Clinical governance and external audit.

Science.gov (United States)

Glazebrook, S G; Buchanan, J G

2001-01-01

This paper describes a model of clinical governance that was developed at South Auckland Health during the period 1995 to 2000. Clinical quality and safety are core objectives. A multidisciplinary Clinical Board is responsible for the development and publicising of sound clinical policies together with monitoring the effects of their implementation on quality and safety. The Clinical Board has several committees, including an organization-wide Continuous Quality Improvement Committee to enhance the explicit nature of the quality system in terms of structure, staff awareness and involvement, and to develop the internal audit system. The second stream stems from the Chief Medical Officer and clinical directors in a clinical management sense. The Audit Committee of the Board of Directors covers both clinical and financial audit. The reporting lines back to that committee are described and the role of the external auditor of clinical standards is explained. The aim has been to create a supportive culture where quality initiatives and innovation can flourish, and where the emphasis is not on censure but improvement.

Using clinical governance levers to support change in a cancer care reform.

Science.gov (United States)

Brault, Isabelle; Denis, Jean-Louis; Sullivan, Terrence James

2015-01-01

Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation. The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario's cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations. From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives. To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers. This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.

Challenges of Clinical Governance in Risk Management: A Qualitative Study of Teaching Hospitals

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Mohammad Keshvari

2017-01-01

Full Text Available Background: Clinical Governance is a Framework in which health care provider will be responsible for continuous quality improvement. This study aimed to identify implementation challenges of Clinical Governance in the area of risk management. Methods: This is a descriptive-qualitative study. We used Content Analysis method for data analysis. Study environment contained 7 teaching hospitals, and the study population included the hospitals staff engaged in Clinical Governance implementation. Using purposive non-randomised sampling, 18 participants were selected. A semi-structured face-to-face interview was used for data collection. Content Analysis method was used to conceptualize, interpret and analyze the texts and maxQDA software for data analysis. Results: Our research findings presented two main themes as cultural factors and lack of resources. Conclusion: Promoting management as well as empowering health care providers could act as a key factor in addressing problems related to the implementation of risk management in health care environments.

Non-Hodgkin's lymphomas: clinical governance issues.

Science.gov (United States)

Fields, P A; Goldstone, A H

2002-09-01

Every patient in every part of the world has the right to expect the best possible quality of care from health care providers. Non-Hodgkin's lymphomas (NHL) are an extremely heterogeneous group of conditions which require important decisions to be taken at many points along the treatment pathway. To get this right every time requires that high-quality standards are instituted and adhered to, so that the best possible outcome is achieved. In the past this has not always been the case because of the failure of clinicians sometimes to adhere to an optimal management plan. In 1995, the UK government commissioned an inquiry into the running of cancer services in the United Kingdom, which culminated in a series of recommendations to improve them. Subsequently, these recommendations were implemented as objectives of the NHS Cancer Plan which is the framework by which the UK government wishes to improve cancer services. Concurrently another general concept has emerged which is designed to ensure that the highest quality standards may be achieved for all patients across the whole National Health Service (NHS). This concept, termed 'clinical governance', brings together a corporate responsibility of all health care workers to deliver high quality standards, in the hope that this will translate into better long-term survival of patients with malignant disease. This chapter focuses on the issues surrounding clinical governance and how the principles of this concept relate to non-Hodgkin's lymphomas.

Implementing plant clinics in the maelstrom of policy reform in Uganda

DEFF Research Database (Denmark)

Danielsen, Solveig; Matsiko, F.B.; Kjær, A.M.

2014-01-01

government commitment and a growing demand for this new type of farmer service, effective implementation of plant clinics turned out to be a challenge.We examine how agricultural policies and institutional setups, and their political context, influenced the implementation of plant clinics from 2010 to 2011...... services. Implementation of plant clinics was further affected by a new district reform and the national elections taking place during the study period. The dual purpose of the plant clinics created uncertainty about their organisational belonging. They fell through the cracks of extension and disease...... the policy and institutional frameworks in which plant clinics operate, but also the effects of political imperatives and donors on policy implementation. This study provides a basis for institutional and policy analysis related to the implementation of plant clinics elsewhere....

Clinical governance; How been understood, what is needed? Nurses' perspective

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Homayoun Sadeghi Bazargani

2015-07-01

Full Text Available Introduction: Clinical Governance (CG is an overarching concept, using organizational capacity, safeguards high standards of the health services and provides a safe care for patients.  The aim of this research was to study nurses’ perception about Clinical Governance. Materials and Methods: A qualitative study was done with Focus Group Discussions (FGD. Purposeful Sampling was used to select the objectives including 65 participants. Actually 7 FGD’s were held. Content analysis was used to extract the meaningful themes. Results:Nurses believed that patient centeredness and evidence based practice is the core of the CG concept. Also they mentioned that cultural change, staffs training, adequate financial and human resources are required to successfully implementation of CG in hospitals.  Conclusion: Spreading up a shared vision about CG and providing the required infrastructures in hospitals would be facilitate CG initiatives. Proper commitment of the managers and staff participation could lead an effective CG implementation.

Multi-professional audit supports clinical governance in projecting and implementing a new stroke care area

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Marco Masina

2013-03-01

Full Text Available Patients with acute stroke have better outcomes in terms of survival or regaining independence if they receive organized inpatient care in a specific setting (Stroke Unit, SU where a coordinated multidisciplinary team can ensure the best level of care. The clinical governance of an SU requires a systematic monitoring of diagnostic, clinical and therapeutic processes through a structured audit. The entire project and set up of a new SU in Bentivoglio, Italy, were based on a model that focused on multidisciplinary teamwork and clinical governance. An audit based on the Benjamin audit cycle followed every step of the set up of the new SU. Markers from national and international guidelines and from the Italian Regional Audit, together with a specific database were used. The audit showed a high level of care and a significant improvement in the majority of clinical, diagnostic and therapeutic parameters. Only a few markers (i.e. waiting times for ultrasound tomography and prescription of oral anticoagulation therapy required specific projects in order to improve the results. Our experience confirmed that a structured audit can support clinical governance of an SU by monitoring clinical processes and quality of care. Such an audit involves the whole professional team and shows the effects of any single actions. It also helps integration and co-operation among staff. Furthermore, a structured audit is a useful instrument for professional accountability for both qualitative and quantitative aspects of care.

Implementing integrated coastal management in a sector-based governance system

CSIR Research Space (South Africa)

Taljaard, Susan

2012-10-01

Full Text Available of cooperative governance early on, ICM implementation still faces the challenge that governance systems remain largely sector-based. In this paper we explore the implementation of ICM within a sector-based governance system in South Africa. First, we draw...

Change Management as a Critical Success Factor in e-Government Implementation

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Janja Nograšek

2011-01-01

Full Text Available Change management in e-government implementation is a very complex issue. E-government services are frequently distributed over different IT systems and organizations. There are also events from outside the public administration that cause changes such as government policies and legislation, public-private partnership, etc., and finally a huge resistance to change exists in public administration proverbial. Another problem is that the e-government is predominantly seen only as a technology mission and not as an organizational transformation issue. Those are probably the main reasons that the existing literature about change management in e-government is still missing at large. There are articles dealing with some aspects of changes affected by the new technology implementation, however, there is no comprehensive framework that would identify changes that have to be managed in e-government implementation. Therefore, the main aim of the paper is to identify a comprehensive set of changes that have to be considered in e-government implementation and the role of leadership in such processes. Finally, the paper proposes a conceptual model of change management in e-government implementation.

Exploring the context for effective clinical governance in infection control.

Science.gov (United States)

Halton, Kate; Hall, Lisa; Gardner, Anne; MacBeth, Deborough; Mitchell, Brett G

2017-03-01

Effective clinical governance is necessary to support improvements in infection control. Historically, the focus has been on ensuring that infection control practice and policy is based on evidence, and that there is use of surveillance and auditing for self-regulation and performance feedback. There has been less exploration of how contextual and organizational factors mediate an infection preventionists (IP's) ability to engage with evidence-based practice and enact good clinical governance. A cross sectional Web-based survey of IPs in Australia and New Zealand was undertaken. Questions focused on engagement in evidence-based practice and perceptions about the context, culture, and leadership within the infection control team and organization. Responses were mapped against dimensions of Scally and Donaldson's clinical governance framework. Three hundred surveys were returned. IPs appear well equipped at an individual level to undertake evidence-based practice. The most serious set of perceived challenges to good clinical governance related to a lack of leadership or active resistance to infection control within the organization. Additional challenges included lack of information technology solutions and poor access to specialist expertise and financial resources. Focusing on strengthening contextual factors at the organizational level that otherwise undermine capacity to implement evidence-based practice is key to sustaining current infection control successes and promoting further practice improvements. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Corporate Governance Scorecards : Assessing and Promoting the Implementation of Codes of Corporate Governance

OpenAIRE

International Finance Corporation

2014-01-01

This is a supplement to second IFC's toolkit: developing Corporate Governance codes of best practice. The focus of second toolkit is the development of codes of corporate governance. This supplement focuses narrowly on how to use scorecards to measure the observance and implementation of such codes. It does not cover the full panoply of governance assessment tools. This supplement provides...

E-Governance and Its Implementation Challenges in the Nigerian Public Service

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Ugochukwu David ABASILIM

2015-09-01

Full Text Available E-governance has become one of the reform tools geared towards effective public service delivery, which is premised on the assumption that the appreciable use of Information and Communication Technologies (ICT method in the day to day activities of government will bring effective service delivery. However, there are lots of challenges that hamper the effective implementation of e-governance in Nigerian public service. It is based on this, that this article identifies some of the challenges to e-governance implementation in Nigerian public service. Although, no robust statistical analysis was done, as the article relied on archival analysis of relevant literature on the subject matter and inferences drawn from it. Based on its findings, it was concluded that e-governance remain the best in encouraging transparency and accountability in government business. The paper therefore, recommends that, government should be more committed to the implementation e-governance as well as embark on adequate enlightenment about the concept.

An overview of clinical governance policies, practices and initiatives.

Science.gov (United States)

Braithwaite, Jeffrey; Travaglia, Joanne F

2008-02-01

To map the emergence of, and define, clinical governance; to discuss current best practices, and to explore the implications of these for boards of directors and executives wishing to promote a clinical governance approach in their health services. Review and analysis of the published and grey literature on clinical governance from 1966 to 2006. Medline and CINAHL databases, key journals and websites were systematically searched. Central issues were identified in the literature as key to effective clinical governance. These include: ensuring that links are made between health services' clinical and corporate governance; the use of clinical governance to promote quality and safety through a focus on quality assurance and continuous improvement; the creation of clinical governance structures to improve safety and quality and manage risk and performance; the development of strategies to ensure the effective exchange of data, knowledge and expertise; and the sponsoring of a patient-centred approach to service delivery. A comprehensive approach to clinical governance necessarily includes the active participation of boards and executives in sponsoring and promoting clinical governance as a quality and safety strategy. Although this is still a relatively recent development, the signs are promising.

Implementering af ITIL® IT-governance

DEFF Research Database (Denmark)

Salling, Allan

The IT Infrastructure Library (ITIL) fremhæves ofte som et IT-governance best practice framework, men det er tilsyneladende vanskeligt at implementere. ”Many organizations that decide to implement ITIL fail completely [...]” (Pereira og da Silva 2010). Dette vurderes som et væsentligt IS-forsknin......The IT Infrastructure Library (ITIL) fremhæves ofte som et IT-governance best practice framework, men det er tilsyneladende vanskeligt at implementere. ”Many organizations that decide to implement ITIL fail completely [...]” (Pereira og da Silva 2010). Dette vurderes som et væsentligt IS......-forskningsproblem. ITIL-litteraturen anviser bl.a. Critical Success Factors (CSF) som en løsning. Baseret på et identificeret litteraturgap blev det besluttet at undersøge, om kendte CSF kunne løse problemet. På den baggrund er der gennemført et aktionsforskningsprojekt, hvor ITILimplementeringsproblemet søges løs ved......, at kulturen delvist kunne forklare problemerne, og på den baggrund blev der opstillet handleanvisninger for diagnosticering og ændring af kulturen. ITIL-implementeringen var kun delvist en succes, men under aktionsforskningen blev der alligevel etableret en række holdbare rutiner, der stadig bruges flere år...

Assessing the Knowledge and Attitudes of Medical Students and Graduates about Clinical Governance

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Rana Gholamzadeh nikjoo

2015-08-01

Full Text Available Background and Objectives : In order to implement clinical governance successfully, it should be perceived positively and there must be a positive attitude towards it. The current policy of the Ministry of Health and Medical Education about clinical governance requires assessing the knowledge and attitudes of medical students to identify their educational needs and the necessary steps needed to be taken in educational planning, designing and modification of the courses. This study aimed to evaluate the knowledge and attitudes of medical students and graduates about clinical governance in 1391. Materials and Methods : This is a descriptive–analytic study. This research was conducted on 159 students from different medical fields simple random sampling method. For data collecting, a researcher-made questionnaire was used which its validity was confirmed by using content validity and construct validity. To determine the reliability of the questionnaire, internal consistency and Cronbach's Alpha were used for field of knowledge (0.78 and attitude (0.68. For data analysis, SPSS version 11.5 software was applied using exploratory factor analysis method. Results : 64% of the participants were female and 36% were male. 71% of the participants were in the health care management field and 29% from other medical fields. Mean and standard deviation of knowledge and attitude scores were 64.2 ± 5.8 and 13.06 ± 3.02 respectively. Comparing the students' and graduates’ knowledge and attitudes with their educational level showed no significant correlation. (P> 0.05 Although, there was a significant correlation between educational level and attitude (P = 0.001. In higher levels of education, students' attitude towards clinical governance reduced. Conclusion : The knowledge of medical students and graduates was estimated average to high about clinical governance but their attitude was very poor. This reflects negative views of medical students despite the

The Implementation of Government Regulation No 19/2008 about Sub District

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Hasoloan Nadeak

2014-09-01

Full Text Available The purpose of this study was to determine and analyze the implementation of the policy of districts in the city of Bogor; to determine and analyze the technical and operational guidelines support the tasks assigned to the sub-district and the districts in the city of Bogor; and to determine and analyze the performance of the policy after the implementation of the district and sub-district in each region. Implementation of Government Regulation Number 19 Year 2008 concerning the sub-district is a must, because of government regulation in question is the implementing regulations that apply nationally and mandated by Law No. 32 of 2004 on Regional Government. The approach used to look at the problem in question is descriptive qualitative content analysis or document analysis. Based approach is known that the City Government has implemented PP No. 19 of 2008 in the form of Mayor Regulation No. 54 Year 2010 on Main Duties, Functions, Duties Work Procedures and structural positions within the District and No. 10 of 2010 on Delegation of Authority. The implementation of policy shall include: (1 Common Tasks Government, and (2 Some tasks are delegated by the Mayor of the District Head in terms of regional autonomy.

Preparedness of Government Owned Dental Clinics for the ...

African Journals Online (AJOL)

Preparedness of Government Owned Dental Clinics for the Management of Medical Emergencies: A Survey of Government Dental Clinics in Lagos. ... emergencies and the availability of emergency drugs and equipment in government dental ...

Maintaining clinical governance when giving telephone advice.

Science.gov (United States)

Alazawi, William; Agarwal, Kosh; Suddle, Abid; Aluvihare, Varuna; Heneghan, Michael A

2013-10-01

Delivering excellent healthcare depends on accurate communication between professionals who may be in different locations. Frequently, the first point of contact with the liver unit at King's College Hospital (KCH) is through a telephone call to a specialist registrar or liver fellow, for whom no case notes are available in which to record information. The aim of this study was to improve the clinical governance of telephone referrals and to generate contemporaneous records that could be easily retrieved and audited. An electronic database for telephone referrals and advice was designed and made securely available to registrars in our unit. Service development in a tertiary liver centre that receives referrals from across the UK and Europe. Demographic and clinical data were recorded prospectively and analysed retrospectively. Data from 350 calls were entered during 5 months. The information included the nature and origin of the call (200 from 75 different institutions), disease burden and severity of disease among the patients discussed with KCH, and outcome of the call. The majority of cases were discussed with consultants or arrangements were made for formal review at KCH. A telephone referrals and advice database provides clinical governance, serves as a quality indicator and forms a contemporaneous record at the referral centre. Activity data and knowledge of disease burden help to tailor services to the needs of referrers and commissioners. We recommend implementation of similar models in other centres that give extramural verbal advice.

Theoretical interpretation of e-government implementation challenges in South Africa: A case study of a selected provincial government

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Michael Twum-Darko

2015-04-01

Full Text Available This paper discusses factors influencing e-Government initiatives by African Governments to improve services to their citizens, businesses and their constituent. It further discusses, as a socially constructed phenomenon, the degree of readiness of governments to implement e-Government initiatives to improve services. The discussion uses Actor Network Theory (ANT and in particular the concepts of moments of translation and irreversibility as a lens through which to understand and interpret the social phenomenon. Although a number of e-Government researchers have argued that strong leadership and clear vision is required to implement e-Government initiatives, the view is that Governments have continuously failed to achieve the intended results. E-Government potentials and benefits which are well documented in Information Systems and e-Government research literature have not been realised by governments due to limited capabilities in the administration of the public service. The study applied a deductive approach where semi-structured interviews were used for data collection in a selected Provincial Government in South Africa. The outcome is a general framework to determine the readiness of South Africa government and generally, African governments for e-Government initiatives to achieve the intended results.

A clinical governance framework for blood services.

Science.gov (United States)

Williamson, L M; Benjamin, R J; Devine, D V; Katz, L M; Pink, J

2015-05-01

The elements of clinical governance, which ensure excellence in clinical care, can be applied to blood services. In this survey, their application in a range of blood providers was gauged, with the aim of identifying best practice and producing a generalizable framework. The Medical Directors of members of the Alliance of Blood Operators surveyed how different elements of clinical governance operated within their organizations and developed recommendations applicable in the blood service environment. The recommendations that emerged highlighted the importance of an organization's culture, with the delivery of optimal clinical governance being a corporate responsibility. Senior management must agree and promote a set of values to ensure that the system operates with the patient and donor at its heart. All staff should understand how their role fits into the 'journey to the patient', and a culture of openness promoted. Thus, reporting of errors and risks should be actively sought and praised, with penalties applied for concealment. Systems should exist to collect, analyse and escalate clinical outcomes, safety data, clinical risk assessments, incident reports and complaints to inform organizational learning. Clinical governance principles from general health care can be applied within blood services to complement good manufacturing practice. This requires leadership, accountability, an open culture and a drive for continuous improvement and excellence in clinical care. © 2015 International Society of Blood Transfusion.

Factors affecting knowledge governance implementation among Malaysian SMEs

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Khong Sin Tan

2018-05-01

Full Text Available Knowledge governance is a relatively new discipline in Malaysia with very little research work performed so far. As Malaysian government is actively involved in the implementation of Economic Transformation Program (ETP, Government Transformation Program (GTP and Urban Trans-formation Program (UTP, Small and Medium Enterprises (SMEs need to react to the government move by transforming their conventional knowledge management practices to knowledge govern-ance. As of today, there has been very limited study conducted in Malaysia on the extent of the company acceptance of such governance. This research was therefore conducted to measure the SME users' acceptance and identify the pros and cons of knowledge governance. With these findings, recommendations were given to policy makers and industries to increase the company's knowledge governance acceptance. Questionnaire was used for data collection. Systematic random sampling methods was used to select respondents. The questionnaire was developed and adapted based on knowledge management and IT governance frameworks. In this model, the dependent variable was company's intention to adopt knowledge governance. Independent variables included knowledge application needs, knowledge architecture, knowledge infrastructure, knowledge investment and knowledge principles.

[Clinical governance and patient safety culture in clinical laboratories in the Spanish National Health System].

Science.gov (United States)

Giménez-Marín, Á; Rivas-Ruiz, F

To conduct a situational analysis of patient safety culture in public laboratories in the Spanish National Health System and to determine the clinical governance variables that most strongly influence patient safety. A descriptive cross-sectional study was carried out, in which a Survey of Patient Safety in Clinical Laboratories was addressed to workers in 26 participating laboratories. In this survey, which consisted of 45 items grouped into 6 areas, scores were assigned on a scale from 0 to 100 (where 0 is the lowest perception of patient safety). Laboratory managers were asked specific questions about quality management systems and technology. The mean scores for the 26 participating hospitals were evaluated, and the following results observed: in 4of the 6areas, the mean score was higher than 70 points. In the third area (equipment and resources) and the fourth area (working conditions), the scores were lower than 60 points. Every hospital had a digital medical record system. This 100% level of provision was followed by that of an electronic request management system, which was implemented in 82.6% of the hospitals. The results obtained show that the culture of security is homogeneous and of high quality in health service laboratories, probably due to the steady improvement observed. However, in terms of clinical governance, there is still some way to go, as shown by the presence of weaknesses in crucial dimensions of safety culture, together with variable levels of implementation of fail-safe technologies and quality management systems. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

E-government Policy and its Implementation in the Czech Republic: Selected Shortcomings

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Špaček David

2015-05-01

Full Text Available The paper summarizes the specifics and challenges of e-government policy, and then discusses the apparent shortcomings of policy implementation and challenges for further development in the Czech Republic. It draws attention to problems in national e-government policy and in practical policy implementation (instability of governance, low quality of evaluation, low involvement of stakeholders in project design, and public procurement issues.

Policy Implementation Decentralization Government in Indonesia

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Kardin M. Simanjuntak

2015-06-01

Full Text Available Decentralization in Indonesia is that reforms not completed and until the current implementation is not maximized or have not been successful. The essence of decentralization is internalising cost and benefit' for the people and how the government closer to the people. That's the most important essence of essence 'decentralization’. However, the implementation of decentralization in Indonesia is still far from the expectations. It is shown that only benefits of decentralization elite and local authorities, decentralization is a neo-liberal octopus, decentralization of public services are lacking in character, decentralization without institutional efficiency, decentralization fosters corruption in the area, and quasi-fiscal decentralization.

Implementation of Computer Assisted Test Selection System in Local Governments

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Abdul Azis Basri

2016-05-01

Full Text Available As an evaluative way of selection of civil servant system in all government areas, Computer Assisted Test selection system was started to apply in 2013. In phase of implementation for first time in all areas in 2014, this system selection had trouble in several areas, such as registration procedure and passing grade. The main objective of this essay was to describe implementation of new selection system for civil servants in the local governments and to seek level of effectiveness of this selection system. This essay used combination of study literature and field survey which data collection was made by interviews, observations, and documentations from various sources, and to analyze the collected data, this essay used reduction, display data and verification for made the conclusion. The result of this essay showed, despite there a few parts that be problem of this system such as in the registration phase but almost all phases of implementation of CAT selection system in local government areas can be said was working clearly likes in preparation, implementation and result processing phase. And also this system was fulfilled two of three criterias of effectiveness for selection system, they were accuracy and trusty. Therefore, this selection system can be said as an effective way to select new civil servant. As suggestion, local governments have to make prime preparation in all phases of test and make a good feedback as evaluation mechanism and together with central government to seek, fix and improve infrastructures as supporting tool and competency of local residents.

Content validity of critical success factors for e-Government implementation in Indonesia

Science.gov (United States)

Napitupulu, D.; Syafrullah, M.; Rahim, R.; Amar, A.; Sucahyo, YG

2018-05-01

The purpose of this research is to validate the Critical Success Factors (CSFs) of e-Government implementation in Indonesia. The e-Government initiative conducted only to obey the regulation but ignoring the quality. Defining CSFs will help government agencies to avoid failure of e-Government projects. A survey with the questionnaire was used to validate the item of CSF based on expert judgment through two round of Delphi. The result showed from 67 subjects in instrument tested; there are 11 invalid items deleted and remain only 56 items that had good content validity and internal reliability. Therefore, all 56 CSFs should be adopted by government agencies in Indonesia to support e-Government implementation.

Implementation of corporate governance principles in Romania

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Ramona Iulia Țarțavulea (Dieaconescu

2014-12-01

Full Text Available The paper aims to conduct a study regarding the manner in which corporate governance principles are applied in Romania, in both public and private sector. In the first part of the paper, the corporate governance principles are presented as they are defined in Romania, in comparison with the main international sources of interest in the domain (OECD corporate governance principles, UE legal framework. The corporate governance (CG principles refer to issues regarding board composition, transparency of scope, objectives and policies; they define the relations between directors and managers, shareholders and stakeholders. The research methodology is based on both fundamental research and empirical study on the implementation of corporate governance principles in companies from Romania. The main instrument of research is a corporate governance index, calculated based on a framework proposed by the author. The corporate governance principles are transposed in criteria that compose the framework for the CG index. The results of the study consist of scores for each CG principles and calculation of CG index for seven companies selected from the public and private sector in Romania. The results are analyzed and discussed in order to formulate general and particular recommendations. The main conclusion of this study is that that a legal framework in the area of corporate governance regulation is needed in Romania. I consider that the main CG principles should be enforced by developing a mandatory legal framework.

Tripartite Governance: Enabling Successful Implementations with Vulnerable Populations.

Science.gov (United States)

Kennedy, Margaret Ann

2016-01-01

Vulnerable populations are often at a distinct disadvantage when it comes to the implementation of health information systems in an equitable, appropriate, and timely manner. The disadvantages experienced by vulnerable populations are innumerable and include lack of representation, lack of appropriate levels of funding, lack of resources and capacity, and lack of representation. Increasingly, models of representation for complex implementations involve a tripartite project governance model. This tripartite partnership distributes accountability across all partners, and ensures that vulnerable populations have an equitable contribution to the direction of implementation according to their needs. This article shares lessons learned and best practices from complex tripartite partnerships supporting implementations with vulnerable populations in Canada.

Implementation of hospital governing boards: views from the field.

Science.gov (United States)

McNatt, Zahirah; Thompson, Jennifer W; Mengistu, Abraham; Tatek, Dawit; Linnander, Erika; Ageze, Leulseged; Lawson, Ruth; Berhanu, Negalign; Bradley, Elizabeth H

2014-04-17

Decentralization through the establishment of hospital governing boards has been touted as an effective way to improve the quality and efficiency of hospitals in low-income countries. Although several studies have examined the process of decentralization, few have quantitatively assessed the implementation of hospital governing boards and their impact on hospital performance. Therefore, we sought to describe the functioning of governing boards and to determine the association between governing board functioning and hospital performance. We conducted a cross-sectional study with governing board chairpersons to assess board (1) structure, (2) roles and responsibilities and (3) training and orientation practices. Using bivariate analysis and multivariable regression, we examined the association between governing board functioning and hospital performance. Hospital performance indicators: 1) percent of hospital management standards met, measured with the Ethiopian Hospital Reform Implementation Guidelines and 2) patient experience, measured with the Inpatient and Outpatient Assessment of Healthcare surveys. A total of 92 boards responded to the survey (96% response rate). The average percentage of EHRIG standards met was 58.1% (standard deviation (SD) 21.7 percentage points), and the mean overall patient experience score was 7.2 (SD 2.2). Hospitals with greater hospital management standards met had governing boards that paid members, reviewed performance in several domains quarterly or more frequently, developed new revenue sources, determined services to be outsourced, reviewed patient complaints, and had members with knowledge in business and financial management (all P-values outsourced, and reviewed patient complaints (all P-values < 0.05). These cross-sectional data suggest that strengthening governing boards to perform essential responsibilities may result in improved hospital performance.

Implementing shared governance in a patient care support industry: information technology leading the way.

Science.gov (United States)

Hartley, Lou Ann

2014-06-01

Implementing technology in the clinical setting is not a project but rather a journey in transforming care delivery. As nursing leaders in healthcare and patient care support organizations embrace technology to drive reforms in quality and efficiency, growing opportunities exist to share experiences between these industries. This department submission describes the journey to nursing shared governance from the perspective of an information technology-based company realizing the goal of supporting patient care.

Good governance in national solid waste management policy (NSWMP) implementation: A case study of Malaysia

Science.gov (United States)

Wee, Seow Ta; Abas, Muhamad Azahar; Mohamed, Sulzakimin; Chen, Goh Kai; Zainal, Rozlin

2017-10-01

The National Solid Waste Management Policy (NSWMP) was introduced in 2007 under the Act 672. The execution of NSWMP involves stakeholders from various government agencies and a collaboration with the private sectors. Despite the initiatives taken by the stakeholders, the objectives of NSWMP failed to materialise. One of the major constraints is weak governance among stakeholders with regards to the NSWMP implementation. This paper will explore the good governance practices implemented by the stakeholders. Identifying the current good governance practices implemented by the stakeholders is crucial as it will serve as a guideline to improve good governance practice in the future. An exploratory research approach is applied in this study through in-depth interviews with several government agencies and concessionaires involved in the NSWMP implementation. A total of six respondents took part in this study. The findings of this study show that there are several good governance practices implemented in policy promotion, participation of stakeholders, and capacity enhancement programme for the staff. This study also proposed some points on good governance practices in the context of policy promotion and staff development. A paradigm shift by the stakeholders is imperative so as to enhance the good governance practice in NSWMP implementation towards an efficient solid waste management in Malaysia.

An online clinical governance learning package for student radiographers

International Nuclear Information System (INIS)

Messer, Simon; Griffiths, Marc

2007-01-01

Purpose: Clinical governance is a key element of the Government's plan for reform in the National Health Service. As such, it is an essential element for final year undergraduate radiography studies. With Ciris becoming a standard web-based solution for clinical governance within the NHS, a need has been identified for it to be introduced at university to undergraduate radiographers. Methods: A distance learning package for Ciris has therefore been developed that was trialed by third year radiography students whilst on their final clinical placement. The package includes a specifically designed online virtual hospital which the students engaged with interactively using a workbook. The students undertook detailed individual and group exercises aimed at delivering practical experience of the Ciris program and its role in clinical governance. Results: The package was evaluated by the students in terms of their experiential learning and their perceived learning needs for clinical governance. Technical and support issues associated with the delivery of this package online were identified. Conclusion: The combination of a distance online learning environment, supported by a workbook, is an effective method of engaging students and is beneficial in terms of helping achieve learning outcomes in clinical governance for final year radiography studies

Groundwater governance in Asia: present state and barriers to implementation of good governance

Science.gov (United States)

Tanaka, T.

2014-09-01

The present state of groundwater governance in Asia was reviewed. The main problem regarding groundwater resources in each Asian country is overexploitation, causing water level decline, land subsidence and salt water intrusion. For those groundwater hazards, many countries have established regulations such as laws and regulations as countermeasures. However, those laws and regulations are not the basic laws on groundwater resources, but only for countermeasures to prevent groundwater hazards. Common problems and barriers for implementing groundwater governance in Asian countries are that there is more than one institute with different and sometimes overlapping responsibilities in groundwater management. To overcome those conflicts among institutions and establishment of good governance, it is necessary to establish an agency in the government as one coordinate function reinforcing the direct coordination and facilitation of groundwater policy-making and management. As one such framework, the conceptual law called the Water Cycle Basic Law, which is under planning in Japan, is examined in this paper.

Improving the implementation of health workforce policies through governance: a review of case studies.

Science.gov (United States)

Dieleman, Marjolein; Shaw, Daniel Mp; Zwanikken, Prisca

2011-04-12

Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'. In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking. This review shows that the term

Mobile government implementation for government service delivery in developing countries: a South Africa context

CSIR Research Space (South Africa)

Ogunleye, OS

2014-07-01

Full Text Available an opportunity to use of this platform to provide better service delivery to the citizens of the developing countries. This paper identifies major service delivery issues in South Africa. Various m-government systems that have been implemented in other countries...

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

Science.gov (United States)

McSherry, R; Haddock, J

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

THEORETIC INCURSION IN THE IDENTIFICATION OF DETERMINANTS AND E-GOVERNMENT STRATEGY. EMPIRIC STUDY OVER THE GRADE OF IMPLEMENTATION OF E-GOVERNMENT IN BIHOR COUNTY

Directory of Open Access Journals (Sweden)

Pop Cohut Ioana

2012-07-01

Full Text Available We are currently witnessing an unprecedented development of new technologies, that offers great opportunities for the modernization of the society, it changes radically the way governments, businesses and citizens have the opportunity to obtain goods and services, the way in which public services are provided that become increasingly important for citizens, the way of obtaining and transmitting information, the way in which business connections are done, the interaction between different communities, etc.. From this point of view we research the way in which public strategies of achievement and implementation of model of e-government are shaped, model which can exploit the opportunities offered by new technologies and can implement roles for the citizen and public policy makers and implicitly of local and regional development. How the public sector should support the implementation of strategies of e-government, to polarize at the highest level all communities of interest, to provide a framework for planning and action across the board, covering local administration, institutions, organizations and government agencies, to empower appropriate training for implementation of IT strategies, can lead to stimulation of generators factors of local and regional development. We also, intend to identify, from carrying out an empirical study in Bihor county, by analysis of 30 public institutions, the degree of implementation of new technologies in public administration, human resources readiness for appropriate use of IT facilities and what level of implementation of e-government in these institutions, in order to outline the main characteristics and determinants of e-government implementation. The present paper is of interest to policy-makers, researchers, local communities through analysis how the introduction of new technology development in developing and implementing public policies, particularly by networking government and e-government, can cause

Rethinking clinical governance : Healthcare professionals' views: a Delphi study

NARCIS (Netherlands)

Veenstra, Gepke L.; Ahaus, Kees; Welker, Gera A.; Heineman, Erik; van der Laan, Maarten J.; Muntinghe, Friso L. H.

OBJECTIVE: Although the guiding principle of clinical governance states that healthcare professionals are the leading contributors to quality and safety in healthcare, little is known about what healthcare professionals perceive as important for clinical governance. The aim of this study is to

Studying citizen-centred implementation networks in the age of governance

DEFF Research Database (Denmark)

Jacobi, Claus Brygger

This paper is suggesting pathways on how to investigate and analyze the implementation of public policies at a time where the idea of governance is leaving no public policy process untouched in any advanced liberal democracy. But due to the bewildering variety of ways in which the concept......, it is suggested that manifestations of hierarchical governance can be studied by using insights from network management combined with Pierre Bourdieu’s concept of the political and administrative fields. This gives the added value of enabling to the analyst to identify hierarchical forms of governance...

Challenges in Evaluating Clinical Governance Systems in Iran: A Qualitative Study

Science.gov (United States)

Hooshmand, Elaheh; Tourani, Sogand; Ravaghi, Hamid; Ebrahimipour, Hossein

2014-01-01

Background: In spite of the pivotal role of clinical governance in enhancing quality of services provided by hospitals across the country, a scientific framework with specific criteria for evaluating hospitals has not been developed so far. Objectives: This study was conducted with the aim to identify the challenges involved in evaluating systems of clinical governance in Iran. Materials and Methods: For the purposes of this qualitative study, 15 semi-structured interviews with experts in the field were conducted in 2011 and the data were analyzed using framework analysis method. Results: Five major challenges in evaluating clinical governance include managing human resources, improving clinical quality, managing development, organizing clinical governance, and providing patient-oriented healthcare system. Conclusions: Healthcare system in Iran requires a clinical governance program which has a patient-oriented approach in philosophy, operation, and effectiveness in order to meet the challenges ahead. PMID:24910799

Clinical implementation of pharmacogenetics.

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García-González, Xandra; Cabaleiro, Teresa; Herrero, María José; McLeod, Howard; López-Fernández, Luis A

2016-03-01

In the last decade, pharmacogenetic research has been performed in different fields. However, the application of pharmacogenetic findings to clinical practice has not been as fast as desirable. The current situation of clinical implementation of pharmacogenetics is discussed. This review focuses on the advances of pharmacogenomics to individualize cancer treatments, the relationship between pharmacogenetics and pharmacodynamics in the clinical course of transplant patients receiving a combination of immunosuppressive therapy, the needs and barriers facing pharmacogenetic clinical application, and the situation of pharmacogenetic testing in Spain. It is based on lectures presented by speakers of the Clinical Implementation of Pharmacogenetics Symposium at the VII Conference of the Spanish Pharmacogenetics and Pharmacogenomics Society, held in April 20, 2015.

An Adaptive Approach for Implementing e-Government in I. R. Iran

Science.gov (United States)

Sharifi, Hossein; Zarei, Behrouz

2004-01-01

Acknowledging the necessity of utilizing the new electronics, information, and communication technologies, the movement toward implementation of e-government in Iran has recently received the attention of the authorities and policy makers. The premise of the work is set around the fact that the e-enabled government is a momentous opportunity for…

Development of clinical pharmacy in Belgian hospitals through pilot projects funded by the government.

Science.gov (United States)

Somers, A; Spinewine, A; Spriet, I; Steurbaut, S; Tulkens, P; Hecq, J D; Willems, L; Robays, H; Dhoore, M; Yaras, H; Vanden Bremt, I; Haelterman, M

2018-04-30

Objectives The goal is to develop clinical pharmacy in the Belgian hospitals to improve drug efficacy and to reduce drug-related problems. Methods From 2007 to 2014, financial support was provided by the Belgian federal government for the development of clinical pharmacy in Belgian hospitals. This project was guided by a national Advisory Working Group. Each funded hospital was obliged to describe yearly its clinical pharmacy activities. Results In 2007, 20 pharmacists were funded in 28 pilot hospitals; this number was doubled in 2009 to 40 pharmacists over 54 institutions, representing more than half of all acute Belgian hospitals. Most projects (72%) considered patient-related activities, whereas some projects (28%) had a hospital-wide approach. The projects targeted patients at admission (30%), during hospital stay (52%) or at discharge (18%). During hospital stay, actions were mainly focused on geriatric patients (20%), surgical patients (15%), and oncology patients (9%). Experiences, methods, and tools were shared during meetings and workshops. Structure, process, and outcome indicators were reported and strengths, weaknesses, opportunities, and threats were described. The yearly reports revealed that the hospital board was engaged in the project in 87% of the cases, and developed a vision on clinical pharmacy in 75% of the hospitals. In 2014, the pilot phase was replaced by structural financing for clinical pharmacy in all acute Belgian hospitals. Conclusion The pilot projects in clinical pharmacy funded by the federal government provided a unique opportunity to launch clinical pharmacy activities on a broad scale in Belgium. The results of the pilot projects showed clear implementation through case reports, time registrations, and indicators. Tools for clinical pharmacy activities were developed to overcome identified barriers. The engagement of hospital boards and the results of clinical pharmacy activities persuaded the government to start structural

Need to implement corporate governance in the Romanian companies

Directory of Open Access Journals (Sweden)

Sorin COSNEANU

2013-04-01

Full Text Available Under the background of the current economic realities, characterized by uncertainty and mistrust, of increased complexity of the environment in which they operate, the Romanian companies must demonstrate good organization, flexibility, skills, good risk management and be trustworthy economic and social partners. The answer to many of these challenges is provided by a modern management system, which makes proof of more convincing development possibilities, namely corporate governance.This article is an attempt to summarize the major theoretical and practical issues related to corporate governance models, as well as a vision of the need to apply this management system in the Romanian companies. At the same time, the paper will briefly present the current state of corporate governance system implementation in the Romanian companies.

Governments should implement energy-efficiency standards and labels--cautiously

International Nuclear Information System (INIS)

Wiel, Stephen; McMahon, James E.

2003-01-01

Energy-efficiency standards and labels can be the most effective long-term energy-efficiency policy any government can implement. This paper describes: (1) the benefits that can be obtained through this policy, (2) which countries are implementing standards and labels and for which products, (3) the processes they are using at each step along the way including the reasons why each step must be done carefully and thoroughly, and (4) the relationship of standard-setting and labeling to other energy-efficiency policies

How GPs implement clinical guidelines in everyday clinical practice

DEFF Research Database (Denmark)

Videbæk Le, Jette; Hansen, Helle P; Riisgaard, Helle

2015-01-01

BACKGROUND: Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood....... OBJECTIVE: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. METHODS: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form....... Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. RESULTS: Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective...

How change management can prevent the failure of information systems implementation among Malaysian government hospitals?

Science.gov (United States)

ChePa, Noraziah; Jasin, Noorhayati Md; Bakar, Nur Azzah Abu

2017-10-01

Fail to prevent or control challenges of Information System (IS) implementation have led to the failure of its implementation. Successful implementation of IS has been a challenging task to any organization including government hospitals. Government has invested a big amount of money on information system (IS) projects to improve service delivery in healthcare. However, several of them failed to be implemented successfully due to several factors. This article proposes a prevention model which incorporated Change Management (CM) concepts to avoid the failure of IS implementation, hence ensuring the success of it. Challenges of IS implementation in government hospitals have been discovered. Extensive literature review and deep interview approaches were employed to discover these challenges. A prevention model has been designed to cater the challenges. The model caters three main phases of implementation; pre-implementation, during implementation, and post-implementation by adopting CM practices of Lewin's, Kotter's and Prosci's CM model. Six elements of CM comprising thirteen sub-elements adopted from the three CM models have been used to handle CFFs of Human and Support issues; guiding team, resistance avoidance, IS adoption, enforcement, monitoring, and IS sustainability. Successful practice of the proposed mapping is expected to prevent CFFs to occur, hence ensuring a successful implementation of IS in the hospitals. The proposed model has been presented and successfully evaluated by the domain experts from the selected hospitals. The proposed model is believed to be beneficial for top management, IT practitioners and medical practitioners in preventing IS implementation failure among government hospitals towards ensuring the success implementation.

The constraints of good governance practice in national solid waste management policy (NSWMP) implementation: A case study of Malaysia

Science.gov (United States)

Wee, Seow Ta; Abas, Muhamad Azahar; Chen, Goh Kai; Mohamed, Sulzakimin

2017-10-01

Nowadays, international donors have emphasised on the adoption of good governance practices in solid waste management which include policy implementation. In Malaysia, the National Solid Waste Management Policy (NSWMP) was introduced as the main guideline for its solid waste management and the Malaysian government has adopted good governance practice in the NSMWP implementation. However, the good governance practices implemented by the Malaysian government encountered several challenges. This study was conducted to explore the good governance constraints experienced by stakeholders in the NSWMP implementation. An exploratory research approach is applied in this study through in-depth interviews with several government agencies and concessionaires that involved in the NSWMP implementation in Malaysia. A total of six respondents took part in this study. The findings revealed three main good governance constraints in the NSWMP implementation, namely inadequate fund, poor staff's competency, and ambiguity of policy implementation system. Moreover, this study also disclosed that the main constraint influenced the other constraints. Hence, it is crucial to identify the main constraint in order to minimise its impact on the other constraints.

Exploring the success, failure and factors influencing M-government implementation in developing countries

CSIR Research Space (South Africa)

Ogunleye, OS

2014-05-01

Full Text Available and to provide better services to citizens, businesses, and government agencies through using mobile technology. This research reviews the success, failures and factors influencing m-Government development and implementation in developing countries...

Clinical Knowledge Governance Framework for Nationwide Data Infrastructure Projects.

Science.gov (United States)

Wulff, Antje; Haarbrandt, Birger; Marschollek, Michael

2018-01-01

The availability of semantically-enriched and interoperable clinical information models is crucial for reusing once collected data across institutions like aspired in the German HiGHmed project. Funded by the Federal Ministry of Education and Research, this nationwide data infrastructure project adopts the openEHR approach for semantic modelling. Here, strong governance is required to define high-quality and reusable models. Design of a clinical knowledge governance framework for openEHR modelling in cross-institutional settings like HiGHmed. Analysis of successful practices from international projects, published ideas on archetype governance and own modelling experiences as well as modelling of BPMN processes. We designed a framework by presenting archetype variations, roles and responsibilities, IT support and modelling workflows. Our framework has great potential to make the openEHR modelling efforts manageable. Because practical experiences are rare, prospectively our work will be predestinated to evaluate the benefits of such structured governance approaches.

