WorldWideScience

Sample records for continuous improvement accomplishments

  1. IMHEX fuel cell repeat component manufacturing continuous improvement accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    Jakaitis, L.A.; Petraglia, V.J.; Bryson, E.S. [M-C Power Corp., Burr Ridge, IL (United States)] [and others

    1996-12-31

    M-C Power is taking a power generation technology that has been proven in the laboratory and is making it a commercially competitive product. There are many areas in which this technology required scale up and refinement to reach the market entry goals for the IMHEX{reg_sign} molten carbonate fuel cell power plant. One of the primary areas that needed to be addressed was the manufacturing of the fuel cell stack. Up to this point, the fuel cell stack and associated components were virtually hand made for each system to be tested. M-C Power has now continuously manufactured the repeat components for three 250 kW stacks. M-C Power`s manufacturing strategy integrated both evolutionary and revolutionary improvements into its comprehensive commercialization effort. M-C Power`s objectives were to analyze and continuously improve stack component manufacturing and assembly techniques consistent with established specifications and commercial scale production requirements. Evolutionary improvements are those which naturally occur as the production rates are increased and experience is gained. Examples of evolutionary (learning curve) improvements included reducing scrap rates and decreasing raw material costs by buying in large quantities. Revolutionary improvements result in significant design and process changes to meet cost and performance requirements of the market entry system. Revolutionary changes often involve identifying new methods and developing designs to accommodate the new process. Based upon our accomplishments, M-C Power was able to reduce the cost of continuously manufactured fuel cell repeat components from the first to third 250 kW stack by 63%. This paper documents the continuous improvement accomplishments realized by M-C Power during IMHEX{reg_sign} fuel cell repeat component manufacturing.

  2. Continual improvement plan

    Science.gov (United States)

    1994-01-01

    NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

  3. SF Bay Water Quality Improvement Fund: Projects and Accomplishments

    Science.gov (United States)

    San Francisco Bay Water Quality Improvement Fund (SFBWQIF) projects listed here are part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  4. Report of Accomplishments under the Airport Improvement Program.

    Science.gov (United States)

    1983-09-30

    0) RUNLWAYMLhy>, FRIEDMAN MEMORIA :. ACCESLS WAY :fHppjV’EMO;:tr, * (COMMERCIAL, HAIILEY U.. 43t, 1% ISCELLAINiAUS SA!L: :v -YT;;:- FRIEDMAN MEMORIA ...airport no. funds Description of work K= 5 0 I S (CONTINUED) CHAMPAIGN/ URBANA 02 $ 423,364 TAXIWAY IMPROVEMEN’:’S; A’WVESS WAY UNIVERSITY OF CONSTRUCTION

  5. Continuous Personal Improvement.

    Science.gov (United States)

    Emiliani, M. L.

    1998-01-01

    Suggests that continuous improvement tools used in the workplace can be applied to self-improvement. Explains the use of such techniques as one-piece flow, kanban, visual controls, and total productive maintenance. Points out misapplications of these tools and describes the use of fishbone diagrams to diagnose problems. (SK)

  6. Continuous quality improvement

    NARCIS (Netherlands)

    Rohlin, Madeleine; Schaub, Rob M.H.; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

    2002-01-01

    Versch. in: Eur J Dent Educ; 6 (Suppl. 3): 67–77 Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of

  7. Continuous quality improvement

    International Nuclear Information System (INIS)

    Bourne, P.B.

    1985-01-01

    This paper describes the various statistical tools used at the Hanford Engineering Development Laboratory to achieve continuous quality improvement in the development of Breeder Reactor Technology and in reactor operations. The role of the quality assurance professionals in this process, including quantifiable measurements using actual examples, is provided. The commitment to quality improvement through top management involvement is dramatically illustrated

  8. KAIZEN CONTINUOUS IMPROVEMENT

    OpenAIRE

    Yenque D., Julio; García P., Manuel; Raez G., Luis

    2014-01-01

    Many times we ask the question why Japanese companies are competitive?, Surely many of the answers to this mystery have support in the Kaizen. And the Kaizen is not a simple concept, it is a whole way of life that involves both managers and workers in the pursuit of progressive improvement of enterprises. In his book Kaizen, The Key to Japanese Competitive Advantage, Masaaki Imai explains in simple terms what is the essence of this philosophy: Kaizen means improvement means further progressiv...

  9. Partnership for Continuous Improvement

    Science.gov (United States)

    1990-01-01

    The proceedings are presented of the sixth annual conference on quality control between NASA and its contractors. The emphasis is placed on a commitment to quality and excellence that guarantees mission success. A forum is provided for representatives from government, industry, and academia to exchange ideas and experiences, encouraging total quality performance that results in high quality products and services. Key points are highlighted from the presentations and activities are described that have resulted in a broad range of improvements in products and services from government, industry, and academia. Long term commitment to quality is an essential requirement that ensures future success. That commitment reinterates the dedication to excellence in space exploration and to national quality and productivity improvement.

  10. Perspectives: The Continuous Improvement Trap

    Science.gov (United States)

    Arnold, David L.

    2011-01-01

    Accrediting agencies, legislators, pundits, and even higher educational professionals have become enamored with applying the language of continuous improvement to learning outcomes. The Southern Association of Colleges and Schools Commission on Colleges specifically uses the term "continuing improvement" in Core Standard 2.5, one of its…

  11. Creative accomplishment of continuous TIP motor torque monitoring system in BWR plant

    International Nuclear Information System (INIS)

    Sun, C.H.; Li, I.N.; Liu, C.S.

    1986-01-01

    The Traveling In-core Probe (TIP) system is designed so delicate that the routine preventive maintenance - torque measurement is required to keep system operating properly. Normally, the torque measurement is performed by manually rotating torque wrench on the local TIP drive mechanism or using wattmeter during automatic operation. Whenever, either torque wrench or wattmeter measurement is performed, the high radiation exposure to maintenance personnel and mass manpower is expected. Because of this reason Taipower has developed a continuous TIP motor torque monitoring system to save manpower and minimize radiation exposure to maintenance personnel. This methods of TIP motor torque measurement will also predict TIP guide tube deterioration. (author)

  12. Baseline budgeting for continuous improvement.

    Science.gov (United States)

    Kilty, G L

    1999-05-01

    This article is designed to introduce the techniques used to convert traditionally maintained department budgets to baseline budgets. This entails identifying key activities, evaluating for value-added, and implementing continuous improvement opportunities. Baseline Budgeting for Continuous Improvement was created as a result of a newly named company president's request to implement zero-based budgeting. The president was frustrated with the mind-set of the organization, namely, "Next year's budget should be 10 to 15 percent more than this year's spending." Zero-based budgeting was not the answer, but combining the principles of activity-based costing and the Just-in-Time philosophy of eliminating waste and continuous improvement did provide a solution to the problem.

  13. Developing a Continuous Improvement System

    Science.gov (United States)

    2016-09-16

    disagree that continuous improvement is critical to an organization’s suc-cess, since conducting business using a status quo philosophy will not work...for implementing one of these processes include: better operational efficiency, increased customer satisfaction, improved employee morale ...when a problem in reliability or maintenance may become the greatest opportunity. As described in the January-February 2011 issue of Defense AT&L

  14. Continuous Improvement in Schools and Districts: Policy Considerations

    Science.gov (United States)

    Best, Jane; Dunlap, Allison

    2014-01-01

    Discussions about improving public education often focus on outcomes without considering how schools and districts can accomplish those outcomes. Research shows that using a continuous improvement process has proven successful in healthcare, manufacturing, and technology, and may hold potential for use in education as well. This brief defines and…

  15. A Report Card on Continuous Quality Improvement

    Science.gov (United States)

    Blumenthal, David; Kilo, Charles M.

    1998-01-01

    Efforts to incorporate the principles of continuous quality improvement (CQI) into health care have been underway for about ten years. In order to understand the lessons of this decade of experience, senior organizational leaders and experts in the field of health care were interviewed. This select group agreed that there have been concrete accomplishments: the tactic of assigning blame for mistakes to individuals is gradually giving way to an emphasis on detecting problems with process; there is a new focus on the health care customer; and many valuable projects have been inaugurated. Nevertheless, the interviews underlined the reality that the movement has not yet made a sizable impact on the U.S. health care system. Until there is a profound, organization-wide recognition of the need for change, universal commitment to CQI principles will not be achieved. PMID:9879305

  16. Continuous improvement of pump seals

    International Nuclear Information System (INIS)

    Wong, W.; Eyvindson, A.; Rhodes, D.B.

    2003-01-01

    Pump seal reliability continues to be an area needing improvement and ongoing vigilance. Methods have been developed for identifying and assessing factors relating to seal performance, selecting the most relevant ones for a specific station, and then focusing on the most significant aspects and how to improve. Discussion invariably addresses maintenance practices, seal design, monitoring capabilities, operating conditions, transients, and pump and motor design. Success in reliability improvement requires ongoing dialogue among the station operators, pump manufacturers and seal designers. AECL CAN-seals lead the nuclear industry in reliability and seal life. They effectively save operators millions of dollars in outage time and person-rem. This paper describes some of the significant developments in AECL's ongoing program in seal R and D, as well as recent new installations following the most demanding seal qualification programs to date. (author)

  17. Sustaining motivation for continuous improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Kofoed, Lise Busk

    2007-01-01

    The objective of this article is to explore possibilities for improving motivation for participation in Continuous Improvement (CI). Due to a number of issues, for example, challenges with measuring outcomes of CI activities on performance, the inherent slower, incremental rather than big bang...... activities is an important issue for managers. The paper begins with a short description of CI, with an emphasis on barriers to successful implementation cited in the literature. Thereafter, a number of widely-acknowledged-albeit perhaps somewhat dated-theories of motivation are explored in relation...... to the elements of CI in practice. Based on their own experiences with CI implementation in numerous action-research based studies, the authors propose a scenario for motivating CI participation through emphasis on factors common to the presented motivational theories. The paper ends with insights into future...

  18. Continuous improvement of software quality

    International Nuclear Information System (INIS)

    Sivertsen, Terje

    1999-04-01

    The present report is the first Halden Work Report delivered from the OECD Halden Reactor Project's research activity on formal methods and software quality. Of particular concern in this activity is to reach a consensus between regulators, licensees and the nuclear industry on questions related to the effective, industrial use of formal methods. The report gives considerable attention to the importance of continuous improvement as a characteristic of a living software quality system, and to the need of providing a basis for software process/product quality integration. In particular, the report discusses these aspects from the perspectives of defect prevention, formal methods, Total Quality Management (TQM), and Bayesian Belief Nets. Another concern is to promote controlled experiments on the use of new methods, techniques, and tools. This is achieved partly by reviewing suggestions on the collection and experimental use of data, and by surveying a number of metrics believed to have some potential for comparison studies (author) (ml)

  19. Continuous Improvement in Schools: Understanding the Practice

    Science.gov (United States)

    Anderson, Stephen; Kumari, Roshni

    2009-01-01

    This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

  20. Teamwork, Leadership, and Continuous Improvement

    NARCIS (Netherlands)

    Keijser, Wouter Alexander; Glaudemans, Andor; Medema, Jitze; Dierckx, Rudi; Ahaus, Kees

    2017-01-01

    In this chapter, we describe the enhanced TeamSTEPPS® curriculum as fundament to creating a “culture of continuous improvement” in nuclear medicine. This evidence-based and modular teamwork system is deployed in concordance with a novel medical leadership development program. It provides a

  1. CTE's Focus on Continuous Improvement

    Science.gov (United States)

    Foster, John; Kelley, Patricia; Pritz, Sandy; Hodes, Carol

    2011-01-01

    Just one of the ways career and technical education (CTE) is revamping its image is through increased attention to data-driven instructional techniques as a means of improving and focusing instruction on what matters most. Accountability and data have increasingly become a core focus of research, news, and commentary about education in recent…

  2. Continuous Improvement and Collaborative Improvement: Similarities and Differences

    DEFF Research Database (Denmark)

    Middel, Rick; Boer, Harry; Fisscher, Olaf

    2006-01-01

    the similarities and differences between key components of continuous and collaborative improvement by assessing what is specific for continuous improvement, what for collaborative improvement, and where the two areas of application meet and overlap. The main conclusions are that there are many more similarities...... between continuous and collaborative improvement. The main differences relate to the role of hierarchy/market, trust, power and commitment to collaboration, all of which are related to differences between the settings in which continuous and collaborative improvement unfold....

