical areas. Run charts were used to document compliance in aggregate and by subgroups throughout the project duration. Institutional targets were achieved and then exceeded, with sustained hand hygiene compliance >90%. Physician compliance lagged behind aggregate compliance but ultimately was sustained at a level exceeding the target. Successfully achieving the institutional goal required collaboration among all stakeholders. Physician-specific data and physician champions were essential to drive improvement. © The Author(s) 2015.

Does a competitive voucher program for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua.

PubMed

Meuwissen, Liesbeth E; Gorter, Anna C; Kester, Arnold D M; Knottnerus, J Andre

2006-08-07

Little is known about how sexual and reproductive (SRH) health can be made accessible and appropriate to adolescents. This study evaluates the impact and sustainability of a competitive voucher program on the quality of SRH care for poor and underserved female adolescents and the usefulness of the simulated patient (SP) method for such evaluation. 28,711 vouchers were distributed to adolescents in disadvantaged areas of Managua that gave free-of-charge access to SRH care in 4 public, 10 non-governmental and 5 private clinics. Providers received training and guidelines, treatment protocols, and financial incentives for each adolescent attended. All clinics were visited by female adolescent SPs requesting contraception. SPs were sent one week before, during (with voucher) and one month after the intervention. After each consultation they were interviewed with a standardized questionnaire. Twenty-one criteria were scored and grouped into four categories. Clinics' scores were compared using non-parametric statistical methods (paired design: before-during and before-after). Also the influence of doctors' characteristics was tested using non-parametric statistical methods. Some aspects of service quality improved during the voucher program. Before the program started 8 of the 16 SPs returned 'empty handed', although all were eligible contraceptive users. During the program 16/17 left with a contraceptive method (p = 0.01). Furthermore, more SPs were involved in the contraceptive method choice (13/17 vs.5/16, p = 0.02). Shared decision-making on contraceptive method as well as condom promotion had significantly increased after the program ended. Female doctors had best scores before- during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements did not sustain after the program ended. This study illustrates provider-related obstacles adolescents often face when requesting contraception. The care provided during the voucher program improved for some important outcomes. The improvements were more pronounced among providers with the weakest initial performance. Shared decision-making and condom promotion were improvements that sustained after the program ended. The SP method is suitable and relatively easy to apply in monitoring clinics' performance, yielding important and relevant information. Objective assessment of change through the SP method is much more complex and expensive.

[Study on sustained release preparations of Epimedium component].

PubMed

Yan, Hong-mei; Ding, Dong-mei; Zhang, Zhen-hai; Sun, E; Song, Jie; Jia, Xiao-bin

2015-04-01

The formulation for sustained release tablet of Epinedium component was selected and the evaluation equation of in vitro release was established. The liquidity of component was improved with the help of colloidal silica aided by spray drying, which would be the main drug in the sustained release tablets. Dissolution was selected as an evaluation index to investigate skeletal material type, fillers, impact porogen, lubricants and other materials on the quality of sustained release tablet. The sustained release tablets were prepared by dry compression. Formulation of sustained release preparations was main drug 35%, HPMC K(4M) 20% and HPMC K(15M) 10% as skeleton material, MCC 31% as filler, PEG6000 2% as porogen and magnesium stearate 2% as lubricant. The sustained release tablets released up to 80% in 8 h. The zero order equation, primary equation and Higuchi equation could simulate the release characteristics of sustained release tablets in vitro, the correlation coefficients r were larger than 0.96. The primary equation was most similar in vitro release characteristics and its correlation coefficient r was 0.9950. The preparation method is simple and the results of formulation selection are reliable. It can be used to guide the production of Epimedium component sustained release preparations.

Innovative Use of Quality Management Methods for Product Improvement

NASA Astrophysics Data System (ADS)

Midor, Katarzyna; Žarnovský, Jozef

2016-12-01

Organisations constantly look for new, innovative solutions and methods which could be used to improve their efficiency and increase the quality of their products. Identifying the causes for returns is an important issue for modern companies, as returns are the cause for the increase in production costs and, most importantly, the loss of credibility in the eyes of the client. Therefore, for the company to be able to sustain or strengthen its position on the market, it has to follow the rules of quality management. Especially important is the rule of constant improvement. This rule is primarily connected with preventing errors and defects from occurring at all the stages of the production process. To achieve that, one must, among other things, use quality management tools. The article presents an analysis of causes for returns of a vibrating screen produced by a company which manufactures machinery and equipment for the extractive industry, using quality management tools such as the Ishikawa diagram and Pareto analysis. The analysis allowed for the identification of the causes of client returns which could not be previously identified, and proposing solutions for them.

Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

PubMed Central

Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

2016-01-01

Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

Long-term Effect of Pig Slurry Application on Soil Carbon Storage, Quality and Yield Sustainability in Murcia Region, Spain

NASA Astrophysics Data System (ADS)

Büyükkılıç Yanardaǧ, Asuman

2013-04-01

Sustainability of agriculture is now a major global concern, especially since the 1980s. Soil organic matter is very important in the proper functions of the soil, which is also a good indicator of soil quality. This is due to its influence on many of the chemical, physical, and biological processes that control the capacity of a soil to perform properly. Understanding of nutrient supply through organic matter mineralization in agricultural systems is essential for maintaining long-term quality and productivity. The composition of pig manure will have a profound impact on soil properties, quality and crop yield when used in agriculture. We studied the effects of pig slurry (PS) application as an organic fertilizer, trying to determine the optimum amount that can be added to the soil, and the effect on soil properties, quality, and productivity. We applied 3 different doses on silty loam soils: Single (D1), Double (D2), Triple (D3) and unfertilized plots (C) served as controls. Samples were collected at two different levels, surface (0-30 cm) and subsurface (30-60 cm). D1 application dose, which is the agronomic rate of N-requirement (170 kg N/ha/yr) (European Directive 91/676/CEE), is very appropriate in term of sustainable agriculture and also can improve physical, chemical and biological soil properties. Therefore that the long-term use of PS with low dose may necessarily enhance soil quality in the long term. There are many factors to be considered when attempting to assess the overall net impact of a management practice on productivity. Additions of pig manure to soils at agronomic rates (170 kg N ha-1 yr-1) to match crop nutrient requirements are expected to have a positive impact on soil productivity. Therefore, the benefits from the use of application depend on the management of PS, carbon and environmental quality. However, PS have high micronutrient contents, and for this reason the application of high doses can pollute soils and damage human, animal and plant health, which is not suitable in term of sustainable agriculture. Keywords: Management, Pig slurry, Productivity, Quality, Soil.

Implementing electronic handover: interventions to improve efficiency, safety and sustainability.

PubMed

Alhamid, Sharifah Munirah; Lee, Desmond Xue-Yuan; Wong, Hei Man; Chuah, Matthew Bingfeng; Wong, Yu Jun; Narasimhalu, Kaavya; Tan, Thuan Tong; Low, Su Ying

2016-10-01

Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Sustained remission of symptoms and improved health-related quality of life in patients with cryopyrin-associated periodic syndrome treated with canakinumab: results of a double-blind placebo-controlled randomized withdrawal study.

PubMed

Koné-Paut, Isabelle; Lachmann, Helen J; Kuemmerle-Deschner, Jasmin B; Hachulla, Eric; Leslie, Kieron S; Mouy, Richard; Ferreira, Alberto; Lheritier, Karine; Patel, Neha; Preiss, Ralph; Hawkins, Philip N

2011-01-01

To assess the effect of canakinumab, a fully human anti-interleukin-1β antibody, on symptoms and health-related quality of life (HRQoL) in patients with cryopyrin-associated periodic syndrome (CAPS). In this 48-week, phase 3 study, patients with CAPS received canakinumab 150 mg subcutaneously at 8-week intervals. All patients (n = 35) received canakinumab during weeks 1 through 8; weeks 9 through 24 constituted a double-blind placebo-controlled withdrawal phase, and weeks 24 through 48 constituted an open-label phase in which all patients received canakinumab. Patient and physician assessments of symptoms, levels of inflammatory markers, and HRQoL were performed. Rapid symptom remission was achieved, with 89% of patients having no or minimal disease activity on day 8. Responses were sustained in patients receiving 8-weekly canakinumab. Responses were lost during the placebo-controlled phase in the placebo group and were regained on resuming canakinumab therapy in the open-label phase. Clinical responses were accompanied by decreases in serum levels of C-reactive protein, serum amyloid A protein, and interleukin-6. HRQoL scores at baseline were considerably below those of the general population. Improvements in all 36-item Short-Form Health Survey (SF-36) domain scores were evident by day 8. Scores approached or exceeded those of the general U.S. population by week 8 and remained stable during canakinumab therapy. Improvements in bodily pain and role-physical were particularly marked, increasing by more than 25 points from baseline to week 8. Therapy was generally well tolerated. Canakinumab, 150 mg, 8-weekly, induced rapid and sustained remission of symptoms in patients with CAPS, accompanied by substantial improvements in HRQoL. Clintrials.gov NCT00465985.

Use of proton pump inhibitors among older Australians: national quality improvement programmes have led to sustained practice change.

PubMed

Pratt, Nicole L; Kalisch Ellett, Lisa M; Sluggett, Janet K; Gadzhanova, Svetla V; Ramsay, Emmae N; Kerr, Mhairi; LeBlanc, Vanessa T; Barratt, John D; Roughead, Elizabeth E

2017-02-01

To evaluate the impact of national multifaceted initiatives to improve use of proton pump inhibitors (PPIs) on the use of PPIs among older Australians. Interrupted time series analysis using administrative health claims data from the Australian Government Department of Veterans' Affairs (DVA). Australia. All veterans and dependents who received PPIs between January 2003 and December 2013. National, multifaceted interventions to improve PPI use were conducted by the Australian Government Department of Veterans' Affairs Veterans' MATES programme and Australia's NPS MedicineWise in April 2004, June 2006, May 2009 and August 2012. Trends in monthly rate of use of any PPI among the veteran population, and the monthly rate of use of low strength PPIs among all veterans dispensed a PPI. Interventions in 2004, 2006, 2009 and 2012 slowed the rate of increase in PPI use significantly, with the 2012 intervention resulting in a sustained 0.04% decrease in PPI use each month. The combined effect of all four interventions was a 20.9% (95% CI 7.8-33.9%) relative decrease in PPI use 12 months after the final intervention. The four interventions also resulted in a 42.2% (95% CI 19.9-64.5%) relative increase in low strength PPI use 12 months after the final intervention. National multifaceted programmes targeting clinicians and consumers were effective in reducing overall PPI use and increasing use of low strength PPIs. Interventions to improve PPI use should incorporate regular repetition of key messages to sustain practice change. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Assessment of eco-environmental quality of Western Taiwan Straits Economic Zone.