Development of a framework towards successful implementation of e-governance initiatives in health sector in India.

Science.gov (United States)

Ray, Subhasis; Mukherjee, Amitava

2007-01-01

The purpose of this paper is to explore the route map for employing efficient e-governance so that at least existing resource and infrastructure are better utilized and deficiencies are tracked for future planning. National health is one of the most important factors in a country's economic growth. India seems to be a victim of the vicious cycle around poor economy and poor health conditions. A detailed study was carried out to find out India's healthcare infrastructure and its standing in e-governance initiatives. After consolidating the fact that effective e-governance can enhance the quality of healthcare service even within limited resources, authors explored success and failure factors of many e-governance initiatives in India and abroad. Finally, an e-governance framework is suggested based on the above factors together with the authors' own experience of implementing e-governance projects in India and abroad. The suggested framework is based on a phased implementation approach. The first phase "Information Dissemination" is more geared towards breaking the "digital divide" across three dimensions: G2Business; G2Citizen; and G2Agent. The most advanced stage is aimed towards joining up healthcare information across the above three dimensions and drawing meaningful analytics out of it. The recommendations also include management of Policies, Scope, Process Reform, Infrastructure, Technology, Finance, Partnership and People for efficient implementation of such e-governance initiatives. The paper provides measures for continuous evaluation of systems as one passes through various stages of implementation. However, the framework can be tested on real or simulated environment to prove its worthiness. This paper can be a potential frame of reference for nation-wide e-healthcare projects not only in India but also in other developing countries. The paper also describes challenges that are most likely to be faced during implementation. Since the paper is practical in

CODES AND PRACTICES OF IMPLEMENTATION OF CORPORATE GOVERNANCE IN ROMANIA AND RESULTS REPORTING

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GROSU MARIA

2011-12-01

Full Text Available Corporate governance refers to the manner in which companies are directed and controlled. Business management was always guided by certain principles, but the current meaning of corporate governance concerns and the contribution that companies must have the overall development of modern society. Romania used quite late in adopting a code of good practice in corporate governance, being driven, in particular, the privatization process, but also the transfer of control and surveillance of political organizations by the Board of Directors (BD. Adoption of codes of corporate governance is necessary to harmonize internal business requirements of a functioning market economy. In addition, the CEE countries, the European Commission adopted an action plan announcing measures to modernize company law and enhance corporate governance. Romania takes steps in this direction by amending the Company Law, and other regulations, although the practice does not necessarily keep pace with the requirements. This study aims on the one hand, an analysis of the evolution of corporate governance codes adopted in Romania, but also an empirical research of the implementation of corporate governance principles of a representative sample of companies listed on the Bucharest Stock Exchange (BSE. Consider relevant research methodology, because the issuer of the Codes of CG in Romania is BSE listed companies requesting their voluntary implementation. Implementation results are summarized and interpreted at the expense of public reports of the companies studied. Most studies undertaken in this direction have been made on multinational companies which respects the rule of corporate governance codes of countries of origin. In addition, many studies also emphasize the fair treatment of stakeholders rather than on models of governance adopted (monist/dualist with implications for optimizing economic objectives but also social. Undertaken research attempts to highlight on the one

Avoiding Implementation Failure in Catchment Landscapes: A Case Study in Governance of the Great Barrier Reef.

Science.gov (United States)

Dale, Allan P; Vella, Karen; Gooch, Margaret; Potts, Ruth; Pressey, Robert L; Brodie, Jon; Eberhard, Rachel

2017-10-04

Water quality outcomes affecting Australia's Great Barrier Reef (GBR) are governed by multi-level and multi-party decision-making that influences forested and agricultural landscapes. With international concern about the GBR's declining ecological health, this paper identifies and focuses on implementation failure (primarily at catchment scale) as a systemic risk within the overall GBR governance system. There has been limited integrated analysis of the full suite of governance subdomains that often envelop defined policies, programs and delivery activities that influence water quality in the GBR. We consider how the implementation of separate purpose-specific policies and programs at catchment scale operate against well-known, robust design concepts for integrated catchment governance. We find design concerns within ten important governance subdomains that operate within GBR catchments. At a whole-of-GBR scale, we find a weak policy focus on strengthening these delivery-oriented subdomains and on effort integration across these subdomains within catchments. These governance problems when combined may contribute to failure in the implementation of major national, state and local government policies focused on improving water quality in the GBR, a lesson relevant to landscapes globally.

Policy Implementation of Government Affairs Devolution Scope of the Ministry of Home Affairs

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Abdul Halik

2015-06-01

Full Text Available Deconcentration policies held because not all authority/government affairs can be done by using the principle of decentralization. The intent of this policy is to synergize the central and local relations. However, in reality not all of the activities of these policies can produce output in accordance with the plans and policy objectives, including those carried out by the Ministry of the Interior. Such conditions occur because of the policy implementation process has not been going well. This study uses naturalistic methods or qualitative descriptive explanation. The purpose of this study is to investigate the process of policy implementation, identify the factors that influence, as well as the results of policy implementation devolution of government affairs deconcentration scope of the Ministry of the Interior in the province of West Java. The results of this study indicate that in general the result of the implementation of deconcentration policy in West Java province is relatively accordance with the objectives of the implementation of deconcentration policy. Similarly, the output of the implementation of deconcentration program targets as predetermined. Nevertheless, there are still many shortcomings in the implementation process.

Clinical governance in practice: closing the loop with integrated audit systems.

Science.gov (United States)

Taylor, L; Jones, S

2006-04-01

Clinical governance has been acknowledged as the driving force behind National Health Service (NHS) reform since the government white paper outlined a new style of NHS in the UK in 1997. The framework of clinical governance ensures that NHS organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will develop. A major component of a clinical governance framework requires utilizing audit procedures, which assess the effectiveness of current systems and ultimately direct continual quality improvement. This paper describes the audit component of a local clinical governance framework designed for a unit based within an NHS trust, which has utilized a multidisciplinary approach to assess the effectiveness of a newly commissioned service and its impact on the residents and staff. The unit is a 12-bedded, low-secure-intensive rehabilitation unit for clients with severe and enduring mental illness. Using recognized and standardized psychometric outcome measures, information was collected on clinical symptoms, social functioning, social behaviour, quality of life, relationship quality with named nurses and medication side-effects. Additionally, confidential staff measures were included to assess levels of burnout, identify expressed emotion and assess staff perception of models of illness. The paper includes a comprehensive account of how managerial commitment, teaching processes and application of technology ensured prompt data collection and maintained the momentum through the audit timescale. Data analysis and presentation of data in both clinical reviews and in senior management meetings within the unit are discussed. Findings highlight the full integration of the audit system into the processes of the unit. Clinically, the paper highlights the enhancement of the knowledge base of the client group and the influence on clinical decision

Implementation of E-Government in Mexico: The Case of Infonavit

Science.gov (United States)

Herrera, Lizbeth; Gil-Garcia, J. Ramon

The implementation of information and communication technologies (ICTs) in the public sector is a strategy for administrative reform that has grown in ­importance in recent years. The use of ICT in government can help to improve the ­efficiency, quality, and transparency of public services and reduce the operating costs of bureaucracy. ICTs have also opened a new communication channel for government to provide public services to citizens without intermediaries. However, the ­implementation of an ICT initiative is not a simple process. Organizations ­frequently invest a great amount of resources into ICT initiatives, but the results they obtain often do not meet expectations. This observation is particularly true in some developing countries. Based on a case study of a Mexican federal agency, this ­chapter analyzes a successful strategy involving three ICT projects, taking into consideration institutional, organizational, and managerial aspects. Overall, the results of this study show that having a strategic plan that aligns the ICT project objectives with the overarching organizational goals leads to successful implementation because the technical, organizational, and institutional resources are ­managed in an integrated fashion. The chapter also reports on specific factors that had an impact on the characteristics and success of the three ICT projects.

The Essence Of Government Shares Subscription A Review The Implementation Of State-Owned Enterprises

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Urbanisasi

2015-08-01

Full Text Available The purpose of this study was to determine and explain the mechanisms and the implementation of government share subscription in the implementation of SOEs legal standing of the government shares subscription in the implementation of the state budget that separated in the implementation of SOEs and its legal implications of state loss or not and also legal accountability for losses arising out of shares subscription of SOE. In this study the authors use normative legal research. The data obtained in this study will be analyzed using qualitative normative method with inductive logic. Results from the study indicate that state shares subscription in the establishment of SOE or limited company with funds derived from State Budget are separated. Thus the government no longer has any authority in the field of civil law as a business entity. A clear separation of the status of country as business and as government organizer carries consequences. With the separation then there is clarity about the concept of the state financial losses. SOE as one form of business entity that aim to make a profit is a separate legal entity and has responsibilities that are separately anyway though formed and capital originating from the state finances and the loss of one transaction or in legal entity cannot be categorized as a state finance loss because the state has functioned as a private legal entity.

Governance Strengths and Weaknesses to implement the Marine Strategy Framework Directive in European Waters

DEFF Research Database (Denmark)

Freire-Gibb, L. Carlos; Koss, Rebecca; Piotr, Margonski

2014-01-01

addresses the Strengths, Weakness, Opportunities and Threats (SWOT) of the current European marine governance structures and its relationship to implement the MSFD. Results of the SWOT analysis were acquired through a combination of approaches with MSFD experts and stakeholders including: 30 face......-to-face interviews, an online survey with 264 stakeholder respondents and focus groups within each European marine region. The SWOT analysis concurrently identifies common strengths and weakness and key governance issues for implementing the MSFD for European marine regions. This paper forms one assessment within...... the governance component of the Options for Delivering Ecosystem Based Marine Management (ODEMM) project and presents timely issues that can be of benefit to national and European Union policy makers....

PLANNING THE IMPLEMENTATION OF QUALITY THROUGH STRATEGY FORMULATION AND CORPORATE GOVERNANCE

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Nikola Stefanović

2007-09-01

Full Text Available Planning the implementation of quality is a complex process that depends on many different internal and external factors. Planning the implementation is defined by the capabilities of management to visualize the market position of the company and to evaluate the company's strengths, weaknesses, opportunities, and threats. Serving to the company's purposes, planning the implementation of quality must be integrated into the company's strategic objectives and then transferred to other parts of the organization utilizing the corporate governance system. Planning the implementation, as a part of strategy formulation, should be reflected in: 1 company's vision and mission development, 2 goals setting, 3 strategy development aimed at achieving goals, 4 implementation and execution of the strategy, and 4 monitoring, evaluation, control, and readjustment of the strategy. Finally, planning must account for all possible implementation barriers.

Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine.

Science.gov (United States)

Stucki, Gerold; Zampolini, Mauro; Juocevicius, Alvydas; Negrini, Stefano; Christodoulou, Nicolas

2017-04-01

Since its launch in 2001, relevant international, regional and national PRM bodies have aimed to implement the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine (PRM), whereby contributing to the development of suitable practical tools. These tools are available for implementing the ICF in day-to-day clinical practice, standardized reporting of functioning outcomes in quality management and research, and guiding evidence-informed policy. Educational efforts have reinforced PRM physicians' and other rehabilitation professionals' ICF knowledge, and numerous implementation projects have explored how the ICF is applied in clinical practice, research and policy. Largely lacking though is the system-wide implementation of ICF in day-to-day practice across all rehabilitation services of national health systems. In Europe, system-wide implementation of ICF requires the interaction between practice, science and governance. Considering its mandate, the UEMS PRM Section and Board have decided to lead a European effort towards system-wide ICF implementation in PRM, rehabilitation and health care at large, in interaction with governments, non-governmental actors and the private sector, and aligned with ISPRM's collaboration plan with WHO. In this paper we present the current PRM internal and external policy agenda towards system-wide ICF implementation and the corresponding implementation action plan, while highlighting priority action steps - promotion of ICF-based standardized reporting in national quality management and assurance programs, development of unambiguous rehabilitation service descriptions using the International Classification System for Service Organization in Health-related Rehabilitation, development of Clinical Assessment Schedules, qualitative linkage and quantitative mapping of data to the ICF, and the cultural adaptation of the ICF Clinical Data Collection Tool in European languages.

Difficulties in the dissemination and implementation of clinical guidelines in government neonatal intensive care units in Brazil: how managers, medical and nursing, position themselves.

Science.gov (United States)

Magluta, Cynthia; Gomes, Maria A de Sousa Mendes; Wuillaume, Susana M

2011-08-01

Clinical guidelines are tools that systematize scientific evidence and help to achieve proper care. Several difficulties are reported regarding the effective use, such as the shortcomings in the level of knowledge and attitudes by the professionals, the service structure and the preferences appointed by patients. An analysis of these difficulties was the objective of this study in the context of government Neonatal Intensive Care Units (NICU) in Brazil. A semi-structured survey was carried out with 53 managers (medical and nursing) of the 15 NICU in a convenient sample of two groups of government units in Brazil. The managers chose their answers from a list of difficulties to implement the guidelines based on the analytical model of Cabana and graded the difficulties found on a 5-point scale with no reference to quality. Respondents have reported several difficulties with the following priority: lack of professionals to provide care, being perceived as more critical within the nursing and physiotherapy crews, minor participation of professionals in the discussion process and inadequate infrastructure. The lack of acquaintance with the guidelines by the professionals has been reported by few of the surveyed. These findings show some common ground to literature pointing the importance of adequate infrastructure. Managers showed a low valuation of both the level of knowledge and the professionals' adhesion to the guidelines. © 2011 Blackwell Publishing Ltd.

Bridge management system for the Western Cape provincial government, South Africa: implementation and utilization

CSIR Research Space (South Africa)

Nell, AJ

2008-10-01

Full Text Available This paper describes the implementation and utilization of the bridge management system (BMS) of the Department of Transport and Public Works of the Western Cape Provincial Government. The implementation of the BMS as well as the visual assessment...

Curriculum Policy Implementation: How Schools Respond to Government's "Soft" Policy in the Curriculum Reform

Science.gov (United States)

Chan, Jacqueline K. S.

2012-01-01

"Soft" policy has newly emerged as a policy implementation concept in relation to governance. Non-binding in character, "soft" policy is designed for multi-level systems of governance in which there is relative autonomy at different levels of collective decision-making. "Soft" policy has gained attention since the…

Governance of Higher Education--Implementation of Project Governance

Science.gov (United States)

Macheridis, Nikos

2017-01-01

This article focuses on coordination between governance actors in higher education. The object of the study is a department at a public university, seen as a multi-project environment. The purpose of this article is to illustrate and analyze project governance as a tool that allows departmental management to coordinate with the authorities, the…

Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governance.

Science.gov (United States)

Kwedza, Ruyamuro K; Larkins, Sarah; Johnson, Julie K; Zwar, Nicholas

2017-10-01

Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning; alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members' alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants.

IMPLEMENTATION OF WEB GOVERNMENT AS MEDIA INFORMATION POTENTIAL VILLAGE SUKARAJA

Directory of Open Access Journals (Sweden)

Dedi Irawan

2017-05-01

Full Text Available The development of information technology is so rapid that one of them in the form of the Internet. E-government In village Sukaraja is one of the most exciting sites in Sukaraja, the village of Sukaraja, the governance structure of the village of Sukaraja and all related information in the village of Sukaraja. System development Life Cycle (SDLC approach includes planning stages, analysis, in and system implementation, tools in system development process using DAD (Data Flow Diagram, DFD (Data Flow Diagram, and flowchart. In the making of this website use HTML programming language (Hypertext Markup Language, PHP (Hypertext Preprocessor, CSS (Cascading Style Sheet, JQUERY, Java script and presentation of data in the form of MySQL. With the existence of E-government In the Village Sukaraja aims to provide benefits for the wider community about obtaining Village information in a way easily, quickly, effectively and efficiently without knowing the deadline anytime and anywhere.

Evaluating e-Government and Good Governance Correlation

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Suhardi Suhardi

2016-03-01

Full Text Available Assessing the achievement of Indonesian government institutions in implementing e-government has been conducted since around a decade ago. Several national assessments are available with almost the same ranking results. There is an agreement that the ultimate goal of e-government implementation is to achieve good government governance (GGG, while success stories of e-government require good governance practices. This study explored the correlation between e-government achievement and GGG achievement in Indonesia. Spearman’s rank correlation was used to characterize the relationship strength between e-government assessment results and good governance assessment results. The data were collected from institutions that participated in e-government and good governance assessments. The results showed that the correlation between these two entities is not very strong. Most cases showed that e-government implementation and the achievement of good governance have only a moderate positive correlation and none of the studied cases indicated a significant connection. This result can be attributed to the lack of emphasis on goals achievement in the assessments. Thus, it is recommended that future Indonesian e-government assessments should involve impact indicators.

The spirit of democracy in the implementation of public information policy at the provincial government of West Java

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Sjoraida, D. F.; Asmawi, A.; Anwar, R. K.

2018-03-01

This article analyses the implementation of Law Number 14/2008 on Public Information Disclosure on the Provincial Government of West Java. This descriptive-qualitative study presents a discussion of the spirit of democracy in the implementation of the abovem-entioned policy in West Java Province. With the theory of policy implementation and democratization, data obtains that the element of democratic spirit in the implementation of public information policy in the government of West Java is quite thick. Therefore, there must be a massification of the implementation of the law in West Java, especially its socialization to districts/cities and society in general. It was found that the democratization of the West Java Provincial Government in implementing the Act has been well received in the community. However, the lack of publicity about this Law can reduce the strength of moral messages that exist in the law to the public.

Critical Success Factor for Implementing Km in Government Human Capital Management: Case Study Badan Kepegawaian Negara

OpenAIRE

Cahyaningsih, Elin; Sensuse, Dana Indra

2014-01-01

Nowadays, knowledge management in organization became a trend strategy in order to improve organization performance. But unfortunately, it's a big challenge to implementing knowledge management in organization, because it's relatively new and not many people knew about this. This research is done in order to realize bureaucratic reform in government service improvement according to PERMENPAN No. 14 Tahun 2011 is about knowledge management (KM) implementation in government. Knowledge managemen...

Beyond Ambiguity: A Practical Framework for Developing and Implementing Open Government Reforms

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Merlin Chatwin

2017-12-01

Full Text Available The broad idea of ‘Open Government’ is widely accepted as a facilitator for rebuilding trust and validation in governments around the world. The Open Government Partnership is a significant driver of this movement with over 75 member nations, 15 subnational government participants and many others local governments implementing reforms within their national frameworks. The central tenets of transparency, accountability, participation, and collaboration are well understood within scholarly works and practitioner publications. However, open government is yet to be attributed with a universally acknowledged definition. This leads to questions of adaptability and salience of the concept of open government across diverse contexts. This paper addresses these questions by utilizing a human systems framework called the Dialogue Boxes. To develop an understanding of how open government is currently positioned within scholarly works and practitioner publications, an extensive literature search was conducted. The search utilized major search engines, often-cited references, direct journal searches and colleague provided references. Using existing definitions and descriptions, this paper populates the framework with available information and allow for context specific content to be populated by future users. Ultimately, the aim of the paper is to support the development of open government action plans that maximize the direct positive impact on people’s lives.

Looking good or doing better? Patterns of decoupling in the implementation of clinical directorates.

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Mascia, Daniele; Morandi, Federica; Cicchetti, Americo

2014-01-01

The interest toward hospital restructuring has risen significantly in recent years. In spite of its potential benefits, often organizational restructuring in health care produces unexpected consequences. Extant research suggests that institutional theory provides a powerful theoretical lens through which hospital restructuring can be described and explained. According to this perspective, the effectiveness of change is strongly related to the extent to which innovative arrangements, tools, or practices are adopted and implemented within hospitals. Whenever these new arrangements require a substantial modification of internal processes and practices, resistance to implementation emerges and organizational change is likely to become neutralized. This study analyzes how hospital organizations engage in decoupling by adopting but not implementing a new organizational model named clinical directorate. We collected primary data on the diffusion of the clinical directorate model, which was mandated by law in the Italian National Health Service to improve hospital services. We surveyed the adoption and implementation of the clinical directorate model by monitoring the presence of clinical governance tools (measures for the quality improvement of hospital services) within single directorates. In particular, we compared hospitals that adopted the model before (early adopters) or after (later adopters) the mandate was introduced. Hospitals were engaged in decoupling by adopting the new arrangement but not implementing internal practices and tools for quality improvement. The introduction of the law significantly affected the decoupling, with late-adopter hospitals being less likely to implement the adopted model. The present research shows that changes in quality improvement processes may vary in relation to policy makers' interventions aimed at boosting the adoption of new hospital arrangements. Hospital administrators need to be aware and identify the institutional changes

“Future Directions”: m-government computer systems accessed via cloud computing – advantages and possible implementations

OpenAIRE

Daniela LIŢAN

2015-01-01

In recent years, the activities of companies and Public Administration had been automated and adapted to the current information system. Therefore, in this paper, I will present and exemplify the benefits of m-government computer systems development and implementation (which can be accessed from mobile devices and which are specific to the workflow of Public Administrations) starting from the “experience” of e-government systems implementation in the context of their access and usage through ...

The Contextualization of Archetypes: Clinical Template Governance.

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Pedersen, Rune; Ulriksen, Gro-Hilde; Ellingsen, Gunnar

2015-01-01

This paper is a status report from a large-scale openEHR-based EPR project from the North Norway Regional Health Authority. It concerns the standardization of a regional ICT portfolio and the ongoing development of a new process oriented EPR systems encouraged by the unfolding of a national repository for openEHR archetypes. Subject of interest; the contextualization of clinical templates is governed over multiple national boundaries which is complex due to the dependency of clinical resources. From the outset of this, we are interested in how local, regional, and national organizers maneuver to standardize while applying OpenEHR technology.

Implementation of energy-saving policies in China: How local governments assisted industrial enterprises in achieving energy-saving targets

International Nuclear Information System (INIS)

Zhao, Xiaofan; Li, Huimin; Wu, Liang; Qi, Ye

2014-01-01

Local governments have replaced the national ministries that are in charge of various industries to become the primary implementer of energy-saving policies in China since 2000. This paper employs a case study-based approach to demonstrate the significance of local governments’ policy measures in assisting industrial enterprises with energy-saving activities in China. Based on the longitudinal case of the Jasmine Thermal Electric Power Company, this paper hypothesizes that sub-national governments have played a major role in implementing energy-saving policies in China since the 11th Five-year-plan period. A wide range of provincial and municipal agencies collaborated in implementing five types of policy measures – informational policy, skill building, improved enforcement of central directives, price adjustment, and funding – that reduced barriers to energy saving and motivated active pursuit of energy-saving activities at industrial enterprises. The case study demonstrates how an enterprise and local governments work together to achieve the enterprise's energy-saving target. The authors will investigate the hypothesis of this paper in the context of multiple case studies that they plan to undertake in the future. - Highlights: • We employ a case study-based approach to study policy implementation in China. • Local governments have played a major role in implementing energy-saving policies. • Local public agencies collaborated in implementing five types of policy measures. • Local policy measures reduced barriers to energy saving at industrial enterprises. • Enterprises and local governments work together to achieve energy-saving targets

Enacting localist health policy in the English NHS: the 'governing assemblage' of Clinical Commissioning Groups.

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Hammond, Jonathan; Coleman, Anna; Checkland, Kath

2018-01-01

Objectives The Health and Social Care Act 2012 introduced Clinical Commissioning Groups to take responsibility for commissioning (i.e. planning and purchasing) the majority of services for local populations in the English NHS. Constituted as 'membership organizations', with membership compulsory for all GP practices, Clinical Commissioning Groups are overseen by, and are accountable to, a new arm's-length body, NHS England. This paper critically engages with the content and policy narrative of the 2012 Act and explores this in relation to the reality of local policy enactment. Methods Set against a careful review of the 2012 Act, a case study of a nascent Clinical Commissioning Groups was conducted. The research included observations of Clinical Commissioning Group meetings and events (87 h), and in-depth interviews (16) with clinical commissioners, GPs, and managers. Results The 2012 Act was presented as part of a broader government agenda of decentralization and localism. Clinical Commissioning Group membership organizations were framed as a means of better meeting the needs and preferences of local patients and realizing a desirable increase in localism. The policy delineated the 'governing body' and 'the membership', with the former elected from/by the latter to oversee the organization. 'The membership' was duty bound to be 'good', engaged members and to represent their patients' interests. Fieldwork with Notchcroft Clinical Commissioning Group revealed that Clinical Commissioning Groups' statutory duty to NHS England to 'ensure the continuous improvement' of GP practice members involved performance scrutiny of GP practices. These governance processes were carried out by a varied cast of individuals, many of whom did not fit into the binary categorization of membership and governing body constructed in the policy. A concept, the governing assemblage, was developed to describe the dynamic cast of people involved in shaping the work and direction of the Clinical

How GPs implement clinical guidelines in everyday clinical practice--a qualitative interview study.

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Le, Jette V; Hansen, Helle P; Riisgaard, Helle; Lykkegaard, Jesper; Nexøe, Jørgen; Bro, Flemming; Søndergaard, Jens

2015-12-01

Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood. To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form. Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective implementation activities and organized their everyday practice to support these activities. In other practices GPs discussed guidelines collectively but left the application up to the individual GP whilst others again saw no need for discussion or collective activities depending entirely on the individual GP's decision on whether and how to manage implementation. Approaches to implementation of clinical guidelines vary substantially between practices. Supporting activities should take this into account. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Energy summit Hessen. Implementation concept of the state government Hessen; Hessischer Energiegipfel. Umsetzungskonzept der Hessischen Landesregierung

Energy Technology Data Exchange (ETDEWEB)

NONE

2012-02-15

By means of the concept under consideration, the state government of Hessen (Federal Republic of Germany) has pursued the possible and realistic course for the implementation of the targets of the energy summit. The main aspects of this contribution are the implementation of the energy policy of Hessen into the European and national framework; Status quo of the energy consumption in Hessen; Areas of action and measures of the state government of Hessen; Actors of the energy policy turnaround; Monitoring.

The relationship between senior management team culture and clinical governance: Empirical investigation and managerial implications.

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Prenestini, Anna; Calciolari, Stefano; Lega, Federico; Grilli, Roberto

2015-01-01

Health care organizations are pressured to improve the cost-effectiveness of service delivery. Clinical governance is an important trigger to improve care quality and safety and rank high in the reform agenda of health systems. The senior management team culture plays a major role in establishing clinical governance practices, because it strongly influences the values, attitudes, and behaviors of the members of an organization. The aim of this study was to investigate the relationship between senior management team culture and clinical governance in the public health care organizations of three Italian regions. The assessment of senior management culture was conducted using the Competing Values Framework and a corresponding instrument adapted for the Italian context. Clinical governance was assessed using an ad hoc instrument focused on the senior management team's perception and attitude toward clinical governance. The survey achieved a 54% response rate. The results of four different models demonstrate that organizations characterized by different dominant cultures are associated with significant differences in attitudes toward clinical governance. In particular, on average, dominant cultures with a prevailing external focus are associated with a more positive attitude toward clinical governance. The selection and appointments of top managers should consider the style of leadership that is most apt to facilitate the growth of rational and developmental cultures. Furthermore, the training of top managers and leading doctors should reinforce leadership aptitude and approaches that are consistent with the desired organizational cultures.

Clinical pharmacogenetics implementation: approaches, successes, and challenges.

Science.gov (United States)

Weitzel, Kristin W; Elsey, Amanda R; Langaee, Taimour Y; Burkley, Benjamin; Nessl, David R; Obeng, Aniwaa Owusu; Staley, Benjamin J; Dong, Hui-Jia; Allan, Robert W; Liu, J Felix; Cooper-Dehoff, Rhonda M; Anderson, R David; Conlon, Michael; Clare-Salzler, Michael J; Nelson, David R; Johnson, Julie A

2014-03-01

Current challenges exist to widespread clinical implementation of genomic medicine and pharmacogenetics. The University of Florida (UF) Health Personalized Medicine Program (PMP) is a pharmacist-led, multidisciplinary initiative created in 2011 within the UF Clinical Translational Science Institute. Initial efforts focused on pharmacogenetics, with long-term goals to include expansion to disease-risk prediction and disease stratification. Herein we describe the processes for development of the program, the challenges that were encountered and the clinical acceptance by clinicians of the genomic medicine implementation. The initial clinical implementation of the UF PMP began in June 2012 and targeted clopidogrel use and the CYP2C19 genotype in patients undergoing left heart catheterization and percutaneous-coronary intervention (PCI). After 1 year, 1,097 patients undergoing left heart catheterization were genotyped preemptively, and 291 of those underwent subsequent PCI. Genotype results were reported to the medical record for 100% of genotyped patients. Eighty patients who underwent PCI had an actionable genotype, with drug therapy changes implemented in 56 individuals. Average turnaround time from blood draw to genotype result entry in the medical record was 3.5 business days. Seven different third party payors, including Medicare, reimbursed for the test during the first month of billing, with an 85% reimbursement rate for outpatient claims that were submitted in the first month. These data highlight multiple levels of success in clinical implementation of genomic medicine. © 2014 Wiley Periodicals, Inc.

E-Government Partnerships Across Levels of Government

OpenAIRE

Charbit, Claire; Michalun, Varinia

2009-01-01

E-government Partnerships across Levels of Government, is an overview of the challenges and approaches to creating a collaborative and cooperative partnership across levels of government for e-government development and implementation.

Modeling the relations of ethical leadership and clinical governance with psychological empowerment in nurses

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Goona Fathi

2014-07-01

Full Text Available Background: Ethical leadership appeared as a new approach in the leadership perspective and provided the ground for promoting individual and organizational efficiency by giving priorities to ethics in organizations. In this regard, the present study was conducted with the aim of modeling the relations of ethical leadership and clinical governance with psychological empowerment among nurses of public hospitals in Kermanshah in 2014. Methods: the research method was descriptive survey. The study sample consisted of all nurses (n=550 working in public hospitals of Kermanshah University of Medical Science for whom 163 nurses were selected using simple random sampling. The tools for data collection were ethical leadership, clinical governance and psychology empowerment questionnaires whose validity and reliability were confirmed. The structural equation modeling was used to analyze the data. Results: The results showed a significant relationship between ethical leadership and clinical governance (P<0.01 and psychological empowerment (P<0.01. Moreover, there was a significant correlation between clinical governance and psychological empowerment (P<0.05. Based on the results of the research, ethical leadership directly and through clinical governance affected the nurses’ psychological empowerment (P<0.05. Conclusion: reliance on ethics and ethical leadership in hospitals, in addition to providing the space and ground for improving the effectiveness of clinical governance approach, can promote the feeling of psychological empowerment in nurses. Accordingly, the ethical issues are required to be taken into consideration in hospitals.

Is medical perspective on clinical governance practices associated with clinical units’ performance and mortality? A cross-sectional study through a record-linkage procedure

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Guido Sarchielli

2016-07-01

Full Text Available Objective: Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units’ performance measured through mortality rates and efficiency indicators. Methods: This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors’ knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units’ performance indicators which include patients’ mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. Results: The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units’ efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility. These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units’ mortality rates (odds ratio, −8.677; 95% confidence interval, −16.654, −0.700. Conclusion: The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful

Content validity of governing in Building Information Modelling (BIM) implementation assessment instrument

Science.gov (United States)

Hadzaman, N. A. H.; Takim, R.; Nawawi, A. H.; Mohamad Yusuwan, N.

2018-04-01

BIM governance assessment instrument is a process of analysing the importance in developing BIM governance solution to tackle the existing problems during team collaboration in BIM-based projects. Despite the deployment of integrative technologies in construction industry particularly BIM, it is still insufficient compare to other sectors. Several studies have been established the requirements of BIM implementation concerning all technical and non-technical BIM adoption issues. However, the data are regarded as inadequate to develop a BIM governance framework. Hence, the objective of the paper is to evaluate the content validity of the BIM governance instrument prior to the main data collection. Two methods were employed in the form of literature review and questionnaire survey. Based on the literature review, 273 items with six main constructs are suggested to be incorporated in the BIM governance instrument. The Content Validity Ratio (CVR) scores revealed that 202 out of 273 items are considered as the utmost critical by the content experts. The findings for Item Level Content Validity Index (I-CVI) and Modified Kappa Coefficient however revealed that 257 items in BIM governance instrument are appropriate and excellent. The instrument is highly reliable for future strategies and the development of BIM projects in Malaysia.

Conditions That Support the Implementation of E-Government through the Digital Towpath Project: An Exploratory Study

Science.gov (United States)

Tyksinski, Deborah J.

2009-01-01

This study examined the social environmental conditions perceived by local government representatives as relatively important for their implementation of e-government using the Digital Towpath Project (DTP) content management system, referred to as "websites". The survey population included individuals who administered the municipal websites for…

Financial and clinical governance implications of clinical coding accuracy in neurosurgery: a multidisciplinary audit.

Science.gov (United States)

Haliasos, N; Rezajooi, K; O'neill, K S; Van Dellen, J; Hudovsky, Anita; Nouraei, Sar

2010-04-01

Clinical coding is the translation of documented clinical activities during an admission to a codified language. Healthcare Resource Groupings (HRGs) are derived from coding data and are used to calculate payment to hospitals in England, Wales and Scotland and to conduct national audit and benchmarking exercises. Coding is an error-prone process and an understanding of its accuracy within neurosurgery is critical for financial, organizational and clinical governance purposes. We undertook a multidisciplinary audit of neurosurgical clinical coding accuracy. Neurosurgeons trained in coding assessed the accuracy of 386 patient episodes. Where clinicians felt a coding error was present, the case was discussed with an experienced clinical coder. Concordance between the initial coder-only clinical coding and the final clinician-coder multidisciplinary coding was assessed. At least one coding error occurred in 71/386 patients (18.4%). There were 36 diagnosis and 93 procedure errors and in 40 cases, the initial HRG changed (10.4%). Financially, this translated to pound111 revenue-loss per patient episode and projected to pound171,452 of annual loss to the department. 85% of all coding errors were due to accumulation of coding changes that occurred only once in the whole data set. Neurosurgical clinical coding is error-prone. This is financially disadvantageous and with the coding data being the source of comparisons within and between departments, coding inaccuracies paint a distorted picture of departmental activity and subspecialism in audit and benchmarking. Clinical engagement improves accuracy and is encouraged within a clinical governance framework.

Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

Science.gov (United States)

Curran, Geoffrey M; Bauer, Mark; Mittman, Brian; Pyne, Jeffrey M; Stetler, Cheryl

2012-03-01

This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.

Optimalisasi Penerapan Prinsip Good Governance Bidang Akademik dalam Upaya Mewujudkan Good University Governance

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Hery Harjono Muljo

2014-05-01

Full Text Available This study wants to know and understand whether good governance principles have been well applied as well as the factors influencing optimization of the implementation of good governance principles on the academic field in an effort to realize good university governance in Bina Nusantara University. The study aims to evaluate the implementation of good governance principles on the academic field, know the factors that affect the implementation of good governance principles on the academic field, and improve and develop the academic areas in accordance with good governance principles in order to maximize the role of Bina Nusantara University as Good University Governance. The approach model used to understand the implementation of good governance principles was a model to educational institution using the 8 principles, namely academic freedom, shared governance, clear rights and responsibilities, selection at merit, financial stability, accountability, regular testing of standards, and the importance of close cooperation. Research used qualitative method with descriptive analysis, by analyzing the factors influencing optimization of the implementation of good governance principles, particularly on academic areas. The results achieved there were 18 factors that affect the optimization of the implementation of good governance principles. Then the factors affected the optimization ofthe implementation of good governance principles the most are operational centralization and academic decentralization which were the novelty of this study.

Good governance and the implementation of national health insurance in the public health sector: A case of South Africa

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Melody Brauns

2015-09-01

Full Text Available For years it has been argued that implementation failure is one of the main reasons why policies do not yield the results expected. In South Africa, a version of this argument, which often features, is that good policies are drawn up but then not implemented. Government failure is a reality. Just as corporations survive according to whether they make good decisions, so to governments fall or are re-elected on whether they make good decisions. General argument in governance literature is that a wide variety of developments have undermined the capacity of governments to control events within the nation state. As a consequence the state can no longer assume a monopoly of expertise or of the resources to govern.

A Preliminary Evaluation of Instructional Effectiveness of Online Training Implemented at a Government Agency in Thailand

Science.gov (United States)

Supanakorn-Davila, Supawan; Bolliger, Doris U.

2012-01-01

Online training has become popular in the professional development of government employees in Thailand. One large government agency developed an online program to provide training to its employees across the country using two systems: an Internet and Intranet-based system. With the new program implemented, the evaluation of the instructional…

An analysis of Cobit 5 as a framework for the implementation of it governance with reference to King III

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Maseko, L.

2016-02-01

Full Text Available Owing to the complexity and general lack of understanding of information technology (“IT”, the management of IT is often treated as a separately managed value-providing asset. This has resulted in IT rarely receiving the necessary attention of the board, thus creating a disconnect between the board and IT. The King Code of Governance for South Africa 2009 (hereafter referred to as “King III” provides principles and recommended practices for effective IT governance in order to create a greater awareness at board level. King III, however, provides no detailed guidance with regard to the practical implementation of these principles and practices. It is worth noting that numerous international guidelines are recommended within King III that can be adopted as frameworks to assist in the effective implementation of IT governance. COBIT 5 provides, as part of its governance process practices, related guidance activities linking it to the seven IT governance principles of King III, thus making it a practical framework for the implementation of King III recommendations. This study sought to establish the extent to which the governance processes, practices and activities of COBIT 5 are mapped to the recommended practices of IT governance as highlighted in King III in order to resolve COBIT 5 as the de facto framework for IT governance in terms of King III. The study found that though King III principles and practices may be interpreted as vague with regard to how to implement IT governance principles, COBIT 5 succeeds in bridging the gap between control requirements, technical issues, information systems and business risk, which consequently results in a better facilitation of IT governance. The study also revealed that COBIT 5 contains additional activities to assist the board in more transparent reporting of IT performance and conformance management to stakeholders as well activities which enable the connection of resource management with human

Do regulators pay attention? An assessment of IT governance implementation in systemically important banks

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Mehrdad Sepahvand

2017-03-01

Full Text Available The large size and complexity of Information Technology systems in systematically important banks raise the need for creating an IT governance architecture that could make IT strategy aligned with business strategy and delivers value while it effectively identifies and manages IT risk. This study traces the links between IT governance and two more applied risk management frameworks, COSO and BCBS’s principles for managing IT risk. Then it argues due to the magnitude of potential losses caused by any weakness in IT governance in D-SIBs, the assessment of IT governance in these banks should be one of the main concerns of local regulators and supervisors. As a case study, it assesses the relative rank of D-SIBs in Iranian banking system to see where these banks would stand in an ordered list of the banks including both private and public banks in terms of IT governance implementation. The application of the Fuzzy AHP technique shows that IT governance practice in Iranian D-SIBs is not as good as the private banks while it outperforms some state-owned banks.

Pediatric eMental healthcare technologies: a systematic review of implementation foci in research studies, and government and organizational documents.

Science.gov (United States)

Gehring, Nicole D; McGrath, Patrick; Wozney, Lori; Soleimani, Amir; Bennett, Kathryn; Hartling, Lisa; Huguet, Anna; Dyson, Michele P; Newton, Amanda S

2017-06-21

Researchers, healthcare planners, and policymakers convey a sense of urgency in using eMental healthcare technologies to improve pediatric mental healthcare availability and access. Yet, different stakeholders may focus on different aspects of implementation. We conducted a systematic review to identify implementation foci in research studies and government/organizational documents for eMental healthcare technologies for pediatric mental healthcare. A search of eleven electronic databases and grey literature was conducted. We included research studies and documents from organization and government websites if the focus included eMental healthcare technology for children/adolescents (0-18 years), and implementation was studied and reported (research studies) or goals/recommendations regarding implementation were made (documents). We assessed study quality using the Mixed Methods Appraisal Tool and document quality using the Appraisal of Guidelines for Research & Evaluation II. Implementation information was grouped according to Proctor and colleagues' implementation outcomes-acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability-and grouped separately for studies and documents. Twenty research studies and nine government/organizational documents met eligibility criteria. These articles represented implementation of eMental healthcare technologies in the USA (14 studies), United Kingdom (2 documents, 3 studies), Canada (2 documents, 1 study), Australia (4 documents, 1 study), New Zealand (1 study), and the Netherlands (1 document). The quality of research studies was excellent (n = 11), good (n = 6), and poor (n = 1). These eMental health studies focused on the acceptability (70%, n = 14) and appropriateness (50%, n = 10) of eMental healthcare technologies to users and mental healthcare professionals. The quality of government and organizational documents was high (n = 2), medium (n = 6

Foreign practice of introducing conventional communicative strategy in the implementation of the functions of government

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I. P. Zarytska

2014-10-01

Full Text Available This article describes the role of conventional communicative strategy from the standpoint of foreign practice. Depending on scientific approaches to communications, business and management strategies based conventional communicative strategy implementation functions of government. It has certain methodological features and differences in different countries: UK, Germany, Australia, USA, Spain, Holland, Finland, New Zealand. Generalization showed that each state produces its conventional communicative strategy depending on the overall state objectives. However joint is considered important not only communication, but also the ability to communicate effectively, understand how to implement the vision of an opinion on relations between the state and society. Purpose conventional communicative strategy determined by the impact on the optimization of the authorities at the national and regional level, the processes of globalization, the experience of other states, its implementation in practical activities as well as their lack of predictive scenarios of the process of optimizing the functions of government. Demonstrated the appropriateness of existing methodologies to use in domestic practice of public administration.

Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

Science.gov (United States)

Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M

2016-03-01

To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.

Implementation of collaborative governance in cross-sector innovation and education networks: evidence from the National Health Service in England.

Science.gov (United States)

Ovseiko, Pavel V; O'Sullivan, Catherine; Powell, Susan C; Davies, Stephen M; Buchan, Alastair M

2014-11-08

Increasingly, health policy-makers and managers all over the world look for alternative forms of organisation and governance in order to add more value and quality to their health systems. In recent years, the central government in England mandated several cross-sector health initiatives based on collaborative governance arrangements. However, there is little empirical evidence that examines local implementation responses to such centrally-mandated collaborations. Data from the national study of Health Innovation and Education Clusters (HIECs) are used to provide comprehensive empirical evidence about the implementation of collaborative governance arrangements in cross-sector health networks in England. The study employed a mixed-methods approach, integrating both quantitative and qualitative data from a national survey of the entire population of HIEC directors (N = 17; response rate = 100%), a group discussion with 7 HIEC directors, and 15 in-depth interviews with HIEC directors and chairs. The study provides a description and analysis of local implementation responses to the central government mandate to establish HIECs. The latter represent cross-sector health networks characterised by a vague mandate with the provision of a small amount of new resources. Our findings indicate that in the case of HIECs such a mandate resulted in the creation of rather fluid and informal partnerships, which over the period of three years made partial-to-full progress on governance activities and, in most cases, did not become self-sustaining without government funding. This study has produced valuable insights into the implementation responses in HIECs and possibly other cross-sector collaborations characterised by a vague mandate with the provision of a small amount of new resources. There is little evidence that local dominant coalitions appropriated the central HIEC mandate to their own ends. On the other hand, there is evidence of interpretation and implementation of the

Accounting for Lean Implementation in Government Enterprise: Intended and Unintended Consequences

OpenAIRE

Chester S. Labedz; John R. Gray

2013-01-01

This research explores the effects of implementing a lean production system in a government facility. The organization’s formal accounting practices delay recognition of production savings, but informally the facility promotes its lean efforts through attention-getting, off-the-books, “innovative†accounting. The authors state three propositions relating to customer effects of the lean improvements and the financial approaches. They then state four hypotheses relating to the measures’ ...