  3. Teacher Research as Continuous Process Improvement

    Science.gov (United States)

    Ellis, Charles; Castle, Kathryn

    2010-01-01

    Purpose: Teacher research (inquiry) has been characterized as practice improvement, professional development and action research, among numerous names and descriptions. The purpose of this paper is to support the case that teacher research is also a form of quality improvement known as continuous process improvement (CPI).…

  4. Managerial implications for improving continuous production processes

    DEFF Research Database (Denmark)

    Capaci, Francesca; Vanhatalo, Erik; Bergquist, Bjarne

    2017-01-01

    . In this article we highlight SPC and DoE implementation challenges described in the literature for managers, researchers and practitioners interested in continuous production process improvement. The results may help managers support the implementation of these methods and make researchers and practitioners aware......Data analytics remains essential for process improvement and optimization. Statistical process control and design of experiments are among the most powerful process and product improvement methods available. However, continuous process environments challenge the application of these methods...... of methodological challenges in continuous process environments...

  5. Continuous Improvement and Collaborative Improvement: Similarities and Differences

    NARCIS (Netherlands)

    Middel, H.G.A.; Boer, Harm; Fisscher, O.A.M.

    2006-01-01

    A substantial body of theoretical and practical knowledge has been developed on continuous improvement. However, there is still a considerable lack of empirically grounded contributions and theories on collaborative improvement, that is, continuous improvement in an inter-organizational setting. The

  6. Occupational Analysis: A Continuous Improvement Approach

    National Research Council Canada - National Science Library

    Duffy, Tom

    1998-01-01

    .... In doing so, the Air Force has implemented "Quality Air Force (QAF)" (AF Handbook 90-502). QAF is a leadership commitment that inspires trust, teamwork, and continuous improvement everywhere in the Air Force...

  7. Continuous improvement methods in the nuclear industry

    International Nuclear Information System (INIS)

    Heising, Carolyn D.

    1995-01-01

    The purpose of this paper is to investigate management methods for improved safety in the nuclear power industry. Process improvement management, methods of business process reengineering, total quality management, and continued process improvement (KAIZEN) are explored. The anticipated advantages of extensive use of improved process oriented management methods in the nuclear industry are increased effectiveness and efficiency in virtually all tasks of plant operation and maintenance. Important spin off include increased plant safety and economy. (author). 6 refs., 1 fig

  8. Human Resource Management for Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Boer, Harry; Laugen, Bjørge

    2006-01-01

    The objective of this paper is to investigate the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, organizational performance. The paper i...

  9. Human Resource Management for Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Laugen, Bjørge Timenes; Boer, Harry

    2007-01-01

    This paper investigates the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, company performance. The paper begins with a brief review...... of the HRM and CI literature and then presents statistical analyses of data collected from the Continuous Improvement Network Survey (2003), which demonstrate that HRM has a significant effect on CI behaviour and company performance, with the strongest relationship between HRM, CI and performance occurring...

  10. Continue service improvement at CERN computing centre

    International Nuclear Information System (INIS)

    Lopez, M Barroso; Everaerts, L; Meinhard, H; Baehler, P; Haimyr, N; Guijarro, J M

    2014-01-01

    Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

  11. A Typology of Continuous Improvement Implementation Processes

    DEFF Research Database (Denmark)

    Rijnders, Sander; Boer, Harry

    2004-01-01

    This article presents a typology of continuous improvement (CI) implementation processes. The typology is based on an empirical study of 26 companies engaged in the implementation of CI. The data underpinning the typology was collected through retrospective interviews guided by a semi-structured ......This article presents a typology of continuous improvement (CI) implementation processes. The typology is based on an empirical study of 26 companies engaged in the implementation of CI. The data underpinning the typology was collected through retrospective interviews guided by a semi...

  12. Software Maintenance Management Evaluation and Continuous Improvement

    CERN Document Server

    April, Alain

    2008-01-01

    This book explores the domain of software maintenance management and provides road maps for improving software maintenance organizations. It describes full maintenance maturity models organized by levels 1, 2, and 3, which allow for benchmarking and continuous improvement paths. Goals for each key practice area are also provided, and the model presented is fully aligned with the architecture and framework of software development maturity models of CMMI and ISO 15504. It is complete with case studies, figures, tables, and graphs.

  13. A Continuous Improvement Capital Funding Model.

    Science.gov (United States)

    Adams, Matt

    2001-01-01

    Describes a capital funding model that helps assess facility renewal needs in a way that minimizes resources while maximizing results. The article explains the sub-components of a continuous improvement capital funding model, including budgeting processes for finish renewal, building performance renewal, and critical outcome. (GR)

  14. Continuous Improvement in State Funded Preschool Programs

    Science.gov (United States)

    Jackson, Sarah L.

    2012-01-01

    State funded preschool programs were constantly faced with the need to change in order to address internal and external demands. As programs engaged in efforts towards change, minimal research was available on how to support continuous improvement efforts within the context unique to state funded preschool programs. Guidance available had…

  15. Quick and continuous improvement through kaizen blitz.

    Science.gov (United States)

    McNichols, T; Hassinger, R; Bapst, G W

    1999-05-01

    It is our objective to provide you with a step-by-step approach to conducting a kaizen blitz within two days and describe how to achieve dramatic performance improvement with employee buy-in through this process. Kaizen blitz has been used dozens of times by the authors, and in some instances the same area has been blitzed as many as four times, with significant improvements each and every time. Employees have even taken it on themselves to conduct informal blitzes as a continuing improvement effort after a formal blitz has been conducted in their area. Blitzes can succeed in a variety of environments. The morning after the employees of one company attended this presentation, they self initiated a mini-blitz and discovered opportunities for improvement that they enthusiastically presented to management.

  16. Continuous improvement: A win-win process

    International Nuclear Information System (INIS)

    Lawrence, T.M.; Wichert, A.

    1992-01-01

    The strategies used within PanCanadian Petroleum Limited's production division to successfully introduce the continuous improvement (CI) process are discussed. Continuous improvement is an operating philosophy and management style which allows all employees to participate in and improve the way an organization performs its day-to-day business. In the CI work environment the supervisor's traditional role changes from one of monitoring and controlling, to one of inspiring, motivating and leading people by communicating a clear vision. Employees at all levels in the work environment are organized into teams and armed with a good working knowledge of the problem-solving tools which allow them to pursue and implement improvement initiatives. The outcome of the process is an ongoing win-win situation for both PanCanadian and its people. Employees are gaining more trust, eliminating job irritants, and enjoying their work in a team environment. The company is benefiting through increased production, improved safety and reduced operating expenses, thanks to the many innovative ideas introduced by employees. 4 refs

  17. Human Resource Development's Contribution to Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Hyland, Paul

    2007-01-01

    Continuous Improvement (CI) is an approach to organizational change that requires active involvement of skilled and motivated employees, which implies an important role for HRD practitioners. The findings from a literature review and a survey of 168 Danish manufacturing companies indicate however...... that HRD is rarely integrated with CI. The paper contributes by offering a model that depicts how HR and HRD functions could be exploited to support successful CI development and implementation....

  18. Continuous improvement in managing R&D: A TQM approach at SkogForsk, Sweden

    Science.gov (United States)

    Magnus Larsson

    1999-01-01

    Continuous improvement is an imperative process for any organization) even in the R&D field) who wants to stay competitive and alive. Our experience is that the most important ingredients in this process are engagement and participation by everybody) shared visions) and a holistic view of the organization. Structural changes and quick fixes cannot accomplish this....

  19. Continuous Improvement in Action: Educators' Evidence Use for School Improvement

    Science.gov (United States)

    Cannata, Marisa; Redding, Christopher; Rubin, Mollie

    2016-01-01

    The focus of the article is the process educators use to interpret data to turn it into usable knowledge (Honig & Coburn, 2008) while engaging in a continuous improvement process. The authors examine the types of evidence educators draw upon, its perceived relevance, and the social context in which the evidence is examined. Evidence includes…

  20. Continuous improvement: A win... win process

    International Nuclear Information System (INIS)

    Lawrence, T.; Wichert, A.

    1993-01-01

    Implementing a continuous improvement (CI) process within PanCanadian's oil and gas production operations might have been a simple assignment if one were not also trying to capture the hearts and imaginations of the people in a changing work environment. Meeting the challenge is resulting in big payoffs to both the organization and its people. The plan used within the Company's Production Division to successfully introduce the CI process is discussed. A brief insight is provided on the process philosophy, with emphasis placed on planning, training and coaching used to launch the process. Also reviewed at length are the impediments to change and the challenges faced when changing an organization's culture. In a CI work environment, the supervisor's traditional role changes from one of monitoring and controlling to one of inspiring, motivating and leading people by communicating a clear vision. Employees at all levels in the work environment are organized into teams and armed with a good working knowledge of the problem solving tools which allow them to pursue and implement improvement initiatives. The outcome of the process is an ongoing 'win-win' situation for both the Company and its people. Employees are gaining more trust, eliminating job irritants and enjoying their work more in a team environment. The Company is winning through increased production, improved safety and reduced operating expenses, thanks to many innovative ideas which the employees have implemented. 4 refs

  1. How can we recognize continuous quality improvement?

    Science.gov (United States)

    Rubenstein, Lisa; Khodyakov, Dmitry; Hempel, Susanne; Danz, Margie; Salem-Schatz, Susanne; Foy, Robbie; O'Neill, Sean; Dalal, Siddhartha; Shekelle, Paul

    2014-02-01

    Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI. Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process. Primarily United States and Canada. 119 QI experts randomly assigned into four on-line panels. Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s) Panel consensus on definitional CQI features. /st> Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features 'systematic data guided activities,' 'designing with local conditions in mind' and 'iterative development and testing' met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI. We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as 'CQI.' All three features are needed as a minimum standard for recognizing CQI methods.

  2. Continuous improvement projects: an authorship bibliometric analysis.

    Science.gov (United States)

    Gonzalez Aleu, Fernando; Van Aken, Eileen M

    2017-06-12

    Purpose The purpose of this paper is to describe the current research on hospital continuous improvement projects (CIPs) from an author characteristics' perspective. This work addresses the following questions: who are the predominant research authors in hospital CIPs? To what extent are the research communities collaborating in distinct research groups? How internationalized has hospital CIPs research become with respect to author location? Design/methodology/approach A systematic literature review was conducted, identifying 302 academic publications related to hospital CIPs. Publications were analyzed using: author, quantity, diversity, collaboration, and impact. Findings Hospital CIPs are increasingly attracting new scholars each year. Based on the authors' analysis, authors publishing in this area can be described as a relatively new international community given the countries represented. Originality/value This paper describes the current hospital CIP research by assessing author characteristics. Future work should examine additional attributes to characterize maturity such as how new knowledge is being created and to what extent new knowledge is being disseminated to practitioners.

  3. Significant accomplishments, 2009

    Science.gov (United States)

    2009-01-01

    BTS data is vital to improve transportation decision making, as well as evaluations of performance and what works in the nations transportation systems. As BTS continues its course of producing relevant, accurate, and timely transportation d...

  4. NASA total quality management 1990 accomplishments report

    Science.gov (United States)

    1991-01-01

    NASA's efforts in Total Quality Management are based on continuous improvement and serve as a foundation for NASA's present and future endeavors. Given here are numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. These accomplishment benefit our Agency and help to achieve our primary goal, keeping American in the forefront of the aerospace industry.

  5. Case Studies in Continuous Process Improvement

    Science.gov (United States)

    Mehta, A.

    1997-01-01

    This study focuses on improving the SMT assembly process in a low-volume, high-reliability environment with emphasis on fine pitch and BGA packages. Before a process improvement is carried out, it is important to evaluate where the process stands in terms of process capability.

  6. Improved specifications for continuous emission monitoring

    International Nuclear Information System (INIS)

    Dene, C.E.; Eggleston, T.E.; Gray, W.C. Jr.; Bisha, R.M.

    1988-01-01

    Continuous emission monitoring (CEM) in the electric utility industry historically has been plagued by poor performance and inconsistent system reliability. These problems have, in part, been caused by the complexity and diversity of the various systems available, and the dissimilarity of continuous emission monitors CEMs relative to conventional power plant instrumentation. Recognizing the problems faced by the utility industry in implementing CEM programs, the Electric Power Research Institute (EPRI) initiated a multi-phase project to define the current state of technology for CEMs and to provide a comprehensive guide for the purchase and installation of a CEM system. The second phase of this project was the application of these guidelines to the actual purchase, installation, and operation of a CEM system for an electric utility generating station. Through this application of the guidelines it has been possible to determine further research needs and areas of the manual which require clarification or enhancement. This paper describes the development of the guidelines and modifications to the guidelines, and discusses EPRI's plans for future activities in the area of continuous emission monitoring

  7. Continuous improvement in teams : The (mis)fit between improvement and operational activities of improvement teams

    NARCIS (Netherlands)

    Ros, D.J.

    1999-01-01

    Since the 1970s and 1980s, increasing attention has been paid to the Japanese ways of organising production. One of the subjects often discussed is the importance of continuous incremental improvements. Nowadays, for many organisations, continuous improvement has become an important topic; many

  8. Involving vendors in continuous quality improvement efforts.

    Science.gov (United States)

    McDevitt, M C

    1995-03-01

    In the hospital environment, vendors supply a wide range of items, from surgical sutures to the latest in high-cost technological equipment. Also, many clinical and support services, such as respiratory therapy, transcription, and computer databanks are now outsourced to commercial vendors. Interaction with such vendors is often less than satisfactory, with prolonged timelines and disruption of an important process that is being computerized. Although hospitals deal with very few vendors in long-term relationships, such as those seen in manufacturing, this should not preclude the formation of a supplier-customer relationship that goes beyond management's interaction with the sales representative in response to a request for proposal. This is especially true when a process improvement team has studied an internal process and defined a key quality characteristic.