PubMed

Ma, He; Shi, Longyu

2016-05-01

Regional eco-environmental quality is the key and foundation to the sustainable socio-economic development of a region. Eco-environmental quality assessment can reveal the capacity of sustainable socio-economic development in a region and the degree of coordination between social production and the living environment. As part of a new development strategy for Fujian Province, the Western Taiwan Straits Economic Zone (hereafter referred to as the Economic Zone) provides an important guarantee for the development of China's southeastern coastal area. Based on ecological and remote sensing data on the Economic Zone obtained in 2000, 2005, and 2010, this study investigated county-level administrative regions with a comprehensive index of eco-environmental indicators. An objective weighting method was used to determine the importance of each indicator. This led to the development of an indicator system to assess the eco-environmental quality of the economic zone. ArcGIS software was used to assess the eco-environmental quality of the economic zone based on each indicator. The eco-environmental quality index (EQI) of the county-level administrative regions was calculated. The overall eco-environmental quality of the Economic Zone during the period studied is described and analyzed. The results show that the overall eco-environmental quality of the Economic Zone is satisfactory, but significant intraregional differences still exist. The key to improving the overall eco-environmental quality of this area is to restore vegetation and preserve biodiversity.

Research to Improve Emotional Health and Quality of Life Among Service Members with Disabilities (RESTORE LIVES)

DTIC Science & Technology

2012-10-01

and Eye Movement Desensitization and Reprocessing ( EMDR ) which lead to clinically improved outcomes in...that uses eye movements and is designed to be brief (i.e. 1-5 treatment sessions). • By use of a randomized controlled trial, to evaluate ART versus...as to specific therapeutic role of eye movements , and 3-month follow-up results (sustainability) are pending. • Given short treatment duration

Sustaining quality improvement and patient safety training in graduate medical education: lessons from social theory.

PubMed

Wong, Brian M; Kuper, Ayelet; Hollenberg, Elisa; Etchells, Edward E; Levinson, Wendy; Shojania, Kaveh G

2013-08-01

Despite an official mandate to incorporate formal quality improvement (QI) and patient safety (PS) training into graduate medical education, many QI/PS curricular efforts face implementation challenges and are not sustained. Educators are increasingly turning to sociocultural theories to address issues such as curricular uptake in medical education. The authors conducted a case study using Bourdieu's concepts of "field" and "habitus" to identify theoretically derived strategies that can promote sustained implementation of QI/PS curricula. From October 2010 through May 2011, the authors conducted semistructured interviews with principal authors of studies included in a systematic review of QI/PS curricula and with key informants (identified by study participants) who did not publish on their QI/PS curricular efforts. The authors purposively sampled to theoretical saturation and analyzed data concurrently with iterative data gathering within Bourdieu's theoretical framework. The study included 16 participants representing six specialties in the United States and Canada. Data analysis revealed that academic physicians belong to, and compete for legitimate forms of capital within, two separate but related fields associated with QI/PScurricular implementation: the "academic field" and the "health care delivery field." Respondents used specific strategies toexploit and/or redefine the prevailingforms of legitimate capital in each field to encourage changes inacademic physicians' habitus that would legitimizeQI/PS. Situating study findings in a sociocultural theory enables articulation of concrete strategies that can legitimize QI/PS in the academic and health care delivery fields. These strategies can promote sustained QI/PS curricula in graduate medical education.

Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design.

PubMed

Paddick, Stella-Maria; Mkenda, Sarah; Mbowe, Godfrey; Kisoli, Aloyce; Gray, William K; Dotchin, Catherine L; Ternent, Laura; Ogunniyi, Adesola; Kissima, John; Olakehinde, Olaide; Mushi, Declare; Walker, Richard W

2017-06-01

Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design. Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership. Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement. This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.

Iron nutrition, biomass production, and plant product quality.

PubMed

Briat, Jean-François; Dubos, Christian; Gaymard, Frédéric

2015-01-01

One of the grand challenges in modern agriculture is increasing biomass production, while improving plant product quality, in a sustainable way. Of the minerals, iron (Fe) plays a major role in this process because it is essential both for plant productivity and for the quality of their products. Fe homeostasis is an important determinant of photosynthetic efficiency in algae and higher plants, and we review here the impact of Fe limitation or excess on the structure and function of the photosynthetic apparatus. We also discuss the agronomic, plant breeding, and transgenic approaches that are used to remediate Fe deficiency of plants on calcareous soils, and suggest ways to increase the Fe content and bioavailability of the edible parts of crops to improve human diet. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

PubMed

Burkoski, Vanessa; Yoon, Jennifer

2013-01-01

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

Relative value unit-based compensation incentivization in an academic vascular practice improves productivity with no early adverse impact on quality.

PubMed

Awad, Nadia; Caputo, Francis J; Carpenter, Jeffrey P; Alexander, James B; Trani, José L; Lombardi, Joseph V

2017-02-01

Given the increased pressure from governmental programs to restructure reimbursements to reflect quality metrics achieved by physicians, review of current reimbursement schemes is necessary to ensure sustainability of the physician's performance while maintaining and ultimately improving patient outcomes. This study reviewed the impact of reimbursement incentives on evidence-based care outcomes within a vascular surgical program at an academic tertiary care center. Data for patients with a confirmed 30-day follow-up for the vascular surgery subset of our institution's National Surgical Quality Improvement Program submission for the years 2013 and 2014 were reviewed. The outcomes reviewed included 30-day mortality, readmission, unplanned returns to the operating room, and all major morbidities. A comparison of both total charges and work relative value units (RVUs) generated was performed before and after changes were made from a salary-based to a productivity-based compensation model. P value analysis was used to determine if there were any statistically significant differences in patient outcomes between the two study years. No statistically significant difference in outcomes of the core measures studied was identified between the two periods. There was a trend toward a lower incidence of respiratory complications, largely driven by a lower incidence in pneumonia between 2013 and 2014. The vascular division had a net increase of 8.2% in total charges and 5.7% in work RVUs after the RVU-based incentivization program was instituted. Revenue-improving measures can improve sustainability of a vascular program without negatively affecting patient care as evidenced by the lack of difference in evidence-based core outcome measures in our study period. Further studies are needed to elucidate the long-term effects of incentivization programs on both patient care and program viability. Copyright © 2016. Published by Elsevier Inc.

A quality improvement programme to increase compliance with an anti-infective prescribing policy

PubMed Central

Thakkar, Kandarp; Gilchrist, Mark; Dickinson, Edward; Benn, Jonathan; Franklin, Bryony Dean; Jacklin, Ann; Adeniran, Shola; Ali, Alisha; Brannigan, Eimear; Bamford, Kathy; Lam-Chong, Kelly; Dickinson, Edward; Gilchrist, Mark; Jacklin, Ann; Lawson, Wendy; Mehta, Roopal; Newsholme, William; Rana, Ambreen; Reynolds, Sarah; Sanderson, Frances; Wei Tan, Xin; Thakkar, Kandarp; Bracey, Gemma

2011-01-01

Objectives The UK Department of Health has made recommendations on safe and appropriate prescribing of anti-infectives. In response, we reviewed our anti-infective policies to ensure they were in line with best practice. As a result, a new adult anti-infective policy was launched. To help facilitate its implementation, a quality improvement programme was established, with the aim of achieving >90% compliance with the new policy. Methods Patients under the care of the medical admissions teams who had been prescribed one or more systemic anti-infectives between January and November 2008 were included in the study. Study pharmacists collected data daily on all patients, including the anti-infective(s) prescribed and indication(s) documented on either the patient's drug prescription chart or health records. A definition of compliance was developed, which required documented indication(s) and associated anti-infectives to match the anti-infective policy. A baseline compliance level was established; we then implemented a series of interventions using the plan-do-study-act (‘PDSA’) approach to monitor and improve compliance. Three overlapping intervention phases were retrospectively identified: raising awareness; education; and weekly feedback of results in the form of run charts distributed to medical teams. Results Over the 11 month study period, compliance with the policy increased from 30% to 71%. Since 2008, we have seen the average compliance increase year-on-year to over 90% in 2010 using a sustainable once weekly data collection model. Conclusions This study shows that it is possible to use quality improvement methodology to support antimicrobial stewardship within existing resources and suggests that an improvement in policy compliance can be both achieved and sustained. PMID:21642650

Transformational change in health care systems: an organizational model.

PubMed

Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P

2007-01-01

The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care organizations in their efforts to pursue the Institute of Medicine aims of fundamental system redesign to achieve dramatically improved patient care.

Long-Term Nightly Treatment with Indiplon in Adults with Primary Insomnia: Results of a Double-Blind, Placebo-Controlled, 3-Month Study

PubMed Central

Scharf, Martin B.; Black, Jed; Hull, Steven; Landin, Rick; Farber, Robert

2007-01-01

Objectives: To evaluate the efficacy and safety of indiplon in primary insomnia. Design: Randomized, double-blind, placebo-controlled, 3-month study. Setting: Multi-center outpatient setting. Patients: N=702 (61% female; mean age 46 years) who met DSM-IV criteria for primary insomnia of at least 3 months' duration. Interventions: Indiplon 10 mg (n=236), indiplon 20 mg (n=233), or placebo (n=233). Measurements: Subjective assessment of each of the following: latency to sleep onset (sLSO), total sleep time (sTST), number of awakenings after sleep onset (sNAASO), wake time after sleep onset (sWASO), sleep quality, Insomnia Severity Index (ISI), and global improvement. Results: Treatment with indiplon resulted in significant improvement relative to placebo at all time points for the primary endpoint, sLSO. Mean sLSO at Month 1 for each treatment group was: 10 mg (34.0 ± 1.3 mins), 20 mg (33.0 ± 1.3 mins), and placebo (48.7 ± 1.9 mins; P <0.0001 for both comparisons); efficacy was sustained through Month 3. Both doses of indiplon resulted in significant improvement in sleep maintenance and duration endpoints, sTST and sWASO, as well as sleep quality, ISI, and global improvement at all assessment time points. Conclusions: In patients with chronic insomnia, long-term nightly treatment with 10 mg and 20 mg doses of indiplon resulted in significant and sustained efficacy in sleep onset, maintenance, and duration, and significant associated improvement in both daytime functioning and quality of life. Citation: Scharf MB; Black J; Hull S et al. Long-term nightly treatment with indiplon in adults with primary insomnia: Results of a double-blind, placebo-controlled, 3-month study. SLEEP 2007;30(6):743-752. PMID:17580596

Toward malaysian sustainable agriculture in 21st century

NASA Astrophysics Data System (ADS)

Khorramnia, K.; Shariff, A. R. M.; Rahim, A. Abdul; Mansor, S.