Implementing human factors in clinical practice

Science.gov (United States)

Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon

2015-01-01

Objectives To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Methods Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. Results The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. Conclusions In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. PMID:24631959

Government management and implementation of national real-time energy monitoring system for China large-scale public building

International Nuclear Information System (INIS)

Na Wei; Wu Yong; Song Yan; Dong Zhongcheng

2009-01-01

The supervision of energy efficiency in government office buildings and large-scale public buildings (GOBLPB) is the main embodiment for government implementation of Public Administration in the fields of resource saving and environmental protection. It is significant for China government to achieve the target: reducing building energy consumption by 11 million ton standard coal before 2010. In the framework of a national demonstration project concerning the energy management system, Shenzhen Municipality has been selected for the implementation of the system. A data acquisition system and a methodology concerning the energy consumption of the GOBLPB have been developed. This paper summarizes the various features of the system incorporated into identifying the building consumes and energy saving potential. This paper also defines the methods to achieve the real-time monitoring and diagnosis: the meters installed at each building, the data transmitted through internet to a center server, the analysis and unification at the center server and the publication through web. Furthermore, this paper introduces the plans to implement the system and to extend countrywide. Finally, this paper presents some measurements to achieve a common benefit community in implementation of building energy efficiency supervisory system on GOBLPB in its construction, reconstruction or operation stages.

Challenges in developing e-government for good governance in North Sumatra

Science.gov (United States)

Siahaan, AY

2017-01-01

E-government as one form of public administration reform in Indonesia is increasingly related to the pursuance of good governance. This paper examines the relationship between of e-government and good governance by utilizing the case study design on the implementation of e-procurement in North Sumatra. It reveals centrality of local politics and business culture in understanding resistances of both local government officials and local business which creates loopholes’ for the practice of ‘bad governance’ in all phases of e-procurement in North Sumatra province. Data transparency does not equate and guarantee the realization of good governance. Public knowledge and understanding on government decision making processes and accountability (process and policy transparency) are central to achieve good governance through e-procurement. E-procurement system does not automatically change organizational and working culture of the implementers and suppliers. This paper provides insight to the attitude and the perception of private sector engage in e-procurement towards government in implementing e-government. Resistance, digital divide and local politics interrelatedly obstruct the realization of pursuing good governance through e-procurement.

The governing body nurse as a clinical commissioning group nurse leader.

Science.gov (United States)

Dempsey, Angela; Minogue, Virginia

2017-02-22

Aim The aim of this study was to understand governing body nurses' perspective of their effect on, and leadership of, clinical commissioning groups (CCGs). Method Semi-structured face-to-face and telephone interviews were conducted with a sample of governing body nurses, CCG chairs and regional chief nurses. A total of 23 individuals were interviewed. Findings Governing body nurses were overwhelmingly positive about their role and believed they had a positive effect on the CCG governing body. Specifically, they provided leadership for the quality agenda and compassionate practice. Challenges experienced by some governing body nurses related to their capacity to undertake the role where this was on a part-time basis, time restraints and difficulties working with colleagues. Conclusion The role of the governing body nurse was not well defined when it was introduced, and as a result its development across CCGs has varied. Governing body nurses have used their leadership skills to advance important agendas for their profession, such as workforce redesign, new integrated care pathways and co-commissioned services.

Nursing domain of CI governance: recommendations for health IT adoption and optimization.

Science.gov (United States)

Collins, Sarah A; Alexander, Dana; Moss, Jacqueline

2015-05-01

There is a lack of recommended models for clinical informatics (CI) governance that can facilitate successful health information technology implementation. To understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders. We conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. We interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects. We found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. We described specific lessons learned and a model of CI governance with recommended roles, partnerships, and councils from the perspective of nursing informatics leaders. Applied CI work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures. Our model of the nursing domain of CI governance with recommended roles, partnerships, and councils provides a starting point that should be further explored and validated. Not only can the model be used to understand, shape, and standardize roles, competencies, and structures within CI practice for nursing, it can be used within other clinical domains and by other informaticians

Health care networks implementation and regional governance challenges in the Legal Amazon Region: an analysis of the QualiSUS-Rede Project.

Science.gov (United States)

Casanova, Angela Oliveira; Cruz, Marly Marques; Giovanella, Ligia; Alves, Glaydes Dos Reis; Cardoso, Gisela Cordeiro Pereira

2017-04-01

This paper aims to analyze the potential, limits and challenges of regional governance in the implementation process of health care networks in three Brazilian regions: Alto Solimões (Amazonas), Belém (Pará) and an interstate region comprising Tocantins, Pará and Maranhão states (Topama). The study is based on the evaluation study on the implementation of the Quality Health Care Network Development and Improvement Project (QualiSUS-Rede). This is a qualitative multiple case study with the analysis of official documents and use of semi-structured interviews with key stakeholders conducted from July to December 2014. Governance review encompassed three components: stakeholders involved, especially local steering groups and their regional coordination capacity; strategies used for strengthening regional governance, anchored on the intervention's modeling; and implementation of local health care networks. Results point that the regional managing commissions were the main governance strategy and that the QualiSUS-Rede Project strengthened regional governance and integration differently in every case, depending on stakeholders' administration and consensus capacity on regional and political priorities.

A Practical Approach to Governance and Optimization of Structured Data Elements.

Science.gov (United States)

Collins, Sarah A; Gesner, Emily; Morgan, Steven; Mar, Perry; Maviglia, Saverio; Colburn, Doreen; Tierney, Diana; Rocha, Roberto

2015-01-01

Definition and configuration of clinical content in an enterprise-wide electronic health record (EHR) implementation is highly complex. Sharing of data definitions across applications within an EHR implementation project may be constrained by practical limitations, including time, tools, and expertise. However, maintaining rigor in an approach to data governance is important for sustainability and consistency. With this understanding, we have defined a practical approach for governance of structured data elements to optimize data definitions given limited resources. This approach includes a 10 step process: 1) identification of clinical topics, 2) creation of draft reference models for clinical topics, 3) scoring of downstream data needs for clinical topics, 4) prioritization of clinical topics, 5) validation of reference models for clinical topics, and 6) calculation of gap analyses of EHR compared against reference model, 7) communication of validated reference models across project members, 8) requested revisions to EHR based on gap analysis, 9) evaluation of usage of reference models across project, and 10) Monitoring for new evidence requiring revisions to reference model.

Implementing human factors in clinical practice.

Science.gov (United States)

Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon

2015-05-01

To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The status of vaccine availability and associated factors in Tshwane government clinics.

Science.gov (United States)

Ngcobo, Ntombenhle Judith; Kamupira, Mercy G

2017-05-24

Vaccines have greatly contributed to the control of vaccine-preventable diseases and to human development. Efforts by many countries to introduce new vaccines are a significant move towards achieving the sustainable development goal for health. However, effective vaccine supply chains that ensure an uninterrupted supply of vaccines are pivotal to attaining universal access to life-saving vaccines and sustainable development. The introduction of new vaccines puts a strain on supply chains; South Africa (SA) is no exception, as there are indications of vaccine stock-outs in clinics. To establish the status of vaccine availability and associated factors in government health facilities of Tshwane Health District in Gauteng Province, SA. A cross-sectional study was conducted in a sample of randomly selected government clinics in the Tshwane health district of Gauteng Province. Data were collected using a structured measurement instrument in participating clinics. Data were analysed using Excel-based software (Microsoft, USA). A total of 31 clinics participated. In the preceding 12 months, clinics had experienced vaccine stock-outs, especially of the three newer vaccines: pneumococcal conjugate vaccine, rotavirus and Pentaxim. These were also out of stock for a long duration; for over 2 weeks in a majority of clinics. The causes of vaccine stock-outs were: poor management of stock, district depot out of stock, unreliable deliveries, lack of pharmacy assistants and limited fridge capacity. Further burdening the situation is the ineffective emergency-ordering system. Significant shortages of vaccines, which are essential drugs, occur in Tshwane government clinics. Vaccine supply chain issues and vaccine shortages should be treated as a priority at all levels of the healthcare system; therefore, a similar study should be conducted at national level. It is recommended that the vaccine supply chain should be restructured and overhauled with the use of advances in technology

Petra Governance Handbook - WP7 – Governance structures & business models : D7.3: Governance Handbook

NARCIS (Netherlands)

Veeneman, W.; Hirschhorn, F.; Klievink, A.J.; Steenhuisen, B.M.; van der Voort, H.G.

2017-01-01

This document represents the governance handbook on mobility data platforms for the PETRA project. The governance handbook provides metropolitan authorities contemplating the implementation of a mobility data platform in line with the PETRA project about governance issues and design.
The

Joined up Clinical Governance: Learning from Our Mistakes

Directory of Open Access Journals (Sweden)

Pam Mosedale

2017-02-01

Full Text Available This session will be a practical demonstration, with group discussion of how a significant event can lead to the practice examining what happened, looking at the evidence base, revising protocols & auditing implementation of the new protocols.A significant event is an event thought by anyone in the team to be significant in the care of patients or the conduct of the practice.Significant Event Audit is a qualitative rather than quantitative form of Audit but still needs a structured framework to be successful.SEA involves gathering information in the form of a timeline of the event, clinical records & accounts of individuals involved.Scenarios around significant events will be discussed and analysed by the group as if they were conducting a non-threatening, open, fair & honest SEA meeting.During the meeting the incident will be analysed to see what happened, why it happened, any underlying reasons, what has been learned & what needs to change. This meeting is not to apportion blame.When looking at what needs to change the group should consider whether it is necessary to go away & look at the evidence base & then make changes to practice protocols. Any need for training or CPD for individuals or the whole team should be identified.A timescale for changes should be agreed.An audit can then be carried out to monitor the improvements and assess the impact of these changes. The group will consider what audits are appropriate, whether process or outcome audits are useful in the circumstances. They will also discuss how these audits can be carried out.SEA is a very useful tool in veterinary practice & a very good way to get all team members engaged with clinical governance & evidence based veterinary medicine in a joined up way which demonstrates the potential improvements to practice systems of work and patient care and safety.This session would be designed to appeal to all team members whether vets, nurses, receptionists or practice managers.

Regional cooperation for European seas: Governance models in support of the implementation of the MSFD

NARCIS (Netherlands)

Tatenhove, van J.P.M.; Raakjaer, J.; Leeuwen, van J.; Hoof, van L.J.W.

2014-01-01

During the implementation process of the Marine Strategy Framework Directive (MSFD), Member States are expected to cooperate and coordinate at the regional sea level as wells as arrange stakeholder involvement. However, the MSFD does not specify any governing structures to do so. The aim of this

Planned change or emergent change implementation approach and nurses' professional clinical autonomy.

Science.gov (United States)

Luiking, Marie-Louise; Aarts, Leon; Bras, Leo; Grypdonck, Maria; van Linge, Roland

2017-11-01

Nurses' clinical autonomy is considered important for patients' outcome and influenced by the implementation approach of innovations. Emergent change approach with participation in the implementation process is thought to increase clinical autonomy. Planned change approach without this participation is thought not to increase clinical autonomy. Evidence of these effects on clinical autonomy is however limited. To examine the changes in clinical autonomy and in personal norms and values for a planned change and emergent change implementation of an innovation, e.g. intensive insulin therapy. Prospective comparative study with two geographically separated nurses' teams on one intensive care unit (ICU), randomly assigned to the experimental conditions. Data were collected from March 2008 to January 2009. Pre-existing differences in perception of team and innovation characteristics were excluded using instruments based on the innovation contingency model. The Nursing Activity Scale was used to measure clinical autonomy. The Personal Values and Norms instrument was used to assess orientation towards nursing activities and the Team Learning Processes instrument to assess learning as a team. Pre-implementation the measurements did not differ. Post-implementation, clinical autonomy was increased in the emergent change team and decreased in the planned change team. The Personal Values and Norms instrument showed in the emergent change team a decreased hierarchic score and increased developmental and rational scores. In the planned change team the hierarchical and group scores were increased. Learning as a team did not differ between the teams. In both teams there was a change in clinical autonomy and orientation towards nursing activities, in line with the experimental conditions. Emergent change implementation resulted in more clinical autonomy than planned change implementation. If an innovation requires the nurses to make their own clinical decisions, an emergent change

Contextual Factors Affecting E-Government Strategy Implementation and Its Impact on Public Sector Performance in Kenya

Directory of Open Access Journals (Sweden)

Dr. James Gathungu

2013-06-01

Full Text Available This paper assesses the contextual factors affecting the implementation of e-government strategy and its impact on the performance of the public sector in Kenya using the Wing Lam, (2005 E-government Integration Model. Electronic government (E-government is viewed in this study as the utilization of Information Communication Technologies (ICTs to transform the efficiency, effectiveness, transparency and accountability of exchanges within government, between government and citizens and businesses locally and abroad; and to empower citizens through access and use of information. Although e-government is a rapidly growing concept in both developing and developed countries very few e-government initiatives progress to maturity. Different countries are faced with different contextual circumstances and environments in the realization of e-government initiatives. This study attempts to address the gap between theory and rhetoric about the potential of e-government and the reality of its application on the ground in Kenya. The study attempts to analyze the philosophy, theories and paradigms of e-government. The development of the commercial concept as a new paradigm in public administration replacing the traditional bureaucratic systems of government is highlighted in the study. A detailed conceptual discussion anchors the study on the Wing Lam, (2005 E-government Integration Model (EGI basing it on the Kenyan perspective. The study also reviews relevant e-government studies from an international, regional and local perspective anchoring the study on the configuration school of management thought. These discussions are used to develop new insights in view of the emerging issues and their relevance to the public sector in Kenya.

Contextual Factors Affecting E-Government Strategy Implementation and Its Impact on Public Sector Performance in Kenya

Directory of Open Access Journals (Sweden)

Dr. James Gathungu

2013-06-01

Full Text Available This paper assesses the contextual factors affecting the implementation of e-government strategy and its impact on the performance of the public sector in Kenya using the Wing Lam, (2005 E-government Integration Model. Electronic government (E-government is viewed in this study as the utilization of Information Communication Technologies (ICTs to transform the efficiency, effectiveness, transparency and accountability of exchanges within government, between government and citizens and businesses locally and abroad; and to empower citizens through access and use of information. Although e-government is a rapidly growing concept in both developing and developed countries very few e-government initiatives progress to maturity. Different countries are faced with different contextual circumstances and environments in the realization of e-government initiatives. This study attempts to address the gap between theory and rhetoric about the potential of e-government and the reality of its application on the ground in Kenya. The study attempts to analyze the philosophy, theories and paradigms of e-government. The development of the commercial concept as a new paradigm in public administration replacing the traditional bureaucratic systems of government is highlighted in the study. A detailed conceptual discussion anchors the study on the Wing Lam, (2005 E-government Integration Model (EGI basing it on the Kenyan perspective. The study also reviews relevant e-government studies from an international, regional and local perspective anchoring the study on the configuration school of management thought. These discussions are used to develop new insights in view of the emerging issues and their relevance to the public sector in Kenya.  

Local Government Implementation of Long-Term Stewardship at Two DOE Facilities

Energy Technology Data Exchange (ETDEWEB)

John Pendergrass; Roman Czebiniak; Kelly Mott; Seth Kirshenberg; Audrey Eidelman; Zachary Lamb; Erica Pencak; Wendy Sandoz

2003-08-13

The Department of Energy (DOE) is responsible for cleaning up the radioactive and chemical contamination that resulted from the production of nuclear weapons. At more than one hundred sites throughout the country DOE will leave some contamination in place after the cleanup is complete. In order to protect human health and the environment from the remaining contamination DOE, U.S. Environmental Protection Agency (EPA), state environmental regulatory agencies, local governments, citizens and other entities will need to undertake long-term stewardship of such sites. Long-term stewardship includes a wide range of actions needed to protect human health in the environment for as long as the risk from the contamination remains above acceptable levels, such as barriers, caps, and other engineering controls and land use controls, signs, notices, records, and other institutional controls. In this report the Environmental Law Institute (ELI) and the Energy Communities Alliance (ECA) examine how local governments, state environmental agencies, and real property professionals implement long-term stewardship at two DOE facilities, Losa Alamos National Laboratory and Oak Ridge Reservation.

Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience.

Science.gov (United States)

Scott, Vera; Schaay, Nikki; Olckers, Patti; Nqana, Nomsa; Lehmann, Uta; Gilson, Lucy

2014-09-01

Health system governance has been recognized as a critical element of the health system strengthening agenda. To date, health governance research often focuses at national or global levels, adopting a macro-perspective that deals with governance structures, forms and principles. Little attention has been given to a micro-perspective which recognizes the role of health system actors in governance, or to considering the operational level of the health system. This article presents a South African case study of an intervention to address conflict in roles and responsibilities between multiple actors supporting service delivery at the local level, and explores the broader insights this experience generates about the nature of local health system governance. In an embedded case study, action learning and reflection theory were used to design and implement the intervention. Data in this article were drawn from minutes, observations and recorded reflections of the meetings and workshops that comprised the intervention. A theoretical governance framework was used both to understand the context of the intervention and to analyse the dimensions of governance relevant in the experience. The study shows how, through action learning and reflection, local managers in two organizations came to understand how the higher level misalignment of organizational structures and processes imposed governance constraints on them, and to see the impact this had on their organizational relationships. By re-framing the conflict as organizational, they were then able to create opportunities for staff to understand their context and participate in negotiating principles for communication and collaborative work. The result reduced conflict between staff in the two organizations, leading to improved implementation of programme support. Strengthening relationships among those working at local level by building collaborative norms and values is an important part of local health system governance for

Cloud Computing Governance Lifecycle

Directory of Open Access Journals (Sweden)

Soňa Karkošková

2016-06-01

Full Text Available Externally provisioned cloud services enable flexible and on-demand sourcing of IT resources. Cloud computing introduces new challenges such as need of business process redefinition, establishment of specialized governance and management, organizational structures and relationships with external providers and managing new types of risk arising from dependency on external providers. There is a general consensus that cloud computing in addition to challenges brings many benefits but it is unclear how to achieve them. Cloud computing governance helps to create business value through obtain benefits from use of cloud computing services while optimizing investment and risk. Challenge, which organizations are facing in relation to governing of cloud services, is how to design and implement cloud computing governance to gain expected benefits. This paper aims to provide guidance on implementation activities of proposed Cloud computing governance lifecycle from cloud consumer perspective. Proposed model is based on SOA Governance Framework and consists of lifecycle for implementation and continuous improvement of cloud computing governance model.

The status of vaccine availability and associated factors in Tshwane government clinics

Directory of Open Access Journals (Sweden)

Ntombenhle Judith Ngcobo

2017-06-01

Full Text Available Background. Vaccines have greatly contributed to the control of vaccine-preventable diseases and to human development. Efforts by many countries to introduce new vaccines are a significant move towards achieving the sustainable development goal for health. However, effective vaccine supply chains that ensure an uninterrupted supply of vaccines are pivotal to attaining universal access to life-saving vaccines and sustainable development. The introduction of new vaccines puts a strain on supply chains; South Africa (SA is no exception, as there are indications of vaccine stock-outs in clinics. Objective. To establish the status of vaccine availability and associated factors in government health facilities of Tshwane Health District in Gauteng Province, SA. Methods. A cross-sectional study was conducted in a sample of randomly selected government clinics in the Tshwane health district of Gauteng Province. Data were collected using a structured measurement instrument in participating clinics. Data were analysed using Excel-based software (Microsoft, USA. Results. A total of 31 clinics participated. In the preceding 12 months, clinics had experienced vaccine stock-outs, especially of the three newer vaccines: pneumococcal conjugate vaccine, rotavirus and Pentaxim. These were also out of stock for a long duration; for over 2 weeks in a majority of clinics. The causes of vaccine stock-outs were: poor management of stock, district depot out of stock, unreliable deliveries, lack of pharmacy assistants and limited fridge capacity. Further burdening the situation is the ineffective emergency-ordering system. Conclusion. Significant shortages of vaccines, which are essential drugs, occur in Tshwane government clinics. Vaccine supply chain issues and vaccine shortages should be treated as a priority at all levels of the healthcare system; therefore, a similar study should be conducted at national level. It is recommended that the vaccine supply chain should

Need for revisiting the role of sexually transmitted disease clinics in government hospitals in India

Directory of Open Access Journals (Sweden)

Madhulekha Bhattacharya

2017-01-01

Full Text Available Introduction: The Government of India provides treatment for sexually transmitted infections (STIs through government's sexually transmitted disease (STD clinics with the mandate of providing curative and preventive services for clients in the context of STIs. However, besides the patients suffering from STDs, other clients with problems related to reproductive and sexual health also attend these clinics. This study aimed to assess the profile and treatment-seeking behavior of clients attending STD clinics in government hospitals in India. Materials and Methods: This multicentric, cross-sectional study with 5098 participants was conducted over 2 months in identified 19 Indian states. Chi–square test was used for statistical analysis. Results: The percentage with STDs (62.98% was nearly double than those with non-STDs (37.1%. Around 8.2% of patients had an STD and were also HIV positive. Compared to the total STD cases, only 9% of the partners had turned up for screening. Of significance were the non-STD cases who presented with both physical and psychological symptoms including infertility. Among males, it was mainly sexual dysfunction and balanoposthitis, and in females, lower abdominal pain and bacterial vaginosis. Only 27.3% reported that they had come directly to the government facility/clinic. Nearly 38% of males and 30% of females had tried home remedies before coming to the government clinic. Majority (77.9% of the clients reported that they had never been counseled on any aspect of STD or HIV. Conclusion: The profile of clients in the various clinics across the country indicates that the name “STD Clinic” is a misnomer since the presenting complaints of clients are varied, and related not only to STDs but also to other reproductive tract problems. Furthermore, the average new patient load observed in our study is low and this was attributed to the name “STDs” given to these clinics. Renaming them as “Reproductive Health

Glocal clinical registries: pacemaker registry design and implementation for global and local integration--methodology and case study.

Directory of Open Access Journals (Sweden)

Kátia Regina da Silva

Full Text Available The ability to apply standard and interoperable solutions for implementing and managing medical registries as well as aggregate, reproduce, and access data sets from legacy formats and platforms to advanced standard formats and operating systems are crucial for both clinical healthcare and biomedical research settings.Our study describes a reproducible, highly scalable, standard framework for a device registry implementation addressing both local data quality components and global linking problems.We developed a device registry framework involving the following steps: (1 Data standards definition and representation of the research workflow, (2 Development of electronic case report forms using REDCap (Research Electronic Data Capture, (3 Data collection according to the clinical research workflow and, (4 Data augmentation by enriching the registry database with local electronic health records, governmental database and linked open data collections, (5 Data quality control and (6 Data dissemination through the registry Web site. Our registry adopted all applicable standardized data elements proposed by American College Cardiology / American Heart Association Clinical Data Standards, as well as variables derived from cardiac devices randomized trials and Clinical Data Interchange Standards Consortium. Local interoperability was performed between REDCap and data derived from Electronic Health Record system. The original data set was also augmented by incorporating the reimbursed values paid by the Brazilian government during a hospitalization for pacemaker implantation. By linking our registry to the open data collection repository Linked Clinical Trials (LinkedCT we found 130 clinical trials which are potentially correlated with our pacemaker registry.This study demonstrates how standard and reproducible solutions can be applied in the implementation of medical registries to constitute a re-usable framework. Such approach has the potential to

Role and Function Sub District in the Implementation of Local Government in Semarang City and District of Semarang Central Java Province

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Gunawan

2014-12-01

Full Text Available Sub district in performing common functions government implementation and administration functions of the tasks that have been submitted by District City in accordance with the Law No. 32 Year 2004 on Regional Government and Government Regulation No. 19 Year 2008 on the District experienced a bottleneck in its application in the form of authority, institutional, resource human resources and management districts, the study used a qualitative approach, purposive sampling areas that have been submitted and have not been handed over authority to the districts, the results showed that the authority has submitted both the mayor and the regent was not fully submitted, institution or organization not adjust districts Government Regulation No. 19 in 2008, the quality and quantity of human resources become a bottleneck in the implementation of tasks and discretionary attributive.

A multidisciplinary audit of clinical coding accuracy in otolaryngology: financial, managerial and clinical governance considerations under payment-by-results.

Science.gov (United States)

Nouraei, S A R; O'Hanlon, S; Butler, C R; Hadovsky, A; Donald, E; Benjamin, E; Sandhu, G S

2009-02-01

To audit the accuracy of otolaryngology clinical coding and identify ways of improving it. Prospective multidisciplinary audit, using the 'national standard clinical coding audit' methodology supplemented by 'double-reading and arbitration'. Teaching-hospital otolaryngology and clinical coding departments. Otolaryngology inpatient and day-surgery cases. Concordance between initial coding performed by a coder (first cycle) and final coding by a clinician-coder multidisciplinary team (MDT; second cycle) for primary and secondary diagnoses and procedures, and Health Resource Groupings (HRG) assignment. 1250 randomly-selected cases were studied. Coding errors occurred in 24.1% of cases (301/1250). The clinician-coder MDT reassigned 48 primary diagnoses and 186 primary procedures and identified a further 209 initially-missed secondary diagnoses and procedures. In 203 cases, patient's initial HRG changed. Incorrect coding caused an average revenue loss of 174.90 pounds per patient (14.7%) of which 60% of the total income variance was due to miscoding of a eight highly-complex head and neck cancer cases. The 'HRG drift' created the appearance of disproportionate resource utilisation when treating 'simple' cases. At our institution the total cost of maintaining a clinician-coder MDT was 4.8 times lower than the income regained through the double-reading process. This large audit of otolaryngology practice identifies a large degree of error in coding on discharge. This leads to significant loss of departmental revenue, and given that the same data is used for benchmarking and for making decisions about resource allocation, it distorts the picture of clinical practice. These can be rectified through implementing a cost-effective clinician-coder double-reading multidisciplinary team as part of a data-assurance clinical governance framework which we recommend should be established in hospitals.

Implementation of quality management for clinical bacteriology in low-resource settings.

Science.gov (United States)

Barbé, B; Yansouni, C P; Affolabi, D; Jacobs, J

2017-07-01

The declining trend of malaria and the recent prioritization of containment of antimicrobial resistance have created a momentum to implement clinical bacteriology in low-resource settings. Successful implementation relies on guidance by a quality management system (QMS). Over the past decade international initiatives were launched towards implementation of QMS in HIV/AIDS, tuberculosis and malaria. To describe the progress towards accreditation of medical laboratories and to identify the challenges and best practices for implementation of QMS in clinical bacteriology in low-resource settings. Published literature, online reports and websites related to the implementation of laboratory QMS, accreditation of medical laboratories and initiatives for containment of antimicrobial resistance. Apart from the limitations of infrastructure, equipment, consumables and staff, QMS are challenged with the complexity of clinical bacteriology and the healthcare context in low-resource settings (small-scale laboratories, attitudes and perception of staff, absence of laboratory information systems). Likewise, most international initiatives addressing laboratory health strengthening have focused on public health and outbreak management rather than on hospital based patient care. Best practices to implement quality-assured clinical bacteriology in low-resource settings include alignment with national regulations and public health reference laboratories, participating in external quality assurance programmes, support from the hospital's management, starting with attainable projects, conducting error review and daily bench-side supervision, looking for locally adapted solutions, stimulating ownership and extending existing training programmes to clinical bacteriology. The implementation of QMS in clinical bacteriology in hospital settings will ultimately boost a culture of quality to all sectors of healthcare in low-resource settings. Copyright © 2017 The Authors. Published by

THE IMPLEMENTATION OF CORPORATE GOVERNANCE INTO BRAND MANAGEMENT

Directory of Open Access Journals (Sweden)

Claudia- Cristina PLOSCARU

2014-11-01

Full Text Available Integrating corporate governance into brand management is fundamental for protecting shareholders, considering the increasing importance of brands in firms’ performance and the dissociation between shareholders and managers in most large and medium firms. This paper designs a corporate governance system model on a brand level, which takes into account preventive, simultaneous and retroactive governance. Moreover, we highlight the importance of transition management when changes to brand management come into question. Finally, we propose six corporate governance instruments for brand management: performance indicators, the brand marketing plan, periodic reports, the brand council, brand audit, and transition management.

Clinical governance and operations management methodologies.

Science.gov (United States)

Davies, C; Walley, P

2000-01-01

The clinical governance mechanism, introduced since 1998 in the UK National Health Service (NHS), aims to deliver high quality care with efficient, effective and cost-effective patient services. Scally and Donaldson recognised that new approaches are needed, and operations management techniques comprise potentially powerful methodologies in understanding the process of care, which can be applied both within and across professional boundaries. This paper summarises four studies in hospital Trusts which took approaches to improving process that were different from and less structured than business process re-engineering (BPR). The problems were then amenable to change at a relatively low cost and short timescale, producing significant improvement to patient care. This less structured approach to operations management avoided incurring overhead costs of large scale and costly change such as new information technology (IT) systems. The most successful changes were brought about by formal tools to control quantity, content and timing of changes.

Legal framework for implementation of m-government in Ethiopia ...

African Journals Online (AJOL)

Higher penetration of mobile services in many countries, including Ethiopia, makes m-Government an eminent technological option for delivering government services to public and businesses. Although the Ethiopian government has introduced e-government services to the public, the legal framework to support such ...

Case Study: Clinical Governance as an Approach to Improve Maternal and Newborn Health in 22 Hospitals in Indonesia.

Science.gov (United States)

Amelia, Dwirani; Suhowatsky, Stephanie; Baharuddin, Mohammad; Tholandi, Maya; Hyre, Anne; Sethi, Reena

Clinical governance is a concept used to improve management, accountability and the provision of quality healthcare. An approach to strengthen clinical governance as a means to improve the quality of maternal and newborn care in Indonesia was developed by the Expanding Maternal and Neonatal Survival (EMAS) Program. This case study presents findings and lessons learned from EMAS program experience in 22 hospitals where peer-to-peer mentoring supported staff in strengthening clinical governance from 2012-2015. Efforts resulted in improved hospital preparedness and significantly increased the odds of facility-level coverage for three evidence-based maternal and newborn healthcare interventions.

Glocal Clinical Registries: Pacemaker Registry Design and Implementation for Global and Local Integration – Methodology and Case Study

Science.gov (United States)

da Silva, Kátia Regina; Costa, Roberto; Crevelari, Elizabeth Sartori; Lacerda, Marianna Sobral; de Moraes Albertini, Caio Marcos; Filho, Martino Martinelli; Santana, José Eduardo; Vissoci, João Ricardo Nickenig; Pietrobon, Ricardo; Barros, Jacson V.

2013-01-01

Background The ability to apply standard and interoperable solutions for implementing and managing medical registries as well as aggregate, reproduce, and access data sets from legacy formats and platforms to advanced standard formats and operating systems are crucial for both clinical healthcare and biomedical research settings. Purpose Our study describes a reproducible, highly scalable, standard framework for a device registry implementation addressing both local data quality components and global linking problems. Methods and Results We developed a device registry framework involving the following steps: (1) Data standards definition and representation of the research workflow, (2) Development of electronic case report forms using REDCap (Research Electronic Data Capture), (3) Data collection according to the clinical research workflow and, (4) Data augmentation by enriching the registry database with local electronic health records, governmental database and linked open data collections, (5) Data quality control and (6) Data dissemination through the registry Web site. Our registry adopted all applicable standardized data elements proposed by American College Cardiology / American Heart Association Clinical Data Standards, as well as variables derived from cardiac devices randomized trials and Clinical Data Interchange Standards Consortium. Local interoperability was performed between REDCap and data derived from Electronic Health Record system. The original data set was also augmented by incorporating the reimbursed values paid by the Brazilian government during a hospitalization for pacemaker implantation. By linking our registry to the open data collection repository Linked Clinical Trials (LinkedCT) we found 130 clinical trials which are potentially correlated with our pacemaker registry. Conclusion This study demonstrates how standard and reproducible solutions can be applied in the implementation of medical registries to constitute a re-usable framework

Critical success factors in implementing clinical pathways/case management.

Science.gov (United States)

Choo, J

2001-07-01

With the advent of casemix reimbursement implementation, rapid technological changes, an ageing population and changing consumer behaviour, the Singapore health care industry is faced with the impetus to provide a cost-effective and efficient care delivery system. One ubiquitous tool used is the establishment of a clinical pathway/case management programme within the hospital. As the concept of clinical pathway for patient care is a relatively new concept in Singapore, several critical factors must be considered to ensure successful implementation of clinical pathway/case management programme. One key success factor lies in continued clinician support and acceptance. Other factors include top management leadership and support and a dedicated team of case managers, nurses and paramedical professionals.

Implementing effect of energy efficiency supervision system for government office buildings and large-scale public buildings in China

International Nuclear Information System (INIS)

Zhao Jing; Wu Yong; Zhu Neng

2009-01-01

The Chinese central government released a document to initiate a task of energy efficiency supervision system construction for government office buildings and large-scale public buildings in 2007, which marks the overall start of existing buildings energy efficiency management in China with the government office buildings and large-scale public buildings as a breakthrough. This paper focused on the implementing effect in the demonstration region all over China for less than one year, firstly introduced the target and path of energy efficiency supervision system, then described the achievements and problems during the implementing process in the first demonstration provinces and cities. A certain data from the energy efficiency public notice in some typical demonstration provinces and cities were analyzed statistically. It can be concluded that different functional buildings have different energy consumption and the average energy consumption of large-scale public buildings is too high in China compared with the common public buildings and residential buildings. The obstacles need to be overcome afterward were summarized and the prospects for the future work were also put forward in the end.

Implementing effect of energy efficiency supervision system for government office buildings and large-scale public buildings in China

Energy Technology Data Exchange (ETDEWEB)

Zhao Jing [School of Environmental Science and Engineering, Tianjin University, Tianjin 300072 (China)], E-mail: zhaojing@tju.edu.cn; Wu Yong [Department of Science and Technology, Ministry of Housing and Urban-Rural Development of the People' s Republic of China, Beijing 100835 (China); Zhu Neng [School of Environmental Science and Engineering, Tianjin University, Tianjin 300072 (China)

2009-06-15

The Chinese central government released a document to initiate a task of energy efficiency supervision system construction for government office buildings and large-scale public buildings in 2007, which marks the overall start of existing buildings energy efficiency management in China with the government office buildings and large-scale public buildings as a breakthrough. This paper focused on the implementing effect in the demonstration region all over China for less than one year, firstly introduced the target and path of energy efficiency supervision system, then described the achievements and problems during the implementing process in the first demonstration provinces and cities. A certain data from the energy efficiency public notice in some typical demonstration provinces and cities were analyzed statistically. It can be concluded that different functional buildings have different energy consumption and the average energy consumption of large-scale public buildings is too high in China compared with the common public buildings and residential buildings. The obstacles need to be overcome afterward were summarized and the prospects for the future work were also put forward in the end.

Implementing effect of energy efficiency supervision system for government office buildings and large-scale public buildings in China

Energy Technology Data Exchange (ETDEWEB)

Zhao, Jing; Zhu, Neng [School of Environmental Science and Engineering, Tianjin University, Tianjin 300072 (China); Wu, Yong [Department of Science and Technology, Ministry of Housing and Urban-Rural Development of the People' s Republic of China, Beijing 100835 (China)

2009-06-15

The Chinese central government released a document to initiate a task of energy efficiency supervision system construction for government office buildings and large-scale public buildings in 2007, which marks the overall start of existing buildings energy efficiency management in China with the government office buildings and large-scale public buildings as a breakthrough. This paper focused on the implementing effect in the demonstration region all over China for less than one year, firstly introduced the target and path of energy efficiency supervision system, then described the achievements and problems during the implementing process in the first demonstration provinces and cities. A certain data from the energy efficiency public notice in some typical demonstration provinces and cities were analyzed statistically. It can be concluded that different functional buildings have different energy consumption and the average energy consumption of large-scale public buildings is too high in China compared with the common public buildings and residential buildings. The obstacles need to be overcome afterward were summarized and the prospects for the future work were also put forward in the end. (author)

From Target to Implementation: Perspectives for the International Governance of Forest Landscape Restoration

Directory of Open Access Journals (Sweden)

Till Pistorius

2014-03-01

Full Text Available Continuing depletion of forest resources, particularly in tropical developing countries, has turned vast areas of intact ecosystems into urbanized and agricultural lands. The degree of degradation varies, but in most cases, the ecosystem functions and the ability to provide a variety of ecosystem services are severely impaired. In addition to many other challenges, successful forest restoration of these lands requires considerable resources and funding, but the ecological, economic and social benefits have the potential to outweigh the investment. As a consequence, at the international policy level, restoration is seen as a field of land use activities that provides significant contributions to simultaneously achieving different environmental and social policy objectives. Accordingly, different policy processes at the international policy level have made ecological landscape restoration a global priority, in particular the Convention on Biological Diversity with the Aichi Target 15 agreed upon in 2010, which aims at restoring 15% of all degraded land areas by 2020. While such ambitious policy targets are important for recognizing and agreeing upon solutions for environmental problems, they are unlikely to be further substantiated or governed. The objective of this paper is thus to develop a complementary governance approach to the top-down implementation of the Aichi target. Drawing on collaborative and network governance theories, we discuss the potential of a collaborative networked governance approach and perspectives for overcoming the inherent challenges facing a rapid large-scale restoration of degraded lands.

Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers.

Science.gov (United States)

Dunnenberger, Henry M; Crews, Kristine R; Hoffman, James M; Caudle, Kelly E; Broeckel, Ulrich; Howard, Scott C; Hunkler, Robert J; Klein, Teri E; Evans, William E; Relling, Mary V

2015-01-01

Although the field of pharmacogenetics has existed for decades, practioners have been slow to implement pharmacogenetic testing in clinical care. Numerous publications describe the barriers to clinical implementation of pharmacogenetics. Recently, several freely available resources have been developed to help address these barriers. In this review, we discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of patients. Array-based preemptive testing includes a large number of relevant pharmacogenes that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to be available prior to any prescribing decision so that genomic variation may be considered as an inherent patient characteristic in the planning of therapy. This review describes the common elements among programs that have implemented preemptive genotyping and highlights key processes for implementation, including clinical decision support.

Implementation of an Ebola virus disease vaccine clinical trial during the Ebola epidemic in Liberia: Design, procedures, and challenges.

Science.gov (United States)

Kennedy, Stephen B; Neaton, James D; Lane, H Clifford; Kieh, Mark W S; Massaquoi, Moses B F; Touchette, Nancy A; Nason, Martha C; Follmann, Dean A; Boley, Fatorma K; Johnson, Melvin P; Larson, Gregg; Kateh, Francis N; Nyenswah, Tolbert G

2016-02-01

The index case of the Ebola virus disease epidemic in West Africa is believed to have originated in Guinea. By June 2014, Guinea, Liberia, and Sierra Leone were in the midst of a full-blown and complex global health emergency. The devastating effects of this Ebola epidemic in West Africa put the global health response in acute focus for urgent international interventions. Accordingly, in October 2014, a World Health Organization high-level meeting endorsed the concept of a phase 2/3 clinical trial in Liberia to study Ebola vaccines. As a follow-up to the global response, in November 2014, the Government of Liberia and the US Government signed an agreement to form a research partnership to investigate Ebola and to assess intervention strategies for treating, controlling, and preventing the disease in Liberia. This agreement led to the establishment of the Joint Liberia-US Partnership for Research on Ebola Virus in Liberia as the beginning of a long-term collaborative partnership in clinical research between the two countries. In this article, we discuss the methodology and related challenges associated with the implementation of the Ebola vaccines clinical trial, based on a double-blinded randomized controlled trial, in Liberia. © The Author(s) 2016.

Negotiating Collaborative Governance Designs

DEFF Research Database (Denmark)

Plotnikof, Mie

2017-01-01

This chapter addresses the design and implementation issues of collaborative governance, a public management practice aimed at involving stakeholders in problem-solving and public innovation.......This chapter addresses the design and implementation issues of collaborative governance, a public management practice aimed at involving stakeholders in problem-solving and public innovation....

E-Government Maturity Model for Sustainable E-Government Services from the Perspective of Developing Countries

Directory of Open Access Journals (Sweden)

Pusp Raj Joshi

2018-06-01

Full Text Available Electric government (e-government projects in developing countries are facing many challenges to deliver sustainable e-government services. From the existing literature, we found that most of the studies considered lack of technology, and limitations in budgets and human resources as the main hurdles in effective implementation of e-government services. Along with these limitations, we found that the e-government maturity models adopted by developing countries are failing to provide an appropriate strategic plan to deploy sustainable e-government services. While assessing the existing e-government maturity model, we made several observations on the lack of detail, the technology-centric nature, the emphasis on implementation, and the lack of an adoption strategy. This work contributes toward the proposition of a new e-government maturity model that would address the limitations of exiting e-government maturity models, and would support governments in developing countries to achieve sustainable e-government services. To achieve this goal, we considered five determinants—a detailed process, streamlined services, agile accessibility, use of state-of-the-art technology, and trust and awareness. The proposed model was validated by employing an empirical investigation through case-study and survey methods. We found that both the implementers (government and adopters (users of the e-government services benefited from the proposed model, resulting in an increased sustainability of e-government services.

Implementation of a pharmacist-managed heart failure medication titration clinic.

Science.gov (United States)

Martinez, Amanda S; Saef, Jerold; Paszczuk, Anna; Bhatt-Chugani, Hetal

2013-06-15

The development, implementation, and initial results of a pharmacist-managed heart failure (HF) medication titration clinic are described. In a quality-improvement initiative at a Veterans Affairs health care system, clinical pharmacists were incorporated into the hospital system's interprofessional outpatient HF clinic. In addition, a separate pharmacist-managed HF medication titration clinic was established, in which pharmacists were granted an advanced scope of practice and prescribing privileges, enabling them to initiate and adjust medication dosages under specific protocols jointly established by cardiology and pharmacy staff. Pharmacists involved in the titration clinic tracked patients' daily body weight, vital signs, and volume status using telephone-monitoring technology and via patient interviews. A retrospective chart review comparing achievement of target doses of angiotensin-converting enzyme inhibitor (ACEI), angiotensin-receptor blocker (ARB), and β-blocker therapies in a group of patients (n = 28) whose dosage titrations were carried out by nurses or physicians prior to implementation of the pharmacist-managed HF medication titration clinic and a group of patients (n = 27) enrolled in the medication titration clinic during its first six months of operation indicated that target ACEI and ARB doses were achieved in a significantly higher percentage of pharmacist-managed titration clinic enrollees (52.9% versus 31%, p = 0.007). Patients enrolled in the pharmacist-managed HF medication titration clinic also had a significantly higher rate of attainment of optimal β-blocker doses (49% versus 24.7%, p = 0.012). Implementation of a pharmacist-managed HF medication titration clinic increased the percentage of patients achieving optimal ACEI, ARB, and β-blocker dosages.