  9. Continual Improvement In Small Soaps Company

    Directory of Open Access Journals (Sweden)

    Borget Alfred Anoye

    2015-08-01

    Full Text Available Abstract In this paper using quality management tools we track root causes and principal causes of the rising manufacturing cost of the bar soaps and propose solution to solve the problem. First we identify and analyze the roots causes of problem with the Fishbone Diagram. We use multivoting approach to reduce roots causes to main causes from which we identify classify and analyze principal causes using the Pareto Diagram. We then perform a deep analysis of these principal causes using the 5 whys analysis technique. Three principal causes were found amp61480high level of overtime poor machine performance and poor employees performanceamp61481 and were weighing 55 of the problem. For that reason working on these areas was necessary to address the problem of the rising manufacturing cost of the bar soaps. With the result we then use the PDCA 7 steps of TQM method to solve the problem of the rising manufacturing cost by testing whether expanding production capacity leads to performance improvements of these areas. We decide to expand production capacity by adding two more machine groups. Six months after implementation of the proposed solution the result shows an enhanced workload and schedule an increased production capacity an elimination of the overtime issue an increased machines performance and an improved workers performance. Two main savings were achieved as wage costs and maintenance costs. As a result while competitors bar soaps prices increased the company bar soaps price decreased by 50 making the company bar soaps more attractive on market as this performance permitted the company to apply price reduction at the retailer level.

  10. Continuing education for performance improvement: a creative approach.

    Science.gov (United States)

    Collins, Patti-Ann; Hardesty, Ilana; White, Julie L; Zisblatt, Lara

    2012-10-01

    In an effort to improve patient safety and health care outcomes, continuing medical education has begun to focus on performance improvement initiatives for physician practices. Boston University School of Medicine's (BUSM) Continuing Nursing Education Accredited Provider Unit has begun a creative project to award nursing contact hours for nurses' participation in performance improvement activities. This column highlights its initial efforts. Copyright 2012, SLACK Incorporated.

  11. The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections

    Directory of Open Access Journals (Sweden)

    Steyerberg Ewout W

    2011-09-01

    healthcare associated infections between the intervention and control group. Discussion This study is the first RCT to investigate the effects of a hand hygiene intervention programme on the number of healthcare associated infections, and the first to investigate the cost-effectiveness of such an intervention. In addition, if the ACCOMPLISH package proves successful in improving hand hygiene compliance and lowering the prevalence of healthcare associated infections, the package could be disseminated at (international level. Trial registration NTR2448

  12. CONTINUOUS IMPROVEMENT PRACTICE IN LARGE ENTERPRISES: STUDY RESULTS

    Directory of Open Access Journals (Sweden)

    Dorota Stadnicka

    2015-03-01

    Full Text Available Continuous improvement is indispensable for ensuring the company's development and its survival on the constantly changing global market. Continuous improvement is particularly important in the quality and production management systems. A company should deliver a product compliant with a client's requirements in a specified time and at an appropriate price. That is why, continuous improvement refers to different areas of an organization's functioning and it is an integral part of Lean Manufacturing. This article presents the results of the study conducted in production enterprises on a limited area. The aim of the study was the assessment of the implementation of continuous improvement in Lean Manufacturing, and, in particular, employees' involvement in the problem identification and in reporting improvements as well as the way of motivating employees to involve themselves. The authors also tried to identify the factors influencing the elements of a continuous improvement system.

  13. Life Sciences Accomplishments 1994

    Science.gov (United States)

    Burnell, Mary Lou (Editor)

    1993-01-01

    The NASA Life and Biomedical Sciences and Applications Division (LBSAD) serves the Nation's life sciences community by managing all aspects of U.S. space-related life sciences research and technology development. The activities of the Division are integral components of the Nation's overall biological sciences and biomedical research efforts. However, NASA's life sciences activities are unique, in that space flight affords the opportunity to study and characterize basic biological mechanisms in ways not possible on Earth. By utilizing access to space as a research tool, NASA advances fundamental knowledge of the way in which weightlessness, radiation, and other aspects of the space-flight environment interact with biological processes. This knowledge is applied to procedures and technologies that enable humans to live and work in and explore space and contributes to the health and well-being of people on Earth. The activities of the Division are guided by the following three goals: Goal 1) Use microgravity and other unique aspects of the space environment to enhance our understanding of fundamental biological processes. Goal 2) Develop the scientific and technological foundations for supporting exploration by enabling productive human presence in space for extended periods. Goal 3) Apply our unique mission personnel, facilities, and technology to improve education, the quality of life on Earth, and U.S. competitiveness. The Division pursues these goals with integrated ground and flight programs involving the participation of NASA field centers, industry, and universities, as well as interactions with other national agencies and NASA's international partners. The published work of Division-sponsored researchers is a record of completed research in pursuit of these goals. During 1993, the LBSAD instituted significant changes in its experiment solicitation and peer review processes. For the first time, a NASA Research Announcement (NRA) was released requesting

  14. AEL Continuous School Improvement Questionnaire. User Manual and Technical Report.

    Science.gov (United States)

    Meehan, Merrill L.; Cowley, Kimberly S.; Craig, James R.; Balow, Nancy; Childers, Robert D.

    The Continuous School Improvement Questionnaire (CSIQ) developed by the AEL helps a school staff gauge its performance on six dimensions related to continuous school improvement. Each member of the staff responds to the CSIQ individually. Although results might be used at the district or regional level, the most widely intended unit for applying…

  15. Continuous Improvement and its Barriers in Electrical and Electronic Industry

    Directory of Open Access Journals (Sweden)

    Ahmad Md Fauzi

    2017-01-01

    Full Text Available Continuous improvement is one of the core strategies for manufacturing excellent and it is considered vital in today’s business environment. Continuous improvement is an important factor in TQM implementation. However, manufacturers in Electrical and Electronic Industry is facing variety of challenges such as, time constraint, quality issue, headcount issue, human issue and competition in domestic as well as the global market. This paper presents total quality management practices in Electrical and Electronic (EE Industry. These manufacturers have to keep improving in key activities and processes to cope the challenges. Therefore, EE industry realize the importance of continuous improvement in helping the industries by setting clear goals and priorities for the area of improvement. The aims of this study are to determine the main factor in implementing continuous improvement practices, identify tools of continuous improvement that have been used and their obstacle in implementing continuous improvement practices. 200 questionnaires had been distributed to the employees in Electrical and Electronic Industry located at Bayan Lepas, Penang, Malaysia. A total of 41 questionnaires were answered which represented about 20.5% response rates. Survey result shows that teamwork and training and learning are respectively the importance factor and the most practices factor in Electrical and Electronic Industry. Most of the Electrical and Electronic Industry emphasis is on using Lean Manufacturing as the tool of continuous improvement practices. Besides that, Electrical and Electronic Industry faced the problems of lack of budget and lack of worker commitment.

  16. Can Schools Meet the Promise of Continuous Improvement?

    Science.gov (United States)

    Elgart, Mark A.

    2018-01-01

    Continuous improvement is "an embedded behavior within the culture of a school that constantly focuses on the conditions, processes, and practices that will improve teaching and learning." The phrase has been part of the lexicon of school improvement for decades, but real progress is rare. Based on its observations of about 5,000…

  17. SIMMER Program: its accomplishments

    International Nuclear Information System (INIS)

    Smith, L.L.; Bell, C.R.; Bohl, W.R.; Luck, L.B.; Wehner, T.R.; DeVault, G.P.; Parker, F.R.

    1985-01-01

    SIMMER's mechanistic framework has contributed to substantial progress in understanding severe LMFBR accidents, the important accident processes, the process environments, and the need for consistency in assessing the total accident sequence. A comprehensive program of model and code development, experiment analyses, separate-effects studies, and whole-core accident calculations has resolved issues in transition-phase, behavior and showed convincingly that Clinch River Breeder Reactor accident energetics were within design requirements. The current international program continues progress toward improving our understanding of severe accidents in LMFBRs. 17 refs

  18. Continuous Improvement Implementation in the Nottingham University Hospitals NHS Trust: A Case Study of a Continuous Improvement Programme & Project

    OpenAIRE

    Velzen, Jeena

    2012-01-01

    This paper aims at identifying the extent to which the Nottingham University Hospitals NHS Trust has fulfilled literature requirements for successful continuous improvement as exemplified by its Better for You programme and chemotherapy service improvement project. Both the theory and ideals of the continuous improvement programme, along with the actualization of these philosophies and methodologies in the context of the particular project,were compared against a framework for the enabling...

  19. NASA total quality management 1989 accomplishments report

    Science.gov (United States)

    Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)

    1990-01-01

    NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.

  20. The soul of the machine: continual improvement in ISO 14001

    NARCIS (Netherlands)

    Brouwer, M.A.C.; van Koppen, C.S.A.

    2008-01-01

    Continual improvement is a key component of ISO 14001, but in contrast to most other specifications in the standard, it is difficult to assess. Based on interviews with 19 certified companies in the chemical, food, and environmental services sectors, this article explores the dynamics of continual

  1. The soul of the machine: continual improvement in ISO 14001.

    NARCIS (Netherlands)

    Brouwer, M.A.C.; Koppen, van C.S.A.

    2008-01-01

    Continual improvement is a key component of ISO 14001, but in contrast to most other specifications in the standard, it is difficult to assess. Based on interviews with 19 certified companies in the chemical, food, and environmental services sectors, this article explores the dynamics of continual

  2. Continuous improvement and the mini-company concept

    NARCIS (Netherlands)

    de Leede, Jan; Looise, Jan C.

    1999-01-01

    The key issue of continuous improvement (CI) seems to be the problem of combining extensive employee involvement with market orientation and continuation of CI. In this article we review some existing organisational designs for CI on these three essential characteristics of CI. As an alternative to

  3. Continuous Improvement and its Barriers in Electrical and Electronic Industry

    OpenAIRE

    Ahmad Md Fauzi; Yan Toh Li; Wei Chan Shiau; Aizat Ahmad Ahmad Nur; Raja Mohd Rasi Raja Zuraidah; Abdul Rahman Nor Aida; Muhd Nor Nik Hisyamudin; Hassan Mohd Fahrul; Hashim Fatan Adibah

    2017-01-01

    Continuous improvement is one of the core strategies for manufacturing excellent and it is considered vital in today’s business environment. Continuous improvement is an important factor in TQM implementation. However, manufacturers in Electrical and Electronic Industry is facing variety of challenges such as, time constraint, quality issue, headcount issue, human issue and competition in domestic as well as the global market. This paper presents total quality management practices in Electric...

  4. The program of continuous improvements in factory in Juzbado

    International Nuclear Information System (INIS)

    Prieto, M.

    2015-01-01

    This articles describes the historical development of the continuous improvement program at Juzbado Factory, since its beginning to nowadays. The evolution throughout the ideas of Total Quality, ISO, EFQM, Six Sigma, and so on, leading to the present situation in which all these tools and methodologies live together is shown. all this has led to a philosophy and business culture focused on safety, quality and continuous improvement. (Author)

  5. Implications of Continuous Quality Improvement for Program Evaluation and Evaluators.

    Science.gov (United States)

    Mark, Melvin M.; Pines, Edward

    1995-01-01

    Explores the implications that continuous quality improvement (CQI) programs are likely to have for evaluation. CQI, often known as total quality management, offers a structured approach to the analysis of an organization's processes and improvement that should provide advantages to evaluators once they have gained experience with the approach.…

  6. Closing the Loop on a Continuous Program Improvement Process

    Science.gov (United States)

    Booth, Vickie; Booth, Larry

    2010-01-01

    The WebBSIT, a Bachelor of Science in Information Technology, is a fully online degree offered through a consortium of five University System of Georgia institutions. This paper begins by summarizing the change management system developed for continuous program improvement. Analysis of data should drive improvement, closing the loop. The balance…

  7. Creating a Cycle of Continuous Improvement through Instructional Rounds

    Science.gov (United States)

    Meyer-Looze, Catherine L.

    2015-01-01

    Instructional Rounds is a continuous improvement strategy that focuses on the technical core of educational systems as well as educators collaborating side-by-side. Concentrating on collective learning, this process only makes sense within an overall strategy of improvement. This case study examined the Instructional Rounds process in a northern…

  8. The Keys to Effective Schools: Educational Reform as Continuous Improvement

    Science.gov (United States)

    Hawley, Willis D., Ed.