2014-02-01

Sustainable agriculture should be able to meet various social goals and objectives so that it can be maintained for an indefinite period without significant negative impacts on environment and natural resources. A wide variety of agricultural activities are running in Malaysia. Maintaining high quality of agricultural products with lower environmental impacts through a sustainable economic viability and life satisfaction of farmers and community are important factors helping to meet sustainable agriculture. Human resources are playing key role in directing the community toward sustainable development. The trend of improving the human development index in Malaysia is highest in the East Asia and the Pacific, high human development countries and the world, since 2000. Precision agriculture is providing strong tools to achieve sustainable agriculture. Different types of sensors, positioning and navigation systems, GIS, software and variable rate technology are well known components of precision agriculture. Drones and robots are promising tools that enabling farmers and managers to collect information or perform particular actions in remote areas or tough conditions. According to a survey, forestry and timber, rubber production and oil palm estates are three main agricultural divisions that precision agriculture may improve the productivity in respect to area of cropland/worker. Main factors affecting the adoption of precision agriculture in Malaysia are: a) Political and legal supports, b) Decision support systems and user interfaces c) Experienced research team works d) National educational policy e) Success in commercialization of precision agriculture system.

Implementation of efficient irrigation management for a sustainable agriculture. LIFE+ project IRRIMAN

NASA Astrophysics Data System (ADS)

Pérez-Pastor, Alejandro; Garcia-Vila, Margarita; Gamero-Ojeda, Pedro; Ascensión Carmona, M.°; Hernandez, David; José Alarcón, Juan; Nicolás, Emilio; Nortes, Pedro; Aroca, Antonio; María de la Rosa, Jose; Zornoza, Raúl; Faz, Ángel; Molina, Angel; Torres, Roque; Ruiz, Manuel; Calatrava, Javier

2016-04-01

In water scarcity areas, it must be highlighted that the maximum productions of the crops do not necessarily imply maximum profitability. Therefore, during the last years a special interest in the development of deficit irrigation strategies based on significant reductions of the seasonal ET without affecting production or quality has been observed. The strategies of regulated deficit irrigation (RDI) are based on the reduction of water supply during non critical periods, the covering of water needs during critical periods and maximizing, at the same time, the production by unit of applied water. But its success greatly depends on the adequate application of the water deficit and requires a continuous and precise control of the plant and soil water status to adjust the water supplies at every crop phenological period. The main objective of this project is to implement, demonstrate and disseminate a sustainable irrigation strategy based on deficit irrigation to promote its large scale acceptance and use in woody crops in Mediterranean agroecosystems, characterized by water scarcity, without affecting the quality standards demanded by exportation markets. With the adoption of this irrigation management we mean to ensure efficient use of water resources, improving quantitative water management, preserving high level of water quality and avoiding misuse and deterioration of water resources. The adoption of efficient irrigation will also lead to increments in water productivity, increments in the potential carbon fixation of the agroecosystem, and decrease energy costs of pressurized irrigation, together with mitigation and adaptation to climate change. The project will achieve the general objective by implication of farmers, irrigation communities, agronomists, industry, consultants, associations and public administration, by increments in social awareness for sustainable irrigation benefits, optimization of irrigation scheduling, improvements in technology, and dissemination of sustainable irrigation guidelines. Acknowledgements This work has been funded by the European Union LIFE+ project IRRIMAN (LIFE13 ENV/ES/000539).

Brief educational intervention improves content of intern handovers.

PubMed

Shaughnessy, Erin E; Ginsbach, Kimberly; Groeschl, Nicole; Bragg, Dawn; Weisgerber, Michael

2013-03-01

The Accreditation Council for Graduate Medical Education requires residency programs to ensure safe patient handovers and to document resident competency in handover communication, yet there are few evidence-based curricula teaching resident handover skills. We assessed the immediate and sustained impact of a brief educational intervention on pediatrics intern handover skills. Interns at a freestanding children's hospital participated in an intervention that included a 1-hour educational workshop on components of high-quality handovers, as well as implementation of a standardized handover format. The format, SAFETIPS, includes patient information, current diagnosis and assessment, patient acuity, a focused plan, a baseline exam, a to-do list, anticipatory guidance, and potential pointers and pitfalls. Important communication behaviors, such as paraphrasing key information, were addressed. Quality of intern handovers was evaluated using a simulated encounter 2 weeks before, 2 weeks after, and 7 months after the workshop. Two trained, blinded, independent observers scored the videotaped encounters. All 27 interns rotating at the Children's Hospital consented to participate in the study, and 20 attended the workshop. We included all participant data in the analysis, regardless of workshop attendance. Following the intervention, intern reporting of patient acuity improved from 13% to 92% (P < .001), and gains were maintained 7 months later. Rates of key communication behaviors, such as paraphrasing critical information, did not improve. A brief educational workshop promoting standardized handovers improved the inclusion of essential information during intern handovers, and these improvements were sustained over time. The intervention did not improve key communication behaviors.

The Effects of Organization Design and Patient Perceptions of Care on Switching Behavior and Reliance on a Health Care System Across Time.

PubMed

Labonte, Alan J; Benzer, Justin K; Burgess, James F; Cramer, Irene E; Meterko, Mark; Pogoda, Terri K; Charns, Martin P

2016-04-01

Sustaining ongoing relationships with patients is a strategic, clinically relevant goal of health care systems. This study develops and tests a conceptual model that aims to account for the influence of organization design, perceptions of quality of patient care, and other patient-level factors on the extent to which patients sustain reliance on a health care system. We use a longitudinal survey design and structural equation modeling to predict increases or decreases in patient reliance on the Department of Veterans Affairs health care system across a 4-year period for Veterans with Parkinson's Disease. Our findings show that specialized and integrated clinical practices have a positive association with the quality of patient care. Health care systems may be able to foster long-term relations with patients and improve service quality by allocating resources to form integrated, specialized, disease-specific centers of care designed for patients with chronic illnesses. © The Author(s) 2016.

Assessment of soil quality index for wheat and sugar beet cropping systems on an entisol in Central Anatolia.

PubMed

Şeker, Cevdet; Özaytekin, Hasan Hüseyin; Negiş, Hamza; Gümüş, İlknur; Dedeoğlu, Mert; Atmaca, Emel; Karaca, Ümmühan

2017-04-01

The sustainable use of agricultural lands is significantly affected by the implemented management and land processing methods. In sugar beet and wheat cropping, because the agronomic characteristics of plants are different, the tillage methods applied also exhibit significant variability. Soil quality concept is used, as a holistic approach to determining the effects of these applications on the sustainable use of soil. Agricultural soil quality evaluation is essential for economic success and environmental stability in rapidly developing regions. At present, a variety of methods are used to evaluate soil quality using different indicators. This study was conducted in one of the most important irrigated agriculture areas of Çumra plain in Central Anatolia, Turkey. In the soil under sugar beet and wheat cultivation, 12 soil quality indicators (aggregate stability (AS), available water capacity (AWC), surface penetration resistance (PR 0-20 ), subsurface penetration resistance (PR 20-40 ), organic matter (OM), active carbon (AC), potentially mineralizable nitrogen (PMN), root health value (RHV), pH, available phosphorus (AP), potassium (K), and macro-micro elements (ME) (Mg, Fe, Mn, and Zn)) were measured and scored according to the Cornell Soil Health Assessment (CSHA) and the Soil Management Assessment Framework (SMAF). The differences among 8 (AS, AWC, PR 0-20 , PR 20-40 , AC, PMN, AP, and ME) of these 12 soil quality characteristics measured in two different plant cultivation were found statistically significant. The result of the soil quality evaluation with scoring function in the examined area revealed a soil quality score of 61.46 in the wheat area and of 51.20 in the sugar beet area, which can be classified as medium and low, respectively. Low soil quality scores especially depend on physical and biological soil properties. Therefore, improvement of soil physical and biological properties with sustainable management is necessary to enhance the soil quality in the study area soils.

Trade and commerce in improved crops and food: an essay on food security.

PubMed

Kershen, Drew L

2010-11-30

Agricultural trade between nations is a significant proportion of total international trade. Agricultural trade in transgenic crops faces extra complications due to the existence of domestic and international regimes that focus specifically on agricultural biotechnology. These specialized regimes create legal and commercial challenges for trade in transgenic crops that have significant implications for the food security of the nations of the world. By food security, one should understand not just the available supply of food, but also the quality of the food and the environmental impact of agricultural production systems. These specialized regimes for transgenic crops can either encourage or hinder the adoption of agricultural biotechnology as a sustainable intensive agriculture. Sustainable intensive agriculture offers hope for agronomic improvements for agricultural production, socio-economic betterment for farmers and environmental benefits for societies. Sustainable intensive agriculture offers particular hope for the poorest farmers of the world because agricultural biotechnology is a technology in the seed. Copyright © 2010 Elsevier B.V. All rights reserved.

[Sustainability and excellence of the Catalan health system. New paradigms, challenges and responses].

PubMed

Fernández i Alegre, Roser; Argenter i Giralt, Miquel; Rodríguez i Guasch, Xavier

2015-11-01

The aim of a health system and the priority of any government is to anticipate problems before they appear, provide an innovative response to these new needs and healthcare models, improve access of the general public and patients to health care, especially care for the most vulnerable groups, improve healthcare results and implement the structural reforms necessary to maintain a viable and sustainable quality public healthcare system for everyone. In the current environment, health systems are facing new economic, demographic, care, social, technological and political paradigms to which health policy must respond. Faced with these challenges, health systems, especially in the case of Catalonia, are challenged to take decisions on how best to approach the implementation of structural reform designed to facilitate the necessary economic and fiscal sustainability in the service of fresh and innovative health policies and patient-centred care within a system marked by excellence and equity. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Selecting ICT Based Solutions for Quality Learning and Sustainable Practice

ERIC Educational Resources Information Center

Gosper, Maree; Woo, Karen; Muir, Helen; Dudley, Christine; Nakazawa, Kayo

2007-01-01

This paper reports on a project involving software selection in the context of a curriculum redesign of a university level Japanese language program. The project aimed to improve learning outcomes, increase flexibility in student access, and increase flexibility in approaches to teaching and learning, through the use of a variety of software…

A practical alternative to single tree selection?

Treesearch

Gary W. Miller; H. Clay Smith

1993-01-01

When landowners want to develop and maintain an uneven-aged tree structure in eastern hardwood stands, single-tree selection often is suggested as the only advisable, long-term partial regeneration harvest method. Single-tree selection is preferred because it provides a means for improving quality and controlling stocking of the residual stand necessary for sustained...

Joining Rural Development Theory and Rural Education Practice.

ERIC Educational Resources Information Center

Hammer, Patricia Cahape

Karl N. Stauber proposes three goals for rural development policy: helping the rural middle class survive, reducing concentrated rural poverty, and sustaining and improving the quality of the natural environment. In contrast to other visions, he advises policy that focuses on rural places rather than rural economic sectors such as agriculture,…

Who is and who should be investing in soil?

USDA-ARS?s Scientific Manuscript database

Management of private and public lands is needed to improve the quality of soil and restore its ecological functions. Soil is as vital to human survival as is air, water, and the sun; its protection and enrichment with organic matter is needed for life sustaining ecosystems of our planet. Loss of ...

Improved quality management to enhance the efficacy of the sterile insect technique for lepidopteran pests

USDA-ARS?s Scientific Manuscript database

Lepidoptera are among the most severe pests of food and fibre crops in the world and are mainly controlled using broad spectrum insecticides. This does not lead to sustainable control and farmers are demanding alternative control tools which are both effective and friendly to the environment. The st...