Implementing clinical guidelines in psychiatry: a qualitative study of perceived facilitators and barriers

Directory of Open Access Journals (Sweden)

Wistedt Anna

2010-01-01

Full Text Available Abstract Background Translating scientific evidence into daily practice is complex. Clinical guidelines can improve health care delivery, but there are a number of challenges in guideline adoption and implementation. Factors influencing the effective implementation of guidelines remain poorly understood. Understanding of barriers and facilitators is important for development of effective implementation strategies. The aim of this study was to determine perceived facilitators and barriers to guideline implementation and clinical compliance to guidelines for depression in psychiatric care. Methods This qualitative study was conducted at two psychiatric clinics in Stockholm, Sweden. The implementation activities at one of the clinics included local implementation teams, seminars, regular feedback and academic detailing. The other clinic served as a control and only received guidelines by post. Data were collected from three focus groups and 28 individual, semi-structured interviews. Content analysis was used to identify themes emerging from the interview data. Results The identified barriers to, and facilitators of, the implementation of guidelines could be classified into three major categories: (1 organizational resources, (2 health care professionals' individual characteristics and (3 perception of guidelines and implementation strategies. The practitioners in the implementation team and at control clinics differed in three main areas: (1 concerns about control over professional practice, (2 beliefs about evidence-based practice and (3 suspicions about financial motives for guideline introduction. Conclusions Identifying the barriers to, and facilitators of, the adoption of recommendations is an important way of achieving efficient implementation strategies. The findings of this study suggest that the adoption of guidelines may be improved if local health professionals actively participate in an ongoing implementation process and identify

The Effectiveness of Social Media Implementation at Local Government Levels

Directory of Open Access Journals (Sweden)

Elvira NICA

2014-12-01

Full Text Available The purpose of this article is to gain a deeper understanding of the management of social me-dia at the local government level, the availability of opportunities for citizen dialogue on govern-ment websites, and the impact that social net-working applications have on e-government. The results of the current study converge with prior research on the growing awareness amongst government practitioners regarding the relevance of social media, the use of social media for feed-back on service quality, and privacy and security commitments in e-government. The literature on the use of information technology to transform government, the potential for online government information to contribute to citizen engagement, and the rapid growth in local government use of social media is relevant to this discussion.

Implementation of workflow engine technology to deliver basic clinical decision support functionality.

Science.gov (United States)

Huser, Vojtech; Rasmussen, Luke V; Oberg, Ryan; Starren, Justin B

2011-04-10

Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. We describe an implementation of a free workflow technology

Implementation of workflow engine technology to deliver basic clinical decision support functionality

Science.gov (United States)

2011-01-01

Background Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. Results We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. Conclusions We describe an implementation of

Development and Implementation of a Pharmacist-Managed Clinical Pharmacogenetics Service

Science.gov (United States)

Crews, Kristine R.; Cross, Shane J.; McCormick, John N.; Baker, Donald K.; Molinelli, Alejandro R.; Mullins, Richard; Relling, Mary V.; Hoffman, James M.

2011-01-01

Purpose The development and implementation of a pharmacist-managed Clinical Pharmacogenetics service is described. Summary Therapeutic drug monitoring (TDM) is a well-accepted role of the pharmacist. Pharmacogenetics, the study of genetic factors that influence the variability in drug response among patients, is a rapidly evolving discipline that integrates knowledge of pharmacokinetics and pharmacodynamics with modern advances in genetic testing. There is growing evidence for the clinical utility of pharmacogenetics, and pharmacists can play an essential role in the thoughtful application of pharmacogenetics to patient care. A pharmacist-managed Clinical Pharmacogenetics service was designed and implemented. The goal of the service is to provide clinical pharmacogenetic testing for gene products important to the pharmacodynamics of medications used in our patients. The service is modeled after and integrated with an already established Clinical Pharmacokinetics service. All clinical pharmacogenetic test results are first reported to one of the pharmacists, who reviews the result and provides a written consult. The consult includes an interpretation of the result and recommendations for any indicated changes to therapy. In 2009, 136 clinical pharmacogenetic tests were performed, consisting of 66 TPMT tests, 65 CYP2D6 tests, and 5 UGT1A1 tests. Our service has been met with positive clinician feedback. Conclusion Our experience demonstrates the feasibility of the design and function of a pharmacist-managed Clinical Pharmacogenetics service at an academic specialty hospital. The successful implementation of this service highlights the leadership role that pharmacists can take in moving pharmacogenetics from research to patient care, thereby potentially improving patient outcomes. PMID:21200062

Development and implementation of a Bridge Management System for the Provincial Government of the Western Cape, South Africa

CSIR Research Space (South Africa)

Nordengen, Paul A

2005-04-01

Full Text Available This paper describes the development and implementation of a bridge management system for the Provincial Government Western Cape (PGWC). During the first phase of the project, the inventory and inspection modules were customised to meet the needs...

Governing EU employment policy

DEFF Research Database (Denmark)

Sørensen, Eva; Triantafillou, Peter; Damgaard, Bodil

2015-01-01

In the European Union (EU), employment policy is a prerogative of the member states. Therefore the EU's ability to govern in this area depends on its capability to involve national governments and relevant stakeholders in a collaborative effort to formulate and implement shared policy objectives....... of collaboration, the implementation phase mainly consists in the less demanding forms of cooperation and coordination....

Implementation of a clinical pathway may improve alcohol treatment outcome

DEFF Research Database (Denmark)

Nielsen, Anette Søgaard; Nielsen, Bent

2015-01-01

This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...

Towards meaningful medication-related clinical decision support: recommendations for an initial implementation.

Science.gov (United States)

Phansalkar, S; Wright, A; Kuperman, G J; Vaida, A J; Bobb, A M; Jenders, R A; Payne, T H; Halamka, J; Bloomrosen, M; Bates, D W

2011-01-01

Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings.

Transforming Government Service

DEFF Research Database (Denmark)

Pedersen, Keld

2017-01-01

The Danish government has defined an ambitious e-government strategy aiming to increase both citizen centricity and the efficiency of government service production and delivery. This research uses dynamic capability theory to compare a highly successful and a less successful e-government program...... both aiming at realizing this strategy by reengineering back office processes and implement one-stop shopping. The research contributes to the e-government literature by identifying key differences between the two cases in terms of dynamic capabilities, by identifying the importance...

Implementing geological disposal. A long-term governance challenge

Energy Technology Data Exchange (ETDEWEB)

Bergmans, Anne [Antwerp Univ. (Belgium). Faculty of Political and Social Sciences and Faculty of Law

2015-07-01

Calling geological disposal (GD) a technical and societal challenge and arguing that democratic decision-making on GD requires public and stakeholder engagement (PSE), are statements that will not meet much opposition. A process of 'governance' consists of engaging stakeholder groups in decision making processes and contrasts with more traditional, often technocratic forms of government. As will be argued in other papers in this conference (e.g. Grunwald; Kallenbach-Herbert et al.; Roehlig et al.) it is of fairly recent date, that concerned actors increasingly recognize that PSE should relate to both the societal and technical questions concerning GD. While most people would agree in theory, putting 'technical democracy' (Callon et al. 2001) in practice, often proofs to be less obvious. Opening up the technical 'black box' remains a crucial challenge in discussing the implications of GD for society and for the environment. As findings from the InSOTEC project show, this can be explained because different types of problematization occur, often considered as sequential, rather than intertwined (Barthe et al. 2014). Social problematization of GD, i.e. considering the remaining obstacles for implementation to be in essence social in nature, is often associated with the siting stage, when the technological project meets its social environment (ibidem). Formal participatory processes are often aimed mainly at dealing with socio-economic impacts and adapting life on the surface to the underground technology project, rather than the other way around (Bergmans et al. forthcoming). Still such interactions can, and have indeed proven to, lead to technical problematization, i.e. putting into question the technical project or certain aspects of it (cf. Barthe et al. 2014), by concerned stakeholders. As can be observed in the case of Sweden - for GD of spent fuel, and Belgium - for surface disposal of low- and intermediate level waste, this does not

Implementing geological disposal. A long-term governance challenge

International Nuclear Information System (INIS)

Bergmans, Anne

2015-01-01

Calling geological disposal (GD) a technical and societal challenge and arguing that democratic decision-making on GD requires public and stakeholder engagement (PSE), are statements that will not meet much opposition. A process of 'governance' consists of engaging stakeholder groups in decision making processes and contrasts with more traditional, often technocratic forms of government. As will be argued in other papers in this conference (e.g. Grunwald; Kallenbach-Herbert et al.; Roehlig et al.) it is of fairly recent date, that concerned actors increasingly recognize that PSE should relate to both the societal and technical questions concerning GD. While most people would agree in theory, putting 'technical democracy' (Callon et al. 2001) in practice, often proofs to be less obvious. Opening up the technical 'black box' remains a crucial challenge in discussing the implications of GD for society and for the environment. As findings from the InSOTEC project show, this can be explained because different types of problematization occur, often considered as sequential, rather than intertwined (Barthe et al. 2014). Social problematization of GD, i.e. considering the remaining obstacles for implementation to be in essence social in nature, is often associated with the siting stage, when the technological project meets its social environment (ibidem). Formal participatory processes are often aimed mainly at dealing with socio-economic impacts and adapting life on the surface to the underground technology project, rather than the other way around (Bergmans et al. forthcoming). Still such interactions can, and have indeed proven to, lead to technical problematization, i.e. putting into question the technical project or certain aspects of it (cf. Barthe et al. 2014), by concerned stakeholders. As can be observed in the case of Sweden - for GD of spent fuel, and Belgium - for surface disposal of low- and intermediate level waste, this does not

How Russia and other BRICS Countries as well as Indonesia Implement the G20/OECD Principles of Corporate Governance

Directory of Open Access Journals (Sweden)

Tatiana Lanshina

2017-12-01

Full Text Available The article analyses the implementation of the G20/OECD Principles of Corporate Governance by Russia in comparison to other BRICS countries and Indonesia. Originally, this document was adopted by OECD in 1999. The last (third version of the document was developed in 2014–2015, with an active involvement of G20 countries, and was adopted at the G20 Summit in Antalya (Turkey in November 2015. Dramatic changes are absent in the new document, however, it contains several new recommendations, which became necessary after the global economic crisis of 2008–2009. The article is focused on the actions of six countries that were chosen for the analysis, as well as on the real changes in these countries. The author takes into account OECD recommendations on the assessment of implementation of G20/OECD principles. According to these recommendations, researchers should not pay too much attention to the quantitative analysis, since many important issues are unobservable for them. Considering this, the author accentuates qualitative research methods and comparative analysis. The results of the study show that Brazil, Indonesia and Russia were most active in implementation, while South Africa and China lacked any actions, and India achieved only partial implementation. Despite the large number of facts documenting formal implementation of corporate governance principles in Russia during the last years, Russia definitely lacks real improvements. This is true for information disclosure (including data on the management remuneration, gender diversity on corporate boards, the share of independent directors, etc. Moreover, Russian companies are characterized by high concentration of capital, and the role of boards is often reduced to formalities. According to the results of the research, similar limitations are found in the systems of corporate governance of other countries covered by this study. Taking into account the limited accessibility of information on

Synthesized Mammography: Clinical Evidence, Appearance, and Implementation.

Science.gov (United States)

Durand, Melissa A

2018-04-04

Digital breast tomosynthesis (DBT) has improved conventional mammography by increasing cancer detection while reducing recall rates. However, these benefits come at the cost of increased radiation dose. Synthesized mammography (s2D) has been developed to provide the advantages of DBT with nearly half the radiation dose. Since its F.D.A. approval, multiple studies have evaluated the clinical performance of s2D. In clinical practice, s2D images are not identical to conventional 2D images and are designed for interpretation with DBT as a complement. This article reviews the present literature to assess whether s2D is a practical alternative to conventional 2D, addresses the differences in mammographic appearance of findings, and provides suggestions for implementation into clinical practice.

Preemptive Clinical Pharmacogenetics Implementation: Current programs in five United States medical centers

Science.gov (United States)

Dunnenberger, Henry M.; Crews, Kristine R.; Hoffman, James M.; Caudle, Kelly E.; Broeckel, Ulrich; Howard, Scott C.; Hunkler, Robert J.; Klein, Teri E.; Evans, William E.; Relling, Mary V.

2015-01-01

Although the field of pharmacogenetics has existed for decades, the implementation of, pharmacogenetic testing in clinical care has been slow. There are numerous publications, describing the barriers to clinical implementation of pharmacogenetics. Recently, several freely, available resources have been developed to help address these barriers. In this review we, discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of, patients. Array-based preemptive testing includes a large number of relevant pharmacogenes, that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to, be available prior to any prescribing decision so that genomic variation may be considered as, an inherent patient characteristic in the planning of therapy. This review describes the common, elements among programs that have implemented preemptive genotyping and highlights key, processes for implementation, including clinical decision support. PMID:25292429

Impact of Atraumatic Restorative Treatment (ART) on the treatment profile in pilot government dental clinics in Tanzania.

Science.gov (United States)

Kikwilu, Emil Namakuka; Frencken, Jo; Mulder, Jan

2009-06-08

The predominant mode of treatment in government dental clinics in Tanzania has been tooth extraction because the economy could not support the conventional restorative care which depends on expensive equipment, electricity and piped water systems. Atraumatic Restorative Treatment (ART) was perceived as a suitable alternative. A 3.5-year study was designed to document the changes in the treatment profiles ascribed to the systematic introduction of ART in pilot government dental clinics. Dental practitioners who were working in 13 government dental clinics underwent a 7-day ART training. Treatment record data on teeth extracted and teeth restored by the conventional and ART approaches were collected from these clinics for the three study periods. The mean percentage of ART restorations to total treatment, ART restorations to total restorations, and total restorations to total treatments rendered were computed. Differences between variables were determined by ANOVA, t-test and Chi-square. The mean percentage of ART restorations to total treatment rendered was 0.4 (SE = 0.5) and 11.9 (SE = 1.1) during the baseline and second follow-up period respectively (ANOVA mixed model; P ART restorations to total restorations rendered at baseline and 2nd follow-up period was 8.4% and 88.9% respectively (ANOVA mixed model; P ART restorations, 96.6% willing to receive ART restoration again in future, and 94.9% willing to recommend ART treatment to their close relatives. ART introduction in pilot government dental clinics raised the number of teeth saved by restorative care. Countrywide introduction of the ART approach in Tanzania is recommended.

Interoperability, Enterprise Architectures, and IT Governance in Government

OpenAIRE

Scholl , Hans ,; Kubicek , Herbert; Cimander , Ralf

2011-01-01

Part 4: Architecture, Security and Interoperability; International audience; Government represents a unique, and also uniquely complex, environment for interoperation of information systems as well as for integration of workflows and processes across governmental levels and branches. While private-sector organizations by and large have the capacity to implement “enterprise architectures” in a relatively straightforward fashion, for notable reasons governments do not enjoy such luxury. For thi...

Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol

Directory of Open Access Journals (Sweden)

Scott Shannon D

2011-12-01

Full Text Available Abstract Background Canada is among the most prosperous nations in the world, yet the health and wellness outcomes of Canadian children are surprisingly poor. There is some evidence to suggest that these poor health outcomes are partly due to clinical practice variation, which can stem from failure to apply the best available research evidence in clinical practice, otherwise known as knowledge translation (KT. Surprisingly, clinical practice variation, even for common acute paediatric conditions, is pervasive. Clinical practice variation results in unnecessary medical treatments, increased suffering, and increased healthcare costs. This study focuses on improving health outcomes for common paediatric acute health concerns by evaluating strategies that improve KT and reduce clinical practice variation. Design/Methods Using a multiple case study design, qualitative and quantitative data will be collected from four emergency departments in western Canada. Data sources will include: pre- and post-implementation focus group data from multidisciplinary healthcare professionals; individual interviews with the local champions, KT intervention providers, and unit/site leaders/managers; Alberta Context Tool (ACT survey data; and aggregated patient outcome data. Qualitative and quantitative data will be systematically triangulated, and matrices will be built to do cross-case comparison. Explanations will be built about the success or lack of success of the clinical practice guidelines (CPG and clinical pathways (CPs uptake based upon the cross-case comparisons. Significance This study will generate new knowledge about the potential causal mechanisms and factors which shape implementation. Future studies will track the impact of the CPG/CPs implementation on children's health outcome, and healthcare costs.

Synthesized Mammography: Clinical Evidence, Appearance, and Implementation

Directory of Open Access Journals (Sweden)

Melissa A. Durand

2018-04-01

Full Text Available Digital breast tomosynthesis (DBT has improved conventional mammography by increasing cancer detection while reducing recall rates. However, these benefits come at the cost of increased radiation dose. Synthesized mammography (s2D has been developed to provide the advantages of DBT with nearly half the radiation dose. Since its F.D.A. approval, multiple studies have evaluated the clinical performance of s2D. In clinical practice, s2D images are not identical to conventional 2D images and are designed for interpretation with DBT as a complement. This article reviews the present literature to assess whether s2D is a practical alternative to conventional 2D, addresses the differences in mammographic appearance of findings, and provides suggestions for implementation into clinical practice.

Governance and human resources for health

Directory of Open Access Journals (Sweden)

Dieleman Marjolein

2011-11-01

Full Text Available Abstract Despite an increase in efforts to address shortage and performance of Human Resources for Health (HRH, HRH problems continue to hamper quality service delivery. We believe that the influence of governance is undervalued in addressing the HRH crisis, both globally and at country level. This thematic series has aimed to expand the evidence base on the role of governance in addressing the HRH crisis. The six articles comprising the series present a range of experiences. The articles report on governance in relation to developing a joint vision, building adherence and strengthening accountability, and on governance with respect to planning, implementation, and monitoring. Other governance issues warrant attention as well, such as corruption and transparency in decision-making in HRH policies and strategies. Acknowledging and dealing with governance should be part and parcel of HRH planning and implementation. To date, few experiences have been shared on improving governance for HRH policy making and implementation, and many questions remain unanswered. There is an urgent need to document experiences and for mutual learning.

Governance and human resources for health.

Science.gov (United States)

Dieleman, Marjolein; Hilhorst, Thea

2011-11-24

Despite an increase in efforts to address shortage and performance of Human Resources for Health (HRH), HRH problems continue to hamper quality service delivery. We believe that the influence of governance is undervalued in addressing the HRH crisis, both globally and at country level. This thematic series has aimed to expand the evidence base on the role of governance in addressing the HRH crisis. The six articles comprising the series present a range of experiences. The articles report on governance in relation to developing a joint vision, building adherence and strengthening accountability, and on governance with respect to planning, implementation, and monitoring. Other governance issues warrant attention as well, such as corruption and transparency in decision-making in HRH policies and strategies. Acknowledging and dealing with governance should be part and parcel of HRH planning and implementation. To date, few experiences have been shared on improving governance for HRH policy making and implementation, and many questions remain unanswered. There is an urgent need to document experiences and for mutual learning.

Privacy, Security, and Patient Engagement: The Changing Health Data Governance Landscape.

Science.gov (United States)

Holmes, John H

2016-01-01

The rapid emergence of new technologies support collection and use of a wide variety of data from clinical, genomic, social and behavioral, environmental, and financial sources, and have a great impact on the governance of personal health information. The papers in this special issue on governance touch on the topic from a variety of focuses, including leadership perspectives, local and federal case studies, and the future importance of patient engagement. This special issue focuses on three major themes-that data governance is growing in importance and presenting new challenges that must be addressed, that health care organizations must prioritize governance design, implementation, and functions as a priority, and that governance seems to be naturally converging on an archetype as described by this set of papers. In order to deal with issues such as data de- and re-identification, data governance must be studied as its own field.

Building effective workforce management practices through shared governance and technology systems integration.

Science.gov (United States)

Krive, Jacob

2013-01-01

In integrated delivery networks (IDNs) with complex management structures, shared governance in nursing is a proven model for health care delivery. After Advocate Health Care, the largest IDN in Illinois, implemented shared governance in its nursing, clinical, and non-clinical departments and restructured the organization's technology use, it benefited greatly from a new, shared decision-making process. After listening to business consultants, clinical professionals, and information technology experts, hospitals should take the blended, or comprehensive, approach to new projects. They can succeed by promoting communication supported by an integrated computer platform that helps nursing and business executives reach a consensus. Traditional modes of operation, in which individual administrative, clinical, and technology departments separately introduce innovation, do not deliver an advantage. However, models that incorporate open communication, integration, and knowledge sharing will help large IDNs and other complex health care organizations make the best possible use of their resources and investments.

Automatic generation of computable implementation guides from clinical information models.

Science.gov (United States)

Boscá, Diego; Maldonado, José Alberto; Moner, David; Robles, Montserrat

2015-06-01

Clinical information models are increasingly used to describe the contents of Electronic Health Records. Implementation guides are a common specification mechanism used to define such models. They contain, among other reference materials, all the constraints and rules that clinical information must obey. However, these implementation guides typically are oriented to human-readability, and thus cannot be processed by computers. As a consequence, they must be reinterpreted and transformed manually into an executable language such as Schematron or Object Constraint Language (OCL). This task can be difficult and error prone due to the big gap between both representations. The challenge is to develop a methodology for the specification of implementation guides in such a way that humans can read and understand easily and at the same time can be processed by computers. In this paper, we propose and describe a novel methodology that uses archetypes as basis for generation of implementation guides. We use archetypes to generate formal rules expressed in Natural Rule Language (NRL) and other reference materials usually included in implementation guides such as sample XML instances. We also generate Schematron rules from NRL rules to be used for the validation of data instances. We have implemented these methods in LinkEHR, an archetype editing platform, and exemplify our approach by generating NRL rules and implementation guides from EN ISO 13606, openEHR, and HL7 CDA archetypes. Copyright © 2015 Elsevier Inc. All rights reserved.

[Hospital governance: between crisis management and implementation of public health policy].

Science.gov (United States)

Bréchat, Pierre-Henri; Antoine, Leenhardt; Mathieu-Grenouilleau, Marie-Christine; Rymer, Roland; Matisse, François; Baraille, Denis; Beaufils, Philippe

2010-01-01

The implementation of the recent act to amend the law on hospitals, patient health and territories (HPST Law) completes the reform of the organization and governance of health facilities, which was announced in 2002 by the "Hospital 2007" plan. What kind of assessments and perspectives can be considered and envisaged for these Hospital Activity Poles? We compared our experience with a review of the professional and scientific literature in order to stimulate answers to these questions for advocacy purposes prior to the Act's implementation. The hospital's cluster of activities should reinforce--not call into question the core activities and the financial stability of the facility, while respecting the contract on agreed objectives and the necessary means and resources to meet the health needs of the catchment population as well as national priorities. Although significant, but limited, successes exist, five obstacles to hospital reorganization can be identified. These include, for example: lack of delegation of management and centralization of decisions, the heterogeneity of numerous Hospital Activity Poles or problems related to timing. These obstacles may cause strain, or put the Hospital Activity Poles and the health facilities in a difficult situation with respect to their dynamics. This may show that the State and social health insurance should steer and direct public health policy and that the delegation of management roles and responsibilities to the Hospital Activity Poles should be addressed.

Broad support for regulating the clinical implementation of future reproductive techniques.

Science.gov (United States)

Hendriks, S; Vliegenthart, R; Repping, S; Dancet, E A F

2018-01-01

Do gynaecologists, infertile patients and the general public, consider that regulation of the clinical implementation of stem cell-based fertility treatments is required? There is broad support from gynaecologists, patients and the general public for regulating the clinical implementation of future stem cell-based fertility treatments. There is debate on the need to regulate the clinical implementation of novel techniques. Regulation may hinder their swift adoption and delay benefits for patients, but may prevent the implementation of ineffective or harmful techniques. Stem cell-based fertility treatments, which involve creating oocytes or spermatozoa by manipulating stem cells, are likely to be implemented in clinical practice in the near future and will probably impact future generations as well as the current one. A cross-sectional survey was conducted among gynaecologists working in fertility clinics (n = 179), patients with severe infertility (n = 348) and a representative sample of the general public (n = 1250). The questionnaire was disseminated in the Netherlands in the winter of 2015-2016. The newly developed questionnaire was reviewed by experts and tested among the general public. The questionnaire assessed whether participants wanted each of nine potential negative consequences of the clinical implementation of stem cell-based fertility treatments to be regulated. In addition, the importance of all negative and positive potential consequences, the appropriate regulatory body and its need to consult with advisors from various backgrounds was questioned. In total, 958 respondents completed the questionnaire (response rate: 54%). A large majority of each participant group (>85%) wanted regulation, for at least one potential negative consequence of the clinical implementation of stem cell-based fertility treatments. The majority of all participant groups wanted regulation for serious health risks for intended parents, serious health risks for children and

Governance of Governance in Higher Education: Practices and Lessons Drawn from the Portuguese Case

Science.gov (United States)

Magalhaes, Antonio; Veiga, Amelia; Amaral, Alberto; Sousa, Sofia; Ribeiro, Filipa

2013-01-01

The implementation of the governance reform of Portuguese higher education has been developed under the influence of "new public management" resulting in the loss of collegial governance. Additionally, the need for meta-governance of the higher education system and institutions to monitor institutional performance against policy…

A review of governance of maternity services at South Tipperary general hospital

LENUS (Irish Health Repository)

Flory, David

2015-09-01

This review of the governance of maternity services at South Tipperary General Hospital has focussed on the systems and processes for assurance of service quality, risk management and patient safety primarily inside the hospital but also in the Hospital Group structure within which it operates. The effectiveness of the governance arrangements is largely determined by the quality of the leadership and management – both clinical and general – which designs, implements, and oversees those systems and processes and is ultimately responsible and accountable.\\r\

The IT - Information Technology Governance and points to be considered in its practical implementation in Corporations

Directory of Open Access Journals (Sweden)

Altino José Mentzingen de Moraes

2015-04-01

Full Text Available This paper presents a Case Study (Issues and Answers, applied in a major industry located in Brazil´s Central Region, related to rise up checkpoints linked to IT Governance. As one of its result, is presented a graph of how the IT Governance was approached in researched Industry, in which, it is possible to see which areas this method of working was active and in which this was not applied. Also a Timeline describes the steps that were undertaken for the implementation of this Case Study, which, can be reused for the resubmission – in a future moment – in the same industry, to evaluate if there was a change of scenery, or in other Organization with the same characteristics of this studied one.

Pilot project for implementing corporate governance of IT

OpenAIRE

Fernández Martínez, Antonio; Gumbau Mezquita, José Pascual; Llorens Largo, Faraón

2012-01-01

This article presents the results of the IT Governance Enhancement Project (ITGEP) carried out in three Spanish universities (the University of Murcia, Jaume I University and the Polytechnic University of Cartagena) on the initiative of the IT Commission of the Spanish Association of University Rectors (CRUE). The aim of the project was to apply the reference framework of Governance of IT for Universities (GTI4U) in order to determine the best practices currently carried out in the three univ...

Using IT Governance

Science.gov (United States)

Brobst, Jan; Council, Chip

2005-01-01

The discussion in this article is intended to provide an examination of why top management, IT management, and internal auditors should be interested in IT governance. Some aspects of IT management will be described including implementation, auditing, availability, security, and alignment. One governance framework, COBIT, will be utilized as a…

m-government legal and regulatory framework

African Journals Online (AJOL)

Wondwossen Mulugeta

Legal Framework for Implementation of m-Government in Ethiopia: Best. Practices and Lessons ... opportunity to government and businesses to provide enhanced mobile .... provide effective governance, offer increased service delivery and ...

Second inter-association evaluation of the PNLCC implementation. PNLCC 2000-2003: The Government economizes its energy

International Nuclear Information System (INIS)

2002-11-01

A group of associations (RAC-F, FNE, WWF, ''les amis de la terre'', CLER, Greenpeace, Helio international, Hespul, ''energies et territoires'', Detente, ''sortir du nucleaire'') realized its own 2002 evaluation of the PNLCC implementation. For each chapters of the Plan (industry, transports, buildings, agriculture and forests, wastes, energy production and conservation and cooling gases, the document takes stock on the actions decided and realized and shows the deficiencies of the government management. (A.L.B.)

Implementation of an Electronic Health Records System in a Small Clinic: The Viewpoint of Clinic Staff

Science.gov (United States)

Carayon, Pascale; Smith, Paul; Hundt, Ann Schoofs; Kuruchittham, Vipat; Li, Qian

2009-01-01

In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with…

Knowledge, perceptions and clinical application of the shortened dental arch concept among Malaysian government dentists.

Science.gov (United States)

Kasim, Siti Kamilah Mohd; Razak, Ishak Abdul; Yusof, Zamros Yuzadi Mohd

2018-02-01

To assess the knowledge and perceptions of Malaysian government dentists regarding the shortened dental arch (SDA) concept and its application in clinical practice. The SDA concept refers to a specific type of dentition with intact anterior teeth and a reduction in posterior occlusal pairs. Dentists' knowledge and perceptions of the SDA concept can influence its application in clinical practice. A self-administered questionnaire on the SDA concept was distributed to 326 government dentists in the states of Selangor and Kuala Lumpur, Malaysia. The data were analysed using SPSS version 22 software. The response rate was 84.0%. The majority of respondents had good knowledge on five of six knowledge items and good attitudes towards 10 of 17 perception items. However, only one-fifth (20.4%) reported having applied the SDA concept in the clinic. A larger number of participants who graduated locally than who graduated abroad perceived that patients 5 years of work experience perceived that the SDA concept enables simpler treatment planning (P concept, it is not widely applied in the clinic. Concerted efforts in SDA training of dentists are needed to help to shorten denture waiting lists and reduce costs. © 2017 FDI World Dental Federation.

E-Government: Initiatives, Developments, and Issues.

Science.gov (United States)

Aldrich, Duncan; Bertot, John Carlo; McClure, Charles R.

2002-01-01

Provides a background of government efforts to incorporate telecommunication and computer technologies to improve government performance and enhance citizen access to government information and services. Describes this symposium issue which discusses key issues that affect the success and implementation of electronic government initiatives. (LRW)

Factors Influencing the Selection of the Systems Integration Organizational Model Type for Planning and Implementing Government High-Technology Programs

Science.gov (United States)

Thomas, Leann; Utley, Dawn

2006-01-01

While there has been extensive research in defining project organizational structures for traditional projects, little research exists to support high technology government project s organizational structure definition. High-Technology Government projects differ from traditional projects in that they are non-profit, span across Government-Industry organizations, typically require significant integration effort, and are strongly susceptible to a volatile external environment. Systems Integration implementation has been identified as a major contributor to both project success and failure. The literature research bridges program management organizational planning, systems integration, organizational theory, and independent project reports, in order to assess Systems Integration (SI) organizational structure selection for improving the high-technology government project s probability of success. This paper will describe the methodology used to 1) Identify and assess SI organizational structures and their success rate, and 2) Identify key factors to be used in the selection of these SI organizational structures during the acquisition strategy process.

Process-based quality management for clinical implementation of adaptive radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Noel, Camille E.; Santanam, Lakshmi; Parikh, Parag J.; Mutic, Sasa, E-mail: smutic@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110 (United States)

2014-08-15

Purpose: Intensity-modulated adaptive radiotherapy (ART) has been the focus of considerable research and developmental work due to its potential therapeutic benefits. However, in light of its unique quality assurance (QA) challenges, no one has described a robust framework for its clinical implementation. In fact, recent position papers by ASTRO and AAPM have firmly endorsed pretreatment patient-specific IMRT QA, which limits the feasibility of online ART. The authors aim to address these obstacles by applying failure mode and effects analysis (FMEA) to identify high-priority errors and appropriate risk-mitigation strategies for clinical implementation of intensity-modulated ART. Methods: An experienced team of two clinical medical physicists, one clinical engineer, and one radiation oncologist was assembled to perform a standard FMEA for intensity-modulated ART. A set of 216 potential radiotherapy failures composed by the forthcoming AAPM task group 100 (TG-100) was used as the basis. Of the 216 failures, 127 were identified as most relevant to an ART scheme. Using the associated TG-100 FMEA values as a baseline, the team considered how the likeliness of occurrence (O), outcome severity (S), and likeliness of failure being undetected (D) would change for ART. New risk priority numbers (RPN) were calculated. Failures characterized by RPN ≥ 200 were identified as potentially critical. Results: FMEA revealed that ART RPN increased for 38% (n = 48/127) of potential failures, with 75% (n = 36/48) attributed to failures in the segmentation and treatment planning processes. Forty-three of 127 failures were identified as potentially critical. Risk-mitigation strategies include implementing a suite of quality control and decision support software, specialty QA software/hardware tools, and an increase in specially trained personnel. Conclusions: Results of the FMEA-based risk assessment demonstrate that intensity-modulated ART introduces different (but not necessarily

Process-based quality management for clinical implementation of adaptive radiotherapy

International Nuclear Information System (INIS)

Noel, Camille E.; Santanam, Lakshmi; Parikh, Parag J.; Mutic, Sasa

2014-01-01

Purpose: Intensity-modulated adaptive radiotherapy (ART) has been the focus of considerable research and developmental work due to its potential therapeutic benefits. However, in light of its unique quality assurance (QA) challenges, no one has described a robust framework for its clinical implementation. In fact, recent position papers by ASTRO and AAPM have firmly endorsed pretreatment patient-specific IMRT QA, which limits the feasibility of online ART. The authors aim to address these obstacles by applying failure mode and effects analysis (FMEA) to identify high-priority errors and appropriate risk-mitigation strategies for clinical implementation of intensity-modulated ART. Methods: An experienced team of two clinical medical physicists, one clinical engineer, and one radiation oncologist was assembled to perform a standard FMEA for intensity-modulated ART. A set of 216 potential radiotherapy failures composed by the forthcoming AAPM task group 100 (TG-100) was used as the basis. Of the 216 failures, 127 were identified as most relevant to an ART scheme. Using the associated TG-100 FMEA values as a baseline, the team considered how the likeliness of occurrence (O), outcome severity (S), and likeliness of failure being undetected (D) would change for ART. New risk priority numbers (RPN) were calculated. Failures characterized by RPN ≥ 200 were identified as potentially critical. Results: FMEA revealed that ART RPN increased for 38% (n = 48/127) of potential failures, with 75% (n = 36/48) attributed to failures in the segmentation and treatment planning processes. Forty-three of 127 failures were identified as potentially critical. Risk-mitigation strategies include implementing a suite of quality control and decision support software, specialty QA software/hardware tools, and an increase in specially trained personnel. Conclusions: Results of the FMEA-based risk assessment demonstrate that intensity-modulated ART introduces different (but not necessarily

PENGARUH PENERAPAN E-GOVERNMENT TERHADAP PELAKSANAAN TATA KELOLA PEMERINTAH DI PEMERINTAH KABUPATEN CIANJUR

Directory of Open Access Journals (Sweden)

Toni Heryana

2013-04-01

Full Text Available This research has purposes to know how the implementation of e-government, implementation of the Government Governance and e-government influence on the implementation of the Government Governance in the Government of Cianjur. The population in this research is 58 (Fifty eight OPD in the Government environment Cianjur. Based on purposive sampling is then used 26 (twenty six OPD in the Government environment of Cianjur. Data collection was done through the dissemination of a questionnaire using the semantic defferential scale. To test the effect of e-government (X with respect to the implementation of the governance of the Government (Y, then in this study used a simple linear regression. The final results of the research done indicates that the implementation of e-government on most of the Department, Agencies and Offices in Cianjur influence of 78,5% with respect to the implementation of the governance of the Department, Agencies and Offices in Cianjur. While the rest 21,5% is the influence of another factors outside of e-government.

Student Government and Student Participation in Junior College Governance--Models for the 1970's.

Science.gov (United States)

Deegan, William L.

It is the author's contention that student government revitalization will come only when student government begins to play a substantive role in policy making and implementation. The purpose of this paper is to consider, criticize, and propose a number of models for student participation in junior college governance. The first, a traditional…

Implementing ABPM into Clinical Practice.

Science.gov (United States)

Hinderliter, Alan L; Voora, Raven A; Viera, Anthony J

2018-02-05

To review the data supporting the use of ambulatory blood pressure monitoring (ABPM), and to provide practical guidance for practitioners who are establishing an ambulatory monitoring service. ABPM results more accurately reflect the risk of cardiovascular events than do office measurements of blood pressure. Moreover, many patients with high blood pressure in the office have normal blood pressure on ABPM-a pattern known as white coat hypertension-and have a prognosis similar to individuals who are normotensive in both settings. For these reasons, ABPM is recommended by the US Preventive Services Task Force to confirm the diagnosis of hypertension in patients with high office blood pressure before medical therapy is initiated. Similarly, the 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline advocates the use of out-of-office blood pressure measurements to confirm hypertension and evaluate the efficacy of blood pressure-lowering medications. In addition to white coat hypertension, blood pressure phenotypes that are associated with increased cardiovascular risk and that can be recognized by ABPM include masked hypertension-characterized by normal office blood pressure but high values on ABPM-and high nocturnal blood pressure. In this review, best practices for starting a clinical ABPM service, performing an ABPM monitoring session, and interpreting and reporting ABPM data are described. ABPM is a valuable adjunct to careful office blood pressure measurement in diagnosing hypertension and in guiding antihypertensive therapy. Following recommended best practices can facilitate implementation of ABPM into clinical practice.

On the practice of the clinical implementation of enhanced dynamic wedges

International Nuclear Information System (INIS)

Koken, Phil W.; Heukelom, Stan; Cuijpers, Johan P.

2003-01-01

Practical aspects of the clinical implementation of enhanced dynamic wedges (EDW) replacing manual wedges are presented and discussed extensively. A comparison between measured and calculated data is also presented. Relative dose distributions and wedge factors were calculated with a commercially available treatment planning system and measured in a water-phantom and with an ionization chamber. Wedge factor calculations and measurements were also compared with an independent method of wedge factor calculations available from the literature. Aspects of the clinical implementation, such as safety and quality assurance, were evaluated. Measurements and calculations agreed very well and were slightly better than results of previous studies. Profiles and percentage depth doses (PDDs) agreed within 1% to 1.5% and within 0.5%, respectively. Measured and calculated wedge factors ratios agreed within 0.5% to 1%. Calculated and measured EDW dose distributions showed excellent agreement, both relative and absolute. However, for safe and practical use, specific aspects need to be taken into consideration. Once the treatment planning system is commissioned properly, the clinical implementation of EDW is rather straightforward

Audit mode change, corporate governance

OpenAIRE

Limei Cao; Wanfu Li; Limin Zhang

2015-01-01

This study investigates changes in audit strategy in China following the introduction of risk-based auditing standards rather than an internal control-based audit mode. Specifically, we examine whether auditors are implementing the risk-based audit mode to evaluate corporate governance before distributing audit resources. The results show that under the internal control-based audit mode, the relationship between audit effort and corporate governance was weak. However, implementation of the ri...

Project governance: selected South African government experiments

Directory of Open Access Journals (Sweden)

G. van der Walt

2008-07-01

Full Text Available Some form of accountability and power structure binds all organisations. Such structures are typically referred to as the “governance” structure of the organisation. In organisations that have relatively mature project applications and methodologies in place, governance mechanisms are established on more permanent bases. With its focus on performance, results and outcomes, project governance establishes decision-making structures, as well as accountability and responsibility mechanisms in public institutions to oversee projects. As government institutions increasingly place emphasis on project applications for policy implementation and service delivery initiatives, mechanisms or structures should be established to facilitate clear interfaces between the permanent organisation and the temporary project organisation. Such mechanisms or structures should enhance the governance of projects, that is, the strategic alignment of projects, the decentralisation of decision- making powers, rapid resource allocation, and the participation of external stakeholders. The purpose of this article is to explore the concept “project governance”, and to highlight examples of project governance as applied in selected government departments in provincial and national spheres. This would enable the establishment of best practice examples and assist to develop benchmarks for effective project applications for service delivery improvement.

Implementation of internet-delivered cognitive behavior therapy within community mental health clinics: a process evaluation using the consolidated framework for implementation research.

Science.gov (United States)

Hadjistavropoulos, H D; Nugent, M M; Dirkse, D; Pugh, N

2017-09-12

Depression and anxiety are prevalent and under treated conditions that create enormous burden for the patient and the health system. Internet-delivered cognitive behavior therapy (ICBT) improves patient access to treatment by providing therapeutic information via the Internet, presented in sequential lessons, accompanied by brief weekly therapist support. While there is growing research supporting ICBT, use of ICBT within community mental health clinics is limited. In a recent trial, an external unit specializing in ICBT facilitated use of ICBT in community mental health clinics in one Canadian province (ISRCTN42729166; registered November 5, 2013). Patient outcomes were very promising and uptake was encouraging. This paper reports on a parallel process evaluation designed to understand facilitators and barriers impacting the uptake and implementation of ICBT. Therapists (n = 22) and managers (n = 11) from seven community mental health clinics dispersed across one Canadian province who were involved in implementing ICBT over ~2 years completed an online survey (including open and closed-ended questions) about ICBT experiences. The questions were based on the Consolidated Framework for Implementation Research (CFIR), which outlines diverse constructs that have the potential to impact program implementation. Analyses suggested ICBT implementation was perceived to be most prominently facilitated by intervention characteristics (namely the relative advantages of ICBT compared to face-to-face therapy, the quality of the ICBT program that was delivered, and evidence supporting ICBT) and implementation processes (namely the use of an external facilitation unit that aided with engaging patients, therapists, and managers and ICBT implementation). The inner setting was identified as the most significant barrier to implementation as a result of limited resources for ICBT combined with greater priority given to face-to-face care. The results contribute to understanding

Can the theoretical domains framework account for the implementation of clinical quality interventions?

Science.gov (United States)

Lipworth, Wendy; Taylor, Natalie; Braithwaite, Jeffrey

2013-12-21

The health care quality improvement movement is a complex enterprise. Implementing clinical quality initiatives requires attitude and behaviour change on the part of clinicians, but this has proven to be difficult. In an attempt to solve this kind of behavioural challenge, the theoretical domains framework (TDF) has been developed. The TDF consists of 14 domains from psychological and organisational theory said to influence behaviour change. No systematic research has been conducted into the ways in which clinical quality initiatives map on to the domains of the framework. We therefore conducted a qualitative mapping experiment to determine to what extent, and in what ways, the TDF is relevant to the implementation of clinical quality interventions. We conducted a thematic synthesis of the qualitative literature exploring clinicians' perceptions of various clinical quality interventions. We analysed and synthesised 50 studies in total, in five domains of clinical quality interventions: clinical quality interventions in general, structural interventions, audit-type interventions, interventions aimed at making practice more evidence-based, and risk management interventions. Data were analysed thematically, followed by synthesis of these themes into categories and concepts, which were then mapped to the domains of the TDF. Our results suggest that the TDF is highly relevant to the implementation of clinical quality interventions. It can be used to map most, if not all, of the attitudinal and behavioural barriers and facilitators of uptake of clinical quality interventions. Each of these 14 domains appeared to be relevant to many different types of clinical quality interventions. One possible additional domain might relate to perceived trustworthiness of those instituting clinical quality interventions. The TDF can be usefully applied to a wide range of clinical quality interventions. Because all 14 of the domains emerged as relevant, and we did not identify any

Organizing and implementing a multidisciplinary fast track oncology clinic.