    2006-01-01

    Working in tandem with the powerful National Education Association's KEYS initiative (Keys to Excellence in Your Schools), this second edition focuses on how to change a school's organizational structure and culture to improve the quality of teaching and learning. Each chapter, revised and updated to address continuous improvement and narrowing…

  9. Continuous Improvement in Nursing Education through Total Quality Management (TQM

    Directory of Open Access Journals (Sweden)

    Tang Wai Mun

    2013-11-01

    Full Text Available Total Quality Management (TQM has generally been validated as a crucial revolution in the management field. Many academicians believe that the concept of TQM is applicable to academics and provides guiding principles towards improving education. Therefore, an increasing number of educational institutions such as schools, colleges and universities have started to embrace TQM philosophies to their curricula.Within the context of TQM, this paper would explore the concept of continuous improvement by using the Deming philosophy. Subsequently, this paper would elaborate on the application of TQM to bring about continuous improvement in the current education system.

  10. The continuous improvement process and ergonomics in ultrasound department.

    Science.gov (United States)

    Coffin, Carolyn T

    2013-01-01

    Continuous improvement processes, such as Lean, Six Sigma and Quality Control Circles, have been implemented in the manufacturing industries in an effort to increase productivity, eliminate waste, and engage employees in problem solving. These processes can be adapted to the healthcare sector as medical facilities strive to improve the patient experience, increase financial returns, and improve worker safety and morale. In the ultrasound department, productivity can be improved and the quality of patient care can be ensured by standardizing exam protocols and decreasing work related musculoskeletal disorders among sonography professionals. This article summarizes the more commonly used continuous improvement processes and provides a description of how one method might be applied to the ultrasound department.

  11. Matrix Wings: Continuous Process Improvement an Operator Can Love

    Science.gov (United States)

    2016-09-01

    key processes in our normal operations. In addition to the almost inevitable resistance to change, one of the points of pushback is that members of...Fall 2016 | 9 Matrix Wings Continuous Process Improvement an Operator Can Love Dr. A. J. Briding, Colonel, USAF, Retired Disclaimer: The views and...Operations for the 21st Century (AFSO21), the latest comprehensive effort at finding the right ap- proach for implementing a continuous process

  12. Agile kaizen managing continuous improvement far beyond retrospectives

    CERN Document Server

    Medinilla, Ángel

    2014-01-01

    Agile teams have been struggling with the concept of continuous improvement since the first Agile frameworks were developed, and still very little has been written about the practice of continuous improvement in Agile environments. Although team retrospectives have been prescribed and some practices have been introduced in order to implement and facilitate them, the truth is that most Agile teams are conducting dull retrospectives that end with a list of things that have been done wrong, just to repeat the same list two weeks later at the next meeting.Instead of listing hundreds of Japanese-la

  13. Continuous improvement comparison between Danish and Mexican companies

    DEFF Research Database (Denmark)

    Christiansen, Thomas Bøhm

    2004-01-01

    This article investigates continuous improvement tools that are used in two countries on two continents. For that purpose two surveys were conducted in the metropolitan area of Mexico City and in Denmark using the same scales and having about the same sample size. The continuous improvement tools...... comprise such concepts as TQM, Kaizen, Six Sigma and Lean Manufacturing. The paper shows the results of the analysis and a comparison of how and to what degree such tools are used in different places, which allow us to address similarities and dissimilarities of the application. The results are discussed...

  14. Concept Evaluation Using the PDSA Cycle for Continuous Quality Improvement.

    Science.gov (United States)

    Laverentz, Delois Meyer; Kumm, Sharon

    As concept-based nursing education gains popularity, there is little literature on how to sustain quality after initiation of the curriculum. Critical appraisal of concepts in a university program revealed varying definitions, attributes, and exemplars resulting in student confusion. The Plan, Do, Study, Act (PDSA) cycle for continuous quality improvement was used for concept evaluation. The goals of the evaluation project were: 1) to develop common definition and attributes for concepts and 2) to develop horizontal and vertical leveling of exemplars to build on prior student learning. The continuous quality improvement process can be used to prevent "concept creep" and ensure internal consistency of concept definitions, attributes, and exemplars.

  15. Design of launch systems using continuous improvement process

    Science.gov (United States)

    Brown, Richard W.

    1995-01-01

    The purpose of this paper is to identify a systematic process for improving ground operations for future launch systems. This approach is based on the Total Quality Management (TQM) continuous improvement process. While the continuous improvement process is normally identified with making incremental changes to an existing system, it can be used on new systems if they use past experience as a knowledge base. In the case of the Reusable Launch Vehicle (RLV), the Space Shuttle operations provide many lessons. The TQM methodology used for this paper will be borrowed from the United States Air Force 'Quality Air Force' Program. There is a general overview of the continuous improvement process, with concentration on the formulation phase. During this phase critical analyses are conducted to determine the strategy and goals for the remaining development process. These analyses include analyzing the mission from the customers point of view, developing an operations concept for the future, assessing current capabilities and determining the gap to be closed between current capabilities and future needs and requirements. A brief analyses of the RLV, relative to the Space Shuttle, will be used to illustrate the concept. Using the continuous improvement design concept has many advantages. These include a customer oriented process which will develop a more marketable product and a better integration of operations and systems during the design phase. But, the use of TQM techniques will require changes, including more discipline in the design process and more emphasis on data gathering for operational systems. The benefits will far outweigh the additional effort.

  16. Continuous quality improvement program for hip and knee replacement.

    Science.gov (United States)

    Marshall, Deborah A; Christiansen, Tanya; Smith, Christopher; Squire Howden, Jane; Werle, Jason; Faris, Peter; Frank, Cy

    2015-01-01

    Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program. A validated, evidence-based clinical pathway that measures quality across the continuum of care was adopted. Working collaboratively, multidisciplinary experts embedded the CQI program into everyday practices in clinics across Alberta. Currently, 83% of surgeons participate in the CQI program, representing 95% of the total volume of hip and knee surgeries. Biannual reports provide feedback to improve care processes, infrastructure planning, and patient outcomes. CQI programs evaluating health care services inform choices to optimize care and improve efficiencies through continuous knowledge translation. © The Author(s) 2014.

  17. Methods and Conditions for Achieving Continuous Improvement of Processes

    OpenAIRE

    Florica BADEA; Catalina RADU; Ana-Maria GRIGORE

    2010-01-01

    In the early twentieth century, the Taylor model improved, in a spectacular maner the efficiency of the production processes. This allowed obtaining high productivity by low-skilled workers, but used in large number in the execution of production. Currently this model is questioned by experts and was replaced by the concept of "continuous improvement". The first signs of change date from the '80s, with the apparition of quality circles and groups of operators on quality issues, principles whi...

  18. Jump starting of continuous improvement through self-assessment

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Boer, Harry; Gertsen, Frank

    2004-01-01

    The innumerable accounts of successful implementation of kaizen in Japan during more than 40 years has led to the expectation that continuous improvement (CI) might offer companies a means to gain and maintain a competitive advantage in the turbulent 1980s and 1990s. However, the majority of CI i...

  19. From Continuous Improvement to Organisational Learning: Developmental Theory.

    Science.gov (United States)

    Murray, Peter; Chapman, Ross

    2003-01-01

    Explores continuous improvement methods, which underlie total quality management, finding barriers to implementation in practice that are related to a one-dimensional approach. Suggests a multiple, unbounded learning cycle, a holistic approach that includes adaptive learning, learning styles, generative learning, and capability development.…

  20. Sustainable production. The ultimate result of a continuous improvement

    NARCIS (Netherlands)

    Ron, de A.J.

    1998-01-01

    To fulfil market requirements, companies have introduced cost awareness, quality programs and techniques to become flexible. These items should be handled as a continuous process of improvement. The cost awareness implies that e.g. material waste is avoided during production, the quality programs

  1. Promoting Continuous Quality Improvement in Online Teaching: The META Model

    Science.gov (United States)

    Dittmar, Eileen; McCracken, Holly

    2012-01-01

    Experienced e-learning faculty members share strategies for implementing a comprehensive postsecondary faculty development program essential to continuous improvement of instructional skills. The high-impact META Model (centered around Mentoring, Engagement, Technology, and Assessment) promotes information sharing and content creation, and fosters…

  2. The Continuous Improvement Model: A K-12 Literacy Focus

    Science.gov (United States)

    Brown, Jennifer V.

    2013-01-01

    The purpose of the study was to determine if the eight steps of the Continuous Improvement Model (CIM) provided a framework to raise achievement and to focus educators in identifying high-yield literacy strategies. This study sought to determine if an examination of the assessment data in reading revealed differences among schools that fully,…

  3. Infrastructure under construction: continuous improvement and learning in projects

    NARCIS (Netherlands)

    Gieskes, J.F.B.; ten Broeke, André M.

    2000-01-01

    Continuous improvement and learning are popular concepts in management literature and practice. Often they are situated in an environment where the work is of a repetitive nature. However, there are a lot of organisations where (part of) the primary processes are carried out by means of projects. An

  4. Continuous restraint control systems: safety improvement for various occupants

    NARCIS (Netherlands)

    Laan, E. van der; Jager, B. de; Veldpaus, F.; Steinbuch, M.; Nunen, E. van; Willemsen, D.

    2009-01-01

    Occupant safety can be significantly improved by continuous restraint control systems. These restraint systems adjust their configuration during the impact according to the actual operating conditions, such as occupant size, weight, occupant position, belt usage and crash severity. In this study,

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

    Science.gov (United States)

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

    2013-08-01

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

  6. Continuous improvement in manufacturing and inspection of fuel

    International Nuclear Information System (INIS)

    Domingon, A.; Ruiz, R.

    2015-01-01

    The manufacturing and inspection process of fuel assemblies in ENUSA is characterized by its robustness acquired over the last thirty years of experience in manufacturing. The reliability of these processes is based on a qualified processes and continuous improvement in the design and upgrading of equipment and optimization of software and manufacturing processes. Additionally, management and quality control systems have been improved in both software and measuring business objectives. this article emphasizes the improvements made over the past five years in management, production and inspection of fuel assemblies. (Author)

  7. Organisational learning: A tool for continuous improvement of the organization

    International Nuclear Information System (INIS)

    Santos, J. L.; Esteban, M. J.

    2013-01-01

    We are used to hear a success company in today's world is not possible unless a continuous improvement is developed. How can we be successful in the nuclear plant? We have to achieve safety for workers, people and environment in the first step, and for the second step availability and reliability for systems and components to avoid failure of components that could reduce availability. The aim is to search for new measures to reach this way. One of the improvements implemented in the plants to improve continuously was mainly Operating Experience activities, which was based in event analysis in the plants, causes identification, and to implement corrective actions. For External Operating Experience the aim was to learn from others to avoid occurrence of events in our plants. This was the lessons learned from Three Mile Island event. This was the learning process implemented so far, to get a continuous improvement. So far, the developed capabilities for process improvement follow the Operating Experience process that could be considered classical and will be revitalized nowadays. (Author)

  8. Applying PPM to ERP Maintenance and Continuous Improvement Initiatives

    DEFF Research Database (Denmark)

    El-Tal, Nada Maria; Fonnesbæk, Majbrit; Kræmmergaard, Pernille

    2006-01-01

    to gain business benefits from the systems. However the ERP literature on how to do this is limited. The purpose of this article is to explore how Project Portfolio Management (PPM) from the Research and Development (R&D) literature can be applied to an ERP second wave context, when companies...... are to prioritize and select maintenance and continuous improvement initiatives. This is done by reviewing the existing literature in the fields of PPM from R&D literature and then by reviewing the existing literature about maintenance and improvement initiatives in the ERP literature, after which the two...... are compared and discussed using three case-studies. The paper contributes with a discussion on how PPM from R&D can be applied to maintenance and continuous improvement initiatives in the second wave of ERP. The paper ends with arguing that emphasis needs to be given to this field, since a conscious...

  9. Strategy for continuous improvement in IC manufacturability, yield, and reliability

    Science.gov (United States)

    Dreier, Dean J.; Berry, Mark; Schani, Phil; Phillips, Michael; Steinberg, Joe; DePinto, Gary

    1993-01-01

    Continual improvements in yield, reliability and manufacturability measure a fab and ultimately result in Total Customer Satisfaction. A new organizational and technical methodology for continuous defect reduction has been established in a formal feedback loop, which relies on yield and reliability, failed bit map analysis, analytical tools, inline monitoring, cross functional teams and a defect engineering group. The strategy requires the fastest detection, identification and implementation of possible corrective actions. Feedback cycle time is minimized at all points to improve yield and reliability and reduce costs, essential for competitiveness in the memory business. Payoff was a 9.4X reduction in defectivity and a 6.2X improvement in reliability of 256 K fast SRAMs over 20 months.

  10. Continuous improvement in the Netherlands: A survey-based study into the current practices of continuous improvement

    NARCIS (Netherlands)

    Middel, H.G.A.; op de Weegh, S.; Gieskes, J.F.B.; Schuring, R.W.