Human Securitability: A Participatory Action Research Study Involving Novice Teachers and Youngsters

ERIC Educational Resources Information Center

Kravale-Paulina, Marite; Olehnovica, Eridiana

2015-01-01

Civic participation, initiative and interest in current events can bridge the alienation felt towards national and municipal institutions, thereby enabling individuals to improve their quality of life and contribute to all-round sustainable development of their resident state. This paper reports on a participatory action research study into civic…

The Relevance of the Alliance for CME Competencies for Planning, Organizing, and Sustaining an Interorganizational Educational Collaborative

ERIC Educational Resources Information Center

Balmer, Jann T.; Bellande, Bruce J.; Addleton, Robert L.; Havens, Carol S.

2011-01-01

The heightened demand for accountability, access, and quality performance from health care professionals has resulted in linkages between continuing education (CE), performance improvement (PI), and outcomes. CE health professionals must also expand their skills and abilities to design, implement, and measure CE activities consistent with these…

Effects of peach tree root system morphology and transpiration on leaf nitrogen and phosphorus

USDA-ARS?s Scientific Manuscript database

Adequate mineral nutrition is critical for high fruit quality and sustained yield of fruit trees. It is likely that nutritional competence of a fruit tree depends on several physiological and morphological traits that affect nutrient uptake. Fruit trees with improved root systems (own-rooted or as ...

Life-Cycle Analysis and Inquiry-Based Learning in Chemistry Teaching

ERIC Educational Resources Information Center

Juntunen, Marianne; Aksela, Maija

2013-01-01

The purpose of this design research is to improve the quality of environmental literacy and sustainability education in chemistry teaching through combining a socio-scientific issue, life-cycle analysis (LCA), with inquiry-based learning (IBL). This first phase of the cyclic design research involved 20 inservice trained chemistry teachers from…

Thoroughly Applying Scientific Outlook on Development Implementing Sustainable Development Strategy in Higher Vocational Colleges

ERIC Educational Resources Information Center

Li, Zhi; Wang, Youhua

2008-01-01

To make breakthroughs, obtain further development, and win in the fierce competition, higher vocational colleges must apply scientific outlook on development, set up students-and-teachers oriented educational concept, enhance connotation construction, create competition advantages so as to fully improve education and teaching quality and realize…

The Future Architects' Attitude towards Innovations in the Context of Sustainable Development

ERIC Educational Resources Information Center

Artemeva, Veronika

2014-01-01

The architectural innovations are becoming more and more important in the economic and social development and in the quality improvement of people's lives. Sometimes, however, the implementation of innovative projects can lead to negative consequences. The development of any innovation should be based on a comprehensive analysis of their…

Teacher Unions and the Teaching Workforce: Mismatch or Vital Contribution?

ERIC Educational Resources Information Center

Bascia, Nina

2004-01-01

Establishing and sustaining quality teaching is equally dependent on the capacity of organizations and networks at regional, district and school levels to productively engage in improvement efforts that are realized in the classroom. The "teacher workforce" evokes military and industrial images, huge numbers of workers who must be trained,…

The 4Rs for cover crops and other advances in cover crop management for environmental quality

USDA-ARS?s Scientific Manuscript database

Cover crops (CC) are universal tools that can be used to improve management practices to draw multiple benefits with increased sustainability across different continents (Dabney et al. 2001; Reeves 1994; Woodruff and Siddoway 1965; Frye et al. 1985; Holderbaum et al. 1990; Bilbro 1991; Langdale et a...

Listening to and Learning from Graduate's Perceptions: Implications for Change?

ERIC Educational Resources Information Center

Kotsifos, Vangelis; Alegakis, Athanasios; Philalithis, Anastas

2013-01-01

The impact of Word of Mouth Communication (WoMC) in attracting new candidates, and thus contributing to the sustainability of Higher Education Institutions, is highlighted in the literature along with its importance as an indicator for quality improvements in course provision. In the present study graduates were questioned concerning their…

Aerobic Decomposition and Organic Amendments Effects on Grain Yield of Triple-Cropped Rice in the Mekong Delta, Vietnam

USDA-ARS?s Scientific Manuscript database

Soil aeration during decomposition of incorporated crop residues and application of organic amendments might help improve soil quality and rice yield for sustainable intensive rice production. A field experiment was conducted on triple-cropped rice during three consecutive crops with five treatments...

Are Teachers Who Need Sustained, Content-Focused Professional Development Getting It? An Administrator's Dilemma

ERIC Educational Resources Information Center

Desimone, Laura M.; Smith, Thomas M.; Ueno, Koji

2006-01-01

Purpose: Policymakers and administrators are increasingly focusing on professional development as a means to improve teaching quality. In this study, the authors examine whether professional development in mathematics is primarily performing an educative function by addressing weak teacher preparation, or a catalytic function by serving mainly…

Exploring the Influences on Classroom-Based Contact via Shared Education in Northern Ireland

ERIC Educational Resources Information Center

Loader, Rebecca

2017-01-01

Initiatives in intercultural education have frequently involved the promotion of contact between members of different groups as a means of improving intergroup relations. Experience from Northern Ireland suggests, however, that such schemes have often been organised and delivered in such a way that opportunities for sustained, high-quality contact…

Introducing Online Training in an Early Childhood Professional Development System: Lessons Learned in One State

ERIC Educational Resources Information Center

Stone-MacDonald, Angi; Douglass, Anne

2015-01-01

Online educational opportunities provide improved access to high quality professional development for the early education and care workforce. Online and technology mediated learning can create sustainable education and development opportunities for states when face-to-face training is financially prohibitive. This study examined one state's…

Higher Education Technology and Research: Creating Excellence through State Investments

ERIC Educational Resources Information Center

New Jersey Commission on Higher Education, 2004

2004-01-01

Colleges and universities in New Jersey play a critical role in building and sustaining economic prosperity and quality of life in the state and beyond. Through advancements in technology and research, higher education helps to create new jobs, improve the workforce, develop new knowledge, and boost the overall economy. This report summarizes…

A framework of connections between soil and people can help improve sustainability of the food system and soil functions.

PubMed

Ball, Bruce C; Hargreaves, Paul R; Watson, Christine A

2018-04-01

Globally soil quality and food security continue to decrease indicating that agriculture and the food system need to adapt. Improving connection to the soil by knowledge exchange can help achieve this. We propose a framework of three types of connections that allow the targeting of appropriate messages to different groups of people. Direct connection by, for example, handling soil develops soil awareness for management that can be fostered by farmers joining groups on soil-focused farming such as organic farming or no-till. Indirect connections between soil, food and ecosystem services can inform food choices and environmental awareness in the public and can be promoted by, for example, gardening, education and art. Temporal connection revealed from past usage of soil helps to bring awareness to policy workers of the need for the long-term preservation of soil quality for environmental conservation. The understanding of indirect and temporal connections can be helped by comparing them with the operations of the networks of soil organisms and porosity that sustain soil fertility and soil functions.

Restoration of urban waterways and vacant areas: the first steps toward sustainability.

PubMed Central

Cairns, J; Palmer, S E

1995-01-01

Increased population pressure and human activities have significantly altered the effectiveness of functions of ecosystems ("ecosystem services") at the local and regional scale. Of primary importance is the decrease in water quality due to urban storm water runoff. A number of communities have initiated restoration strategies to improve water quality standards. One such strategy is the incorporation of riparian walkways with native flora. As a result of such restoration efforts, habitats for native fauna have improved, and the number and diversity of wildlife have increased in urban settings. Restoration of urban habitats also provides social and economic benefits to the surrounding community. Efforts to mitigate the loss of ecological resources by restoring native habitats on lots that cannot be developed or on abandoned lots hold a high, unrealized potential. Habitat restoration not only provides natural diversions to urban surroundings, but also enlightens and educates individual citizens about the importance of balanced ecosystems and the role of humans within ecosystems. Education is the primary step toward creating ecologically sustainable communities. Images p452-a PMID:7656873

Quality of care: measuring a neglected driver of improved health

PubMed Central

Kruk, Margaret E

2017-01-01

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

Comparing Measures of Voice Quality From Sustained Phonation and Continuous Speech.

PubMed

Gerratt, Bruce R; Kreiman, Jody; Garellek, Marc

2016-10-01

The question of what type of utterance-a sustained vowel or continuous speech-is best for voice quality analysis has been extensively studied but with equivocal results. This study examines whether previously reported differences derive from the articulatory and prosodic factors occurring in continuous speech versus sustained phonation. Speakers with voice disorders sustained vowels and read sentences. Vowel samples were excerpted from the steadiest portion of each vowel in the sentences. In addition to sustained and excerpted vowels, a 3rd set of stimuli was created by shortening sustained vowel productions to match the duration of vowels excerpted from continuous speech. Acoustic measures were made on the stimuli, and listeners judged the severity of vocal quality deviation. Sustained vowels and those extracted from continuous speech contain essentially the same acoustic and perceptual information about vocal quality deviation. Perceived and/or measured differences between continuous speech and sustained vowels derive largely from voice source variability across segmental and prosodic contexts and not from variations in vocal fold vibration in the quasisteady portion of the vowels. Approaches to voice quality assessment by using continuous speech samples average across utterances and may not adequately quantify the variability they are intended to assess.

The Joint Commission Children’s Asthma Care Quality Measures and Asthma Readmissions

PubMed Central

Fassl, Bernhard A.; Nkoy, Flory L.; Stone, Bryan L.; Srivastava, Rajendu; Simon, Tamara D.; Uchida, Derek A.; Koopmeiners, Karmella; Greene, Tom; Cook, Lawrence J.

2012-01-01

BACKGROUND AND OBJECTIVES: The Joint Commission introduced 3 Children’s Asthma Care (CAC 1–3) measures to improve the quality of pediatric inpatient asthma care. Validity of the commission’s measures has not yet been demonstrated. The objectives of this quality improvement study were to examine changes in provider compliance with CAC 1–3 and associated asthma hospitalization outcomes after full implementation of an asthma care process model (CPM). METHODS: The study included children aged 2 to 17 years who were admitted to a tertiary care children’s hospital for acute asthma between January 1, 2005, and December 31, 2010. The study was divided into 3 periods: preimplementation (January 1, 2005–December 31, 2007), implementation (January 1, 2008–March 31, 2009), and postimplementation (April 1, 2009–December 31, 2010) periods. Changes in provider compliance with CAC 1–3 and associated changes in hospitalization outcomes (length of stay, costs, PICU transfer, deaths, and asthma readmissions within 6 months) were measured. Logistic regression was used to control for age, gender, race, insurance type, and time. RESULTS: A total of 1865 children were included. Compliance with quality measures before and after the CPM implementation was as follows: 99% versus 100%, CAC-1; 100% versus 100%, CAC-2; and 0% versus 87%, CAC-3 (P < .01). Increased compliance with CAC-3 was associated with a sustained decrease in readmissions from an average of 17% to 12% (P = .01) postimplementation. No change in other outcomes was observed. CONCLUSIONS: Implementation of the asthma CPM was associated with improved compliance with CAC-3 and with a delayed, yet significant and sustained decrease in hospital asthma readmission rates, validating CAC-3 as a quality measure. Due to high baseline compliance, CAC-1 and CAC-2 are of questionable value as quality measures. PMID:22908110

Aligning Forces for Quality multi-stakeholder healthcare alliances: do they have a sustainable future?