Science.gov (United States)

Basta, Y L; Tytgat, K M A J; Greuter, H H; Klinkenbijl, J H G; Fockens, P; Strikwerda, J

2017-11-01

Patients with gastrointestinal malignancies often need multiple appointments with different medical specialists, causing waiting times to accrue. In our hospital, care is organized in a sequential manner, causing long waiting times. To reduce this, a fast track outpatient clinic (FTC) was implemented. The FTC was organized within the hospital's existing structure. Patient centered care was achieved by ensuring that the medical specialists visit the patient, implementing nurse coordinators and considering patient wishes and co-morbidities when formulating a treatment plan. A mandate from the board (Top-down), ensured cooperation between different medical departments and a change in resource allocation (i.e. medical staff); a horizontal clinic across a vertical departmental structure. Brainstorm sessions between the departments led by two physicians who were going to work at the FTC (Bottom-up), assured a swift implementation of the FTC. Since implementation in 2009, patient influx has tripled. Waiting time for an appointment and start of treatment was reduced from 2-4 weeks to 6 working days and from 12-14 weeks to 17 working days, respectively. This was achieved by re-allocating recourses, but without increasing existing resources. The combination of a top-down and bottom-up strategy ensured participation from all involved departments, a strong foundation and a shared vision on patient centered care. The FTC facilitates sharing information between different medical specialists through both proximity and a shared electronic patient record. The implementation of the FTC comprises a change in organization, but not a change in structure. © The Author 2017. 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

Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study

Directory of Open Access Journals (Sweden)

Blevins Dean

2010-10-01

Full Text Available Abstract Background Although for more than a decade healthcare systems have attempted to provide evidence-based mental health treatments, the availability and use of psychotherapies remains low. A significant need exists to identify simple but effective implementation strategies to adopt complex practices within complex systems of care. Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practices. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy (CBT in 20 Department of Veteran Affairs (VA clinics. Methods The 20 clinics were paired on facility characteristics, and 23 clinicians from these were trained in CBT. A clinic in each pair was randomly selected to receive external facilitation. Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not, and to better understand the relationship between individual providers' characteristics and attitudes and their CBT use. Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT. Qualitative methods were used to explore contextual and other factors thought to influence implementation. Results Examination of change scores showed that facilitated therapists averaged an increase of 19% [95% CI: (2, 36] in self-reported CBT use from baseline, while control therapists averaged a 4% [95% CI: (-14, 21] increase. Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase (35% compared to a control therapist who was not providing CBT at baseline (10% or to therapists in either condition who were providing CBT at baseline (average 3%. Increased CBT use was unrelated to prior CBT training. Barriers to CBT implementation were therapists' lack of

How education for sustainable development is implemented in Germany: Looking through the lens of educational governance theory

Science.gov (United States)

Bormann, Inka; Nikel, Jutta

2017-12-01

The United Nations (UN) Decade of Education for Sustainable Development (ESD) aimed to integrate the principles, values and practices of sustainable development into all aspects of education and learning around the world. The authors of this article address the implementation process of ESD in Germany during the UN Decade (2005-2014). By undertaking a meta-analysis of the findings of four related sub-studies they carried out during a three-year project funded by the German Federal Ministry of Education and Research, the authors contribute to the understanding of the process of transferring the concept of ESD within a multi-level education system. They investigated this process at two levels - the federal state (a sub-national entity in Germany) and the communal level. Drawing on educational governance theory, the authors unveil principles, norms, rules and procedures in the coordination of action within constellations of heterogeneous actors contributing to the implementation of ESD in their social entities. The outcome of the meta-analysis describes an emerging governance regime in ESD, taking into consideration the following features impacting the coordination of action being carried out by the actors involved: (1) the understanding of the normative concept of ESD as content of negotiation; (2) the perceived opportunity for actors to gain and increase appreciation within the field of ESD as an incentive for and driver of engagement; and (3) the dynamic quality of the set-up, rules and principles of the coordination of action, which renders these subject to situative changes. In the final part of the paper, the findings are discussed from the perspectives of the theory of transfer and the current empirical basis of ESD policy and governance.

Governing health equity in Scandinavian municipalities

DEFF Research Database (Denmark)

Scheele, Christian Elling; Little, Ingvild; Diderichsen, Finn

2018-01-01

AIMS: Local governments in the Scandinavian countries are increasingly committed to reduce health inequity through 'health equity in all policies' (HEiAP) governance. There exists, however, only very sporadic implementation evidence concerning municipal HEiAP governance, which is the focus...... of this study. METHODS: Data are based on qualitative thematic network analysis of 20 interviews conducted from 2014 to 2015 with Scandinavian political and administrative practitioners. RESULTS: We identify 24 factors located within three categories; political processes, where insufficient political commitment...... to health equity goals outside of the health sector and inadequate economic prioritization budget curbs implementation. Concerning evidence, there is a lack of epidemiological data, detailed evidence of health equity interventions as well as indicators relevant for monitoring implementation. Concerted...

Good governance and budget reform in Lesotho Public Hospitals: performance, root causes and reality.

Science.gov (United States)

Vian, Taryn; Bicknell, William J

2014-09-01

Lesotho has been implementing financial management reforms, including performance-based budgeting (PBB) since 2005 in an effort to increase accountability, transparency and effectiveness in governance, yet little is known about how these efforts are affecting the health sector. Supported by several development partners and $24 million in external resources, the PBB reform is intended to strengthen government capacity to manage aid funds directly and to target assistance to pressing social priorities. This study designed and tested a methodology for measuring implementation progress for PBB reform in the hospital sector in Lesotho. We found that despite some efforts on the national level to promote and support reform implementation, staff at the hospital level were largely unaware of the purpose of the reform and had made almost no progress in transforming institutions and systems to fully realize reform goals. Problems can be traced to a complex reform design, inadequate personnel and capacity to implement, professional boundaries between financial and clinical personnel and weak leadership. The Lesotho reform experience suggests that less complex designs for budget reform, better adapted to the context and realities of health sectors in developing countries, may be needed to improve governance. It also highlights the importance of measuring reform implementation at the sectoral level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

E-Government, Audit Opinion, and Performance of Local Government Administration in Indonesia

Directory of Open Access Journals (Sweden)

Bambang Sutopo

2017-12-01

Full Text Available Local governments (LGs have an important role in providing services to the community. Nevertheless, some local governments still show relatively low performance. Scores of e-government implementation and audit opinions obtained by some local governments are also relatively low. This study examines whether there are relationships between e-government, the dimensions of e-government, and audit opinion and the performance of the local government administration. There are five dimensions of the e-government i.e. policy, institutions, infrastructure, applications, and planning. The sample used in this study includes 246 local governments from 2012 to 2014. Using regression analysis, the results of this study show that e-government has a positive association with the performance of the local government administration. This is supported by the positive association of e-government’s dimensions with performance. The audit opinion is also positively associated with performance as expected. These results suggest that e-government and audit opinion can be used as indicators of the performance of local government administration.

Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

Science.gov (United States)

Schneider, Helen; Nxumalo, Nonhlanhla

2017-09-15

National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes

Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT

DEFF Research Database (Denmark)

Ng, J. A.; Booth, J. T.; O'Brien, R. T.

2014-01-01

is being piloted in a clinical trial for prostate cancer patients treated with VMAT (NCT01742403). The purpose of this work was to develop clinical process and quality assurance (QA) practices for the clinical implementation of KIM. Methods: Informed by and adapting existing guideline documents from other...... real-time monitoring systems, KIM-specific QA practices were developed. The following five KIM-specific QA tests were included: (1) static localization accuracy, (2) dynamic localization accuracy, (3) treatment interruption accuracy, (4) latency measurement, and (5) clinical conditions accuracy. Tests...... developed and implemented for prostate cancer VMAT....

Analysis of the Danish Approach to E-Government benefit relalization

DEFF Research Database (Denmark)

Jensen, Mika Yasuoka; Nielsen, Morten Meyerhoff

2014-01-01

national strategies for electronic government (eGovernment) are attracting attention. The Organisation for Economic Co-operation and Development (OECD), in July 2014, adopted a number of recommendations for public sector digitisation and eGovernment strategies. The recommendations address the strategic...... direction of eGovernment, implementation, governance, and cooperation models. The recommendations focus on the successful benefit realisation of ICT infrastructure and online services investments, rather than a technological and supply-orientated approach. To achieve greater efficiency and effectiveness......, a public- sector governance model and multi-stakeholder cooperation are essential for the successful use and implementation of information technology (IT). In light of the OECD’s recommendations, this paper investigates the three most-important aspects of eGovernment implementation in Denmark...

Dawn of e-government

DEFF Research Database (Denmark)

Henriksen, Helle Zinner; Damsgaard, Jan

2007-01-01

Most countries have defined strategies for e-government. The objectives for implementing e-government are often defined but the means for fuelling the adoption and diffusion of e-government are typically less well clear in the policy statements. The present study assesses the impact of latest...... internally and externally. The e-Day initiative represents a drastic change in the former policy statements concerning IT adoption and diffusion in Danish government. The policy statements had previously been based on voluntary adoption focusing on visions and pedagogical intervention in governmental...

THE RISK OF FRAUD WITHOUT IMPLEMENTATION OF THE PILLARS OF CORPORATE GOVERNANCE AT THE LEVEL OF CREDIT INSTITUTIONS IN ROMANIA

Directory of Open Access Journals (Sweden)

VLAD MARIANA

2013-02-01

Full Text Available In this article, the authors seek to emphasize the risk factors that may occur due to not implementing or faultyimplementation of corporate governance for credit institutions, and its role in fraud prevention and detection. To avoidinappropriate governance, top management should have special preoccupations for the development of strategies,developing internal control policies by which to determine and evaluate the risks of the organization. Corporategovernance starts with a broad range of beneficiaries (stakeholders who contribute with resources to an organization(investments, taxes, charitable contributions, etc. Those members are the direct and indirect beneficiaries of theorganizational unit to be regulated. Corporate governance involving several parties: the leadership board, the internalauditors or those of the external environment. In some cases, regulatory authorities or professional associations,contribute to this process.

Analisis Penerapan E-Government di Kabupaten Sragen

Directory of Open Access Journals (Sweden)

Yan Andriariza AS

2013-09-01

Full Text Available ABSTRAK Kabupaten Sragen merupakan salah satu pemerintah kabupaten yang menerapkan e-government dengan baik, dan merupakan kabupaten yang menjadi percontohan dalam suksesnya penerapan e-government. Karenanya perlu untuk dilakukan analisis penerapan e-government di Kabupaten Sragen, sebagai contoh bagi daerah lain dalam membangun e-government di daerah tersebut. Analisa yang dilakukan antara lain melihat seberapa jauh penerapan G2C, G2B dan G2G di Pemerintah Kabupaten Sragen. Selain itu juga dilakukan analisa menggunakan The UN Web Measure Index, dan analisa terakhir melakukan analisa deskriptif untuk 5 faktor kesuksesan penerapan e-government, yaitu Hukum dan Peraturan, Struktur Organisasi, Proses Bisnis, Teknologi Informasi dan Visi, Objektif dan Strategi. Dari hasil analisis diperoleh kesimpulan bahwa Kabupaten Sragen telah menerapkan G2B dan G2G, serta berada pada tahap awal penerapan G2C, selain itu Kabupaten Sragen juga telah mencapai pemerintahan yang online, tanpa kertas dan transparan. Implementasi e-government di kabupaten Sragen tersebut dapat dikatakan sukses karena telah memenuhi beberapa faktor dalam mencapai kesuksesan implementasi e-government, yaitu hukum dan peraturan, struktur organisasi, teknologi informasi dan visi, objektif dan strategi. Bila dilihat berdasarkan UN Web Measured Index, Kabupaten Sragen telah mencapai tahap 4. Saran yang dapat diberikan melalui penelitian ini adalah untuk unit kerja yang menangani TIK di Kabupaten Sragen akan lebih baik bila dipegang oleh unit kerja setingkat eselon 2 dan perlunya SOP dan peraturan tambahan terkait TIK di Kabupaten Sragen. ABSTRACT Sragen is one of the districts that implement well e-government, and being a model for the successful implementation of e-government. It is necessary to do the analysis of the application of e-government in Sragen, as an example for other regions in developing e-government in the area. Analysis was carried out to see how far the application of G2C

M-government: mobile technologies for responsive governments and connected societies

National Research Council Canada - National Science Library

2011-01-01

This report aims to foster a better understanding on how to leverage the economic and social impacts of the implementation of the Internet into mobile devices to enable ubiquitous governments, sustain...

Renewing governance.

Science.gov (United States)

Loos, Gregory P

2003-01-01

Globalization's profound influence on social and political institutions need not be negative. Critics of globalization have often referred to the "Impossible Trinity" because decision-making must 1. respect national sovereignty, 2. develop and implement firm regulation, and 3. allow capital markets to be as free as possible. To many, such goals are mutually exclusive because history conditions us to view policy-making and governance in traditional molds. Thus, transnational governance merely appears impossible because current forms of governance were not designed to provide it. The world needs new tools for governing, and its citizens must seize the opportunity to help develop them. The rise of a global society requires a greater level of generality and inclusion than is found in most policy bodies today. Politicians need to re-examine key assumptions about government. States must develop ways to discharge their regulatory responsibilities across borders and collaborate with neighboring jurisdictions, multilateral bodies, and business. Concepts such as multilateralism and tripartism show great promise. Governments must engage civil society in the spirit of shared responsibility and democratic decision-making. Such changes will result in a renewal of the state's purpose and better use of international resources and expertise in governance.

Development, Validation, and Implementation of a Clinic Nurse Staffing Guideline.

Science.gov (United States)

Deeken, Debra Jean; Wakefield, Douglas; Kite, Cora; Linebaugh, Jeanette; Mitchell, Blair; Parkinson, Deidre; Misra, Madhukar

2017-10-01

Ensuring that the level of nurse staffing used to care for patients is appropriate to the setting and service intensity is essential for high-quality and cost-effective care. This article describes the development, validation, and implementation of the clinic technical skills permission list developed specifically to guide nurse staffing decisions in physician clinics of an academic medical center. Results and lessons learned in using this staffing guideline are presented.

Aspects of governance in the practical implementation of the concept of reversibility for deep geological disposal. Report no. 308

International Nuclear Information System (INIS)

Reaud, C.; Schieber, C.; Schneider, T.; Gadbois, S.; Heriard Dubreuil, G.

2010-01-01

The European project COWAM in Practice (CIP) was aimed to lead for three years (2007-2009) a process of monitoring, analyzing and evaluating the governance linked with radioactive waste management. This project, in cooperation with a research group and stakeholders, was conducted in parallel in 5 European countries (Spain, France, United Kingdom, Romania, Slovenia). In France, the issue of reversibility for a deep geological disposal was introduced in the Act of December 30, 1991 on the possible options to manage radioactive waste. The Act of June 28, 2006 relative to sustainable management of materials and radioactive waste confirmed the option, by calling for a reversible waste disposal facility in a deep geological formation to be designed. The main issue is no longer to justify the adoption of reversibility, but to investigate the practical procedures for its implementation. The French stakeholder Group 4 involved in the European project COWAM In Practice (CIP) had identified several subjects for investigation: - The different aspects associated with the practical implementation of reversible disposal: technical aspects, and aspects relative to monitoring, safety and expertise, in terms of legal, financial, administrative and political, etc. responsibility related to the notion of reversibility. - The stakes of governance related to the processes of assessment and decision-making - The roles of local stakeholders in these processes. The analysis conducted by CEPN in cooperation with the French stakeholder group, facilitated by Mutadis, showed that the practical implementation of reversibility aims to maintain a capacity of choice between three options: to continue to maintain the reversibility, to retrieve packages or to initiate the closure of all or part the disposal facility. Maintaining this choice in the long term implies setting up specific institutional, financial and decision-making systems,etc,. that need to be jointly developed in advance by all the

Corporate Governance Country Assessment : Uruguay

OpenAIRE

World Bank

2005-01-01

This report provides an assessment of Uruguay's corporate governance policy framework, enforcement and compliance practices. It highlights recent improvements in corporate governance regulation, makes policy recommendations, and provides investors with a benchmark against which to measure corporate governance in Uruguay. The report identifies several key next steps that focus on implementation including: Improving corporate information, particularly ownership disclosure, related party transac...

[Evidence-based clinical oral healthcare guidelines 4. Adherence requires an implementation strategy].

Science.gov (United States)

Braspenning, J C C; Mettes, T G P H; van der Sanden, W J M; Wensing, M J P

2015-03-01

Adherence to clinical guidelines requires support in practice. However, systematic implementation of evidence-based guidelines is not common practice in oral healthcare. The Knowledge Institute Oral Care (KiMo) offers the opportunity to take into account potential barriers and facilitators during the development of evidence-based clinical practice guidelines. These factors which are relevant to the guideline and the oral healthcare practice provide the ingredients for a tailor-made programme of implementation that has a scientific basis. Elements of any implementation programme are the quality indicators derived from the oral healthcare guidelines. These indicators should fit, on the one hand, the specific goals of the guidelines (patient safety, effectiveness, efficiency, patient-centred, timeliness, accessibility) and, onthe other hand, the various perspectives of the different stakeholders, such as patients, caregivers, health insurers and inspectorate. These quality indicators provide information on adherence to the guidelines, the results of a certain treatment and the success of the implementation strategy, all with the aim to improve the quality of oral healthcare.

Policy implementation in practice: the case of national service frameworks in general practice.

Science.gov (United States)

Checkland, Kath; Harrison, Stephen

2004-10-01

National Service Frameworks are an integral part of the government's drive to 'modernise' the NHS, intended to standardise both clinical care and the design of the services used to deliver that clinical care. This article uses evidence from qualitative case studies in three general practices to illustrate the difficulties associated with the implementation of such top-down guidelines and models of service. In these studies it was found that, while there had been little explicit activity directed at implementation overall, the National Service Framework for coronary heart disease had in general fared better than that for older people. Gunn's notion of 'perfect implementation' is used to make sense of the findings.

Effects of performance measure implementation on clinical manager and provider motivation.

Science.gov (United States)

Damschroder, Laura J; Robinson, Claire H; Francis, Joseph; Bentley, Douglas R; Krein, Sarah L; Rosland, Ann-Marie; Hofer, Timothy P; Kerr, Eve A

2014-12-01

Clinical performance measurement has been a key element of efforts to transform the Veterans Health Administration (VHA). However, there are a number of signs that current performance measurement systems used within and outside the VHA may be reaching the point of maximum benefit to care and in some settings, may be resulting in negative consequences to care, including overtreatment and diminished attention to patient needs and preferences. Our research group has been involved in a long-standing partnership with the office responsible for clinical performance measurement in the VHA to understand and develop potential strategies to mitigate the unintended consequences of measurement. Our aim was to understand how the implementation of diabetes performance measures (PMs) influences management actions and day-to-day clinical practice. This is a mixed methods study design based on quantitative administrative data to select study facilities and quantitative data from semi-structured interviews. Sixty-two network-level and facility-level executives, managers, front-line providers and staff participated in the study. Qualitative content analyses were guided by a team-based consensus approach using verbatim interview transcripts. A published interpretive motivation theory framework is used to describe potential contributions of local implementation strategies to unintended consequences of PMs. Implementation strategies used by management affect providers' response to PMs, which in turn potentially undermines provision of high-quality patient-centered care. These include: 1) feedback reports to providers that are dissociated from a realistic capability to address performance gaps; 2) evaluative criteria set by managers that are at odds with patient-centered care; and 3) pressure created by managers' narrow focus on gaps in PMs that is viewed as more punitive than motivating. Next steps include working with VHA leaders to develop and test implementation approaches to help

Forms of global governence

Directory of Open Access Journals (Sweden)

Maxim V. Kharkevich

2014-01-01

Full Text Available Global governance as a concept defines the meaning of contemporary world politics both as a discipline and as reality. Interdependent and globalized world requires governance, and a global government has not been formed yet. The theoretical possibility of global governance without global government is proved and justified. The purpose of this article is to analytically identify possible forms of global governance. Three such forms of global governance are identified: hierarchical, market and network. In a hierarchy the governance is due to the asymmetry of power between the parties. Market control happens via anonymous pricing mechanism. Network, in contrast to the market is characterized by a closer value link between the actors, but unlike the hierarchical relationship actors are free to leave the network. Global governance takes three forms and is being implemented by different actors. To determine the most efficient form of global governance is impossible. Efficiency depends on the match between a form and an object of government. It should be noted that meta governance is likely to remain a monopoly of institutionally strong states in global governance.

SU-E-T-181: Clinical Implementation of Task Group 176

Energy Technology Data Exchange (ETDEWEB)

Burgdorf, B [University of Pennsylvania, Philadelphia, PA (United States); Yeager, C; Zhou, F; Hand, C [Albert Einstein Medical Center, Philadelphia, PA (United States)

2015-06-15

Purpose: The implementation of TG-176 with regards to immobilization devices and couch tops as they effect dosimetric treatment planning. Methods: The external devices used clinically were scanned to measure their HU values. Plans were created in the Eclipse treatment planning system (TPS) using these devices, one that accounted for the correct HU value of the each device and another that did not include the device as a structure. A dose subtraction was performed between the two plans to evaluate the dosimetric differences. The metrics used for evaluation included attenuation and surface dose. Plan parameters were varied to evaluate the impact of the devices in different clinical scenarios. Results: While the exact HU values of our results are clinic-dependent, the protocol being implemented is widely applicable. We recommend a four step process for implementing this task group. First, physics should scan each treatment device to determine accurate HU values. Second, CT therapists should include in the setup note which table top was used during patient CT simulation and are asked to make immobilization devices as uniform in thickness as possible. Therapists should also index the devices whenever possible so beam will traverse the same area of the device. Third, the dosimetrist should manually correct the HU value for any external device, including the couch. For H&N cases, the rails must be removed from the couch structure. When rails are used during treatments, it is important to make note of their exact position in the setup notes. Finally, physicians should be made aware that there could be changes in surface doses depending on whether or not immobilization devices or couch tops are in the beam path. Conclusion: The protocol outlined above was implemented to reduce the errors that arise from ignoring effects of external devices, thus ensuring safer, more accurate patient treatments.

Negotiating Collaborative Governance Designs: A Discursive Approach

DEFF Research Database (Denmark)

Plotnikof, Mie

2015-01-01

This article addresses the design and implementation issues of collaborative governance, a public-management practice aimed at involving stakeholders in problem solving and public innovation. Although aspects of for example stakeholder inclusion and power are conceptualized in the literature......, these issues remain challenging in practice. Therefore, the interest in understanding the emerging processes of collaborative governance is growing. This article contributes to theorizing discursive aspects of such processes by conceptualizing and exploring the meaning negotiations through which collaborative...... governance designs emerge and change. The findings of a case study of local governments’ efforts to innovate quality management in education through collaborative governance suggest that such form of governance is continuingly negotiated in communication during both design and implementation phases. Through...

Clinical implementation and quality assurance for intensity modulated radiation therapy

International Nuclear Information System (INIS)

Ma, C.-M.; Price, R.; McNeeley, S.; Chen, L.; Li, J.S.; Wang, L.; Ding, M.; Fourkal, E.; Qin, L.

2002-01-01

This paper describes the clinical implementation and quality assurance (QA) for intensity-modulated radiation therapy (IMRT) based on the experience at Fox Chase Cancer Center, Philadelphia, USA. We will review our procedures for the clinical implementation of the IMRT technique and the requirements for patient immobilization, target delineation, treatment optimization, beam delivery and system administration. We will discuss the dosimetric requirements and measurement procedures for beam commissioning and dosimetry verification for IMRT. We will examine the details of model-based dose calculation for IMRT treatment planning and the potential problems with such dose calculation algorithms. We will discuss the effect of beam delivery systems on the actual dose distributions received by the patients and the methods to incorporate such effects in the treatment optimization process. We will investigate the use of the Monte Carlo method for dose calculation and treatment verification for IMRT

Implementing Trauma-Informed Partner Violence Assessment in Family Planning Clinics.

Science.gov (United States)

Decker, Michele R; Flessa, Sarah; Pillai, Ruchita V; Dick, Rebecca N; Quam, Jamie; Cheng, Diana; McDonald-Mosley, Raegan; Alexander, Kamila A; Holliday, Charvonne N; Miller, Elizabeth

2017-09-01

Intimate partner violence (IPV) and reproductive coercion (RC) are associated with poor reproductive health. Little is known about how family planning clinics implement brief IPV/RC assessment interventions in practice. We describe the uptake and impact of a brief, trauma-informed, universal IPV/RC assessment and education intervention. Intervention implementation was evaluated via a mixed methods study among women ages 18 and up receiving care at one of two family planning clinics in greater Baltimore, MD. This mixed methods study entailed a quasi-experimental, single group pretest-posttest study with family planning clinic patients (baseline and exit survey n = 132; 3-month retention n = 68; retention rate = 52%), coupled with qualitative interviews with providers and patients (total n = 35). Two thirds (65%) of women reported receiving at least one element of the intervention on their exit survey immediately following the clinic-visit. Patients reported that clinic-based IPV assessment is helpful, irrespective of IPV history. Relative to those who reported neither, participants who received either intervention element reported greater perceived caring from providers, confidence in provider response to abusive relationships, and knowledge of IPV-related resources at follow-up. Providers and patients alike described the educational card as a valuable tool. Participants described trade-offs of paper versus in-person, electronic medical record-facilitated screening, and patient reluctance to disclose current situations of abuse. In real-world family planning clinic settings, a brief assessment and support intervention was successful in communicating provider caring and increasing knowledge of violence-related resources, endpoints previously deemed valuable by IPV survivors. Results emphasize the merit of universal education in IPV/RC clinical interventions over seeking IPV disclosure.

PENGARUH PELAKSANAAN AUDIT INTERNAL TERHADAP PENERAPAN GOOD CORPORATE GOVERNANCE

Directory of Open Access Journals (Sweden)

Karli Soedijatno

2013-08-01

Hypothesis testing in this study using software SPSS 19.0 for windows. The research method used is associative method with quantitative approach. The data used is the primary data in the form of questionnaires distributed to respondents. Data collected amounted to 66 questionnaires from BUMN internal auditors headquartered in Bandung. The results of this study indicate that the implementation of internal audit on SOEs headquartered in Bandung has been implemented very well and the implementation and application of Good Corporate Governance principles in SOEs headquartered in Bandung has been implemented very well so that only need to be maintained implementation. While the influence of internal audit variables on the implementation of principles of Good Corporate Governance of 67.08%. Thus, the hypothesis proposed in this study is accepted, that is, internal audit has an effect on the implementation of Good Corporate Governance.

Human resource governance: what does governance mean for the health workforce in low- and middle-income countries?

Directory of Open Access Journals (Sweden)

Kaplan Avril D

2013-02-01

Full Text Available Abstract Background Research on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation. Methods This study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance. Results/discussion The 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to

Human resource governance: what does governance mean for the health workforce in low- and middle-income countries?

Science.gov (United States)

Kaplan, Avril D; Dominis, Sarah; Palen, John Gh; Quain, Estelle E

2013-02-15

Research on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation. This study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA) data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance. The 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to hold health workers accountable after they enter the workforce

Trans-European transport network and cross-border governance

DEFF Research Database (Denmark)

Guasco, Clement Nicolas

2014-01-01

for coordinating knowledge, efforts and solutions across several national systems. In order to understand this governance setting, one needs to understand the specific quality of transnational governance in the EU, which is neither purely international nor federally integrated. The transport corridor between Malmö......This article looks at the implementation of trans-European transport corridors in the EU and the influence it has on governance within EU member-states. It considers the implementation of such a scheme in the context of cross-border cooperation and discusses the system of governance necessary...

A New Frontier for LIS Programs: E-Government Education, Library/Government Partnerships, and the Preparation of Future Information Professionals

Science.gov (United States)

Jaeger, Paul T.; Bertot, John Carlo; Shuler, John A.; McGilvray, Jessica

2012-01-01

This paper examines the implications of the continued growth of e-government information, communication, and services for Library and Information Science programs in the United States in light of the development of e-government educational programs and library/government partnerships. The implementation of e-government raises several important…

Implementing a Measurement Feedback System in Community Mental Health Clinics: A Case Study of Multilevel Barriers and Facilitators.

Science.gov (United States)

Gleacher, Alissa A; Olin, Serene S; Nadeem, Erum; Pollock, Michele; Ringle, Vanesa; Bickman, Leonard; Douglas, Susan; Hoagwood, Kimberly

2016-05-01

Measurement feedback systems (MFSs) have been proposed as a means of improving practice. The present study examined the implementation of a MFS, the Contextualized Feedback System (CFS), in two community-based clinic sites. Significant implementation differences across sites provided a basis for examining factors that influenced clinician uptake of CFS. Following the theoretical implementation framework of Aarons et al. (Adm Policy Mental Health Mental Health Serv Res 38(1):4-23, 2011), we coded qualitative data collected from eighteen clinicians (13 from Clinic U and 5 from Clinic R) who participated in semi-structured interviews about their experience with CFS implementation. Results suggest that clinicians at both clinics perceived more barriers than facilitators to CFS implementation. Interestingly, clinicians at the higher implementing clinic reported a higher proportion of barriers to facilitators (3:1 vs. 2:1); however, these clinicians also reported a significantly higher level of organizational and leadership supports for CFS implementation. Implications of these findings are discussed.

Effect Of Implementation Of Good Corporate Governance And Internal Audit Of The Quality Of Financial Reporting And Implications Of Return Of Shares

Directory of Open Access Journals (Sweden)

Erlynda Y. Kasim

2015-08-01

Full Text Available Abstract The quality of financial reporting produced by the company are expected to meet the quality characteristics to Achieve the objective of the conceptual framework of financial reporting. Good implementation of adequate corporate governance in a company is one of the factors that Determine the quality of financial reporting. Similarly the internal implementation of audit firm certainly factors Affect the quality of financial reporting. Quality financial reporting will certainly get a market response that can be seen from the level of the stock return. The paper examines two independent variables items namely Good Corporate Governance and Internal Audit and its influence on the quality of financial reporting and its implications to Return Shares. In the design of this study will be performed on companies listed in the Indonesia Stock Exchange with multiple linear regression method.

PG4KDS: a model for the clinical implementation of pre-emptive pharmacogenetics.

Science.gov (United States)

Hoffman, James M; Haidar, Cyrine E; Wilkinson, Mark R; Crews, Kristine R; Baker, Donald K; Kornegay, Nancy M; Yang, Wenjian; Pui, Ching-Hon; Reiss, Ulrike M; Gaur, Aditya H; Howard, Scott C; Evans, William E; Broeckel, Ulrich; Relling, Mary V

2014-03-01

Pharmacogenetics is frequently cited as an area for initial focus of the clinical implementation of genomics. Through the PG4KDS protocol, St. Jude Children's Research Hospital pre-emptively genotypes patients for 230 genes using the Affymetrix Drug Metabolizing Enzymes and Transporters (DMET) Plus array supplemented with a CYP2D6 copy number assay. The PG4KDS protocol provides a rational, stepwise process for implementing gene/drug pairs, organizing data, and obtaining consent from patients and families. Through August 2013, 1,559 patients have been enrolled, and four gene tests have been released into the electronic health record (EHR) for clinical implementation: TPMT, CYP2D6, SLCO1B1, and CYP2C19. These genes are coupled to 12 high-risk drugs. Of the 1,016 patients with genotype test results available, 78% of them had at least one high-risk (i.e., actionable) genotype result placed in their EHR. Each diplotype result released to the EHR is coupled with an interpretive consult that is created in a concise, standardized format. To support-gene based prescribing at the point of care, 55 interruptive clinical decision support (CDS) alerts were developed. Patients are informed of their genotyping result and its relevance to their medication use through a letter. Key elements necessary for our successful implementation have included strong institutional support, a knowledgeable clinical laboratory, a process to manage any incidental findings, a strategy to educate clinicians and patients, a process to return results, and extensive use of informatics, especially CDS. Our approach to pre-emptive clinical pharmacogenetics has proven feasible, clinically useful, and scalable. © 2014 Wiley Periodicals, Inc.

How to implement live video recording in the clinical environment: A practical guide for clinical services.

Science.gov (United States)

Lloyd, Adam; Dewar, Alistair; Edgar, Simon; Caesar, Dave; Gowens, Paul; Clegg, Gareth

2017-06-01

The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. To provide a practical guide for clinical services to embed live video recording. Using Kotter's 8-step process for leading change, we provide a 'how to' guide to navigate the challenges required to implement a continuous video-audit system based on our experience of video recording in our emergency department resuscitation rooms. The most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. Clinicians are faced with considerable ethical, legal and data protection challenges which are the primary barriers for services that pursue video recording of patient care. Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. This article outlines core implementation issues that need to be addressed if video is to become part of routine care delivery. By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care. © 2017 John Wiley & Sons Ltd.

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial.

Science.gov (United States)

Jabbour, Mona; Curran, Janet; Scott, Shannon D; Guttman, Astrid; Rotter, Thomas; Ducharme, Francine M; Lougheed, M Diane; McNaughton-Filion, M Louise; Newton, Amanda; Shafir, Mark; Paprica, Alison; Klassen, Terry; Taljaard, Monica; Grimshaw, Jeremy; Johnson, David W

2013-05-22

The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for 'point of care' management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma--the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis--the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process

Issues on Building Kazakhstan Geospatial Portal to Implement E-Government

Science.gov (United States)

Sagadiyev, K.; Kang, H. K.; Li, K. J.

2016-06-01

A main issue in developing e-government is about how to integrate and organize many complicated processes and different stakeholders. Interestingly geospatial information provides an efficient framework to integrate and organized them. In particular, it is very useful to integrate the process of land management in e-government with geospatial information framework, since most of land management tasks are related with geospatial properties. In this paper, we present a use-case on the e-government project in Kazakhstan for land management. We develop a geoportal to connect many tasks and different users via geospatial information framework. This geoportal is based on open source geospatial software including GeoServer, PostGIS, and OpenLayers. With this geoportal, we expect three achievements as follows. First we establish a transparent governmental process, which is one of main goal of e-government. Every stakeholder monitors what is happening in land management process. Second, we can significantly reduce the time and efforts in the government process. For example, a grant procedure for a building construction has taken more than one year with more than 50 steps. It is expected that this procedure would be reduced to 2 weeks by the geoportal framework. Third we provide a collaborative environment between different governmental structures via the geoportal, while many conflicts and mismatches have been a critical issue of governmental administration processes.

ISSUES ON BUILDING KAZAKHSTAN GEOSPATIAL PORTAL TO IMPLEMENT E-GOVERNMENT

Directory of Open Access Journals (Sweden)

K. Sagadiyev

2016-06-01

Full Text Available A main issue in developing e-government is about how to integrate and organize many complicated processes and different stakeholders. Interestingly geospatial information provides an efficient framework to integrate and organized them. In particular, it is very useful to integrate the process of land management in e-government with geospatial information framework, since most of land management tasks are related with geospatial properties. In this paper, we present a use-case on the e-government project in Kazakhstan for land management. We develop a geoportal to connect many tasks and different users via geospatial information framework. This geoportal is based on open source geospatial software including GeoServer, PostGIS, and OpenLayers. With this geoportal, we expect three achievements as follows. First we establish a transparent governmental process, which is one of main goal of e-government. Every stakeholder monitors what is happening in land management process. Second, we can significantly reduce the time and efforts in the government process. For example, a grant procedure for a building construction has taken more than one year with more than 50 steps. It is expected that this procedure would be reduced to 2 weeks by the geoportal framework. Third we provide a collaborative environment between different governmental structures via the geoportal, while many conflicts and mismatches have been a critical issue of governmental administration processes.

THE EVOLUTION OF LOCAL GOVERNMENT AND SELF-GOVERNMENT IN RUSSIA

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Tatiana Yashchuk

2017-01-01

Full Text Available УДК 34The article highlights the main stages in the development of local government and self-gov-ernment in Russia. It shows the specifics of each stage. The formation of the Russian state was accompanied by the synthesis of the princely power and the community self-government. The genesis autocracy was accompanied by a struggle with the self-government institutions. The creation of rural and urban self-government in the second half of the XIX century was accom-panied by a debate on the social and public origin of these institutions.The Soviet state was based on the unity of the Soviet system. It concluded the discrete de-velopment of local self-government in Russia. There is no historical strong tradition of local government in this system.Objective of the article is to identify and characterize the main stages of development of local government and self-government in Russia. Show the discrete nature of the develop-ment of local self-government in Russia.The formation of the Russian state was accompanied by the synthesis of princely power and community self-government. Genesis autocracy was accompanied by a struggle with self-government institutions. The absence of territorial self-government in Russia was offset by the presence of social class municipality for a long time. Caste traditions tradition had a negative impact after the establishment of rural and urban self-government in the second half of the XIX century.During the preparation of the reforms and their implementation were discussions of the rela-tionship between the state and the community began in management. As a result, there is the inclusion of local authorities in the sphere of active state regulation. The desire of the county public to the political activity was suppressed by autocracy. The Provisional Government at-tempt to rely on the local self-government to create new authorities ended in failure.The Soviet state was based on a single management system. Certain powers

Implementation of Clinical Quality Management for Rehabilitation in Malaysia.

Science.gov (United States)

Engkasan, Julia Patrick; Stucki, Gerold; Ali, Sadeeq; Yusof, Yusniza Mohd; Hussain, Hafez; Latif, Lydia Abdul

2018-04-18

In February 2017, the World Health Organization (WHO) launched its historic "Rehabilitation 2030: A Call for Action". Scaling up rehabilitation in health systems requires concerted action across all 6 components of WHO's Health Systems Framework. For rehabilitation, information about functioning is essential, as it is required for effective rehabilitation at all levels of the health system. What is missing is a countrywide demonstration project involving the implementation of a clinical quality management system for the continuous improvement of rehabilitation, both at the level of clinical care for individual patients and at the level of rehabilitation service provision. Consequently, the Department of Rehabilitation Medicine at the University of Malaya and University Malaya Medical Centre, together with the Cheras Rehabilitation Hospital of the Ministry of Health, and the Social Security Organisation (SOCSO) Rehabilitation Centre in Malacca, Malaysia, initiated a project to develop a Malaysian-wide clinical quality management system for rehabilitation (CQM-R Malaysia). The objective of this paper is to describe CQM-R Malaysia. First, a conceptual description of a CQM-R based on the International Classification of Functioning, Disability and Health (ICF) is set out. The methods, results and conclusions of a situation analysis conducted in January 2017 are then reported. Finally, the building blocks and implementation action plan developed for CQM-R Malaysia are presented.

Implementation of Clinical Quality Management for Rehabilitation in Malaysia

Directory of Open Access Journals (Sweden)

Julia Patrick Engkasan

2017-11-01

Full Text Available In February 2017, the World Health Organization (WHO launched its historic ”Rehabilitation 2030: A Call for Action”. Scaling up rehabilitation in health systems requires concerted action across all 6 components of WHO’s Health Systems Framework. For rehabilitation, information about functioning is essential, as it is required for effective rehabilitation at all levels of the health system. What is missing is a countrywide demonstration project involving the implementation of a clinical quality management system for the continuous improvement of rehabilitation, both at the level of clinical care for individual patients and at the level of rehabilitation service provision. Consequently, the Department of Rehabilitation Medicine at the University of Malaya and University Malaya Medical Centre, together with the Cheras Rehabilitation Hospital of the Ministry of Health, and the Social Security Organisation (SOCSO Rehabilitation Centre in Malacca, Malaysia, initiated a project to develop a Malaysian-wide clinical quality management system for rehabilitation (CQM-R Malaysia. The objective of this paper is to describe CQM-R Malaysia. First, a conceptual description of a CQM-R based on the International Classification of Functioning, Disability and Health (ICF is set out. The methods, results and conclusions of a situation analysis conducted in January 2017 are then reported. Finally, the building blocks and implementation action plan developed for CQM-R Malaysia are presented.

Technical experiences of implementing a wireless tracking and facial biometric verification system for a clinical environment

Science.gov (United States)

Liu, Brent; Lee, Jasper; Documet, Jorge; Guo, Bing; King, Nelson; Huang, H. K.

2006-03-01

By implementing a tracking and verification system, clinical facilities can effectively monitor workflow and heighten information security in today's growing demand towards digital imaging informatics. This paper presents the technical design and implementation experiences encountered during the development of a Location Tracking and Verification System (LTVS) for a clinical environment. LTVS integrates facial biometrics with wireless tracking so that administrators can manage and monitor patient and staff through a web-based application. Implementation challenges fall into three main areas: 1) Development and Integration, 2) Calibration and Optimization of Wi-Fi Tracking System, and 3) Clinical Implementation. An initial prototype LTVS has been implemented within USC's Healthcare Consultation Center II Outpatient Facility, which currently has a fully digital imaging department environment with integrated HIS/RIS/PACS/VR (Voice Recognition).

Clinical and financial considerations for implementing an ICU telemedicine program.

Science.gov (United States)

Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M

2014-06-01

As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs.

Enhanced Multi-Service Markets: An Evolution in Military Health System Governance.

Science.gov (United States)

Hudak, Ronald P; Russell, Rebecca; Toland, P Paul

2018-02-06

The evolution of governance models for the Military Health System's (MHS) large hospitals, called medical treatment facilities (MTFs), has culminated with the effort to implement Enhanced Multi-Service Markets (eMSM). The term eMSM refers to two separate concepts. First, MSM refers to those geographic areas, that is, markets, which have the following characteristics: they have MTFs that are operated by two or more Department of Defense (DoD) Services, that is, Army, Navy, or Air Force; there is a large beneficiary population; there is a substantial amount of direct care (i.e., beneficiaries are treated at MTFs instead of TRICARE's purchased care from civilian providers); and there is a substantial readiness and training platform. Second, the term "enhanced" refers to an increase in management authority over clinical and business operations, readiness, and MTF workload. A retrospective review was conducted to study the evolution of military and civilian health care delivery models for the purpose of understanding how governance models have changed since the 1980s to design and manage MTFs with overlapping catchments areas. Primary and secondary data sources were analyzed through a comprehensive literature review. Since the 1980s, the MHS governance models have evolved from testing various managed care models to a regionally focused TRICARE model and culminating with an overlapping catchment area model entitled eMSMs. The eMSM model partially fulfills the original vision because the eMSM leaders have limited budgetary and resource allocation authority. The various models sought to improve governance of overlapping catchment areas with the intent to enhance medical readiness, community health, and individual health care while reducing costs. However, the success of the current model, that is, eMSMs, cannot be fully assessed because the eMSM model was not fully implemented as originally envisioned. Instead, the current eMSM model partially implements the eMSM model. As

Corporate Governance in Publicly Traded Canadian Companies

OpenAIRE

Hu, Jie; Wang, Chong

2011-01-01

We investigate the effectiveness of corporate governance practices in this paper, focusing on the corporate governance practices implemented by TSX listed companies in Canada. We analyze the determinants of the effectiveness of corporate governance practices and test whether corporate governance mechanisms relate to quality of accounting earnings and company performance. We obtain mixed results from regression analyses indicating that corporate governance mechanisms are not significantly rela...

Improving outcomes in veterans with oropharyngeal squamous cell carcinoma through implementation of a multidisciplinary clinic.

Science.gov (United States)

Light, Tyler; Rassi, Edward El; Maggiore, Ronald J; Holland, John; Reed, Julie; Suriano, Kathleen; Stooksbury, Marcelle; Tobin, Nora; Gross, Neil; Clayburgh, Daniel

2017-06-01

Treatment of head and neck cancer is complex, and a multidisciplinary clinic may improve the coordination of care. The value of a head and neck multidisciplinary clinic has not yet been established in oropharyngeal squamous cell carcinoma (SCC). A retrospective review was conducted of Veterans Affairs patients with oropharyngeal SCC undergoing concurrent chemoradiation before and after implementation of the head and neck multidisciplinary clinic. Fifty-two patients before and 54 patients after multidisciplinary clinic were included in this study. Age, tobacco use, and p16+ status were similar between groups. With multidisciplinary clinic, time to treatment decreased, and utilization of supportive services, including speech pathology, dentistry, and nutrition increased. The 5-year disease-specific survival rate increased from 63% to 81% (p = .043) after implementation of the multidisciplinary clinic. Multivariate analysis showed that disease stage (p = .016), p16 status (p = .006), and multidisciplinary clinic participation (p = .042) were predictors of disease-specific survival. Implementation of a multidisciplinary clinic improved care coordination and disease-specific survival in patients with oropharyngeal SCC. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1106-1112, 2017. © 2017 Wiley Periodicals, Inc.

Implementing an Assessment Clinic in a Residential PTSD Program

Directory of Open Access Journals (Sweden)

Joan McDowell

2014-08-01

Full Text Available Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included.

Policy Implementation: Implications for Evaluation

Science.gov (United States)

DeGroff, Amy; Cargo, Margaret

2009-01-01

Policy implementation reflects a complex change process where government decisions are transformed into programs, procedures, regulations, or practices aimed at social betterment. Three factors affecting contemporary implementation processes are explored: networked governance, sociopolitical context and the democratic turn, and new public…

Environmental governance and role of judiciary in India

International Nuclear Information System (INIS)

Sahu, G.