    2004-01-01

    Continuous Improvement is a well-known and consolidated concept in literature and practice and is considered vital in today¿s business environment. In 2003 a survey, as part of the international CINet survey, has been performed in the Netherlands in order to gain insight into the current practices

  11. Continuous improvement program in ENUSA: personnel participation and six sigma

    International Nuclear Information System (INIS)

    Montes Navarro, J.

    1998-01-01

    Since the beginning of its activities ENUSA has been a company committed with the quality of its products and services. To talk about quality is something inherent in ENUSA's daily work ENUSA's position in the market depends on its capacity to satisfy customers expectations with the best products and services, as a result of an efficient management of its processes. The word quality in its broadest sense, means that any activity can be improved. ENUSA has implemented a continuous improvement program as part of its company change project. That program consists of six basic steps: 1.- Managers commitment. 2.- Organization for continuous improvement. 3.- Quality goals. 4.- Training and informing. 5.- Personnel participation. 6.- Methodology. ENUSA has introduced these six steps during 1997-98 period. It is important to point out the commitment degree at all the company levels, focusing the organization to the continuous improvement in a multifunctional way, following the business processes: - Board of Directors - Quality Steering Committee - Quality Improvement Groups (GMC) - Quality Operative Groups (GOC) - Suggestions Mailboxes The following GMC's have been set up and are operative. - Manufacturing GMC - Supplies GMC - Installation GMC - Design GMC - Quality System GM - Projects GMC - Administrative GMC These GMC's have established thirty-six Quality Operative Groups which carry out the improvement projects. The methodology chosen by ENUSA is known as ''SIX SIGMA''. Six sigma programs have proved their huge power in big companies as MOTOROLA and, recently, GE being recognized in all the quality fields. It is, by itself, a change program in which a quality improvement methods is structured with an excellent view of processes, products and services. (Author)

  12. Continuous Improvement in Education. Advancing Teaching--Improving Learning. White Paper

    Science.gov (United States)

    Park, Sandra; Hironaka, Stephanie; Carver, Penny; Nordstrum, Lee

    2013-01-01

    In recent years, "continuous improvement" has become a popular catchphrase in the field of education. However, while continuous improvement has become commonplace and well-documented in other industries, such as healthcare and manufacturing, little is known about how this work has manifested itself in education. This white paper attempts…

  13. Continuous quality improvement for the clinical decision unit.

    Science.gov (United States)

    Mace, Sharon E

    2004-01-01

    Clinical decision units (CDUs) are a relatively new and growing area of medicine in which patients undergo rapid evaluation and treatment. Continuous quality improvement (CQI) is important for the establishment and functioning of CDUs. CQI in CDUs has many advantages: better CDU functioning, fulfillment of Joint Commission on Accreditation of Healthcare Organizations mandates, greater efficiency/productivity, increased job satisfaction, better performance improvement, data availability, and benchmarking. Key elements include a database with volume indicators, operational policies, clinical practice protocols (diagnosis specific/condition specific), monitors, benchmarks, and clinical pathways. Examples of these important parameters are given. The CQI process should be individualized for each CDU and hospital.

  14. Improved USGS methodology for assessing continuous petroleum resources

    Science.gov (United States)

    Charpentier, Ronald R.; Cook, Troy A.

    2010-01-01

    This report presents an improved methodology for estimating volumes of continuous (unconventional) oil and gas resources within the United States and around the world. The methodology is based on previously developed U.S. Geological Survey methodologies that rely on well-scale production data. Improvements were made primarily to how the uncertainty about estimated ultimate recoveries is incorporated in the estimates. This is particularly important when assessing areas with sparse or no production data, because the new methodology allows better use of analog data from areas with significant discovery histories.

  15. Successful integration of ergonomics into continuous improvement initiatives.

    Science.gov (United States)

    Monroe, Kimberly; Fick, Faye; Joshi, Madina

    2012-01-01

    Process improvement initiatives are receiving renewed attention by large corporations as they attempt to reduce manufacturing costs and stay competitive in the global marketplace. These initiatives include 5S, Six Sigma, and Lean. These programs often take up a large amount of available time and budget resources. More often than not, existing ergonomics processes are considered separate initiatives by upper management and struggle to gain a seat at the table. To effectively maintain their programs, ergonomics program managers need to overcome those obstacles and demonstrate how ergonomics initiatives are a natural fit with continuous improvement philosophies.

  16. Expanding Educators' Contributions to Continuous Quality Improvement of American Board of Medical Specialties Maintenance of Certification.

    Science.gov (United States)

    Nora, Lois Margaret; Pouwels, Mellie Villahermosa; Irons, Mira

    2016-01-01

    The American Board of Medical Specialties board certification has transformed into a career-long process of learning, assessment, and performance improvement through its Program for Maintenance of Certification (MOC). Medical educators across many medical professional organizations, specialty societies, and other institutions have played important roles in shaping MOC and tailoring its overarching framework to the needs of different specialties. This Commentary addresses potential barriers to engagement in work related to MOC for medical school (MS) and academic health center (AHC) educators and identifies reasons for, and ways to accomplish, greater involvement in this work. The authors present ways that medical and other health professions educators in these settings can contribute to the continuous improvement of the MOC program including developing educational and assessment activities, engaging in debate about MOC, linking MOC with institutional quality improvement activities, and pursuing MOC-related scholarship. MS- and AHC-based educators have much to offer this still-young and continually improving program, and their engagement is sought, necessary, and welcomed.

  17. Continuous improvement of the BNFL transport integrated management system

    International Nuclear Information System (INIS)

    Hale, J.A.

    1998-01-01

    The integrated Management System of BNFL Transport and Pacific Nuclear Transport Limited (PNTL) is subject to continuous improvement by the application of established improvement techniques adopted by BNFL. The technique currently being used is the application of a Total Quality Management (TQM) philosophy, involving the identification of key processes, benchmarking against existing measures, initiating various improvement projects and applying process changes within the Company. The measurement technique being used is based upon the European Foundation for Quality Management Model (EFQM). A major initiative was started in 1996 to include the requirements of the Environmental Management Systems standard ISO 14001 within the existing integrated management system. This resulted in additional activities added to the system, modification to some existing activities and additional training for personnel. The system was audited by a third party certification organisation, Lloyds Register Quality Assurance (LRQA), during 1997. This paper describes the arrangements to review and update the integrated management system of BNFL Transport and PNTL to include the requirements of the environmental standard ISO 14001 and it also discusses the continuous improvement process adopted by BNFL Transport. (authors)

  18. Paths to continuous improvement of a CRM strategy

    Directory of Open Access Journals (Sweden)

    Lluís G. Renart

    2008-07-01

    Full Text Available The concept of relationship marketing has led to a paradigm change in marketing. Over the last few decades, numerous studies have analyzed the impact of customer relationship management (CRM programs on customer satisfaction and loyalty. Quite a few CRM programs have been found to have little or no impact. Having already published several articles and cases on the subject, in this paper we set out to answer the following question: assuming a company already has a reasonably successful CRM strategy in place, how can it continuously adapt and improve that strategy? Our recommendation is that such companies implement a continuous improvement process at four different but complementary levels: first, review and reinforce the company’s mission, culture and values; second, reconsider and, if necessary, redesign the CRM strategy; third, manage the various relationship-building activities more effectively; and lastly, review and, if necessary, improve the quality of material and human resources, program execution and process governance. A systematic review of these four levels or “paths” of improvement should help generate and maintain high quality relationships over time.

  19. Improving Our Odds: Success through Continuous Risk Management

    Science.gov (United States)

    Greenhalgh, Phillip O.

    2009-01-01

    Launching a rocket, running a business, driving to work and even day-to-day living all involve some degree of risk. Risk is ever present yet not always recognized, adequately assessed and appropriately mitigated. Identification, assessment and mitigation of risk are elements of the risk management component of the "continuous improvement" way of life that has become a hallmark of successful and progressive enterprises. While the application of risk management techniques to provide continuous improvement may be detailed and extensive, the philosophy, ideals and tools can be beneficially applied to all situations. Experiences with the use of risk identification, assessment and mitigation techniques for complex systems and processes are described. System safety efforts and tools used to examine potential risks of the Ares I First Stage of NASA s new Constellation Crew Launch Vehicle (CLV) presently being designed are noted as examples. Recommendations from lessons learned are provided for the application of risk management during the development of new systems as well as for the improvement of existing systems. Lessons learned and suggestions given are also examined for applicability to simple systems, uncomplicated processes and routine personal daily tasks. This paper informs the reader of varied uses of risk management efforts and techniques to identify, assess and mitigate risk for improvement of products, success of business, protection of people and enhancement of personal life.

  20. Advanced Fuels Campaign 2016 Accomplishments

    International Nuclear Information System (INIS)

    Richardson, Kate M.

    2016-01-01

    AFC management and integration activities in FY-16 included continued support for international collaborations, primarily with France, Japan, the European Union, Republic of Korea, and China, as well as various working group and expert group activities in the Organization for Economic Cooperation and Development Nuclear Energy Agency (OECD-NEA) and the International Atomic Energy Agency (IAEA). Three industry-led Funding Opportunity Announcements (FOAs) and two university-led Integrated Research Projects (IRPs) funded in 2013, made significant progress in fuels and materials development. All are closely integrated with AFC and accident-tolerant fuels (ATF) research. Accomplishments made during FY-16 are highlighted in this report, which focuses on completed work and results.

  1. Advanced Fuels Campaign 2016 Accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, Kate M. [Idaho National Lab., Idaho Falls, ID (United States)

    2016-11-01

    AFC management and integration activities in FY-16 included continued support for international collaborations, primarily with France, Japan, the European Union, Republic of Korea, and China, as well as various working group and expert group activities in the Organization for Economic Cooperation and Development Nuclear Energy Agency (OECD-NEA) and the International Atomic Energy Agency (IAEA). Three industry-led Funding Opportunity Announcements (FOAs) and two university-led Integrated Research Projects (IRPs) funded in 2013, made significant progress in fuels and materials development. All are closely integrated with AFC and accident-tolerant fuels (ATF) research. Accomplishments made during FY-16 are highlighted in this report, which focuses on completed work and results.

  2. A Health Care Project Management Office's Strategies for Continual Change and Continuous Improvement.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Aubry, Monique; Richer, Marie-Claire; Cyr, Guylaine

    Health care organizations need project and change management support in order to achieve successful transformations. A project management office (PMO) helps support the organizations through their transformations along with increasing their capabilities in project and change management. The aim of the present study was to extend understanding of the continuous improvement mechanisms used by PMOs and to describe PMO's strategies for continual change and continuous improvement in the context of major transformation in health care. This study is a descriptive case study design with interviews conducted from October to December 2015 with PMO's members (3 managers and 1 director) and 3 clients working with the PMO after a major redevelopment project ended (transition to the new facility). Participants suggested a number of elements including carefully selecting the members of the PMO, having a clear mandate for the PMO, having a method and a discipline at the same time as allowing openness and flexibility, clearly prioritizing projects, optimizing collaboration, planning for everything the PMO will need, not overlooking organizational culture, and retaining the existing support model. This study presents a number of factors ensuring the sustainability of changes.

  3. The eighth NASA total quality management accomplishments report, 1990

    Science.gov (United States)

    1990-01-01

    The eighth annual accomplishments report provides numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. NASA's continuous improvement efforts can provide insight for others to succeed in their own endeavors. The report covers: top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

  4. Compression planning for continuous improvement in quality programs

    International Nuclear Information System (INIS)

    Willis, Y.A.; Hood, F.C.

    1992-01-01

    This paper describes Compression Planning, an innovative approach for planning in groups. This participative and structured approach is especially suitable for technical and highly regulated organizations. Compression Planning was applied to the first organization-wide effort at training integration for regulatory compliance, at Battelle Pacific Northwest Laboratory (PNL), a multi-program national laboratory. The planning process was judged as measurably superior to PNL's customary planning. Within 10 days a training policy was issued and an action plan drafted. The participants produced a report identifying and prioritizing 33 key training issues; began to data gather and solicit input from personnel Lab-wide, producing a 2-volume training inventory; and formulated 14 recommendations for implementation. Two years later the plan is still evolving, as PNL training continues to develop, consistent with Continuous Improvement Process objectives

  5. Risk reduction and TQM: A corporate culture of continuous improvement

    International Nuclear Information System (INIS)

    Nau, D.C.

    1992-01-01

    A company supplying products and services to the nuclear industry that implements a cultural commitment to continuous improvement, in addition to providing higher quality products and services, also represents a significant reduction in operational risk to that industry. The implementation of a culture of total quality management (TQM), initiated by Sorrento Electronics (SE) in 1989, involves total commitment to the basic TQM principles: continuous improvement, people performing the work are the best sources of how to do it better, and employees must be empowered to make the improvements. What this means to the nuclear industry is a significant reduction in operational risk through: (1) products based on simpler, standardized, proven designs with established operational track records, enhancing confidence that they will perform as expected; (2) the highest confidence that products and supporting documentation are delivered with zero defects; (3) critical power plant schedules can be supported through the shortest possible equipment delivery times; (4) highly motivated employees with extremely positive attitudes, working together in cross-functional teams, virtually eliminate the possibility of deliberate product tampering or sabotage

  6. R and D techniques and how to continuously improve them?

    International Nuclear Information System (INIS)

    Massaut, V.; Collard, G.