PubMed

Alexander, Jeffrey A; Hearld, Larry R; Wolf, Laura J; Vanderbrink, Jocelyn M

2016-08-01

Multi-stakeholder healthcare alliances in the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program brought together diverse stakeholders to work collaboratively to improve healthcare in their local communities. This article evaluates how well the AF4Q alliances were collectively positioned to sustain themselves as AF4Q program support ended. This analysis relied on a mixed-methods design using data from a survey of more than 700 participants in 15 of the 16 AF4Q alliances (1 alliance was unable to participate because it was in the process of closing down operations at the time of survey implementation), qualitative interviews with leaders in all 16 of the alliances, and secondary sources. Qualitative analysis of interview data and secondary sources were used to develop a classification of alliance strategic directions after the AF4Q program relative to their strategies during the AF4Q initiative. Descriptive analyses of survey data were conducted in the following areas: (1) alliance priorities for sustainability, (2) alliance positioning for sustainability, and (3) alliance challenges to sustainability. The likelihood of sustainability and the strategic direction of the former AF4Q alliances are both decidedly mixed. A substantial number of alliances are at risk because of an unclear strategic direction following the AF4Q program, poor financial support, and a lack of relevant community leadership. Some have a clear plan to continue on the path they set during the program. Others appear likely to continue to operate, but they plan to do so in a form that differs from the neutral convener multi-stakeholder model emphasized during the AF4Q program as they specialize, make a major shift in focus, develop fee-for-service products, or focus on particular stakeholder groups (ie, employers and providers). In most cases, preserving the organization itself, rather than its programmatic activities from the AF4Q program era, appeared to receive the greatest emphasis in sustainability efforts. As their core strategy, most alliances will not perpetuate the original AF4Q program vision of diverse local stakeholders coming together to implement a prescribed set of aligned interventions centered on healthcare improvement.

Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment.

PubMed

Mohr, David C; Lyon, Aaron R; Lattie, Emily G; Reddy, Madhu; Schueller, Stephen M

2017-05-10

Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients. ©David C. Mohr, Aaron R Lyon, Emily G Lattie, Madhu Reddy, Stephen M Schueller. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.05.2017.

Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment

PubMed Central

Lyon, Aaron R; Lattie, Emily G; Reddy, Madhu; Schueller, Stephen M

2017-01-01

Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients. PMID:28490417

Supplier selection criteria for sustainable supply chain management in thermal power plant

NASA Astrophysics Data System (ADS)

Firoz, Faisal; Narayan Biswal, Jitendra; Satapathy, Suchismita

2018-02-01

Supplies are always in great demand when it comes to industrial operations. The quality of raw material their price accompanied by sustainability and environmental effects are a major concern for industrial operators these days. Supply Chain Management is the subject which is focused on how the supply of different products is carried out. The motive is that each operation performed can be optimized and inherently the efficiency of the whole chain is integrated. In this paper we will be dealing with all the criteria that are required to be evaluated before selecting a supplier, in particular, focusing on Thermal Power Plant. The most suppliers of the thermal power plant are the coal suppliers. The quality of coal directly determines the efficiency of the whole plant. And when there are matters concerning coal environmental pollution plays a very crucial role. ANP method has been used here to select suppliers of thermal power sectors in Indian context. After applying ANP to prioritize the sustainable supplier selection criteria, it is found that for thermal power industries best suppliers are Nationalized/State owned suppliers then 2nd ranked suppliers are imported supplier. Private owned suppliers are ranked least. So private owned suppliers must be more concerned about their performance. Among these suppliers it is found that to compete in the global market privatized suppliers have to give more emphasize on most important criteria like sustainability, then fuel cost and quality. Still some sub-criteria like a clean program, environmental issues, quality, reliability, service rate, investment in high technology, green transportation channel, waste management etc needs for continuous improvement as per their priority.

Restorative Yoga and Metabolic Risk Factors: The Practicing Restorative Yoga vs. Stretching for the Metabolic Syndrome (PRYSMS) randomized trial

PubMed Central

Kanaya, Alka M.; Araneta, Maria Rosario G.; Pawlowsky, Sarah B.; Barrett-Connor, Elizabeth; Grady, Deborah; Vittinghoff, Eric; Schembri, Michael; Chang, Ann; Carrion-Petersen, Mary Lou; Coggins, Traci; Tanori, Daniah; Armas, Jean M.; Cole, Roger J.

2014-01-01

Aims Intensive lifestyle change prevents type 2 diabetes but is difficult to sustain. Preliminary evidence suggests that yoga may improve metabolic factors. We tested a restorative yoga intervention vs. active stretching for metabolic outcomes. Methods In 2009–2012, we conducted a 48-week randomized trial comparing restorative yoga vs. stretching among underactive adults with the metabolic syndrome at the Universities of California, San Francisco and San Diego. We provided lifestyle counseling and a tapering series of 90-minute group classes in the 24-week intervention period and 24-week maintenance period. Fasting and 2-hour glucose, HbA1c, triglycerides, HDL-cholesterol, insulin, systolic blood pressure, visceral fat, and quality of life were assessed at baseline, 6- and 12-months. Results 180 participants were randomized and 135 (75%) completed the trial. At 12 months, fasting glucose decreased more in the yoga group than in the stretching group (−0.35 mmol/L vs. −0.03 mmol/L; p=0.002); there were no other significant differences between groups. At 6 months favorable changes within the yoga group included reductions in fasting glucose, insulin, and HbA1c and an increase in HDL-cholesterol that were not sustained at 1 year except changes in fasting glucose. The stretching group had a significant reduction in triglycerides at 6 months which was not sustained at 1 year but had improved quality of life at both time-points. Conclusions Restorative yoga was marginally better than stretching for improving fasting glucose but not other metabolic factors. PMID:24418351

Restorative yoga and metabolic risk factors: the Practicing Restorative Yoga vs. Stretching for the Metabolic Syndrome (PRYSMS) randomized trial.

PubMed

Kanaya, Alka M; Araneta, Maria Rosario G; Pawlowsky, Sarah B; Barrett-Connor, Elizabeth; Grady, Deborah; Vittinghoff, Eric; Schembri, Michael; Chang, Ann; Carrion-Petersen, Mary Lou; Coggins, Traci; Tanori, Daniah; Armas, Jean M; Cole, Roger J

2014-01-01

Intensive lifestyle change prevents type 2 diabetes but is difficult to sustain. Preliminary evidence suggests that yoga may improve metabolic factors. We tested a restorative yoga intervention vs. active stretching for metabolic outcomes. In 2009-2012, we conducted a 48-week randomized trial comparing restorative yoga vs. stretching among underactive adults with the metabolic syndrome at the Universities of California, San Francisco and San Diego. We provided lifestyle counseling and a tapering series of 90-min group classes in the 24-week intervention period and 24-week maintenance period. Fasting and 2-h glucose, HbA1c, triglycerides, HDL-cholesterol, insulin, systolic blood pressure, visceral fat, and quality of life were assessed at baseline, 6- and 12-months. 180 participants were randomized and 135 (75%) completed the trial. At 12 months, fasting glucose decreased more in the yoga group than in the stretching group (-0.35 mmol/L vs. -0.03 mmol/L; p=0.002); there were no other significant differences between groups. At 6 months favorable changes within the yoga group included reductions in fasting glucose, insulin, and HbA1c and an increase in HDL-cholesterol that were not sustained at 1 year except changes in fasting glucose. The stretching group had a significant reduction in triglycerides at 6 months which was not sustained at 1 year but had improved quality of life at both time-points. Restorative yoga was marginally better than stretching for improving fasting glucose but not other metabolic factors. Copyright © 2014 Elsevier Inc. All rights reserved.

Permeable pavement and stormwater management systems: a review.

PubMed

Imran, H M; Akib, Shatirah; Karim, Mohamed Rehan

2013-01-01

Uncontrolled stormwater runoff not only creates drainage problems and flash floods but also presents a considerable threat to water quality and the environment. These problems can, to a large extent, be reduced by a type of stormwater management approach employing permeable pavement systems (PPS) in urban, industrial and commercial areas, where frequent problems are caused by intense undrained stormwater. PPS could be an efficient solution for sustainable drainage systems, and control water security as well as renewable energy in certain cases. Considerable research has been conducted on the function of PPS and their improvement to ensure sustainable drainage systems and water quality. This paper presents a review of the use of permeable pavement for different purposes. The paper focuses on drainage systems and stormwater runoff quality from roads, driveways, rooftops and parking lots. PPS are very effective for stormwater management and water reuse. Moreover, geotextiles provide additional facilities to reduce the pollutants from infiltrate runoff into the ground, creating a suitable environment for the biodegradation process. Furthermore, recently, ground source heat pumps and PPS have been found to be an excellent combination for sustainable renewable energy. In addition, this study has identified several gaps in the present state of knowledge on PPS and indicates some research needs for future consideration.

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.

Sustainability of community-led total sanitation outcomes: Evidence from Ethiopia and Ghana.

PubMed

Crocker, Jonny; Saywell, Darren; Bartram, Jamie

2017-05-01

We conducted a study to evaluate the sustainability of community-led total sanitation (CLTS) outcomes in Ethiopia and Ghana. Plan International, with local actors, implemented four CLTS interventions from 2012 to 2014: health extension worker-facilitated CLTS and teacher-facilitated CLTS in Ethiopia, and NGO-facilitated CLTS with and without training for natural leaders in Ghana. We previously evaluated these interventions using survey data collected immediately after implementation ended, and concluded that in Ethiopia health extension workers were more effective facilitators than teachers, and that in Ghana training natural leaders improved CLTS outcomes. For this study, we resurveyed 3831 households one year after implementation ended, and analyzed latrine use and quality to assess post-intervention changes in sanitation outcomes, to determine if our original conclusions were robust. In one of four interventions evaluated (health extension worker-facilitated CLTS in Ethiopia), there was an 8 percentage point increase in open defecation in the year after implementation ended, challenging our prior conclusion on their effectiveness. For the other three interventions, the initial decreases in open defecation of 8-24 percentage points were sustained, with no significant changes occurring in the year after implementation. On average, latrines in Ethiopia were lower quality than those in Ghana. In the year following implementation, forty-five percent of households in Ethiopia repaired or rebuilt latrines that had become unusable, while only 6% did in Ghana possibly due to higher latrine quality. Across all four interventions and three survey rounds, most latrines remained unimproved. Regardless of the intervention, households in villages higher latrine use were more likely to have sustained latrine use, which together with the high latrine repair rates indicates a potential social norm. There are few studies that revisit villages after an initial evaluation to assess sustainability of sanitation outcomes. This study provides new evidence that CLTS outcomes can be sustained in the presence of training provided to local actors, and strengthens previous recommendations that CLTS is not appropriate in all settings and should be combined with efforts to address barriers households face to building higher quality latrines. Copyright © 2017 The Authors. Published by Elsevier GmbH.. All rights reserved.

Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

PubMed

Maina, Robert N; Mengo, Doris M; Mohamud, Abdikher D; Ochieng, Susan M; Milgo, Sammy K; Sexton, Connie J; Moyo, Sikhulile; Luman, Elizabeth T

2014-01-01

Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5-45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories.

Progressing beyond SLMTA: Are internal audits and corrective action the key drivers of quality improvement?

PubMed Central

Mengo, Doris M.; Mohamud, Abdikher D.; Ochieng, Susan M.; Milgo, Sammy K.; Sexton, Connie J.; Moyo, Sikhulile; Luman, Elizabeth T.

2014-01-01

Background Kenya has implemented the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme to facilitate quality improvement in medical laboratories and to support national accreditation goals. Continuous quality improvement after SLMTA completion is needed to ensure sustainability and continue progress toward accreditation. Methods Audits were conducted by qualified, independent auditors to assess the performance of five enrolled laboratories using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. End-of-programme (exit) and one year post-programme (surveillance) audits were compared for overall score, star level (from zero to five, based on scores) and scores for each of the 12 Quality System Essential (QSE) areas that make up the SLIPTA checklist. Results All laboratories improved from exit to surveillance audit (median improvement 38 percentage points, range 5–45 percentage points). Two laboratories improved from zero to one star, two improved from zero to three stars and one laboratory improved from three to four stars. The lowest median QSE scores at exit were: internal audit; corrective action; and occurrence management and process improvement (< 20%). Each of the 12 QSEs improved substantially at surveillance audit, with the greatest improvement in client management and customer service, internal audit and information management (≥ 50 percentage points). The two laboratories with the greatest overall improvement focused heavily on the internal audit and corrective action QSEs. Conclusion Whilst all laboratories improved from exit to surveillance audit, those that focused on the internal audit and corrective action QSEs improved substantially more than those that did not; internal audits and corrective actions may have acted as catalysts, leading to improvements in other QSEs. Systematic identification of core areas and best practices to address them is a critical step toward strengthening public medical laboratories. PMID:29043193

Improving inferior vena cava filter retrieval rates with the define, measure, analyze, improve, control methodology.

PubMed

Sutphin, Patrick D; Reis, Stephen P; McKune, Angie; Ravanzo, Maria; Kalva, Sanjeeva P; Pillai, Anil K

2015-04-01

To design a sustainable process to improve optional inferior vena cava (IVC) filter retrieval rates based on the Define, Measure, Analyze, Improve, Control (DMAIC) methodology of the Six Sigma process improvement paradigm. DMAIC, an acronym for Define, Measure, Analyze, Improve, and Control, was employed to design and implement a quality improvement project to increase IVC filter retrieval rates at a tertiary academic hospital. Retrievable IVC filters were placed in 139 patients over a 2-year period. The baseline IVC filter retrieval rate (n = 51) was reviewed through a retrospective analysis, and two strategies were devised to improve the filter retrieval rate: (a) mailing of letters to clinicians and patients for patients who had filters placed within 8 months of implementation of the project (n = 43) and (b) a prospective automated scheduling of a clinic visit at 4 weeks after filter placement for all new patients (n = 45). The effectiveness of these strategies was assessed by measuring the filter retrieval rates and estimated increase in revenue to interventional radiology. IVC filter retrieval rates increased from a baseline of 8% to 40% with the mailing of letters and to 52% with the automated scheduling of a clinic visit 4 weeks after IVC filter placement. The estimated revenue per 100 IVC filters placed increased from $2,249 to $10,518 with the mailing of letters and to $17,022 with the automated scheduling of a clinic visit. Using the DMAIC methodology, a simple and sustainable quality improvement intervention was devised that markedly improved IVC filter retrieval rates in eligible patients. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

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.

EO Underpinning the Quality of Ecosystem Services with Geospatial Data- The Case of Sustainable Forest Management

NASA Astrophysics Data System (ADS)

Crosthwaite Eyre, Charles

2010-12-01

Payments for Ecosystem Services (PES) is an exciting and expanding opportunity for sustainably managed forests. PES are derived from a range of ecosystem benefits from forests including climate change mitigation through afforestation and avoided deforestation, green power generation, wetland and watershed rehabilitation, water quality improvement, marine flood defence and the reduction in desertification and soil erosion. Forests are also the ancestral home to many vulnerable communities which need protection. Sustainable forest management plays a key role in many of these services which generates a potentially critical source of finance. However, for forests to realise revenues from these PES, they must meet demanding standards of project validation and service verification. They also need geospatial data to manage and monitor operational risk. In many cases the data is difficult to collect on the ground - in some cases impossible. This will create a new demand for data that must be impartial, timely, area wide, accurate and cost effective. This presentation will highlight the unique capacity of EO to provide these geospatial inputs required in the generation of PES from forestry and demonstrate products with practical examples.

Preventing Harm in the ICU-Building a Culture of Safety and Engaging Patients and Families.

PubMed

Thornton, Kevin C; Schwarz, Jennifer J; Gross, A Kendall; Anderson, Wendy G; Liu, Kathleen D; Romig, Mark C; Schell-Chaple, Hildy; Pronovost, Peter J; Sapirstein, Adam; Gropper, Michael A; Lipshutz, Angela K M

2017-09-01

Preventing harm remains a persistent challenge in the ICU despite evidence-based practices known to reduce the prevalence of adverse events. This review seeks to describe the critical role of safety culture and patient and family engagement in successful quality improvement initiatives in the ICU. We review the evidence supporting the impact of safety culture and provide practical guidance for those wishing to implement initiatives aimed at improving safety culture and more effectively integrate patients and families in such efforts. Literature review using PubMed including evaluation of key studies assessing large-scale quality improvement efforts in the ICU, impact of safety culture on patient outcomes, methodologies for quality improvement commonly used in healthcare, and patient and family engagement. Print and web-based resources from leading patient safety organizations were also searched. Our group completed a review of original studies, review articles, book chapters, and recommendations from leading patient safety organizations. Our group determined by consensus which resources would best inform this review. A strong safety culture is associated with reduced adverse events, lower mortality rates, and lower costs. Quality improvement efforts have been shown to be more effective and sustainable when paired with a strong safety culture. Different methodologies exist for quality improvement in the ICU; a thoughtful approach to implementation that engages frontline providers and administrative leadership is essential for success. Efforts to substantively include patients and families in the processes of quality improvement work in the ICU should be expanded. Efforts to establish a culture of safety and meaningfully engage patients and families should form the foundation for all safety interventions in the ICU. This review describes an approach that integrates components of several proven quality improvement methodologies to enhance safety culture in the ICU and highlights opportunities to include patients and families.

Improving efficiency and access to mental health care: combining integrated care and advanced access.

PubMed

Pomerantz, Andrew; Cole, Brady H; Watts, Bradley V; Weeks, William B

2008-01-01

To provide an example of implementation of a new program that enhances access to mental health care in primary care. A general and specialized mental health service was redesigned to introduce open access to comprehensive mental health care in a primary care clinic. Key variables measured before and after implementation of the clinic included numbers of completed referrals, waiting time for appointments and clinic productivity. Workload and pre/post-implementation waiting time data were gathered through a computerized electronic monitoring system. Waiting time for new appointments was shortened from a mean of 33 days to 19 min. Clinician productivity and evaluations of new referrals more than doubled. These improvements have been sustained for 4 years. Moving mental health services into primary care, initiating open access and increasing use of technological aids led to dramatic improvements in access to mental health care and efficient use of resources. Implementation and sustainability of the program were enhanced by using a quality improvement approach.

Gardens on the Arid Climate

NASA Astrophysics Data System (ADS)

Eka Saputra, Weldy

2017-12-01

Bahrain is located in the climate of the arid zone which rainfall is low and irregular. This paper discusses the approaches which response to the local context that has been implemented by the government of Bahrain to sustain the quality of the public garden in the arid climate, turning to green. Generally, the approach is an improvement in the central treatment of waste water system plant that used to irrigate the landscaping, agriculture as well as for industry use. These approaches are not the only technologically, but also involves the participation of community to achieve sustainable garden in this country.

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2012-01-01

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

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

PubMed

Ng, Alfred; Henshaw, Carly; Carter, Michael

2017-05-01

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

Comparison of methods to improve induction of spermiation in wild-caught carp (Cyprinus carpio carpio), a threatened species from the Caspian Sea basin.

PubMed

Vazirzadeh, Arya; Farhadi, Ahmad; Naseri, Mahmood; Jeffs, Andrew

2016-07-01

Wild carp (Cyprinus carpio carpio) forms the basis of an important fishery in the Southern Caspian Sea Basin which is increasingly underpinned by the release of cultured juveniles. A significant bottleneck to hatchery-rearing of juveniles is the spermiation of male broodstock. Therefore, four approaches to improving spermiation were investigated. The effectiveness of two delivery methods for the sustained release of salmon gonadotropin releasing hormone analogue (sGnRHa; i.e., via intramuscular cholesterol pellet vs emulsion injection) on the spermiation success and duration, sperm quality and quantity over 14days in wild-caught carp were compared to single injection of sGnRHa with Pimozide(®) (Linpe method) or carp pituitary extract (CPE). The consequence of the spermiation treatments on resulting embryonic quality was evaluated for subsequent fertilization and hatching success from wild male carp (mean weight±S.D. 1021±112g). All hormonal treatments, except for Linpe method, led to 100% spermiation of treated fish compared to only 25% in the control with no hormone intervention. The duration of spermiation, as well as the various quantitative variables of the sperm and the mean total sperm production were all generally improved with the sustained hormone delivery compared with the acute treatments. The GnRHa-FIA was the most effective method for improving spermiation. Copyright © 2016. Published by Elsevier B.V.

Measuring and improving quality of care in an academic medical center.

PubMed

Blayney, Douglas W

2013-05-01

The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.

[Healthy design for sustainable communities].

PubMed

Capolongo, S; Battistella, A; Buffoli, M; Oppio, A

2011-01-01

Health, quality of life and sustainable development are strongly interconnected. The quality of living is a complex concept that includes different meanings. The quality of life issue has been studied for a long time, even if its measurement is a more recent matter. It's possible to distinguish two main approaches: the first one, depending on which the quality of life corresponds to the social wellbeing and it can be measured objectively; the second one, that emphasizes the perceptive dimension of quality of life, such as needs, feelings and aspirations. According to the WHO's wide definition of wellbeing, this paper suggests an approach focused on the effects that urban planning and designing can have on the health of citizens. Actually many of the problems of the cities like pollution, inequity, lack of services and accessibility depends on decisions about the development of land and buildings. To have more attractive cities in the future it is important that professionals involved in planning and local authorities focus on the major determinants of health: the physical and social environment in which people live and the nature of their lifestyles. The experience explained in this paper shows as local authorities can support professionals in designing process, producing quick and effective benchmark in order to improve the quality of urban spaces and architecture. More in deep the tool works by a set of performance indicators developed with the purpose to assess the degree of sustainability of building and urban space proposals at the planning stage (and at later stages), against a range of criteria. This evaluation procedure can be considered as a common platform from which different stakeholders can agree goals and work together contributing to increase the benefits of a well-designed built environment.