2005-01-01

This paper attempts to examine the role of judiciary in environmental governance of India in terms of judiciary intervention in the environmental policy making process as well as its role in the implementation of existing environmental laws and shaping its implementation process. In consonance with this exercise, the paper has highlighted the contributing factors influencing judiciary role in environmental governance and thereby examines the impact of judicial intervention in environmental governance of India. The discussion in the paper is drawn from the case studies of a few environmental cases where the role of judiciary in environmental governance can be observed. (author)

The impact on nurses and nurse managers of introducing PEPFAR clinical services in urban government clinics in Uganda

Directory of Open Access Journals (Sweden)

Kyegombe Nambusi

2011-03-01

Full Text Available Abstract Background Improving provider performance is central to strengthening health services in developing countries. Because of critical shortages of physicians, many clinics in sub-Saharan Africa are led by nurses. In addition to clinical skills, nurse managers need practical managerial skills and adequate resources to ensure procurement of essential supplies, quality assurance implementation, and productive work environment. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create positive influence on work attitudes and behaviors. The Infectious Disease Institute, an affiliate of Makerere University College of Health Science, in an effort to expand the needed HIV services in the Ugandan capital, established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. This paper evaluates the impact on the nurses from this innovative program to provide more health care in six nurse managed Kampala City Council (KCC Clinics. Methods A mixed method approach was used. The descriptive study collected key informant interviews from the six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Key themes were manually identified from the interviews, and the questionnaire data were analyzed using SPSS. Results Introducing new HIV services into six KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction. Conclusions This community-university HIV

The impact on nurses and nurse managers of introducing PEPFAR clinical services in urban government clinics in Uganda.

Science.gov (United States)

Nankumbi, Joyce; Groves, Sara; Leontsini, Elli; Kyegombe, Nambusi; Coutinho, Alex; Manabe, Yuka

2011-03-09

Improving provider performance is central to strengthening health services in developing countries. Because of critical shortages of physicians, many clinics in sub-Saharan Africa are led by nurses. In addition to clinical skills, nurse managers need practical managerial skills and adequate resources to ensure procurement of essential supplies, quality assurance implementation, and productive work environment. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create positive influence on work attitudes and behaviors. The Infectious Disease Institute, an affiliate of Makerere University College of Health Science, in an effort to expand the needed HIV services in the Ugandan capital, established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. This paper evaluates the impact on the nurses from this innovative program to provide more health care in six nurse managed Kampala City Council (KCC) Clinics. A mixed method approach was used. The descriptive study collected key informant interviews from the six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Key themes were manually identified from the interviews, and the questionnaire data were analyzed using SPSS. Introducing new HIV services into six KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction. This community-university HIV innovative model was successful from the point of view of the nurses

Challenges facing transactional e-government systems

OpenAIRE

AI-Sebie, Madi M

2005-01-01

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 17/10/2005. A review of normative literature, in the field of e-government, indicates that the transactional stage of e-government is one of the most important to the implementation of an e-government system as it represents the highest level of interaction within organisations and between customers and government organisations. Due to the importance of the transactional stage of the e-govern...

Clinical Chemistry of Patients With Ebola in Monrovia, Liberia.

Science.gov (United States)

de Wit, Emmie; Kramer, Shelby; Prescott, Joseph; Rosenke, Kyle; Falzarano, Darryl; Marzi, Andrea; Fischer, Robert J; Safronetz, David; Hoenen, Thomas; Groseth, Allison; van Doremalen, Neeltje; Bushmaker, Trenton; McNally, Kristin L; Feldmann, Friederike; Williamson, Brandi N; Best, Sonja M; Ebihara, Hideki; Damiani, Igor A C; Adamson, Brett; Zoon, Kathryn C; Nyenswah, Tolbert G; Bolay, Fatorma K; Massaquoi, Moses; Sprecher, Armand; Feldmann, Heinz; Munster, Vincent J

2016-10-15

The development of point-of-care clinical chemistry analyzers has enabled the implementation of these ancillary tests in field laboratories in resource-limited outbreak areas. The Eternal Love Winning Africa (ELWA) outbreak diagnostic laboratory, established in Monrovia, Liberia, to provide Ebola virus and Plasmodium spp. diagnostics during the Ebola epidemic, implemented clinical chemistry analyzers in December 2014. Clinical chemistry testing was performed for 68 patients in triage, including 12 patients infected with Ebola virus and 18 infected with Plasmodium spp. The main distinguishing feature in clinical chemistry of Ebola virus-infected patients was the elevation in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyltransferase levels and the decrease in calcium. The implementation of clinical chemistry is probably most helpful when the medical supportive care implemented at the Ebola treatment unit allows for correction of biochemistry derangements and on-site clinical chemistry analyzers can be used to monitor electrolyte balance. 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.

Teaching Case: Initial Public Offering and Implementation of a Corporate Governance System in a Family Business

Directory of Open Access Journals (Sweden)

Isaac Gezer Silva de Oliveira

2016-01-01

Full Text Available Prime Hospitality Group (PHG is a family-owned company, which was founded 17 years ago by Mr. Milton Albuquerque, with hotels and resorts scattered in different regions of Brazil. Recently, the company decided to go public in BM&FBOVESPA. Conducting an IPO, however, requires many changes in the company’s structure. These changes generate costs and change the view of family members and different stakeholders involved in the process. This case proposes an assessment of the impact caused by the implementation of a corporate governance mechanism after the completion of an IPO of a family-run company.

Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

Science.gov (United States)

Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

2018-03-20

No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

Developing a Generic Framework for E-Government

OpenAIRE

Gerald Grant; Derek Chau

2005-01-01

Electronic government (e-government) initiatives are pervasive and form a significant part of government investment portfolio in almost all countries around the world. However, understanding of what is meant by e-government is still nascent and becomes complicated because the construct means different things to different people. Consequently, the conceptualization and implementation of e-government programs are diverse and are often difficult to assess and compare across different contexts of...

Implementation aspects of image management, archiving, and communication systems in routine clinical use

NARCIS (Netherlands)

Haar Romenij, ter B.M.

1991-01-01

Implementation of a digital imaging network in routine clinical use is a difficult task. Not only the high technical requirements, but especially the complexity of the organization of the diagnostic information flow in a hospital makes commitment essential in PACS implementation. The application of

Multidirectional Networks of Government Transparency: A Preliminary Model

Directory of Open Access Journals (Sweden)

Ahmad Subhan

2016-11-01

Full Text Available This article reviews some literature in theoretical level regarding two concepts: governance network and government transparency, in order to search for theoretical linkages and to build an alternative framework that can support the implementation of public disclosure. Transparency agenda has been implemented in various forms at international, national, and local level. Transparency application was also followed by Indonesia with the implementation of Public Information Disclosure Law since 2008. This enthusiasm is quite reasonable because transparency is believed to be one of the human rights principles; as well as a key to better governance, that can help democracy consolidation, prevent corruption, strengthen the legitimacy and improve efficiency. In order to maximize transparency, the government can use a network approach because of some changes at this time, such as democratization, decentralization, and liberalization has placed the government in a position where there is not one actor who manages the state power without stakeholder’s participation. In this context, the government needs to build synergies with other institutions in a reciprocal relationship with all stakeholders. Therefore, adopting the theory of government networks can be one of the strategies to strengthen government transparency. The findings of this article indicate that the government transparency application needs to develop networks in all directions: intragovernmental, intergovernmental and collaborative networks. These three types of network in contrast with the popular belief that government transparency is interpreted only as a procedural activity to outside parties. A preliminary model in this article gives an overview about the arena of government transparency with multi-directional networks more comprehensively.

The home hemodialysis hub: physical infrastructure and integrated governance structure.

Science.gov (United States)

Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Masakane, Ikuto; Herold, Aaron M

2015-04-01

An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. © 2015 International Society for Hemodialysis.

Tax Governance

DEFF Research Database (Denmark)

Boll, Karen; Brehm Johansen, Mette

to wider international trends within tax administration, especially concerning the development of risk assessments and internal control in the corporations and a greater focus on monitoring of these elements by the tax authorities. Overall, the working paper concludes that Tax Governance as a model......This working paper presents an analysis of the experiences of Cooperative Compliance in Denmark. Cooperative Compliance denotes a specific kind of collaborative program for the regulation of large corporate taxpayers by the tax authorities. Cooperative Compliance programs have been implemented...... in several countries worldwide. In Denmark the program is called Tax Governance. Tax Governance has been studied using qualitative method and the analyses of the working paper build on an extensive base of in-depth interviews – primarily with tax directors from corporations participating in the program...

Implementing Peer Learning in Clinical Education: A Framework to Address Challenges In the "Real World".

Science.gov (United States)

Tai, Joanna Hong Meng; Canny, Benedict J; Haines, Terry P; Molloy, Elizabeth K

2017-01-01

Phenomenon: Peer learning has many benefits and can assist students in gaining the educational skills required in future years when they become teachers themselves. Peer learning may be particularly useful in clinical learning environments, where students report feeling marginalized, overwhelmed, and unsupported. Educational interventions often fail in the workplace environment, as they are often conceived in the "ideal" rather than the complex, messy real world. This work sought to explore barriers and facilitators to implementing peer learning activities in a clinical curriculum. Previous peer learning research results and a matrix of empirically derived peer learning activities were presented to local clinical education experts to generate discussion around the realities of implementing such activities. Potential barriers and limitations of and strategies for implementing peer learning in clinical education were the focus of the individual interviews. Thematic analysis of the data identified three key considerations for real-world implementation of peer learning: culture, epistemic authority, and the primacy of patient-centered care. Strategies for peer learning implementation were also developed from themes within the data, focusing on developing a culture of safety in which peer learning could be undertaken, engaging both educators and students, and establishing expectations for the use of peer learning. Insights: This study identified considerations and strategies for the implementation of peer learning activities, which took into account both educator and student roles. Reported challenges were reflective of those identified within the literature. The resultant framework may aid others in anticipating implementation challenges. Further work is required to test the framework's application in other contexts and its effect on learner outcomes.

Audit mode change, corporate governance

Directory of Open Access Journals (Sweden)

Limei Cao

2015-12-01

Full Text Available This study investigates changes in audit strategy in China following the introduction of risk-based auditing standards rather than an internal control-based audit mode. Specifically, we examine whether auditors are implementing the risk-based audit mode to evaluate corporate governance before distributing audit resources. The results show that under the internal control-based audit mode, the relationship between audit effort and corporate governance was weak. However, implementation of the risk-based mode required by the new auditing standards has significantly enhanced the relationship between audit effort and corporate governance. Since the change in audit mode, the Big Ten have demonstrated a significantly better grasp of governance risk and allocated their audit effort accordingly, relative to smaller firms. The empirical evidence indicates that auditors have adjusted their audit strategy to meet the regulations, risk-based auditing is being achieved to a degree, reasonable and effective corporate governance helps to optimize audit resource allocation, and smaller auditing firms in particular should urgently strengthen their risk-based auditing capability. Overall, our findings imply that the mandatory switch to risk-based auditing has optimized audit effort in China.

Clinical implementation of enhanced dynamic wedge

International Nuclear Information System (INIS)

Klein, Eric E.; Zhu Xiaorong; Low, Daniel A.; Drzymala, Robert E.; Harms, William B.; Purdy, James A.

1996-01-01

Purpose/Objective: Our clinic has been using dynamic wedge since 1993. We appreciate the customized wedge shaped distributions (independent of field size) and the positive aspects of replacing filters with dynamic jaw motion. Varian recently introduced enhanced dynamic wedge (EDW) software. The EDW can be delivered over; a 30 cm field, asymmetric fields (in both wedged and non-wedged directions), and additional wedge angles (10, 15, 20, 25, 30, 45, 60). The EDW software creates customized segmented treatment tables (STTs) for the desired wedge angle and field size. The STT is created from a 'golden' fluence profile of 60 deg. over 30 cm. The wedge STT is derived using ratio-of-tangents and the truncated field segment extracted from the 'golden' table. A review of our dosimetric studies will be presented as well as a discussion of clinical implementation issues including treatment planning and quality assurance. Methods and Materials: We tested a set of angle and field size combinations chosen to encompass clinical needs. The wedge factor (WF) was measured using an ionization chamber along central axis for symmetric fields ranging from 4 to 20 cm, and asymmetric fields to 30 cm. The non-wedged field dimension was found to be inconsequential. An algorithm was developed to predict the wedge factor for any angle and field dimension. Isodoses were measured with film and used for profile evaluation and treatment planning development. The 'golden' fluence table was used to create a universal 60 deg. 'physical' wedge for planning. The universal wedge is combined with an open field (to derive intermediate wedge angles) and blocked according to the treatment field segment. A quality assurance program was developed that relies on multi-point diode measurements. Results: We found the WF is a function of wedge angle and field settings of the final sweep position. There is a nearly linear dependence of WF vs. field size thus allowing a minimal WF table. This eliminates a

Implementation of Epic Beaker Clinical Pathology at an academic medical center

Directory of Open Access Journals (Sweden)

Matthew D Krasowski

2016-01-01

Full Text Available Background: Epic Beaker Clinical Pathology (CP is a relatively new laboratory information system (LIS operating within the Epic suite of software applications. To date, there have not been any publications describing implementation of Beaker CP. In this report, we describe our experience in implementing Beaker CP version 2012 at a state academic medical center with a go-live of August 2014 and a subsequent upgrade to Beaker version 2014 in May 2015. The implementation of Beaker CP was concurrent with implementations of Epic modules for revenue cycle, patient scheduling, and patient registration. Methods: Our analysis covers approximately 3 years of time (2 years preimplementation of Beaker CP and roughly 1 year after using data summarized from pre- and post-implementation meetings, debriefings, and the closure document for the project. Results: We summarize positive aspects of, and key factors leading to, a successful implementation of Beaker CP. The early inclusion of subject matter experts in the design and validation of Beaker workflows was very helpful. Since Beaker CP does not directly interface with laboratory instrumentation, the clinical laboratories spent extensive preimplementation effort establishing middleware interfaces. Immediate challenges postimplementation included bar code scanning and nursing adaptation to Beaker CP specimen collection. The most substantial changes in laboratory workflow occurred with microbiology orders. This posed a considerable challenge with microbiology orders from the operating rooms and required intensive interventions in the weeks following go-live. In postimplementation surveys, pathology staff, informatics staff, and end-users expressed satisfaction with the new LIS. Conclusions: Beaker CP can serve as an effective LIS for an academic medical center. Careful planning and preparation aid the transition to this LIS.

RE-ENGINEERING GOVERNANCE; E-GOVERNMENT AS A TOOL FOR DECENTRALIZATION; GHANA AS A CASE STUDY

DEFF Research Database (Denmark)

Gyaase, Patrick Ohemeng Kwadwo

This research was undertaken to study the diffusion of E-government as a tool for decentralization, using Ghana as a case study. E-governance has been credited with the potency of facilitating good governance in countries with appreciable level of E-government maturity. Much attention is being...... espoused by E-government. This research therefore assesses the diffusion of E-government as a tool for decentralization in Ghana. The research was carried out using mixed-methods and was approached from four theoretical perspectives namely Innovation Diffusion theory the TOE framework for technological....... Qualitative data was used to assess the factors affecting the diffusion of e-government as a tool for decentralization and the results pointed to vendor and donor led diffusion as affecting E-government implementation. There is also the absence of convergence between the E-government, the decentralization...

Action and inertia in collaborative governance

NARCIS (Netherlands)

Kossmann, Christina M.; Behagel, Jelle H.; Bailey, Megan

2016-01-01

Marine Protected Areas (MPAs) have emerged as an important tool to protect the marine environment and are increasingly implemented through collaborative governance networks. Even though collaborative governance is thought of as a way towards more effective decision-making, sustainable outcomes

Transitioning couple's voluntary HIV counseling and testing (CVCT from stand-alone weekend services into routine antenatal and VCT services in government clinics in Zambia's two largest cities.

Directory of Open Access Journals (Sweden)

Mubiana Inambao

Full Text Available Most HIV infections in Africa are acquired by married/cohabiting adults and WHO recommends couple's voluntary HIV counseling and testing (CVCT for prevention. The handover from NGO-sponsored weekend CVCT to government-sponsored services in routine weekday antenatal care (ANC and individual voluntary testing and counseling (VCT services in Zambia's two largest cities from 2009-2015 is described.Government clinic counselors were trained to provide CVCT, and along with community health workers they promoted CVCT services in their clinic and surrounding areas. When client volume exceeded the capacity of on-duty staff in ANC and VCT, non-governmental organization (NGO subsidies were offered for overtime pay.Implementation of routine CVCT services varied greatly by clinic and city. The 12 highest volume clinics were examined further, while 13 clinics had CVCT numbers that were too low to warrant further investigation. In Lusaka, the proportion of pregnant women whose partners were tested rose from 2.6% in 2009 to a peak of 26.2% in 2012 and 24.8% in 2015. Corresponding reports in Ndola were 2.0% in 2009, 17.0% in 2012 and 14.5% in 2015. Obstacles to CVCT included: limited space and staffing, competing priorities, record keeping not adapted for couples, and few resources for promotion and increasing male involvement. Conflicting training models for 'partner testing' with men and women separately vs. CVCT with joint post-test counseling led to confusion in reporting to district health authorities.A focused and sustained effort will be required to reach a meaningful number of couples with CVCT to prevent heterosexual and perinatal HIV transmission. Establishing targets and timelines, funding for dedicated and appropriately trained staff, adoption of standardized data recording instruments with couple-level indicators, and expansion of community and clinic-based promotions using proven models are recommended.

Data governance for health care providers.

Science.gov (United States)

Andronis, Katerina; Moysey, Kevin

2013-01-01

Data governance is characterised from broader definitions of governance. These characteristics are then mapped to a framework that provides a practical representation of the concepts. This representation is further developed with operating models and roles. Several information related scenarios covering both clinical and non-clinical domains are considered in information terms and then related back to the data governance framework. This assists the reader in understanding how data governance would help address the issues or achieve a better outcome. These elements together enable the reader to gain an understanding of the data governance framework and how it applies in practice. Finally, some practical advice is offered for establishing and operating data governance as well as approaches for justifying the investment.

Implementation of a Mobile Clinical Decision Support Application to Augment Local Antimicrobial Stewardship.

Science.gov (United States)

Hoff, Brian M; Ford, Diana C; Ince, Dilek; Ernst, Erika J; Livorsi, Daniel J; Heintz, Brett H; Masse, Vincent; Brownlee, Michael J; Ford, Bradley A

2018-01-01

Medical applications for mobile devices allow clinicians to leverage microbiological data and standardized guidelines to treat patients with infectious diseases. We report the implementation of a mobile clinical decision support (CDS) application to augment local antimicrobial stewardship. We detail the implementation of our mobile CDS application over 20 months. Application utilization data were collected and evaluated using descriptive statistics to quantify the impact of our implementation. Project initiation focused on engaging key stakeholders, developing a business case, and selecting a mobile platform. The preimplementation phase included content development, creation of a pathway for content approval within the hospital committee structure, engaging clinical leaders, and formatting the first version of the guide. Implementation involved a media campaign, staff education, and integration within the electronic medical record and hospital mobile devices. The postimplementation phase required ongoing quality improvement, revision of outdated content, and repeated staff education. The evaluation phase included a guide utilization analysis, reporting to hospital leadership, and sustainability and innovation planning. The mobile application was downloaded 3056 times and accessed 9259 times during the study period. The companion web viewer was accessed 8214 times. Successful implementation of a customizable mobile CDS tool enabled our team to expand beyond microbiological data to clinical diagnosis, treatment, and antimicrobial stewardship, broadening our influence on antimicrobial prescribing and incorporating utilization data to inspire new quality and safety initiatives. Further studies are needed to assess the impact on antimicrobial utilization, infection control measures, and patient care outcomes.

Peer Review of Clinical Information Models: A Web 2.0 Crowdsourced Approach.

Science.gov (United States)

Leslie, Heather; Ljosland Bakke, Silje

2017-01-01

Over the past 8 years the openEHR Clinical Model program has been developing a Web 2.0 approach and tooling to support the development, review and governance of atomic clincial information models, known as archetypes. This paper describes the background and review process, and provides a practical example where cross standards organisation collaboration resulted in jointly agreed clinical content which was subsequently represented in different implementation formalisms that were effectively semantically aligned. The discussion and conclusions highlight some of the socio-technical benefits and challenges facing organisations who seek to govern automic clinical information models in a global and collaborative online community.

How Governance Regimes Shape the Implementation of Water Reuse Schemes

OpenAIRE

Frijns, Jos; Smith, Heather M.; Brouwer, Stijn; Garnett, Kenisha; Elelman, Richard; Jeffrey, Paul

2016-01-01

The governance dimensions of water reuse scheme development and operation, such as policies and regulatory frameworks, and public involvement and stakeholder collaboration, can serve to both facilitate and constrain wider adoption of water reuse practices. This paper explores the significance and underlying structure of the key governance challenges facing the water reuse sector in Europe. It presents empirical evidence from interviews and focus group sessions conducted at four water reuse sc...

Clinical audit and quality systems - practical implementation in Finland

International Nuclear Information System (INIS)

Jaervinen, H.

2003-01-01

Clinical audit is a new concept of significant importance for the quality of radiological practices, introduced by the EC Medical Exposure Directive (MED, 97/43/EURATOM). By definition, clinical audit means 'a systematic examination or review of medical radiological procedures which seeks to improve the quality and the outcome of patient care, through structured review whereby radiological practices, procedures, and results are examined against agreed standards for good medical radiological procedures, with modifications of the practices where indicated and the application of new standards if necessary'. In its most profound meaning, being introduced in the medical exposure directive, clinical audit can be seen as a review of the success in implementing the justification and optimization principles, and therefore, it is to a large extent an issue of radiation safety for the patient. According to the directive, clinical audits shall be 'carried out in accordance with national procedures'. For the last few years, parallel to the development of the MED in Europe, there has been a worldwide tendency to implement appropriate quality systems (QS) in the health care organizations, in accordance with the international quality standards (ISO 9000 series etc). Such quality systems have been applied for a long time and very widely by the industry. It is a strong belief that the development of quality systems for health care would result in equal benefits as trusted in industry, in terms of efficiency and safety of health care services. For radiological practices, the quality systems are expected to become a framework for improving the optimization of practices and for maintaining good radiation safety, as well as providing a mechanism to prevent mistakes and accidents. In some countries, like the UK and The Netherlands, there are legal requirements to establish and maintain quality systems at certain type of radiological units. In some countries and some radiological units

A Method to Evaluate Critical Factors for Successful Implementation of Clinical Pathways.

Science.gov (United States)

Dong, W; Huang, Z

2015-01-01

Clinical pathways (CPs) have been viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Despite widespread enthusiasm for CPs, research has shown that many CP initiatives are unsuccessful. To this end, this study provides a methodology to evaluate critical success factors (CSFs) that can aid healthcare organizations to achieve successful CP implementation. This study presents a new approach to evaluate CP implementation CSFs, with the aims being: (1) to identify CSFs for implementation of CPs through a comprehensive literature review and interviews with collaborative experts; (2) to use a filed study data with a robust fuzzy DEMATEL (the decision making trial and evaluation laboratory) approach to visualize the structure of complicated causal relationships between CSFs and obtain the influence level of these factors. The filed study data is provided by ten clinical experts of a Chinese hospital. 23 identified CSF factors which are initially identified through a review of the literature and interviews with collaborative experts. Then, a number of direct and indirect relationships are derived from the data such that different perceptions can be integrated into a compromised cause and effect model of CP implementation. The results indicate that the proposed approach can systematically evaluate CSFs and realize the importance of each factor such that the most common causes of failure of CP implementation could be eliminated or avoided. Therefore, the tool proposed would help healthcare organizations to manage CP implementation in a more effective and proactive way.

Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care.

Science.gov (United States)

Leggat, Sandra G; Balding, Cathy

2017-11-13

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for

Community-based interventions to improve HPV vaccination coverage among 13- to 15-year-old females: measures implemented by local governments in Japan.

Directory of Open Access Journals (Sweden)

Hiroyuki Fujiwara

Full Text Available The purpose of this study was to examine the effect of various community-based interventions in support of HPV vaccination implemented by cities and towns within Tochigi prefecture, Japan with a view to identifying useful indicators which might guide future interventions to improve HPV vaccination coverage in the prefecture. A postal questionnaire survey of all 27 local governments in Tochigi Prefecture was conducted in December 2010. All 27 responded, and 22 provided the exact numbers of the targeted and vaccinated populations of 13- to 15-year-old girls from April to December 2010. The local governments also answered questions on the type of interventions implemented including public subsidies, school-based programs, direct mail, free tickets and recalls. Local governments that conducted a school-based vaccination program reported 96.8% coverage for the 1(st dose, 96.2% for the 2(nd dose, and 91.2% for the 3(rd dose. Those that provided subsidies without school-based programs reported a wide range of vaccination rates: 45.7%-95.0% for the 1(st dose, 41.1%-93.7% for the 2(nd dose and 3.1%-90.1% for the 3(rd dose. Among this group, the combination of a free ticket, direct mail and recall was most effective, with 95.0% coverage for the 1(st dose, 93.7% for the 2(nd dose, and 90.1% for the 3(rd dose. The governments that did not offer a subsidy had the lowest vaccination coverage, with 0.8%-1.4% for the 1(st dose, 0.0%-0.8% for the 2(nd dose, and 0.1%-0.1% for the 3(rd dose. The results of this survey indicate that school-based vaccinations and public subsidies are the most effective method to improve HPV vaccination coverage; however, the combination of a free ticket, direct mail, and recalls with public subsidies are also important measures in increasing the vaccination rate. These data may afford important indicators for the successful implementation of future HPV vaccination programs.

Framework for local government to implement integrated water ...

African Journals Online (AJOL)

The Water Services Act (No. 8 of 1997) of South Africa states that water service delivery is the responsibility of local government as Water Services Authorities. The principal legal responsibility is to complete a Water Services Development Plan (WSDP) every 5 years with annual review. The WSDP encapsulates all the ...

Implementing Home Health Standards in Clinical Practice.

Science.gov (United States)

Gorski, Lisa A

2016-02-01

In 1986, the American Nurses Association (ANA) published the first Standards of Home Health Practice. Revised in 1992 and expanded in 1999 to become Home Health Nursing: Scope and Standards of Practice, it was revised in 2008 and again in 2014. In the 2014 edition, there are 6 standards of home healthcare nursing practice and 10 standards of professional performance for home healthcare nursing. The focus of this article is to describe the home healthcare standards and to provide guidance for implementation in clinical practice. It is strongly encouraged that home healthcare administrators, educators, and staff obtain a copy of the standards and fully read this essential home healthcare resource.

Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy.

Science.gov (United States)

Brown, Angela; Dewing, Jan; Crookes, Patrick

2016-07-01

To present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan. Globally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership. A multi-method research study using theoretical and empirical literature 1974-2015, a focus group, expert opinion and a national on-line survey. A conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined. Implementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated. Copyright © 2016 Elsevier Ltd. All rights reserved.

Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective.

Science.gov (United States)

Or, Calvin; Dohan, Michael; Tan, Joseph

2014-09-01

This paper addresses key barriers to implementing a clinical information system (CIS) in a Hong Kong nursing home setting, from a healthcare specific socio-technical perspective. Data was collected through field observations (n = 12) and semi-structured individual interviews (n = 18) of CIS stakeholders in a Hong Kong nursing home, and analyzed using the immersion/crystallization approach. Complex interactions relevant to our case were contextualized and interpreted within the perspective of the Sittig-Singh Healthcare Socio-Technical Framework (HSTF). Three broad clusters of implementation barriers from the eight HSTF dimensions were identified: (a) Infrastructure-based barriers, which relate to conflict between government regulations and system functional needs of users; lack of financial support; inconsistency between workflow, work policy, and procedures; and inadequacy of hardware-software infrastructural and technical support; (b) Process-based barriers, which relate to mismatch between the technology, existing work practice and workflow, and communication; low system speed, accessibility, and stability; deficient computer literacy; more experience in health care profession; clinical content inadequacy and unavailability; as well as poor system usefulness and user interface design; and (c) Outcome-based barriers, which relate to the lack of measurement and monitoring of system effectiveness. Two additional dimensions underlining the importance of the ability of a CIS to change are proposed to extend the Sittig-Singh HSTF. First, advocacy would promote the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and second, adaptability would ensure the ability of the system to adjust to emerging needs. The broad set of discovered implementation shortcomings expands prior research on why CIS can fail in nursing home settings. Moreover, our investigation offers a knowledge base and recommendations that can serve

Impacts, risks, and governance of climate engineering

Directory of Open Access Journals (Sweden)

Zhe Liu

2015-09-01

Full Text Available Climate engineering is a potential alternative method to curb global warming, and this discipline has garnered considerable attention from the international scientific community including the Chinese scientists. This manuscript provides an overview of several aspects of climate engineering, including its definition, its potential impacts and risk, and its governance status. The overall conclusion is that China is not yet ready to implement climate engineering. However, it is important for China to continue conducting research on climate engineering, particularly with respect to its feasible application within China, its potential social, economic, and environmental impacts, and possible international governance structures and governing principles, with regard to both experimentation and implementation.

Structural and Process Factors That Influence Clinical Nurse Specialist Role Implementation.

Science.gov (United States)

Kilpatrick, Kelley; Tchouaket, Eric; Carter, Nancy; Bryant-Lukosius, Denise; DiCenso, Alba

2016-01-01

The aim of this study was to examine the influence of structure and process on clinical nurse specialist (CNS) role implementation. We conducted a secondary analysis of cross-sectional survey data. The study was performed in Canada. The authors included 445 of 471 questionnaires (94.5%) of graduate-prepared CNSs. Based on Donabedian's framework, we conducted a secondary analysis of CNS responses using hierarchical regression. The internal consistency of the 6 CNS role dimensions and team dynamics subscales was excellent. The use of a framework to guide CNS role implementation influences all the role dimensions. Employer understanding of the CNS role, working in an urban catchment area, specialty certification, and more years in a CNS role had a direct positive influence on team dynamics. Full-time employment exerted a direct negative influence on this dimension. Furthermore, team dynamics (as a mediator variable), seeing patients in practice, and having an office in the clinical unit exerted a direct positive influence on the clinical dimension. Having an annual performance appraisal and a job description exerted a direct negative influence on the clinical dimension. Employer understanding, working in an urban area, full-time employment, and specialty certification had an indirect effect on the clinical dimension. Accountability to a nonnurse manager exerted a direct negative influence on the education dimension. The research and scholarly/professional development dimensions were influenced by more years in a CNS role. Accountability to a nurse manager exerted a direct positive influence on the organizational leadership dimension; unionization and seeing patients in practice had a direct negative influence on this dimension. Seeing patients in practice and full-time employment exerted a direct positive influence on the consultation dimension. The identification of structures and processes that influence CNS role implementation may inform strategies used by

Success Factors for an E-Government Strategy: Austrian Experiences, Indonesian Challenges

Directory of Open Access Journals (Sweden)

Christoph Behrens

2012-02-01

Full Text Available Focus of this paper are success factors for the implementation of an E-Government strategy. While concepts for a sophisticated strategy process in Public Sector are delivered on a regular basis, the gap between ambitious planning and its implementation seems to get wider. Authors seek to define what makes a “good strategy” in order to enhance management capacity. Meanwhile some scholars from Political Science see limitation of Governments on announcements which are not followed up by sufficient action rather as systematic problems, challenging concept and rules of liberal western democracy, or owed to growing complexity of Governance under the conditions of globalization. In context of the introduction of New Public Management and its perception of citizens as customers and on the basis of new available technical options in Information Society, a key Governance reform project in European and other Countries over the last fifteen years has been the introduction of E-Government. European market leader in this field is Austria. The author reviews concept and implementation experiences of the Austrian E-Government strategy, analyzes key success factors and opens a discussion, under which conditions a successful implementation of E-Government can take place in Indonesia.

Clinical Decision Support to Implement CYP2D6 Drug-Gene Interaction.

Science.gov (United States)

Caraballo, Pedro J; Parkulo, Mark; Blair, David; Elliott, Michelle; Schultz, Cloann; Sutton, Joseph; Rao, Padma; Bruflat, Jamie; Bleimeyer, Robert; Crooks, John; Gabrielson, Donald; Nicholson, Wayne; Rohrer Vitek, Carolyn; Wix, Kelly; Bielinski, Suzette J; Pathak, Jyotishman; Kullo, Iftikhar

2015-01-01

The level of CYP2D6 metabolic activity can be predicted by pharmacogenomic testing, and concomitant use of clinical decision support has the potential to prevent adverse effects from those drugs metabolized by this enzyme. Our initial findings after implementation of clinical decision support alerts integrated in the electronic health records suggest high feasibility, but also identify important challenges.

State governance versus dentists' autonomy - the case of Swedish dental care.

Science.gov (United States)

Franzén, Cecilia

2018-03-01

A trend towards the state governance of healthcare through quality indicators and national clinical guidelines has been observed, and it is argued that this trend can be a challenge to the autonomy of healthcare professionals. In Sweden, these regulatory tools have been implemented in combination with subsidies for adult dental care that are based on guideline recommendations which serve to ensure that dental care is evidence-based and cost-effective. This paper aims to analyse the implications of these changes regarding dentists' autonomy and whether the government's political intentions can be fulfilled. The paper is based on documents from government authorities and professional theories. The financial control over Swedish dental care has been strengthened, and it can be argued that this is a step in the right direction from a societal point of view, as public resources are limited. Dentists' professional autonomy with their patients is not affected, which is appropriate, as patients should be treated according to their individual needs and expectations. This article shows that the state's governance does not directly detail dentists' work, which indicates a balance between state governance and dentists' autonomy. However, further research is required to get knowledge on Swedish dentists' view of the governance.

Nurse manager perspective of staff participation in unit level shared governance.

Science.gov (United States)

Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J

2017-11-01

To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.

People, Governance and Forests—The Stumbling Blocks in Forest Governance Reform in Latin America

Directory of Open Access Journals (Sweden)

Arnoldo Contreras-Hermosilla

2011-01-01

Full Text Available This article examines common barriers to achieving adequate levels of forest resource governance in countries of Latin America. It looks at the deficiencies of the policy and regulatory frameworks affecting forests, the common failure to impose the rule of law, the main factors that constrain the effectiveness of government actions in the forest sector and at the political barriers to introducing reforms for change in governance structures. The elimination of these barriers acquires new importance in the implementation of successful REDD+ programs in the countries of the region.

Clinical guideline implementation strategies for common mental health disorders.

Science.gov (United States)

Moreno, Eliana María; Moriana, Juan Antonio

2016-01-01

There has been a considerable proliferation of clinical guidelines recently, but their practical application is low, and organisations do not always implement their own ones. The aim of this study is to analyse and describe key elements of strategies and resources designed by the National Institute for Health and Care Excellence for the implementation of guidelines for common mental health disorders in adults, which are some of the most prevalent worldwide. A systematic review was performed following PRISMA model. Resources, tools and implementation materials where included and categorised considering type, objectives, target and scope. A total of 212 elements were analysed, of which 33.5 and 24.5% are related to the implementation of generalized anxiety and depression guidelines, respectively. Applied tools designed to estimate costs and assess the feasibility of the setting up at local level are the most frequent type of resource. The study highlights the important variety of available materials, classified into 3 main strategies: tools targeting the professionals (30.6%), structural (26.4%), and organizational (24%). Developing guidelines is not enough; it is also necessary to promote their implementation in order to encourage their application. The resources and strategies described in this study may be potentially applicable to other contexts, and helpful to public health managers and professionals in the design of programmes and in the process of informed decision making to help increase access to efficient treatments. Copyright © 2015. Published by Elsevier España.

Beyond Good Governances: Lesson from Forest and Cultural Governance in Pelalawan, Pangkalan Kerinci, Riau

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Novi Paramita Dewi

2017-11-01

Full Text Available The shift in government concept into governance takes the consequence of changes in public governance including in the forestry sector. Good forest governance becomes a great hope for managing the forest condition so that sustainable forest management can be realized. However, in its implementation, it contains a big challenge for the forest in Indonesia which is mostly identical with indigenous people. Meanwhile, the development becomes a necessity that cannot be inhibited in which business corporation as the actor who plays in the forest governance is considered as a major threat to the environment and indigenous people. To achieve good forest governance, it is necessary to have a synergy with cultural governance that is hoped to be able to accommodate the indigenous people interests. This paper is a case study related to the practice as an effort to achieve good forest governance in the indigenous people of Pelalawan that are followed by the cultural governance effort so that the indigenous people culture of Pelalawan that is closely related to the forest can still be maintained.

Strategic governance: Addressing neonatal mortality in situations of political instability and weak governance.

Science.gov (United States)

Wise, Paul H; Darmstadt, Gary L

2015-08-01

Neonatal mortality is increasingly concentrated globally in situations of conflict and political instability. In 1991, countries with high levels of political instability accounted for approximately 10% of all neonatal deaths worldwide; in 2013, this figure had grown to 31%. This has generated a "grand divergence" between those countries showing progress in neonatal mortality reduction compared to those lagging behind. We present new analyses demonstrating associations of neonatal mortality with political instability (r = 0.55) and poor governance (r = 0.70). However, heterogeneity in these relationships suggests that progress is possible in addressing neonatal mortality even in the midst of political instability and poor governance. In order to address neonatal mortality more effectively in such situations, we must better understand how specific elements of "strategic governance"--the minimal conditions of political stability and governance required for health service implementation--can be leveraged for successful introduction of specific health services. Thus, a more strategic approach to policy and program implementation in situations of conflict and political instability could lead to major accelerations in neonatal mortality reduction globally. However, this will require new cross-disciplinary collaborations among public health professionals, political scientists, and country actors. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Examining dog owners' beliefs regarding rabies vaccination during government-funded vaccine clinics in Grenada to improve vaccine coverage rates.

Science.gov (United States)

Thomas, D; Delgado, A; Louison, B; Lefrancois, T; Shaw, J

2013-07-01

Vaccination of domestic pets is an important component of rabies control and prevention in countries where the disease is maintained in a wildlife reservoir. In Grenada, vaccine coverage rates were low, despite extensive public education and advertising of government-sponsored vaccine clinics where rabies vaccine is administered to animals at no cost to animal owners. Information was needed on reasons for decreased dog owner participation in government-funded rabies vaccination clinics. A total of 120 dog owners from 6 different parishes were asked to complete a questionnaire assessing their currently held beliefs about rabies vaccination and perception of the risk posed by rabies. Over 70% of respondents believed that problems in the organization and management of clinic sites could allow for fighting between dogs or disease spread among dogs, while 35% of owners did not believe that they had the ability or adequate help to bring their dogs to the clinic sites. Recommendations for improving vaccine coverage rates included: improved scheduling of clinic sites and dates; increased biosecurity at clinic locations; focused advertising on the availability of home visits, particularly for aggressive dogs or dogs with visible skin-related diseases such as mange; and the recruitment of community volunteers to assist with bringing dogs to the clinic sites. Copyright © 2013. Published by Elsevier B.V.

Influence of food intake and eating habits on hypertension control among outpatients at a government health clinic in the Klang Valley, Malaysia.

Science.gov (United States)

Suzana, S; Azlinda, A; Hin, S L; Khor, W H; Zahara, Z; Sa'ida, Munira J; Norliza, M

2011-08-01

In Malaysia, hypertension prevalence has increased from 13% in 1996 to 43% in 2006 based on the Third National Health and Morbidity Survey. Recognising the importance of hypertension control to prevent cardiovascular morbidity and mortality, a cross-sectional study was carried out to assess factors influencing blood pressure among 74 hypertensive adults (22 men, 52 women, mean age 61.1 +/- 8.8 years old) attending an outpatient clinic of a government health clinic in Klang Valley. Subjects were interviewed to obtain information on social and health, physical activity level and food intake using Diet History Questionnaire (DHQ) and Food Frequency Questionnaire (FFQ). Anthropometric measurements including weight, height, waist circumference and percentage of body fat were also conducted. The majority of the subjects (71.6%) had poor hypertension control as determined using blood pressure. Women aged 30-59 years old had a higher mean diastolic blood pressure (87.3 +/- 11.6 mmHg) than women aged 60 years old (78.5 +/- 9.5 mmHg) (p diet, coffee consumption and inadequate milk intake were unsatisfactory. There is a need to implement a nutrition intervention programme based on MNT to achieve good hypertensive control among subjects.

Managing e-government

DEFF Research Database (Denmark)

Rose, Jeremy; Persson, John Stouby; Heeager, Lise Tordrup

2015-01-01

Public sector managers take much of the responsibility for selecting, commissioning, implementing and realising benefits from information technology (IT) projects. However, e-Government initiatives often suffer from complexity, vision failure, lack of goal clarity and insufficient commitment....... These problems may stem from value traditions that are deeply ingrained in managers' cultural environments but not always in harmony with each other. A first step towards working with value complexity is to understand it; we synthesise a model of value positions for e-Government derived from major traditions...... in the public administration literature. Four value positions relevant to e-Government together with their IT assumptions are identified; they reflect the ideals of professionalism, efficiency, service and engagement. A qualitative investigation of Danish local authority managers displays both value congruence...

A Virtual Organisation Model for E-Government

Directory of Open Access Journals (Sweden)

Janice Bum

2002-05-01

Full Text Available This paper looks at the implementation of a new customer value alliance model in e-govemment. Firstly we review the issues of e-govemment and the drive towards customer centric organisations in the context of multiple government agencies. A model of e-Government is introduced and examined within the context of a virtual organisation model which can be applied along the customer value chain across multiple service agencies. A case study is used to demonstrate how this concept of a virtual organisation as a customer value-alliance model can effect a successful transition to e-Govemment from a traditional Government model. Finally, we examine how the Aboriginal Affairs Department, a Western Australian Government agency is implementing this model for improved customer service and the implications of this model for the management of change in a developing e-community.

Obstacles to Successful Implementation of eHealth Applications into Clinical Practice.

Science.gov (United States)

Voogt, Marianne P; Opmeer, Brent C; Kastelein, Arnoud W; Jaspers, Monique W M; Peute, Linda W

2018-01-01

eHealth can improve healthcare worldwide, and scientific research should provide evidence on the efficacy, safety and added value of such interventions. For successful implementation of eHealth interventions into clinical practice, barriers need to be anticipated. We identified seven barriers by interviewing health professionals in the Dutch healthcare system. These barriers covered three topics: financing, human factors and organizational factors. This paper discusses their potential impact on eHealth uptake. Bridging the gap between studies to assess effective eHealth interventions and their value-based implementation in healthcare is much needed.

Barriers facing local governance in the implementation of sanitation ...

African Journals Online (AJOL)

The study aimed at exploring the barriers facing local governance in the ... Methods: A qualitative research method was employed whereby in-depth interviews were ... All interviews were audio recorded and transcribed verbatim and content ...

Investigating the congruence of crowdsourced information with official government data: the case of pediatric clinics.