    2005-01-01

    Although decommissioning of nuclear installations has been carried out successfully in different countries, and decommissioning is sometimes considered as a mature industrial activity, Research and Development can still improve the operations, and is also needed to keep the current know how. The research and development can bring reduction of costs, limitation of radioactive waste generation, and improve the safety and radioprotection aspects. When one consider that less than 100 facilities are currently in decommissioning for more than 800 reactors (power plants and research reactors, almost half and half) worldwide, the present used technology can be considered as the prehistory of D and D. The paper will focus on the needs for improvements and developments, on the attached constraints and restriction, and will then look at the potential ways to continue R and D and technology improvement. Regarding the rather recent development of the D and D technology and the large remaining market for D and D of nuclear installations, there is still a large field of open development for techniques and technologies for the dismantling of nuclear installations worldwide. Although D and D of all kinds of nuclear installations have proven to be feasible, improvements are surely needed to reduce the costs and waste of D and D, therefore reducing the burden to the plant owners, and to improve the radioprotection of the operations. The same applies for the improvement of the overall operators safety during such operations. There are different ways to go in this direction and the groups to gather the necessary experience and technological data are existing, but the will has to be present to go forward, in a competitive environment. It is difficult to believe that such improvements in the technologies and the approach of decommissioning can rely only on commercial and private initiatives. Therefore, organized international R and D should be promoted wherever it is possible, enhancing

  7. Continual improvement: A bibliography with indexes, 1992-1993

    Science.gov (United States)

    1994-01-01

    This bibliography lists 606 references to reports and journal articles entered into the NASA Scientific and Technical Information Database during 1992 to 1993. Topics cover the philosophy and history of Continual Improvement (CI), basic approaches and strategies for implementation, and lessons learned from public and private sector models. Entries are arranged according to the following categories: Leadership for Quality, Information and Analysis, Strategic Planning for CI, Human Resources Utilization, Management of Process Quality, Supplier Quality, Assessing Results, Customer Focus and Satisfaction, TQM Tools and Philosophies, and Applications. Indexes include subject, personal author, corporate source, contract number, report number, and accession number.

  8. La Hague Continuous Improvement Program: Enhancement of the Vitrification Throughput

    International Nuclear Information System (INIS)

    Petitjean, V.; De Vera, R.; Hollebecque, J.F.; Tronche, E.; Flament, T.; Pereira Mendes, F.; Prod'homme, A.

    2006-01-01

    The vitrification of high-level liquid waste produced from nuclear fuel reprocessing has been carried out industrially for over 25 years by AREVA/COGEMA, with two main objectives: containment of the long lived fission products and reduction of the final volume of waste. At the 'La Hague' plant, in the 'R7' and 'T7' facilities, vitrified waste is obtained by first evaporating and calcining the nitric acid feed solution-containing fission products in calciners. The product-named calcinate- is then fed together with glass frit into induction-heated metallic melters to produce the so-called R7/T7 glass, well known for its excellent containment properties. Both facilities are equipped with three processing lines. In the near future the increase of the fuel burn-up will influence the amount of fission product solutions to be processed at R7/T7. As a consequence, in order to prepare these changes, it is necessary to feed the calciner at higher flow-rates. Consistent and medium-term R and D programs led by CEA (French Atomic Energy Commission, the AREVA/COGEMA's R and D and R and T provider), AREVA/COGEMA (Industrial Operator) and AREVA/SGN (AREVA/COGEMA's Engineering), and associated to the industrial feed back of AREVA/COGEMA operations, have allowed continuous improvement of the process since 1998: - The efficiency and limitation of the equipment have been studied and solutions for technological improvements have been proposed whenever necessary, - The increase of the feeding flow-rate has been implemented on the improved CEA test rig (so called PEV, Evolutional Prototype of Vitrification) and adapted by AREVA/SGN for the La Hague plant using their modeling studies; the results obtained during this test confirmed the technological and industrial feasibility of the improvements achieved, - After all necessary improved equipments have been implemented in R7/T7 facilities, and a specific campaign has been performed on the R7 facility by AREVA/COGEMA. The flow-rate to the

  9. Framework for continuous performance improvement in small drinking water systems.

    Science.gov (United States)

    Bereskie, Ty; Haider, Husnain; Rodriguez, Manuel J; Sadiq, Rehan

    2017-01-01

    Continuous performance improvement (CPI) can be a useful approach to overcome water quality problems impacting small communities. Small drinking water systems (SDWSs) struggle to meet regulatory requirements and often lack the economic and human resource flexibility for immediate improvement. A CPI framework is developed to provide SDWS managers and operators an approach to gauge their current performance against similar systems and to track performance improvement from the implementation of the new technologies or innovations into the future. The proposed CPI framework incorporates the use of a water quality index (WQI) and functional performance benchmarking to evaluate and compare drinking water quality performance of an individual water utility against that of a representative benchmark. The results are then used to identify and prioritize the most vulnerable water quality indicators and subsequently identify and prioritize performance improvement strategies. The proposed CPI framework has been demonstrated using data collected from SDWSs in the province of Newfoundland and Labrador (NL), Canada and using the Canadian Council of Ministers of the Environment (CCME) WQI. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Strategic planning as a focus for continuous improvement. A case study

    Science.gov (United States)

    Oneill, John W.; Gordon-Winkler, Lyn

    1992-01-01

    What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

  11. Strategic planning as a focus for continuous improvement. A case study

    Science.gov (United States)

    Oneill, John W.; Gordon-Winkler, Lyn

    What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

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

    Science.gov (United States)

    Aluri, Rao

    1993-01-01

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

  13. Steam generator replacement: a story of continuous improvement

    International Nuclear Information System (INIS)

    Sills, M.S.; Wilkerson, R.

    2009-01-01

    This paper provides a review of the history of steam generator replacement in the US focusing on the last five years. From the early replacements in the 1980s, there have been major technology improvements resulting in dramatically shorter outages and reduced radiological exposure for workers. Even though the changes for the last five years have been less dramatic, the improvement trend continues. No two steam generator replacement (SGR) projects are the same and there are some major differences including; the access path for the components to containment (is a construction opening in containment required), type of containment, number of steam generators, one piece or two piece replacement, plant type (Westinghouse, CE or B and W) and plant layout. These differences along with other variables such as delays due to plant operations and other activities not related to the steam generator replacement make analysis of performance data difficult. However, trends in outage performance and owner expectations can be identified. How far this trend will go is also discussed. Along with the trend of improved performance, there is also a significant variation in performance. Some of the contributors to this variation are identified. This paper addresses what is required for a successful outage, meeting the increasing expectations and setting new records. The authors will discuss various factors that contribute to the success of a steam generator replacement. These factors include technical issues and, equally important, organizational interface and the role the customer plays. Recommendations are provided for planning a successful steam generator replacement outage. (author)

  14. Improving continuing medical education by enhancing interactivity: lessons from Iran.

    Science.gov (United States)

    Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Parikh, Sagar V; Shirazi, Mandana

    2016-04-01

    Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

  15. Performance indicators: A tool for continuous quality improvement

    Directory of Open Access Journals (Sweden)

    Nidhi M Bhatnagar

    2016-01-01

    Full Text Available Background: Performance monitoring is an important tool which can be used for setting priorities for process improvement. At our centre, we have been monitoring every step in the processes, right from inventory of consumables (both critical and routine to number of donors reactive for TTI. We conducted a study to measure the impact of monitoring Performance Indicators and how it could be used as a tool for Continuous Quality Improvement (CQI. Materials and Methods: The present study was a retrospective study where the performance indicator (PI data of blood bank was analyzed for over four years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. "Shifts" or "Trends", if any, were identified and Corrective and Preventive Action (CAPA taken accordingly. At the end, outcomes of the analysis were charted. Results: After the yearly data evaluation, outcomes obtained were used to plan, correct and amend processes and systems in the blood center. It was observed that the workload of the center showed an upward trend. This helped us to plan for the purchase of consumables and management of manpower. The monitoring of usage and discard of blood helped in the efficient management of blood stocks. The need for any new equipment could also be judged by the trends in workload. Conclusion: Performance indicators are indispensible tools which various stakeholders in the Blood Transfusion centres should implement to improve on quality performance.

  16. Performance indicators: A tool for continuous quality improvement.

    Science.gov (United States)

    Bhatnagar, Nidhi M; Soni, Shital; Gajjar, Maitrey; Shah, Mamta; Shah, Sangita; Patel, Vaidehi

    2016-01-01

    Performance monitoring is an important tool which can be used for setting priorities for process improvement. At our centre, we have been monitoring every step in the processes, right from inventory of consumables (both critical and routine) to number of donors reactive for TTI. We conducted a study to measure the impact of monitoring Performance Indicators and how it could be used as a tool for Continuous Quality Improvement (CQI). The present study was a retrospective study where the performance indicator (PI) data of blood bank was analyzed for over four years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. Shifts or Trends, if any, were identified and Corrective and Preventive Action (CAPA) taken accordingly. At the end, outcomes of the analysis were charted. After the yearly data evaluation, outcomes obtained were used to plan, correct and amend processes and systems in the blood center. It was observed that the workload of the center showed an upward trend. This helped us to plan for the purchase of consumables and management of manpower. The monitoring of usage and discard of blood helped in the efficient management of blood stocks. The need for any new equipment could also be judged by the trends in workload. Performance indicators are indispensible tools which various stakeholders in the Blood Transfusion centres should implement to improve on quality performance.

  17. Innovative Outcome Assessment in Graduate Business Education and Continuous Improvement

    Directory of Open Access Journals (Sweden)

    Chattopadhyay Satya P.

    2014-11-01

    Full Text Available The changed environment of global economy with painful austerity and restructuring measures causing severe economic dislocations in many diverse parts of the world have brought into focus the usefulness and value of management education in general and graduate management education in particular. The various accrediting bodies in America, Europe and Asia in recent years have shifted their emphasis to ensuring that learning outcomes of students in the program are tied to the goals and missions of the academic institution and meet the needs of the external partners of the academic enterprise that the students go on to serve. This has resulted in rapid advances in the field of innovative outcome assessment, and measurement of competency in performing higher order tasks as well as demonstration of traits related to successful transition into the business world and contribution to the success of the enterprise where the students are employed. The mere assessment/measurement of traits is not the end, but rather the first step in the cycle of continuous improvement in the tradition of the Plan-Do-Study-Act tradition of TQM. The goal is to identify shortcomings or opportunities for improvement via the assessment process and then to “close the loop” by introducing planned changes to improve system performance.

  18. Quantitative research versus quality assurance, quality improvement, total quality management, and continuous quality improvement.

    Science.gov (United States)

    Vogelsang, J

    1999-04-01

    The purpose of this report is to provide a review of the scientific method used in the quantitative research studies for consumers, evaluators, and applied nurse researchers. The fundamental characteristics of the problem-solving/ performance-improvement processes of quality assurance, quality improvement, total quality management, and continuous quality improvement are described. Research is compared with these processes, and is followed by a discussion about the publication of quantitative research findings.

  19. Hipparcos: mission accomplished

    Science.gov (United States)

    1993-08-01

    During the last few months of its life, as the high radiation environment to which the satellite was exposed took its toll on the on-board system, Hipparcos was operated with only two of the three gyroscopes normally required for such a satellite, following an ambitious redesign of the on-board and on-ground systems. Plans were in hand to operate the satellite without gyroscopes at all, and the first such "gyro- less" data had been acquired, when communication failure with the on-board computers on 24 June 1993 put an end to the relentless flow of 24000 bits of data that have been sent down from the satellite each second, since launch. Further attempts to continue operations proved unsuccessful, and after a short series of sub-systems tests, operations were terminated four years and a week after launch. An enormous wealth of scientific data was gathered by Hipparcos. Even though data analysis by the scientific teams involved in the programme is not yet completed, it is clear that the mission has been an overwhelming success. "The ESA advisory bodies took a calculated risk in selecting this complex but fundamental programme" said Dr. Roger Bonnet, ESA's Director of Science, "and we are delighted to have been able to bring it to a highly successful conclusion, and to have contributed unique information that will take a prominent place in the history and development of astrophysics". Extremely accurate positions of more than one hundred thousand stars, precise distance measurements (in most cases for the first time), and accurate determinations of the stars' velocity through space have been derived. The resulting HIPPARCOS Star Catalogue, expected to be completed in 1996, will be of unprecedented accuracy, achieving results some 10-100 times more accurate than those routinely determined from ground-based astronomical observatories. A further star catalogue, the Thyco Star Catalogue of more than a million stars, is being compiled from additional data accumulated by the

  20. Continuous quality improvement in the ambulatory endoscopy center.

    Science.gov (United States)

    Johanson, John F

    2002-04-01

    of improvement. Second, learning must be viewed as a process. A quality improvement plan that is successful in one setting may not be as favorable in another situation. Clinicians must be able to focus on their individual situations and adapt what others have implemented to their own practice. Third, the most important aspect of the quality improvement is the implementation step. It matters little if elegant studies of endoscopic complications or patient satisfaction are completed if the information is not used to improve the delivery of health care to every single patient. The delivery of medical care continues to evolve. Resources are becoming increasingly scarce and the progressive rise of health care expenditures suggests a need for control. In this zeal for cost constraint, quality must not be sacrificed. This new-found attention to quality must be extended to the level of the individual practitioner to ensure that individual patients' interests are protected and the best possible care is delivered regardless of the economic implications. As providers of health care, endoscopists need to take an active role in these efforts both in understanding and implementing the techniques of quality assessment into their practices. If physicians are not actively involved in data collection and measurement to improve the quality and value of their own work, someone else will undoubtedly assume this role.