Closing the gap-cardiovascular risk and primary prevention: results from the American College of Physicians quality improvement program.

PubMed

Snow, Vincenza; Reynolds, Cara Egan; Bennett, Lia; Weiss, Kevin B; Snooks, Qianna; Qaseem, Amir

2010-01-01

The objective was to study the impact of a practice-based quality improvement program on practice teams' care for patients who have increased risk of cardiovascular disease. A total of 54 team members from 18 internal medicine practices participated in an educational program that used a pre-post intervention study design and focused on measures related to cardiovascular risk factors. The program involved live instruction, faculty-led conference calls, practice data collection, and progress reports detailing practices' improvement strategies. Data on 817 patients were reported. Practices showed significant improvement in counseling for diet (70% to 78%), exercise (67% to 74%), and weight loss (64% to 72%). Use of aspirin (53% to 64%) and statins (83% to 89%) also showed significant improvement. Administration of flu vaccine increased significantly from 51% to 54%. Improvements in patient counseling and medication management, if sustained, should lead to fewer cardiovascular events. However, program duration did not allow the capture of outcomes measures improvement.

Experiences of Agency for Healthcare Research and Quality-funded projects that implemented practices for safer patient care.

PubMed

Taylor, Stephanie L; Ridgely, M Susan; Greenberg, Michael D; Sorbero, Melony E S; Teleki, Stephanie S; Damberg, Cheryl L; Farley, Donna O

2009-04-01

To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices. Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS) grantees, from 2003 to 2006. Interviews with three grantee groups (n=60 total) implementing safe practice projects, with comparisons on factors influencing project implementation and sustainability. Semi-structured protocols contained open-ended questions on lessons learned and more structured questions on factors associated with project implementation and sustainability. The grantees shared common experiences, frequently identifying lessons learned regarding structural components needing to be in place before implementation, components of the implementation process, components of interventions' results needed for sustainability, changes in timelines or activities, unanticipated issues, and staff acceptance/adoption. Also, fewer Original grants had many of the factors related project to implementation/sustainability than the PIPS or Challenge grantees had. Although much of what was reported seemed like common sense, surprisingly few projects actually planned for or expected many of the barriers or facilitators they experienced during their project implementation. Others implementing practice improvements likely will share the experiences and issues identified by these implementation projects and can learn from their lessons.

Video recording of neonatal resuscitation: A feasibility study to inform widespread adoption

PubMed Central

Shivananda, Sandesh; Twiss, Jennifer; el-Gouhary, Enas; el-Helou, Salhab; Williams, Connie; Murthy, Prashanth; Suresh, Gautham

2017-01-01

AIM To determine the feasibility of introducing video recording (VR) of neonatal resuscitation (NR) in a perinatal centre. METHODS This was a prospective cohort quality improvement study on preterm infants and their caregivers. Based on evidence and experience of other centers using VR intervention, a contextually relevant implementation and evaluation strategy was designed in the planning phase. The components of intervention were pre-resuscitation team huddle, VR of NR and video debriefing (VD), all occurring on the same day. Various domains of feasibility and sustainability as well as feasibility criteria were predefined. Data for analysis was collected using quantitative and qualitative methods. RESULTS Seventy-one caregivers participated in VD of 14 NRs facilitated by six trained instructors. Ninety-one percent of caregivers perceived enhanced learning and patient safety and, 48 issues were identified related to policy, caregiver roles, and latent safety threats. Ninety percent of caregivers expressed their willingness to participate in VD activity and supported the idea of integrating it into a resuscitation team routine. Eighty-three percent and 50% of instructors expressed satisfaction with video review software and quality of audio VR. No issues about maintenance of infant or caregivers’ confidentiality and erasure of videos were reported. Criteria for feasibility were met (refusal rate of < 10%, VR performed on > 50% of occasions, and < 20% caregivers’ perceiving a negative impact on team performance). Necessary adaptations to enhance sustainability were identified. CONCLUSION VR of NR as a standard of care quality assurance activity to enhance caregivers’ learning and create opportunities that improve patient safety is feasible. Despite its complexity with inherent challenges in implementation, the intervention was acceptable, implementable, and potentially sustainable with adaptations. PMID:28224098

Long-term ecosystem monitoring and assessment of the Detroit River and Western Lake Erie.

PubMed

Hartig, J H; Zarull, M A; Ciborowski, J J H; Gannon, J E; Wilke, E; Norwood, G; Vincent, A N

2009-11-01

Over 35 years of US and Canadian pollution prevention and control efforts have led to substantial improvements in environmental quality of the Detroit River and western Lake Erie. However, the available information also shows that much remains to be done. Improvements in environmental quality have resulted in significant ecological recovery, including increasing populations of bald eagles (Haliaeetus leucocephalus), peregrine falcons (Falco columbarius), lake sturgeon (Acipenser fulvescens), lake whitefish (Coregonus clupeaformis), walleye (Sander vitreus), and burrowing mayflies (Hexagenia spp.). Although this recovery is remarkable, many challenges remain, including population growth, transportation expansion, and land use changes; nonpoint source pollution; toxic substances contamination; habitat loss and degradation; introduction of exotic species; and greenhouse gases and global warming. Research/monitoring must be sustained for effective management. Priority research and monitoring needs include: demonstrating and quantifying cause-effect relationships; establishing quantitative endpoints and desired future states; determining cumulative impacts and how indicators relate; improving modeling and prediction; prioritizing geographic areas for protection and restoration; and fostering long-term monitoring for adaptive management. Key management agencies, universities, and environmental and conservation organizations should pool resources and undertake comprehensive and integrative assessments of the health of the Detroit River and western Lake Erie at least every 5 years to practice adaptive management for long-term sustainability.

Delineating the third age: joint models of older people's quality of life and attrition in Britain 2002-2010.

PubMed

Tampubolon, Gindo

2015-07-01

In the public mind, later life is being transformed by the emerging possibility of a flourishing third age with sustained quality of life. We draw trajectories of life quality measured using CASP-19 over eight years. We refine these trajectories by jointly modelling attrition, since older people tend to leave longitudinal studies (attrite) not at random. Growth curve models are applied to the English Longitudinal Study of Ageing waves 1 to 5. Then joint model is estimated where attrition is considered. Extensive predictors are entered including demographic attributes, social and economic status, health conditions, and behaviours. Strong non-linear age trajectory of life quality is revealed by the growth curve models where the peak is achieved in the late 60s. Then the joint model uncovers the peak somewhat later in time, and also reveals secular improvement in life quality experienced by recent cohorts. Sharp estimates for many predictors of higher levels of life quality are also found. For the first time, the trajectories of life quality in the third age are drawn and improvement across cohorts is demonstrated. The contributions are estimated for predictors amenable to intervention such as social capital. This can help in policy discussion on improving the lives of older people in the third age.

[Environmental health and inequalities: building indicators for sustainable development].

PubMed

Carneiro, Fernando Ferreira; Franco Netto, Guilherme; Corvalan, Carlos; de Freitas, Carlos Machado; Sales, Luiz Belino Ferreira

2012-06-01

Despite its progress in terms of socio-economic indicators, Brazil is still unequal, which is due to an unequal and exclusionary historical process. In this paper we selected the Human Development Index - HDI and other social, economic, environmental and health indicators to exemplify this situation. We selected the municipalities that had the lowest HDI in the country in 2000 comparing their evolution over time between 2000 and 2010 by means of indicators linked to the economic, environmental and social pillars of sustainable development. These municipalities have an HDI classified as low (<0.500), and correspond to countries such as Laos, Yemen, Haiti and Madagascar. At national level, data for the decade show a significant improvement in economic indicators (decrease from 23% to 8.9% of people living on less than a quarter of the minimum wage); social indicators (increase from 86.5% to 90.2% of literacy in women), and the environmental indicator associated with access to the water grid, which also improved to a lesser extent (increase from 81% to 85%). It was concluded that in order to achieve sustainable development with quality of life, the improvement of sanitation and education indicators should be a priority for Brazil.

Antecedents and characteristics of lean thinking implementation in a Swedish hospital: a case study.

PubMed

Ulhassan, Waqar; Sandahl, Christer; Westerlund, Hugo; Henriksson, Peter; Bennermo, Marie; von Thiele Schwarz, Ulrica; Thor, Johan

2013-01-01

Despite the reported success of Lean in health care settings, it is unclear why and how organizations adopt Lean and how Lean transforms work design and, in turn, affects employees' work. This study investigated a cardiology department's journey to adopt and adapt Lean. The investigation was focused on the rationale and evolution of the Lean adoption to illuminate how a department with a long quality improvement history arrived at the decision to introduce Lean, and how Lean influenced employees' daily work. This is an explanatory single case study based on semistructured interviews, nonparticipant observations, and document studies. Guided by a Lean model, we undertook manifest content analysis of the data. We found that previous improvement efforts may facilitate the introduction of Lean but may be less important when forecasting whether Lean will be sustained over time. Contextual factors seemed to influence both what Lean tools were implemented and how well the changes were sustained. For example, adoption of Lean varied with the degree to which staff saw a need for change. Work redesign and teamwork were found helpful to improve patient care whereas problem solving was found helpful in keeping the staff engaged and sustaining the results over time.

[Assessing environmental and economical benefits of integrated sewage treatment systems].

PubMed

Li, Jin-rong; Zhang, Xiao-hong; Zhang, Hang-bin; Pan, Heng-yu; Liu, Qiang

2015-08-01

Sewage treatment, treated water treatment and sludge treatment are three basic units of an integrated sewage treatment system. This work assessed the influence of reusing or discharge of treated water and sludge landfill or compost on the sustainability of an integrated sewage treatment system using emergy analysis and newly proposed emergy indicators. This system's value included its environmental benefits and the products. Environmental benefits were the differences of the environmental service values before and after sewage treatment. Due to unavailability of data of the exchanged substance and energy in the internal system, products' values were attained by newly proposed substitution values. The results showed that the combination of sewage treatment, treated water reuse and sludge landfill had the strongest competitiveness, while the combination of sewage treatment, treated water reuse and earthworm compost was the most sustainable. Moreover, treated water reuse and earthworm compost were helpful for improving the sustainability of the integrated sewage treatment system. The quality of treated water and local conditions should be also considered when implementing the treated water reuse or discharge. The resources efficiency of earthworm compost unit needed to be further improved. Improved emergy indices were more suitable for integrated sewage treatment systems.