Science.gov (United States)

Kim, Minki; Jung, Yuchul; Jung, Dain; Hur, Cinyoung

2014-02-03

Health 2.0 is a benefit to society by helping patients acquire knowledge about health care by harnessing collective intelligence. However, any misleading information can directly affect patients' choices of hospitals and drugs, and potentially exacerbate their health condition. This study investigates the congruence between crowdsourced information and official government data in the health care domain and identifies the determinants of low congruence where it exists. In-line with infodemiology, we suggest measures to help the patients in the regions vulnerable to inaccurate health information. We text-mined multiple online health communities in South Korea to construct the data for crowdsourced information on public health services (173,748 messages). Kendall tau and Spearman rank order correlation coefficients were used to compute the differences in 2 ranking systems of health care quality: actual government evaluations of 779 hospitals and mining results of geospecific online health communities. Then we estimated the effect of sociodemographic characteristics on the level of congruence by using an ordinary least squares regression. The regression results indicated that the standard deviation of married women's education (P=.046), population density (P=.01), number of doctors per pediatric clinic (P=.048), and birthrate (P=.002) have a significant effect on the congruence of crowdsourced data (adjusted R²=.33). Specifically, (1) the higher the birthrate in a given region, (2) the larger the variance in educational attainment, (3) the higher the population density, and (4) the greater the number of doctors per clinic, the more likely that crowdsourced information from online communities is congruent with official government data. To investigate the cause of the spread of misleading health information in the online world, we adopted a unique approach by associating mining results on hospitals from geospecific online health communities with the sociodemographic

Governance of disaster risk reduction in Cameroon: The need to empower local government

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Henry N. Bang

2013-02-01

Full Text Available The impact of natural hazards and/or disasters in Cameroon continues to hit local communities hardest, but local government lacks the ability to manage disaster risks adequately. This is partly due to the fact that the necessity to mainstream disaster risk reduction into local governance and development practices is not yet an underlying principle of Cameroon’s disaster management framework. Using empirical and secondary data, this paper analyses the governance of disaster risks in Cameroon with particular focus on the challenges local government faces in implementing disaster risk reduction strategies. The hypothesis is that the governance of disaster risks is too centralised at the national level, with huge implications for the effective governance of disaster risks at the local level. Although Cameroon has reinvigorated efforts to address growing disaster risks in a proactive way, it is argued that the practical actions are more reactive than proactive in nature. The overall aim is to explore the challenges and opportunities that local government has in the governance of disaster risks. Based on the findings from this research, policy recommendations are suggested on ways to mainstream disaster risk reduction strategies into local governance, and advance understanding and practice in the local governance of disaster risks in the country.

In-situ medical simulation for pre-implementation testing of clinical service in a regional hospital in Hong Kong.

Science.gov (United States)

Chen, P P; Tsui, N Tk; Fung, A Sw; Chiu, A Hf; Wong, W Cw; Leong, H T; Lee, P Sf; Lau, J Yw

2017-08-01

The implementation of a new clinical service is associated with anxiety and challenges that may prevent smooth and safe execution of the service. Unexpected issues may not be apparent until the actual clinical service commences. We present a novel approach to test the new clinical setting before actual implementation of our endovascular aortic repair service. In-situ simulation at the new clinical location would enable identification of potential process and system issues prior to implementation of the service. After preliminary planning, a simulation test utilising a case scenario with actual simulation of the entire care process was carried out to identify any logistic, equipment, settings or clinical workflow issues, and to trial a contingency plan for a surgical complication. All patient care including anaesthetic, surgical, and nursing procedures and processes were simulated and tested. Overall, 17 vital process and system issues were identified during the simulation as potential clinical concerns. They included difficult patient positioning, draping pattern, unsatisfactory equipment setup, inadequate critical surgical instruments, blood products logistics, and inadequate nursing support during crisis. In-situ simulation provides an innovative method to identify critical deficiencies and unexpected issues before implementation of a new clinical service. Life-threatening and serious practical issues can be identified and corrected before formal service commences. This article describes our experience with the use of simulation in pre-implementation testing of a clinical process or service. We found the method useful and would recommend it to others.

Governance of Service-Oriented Architecture in a Healthcare Organization: A Case Study

DEFF Research Database (Denmark)

Koumaditis, Konstantinos

2015-01-01

The article introduces a service-oriented architecture (SOA) governance framework for successful implementation in a healthcare organization. The proposed framework, based on a rigorous literature review, proposes nine governance elements that should be considered during the SOA implementation...... process. This proposal aims to pinpoint attributes and guidelines for each element required to successfully govern SOA and tackle longstanding healthcare information systems (HIS) implementation challenges. The framework was tested in a healthcare organization and valuable insights are presented herein...

The clinical implementation of respiratory-gated intensity-modulated radiotherapy

International Nuclear Information System (INIS)

Keall, Paul; Vedam, Sastry; George, Rohini; Bartee, Chris; Siebers, Jeffrey; Lerma, Fritz; Weiss, Elisabeth; Chung, Theodore

2006-01-01

The clinical use of respiratory-gated radiotherapy and the application of intensity-modulated radiotherapy (IMRT) are 2 relatively new innovations to the treatment of lung cancer. Respiratory gating can reduce the deleterious effects of intrafraction motion, and IMRT can concurrently increase tumor dose homogeneity and reduce dose to critical structures including the lungs, spinal cord, esophagus, and heart. The aim of this work is to describe the clinical implementation of respiratory-gated IMRT for the treatment of non-small cell lung cancer. Documented clinical procedures were developed to include a tumor motion study, gated CT imaging, IMRT treatment planning, and gated IMRT delivery. Treatment planning procedures for respiratory-gated IMRT including beam arrangements and dose-volume constraints were developed. Quality assurance procedures were designed to quantify both the dosimetric and positional accuracy of respiratory-gated IMRT, including film dosimetry dose measurements and Monte Carlo dose calculations for verification and validation of individual patient treatments. Respiratory-gated IMRT is accepted by both treatment staff and patients. The dosimetric and positional quality assurance test results indicate that respiratory-gated IMRT can be delivered accurately. If carefully implemented, respiratory-gated IMRT is a practical alternative to conventional thoracic radiotherapy. For mobile tumors, respiratory-gated radiotherapy is used as the standard of care at our institution. Due to the increased workload, the choice of IMRT is taken on a case-by-case basis, with approximately half of the non-small cell lung cancer patients receiving respiratory-gated IMRT. We are currently evaluating whether superior tumor coverage and limited normal tissue dosing will lead to improvements in local control and survival in non-small cell lung cancer

The Value of Clinical Teachers for EMR Implementations and Conversions

Science.gov (United States)

Pantaleoni, J.L.; Longhurst, C.A.

2015-01-01

Summary Effective physician training is an essential aspect of EMR implementation. However, it can be challenging to find instructors who can present the material in a clinically relevant manner. The authors describe a unique physician-training program, utilizing medical students as course instructors. This approach resulted in high learner satisfaction rates and provided significant cost-savings compared to alternative options. PMID:25848414

Data governance requirements for distributed clinical research networks: triangulating perspectives of diverse stakeholders.

Science.gov (United States)

Kim, Katherine K; Browe, Dennis K; Logan, Holly C; Holm, Roberta; Hack, Lori; Ohno-Machado, Lucila

2014-01-01

There is currently limited information on best practices for the development of governance requirements for distributed research networks (DRNs), an emerging model that promotes clinical data reuse and improves timeliness of comparative effectiveness research. Much of the existing information is based on a single type of stakeholder such as researchers or administrators. This paper reports on a triangulated approach to developing DRN data governance requirements based on a combination of policy analysis with experts, interviews with institutional leaders, and patient focus groups. This approach is illustrated with an example from the Scalable National Network for Effectiveness Research, which resulted in 91 requirements. These requirements were analyzed against the Fair Information Practice Principles (FIPPs) and Health Insurance Portability and Accountability Act (HIPAA) protected versus non-protected health information. The requirements addressed all FIPPs, showing how a DRN's technical infrastructure is able to fulfill HIPAA regulations, protect privacy, and provide a trustworthy platform for research. 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.

Shared governance. From vision to reality.

Science.gov (United States)

Westrope, R A; Vaughn, L; Bott, M; Taunton, R L

1995-12-01

Quality patient care is best provided by competent clinical staff members who are committed to their work, organizational values, and goals, and who maintain employment over time. Shared governance has provided the framework for clinical nurses to become more committed to their practice through decision making and to assume accountability for the outcomes of their decisions. At a tertiary teaching facility, shared governance resulted in increased job satisfaction, commitment, and retention among staff nurses. The authors describe the journey from creation of the shared governance vision to reality, and the impact of the changes.

OPTIMALISASI BANK SYARI’AH MENUJU GOOD CORPORATE GOVERNANCE

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Fahrur Ulum Fahrur Ulum

2013-08-01

Full Text Available Abstract: Syarî’ah banking must be optimized earnestly to fulfill the stakeholders interest. The effective implementation of cooporate governance would realize the goal of fairness, accountability, and transparancy.  There are several prior focus of this system manager: basic concept and problems of cooperate governance in syarî’ah banking, the pillars of implementation, and the mechanism.  As a result, to create an effective  cooperate governance of syariah banking, the following aspects must be urgently required: a contract clarity, market discipline, moral dimension, socio-political atmosphere,  law enforcement, and institution. Board of directors, senior management, stockholders, and depositors have important roles to establish the  harmony of syariah banking development. The stakeholders  are directly connected to the mechanism of cooperate governance of syariah banking. Key Words: corporate governance, bank syari’ah, stakeholders, dan mudlârabah

Clinical research data warehouse governance for distributed research networks in the USA: a systematic review of the literature.

Science.gov (United States)

Holmes, John H; Elliott, Thomas E; Brown, Jeffrey S; Raebel, Marsha A; Davidson, Arthur; Nelson, Andrew F; Chung, Annie; La Chance, Pierre; Steiner, John F

2014-01-01

To review the published, peer-reviewed literature on clinical research data warehouse governance in distributed research networks (DRNs). Medline, PubMed, EMBASE, CINAHL, and INSPEC were searched for relevant documents published through July 31, 2013 using a systematic approach. Only documents relating to DRNs in the USA were included. Documents were analyzed using a classification framework consisting of 10 facets to identify themes. 6641 documents were retrieved. After screening for duplicates and relevance, 38 were included in the final review. A peer-reviewed literature on data warehouse governance is emerging, but is still sparse. Peer-reviewed publications on UK research network governance were more prevalent, although not reviewed for this analysis. All 10 classification facets were used, with some documents falling into two or more classifications. No document addressed costs associated with governance. Even though DRNs are emerging as vehicles for research and public health surveillance, understanding of DRN data governance policies and procedures is limited. This is expected to change as more DRN projects disseminate their governance approaches as publicly available toolkits and peer-reviewed publications. While peer-reviewed, US-based DRN data warehouse governance publications have increased, DRN developers and administrators are encouraged to publish information about these programs. 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.

Clarification of Safe Delivery by Iranian Experts Based on Clinical Governance: A Qualitative Study

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Forozun Olfati

2015-10-01

Full Text Available Objective:To clarify the principles of a safe delivery based on Clinical Governance Criteria, as recommended by the pertinent experts.Materials and methods:The current study was part of a qualitative research conducted by content analysis method in 2013 and purposive sampling, performing 24 in-depth interviews based on semi-structured questions and analyzed using thematic content analysis. The participants in this research included midwives, obstetricians, managers, and hospital doctors. The data were under continuous consideration and comparative analysis in order to achieve data saturation.Results:The main concepts derived from interpretations of the pertinent experts include: Patient & Public involvement; Risk Management; Education; Clinical efficiency; Clinical audit; Personnel & Management.Conclusion:In a safe delivery, there is a vicious cycle of causes the elimination of which is only possible through benchmarking patterns that attend to most aspects of a safe delivery.Changes to services require utilization of appropriate change management strategies.

Innovation in Multi-Level Governance for Energy Efficiency. Sharing experience with multi-level governance to enhance energy efficiency. Information paper

Energy Technology Data Exchange (ETDEWEB)

Jollands, Nigel; Gasc, Emilien; Pasquier, Sara Bryan

2009-12-15

Despite creating a plethora of national and international regulations and voluntary programmes to improve energy efficiency, countries are far from achieving full energy efficiency potential across all sectors of the economy. One major challenge, among numerous barriers, is policy implementation. One strategy that many national governments and international organisations have used to address the implementation issue is to engage regional and local authorities. To that end, many programmes have been created that foster energy efficiency action and collaboration across levels of government. The aim of this report is to identify trends and detail recent developments in multi-level governance in energy efficiency (MLGEE). By sharing lessons learned from daily practitioners in the field, the IEA hopes energy efficiency policy makers at all levels of government will be able to identify useful multilevel governance (MLG) practices across geographical and political contexts and use these to design robust programmes; modify existing programmes, and connect and share experiences with other policy makers in this field.

Implementing a sustainable clinical supervision model for Isles nurses in Orkney.

Science.gov (United States)

Hall, Ian

2018-03-02

The Isles Network of Care (INOC) community nurses work at the extreme of the remote and rural continuum, working mostly as lone practitioners. Following the development of sustainable clinical supervision model for Isles nurses in Orkney, clinical supervision was found to improve both peer support and governance for this group of isolated staff. A literature overview identified the transition of clinical supervision in general nursing over 24 years from 'carrot' to 'stick'. The study included a questionnaire survey that was sent to the 2017 Queen's Nursing Institute Scotland cohort to elicit information about the nurses' experience of clinical supervision. The survey found that 55% provide supervision and 40% receive it. Health board encouragement of its use was found to be disappointingly low at 40%. The INOC nurses were surveyed about the new peer-support (restorative) model, which relies on video-conference contact to allow face to face interaction between isolated isles nurses. Feedback prompted a review of clinical supervision pairings, and the frequency and methods of meeting. The need for supervisor training led to agreement with the Remote and Rural Health Education Alliance to provide relevant support. The perceived benefits of supervision included increased support and reflection, and improved relationships with isolated colleagues.

Mature e-Government based on spatial data

DEFF Research Database (Denmark)

Hvingel, Line; Baaner, Lasse; Schrøder, Lise

2014-01-01

The relation of spatial data and e-Government is important, but not always acknowledged in the development and implementation of e-Government. The implementation of the INSPIRE directive pushed this agenda towards a growing awareness of the role of spatial data and the need for a spatial data...... infrastructure to support e-Government. With technology, policies, data and infrastructure in place, new iterations of this relationship are needed, in order to reach a higher level of maturity. This paper analyses and discusses the need for the differentiated roles of spatial data as an important step towards...... of these data is the wording of the law and the spatial data are just visualisation thereof. Under other circumstances, the spatial data themselves represent the legal status. Compliance between spatial data and the legal administrative framework is necessary, to obtain a mature e-Government. A preliminary test...

Filling the Gap between IT Governance and IT Project Management

DEFF Research Database (Denmark)

Lundin, Jette

2007-01-01

there is a gap between IT governance and IT project management. Theory on IT governance assumes that strategies are implemented through projects - but do not go into detail on how to do it. Theories on project management do not include interaction with governance processes. A gap between IT governance...... and IT project management can result in IT that does not support business strategy and in lack of flexibility and agility. Competitive, changing business environments combined with the uncertainty and unpredictability of IT implementation projects call for IT governance organisation and processes to sense......The goal of this paper is to explore coordination mechanisms as part of a solution to fill the gap between IT Governance and IT project management. The Gap between IT governance and IT project management has not been fully explored in IT management research. Both in theory and in practice...

E-government strategy of Surabaya city government through e-rt / rw to improve the quality of public service

Science.gov (United States)

Oktariyanda, T. A.; Rahaju, T.

2018-01-01

The use of information technology by Surabaya City Government has generated various innovations of public services such as “e-Sapa Warga”, e-Commerce, “e-RT/RW”, e-Budgeting, e-Project, e-Procurement, “e-Pendidikan”. Among the many innovations, e-RT/RW (Rukun Tetangga / Rukun Warga) is an innovation that is quite prominent because there are still many areas that have not implemented. This research can be classified as literature review and critical research. The aims of this research are to describe and analyze e-government strategy in Surabaya City through e-RT / RW to improve public service quality. The result of this research is e-government strategy in Surabaya City through e-RT / RW is already relevant and in accordance with Goldsmith’s theory of e-government. The positive impact of the implementation of e-RT / RW is the increasing quality of public services to bring benefits to all citizens Surabaya City.

Energy Conservation of the Designated Government Buildings in Thailand

Directory of Open Access Journals (Sweden)

Wangskarn Prapat

2016-01-01

Full Text Available The designated government buildings have implemented and administered energy program under the energy development and promotion Act 2007 for many years continuously until 2015. Appointment person responsible for energy, performing energy management and implementing the energy conservation work plan and measures are legal requirements for the designated buildings. Therefore, the ministry of Energy has launched the project to support the implementation of energy management. The aim of the project was to create the energy management system in the designated government buildings, and to reduce energy consumption. In this paper, the evaluation of the project has been presented from the achievements of 839 designated government buildings. The energy saving is more than 440 ktoe/year. This is about 3% of energy consumptions of buildings.

STATE-OWNED RURAL BANK PERFORMANCE: DO GOVERNMENT OWNERSHIP AND CORPORATE GOVERNANCE UNIQUENESS MATTER?

Directory of Open Access Journals (Sweden)

Azilsyah Noerdin

2016-12-01

Full Text Available It has been widely recognized that ownership structure has an impact on firm performance. This paper examines whether rural banks owned by government have poorer performance than those owned by private parties with the emphasis on corporate governance uniqueness of state-owned rural banks. 42 rural banks in Indonesia has been selected as the sample. MANOVA test is used to investigate the difference performance between the two types of the rural banks. The results show that state-owned rural banks perform poorer than their privately-owned counterparts. It is indicated by lower ROA ratio and higher OEOI and NPL ratios. The important implication of this finding suggets that government ownership impede boards of rural banks to implement good corporate governance practices in order to improve their banks performance.

Augmenting Predictive Modeling Tools with Clinical Insights for Care Coordination Program Design and Implementation.

Science.gov (United States)

Johnson, Tracy L; Brewer, Daniel; Estacio, Raymond; Vlasimsky, Tara; Durfee, Michael J; Thompson, Kathy R; Everhart, Rachel M; Rinehart, Deborath J; Batal, Holly

2015-01-01

The Center for Medicare and Medicaid Innovation (CMMI) awarded Denver Health's (DH) integrated, safety net health care system $19.8 million to implement a "population health" approach into the delivery of primary care. This major practice transformation builds on the Patient Centered Medical Home (PCMH) and Wagner's Chronic Care Model (CCM) to achieve the "Triple Aim": improved health for populations, care to individuals, and lower per capita costs. This paper presents a case study of how DH integrated published predictive models and front-line clinical judgment to implement a clinically actionable, risk stratification of patients. This population segmentation approach was used to deploy enhanced care team staff resources and to tailor care-management services to patient need, especially for patients at high risk of avoidable hospitalization. Developing, implementing, and gaining clinical acceptance of the Health Information Technology (HIT) solution for patient risk stratification was a major grant objective. In addition to describing the Information Technology (IT) solution itself, we focus on the leadership and organizational processes that facilitated its multidisciplinary development and ongoing iterative refinement, including the following: team composition, target population definition, algorithm rule development, performance assessment, and clinical-workflow optimization. We provide examples of how dynamic business intelligence tools facilitated clinical accessibility for program design decisions by enabling real-time data views from a population perspective down to patient-specific variables. We conclude that population segmentation approaches that integrate clinical perspectives with predictive modeling results can better identify high opportunity patients amenable to medical home-based, enhanced care team interventions.

Governance, Government, and the Search for New Provider Models

Directory of Open Access Journals (Sweden)

Richard B. Saltman

2016-01-01

Full Text Available A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome.

Governance, Government, and the Search for New Provider Models.

Science.gov (United States)

Saltman, Richard B; Duran, Antonio

2015-11-03

A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory) perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome. © 2016 by Kerman University of Medical Sciences.

Building a world class information security governance model

CSIR Research Space (South Africa)

Lessing, M

2008-05-01

Full Text Available practice documents. The resulting model covers all the relevant aspects on strategic, management and technical level when implemented altogether. This model includes the related aspects of Corporate Governance, Information Technology Governance...

Energy Efficiency Programs in K-12 Schools: A Guide to Developing and Implementing Greenhouse Gas Reduction Programs. Local Government Climate and Energy Strategy Series

Science.gov (United States)

US Environmental Protection Agency, 2011

2011-01-01

Saving energy through energy efficiency improvements can cost less than generating, transmitting, and distributing energy from power plants, and provides multiple economic and environmental benefits. Local governments can promote energy efficiency in their jurisdictions by developing and implementing strategies that improve the efficiency of…

Roadmapping Future E-Government Research

Science.gov (United States)

Bicking, Melanie

Global electronic markets, virtual organisations, virtual identities, virtual products and services, and Internet-related crime are growing in prominence and importance. In a world that is increasingly non-physical and borderless, what are government's roles, responsibilities and limitations? The Internet plays a central role within the transformation process from traditional governments towards modern and innovative government that the requirements of an Information Society. Based on the findings of the eGovRTD2020 project, that aims at identifying key research challenges and at implementing a model for a holistic government with horizon 2020, this paper explains the necessity to investigate and understand the Internet and in particular government's role and responsibilities in it. Furthermore, the paper provides a research roadmap that details how to address certain issue related research questions.

Provincial government performance on climate change: 2000

International Nuclear Information System (INIS)

Hornung, R.

2000-01-01

This assessment of provincial government performance on climate change is intended as a 'baseline' prior to the implementation of the National Implementation Strategy on Climate Change, (NIS) scheduled to be signed by the federal and provincial Ministers of Energy and Environment in Quebec City in October 2000. Participants are also expected to agree on a 'First Business Plan' for the NIS at that same meeting, including identification of measures each of the provincial governments plan to institute to address climate change issues over the next two to three years. The report is based on performance of government activity in climate change in Alberta, British Columbia, Saskatchewan, Ontario and Quebec , the five provinces that together account for 89 per cent of Canada's total GHG emissions, against the greenhouse gas emission measures identified by the various provincial governments on various occasions over the past 10 years. Nine areas of potential activity to address climate change with a total of 38 criteria were used. Each criterion was used to determine whether or not a provincial government has implemented a specific measure that will likely be an integral component of a national effort to address climate change. The nine categories forming the base of the assesment were: transportation, electricity generation,buildings, industry, readiness to facilitate emissions trading, 'own house in order' other sources of GHG, promoting GHG reduction technology development, and enhancing awareness and public education. All provincial governments received a very poor, failing grade . (The 'best': British Columbia with 30.5 per cent; the 'worst': Saskatchewan with 20.5 per cent). The report characterizes the last 10 years as 'the lost decade' with respect to government action on the issue of climate change. It points out that time is running out; provincial governments have to make the effort to be part of the solution to climate change, or they will have solutions

Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals.

Science.gov (United States)

Brazinha, Isabel; Fernandez-Llimos, Fernando

2014-10-01

In some countries, such as Portugal, clinical pharmacy services in the hospital setting may be implemented to a lower extent than desirable. Several studies have analysed the perceived barriers to pharmacy service implementation in community pharmacy. To identify the barriers towards the implementation of advanced clinical pharmacy services at a hospital level in Portugal, using medication follow-up as an example. Hospital pharmacies in Portugal. A qualitative study based on 20 face-to-face semi-structured interviews of strategists and hospital pharmacists. The interview guide was based on two theoretical frameworks, the Borum's theory of organisational change and the Social Network Theory, and then adapted for the Portuguese reality and hospital environments. A constant comparison process with previously analysed interviews, using an inductive approach, was carried out to allow themes to emerge. Themes were organised following the Leavitt's Organizational Model: functions and objectives; hospital pharmacist; structure of pharmacy services; environment; technology; and medication follow-up based on the study topic. Barriers towards practice change. Medication follow-up appeared not to be a well-known service in Portuguese hospital pharmacies. The major barriers at the pharmacist level were their mind-set, resistance to change, and lack of readiness. Lack of time, excessive bureaucratic and administrative workload, reduced workforce, and lack of support from the head of the service and other colleagues were identified as structural barriers. Lack of access to patients' clinical records and cumbersome procedures to implement medication follow-up were recognised as technological barriers. Poor communication with other healthcare professionals, and lack of support from professional associations were the major environmental barriers. Few of the barriers identified by Portuguese hospital pharmacists were consistent with previous reports from community pharmacy. The mind

Keberhasilan Implementasi Elektronik Government Berdasarkan Persepsi Pengguna

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Yuni Rimawati

2012-08-01

Full Text Available This research verifies the success of e-Government that is implemented by directorate general of taxes as state institution based on user satisfaction. Seven variables investigated in this research are the usability of e-Government, information quality of e-Government, service quality of e-Government, trust of the government institution, trust of the internet, and Intention to Use Frequently e-Government. The measurement of independent variables that used in this research is based on Barnes and Vidgen (2006 and Bélangerdan Carter (2008. The measurement of dependent variable (user satisfaction based on Xiao dan Dasgupta (2002 which modified with Verdegem and Verleye (2009.

Export strategy risks and governance in the clothing industry

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Arthur Mapanga

2016-08-01

Full Text Available This paper investigates the export strategy implementation risks in Zimbabwe’s clothing sector with a view to build a framework for improving strategy implementation and governance. The government of Zimbabwe has formulated a five year export strategic blue-print to resuscitate the clothing value chain. However, to date, no visible movement towards implementing the export strategy has materialised. The sector is on the brink of collapse putting the welfare and livelihood of over two million people dependent on the sector at risk. A desk research and key informant interviews were conducted to understand the barriers causing inertia in the implementation of the export strategy. Cotton farmers’ unions’ representatives, the cotton ginners association members, the spinning industry members and garment manufacturers representatives, clothing retailers’ representatives, workers’ unions’ members and government officials were important sources of information towards the discovery of the risks. From the research, six of the strategy implementation risks were linked to human elements. Leadership, consensus and commitment deficiencies militated against the implementation of the export strategy in the clothing value chain. There is also a lack of trust among the value chain actors leading to the dislocation of efforts to resuscitate the sector

'Joined Up' Local Governments?

DEFF Research Database (Denmark)

Bjørnå, Hilde; Casale, Donatella; Hajnal, Gyorgy

eforms inspired by NPM have raised many challenges to governments, such as time lags between implementation and (any) results, fragmentation due to unbundling monolithic organizations and mediocre support from public sector stakeholders (Christensen/Lægreid 2007, Dunleavy et al. 2006, Hood...... measures (6 2004). JUG involves an emphasis on coordinating governmental activities, for example through partnerships and horizontal governing approaches, to eliminate contradictions between different policies, and to deliver integrated and seamless services from a citizen’s perspective (Lægreid et al......, for example one-stop-shops, often combined with e-government solutions (Norway, Italy, Hungary and Germany), public sector recentralisation and de-agencification (Ireland) or refined strategies for steering the ‘landscape of corporatized organizations‘ (Hungary and Austria)....

Good governance as perceived by Dabawenyos

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Adrian M. Tamayo

2016-12-01

Full Text Available The debate on good governance had shaped public policies of many governments. This study was conducted to obtain latent perspectives of good governance. A survey was conducted using two-stage cluster sampling in the first congressional district of Davao City involving 351 respondents. Findings reveal that the notion of good governance of Dabawenyos is primarily a government to implement the rule of law; peace and order is a necessity to facilitate market efficiency. Also, it was found that political leadership creates notions of good governance; public bestowed power to its political leaders as a matter of trust. On the other hand, leaders incorporate soft and hard forms of power in delegating powers without losing control, causing a widespread and significant impact on the formation and development of Davao’s perspectives of good governance. This is the rubber band effect of good governance leadership.

Climate change governance

Energy Technology Data Exchange (ETDEWEB)

Knieling, Joerg [HafenCity Univ. Hamburg (Germany). Urban Planning and Regional Development; Leal Filho, Walter (eds.) [HAW Hamburg (Germany). Research and Transfer Centre Applications of Life Science

2013-07-01

Climate change is a cause for concern both globally and locally. In order for it to be tackled holistically, its governance is an important topic needing scientific and practical consideration. Climate change governance is an emerging area, and one which is closely related to state and public administrative systems and the behaviour of private actors, including the business sector, as well as the civil society and non-governmental organisations. Questions of climate change governance deal both with mitigation and adaptation whilst at the same time trying to devise effective ways of managing the consequences of these measures across the different sectors. Many books have been produced on general matters related to climate change, such as climate modelling, temperature variations, sea level rise, but, to date, very few publications have addressed the political, economic and social elements of climate change and their links with governance. This book will address this gap. Furthermore, a particular feature of this book is that it not only presents different perspectives on climate change governance, but it also introduces theoretical approaches and brings these together with practical examples which show how main principles may be implemented in practice.

Which factors are important for the successful development and implementation of clinical pathways? A qualitative study.

Science.gov (United States)

De Allegri, Manuela; Schwarzbach, Matthias; Loerbroks, Adrian; Ronellenfitsch, Ulrich

2011-03-01

Clinical pathways (CPs) are detailed longitudinal care plans delineating measures to be conducted during a patient's treatment. Although positive effects on resource consumption and quality of care have been shown, CPs are still underutilised in many clinical settings because their development and implementation are difficult. Evidence underpinning successful development and implementation is sparse. The authors conducted semistructured face-to-face interviews with key staff members involved in the design and implementation of CPs in a large surgery department. Interviewees were asked to provide opinions on various issues, which were previously identified as potentially important in CP development and implementation. The transcribed text was read and coded independently by two researchers. Respondents highlighted the importance of a multidisciplinary participatory approach for CP design and implementation. There was a strong initial fear of losing individual freedom of treatment, which subsided after people worked with CPs in clinical everyday life. It was appreciated that the project originated from people at different levels of the department's hierarchy. Likewise, it was felt that CP implementation granted more autonomy to lower-level staff. The structured qualitative approach of this study provides information on what issues are considered important by staff members for CP design and implementation. Whereas some concepts such as the importance of a multidisciplinary approach or continuous feedback of results are known from theories, others such as strengthening the authority especially of lower-level health professionals through CPs have not been described so far. Many of the findings point towards strong interactions between factors important for CP implementation and a department's organisational structure.

Implementation Command Media Manual And Internal Auditor Role In Achieving The Rules Of Good Corporate Governance The Case Of Indonesia

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Syafdinal

2017-05-01

Full Text Available Command Media Manual includes the provision implementation procedures and instructions relating to the management and handling of command media is used by an organization to provide trace archives and uniformity of action operations. The contributions Internal Auditor IA in applying the principles of Good Corporate Governance GCG in the formation of company image and in the improvement of the integrated control function ensure that the operations have been run well and can increase the value added to the organization. Testing the hypothesis first tested the validity and reliability testing. Analysis of data was using path analysis path analysis. Generally not maximum awareness and common understanding among all management and staff that the application of the Manual Command Media is very important for the companys operations in their objective to fulfill the standards of corporate governance.

Green Computing in Local Governments and Information Technology Companies

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Badar Agung Nugroho

2013-06-01

Full Text Available Green computing is a study and practice of designing, manufacturing, using, and disposing of information and communication devices efficiently and effectively with minimum impact on the environment. If the green computing concept was implemented, it will help the agencies or companies to reduce energy and capital cost from their IT infrastructure. The goal from this research is to explore the current condition about the efforts from local governments and IT companies at West Java to implement the green computing concept at their working environment. The primary data were collected by using focus group discussion by inviting the local governments and IT companies representatives who responsible to manage their IT infrastructure. And then, the secondary data were collected by doing brief observation in order to see the real effort of green computing implementation at each institution. The result shows that there are many different perspectives and efforts of green computing implementation between local governments and IT companies.

The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

Science.gov (United States)

Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R

2014-09-01

Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

Instruments of Transformative Governance

DEFF Research Database (Denmark)

Borrás, Susana

production and distribution channels. PDPs aim at overcoming current market and government failures by pooling resources in the attempt to solve this global social challenge. Thus, PDPs are a case of instruments of transformative research and innovation, operating in a transnational governance context....... They exhibit three novelties: they address strategic long-term problems in a holistic manner, set substantive output-oriented goals, and are implemented through new organizational structures. After characterizing the different types of current PDPs and the context in which they emerged, the paper examines...

Government Certification and Accreditation: Make a Choice

Science.gov (United States)

Miles, Tracy L.

2009-01-01

One of the most significant challenges faced by government officials today is securing information systems to make them more resilient to attack from increasingly complex challenges from cyber-criminals, state-sponsored groups, and other threats. Over the years, the federal government has developed and implemented Certification and Accreditation…

Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009.

Science.gov (United States)

Gase, Lauren N; Kuo, Tony; Dunet, Diane O; Simon, Paul A

2011-03-01

This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content. We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County. Study participants reported 3 key facilitators: their organization's authority to impose nutrition standards, their organization's desire to provide nutritious food, and the opportunity to build on existing nutrition policies. Eight key barriers were identified: 1) unique features among food service settings, 2) costs and unavailability of low-sodium foods, 3) complexity of food service arrangements, 4) lack of consumer demand for low-sodium foods, 5) undesirable taste of low-sodium foods, 6) preference for prepackaged products, 7) lack of knowledge and experience in operationalizing sodium standards, and 8) existing multiyear contracts that are difficult to change. Despite perceived barriers, several participants indicated that their organizations have successfully implemented nutritional standards that include limits on sodium. Developing or changing policies for procuring food represents a potentially feasible strategy for reducing sodium consumption in food service venues controlled by the County of Los Angeles. The facilitators and barriers identified here can inform the formulation, adoption, implementation, and evaluation of sodium reduction policies in other jurisdictions.

Implementing national strategies on antimicrobial resistance in Thailand: potential challenges and solutions.

Science.gov (United States)

Sommanustweechai, A; Tangcharoensathien, V; Malathum, K; Sumpradit, N; Kiatying-Angsulee, N; Janejai, N; Jaroenpoj, S

2018-04-01

Thailand has developed a national strategic plan on antimicrobial resistance (NSP-AMR) and endorsed by the Cabinet in August 2016. This study reviewed the main contents of the NSP-AMR and the mandates of relevant implementing agencies and identified challenges and recommends actions to mitigate implementation gaps. This study analysed the contents of NSP-AMR, reviewed institutional mandates and assessed the implementation gaps among agencies responsible for NSP-AMR. Two of six strategies are related to monitoring and surveillance of AMR and antimicrobial consumption in human and animal. Two other strategies aim to improve antibiotic stewardship and control the spread of AMR in both clinical and farm settings. The remaining two strategies aim to increase knowledge and public awareness on AMR and establish national governance for inter-sectoral actions. Strategies to overcome implementation challenges are sustaining cross-sectoral policy commitments, effective cross-sectoral coordination using One Health approach, generating evidence which guides policy implementation, and improving enforcement capacities in regulatory authorities. To address AMR, Thailand requires significant improvements in implementation capacities in two dimensions. First, technical capacities among implementing agencies are needed to translate policies into practice. Second, governance and organizational capacities enable effective multi-sectoral actions across human, animal, and environmental sectors. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Local government and climate policy

International Nuclear Information System (INIS)

Burger, H.; Menkveld, M.; Coenen, F.H.J.M.

2000-01-01

Local government in the Netherlands could play a greater role than they currently do in reducing greenhouse gas emissions in the country. This fact formed the motivation for initiating the research project on Local Government and Climate Policy. Many local climate options are known in theory. Options for reduction that lie within the sphere of influence of Dutch local government are, for example, sustainable building or encouraging the utilisation of sustainable energy. But actual practice turns out to be rather refractory. If such options are to be implemented, then one has to overcome institutional barriers, such as the co-operation between different departments in the same local authority. The objective of this research is to improve the contribution that local government makes to climate policy

Whereto with institutions and governance challenges in African wildlife conservation?

Science.gov (United States)

Muchapondwa, Edwin; Stage, Jesper

2015-09-01

African wildlife conservation has been transformed, shifting from a traditional, state-managed government approach to a broader governance approach with a wide range of actors designing and implementing wildlife policy. The most widely popularized approach has been that of community-managed nature conservancies. The knowledge of how institutions function in relation to humans and their use of the environment is critical to the design and implementation of effective conservation. This paper seeks to review the institutional and governance challenges faced in wildlife conservation in southern and eastern Africa. We discuss two different sets of challenges related to the shift in conservation practices: the practical implementation of wildlife governance, and the capacity of current governance structures to capture and distribute economic benefits from wildlife. To some extent, the issues raised by the new policies must be resolved through theoretical and empirical research addressed at wildlife conservation per se. However, many of these issues apply more broadly to a wide range of policy arenas and countries where similar policy shifts have taken place.

Commissioning and clinical implementation of HDR brachytherapy in El Salvador

International Nuclear Information System (INIS)

Morales Lopez, Jorge Luis; Castillo, Luis Frank; Castillo Bahi, Ramon del

2009-01-01

The Gynecologic Cancer is one of the best known malignancies in different countries of the world, with a high incidence in developing countries. In the treatment of this disease have been used multiple treatment arms among which is the high rate brachytherapy (HDR). The IAEA has put much emphasis on supporting all programs to treat this disease and in this context within the project 'Human Resource Development and Nuclear Technology Support', collaborated with the dispatch of experts on mission ELS0006 01 'Assistance to the ICES in HDR brachytherapy initiating Treatments at the Cancer Institute of El Salvador 'Dr. Narciso Diaz Bazan' in San Salvador, El Salvador. The process of commissioning and implementing clinical service Brachytherapy High Dose Rate (HDR BT) is a relatively complex process that begins with the formation of functional and technical service, based on flow patients to be treated, availability of local technological capability to install, and culminates with the preparation and implementation of protocols. Experts involved in the implementation of this service divided this task in stages organized chronologically: 1st. Study of existing infrastructure and level of training of technical personnel available, 2nd. Proposal and application of amendments in order to adapt the facility to the planned patient flow and optimal use of technological infrastructure, 3rd. Establishment of the process of securing the disposable waste materials and not required, 4th. Performance of tests of physical commissioning clinical dosimetry and instrumentation unit, surgical and therapeutic, 5th. Training of technical personnel, 6th. Preparation of clinical protocol and 7th. Initiation and development of treatment for patients. All these steps are carried out with the integration and consensus of the entire multidisciplinary team that makes up the service and with the support of the administration as a prerequisite. Within two weeks the service was modified according to

Aligning clinical compensation with clinical productivity: design and implementation of the financial value unit (FVU) system in an academic department of internal medicine.

Science.gov (United States)

Stites, Steven; Steffen, Patrick; Turner, Scott; Pingleton, Susan

2013-07-01

A new metric was developed and implemented at the University of Kansas School of Medicine Department of Internal Medicine, the financial value unit (FVU). This metric analyzes faculty clinical compensation compared with clinical work productivity as a transparent means to decrease the physician compensation variability and compensate faculty equitably for clinical work.The FVU is the ratio of individual faculty clinical compensation compared with their total work relative value units (wRVUs) generated divided by Medical Group Management Association (MGMA) salary to wRVUs of a similar MGMA physician.The closer the FVU ratio is to 1.0, the closer clinical compensation is to that of an MGMA physician with similar clinical productivity. Using FVU metrics to calculate a faculty salary gap compared with MGMA median salary and wRVU productivity, a divisional production payment was established annually.From FY 2006 to FY 2011, both total faculty numbers and overall clinical activity increased. With the implementation of the FVU, both clinical productivity and compensation increased while, at the same time, physician retention rates remained high. Variability in physician compensation decreased. Dramatic clinical growth was associated with the alignment of clinical work and clinical compensation in a transparent and equable process.

Acute Clinically Mastitic Animals in villages of Assiut Governance: Diagnosis and Treatment

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Mohammad Sayed and Ahmed Abdel Rady

Full Text Available This investigation was run in some villages in Assiut governance during summer 2007 to diagnose acute clinical mastitis in different animal species and to apply different lines of treatment for evaluating which treatment line of choice giving cure, aiming to another goal by preventing the conversion of acute mastitis towards the chronic one which is difficult to be treated and the dairy animal will be excluded. Therefore, 2150 animals were clinically examined in 5 villages located north to Assiut city, Egypt, including 400 cows, 950 ewes and 800 she goats, and the incidence of acute clinical mastitis was 22.50%, 2.63% and 4.63%, respectively. Milk samples were collected from all clinically mastitic cows for bacteriological examination to identify the causative agents of the intra-mammary infection (IMI. It was found the major causative agents isolated were Staphylococcus aureus, Streptococcus agalactiae, Escherichia coli and Corynebacterium pyogenes, causing either single or mixed type of infection. When applying different lines of treatment, all diseased animals were classified into 3 groups: 1st group received local treatment by intra-mammary infusion antibiotic. 2nd group received systematic treatment by intra-muscular (I/M injection of both antibiotic and anti-inflammatory drugs. While, 3rd group received combination of both local and systematic treatment lines together. Cure% was achieved as 50% for 1st group, 90% for 2nd group, while 3rd group gave complete cure by 100%. It was noticed that the incidence of acute clinical mastitis among examined cows was worrisome and can be considered as indicator of the epidemiology of the disease. While, spreading of the disease among ewes and she goats was somewhat low in comparison with that of cows. In conclusion, combination of both local and systematic treatment lines together should be advised in treatment of acute clinical mastitis to ensure complete cure. The obtained results highlighted the

Development and implementation of a clinical needs assessment to support nursing and midwifery students with a disability in clinical practice: part 1.

Science.gov (United States)

Howlin, Frances; Halligan, Phil; O'Toole, Sinead

2014-09-01

Equality and disability legislation, coupled with increasing numbers of students with a disability, and inadequate supports in clinical practice, acted as catalysts to explore how best to support undergraduate nursing and midwifery students on clinical placements. Historically, higher education institutions provide reasonable accommodations for theoretical rather than clinical modules for practice placements. This paper describes the development and implementation of a Clinical Needs Assessment designed to identify the necessary supports or reasonable accommodations for nursing and midwifery students with a disability undertaking work placements in clinical practice. The existing literature, and consultation with an expert panel, revealed that needs assessments should be competency based and clearly identify the core skills or elements of practice that the student must attain to achieve proficiency and competence. The five Domains of Competence, advocated by An Bord Altranais, the Nursing and Midwifery Board of Ireland, formed the framework for the Clinical Needs Assessment. A panel of experts generated performance indicators to enable the identification of individualised reasonable accommodations for year 1 nursing and midwifery students in one Irish University. Development and implementation of the Clinical Needs Assessment promoted equality, inclusion and a level playing field for nursing and midwifery students with a disability in clinical practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Realigning Shared Governance With Magnet® and the Organization's Operating System to Achieve Clinical Excellence.

Science.gov (United States)

Moreno, Janette V; Girard, Anita S; Foad, Wendy

2018-03-01

In 2012, an academic medical center successfully overhauled a 15-year-old shared governance to align 6 house-wide and 30 unit-based councils with the new Magnet Recognition Program® and the organization's operating system, using the processes of LEAN methodology. The redesign improved cross-council communication structures, facilitated effective shared decision-making processes, increased staff engagement, and improved clinical outcomes. The innovative structural and process elements of the new model are replicable in other health institutions.

Using an International Medical Advisory Board to guide clinical governance in a corporate refractive surgery model.

Science.gov (United States)

Vukich, John A

2009-07-01

To describe the role played by the International Medical Advisory Board (IMAB) in clinical and corporate governance at Optical Express, a corporate provider of refractive surgery. A review of goals, objectives, and actions of the IMAB. The IMAB has contributed to study design, data analysis, and selection of instruments and procedures. Through interactions with Optical Express corporate and clinical staff, the IMAB has supported management's effort to craft a corporate culture focused on continuous improvement in the safety and visual outcomes of refractive surgery. The IMAB has fashioned significant changes in corporate policies and procedures and has had an impact on corporate culture at Optical Express.

Government Financial Management, Strategy for Preventing Corruption in Indonesia

Directory of Open Access Journals (Sweden)

Haryono Umar

2013-07-01

Full Text Available In popular view, the term accountability generally refers to a wide spectrum of public expectations dealing with organizational performance, responsiveness, good governance, and even morality of government and nonprofit organizations. These expectations often include implicit performance criteria – related to obligations and responsibilities – that are subjectively interpreted and sometimes even contradictory. And in this broader conception of accountability, the range of people and institutions to whom public and nonprofit organizations must account include not only higher authorities in the institutional chain of command but also the general public, the news media, peer agencies, donors, and many other stakeholders (Kearns, 1996. Government could build its accountability by implementing good and proper financial management. Financial management is a tool for government to show its performance and accountability to the public. Meanwhile, corruption is the misuse of public office for private gain. As such, it involves the improper and unlawful behavior of public-service officials, both politicians and civil servants, whose positions create opportunities for the diversion of money and assets from government to them and their accomplices (Langseth, 1999. The more corruption, the more far away from good governance, and the less public accountability. According to Klitgaard (1988, power minus accountability is corruption. This paper explains about the influences of implementing government financial management to corruption fighting and good governance in broadly view. Discussion will be derived to find out the understanding of financial management, corruption, and good governance terminology fits for Indonesia environment. The purpose of this paper is to achieve common knowledge that financial management should be implemented by public organization from strategic management for public organization approaches. Besides, reader will find out

Development and Implementation of an Electronic Clinical Formative Assessment: Dental Faculty and Student Perspectives.