  1. Development of the Continued Improvement System for Nuclear Safety Culture

    International Nuclear Information System (INIS)

    Park, H. C.; Park, H. G.; Park, Y. W.; Park, J. Y.

    2016-01-01

    It has been found that almost 80 % of the incidents and accidents occurred recently, such as the Fukushima Daiichi disaster and Domestic SBO accident etc. were analyzed to be caused from human errors. (IAEA NES NG-G-2.1) Which strongly claims the importance of the safety culture system. Accordingly, it should be away from a cursory approach like one-off field survey or Snap shop which were being conducted at present for the continued improvement of safety culture. This study introduces an analytical methodology which approaches the generic form of the safety both consciously and unconsciously expressed with behavior, thoughts, and attitude etc. This study was implemented only for open materials such as Inspection report, incidents and accidents reports, QA documents because of the limitation in accessibility to data. More effective use with securing operational data will be possible in future

  2. Modelling the Role of Human Resource Management in Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Hyland, Paul; Kofoed, Lise B.

    2006-01-01

    Although it is widely acknowledged that both Human Resource Management (HRM) and Continuous Improvement have the potential to positively influencing organizational performance, very little attention has been given to how certain HRM practices may support CI, and consequently, a company...... developed by de Leede and Looise (2005) serve as the framework for examining how specific bundles of HRM practices utilized during different phases of the CI implementation process may contribute to sustained organizational performance and enhanced operational performance. The primary contribution...... of the paper is theoretical in nature, as the model developed provides a greater understanding of how HRM can contribute to CI; however, the model also has practical value in that it suggests important relationships between various HRM practices and the behaviors necessary for successful CI. The paper...

  3. Pump Early, Pump Often: A Continuous Quality Improvement Project.

    Science.gov (United States)

    Spatz, Diane L; Froh, Elizabeth B; Schwarz, Jessica; Houng, Kathy; Brewster, Isabel; Myers, Carey; Prince, Judy; Olkkola, Michelle

    2015-01-01

    Research demonstrates that although many mothers initiate pumping for their critically ill children, few women are successful at maintaining milk supply throughout their infants' entire hospital stay. At the Garbose Family Special Delivery Unit (SDU) at the Children's Hospital of Philadelphia, we care for mothers who have critically ill infants born with complex cardiac and congenital anomalies. Human milk is viewed as a medical intervention at our institution. Therefore, nurses on the SDU wanted to ensure best practice in terms of pumping initiation. This article describes a continuous quality improvement project that ensured mothers pumped early and often. Childbirth educators can play a key role in preparing mothers who are anticipating an infant who will require hospitalization immediately post-birth.

  4. Development of the Continued Improvement System for Nuclear Safety Culture

    Energy Technology Data Exchange (ETDEWEB)

    Park, H. C.; Park, H. G.; Park, Y. W.; Park, J. Y. [KAIST, Daejeon (Korea, Republic of)

    2016-05-15

    It has been found that almost 80 % of the incidents and accidents occurred recently, such as the Fukushima Daiichi disaster and Domestic SBO accident etc. were analyzed to be caused from human errors. (IAEA NES NG-G-2.1) Which strongly claims the importance of the safety culture system. Accordingly, it should be away from a cursory approach like one-off field survey or Snap shop which were being conducted at present for the continued improvement of safety culture. This study introduces an analytical methodology which approaches the generic form of the safety both consciously and unconsciously expressed with behavior, thoughts, and attitude etc. This study was implemented only for open materials such as Inspection report, incidents and accidents reports, QA documents because of the limitation in accessibility to data. More effective use with securing operational data will be possible in future.

  5. Continuous improvement of environmental aspect in Juzbado factory

    International Nuclear Information System (INIS)

    2005-01-01

    ENUSA's Fuel Assembly Factory in Juzbado (Salamanca), conscious of its responsibilities with the environment where its activities are carried out, has an Environmental Management System (EMS) certified by AENOR (N. CGM-99/31) according to the requirements of Standard UNE E N-ISO 14001 and afterwards, as a result of compromise with continuous improvement of its environmental performance, joined the European Regulation 761/2001(EMAS), which has allowed the EMS to achieve levels of excellence in environmental management, doing it in a much more transparent and participative way and letting the public and other interested parts to have access to the information referring its environmental activities, as demanded by society, by the elaboration and verification of an Environmental Statement (VDM-03/010) on a yearly basis. (Author)

  6. Continuous improvement of the MHTGR safety and competitive performance

    International Nuclear Information System (INIS)

    Eichenberg, T.W.; Etzel, K.T.; Mascaro, L.L.; Rucker, R.A.

    1992-05-01

    An increase in reactor module power from 350 to 450 MW(t) would markedly improve the economics of the Modular High Temperature Gas-Cooled Reactor (MHTGR). The higher power level was recommended as the result of an in-depth cost reduction study undertaken to compete with the declining price of fossil fuel. The safety assessment confirms that the high level of safety, which relies on inherent characteristics and passive features, is maintained at the elevated power level. Preliminary systems, nuclear, and safety performance results are discussed for the recommended 450 MW(t) design. Optimization of plant parameters and design modifications accommodated the operation of the steam generator and circulator at the higher power level. Events in which forced cooling is lost, designated as conduction cooldowns are described in detail. For the depressurized conduction cooldown, without full helium inventory, peak fuel temperatures are significantly lowered. A more negative temperature coefficient of reactivity was achieved while maintaining an adequate fuel cycle and reactivity control. Continual improvement of the MHTGR delivers competitive performance without relinquishing the high safety margins demanded of the next generation of power plants

  7. Continuous quality improvement using intelligent infusion pump data analysis.

    Science.gov (United States)

    Breland, Burnis D

    2010-09-01

    The use of continuous quality-improvement (CQI) processes in the implementation of intelligent infusion pumps in a community teaching hospital is described. After the decision was made to implement intelligent i.v. infusion pumps in a 413-bed, community teaching hospital, drug libraries for use in the safety software had to be created. Before drug libraries could be created, it was necessary to determine the epidemiology of medication use in various clinical care areas. Standardization of medication administration was performed through the CQI process, using practical knowledge of clinicians at the bedside and evidence-based drug safety parameters in the scientific literature. Post-implementation, CQI allowed refinement of clinically important safety limits while minimizing inappropriate, meaningless soft limit alerts on a few select agents. Assigning individual clinical care areas (CCAs) to individual patient care units facilitated customization of drug libraries and identification of specific CCA compliance concerns. Between June 2007 and June 2008, there were seven library updates. These involved drug additions and deletions, customization of individual CCAs, and alterations of limits. Overall compliance with safety software use rose over time, from 33% in November 2006 to over 98% in December 2009. Many potentially clinically significant dosing errors were intercepted by the safety software, prompting edits by end users. Only 4-6% of soft limit alerts resulted in edits. Compliance rates for use of infusion pump safety software varied among CCAs over time. Education, auditing, and refinement of drug libraries led to improved compliance in most CCAs.

  8. 2003 Stewardship progress report : committed to continuous improvement

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-12-01

    The stewardship initiative is a mandatory requirement for members of the Canadian Association of Petroleum Producers (CAPP). It involves performance management and benchmarking, voluntary audits and verification, as well as training and improved communication inside and outside the industry. This fourth annual progress report describes the environment, health, safety and socio-economic stewardship initiative. This report presents an aggregate of industry performance. Stewardship of Excellence awards were presented in 2003, celebrating outstanding performance by members who demonstrated their commitment to responsible development and continuous improvement within a business framework. The awards were presented in three categories, namely environment, health and safety, and socio-economic. Northrock Resources was presented with the award in the environment category for its voluntary waste gas reduction. The health and safety recognition went to Burlington Resources Canada Ltd. for superior office ergonomics, while the award in the socio-economic category was presented to Suncor Energy Inc. for Aboriginal business development. A brief overview of the achievements of each of these three companies was presented. tabs., figs.

  9. Implementing a customer focused continual business improvement program to improve the maintenance process

    International Nuclear Information System (INIS)

    Kharshafdjian, G.; Fisher, C.; Beres, T.; Brooks, S.; Forbes, S.; Krause, M.; McAuley, K.; Wendorf, M.

    2006-01-01

    Global market pressures and increasing competition demands that successful companies establish a continual business improvement program as part of implementing its business strategy. Such programs must be driven by the definition of quality from the customer's perspective. This customer quality focus often requires a change in all aspects of the business including products, services, processes and culture. This paper will describe how Atomic Energy of Canada Limited implemented a Continual Business Improvement Program in their Nuclear Laboratories Business Unit. In particular, to review how the techniques were applied to improve the maintenance process and the status of the project. Customer (internal users of the processes at CRL) feedback has shown repeatedly there is dissatisfaction of the maintenance process. Customers complain about jobs not getting done to schedule or being deferred. A project has been launched with the following goals: to improve the maintenance process customer satisfaction and increase trades wrench time by 30 minutes / trade / day. DMAIC (Define-Measure-Analyze-Improve-Control) methodology was applied to find out the Root Cause(s) of the problem, provide solutions, and implement improvements. The expected Operational Benefits include: Executing work efficiently to quality standards and business performance of the site, improve maintenance efficiencies, reduce cycle time for maintenance process and improve process yield, and improve customer and employee satisfaction. (author)

  10. Implementing a customer focused continual business improvement program to improve the maintenance process

    Energy Technology Data Exchange (ETDEWEB)

    Kharshafdjian, G.; Fisher, C.; Beres, T.; Brooks, S.; Forbes, S.; Krause, M.; McAuley, K.; Wendorf, M. [Atomic Energy of Canada Limited, Chalk River, Ontario (Canada)

    2006-07-01

    Global market pressures and increasing competition demands that successful companies establish a continual business improvement program as part of implementing its business strategy. Such programs must be driven by the definition of quality from the customer's perspective. This customer quality focus often requires a change in all aspects of the business including products, services, processes and culture. This paper will describe how Atomic Energy of Canada Limited implemented a Continual Business Improvement Program in their Nuclear Laboratories Business Unit. In particular, to review how the techniques were applied to improve the maintenance process and the status of the project. Customer (internal users of the processes at CRL) feedback has shown repeatedly there is dissatisfaction of the maintenance process. Customers complain about jobs not getting done to schedule or being deferred. A project has been launched with the following goals: to improve the maintenance process customer satisfaction and increase trades wrench time by 30 minutes / trade / day. DMAIC (Define-Measure-Analyze-Improve-Control) methodology was applied to find out the Root Cause(s) of the problem, provide solutions, and implement improvements. The expected Operational Benefits include: Executing work efficiently to quality standards and business performance of the site, improve maintenance efficiencies, reduce cycle time for maintenance process and improve process yield, and improve customer and employee satisfaction. (author)

  11. Continuous quality improvement in nephrology: a systematic review.

    Science.gov (United States)

    Nunes, Julie Wright; Seagull, F Jacob; Rao, Panduranga; Segal, Jonathan H; Mani, Nandita S; Heung, Michael

    2016-11-24

    Continuous quality improvement (CQI) has been successfully applied in business and engineering for over 60 years. While using CQI techniques within nephrology has received increased attention, little is known about where, and with what measure of success, CQI can be attributed to improving outcomes within nephrology care. This is particularly important as payors' focus on value-based healthcare and reimbursement is tied to achieving quality improvement thresholds. We conducted a systematic review of CQI applications in nephrology. Studies were identified from PubMed, MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, ProQuest Dissertation Abstracts and sources of grey literature (i.e., available in print/electronic format but not controlled by commercial publishers) between January 1, 2004 and October 13, 2014. We developed a systematic evaluation protocol and pre-defined criteria for review. All citations were reviewed by two reviewers with disagreements resolved by consensus. We initially identified 468 publications; 40 were excluded as duplicates or not available/not in English. An additional 352 did not meet criteria for full review due to: 1. Not meeting criteria for inclusion = 196 (e.g., reviews, news articles, editorials) 2. Not nephrology-specific = 153, 3. Only available as abstracts = 3. Of 76 publications meeting criteria for full review, the majority [45 (61%)] focused on ESRD care. 74% explicitly stated use of specific CQI tools in their methods. The highest number of publications in a given year occurred in 2011 with 12 (16%) articles. 89% of studies were found in biomedical and allied health journals and most studies were performed in North America (52%). Only one was randomized and controlled although not blinded. Despite calls for healthcare reform and funding to inspire innovative research, we found few high quality studies either rigorously evaluating the use of CQI in nephrology or reporting best practices. More rigorous

  12. What drives continuous improvement project success in healthcare?

    Science.gov (United States)

    Stelson, Paul; Hille, Joshua; Eseonu, Chinweike; Doolen, Toni

    2017-02-13

    Purpose The purpose of this paper is to present findings from a study of factors that affect continuous improvement (CI) project success in hospitals. Design/methodology/approach Quantitative regression analysis was performed on Likert scale survey responses. Qualitative thematic analysis was performed on open-ended survey responses and written reports on CI projects. Findings The paper identifies managerial and employee factors that affect project success. These factors include managerial support, communication, and affective commitment. Affective commitment is the extent to which employees perceive the change as being needed or necessary. Practical implications The results highlight how managerial decisions, approaches to communication - including communication before, during and after CI projects affect project success. The results also show that success depends on the way employees perceive proposed changes. This suggests the need for a more individualized approach to CI, lean, and broader change initiatives. Originality/value This research is the first to fuse project success and sustainability theory to CI projects, beyond Kaizen events, in healthcare environments. The research is particularly important at a time when healthcare organizations are required to make rapid changes with limited resources as they work toward outcome-based assessment and reimbursement rules.