Collaboration of liquid bio-ameliorant and compost effect to crop yield and decreasing of inorganic fertilizer utilization for sustainable agriculture

NASA Astrophysics Data System (ADS)

Rasyid, B.

2018-05-01

Soil quality and plant productivity are main issue in agriculture production. The purpose of this research was to obtain sustainable crop management in effort to improve soil quality and increase maize production through collaboration of liquid bio-ameliorant and compost. Field experiment was carried out in two planting season with factorial experimental design replicated three times in 2m x 2m plots. Duncan multiple range test was used to analysis the effect of treatment on all parameters evaluated. The first planting season, treatments were arranged in three factors as: (1) planting space with two spaces, (2) three concentration of liquid bio-ameliorant, and (3) three level of urea fertilizer. The second planting season, treatments were arranged in two factors as: (1) liquid bio-ameliorant (LBA) with four concentrations and (2) compost with four levels. In the first season, result showed in soil quality parameters such as microbial density and soil chemical properties increased approximately 28%. The highest yield of 9.00 ton ha-1 was found in application 300 ml l-1 LBA + urea 240 kg ha-1. In the second season, collaboration treatment of 250 ml l-1 LBA + 10 ton ha-1 compost had the highest yield by 10.47 ton ha-1. This study confirmed that collaboration of liquid bio-ameliorant and compost could be used as fertilizer complement and reducing inorganic fertilizer utilization to sustain crop production and soil quality.

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

PubMed

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

2013-07-01

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

Ploidy Manipulation of the Gametophyte, Endosperm, and Sporophyte in Nature and for Crop Improvement – A Tribute to Prof. Stanley J. Peloquin (1921-2008)

USDA-ARS?s Scientific Manuscript database

Emeritus Campbell-Bascom Professor Dr. Stanley J. Peloquin was an internationally renowned plant geneticist and breeder who made exceptional contributions to the quantity, quality, and sustainable supply of food for the world from his innovative and extensive scientific contributions. For five deca...

Using Continuous Quality Improvement (CQI) to Sustain Success in Faculty Development for Online Teaching

ERIC Educational Resources Information Center

Kerrick, Sharon A.; Miller, Karen Hughes; Ziegler, Craig

2015-01-01

This article shares the curriculum and evaluation findings over four years for a faculty development program aimed at increasing skills in designing and teaching online courses. The University of Louisville's "Delphi U" is a four-day retreat style program covering 17 modules, each of which includes an exercise or activity. Over the four…

The Hardwood Ecosystem Experiment: a framework for studying responses to forest management

Treesearch

Robert K. Swihart; Michael R. Saunders; Rebecca A. Kalb; G. Scott Haulton; Charles H., eds. Michler

2013-01-01

Conditions in forested ecosystems of southern Indiana are described before initiation of silvicultural treatments for the Hardwood Ecosystem Experiment (HEE). The HEE is a 100-year study begun in 2006 in Morgan-Monroe and Yellowwood State Forests to improve the sustainability of forest resources and quality of life of Indiana residents by understanding ecosystem and...

Creating a Seamless Web of Services for Youth: The DC Children and Youth Investment Partnership.

ERIC Educational Resources Information Center

Keegan, Sinead; Chaplin, Duncan

This report describes the DC Children and Youth Investment Partnership, which helps improve outcomes for DC youth by building a sustainable partnership to increase the quality and quantity of youth services. Data from interviews with key actors, attendance at Partnership meetings, and site visits with affiliated initiatives show progress in…

It's a Long Way down: The Underlying Tensions in the Education Export Industry

ERIC Educational Resources Information Center

Marginson, Simon

2011-01-01

The stellar rise of the education export industry in Australian higher education, and the even more spectacular downturn now occurring, mask underlying tensions that have long dogged the industry and prevented it from improving quality or achieving long-term sustainability. The international education programme has been unbalanced by the drive for…

Overcoming the Glassy-Eyed Nod: An Application of Process-Oriented Guided Inquiry Learning Techniques in Information Technology

ERIC Educational Resources Information Center

Myers, Trina; Monypenny, Richard; Trevathan, Jarrod

2012-01-01

Two significant problems faced by universities are to ensure sustainability and to produce quality graduates. Four aspects of these problems are to improve engagement, to foster interaction, develop required skills and to effectively gauge the level of attention and comprehension within lectures and large tutorials. Process-Oriented Guided Inquiry…

Education Reform as Platform for Promoting Lifelong Learning: The Case of Hong Kong

ERIC Educational Resources Information Center

Poon-McBrayer, Kim Fong

2008-01-01

The fierce competition largely brought by the globalization of a knowledge-based economy provided an impetus for the Hong Kong government to endorse massive education reforms in 2000, as proposed by the Education Commission, as the central strategy to improve and sustain workforce quality and social justice through the provision of lifelong…

Features of Effective Professional Learning: A Case Study of the Implementation of a System-Based Professional Learning Model

ERIC Educational Resources Information Center

Labone, Elizabeth; Long, Janette

2016-01-01

The impact of quality teaching on student learning has led to an increased focus on professional learning to support and improve teacher practice. Review of the literature on effective professional learning suggests six elements that support sustained change in teacher practice; namely, focus, learning components, feedback, collaborative…

Building up STEM: An Analysis of Teacher-Developed Engineering Design-Based STEM Integration Curricular Materials

ERIC Educational Resources Information Center

Guzey, S. Selcen; Moore, Tamara J.; Harwell, Michael

2016-01-01

Improving K-12 Science, Technology, Engineering, and Mathematics (STEM) education has a priority on numerous education reforms in the United States. To that end, developing and sustaining quality programs that focus on integrated STEM education is critical for educators. Successful implementation of any STEM program is related to the curriculum…

The Lisbon Strategy Challenges to the Czech Republic Human Resources

ERIC Educational Resources Information Center

Kaderabkova, Anna

2005-01-01

When achieving long-term sustainable growth, the key role is assigned to knowledge-based competitiveness. The new EU Member States therefore face a double challenge on the Lisbon road. On the one hand, higher expenditure is required to improve the quality of research and education input and infrastructure, and on the other, innovation system…

Harnessing the Environmental Professional Expertise of Engineering Students--The Course: "Environmental Management Systems in the Industry"

ERIC Educational Resources Information Center

Ben-Zvi-Assaraf, Orit; Ayal, Nitzan

2010-01-01

More and more technical universities now advocate integrating sustainability in higher education and including it as a strategic goal for improving education's quality and relevance to society. This study examines 30 fourth-year chemical engineering students, graduates of a university course designed to combine their terminological domain with…

Unravelling the Social Dynamics of an Industry-School Partnership: Social Capital as Perspective for Co-Creation

ERIC Educational Resources Information Center

Ehlen, Corry G. J. M.; van der Klink, Marcel R.; Boshuizen, Henny P. A.

2016-01-01

Increasingly, innovative collaboration between industry and schools is being exploited as a way of improving the quality and relevance of education. Even though these innovations appear to have substantial benefits, often the impact proves to fade away after their implementation. A better understanding of how to sustain complex innovations seems…

Reforming Public School Systems through Sustained Union-Management Collaboration

ERIC Educational Resources Information Center

Rubinstein, Saul A.; McCarthy, John E.

2011-01-01

For most of the past decade the policy debate over improving U.S. public education has centered on teacher quality. In this debate, teachers and their unions have often been seen as the problem, not part of the solution. Further, current discourse often assumes that conflicting interests between teacher unions and administration is inevitable.…

Use of Tablet Computers to Improve Access to Education in a Remote Location

ERIC Educational Resources Information Center

Ally, Mohamed; Balaji, V.; Abdelbaki, Anwar; Cheng, Ricky

2017-01-01

A research project was carried out in using mobile learning to increase access to education. This project is contributing to the achievement of Goal 4 of the Sustainable Development Goals (SDGs), which is to "Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all". The mobile learning project…

Challenges of using quality improvement methods in nursing homes that "need improvement".

PubMed

Rantz, Marilyn J; Zwygart-Stauffacher, Mary; Flesner, Marcia; Hicks, Lanis; Mehr, David; Russell, Teresa; Minner, Donna

2012-10-01

Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement". To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams. A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in "need of improvement". Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home administrator, director of nurses) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; (2) one of the leaders to be a "change champion" and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff in quality improvement committee and team activities so they "own" the process and are responsible for change. Results of this qualitative analysis can help allocate expert nurse time to facilities that are actually ready to improve. Wide-spread adoption of this intervention is feasible and could be enabled by nursing home medical directors in collaborative practice with advanced practice nurses. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

The "TRAUMA LIFE" initiative: The impact of a multidisciplinary checklist process on outcomes and communication in a Trauma Intensive Care Unit.

PubMed

Joseph, Kimberly; Gupta, Sameer; Yon, James; Partida, Renee; Cartagena, Lee; Kubasiak, John; Buie, Vanessa; Miller, Jared; Wiley, Dorion; Nagy, Kimberly; Starr, Frederic; Dennis, Andrew; Kaminsky, Matthew; Bokhari, Faran

2018-03-09

Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU. "TRAUMA LIFE" was considered maturely implemented by 2016. Multiple quality metrics, including restraint order compliance, were compared between 2013 and 2016 (pre- and post-implementation). Compliance with the "Family Message" (FM), a part of the "TRAUMA LIFE" communication process, was analyzed in 2016. Improvement was seen in CAUTI, VAE, and IUCU; CLABSI rates increased. Restraint order compliance increased significantly. FM delivery compliance was inconsistent; improvement was noted in concordance between update content and FM documented in Electronic Medical Record. Implementation of "TRAUMA LIFE" was well integrated into the rounding process and was associated with some improvement in quality metrics and communication. Additional evaluation is required to assess sustainability. Copyright © 2018 Elsevier Inc. All rights reserved.

Improving student satisfaction of Andalas University Dormitory through Service Quality and Importance Performance Analysis

NASA Astrophysics Data System (ADS)

Putri, Nilda Tri; Anggraini, Larisa

2018-03-01

Residential satisfaction of university dormitories serve as one of the significant aspects in the framework of sustainability in higher education. This research investigated the quality of dormitory services in Andalas University Dormitory based on student’s satisfaction. According to management residential, the enrollment of residential student has increased gradually in Andalas University. In 2016, capacity of residential student is 1686, but only 1081 students can stay at dormitory because some rooms in bad condition. There are a lot of problems and complaints regarding dormitory’s service quality i.e water problems, leaky rooms and bathrooms, cleanliness and inadequate facilities in residential college. In addition, there are 20% of last year student’s residential check out before the time of contract runs out. The aim of this research are understanding the level of GAP exists between expectation and perception students’ residential in the content of service quality and evaluating the improvement priority services using Importance Performance Analysis. This study is measuring service quality by using Responsiveness, Assurance, Empathy, Reliability and Tangible dimension. A negative GAP indicates that the actual services are than what was expected and the GAP is highlighted area for improvement. Based on IPA, management should improve this following dimension services : responsiveness, tangible and assurance dimension.