Science.gov (United States)

Kirkup, Michele L; Adams, Brooke N; Meadows, Melinda L; Jackson, Richard

2016-06-01

A traditional summative grading structure, used at Indiana University School of Dentistry (IUSD) for more than 30 years, was identified by faculty as outdated for assessing students' clinical performance. In an effort to change the status quo, a feedback-driven assessment was implemented in 2012 to provide a constructive assessment tool acceptable to both faculty and students. Building on the successful non-graded clinical evaluation employed at Baylor College of Dentistry, IUSD implemented a streamlined electronic formative feedback model (FFM) to assess students' daily clinical performance. An important addition to this evaluation tool was the inclusion of routine student self-assessment opportunities. The aim of this study was to determine faculty and student response to the new assessment instrument. Following training sessions, anonymous satisfaction surveys were examined for the three user groups: clinical faculty (60% response rate), third-year (D3) students (72% response rate), and fourth-year (D4) students (57% response rate). In the results, 70% of the responding faculty members preferred the FFM over the summative model; however, 61.8% of the D4 respondents preferred the summative model, reporting insufficient assessment time and low faculty participation. The two groups of students had different responses to the self-assessment component: 70.2% of the D4 respondents appreciated clinical self-assessment compared to 46% of the D3 respondents. Overall, while some components of the FFM assessment were well received, a phased approach to implementation may have facilitated a transition more acceptable to both faculty and students. Improvements are being made in an attempt to increase overall satisfaction.

MO-E-BRC-00: Online Adaptive Radiotherapy - Considerations for Practical Clinical Implementation

International Nuclear Information System (INIS)

2016-01-01

Online adaptive radiation therapy has the potential to ensure delivery of optimal treatment to the patient by accounting for anatomical and potentially functional changes that occur from one fraction to the next and over the course of treatment. While on-line adaptive RT (ART) has been a topic of many publications, discussions, and research, it has until very recently remained largely a concept and not a practical implementation. However, recent advances in on-table imaging, use of deformable image registration for contour generation and dose tracking, faster and more efficient plan optimization, as well as fast quality assurance method has enabled the implementation of ART in the clinic in the past couple of years. The introduction of these tools into routine clinical use requires many considerations and progressive knowledge to understand how processes that have historically taken hours/days to complete can now be done in less than 30 minutes. This session will discuss considerations to perform real time contouring, planning and patient specific QA, as well as a practical workflow and the required resources. Learning Objectives: To understand the difficulties, challenges and available technologies for online adaptive RT. To understand how to implement online adaptive therapy in a clinical environment and to understand the workflow and resources required. To understand the limitations and sources of uncertainty in the online adaptive process I have research funding from ViewRay Inc. and Philips Medical Systems.; R. Kashani, I have research funding from ViewRay Inc. and Philips Medical Systems.; X. Li, Research supported by Elekta Inc.

MO-E-BRC-00: Online Adaptive Radiotherapy - Considerations for Practical Clinical Implementation

Energy Technology Data Exchange (ETDEWEB)

NONE

2016-06-15

Online adaptive radiation therapy has the potential to ensure delivery of optimal treatment to the patient by accounting for anatomical and potentially functional changes that occur from one fraction to the next and over the course of treatment. While on-line adaptive RT (ART) has been a topic of many publications, discussions, and research, it has until very recently remained largely a concept and not a practical implementation. However, recent advances in on-table imaging, use of deformable image registration for contour generation and dose tracking, faster and more efficient plan optimization, as well as fast quality assurance method has enabled the implementation of ART in the clinic in the past couple of years. The introduction of these tools into routine clinical use requires many considerations and progressive knowledge to understand how processes that have historically taken hours/days to complete can now be done in less than 30 minutes. This session will discuss considerations to perform real time contouring, planning and patient specific QA, as well as a practical workflow and the required resources. Learning Objectives: To understand the difficulties, challenges and available technologies for online adaptive RT. To understand how to implement online adaptive therapy in a clinical environment and to understand the workflow and resources required. To understand the limitations and sources of uncertainty in the online adaptive process I have research funding from ViewRay Inc. and Philips Medical Systems.; R. Kashani, I have research funding from ViewRay Inc. and Philips Medical Systems.; X. Li, Research supported by Elekta Inc.

Implementation of molecular karyotyping in clinical genetics

Directory of Open Access Journals (Sweden)

Luca Lovrecic

2013-11-01

Full Text Available Rapid development of technologies for the study of the human genome is an expected step after the discovery and sequencing of the entire human genome. Chromosomal microarrays, which allow us to perform tens of thousands of previously individual experiments simultaneously, are being utilized in all areas of human genetics and genomics. Initially, this was applicable only for research purposes, but in the last few years their clinical diagnostic purposes are becoming more and more relevant. Using molecular karyotyping (also chromosomal microarray, comparative genomic hybridization with microarray, aCGH, one can analyze microdeletions / microduplications in the whole human genome at once. It is a first-tier cytogenetic diagnostic test instead of G-banded karyotyping in patients with developmental delay and/or congenital anomalies. Molecular karyotyping is used as a diagnostic test in patients with unexplained developmental delay and/or idiopathic intellectual disability and/or dysmorphic features and/or multiple congenital anomalies (DD/ID/DF/MCA. In addition, the method is used in prenatal diagnostics and in some centres also in preimplantation genetic diagnosis.The aim of this paper is to inform the professional community in the field about this new diagnostic method and its implementation in Slovenia, and to define the clinical situations where the method is appropriate.

A Framework for Cloud Based E-Government from the Perspective of Developing Countries

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Pusp Raj Joshi

2017-11-01

Full Text Available Despite significant efforts to initiate electronic government projects, developing countries are still struggling to reap the benefits of using e-government services. An effective implementation of e-government infrastructure is necessary to increase the efficiency and transparency of the government services. There are several studies that observed causes like lack of infrastructure support, lack of payment gateway and improper e-government service delivery channel as main barriers to a wider adoption of e-government services. The main contribution of this research is to propose a cloud-based G2G (Government-to-government e-government framework for a viable e-government solution from the perspective of developing countries. We have introduced a list of concepts and a systematic process to guide the implementation of e-government project based on the government’s vision, goals, chosen services through the service delivery channel to the appropriate cloud service and deployment model. We have used Nepal as a context of the case study and applied the framework to a real e-government project of driving licensing department using action research methodology. The results from the study show that the G2G approach of e-government implementation would be the best for providing effective government services to the stakeholders of developing countries. The proposed framework also supports a smooth integration of government services and reduces the time of the overall project.

Optimal Policy under Restricted Government Spending

DEFF Research Database (Denmark)

Sørensen, Anders

2006-01-01

Welfare ranking of policy instruments is addressed in a two-sector Ramsey model with monopoly pricing in one sector as the only distortion. When government spending is restricted, i.e. when a government is unable or unwilling to finance the required costs for implementing the optimum policy...... effectiveness canexceed the welfare loss from introducing new distortions. Moreover, it is found that the investment subsidy is gradually phased out of the welfare maximizing policy, which may be a policy combining the two subsidies, when the level of government spending is increased.Keywords: welfare ranking......, indirect and direct policy instruments, restricted government spending JEL: E61, O21, O41...

Electoral Governance: More than Just Electoral Administration

OpenAIRE

Medina Torres, Luis Eduardo; Ramírez Díaz, Edwin Cuitláhuac

2015-01-01

The meaning of "electoral governance" is often equated with "electoral administration". The process, however, can be divided into three distinct stages: 1) formation of regulatory bodies and norms; 2) implementation of these norms; and 3) dispute resolution. Given these three parts, electoral governance amounts to much more than just administration. In this article we explain why many academic studies of electoral governance have neglected the role of conflict resolution, focusing instead on ...

A Model for Good Governance of Healthcare Technology Management in the Public Sector: Learning from Evidence-Informed Policy Development and Implementation in Benin.

Directory of Open Access Journals (Sweden)

P Th Houngbo

Full Text Available Good governance (GG is an important concept that has evolved as a set of normative principles for low- and middle-income countries (LMICs to strengthen the functional capacity of their public bodies, and as a conditional prerequisite to receive donor funding. Although much is written on good governance, very little is known on how to implement it. This paper documents the process of developing a strategy to implement a GG model for Health Technology Management (HTM in the public health sector, based on lessons learned from twenty years of experience in policy development and implementation in Benin. The model comprises six phases: (i preparatory analysis, assessing the effects of previous policies and characterizing the HTM system; (ii stakeholder identification and problem analysis, making explicit the perceptions of problems by a diverse range of actors, and assessing their ability to solve these problems; (iii shared analysis and visioning, delineating the root causes of problems and hypothesizing solutions; (iv development of policy instruments for pilot testing, based on quick-win solutions to understand the system's responses to change; (v policy development and validation, translating the consensus solutions identified by stakeholders into a policy; and (vi policy implementation and evaluation, implementing the policy through a cycle of planning, action, observation and reflection. The policy development process can be characterized as bottom-up, with a central focus on the participation of diverse stakeholders groups. Interactive and analytical tools of action research were used to integrate knowledge amongst actor groups, identify consensus solutions and develop the policy in a way that satisfies criteria of GG. This model could be useful for other LMICs where resources are constrained and the majority of healthcare technologies are imported.

Canadian Association of Gastroenterology policy on the application for, and implementation of, clinical practice guidelines

Science.gov (United States)

Singh, Harminder; Leontiadis, Grigorios I; Hookey, Lawrence; Enns, Robert; Bistritz, Lana; Rioux, Louis-Charles; Hope, Louise; Sinclair, Paul

2014-01-01

An important mandate of the Canadian Association of Gastroenterology (CAG), as documented in the Association’s governance policies, is to optimize the care of patients with digestive disorders. Clinical practice guidelines are one means of achieving this goal. The benefits of timely, high-quality and evidenced-based recommendations include: Enhancing the professional development of clinical members through education and dissemination of synthesized clinical research;Improving patient care provided by members by providing focus on quality and evidence;Creating legislative environments that favour effective clinical practice;Enhancing the clinical care provided to patients with digestive disease by nongastroenterologists; andIdentifying areas that require further information or research to improve clinical care.The present document provides the foundation required to ensure that clinical practice guidelines produced by the CAG are necessary, appropriate, credible and applicable. These recommendations should be adhered to as closely as possible to obtain CAG endorsement. PMID:25314352

Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT

International Nuclear Information System (INIS)

Ng, J. A.; Booth, J. T.; O’Brien, R. T.; Huang, C.-Y.; Keall, P. J.; Colvill, E.; Poulsen, P. R.

2014-01-01

Purpose: Kilovoltage intrafraction monitoring (KIM) is a real-time 3D tumor monitoring system for cancer radiotherapy. KIM uses the commonly available gantry-mounted x-ray imager as input, making this method potentially more widely available than dedicated real-time 3D tumor monitoring systems. KIM is being piloted in a clinical trial for prostate cancer patients treated with VMAT (NCT01742403). The purpose of this work was to develop clinical process and quality assurance (QA) practices for the clinical implementation of KIM. Methods: Informed by and adapting existing guideline documents from other real-time monitoring systems, KIM-specific QA practices were developed. The following five KIM-specific QA tests were included: (1) static localization accuracy, (2) dynamic localization accuracy, (3) treatment interruption accuracy, (4) latency measurement, and (5) clinical conditions accuracy. Tests (1)–(4) were performed using KIM to measure static and representative patient-derived prostate motion trajectories using a 3D programmable motion stage supporting an anthropomorphic phantom with implanted gold markers to represent the clinical treatment scenario. The threshold for system tolerable latency is <1 s. The tolerances for all other tests are that both the mean and standard deviation of the difference between the programmed trajectory and the measured data are <1 mm. The (5) clinical conditions accuracy test compared the KIM measured positions with those measured by kV/megavoltage (MV) triangulation from five treatment fractions acquired in a previous pilot study. Results: For the (1) static localization, (2) dynamic localization, and (3) treatment interruption accuracy tests, the mean and standard deviation of the difference are <1.0 mm. (4) The measured latency is 350 ms. (5) For the tests with previously acquired patient data, the mean and standard deviation of the difference between KIM and kV/MV triangulation are <1.0 mm. Conclusions: Clinical process and

Systematic implementation of evidence-based practice in a clinical nursing setting: a participatory action research project.

Science.gov (United States)

Friesen-Storms, Jolanda H H M; Moser, Albine; van der Loo, Sandra; Beurskens, Anna J H M; Bours, Gerrie J J W

2015-01-01

To describe the process of implementing evidence-based practice in a clinical nursing setting. Evidence-based practice has become a major issue in nursing, it is insufficiently integrated into daily practice and its implementation is complex. Participatory action research. The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of evidence-based practice were that nurses had little knowledge of evidence-based practice and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of evidence-based practice was adapted. Nurses worked according to the evidence-based practice discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. Action research provides an opportunity to empower nurses and to tailor evidence-based practice to the practice context. Applying and implementing evidence-based practice is difficult for front-line nurses with limited evidence-based practice competencies. Adaptation of the academic model of evidence-based practice to a more pragmatic approach seems necessary to introduce evidence-based practice into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice

Implementation and evaluation of Parkinson disease management in an outpatient clinical pharmacist-run neurology telephone clinic.

Science.gov (United States)

Stefan, Teodora Cristina; Elharar, Nicole; Garcia, Guadalupe

2018-05-01

Parkinson disease (PD) is a progressive, debilitating neurodegenerative disease that often requires complex pharmacologic treatment regimens. Prior to this clinic, there was no involvement of a clinical pharmacy specialist (CPS) in the outpatient neurology clinic at the West Palm Beach Veterans Affairs Medical Center. This was a prospective, quality-improvement project to develop a clinical pharmacist-run neurology telephone clinic and evaluate pharmacologic and nonpharmacologic interventions in an effort to improve the quality of care for patients with PD. Additionally, the CPS conducted medication education groups to 24 patients with PD and their caregivers, if applicable, at this medical center with the purpose of promoting patient knowledge and medication awareness. Medication management was performed via telephone rather than face to face. Only patients with a concomitant mental health diagnosis for which they were receiving at least one psychotropic medication were included for individual visits due to the established scope of practice of the CPS being limited to mental health and primary care medications. Data collection included patient and clinic demographics as well as pharmacologic and nonpharmacologic interventions made for patients enrolled from January 6, 2017, through March 31, 2017. A total of 49 pharmacologic and nonpharmacologic interventions were made for 10 patients. We successfully implemented and evaluated a clinical pharmacist-run neurology telephone clinic for patients with PD. Expansion of this clinic to patients with various neurological disorders may improve access to care using an innovative method of medication management expertise by a CPS.

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Pharmacogenetics-Guided Warfarin Dosing: 2017 Update.

Science.gov (United States)

Johnson, J A; Caudle, K E; Gong, L; Whirl-Carrillo, M; Stein, C M; Scott, S A; Lee, M T; Gage, B F; Kimmel, S E; Perera, M A; Anderson, J L; Pirmohamed, M; Klein, T E; Limdi, N A; Cavallari, L H; Wadelius, M

2017-09-01

This document is an update to the 2011 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2C9 and VKORC1 genotypes and warfarin dosing. Evidence from the published literature is presented for CYP2C9, VKORC1, CYP4F2, and rs12777823 genotype-guided warfarin dosing to achieve a target international normalized ratio of 2-3 when clinical genotype results are available. In addition, this updated guideline incorporates recommendations for adult and pediatric patients that are specific to continental ancestry. © 2017 American Society for Clinical Pharmacology and Therapeutics.

Do Policy Networks lead to Network Governing?

DEFF Research Database (Denmark)

Damgaard, Bodil

This paper challenges the notion that creation of local policy networks necessarily leads to network governing. Through actor-centred case studies in the area of municipally implemented employment policy in Denmark it was found that the local governing mode is determined mainly by the municipality......’s approach to local co-governing as well as by the capacity and interest of key private actors. It is argued that national legislation requesting the creation of local policy networks was not enough to assure network governing and the case studies show that local policy networks may subsist also under...... hierarchical governing modes. Reasons why hierarchical governing modes prevail over network governing in some settings are identified pointing to both actor borne and structural factors. Output indicators of the four cases do not show that a particular governing mode is more efficient in its employment policy...

Introduction to the special issue: toward implementing physiological measures in clinical child and adolescent assessments.

Science.gov (United States)

De Los Reyes, Andres; Aldao, Amelia

2015-01-01

The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). The RDoC is an initiative to improve classification of mental health concerns by promoting research on the brain mechanisms underlying these concerns, with the ultimate goal of developing interventions that target these brain mechanisms. A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures. The RDoC presents unique challenges to mental health professionals who work with children and adolescents. Indeed, mental health professionals rarely integrate biological measures into clinical assessments. Thus, RDoC's ability to improve patient care rests, in part, on the development of strategies for implementing biological measures within mental health assessments. Further, mental health professionals already carry out comprehensive assessments that frequently yield inconsistent findings. These inconsistencies have historically posed challenges to interpreting research findings as well as assessment outcomes in practice settings. In this introductory article, we review key issues that informed the development of a special issue of articles demonstrating methods for implementing low-cost measures of physiological functioning in clinical child and adolescent assessments. We also outline a conceptual framework, informed by theoretical work on using and interpreting multiple informants' clinical reports (De Los Reyes, Thomas, Goodman, & Kundey, 2013 ), to guide hypothesis testing when using physiological measures within clinical child and adolescent assessments. This special issue and the conceptual model described in this article may open up new lines of research testing paradigms for implementing clinically feasible physiological measures in clinical child and adolescent assessments.

Oxytocin augmentation during labor: how to implement medical guidelines into clinical practice.

Science.gov (United States)

Holmgren, Stina; Silfver, Kristina Gren; Lind, Cecilia; Nordström, Lennart

2011-11-01

To describe an extensive process to implement guidelines for oxytocin use during labor and to report its effects on compliance to clinical practice guidelines after 1 year. A multifaceted strategy was developed to involve all obstetric staff and identify possible local barriers to change in advance. The process lasted for more than 1 year. To describe the implementation of oxytocin use according to the new guidelines, and to compare management in clinical practice with guideline recommendations from audits performed before and after the project. Identification of possible barriers to change, academic detailing, audits with feedback, and local opinion leaders were important factors for a successful process. Documentation of the indication for oxytocin use increased from 54% before, to 86% after the completion of the project (Pcheck list to monitor oxytocin use. However, audits with feedback need to continue for medical safety, and have been planned to take place every 6 months. Copyright © 2011 Elsevier B.V. All rights reserved.

Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

Science.gov (United States)

Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

2014-12-01

The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

PENERAPAN E-GOVERNMENT DALAM MENDORONG TERWUJUDNYA PENYELENGGARAAN PEMERINTAHAN YANG BAIK (STUDI PENELITIAN KABUPATEN / KOTA DI JAWA TENGAH

Directory of Open Access Journals (Sweden)

Nunik Retno Herawati

2016-02-01

Full Text Available The implementation of e-government aims to establish a good relationship between the government and the society as well as businesses that take place in an efficient, effective and economical. In addition, the purpose of implementing e-government is to achieve a good governance (good governance. Good governance has several elements one of which is the effectiveness and efficiency. Departing from the above conditions, this study tried to describe the general adoption of e-Government Regency/City in Central Java. In detail, this study will discuss how the implementation of E Government Regency/City in Central Java and what the barriers to implementation of the E Government. Application of E Government by Regency City in Central Java, most of the entry on stage 2 (two, but there are some districts / municipalities that have entered at step 3 (three which apply online application for public services. For institutions, the need for clarity of authority and responsibility of all agencies in the government district / municipality. Some of Regency/City there that give's responsibility in the development of E Government Electronic Data Processing Section (PDE in the Regional Secretariat. However there are some Regency/city that provide responsibility under the Department of Transportation, Communication and other Information. Another problem encountered is the lack of ability of the ranks of civil servants and others in the field of ICT for the conduct of government in the Regional (E-Government and lack of budget implementation of e-government.

Use of RSS feeds for the implementation of clinical reminder.

Science.gov (United States)

Chi, Wen-Chou; Wen, Chia-Hsien; Lin, Chih-Yu; Poon, Sek-Kwong; Huang, Shih-Che

2012-06-01

A computer-based reminder system can help physicians get right information and make right decisions in daily clinical work in time. This study presents a RSS-based Clinical Reminding System (RCRS) designed for reminding clinicians to deal with their varied unfinished clinical works. The RCRS was implemented in a hospital to automatically generate messages for every clinician on the basis of clinical information gathered from the hospital information system (HIS) and send them by RSS feed. In order to allow all physicians to participate in the project, the RCRS was integrated with the Computerized Physician Order Entry (COPE) system to provide messages whenever a clinician logs in the HIS; the connection on screen lets the clinician easily make some response. The system can help clinicians focus on patient care without keeping track of the schedule of clinical chores stored in various systems. Two physicians, also directors from Clinical Informatics Research & Development Center (CIRD) who were appointed as project leaders of the RCRS project who went through the entire development process were chosen as interviewees to obtain a preliminary evaluation of the system. The results show the "Information Content" of this system was suggested to be modified, and "Information Accuracy", "Formats", "Ease of use" and "Timeliness" of the system were appropriate to meet the system design purposes.

Corporate Governance, Sustainability and Capital Markets Orientation

OpenAIRE

Daniela M. Salvioni; Francesca Gennari

2014-01-01

Generally accepted principles of effective corporate governance have taken hold in the context of different models of governance, whose implementation is also linked to the share structure of the companies and to the dynamics of risk’s capital markets. Global companies need a global approach in the acquisition of consensus and financial resources, first of all through a correct development of the corporate governance activities and promoting a market-driven management inspired by long-term su...

Weighted Components of i-Government Enterprise Architecture

Science.gov (United States)

Budiardjo, E. K.; Firmansyah, G.; Hasibuan, Z. A.

2017-01-01

Lack of government performance, among others due to the lack of coordination and communication among government agencies. Whilst, Enterprise Architecture (EA) in the government can be use as a strategic planning tool to improve productivity, efficiency, and effectivity. However, the existence components of Government Enterprise Architecture (GEA) do not show level of importance, that cause difficulty in implementing good e-government for good governance. This study is to explore the weight of GEA components using Principal Component Analysis (PCA) in order to discovered an inherent structure of e-government. The results show that IT governance component of GEA play a major role in the GEA. The rest of components that consist of e-government system, e-government regulation, e-government management, and application key operational, contributed more or less the same. Beside that GEA from other countries analyzes using comparative base on comon enterprise architecture component. These weighted components use to construct i-Government enterprise architecture. and show the relative importance of component in order to established priorities in developing e-government.

Accrual based accounting implementation: An approach for modelling major decisions

Directory of Open Access Journals (Sweden)

Ratno Agriyanto

2016-12-01

Full Text Available Over the last three decades the main issues of implementation of accrual based accounting government institutions in Indonesia. Implementation of accrual based accounting in government institutions amid debate about the usefulness of accounting information for decision-making. Empirical study shows that the accrual based of accounting information on a government institution is not used for decision making. The research objective was to determine the impact of the implementation of the accrual based accounting to the accrual basis of accounting information use for decision-making basis. We used the survey questionnaires. The data were processed by SEM using statistical software WarpPLS. The results showed that the implementation of the accrual based accounting in City Government Semarang has significantly positively associated with decision-making. Another important finding is the City Government officials of Semarang have personality, low tolerance of ambiguity is a negative effect on the relationship between the implementation of the accrual based accounting for decision making

How to Evaluate a Faculty Governance Structure

Science.gov (United States)

Cordes, John W.; Dunbar, David; Gingerich, Jeff

2013-01-01

During the 2010-11 academic year, Cabrini College began an evaluation of a faculty governance structure that had been implemented in fall 2007. The processes involved might serve as a roadmap for faculty members and administrators at other institutions who seek to understand the strengths and weaknesses of their governance model and improve shared…

A Methodology to Institutionalise User Experience in Provincial Government

Directory of Open Access Journals (Sweden)

Marco Cobus Pretorius

2014-12-01

Full Text Available Problems experienced with website usability can prevent users from accessing and adopting technology, such as e-Government. At present, a number of guidelines exist for e-Government website user experience (UX design; however, the effectiveness of the implementation of these guidelines depends on the expertise of the website development team and on an organisation’s understanding of UX. Despite the highlighted importance of UX, guidelines are rarely applied in South African e-Government website designs. UX guidelines cannot be implemented if there is a lack of executive support, trained staff, budget and user-centred design processes. The goal of this research is to propose and evaluate a methodology (called the “Institutionalise UX in Government (IUXG methodology” to institutionalise UX in South African Provincial Governments (SAPGs. The Western Cape Government in South Africa was used as a case study to evaluate the proposed IUXG methodology. The results show that the IUXG methodology can assist SAPGs to establish UX as standard practice and improve the UX maturity levels.

Beyond Bureaucracy? Assessing Institutional Change in the Governance of Water in England

Directory of Open Access Journals (Sweden)

Nigel Watson

2009-10-01

Full Text Available Alternative governance approaches in which non-state actors play a substantial role in policy making and implementation are currently attracting attention. Government-centred water bureaucracies have to adapt to increased complexity. Relationships among state and non-state actors in the English water sector have markedly changed in the last few decades in connection with the privatisation of water services, reform of arrangements for flood management, and implementation of the European Union Water Framework Directive (WFD. The paper assesses whether such changes represent a shift 'beyond bureaucracy' and the beginning of a new era of multi-party 'water governance'. From an examination of institutional reform in river basin management and flood risk management, the paper concludes that the water bureaucracy has actually strengthened its control, despite using language emphasising partnerships and collaborative governance. Responsibility for policy implementation has been reallocated among a range of public, private and civic groups. This 'neo-bureaucratic' arrangement is problematic because the government-centred water bureaucracy has lost some of its accountability and legitimacy, while the newer collaborative arrangements have little real influence over the direction of water policy. Governance capacity needs to be enhanced by adopting a collaborative approach to development of water policy in addition to its implementation.

Accrual based accounting implementation: An approach for modelling major decisions

OpenAIRE

Ratno Agriyanto; Abdul Rohman; Dwi Ratmono; Imam Ghozali

2016-01-01

Over the last three decades the main issues of implementation of accrual based accounting government institutions in Indonesia. Implementation of accrual based accounting in government institutions amid debate about the usefulness of accounting information for decision-making. Empirical study shows that the accrual based of accounting information on a government institution is not used for decision making. The research objective was to determine the impact of the implementation of the accrual...

Implementing tobacco use treatment guidelines in public health dental clinics in New York City.

Science.gov (United States)

Shelley, Donna; Anno, Jaime; Tseng, Tuo-Yen; Calip, Greg; Wedeles, John; Lloyd, Madeleine; Wolff, Mark S

2011-04-01

In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service (PHS) guideline Treating Tobacco Use and Dependence in six randomly selected dental clinics in New York University's College of Dentistry. The main outcome measure-provider adherence to tobacco use treatment guidelines-was assessed by auditing a random selection of patient charts pre (698) and post (641) intervention. The intervention components included a chart reminder and referral system, free nicotine replacement therapy (NRT), and provider training and feedback. The results showed that rates of screening for tobacco use did not change between pre and post test chart audits. However, providers were significantly more likely to offer advice (28.4 percent pre, 49 percent post), assess readiness to quit (17.8 percent pre, 29.9 percent post), and offer assistance (6.5 percent pre and 15.6 percent post) in the post test period. Increases in NRT distribution were associated with booster training sessions but declined in the time periods between those trainings. Research is needed to further define sustainable strategies for implementing tobacco use treatment in dental clinics. The results of this study suggest the feasibility and effectiveness of using a tailored multicomponent approach to implement tobacco use treatment guidelines in dental clinics.

Clinimetrics: the science of clinical measurements.

Science.gov (United States)

Fava, G A; Tomba, E; Sonino, N

2012-01-01

'Clinimetrics' is the term introduced by Alvan R. Feinstein in the early 1980s to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena. Clinimetrics has a set of rules that govern the structure of indexes, the choice of component variables, the evaluation of consistency, validity and responsiveness. This review illustrates how clinimetrics may help expanding the narrow range of information that is currently used in clinical science. It will focus on characteristics and types of clinimetric indexes and their current use. The clinimetric perspective provides an intellectual home for clinical judgment, whose implementation is likely to improve outcomes both in clinical research and practice. © 2011 Blackwell Publishing Ltd.

Designing and Implementing a Mentoring Program to Support Clinically-Based Teacher Education

Science.gov (United States)

Henning, John E.; Gut, Dianne; Beam, Pamela

2015-01-01

This article describes one teacher preparation program's approach to designing and implementing a mentoring program to support clinically-based teacher education. The design for the program is based on an interview study that compared the mentoring experiences of 18 teachers across three different contexts: student teaching, early field…

Corporate Governance in Singapore : Recent Developments For the Next Millennium

OpenAIRE

Mak Yuen Teen; Phillip H. Phan

2000-01-01

This paper surveys the regulatory and structural environment as it relates to corporate governance in Singapore, and present empirical evidence on corporate governance practices in areas such as ownership structure, disclosure, board and directors, the use of share option schemes, and the impact of government corporate ownership. It reviews corporate governance reforms that have been implemented or proposed, and assesses their likely impact on future corporate governance practices in Singapor...

Iterative Reconstruction Techniques in Abdominopelvic CT: Technical Concepts and Clinical Implementation.

Science.gov (United States)

Patino, Manuel; Fuentes, Jorge M; Singh, Sarabjeet; Hahn, Peter F; Sahani, Dushyant V

2015-07-01

This article discusses the clinical challenge of low-radiation-dose examinations, the commonly used approaches for dose optimization, and their effect on image quality. We emphasize practical aspects of the different iterative reconstruction techniques, along with their benefits, pitfalls, and clinical implementation. The widespread use of CT has raised concerns about potential radiation risks, motivating diverse strategies to reduce the radiation dose associated with CT. CT manufacturers have developed alternative reconstruction algorithms intended to improve image quality on dose-optimized CT studies, mainly through noise and artifact reduction. Iterative reconstruction techniques take unique approaches to noise reduction and provide distinct strength levels or settings.

Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline

NARCIS (Netherlands)

Wees, P.J. van der; Zagers, C.A.; Die, S.E. de; Hendriks, E.J.; Nijhuis-Van der Sanden, M.W.G.; Bie, R.A. de

2013-01-01

BACKGROUND: Clinical practice guidelines have been developed to assist healthcare practitioners in clinical decision making. Publication of clinical practice guidelines does not automatically lead to their uptake and barrier identification has been recognized as an important step in implementation

Evaluation of the implementation of a clinical pharmacy service on an acute internal medicine ward in Italy.

Science.gov (United States)

Lombardi, Nicola; Wei, Li; Ghaleb, Maisoon; Pasut, Enrico; Leschiutta, Silvia; Rossi, Paolo; Troncon, Maria Grazia

2018-04-10

Successful implementation of clinical pharmacy services is associated with improvement of appropriateness of prescribing. Both high clinical significance of pharmacist interventions and their high acceptance rate mean that potential harm to patients could be avoided. Evidence shows that low acceptance rate of pharmacist interventions can be associated with lack of communication between pharmacists and the rest of the healthcare team. The objective of this study was to evaluate the effect of a structured communication strategy on acceptance rate of interventions made by a clinical pharmacist implementing a ward-based clinical pharmacy service targeting elderly patients at high risk of drug-related problems. Characteristics of interventions made to improve appropriateness of prescribing, their clinical significance and intervention acceptance rate by doctors were recorded. A clinical pharmacy intervention study was conducted between September 2013 and December 2013 in an internal medicine ward of a teaching hospital. A trained clinical pharmacist provided pharmaceutical care to 94 patients aged over 70 years. The clinical pharmacist used the following communication and marketing tools to implement the service described: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis; Specific, Measurable, Achievable, Realistic and Timely (SMART) goals; Awareness, Interest, Desire, Action (AIDA) model. A total of 740 interventions were made by the clinical pharmacist. The most common drug classes involved in interventions were: antibacterials for systemic use (11.1%) and anti-parkinson drugs (10.8%). The main drug-related problem categories triggering interventions were: no specific problem (15.9%) and prescription writing error (12.0%). A total of 93.2% of interventions were fully accepted by physicians. After assessment by an external panel 63.2% of interventions (96 interventions/ per month) were considered of moderate clinical significance and 23.4% (36

Implementasi Shariah Governance serta Implikasinya terhadap Reputasi dan Kepercayaan Bank Syariah

Directory of Open Access Journals (Sweden)

Rahman El Junusi

2012-05-01

Full Text Available Syariah banking is currently growing rapidly and become part of financial life in the Islamic world. However, there are two important realities to observe in the life of Islamic Banking in Indonesia. First, Islamic banks are faced with a market share that has not met the target by 5 percent. Second, compliance of Islamic banking to Islamic principles was decline. Therefore, it is needed a strategy of development through the implementation of syariah governance. Syariah Governance implementation is expected to have an impact on reputation and customer confidence which in turn can increase the market share of syariah banks. Based on this background, the research problem is how the implementation of syariah governance and its impact on the reputation and confidence in Islamic banks. This research object is Muamalat banks operating in Central Java (Semarang, Solo, Purwokerto. The research sample is 200 respondents using the techniques of analytical judgment. Measurement instrument using 1-5 Likert scale, from strongly disagree (STS untill Strongly Agree (SS. Firth to know implementation of Shariah governance, it is used a quantitative descriptive analysis using the average (mean. Second, to examine the effect of the implementation of Shariah governance to reputation and customer confidence in Islamic banks, it uses Structur Equation Model (SEM with program AMOS 4.0 Engineering Structural Equation Modeling (SEM which consists of two kinds of technical analysis, the goodness of fit and regression weight on the SEM to assess the suitability of the model estimation based on measuring the level of significance of some of the goodness of fit good and bad in a model, so the degree of the model accuracy is determined by the cut-off value.This research concluded that calculations of total assessment on the implementation of Shariah Governance Islamic bank (Bank Muamalat showed an average score of 3.42 7 in good categories. It shows that shariah compliance is

Barriers to implementing the clinical guideline on borderline personality disorder in the Netherlands

NARCIS (Netherlands)

Hermens, M.L.M.; van Splunteren, P.T.; van den Bosch, A.; Verheul, R.

2011-01-01

Objective: This study determined the gap between actual care and optimal care (recommended in the clinical guideline) for patients with borderline personality disorder in the Netherlands. Factors that affected guideline implementation were identified. Methods: Ten specialized mental health

Systematic implementation of evidence-based practice in a clinical nursing setting : a participatory action research project

NARCIS (Netherlands)

Sandra van der Loo; Gerrie Bours; Anna Beurskens; Albine Moser; Jolanda Friesen-Storms

2015-01-01

Aims and objectives: To describe the process of implementing evidence-based practice (EBP) in a clinical nursing setting. Background: EBP has become a major issue in nursing, it is insufficiently integrated in daily practice and its implementation is complex. Design: Participatory action

The Economy Governing During Globalization Era

Directory of Open Access Journals (Sweden)

Ion Bucur

2006-09-01

Full Text Available World and national economie governing is an essential premise of the political stability and democratic evolution. In this study are approached theoretical and practical aspects of the economie governing. Theoretical acquisitions in this field highlit multiple perspectives of approaching and difficulties to characterize this complex and multisized fenomenon. A possible theory of governing the economy needs to use some concepts and mechanisms particular to more scientific fields (political science, economy, cibernetics, the theory of systems and others. The dinamic character and the instability of the present system of governing imposed the analysis of the factors and conditions which have generated the crises of the national and world economic governing. In this context, there are indentified the forms of manifesting the instability (lack of legitimacy, transpa¬rence and democratic responsability, and also the direction of necessary action to implement an efficient and responsable economic governing.

The Economy Governing During Globalization Era

Directory of Open Access Journals (Sweden)

Ion Bucur

2006-07-01

Full Text Available World and national economie governing is an essential premise of the political stability and democratic evolution. In this study are approached theoretical and practical aspects of the economie governing. Theoretical acquisitions in this field highlit multiple perspectives of approaching and difficulties to characterize this complex and multisized fenomenon. A possible theory of governing the economy needs to use some concepts and mechanisms particular to more scientific fields (political science, economy, cibernetics, the theory of systems and others. The dinamic character and the instability of the present system of governing imposed the analysis of the factors and conditions which have generated the crises of the national and world economic governing. In this context, there are indentified the forms of manifesting the instability (lack of legitimacy, transpa¬rence and democratic responsability, and also the direction of necessary action to implement an efficient and responsable economic governing.

Measuring Innovation in Government

Energy Technology Data Exchange (ETDEWEB)

Mahroum, S.

2016-07-01

Over the past few decades, there has been growing interest in supporting innovation in the public sector as a means of increasing the efficiency and quality of government services. Generally speaking, innovation in government could be defined as “The creation and implementation of new processes, products, services and methods of delivery which result in significant improvements in outcome efficiency, effectiveness or quality’’ [3]. A ‘Process Innovation’ is an activity oriented mainly towards enhancing ‘efficiency’. A ‘Product or Service Innovation’ is an activity oriented mainly towards enhancing the ‘effectiveness’ of government. A ‘Policy Innovation’ is mainly oriented at enhancing outcomes. These categorisations are important for identifying and selecting the metrics of measurement and to make distinctions between inputs, outputs, and outcomes. (Author)

Evaluating Adaptive Governance Approaches to Sustainable Water Management in North-West Thailand

Science.gov (United States)

Clark, Julian R. A.; Semmahasak, Chutiwalanch

2013-04-01

Adaptive governance is advanced as a potent means of addressing institutional fit of natural resource systems with prevailing modes of political-administrative management. Its advocates also argue that it enhances participatory and learning opportunities for stakeholders over time. Yet an increasing number of studies demonstrate real difficulties in implementing adaptive governance `solutions'. This paper builds on these debates by examining the introduction of adaptive governance to water management in Chiang Mai province, north-west Thailand. The paper considers, first, the limitations of current water governance modes at the provincial scale, and the rationale for implementation of an adaptive approach. The new approach is then critically examined, with its initial performance and likely future success evaluated by (i) analysis of water stakeholders' opinions of its first year of operation; and (ii) comparison of its governance attributes against recent empirical accounts of implementation difficulty and failure of adaptive governance of natural resource management more generally. The analysis confirms the potentially significant role that the new approach can play in brokering and resolving the underlying differences in stakeholder representation and knowledge construction at the heart of the prevailing water governance modes in north-west Thailand.

How Governance Regimes Shape the Implementation of Water Reuse Schemes

Directory of Open Access Journals (Sweden)

Jos Frijns

2016-12-01

Full Text Available The governance dimensions of water reuse scheme development and operation, such as policies and regulatory frameworks, and public involvement and stakeholder collaboration, can serve to both facilitate and constrain wider adoption of water reuse practices. This paper explores the significance and underlying structure of the key governance challenges facing the water reuse sector in Europe. It presents empirical evidence from interviews and focus group sessions conducted at four water reuse schemes: an indirect potable reuse scheme at Torreele (Belgium, the urban reuse of treated municipal wastewater at the London Olympic Park (United Kingdom and at Sabadell (Spain, and the reuse of agro-industrial effluent for irrigation at Capitanata (Italy. The findings underscore the importance of clarity in policy arrangements around water reuse, as well as of the financial competitiveness of reuse projects compared to alternative water supply options. Operators of water reuse schemes expressed a preference for water quality standards, which focus on appropriateness for use rather than over-emphasise the waters’ origin so that unnecessary treatment and costs can be avoided. Positive public support was widely acknowledged as an important factor in the success or failure of water reuse schemes. We conclude that constructive institutional relationships underpin many of the challenges faced by reuse scheme operators and that greater emphasis should be given to building confidence and gaining trust in water service providers through early identification of how governance regimes shape the viability of new schemes.

TU-C-201-00: Clinical Implementation of HDR Brachytherapy

Energy Technology Data Exchange (ETDEWEB)

NONE

2015-06-15

Recent use of HDR has increased while planning has become more complex often necessitating 3D image-based planning. While many guidelines for the use of HDR exist, they have not kept pace with the increased complexity of 3D image-based planning. Furthermore, no comprehensive document exists to describe the wide variety of current HDR clinical indications. This educational session aims to summarize existing national and international guidelines for the safe implementation of an HDR program. A summary of HDR afterloaders available on the market and their existing applicators will be provided, with guidance on how to select the best fit for each institution’s needs. Finally, the use of checklists will be discussed as a means to implement a safe and efficient HDR program and as a method by which to verify the quality of an existing HDR program. This session will provide the perspective of expert HDR physicists as well as the perspective of a new HDR user. Learning Objectives: Summarize national and international safety and staffing guidelines for HDR implementation Discuss the process of afterloader and applicator selection for gynecologic, prostate, breast, interstitial, surface treatments Learn about the use of an audit checklist tool to measure of quality control of a new or existing HDR program Describe the evolving use of checklists within an HDR program.

Prospects and Challenges of Corporate Governance in Ghana

OpenAIRE

Agyemang, Otuo Serebour; Aboagye, Emmanuel; Ahali, Aaron Yao Ofoe

2013-01-01

The relevance of corporate governance principles in the management of corporate organisations cannot be underestimated. The increasing influence of principles of corporate governance across the globe has been greatly linked to the recent corporate frauds and scandals. These frauds and scandals largely resulted from the failure of authorities of countries to effectively implement the legal and regulatory frameworks pertaining to corporate governance. Ghana is archetypal in regards to the failu...

Implementation and evaluation of a clinical data management programme in a primary care centre.

LENUS (Irish Health Repository)

Sweeney, J

2014-11-01

Electronic health records (EHR) support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care.

A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems

OpenAIRE

Phansalkar, Shobha; Edworthy, Judy; Hellier, Elizabeth; Seger, Diane L; Schedlbauer, Angela; Avery, Anthony J; Bates, David W

2010-01-01

The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decisio...

Comparing the use of SNOMED CT and ICD10 for coding clinical conditions to implement laboratory guidelines.

Science.gov (United States)

Yasini, Mobin; Ebrahiminia, Vahid; Duclos, Catherine; Venot, Alain; Lamy, Jean-Baptiste

2013-01-01

Laboratory medicine is responsible for an important part of hospital expenditure. Providing appropriate decision support to laboratory test requesters at the point of care is one of the main incentives for implementing laboratory guidelines, which can improve medical care. Laboratory guidelines developed by local experts in the Parisian region and two national guidelines for dyslipidemia were analyzed to extract test ordering recommendations. Clinical conditions which can be a trigger to order or not to order laboratory tests were extracted and mapped with ICD10 and SNOMED CT: 43.1% of clinical conditions were matched by ICD10 whereas SNOMED CT covered 80.1% of these conditions. For the non-mapped conditions, the main problem was found to be the ambiguity of the terms used in the guidelines. Ordinal characteristics of some clinical conditions and using terms more specific than SNOMED CT were other causes of mapping failure. Applying consistent and explicit concepts in the development of guidelines would lead to better implementation. By resolving the guideline ambiguity, SNOMED CT is a good choice and covers almost all of the clinical conditions in laboratory guidelines which are needed to implement in a Clinical Decision Support System.