  13. Benchmarking: a method for continuous quality improvement in health.

    Science.gov (United States)

    Ettorchi-Tardy, Amina; Levif, Marie; Michel, Philippe

    2012-05-01

    Benchmarking, a management approach for implementing best practices at best cost, is a recent concept in the healthcare system. The objectives of this paper are to better understand the concept and its evolution in the healthcare sector, to propose an operational definition, and to describe some French and international experiences of benchmarking in the healthcare sector. To this end, we reviewed the literature on this approach's emergence in the industrial sector, its evolution, its fields of application and examples of how it has been used in the healthcare sector. Benchmarking is often thought to consist simply of comparing indicators and is not perceived in its entirety, that is, as a tool based on voluntary and active collaboration among several organizations to create a spirit of competition and to apply best practices. The key feature of benchmarking is its integration within a comprehensive and participatory policy of continuous quality improvement (CQI). Conditions for successful benchmarking focus essentially on careful preparation of the process, monitoring of the relevant indicators, staff involvement and inter-organizational visits. Compared to methods previously implemented in France (CQI and collaborative projects), benchmarking has specific features that set it apart as a healthcare innovation. This is especially true for healthcare or medical-social organizations, as the principle of inter-organizational visiting is not part of their culture. Thus, this approach will need to be assessed for feasibility and acceptability before it is more widely promoted.

  14. A formula for continued improvement: Audit follow-up

    International Nuclear Information System (INIS)

    Maday, J.H. Jr.

    1989-10-01

    In his book Management Audits, Allan J. Sayle states, ''QA standards stipulate that corrective action, required as a result of performing an audit, be followed up and closed out. There would, indeed, be little point in performing audits, requiring corrective action, or having a QA system at all if the auditee knows that the auditor will never verify that the corrective action has been efficaciously implemented.'' The QA auditor has an obligation to include follow-up in the overall audit planning. All too often the auditor will go to great lengths to plan and perform an audit only to have a recurring finding in the next audit. The proposed corrective action was only promissory and was not designed to stop the problem from recurring or to identify its root cause. Auditors do a disservice to the overall QA program and particularly to the customer when they fail to follow up and verify that an audit corrective action has been effectively implemented. In this paper, the techniques used by the quality assurance auditors at the Pacific Northwest Laboratory (PNL) will be presented. Although PNL is a research and development laboratory, the techniques outlined in this paper could be applied to any industry conducting quality assurance audits. Most important, they provide a formula for continued improvement by assuring that audit follow-up is timely, meaningful, and permanent

  15. From continuous improvement to collaborative improvement: scope, scale, skill and social networking in collaborative improvement

    NARCIS (Netherlands)

    Middel, H.G.A.; Groen, Arend J.; Fisscher, O.A.M.

    2004-01-01

    More than ever, companies are challenged to improve their performance and respond quickly and accurately to changes within the market. As competitive battlefield is moving towards the level of networks of organisations, the individual firm is an inadequate entity for identifying improvements.

  16. Continued SOFC cell and stack technology and improved production methods

    Energy Technology Data Exchange (ETDEWEB)

    Wandel, M.; Brodersen, K.; Phair, J. (and others)

    2009-05-15

    Within this project significant results are obtained on a number of very diverse areas ranging from development of cell production, metallic creep in interconnect to assembling and test of stacks with foot print larger than 500 cm2. Out of 38 milestones 28 have been fulfilled and 10 have been partly fulfilled. This project has focused on three main areas: 1) The continued cell development and optimization of manufacturing processes aiming at production of large foot-print cells, improving cell performance and development environmentally more benign production methods. 2) Stack technology - especially stacks with large foot print and improving the stack design with respect to flow geometry and gas leakages. 3) Development of stack components with emphasis on sealing (for 2G as well as 3G), interconnect (coat, architecture and creep) and test development. Production of cells with a foot print larger than 500 cm2 is very difficult due to the brittleness of the cells and great effort has been put into this topic. Eight cells were successfully produced making it possible to assemble and test a real stack thereby giving valuable results on the prospects of stacks with large foot print. However, the yield rate is very low and a significant development to increase this yield lies ahead. Several lessons were learned on the stack level regarding 'large foot print' stacks. Modelling studies showed that the width of the cell primarily is limited by production and handling of the cell whereas the length (in the flow direction) is limited by e.g. pressure drop and necessary manifolding. The optimal cell size in the flow direction was calculated to be between approx20 cm and < 30 cm. From an economical point of view the production yield is crucial and stacks with large foot print cell area are only feasible if the cell production yield is significantly enhanced. Co-casting has been pursued as a production technique due to the possibilities in large scale production

  17. Drivers of Dashboard Development (3-D): A Curricular Continuous Quality Improvement Approach.

    Science.gov (United States)

    Shroyer, A Laurie; Lu, Wei-Hsin; Chandran, Latha

    2016-04-01

    Undergraduate medical education (UME) programs are seeking systematic ways to monitor and manage their educational performance metrics and document their achievement of external goals (e.g., Liaison Committee on Medical Education [LCME] accreditation requirements) and internal objectives (institution-specific metrics). In other continuous quality improvement (CQI) settings, summary dashboard reports have been used to evaluate and improve performance. The Stony Brook University School of Medicine UME leadership team developed and implemented summary dashboard performance reports in 2009 to document LCME standards/criteria compliance, evaluate medical student performance, and identify progress in attaining institutional curricular goals and objectives. Key performance indicators (KPIs) and benchmarks were established and have been routinely monitored as part of the novel Drivers of Dashboard Development (3-D) approach to curricular CQI. The systematic 3-D approach has had positive CQI impacts. Substantial improvements over time have been documented in KPIs including timeliness of clerkship grades, midclerkship feedback, student mistreatment policy awareness, and student satisfaction. Stakeholder feedback indicates that the dashboards have provided useful information guiding data-driven curricular changes, such as integrating clinician-scientists as lecturers in basic science courses to clarify the clinical relevance of specific topics. Gaining stakeholder acceptance of the 3-D approach required clear communication of preestablished targets and annual meetings with department leaders and course/clerkship directors. The 3-D approach may be considered by UME programs as a template for providing faculty and leadership with a CQI framework to establish shared goals, document compliance, report accomplishments, enrich communications, facilitate decisions, and improve performance.

  18. Report: EPA Needs to Improve Continuity of Operations Planning

    Science.gov (United States)

    Report #10-P-0017, October 27, 2009. EPA has limited assurance that it can successfully maintain continuity of operations and execute its mission essential functions during a significant national event such as a pandemic influenza outbreak.

  19. Studying Implementation within a Continuous Continuous-Improvement Process: What Happens When We Design with Adaptations in Mind?

    Science.gov (United States)

    Tichnor-Wagner, Ariel; Allen, Danielle; Socol, Allison Rose; Cohen-Vogel, Lora; Rutledge, Stacey A.; Xing, Qi W.

    2018-01-01

    Background/Context: This study examines the implementation of an academic and social-emotional learning innovation called Personalization for Academic and Social-Emotional Learning, or PASL. The innovation was designed, tested, and implemented using a continuous continuous-improvement model. The model emphasized a top-and-bottom process in which…

  20. Course Development Cycle Time: A Framework for Continuous Process Improvement.

    Science.gov (United States)

    Lake, Erinn

    2003-01-01

    Details Edinboro University's efforts to reduce the extended cycle time required to develop new courses and programs. Describes a collaborative process improvement framework, illustrated data findings, the team's recommendations for improvement, and the outcomes of those recommendations. (EV)

  1. Improving pediatric immunization rates: description of a resident-led clinical continuous quality improvement project.

    Science.gov (United States)

    Jones, Kyle Bradford; Gren, Lisa H; Backman, Richard

    2014-09-01

    Increased emphasis is being placed on the continuous quality improvement (CQI) education of residents of all specialties. This article describes a resident-led continuous quality improvement (CQI) project, based on a novel curriculum, to improve the immunization rates of children under 2 years old at the Madsen Family Health Center (MHC). All third-year residents were trained in the FOCUS-PDSA CQI methodology through concurrent didactic lectures and experience leading the CQI team. The CQI team included clinical staff led by a third-year family medicine resident and mentored by a member of the family medicine faculty. Immunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic as the intervention. Compliance with the intervention (process measure), as well as immunization rates at 2 and 5 months post-intervention (outcome measure), were monitored. Immunization records were printed on 84% of clinic days from October 24, 2011 to March 31, 2012. The percentage of patients immunized at baseline was 66%. The percentage immunized as of December 31, 2011 was 96% and was 91% as of March 31, 2012. An important educational experience was organized for third-year family medicine residents through learning CQI skills, leading a CQI team, and directing a CQI project to completion. Significant improvement in the percentage of patients under 2 years old immunized at the MHC was achieved by presenting provider-medical assistant teamlets with immunization records of all pediatric patients on the daily clinic schedule.

  2. How to Sustain Change and Support Continuous Quality Improvement.

    Science.gov (United States)

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

    2016-05-06

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are

  3. 78 FR 40625 - National School Lunch Program: Direct Certification Continuous Improvement Plans Required by the...

    Science.gov (United States)

    2013-07-08

    ... National School Lunch Program: Direct Certification Continuous Improvement Plans Required by the Healthy... Continuous Improvement Plans Required by the Healthy, Hunger-Free Kids Act of 2010'' on February 22, 2013... performance benchmarks and to develop and implement continuous improvement plans if they fail to do so. The...

  4. Improving the Relationship between Continuing Education Leadership and Marketing Directors

    Science.gov (United States)

    Fong, Jim

    2009-01-01

    In this economy, college and university continuing education units will not automatically reap the benefits of returning adult learners as in past recessions: this economy caused a drastic reduction of resources available to the workforce and for personal revenue. As a result of decreased personal income and workforce training funding, competition…

  5. Nasal continuous positive airway pressure: does bubbling improve gas exchange?

    Science.gov (United States)

    Morley, C J; Lau, R; De Paoli, A; Davis, P G

    2005-07-01

    In a randomised crossover trial, 26 babies, treated with Hudson prong continuous positive airway pressure (CPAP) from a bubbling bottle, received vigorous, high amplitude, or slow bubbling for 30 minutes. Pulse oximetry, transcutaneous carbon dioxide, and respiratory rate were recorded. The bubbling rates had no effect on carbon dioxide, oxygenation, or respiratory rate.

  6. The Social Intelligence of Principals: Links to Teachers' Continuous Improvement

    Science.gov (United States)

    McQuade, Joan

    2013-01-01

    Despite multiple efforts to reform 21st education to better meet the needs of all students, school improvement successes have been sporadic and debatable. Research suggests that significant improvement lies within the purview of teachers and principals, and this current research provided the underpinnings for the study. Based on neuroscience…

  7. The virtual accomplishment of knitting

    DEFF Research Database (Denmark)

    Heinemann, T.; Möller, R. L.

    2016-01-01

    . This means, among other things, that learners need to detect, diagnose and correct their errors without assistance from an expert. In this paper we focus on how this is accomplished by individuals attempting to learn how to knit by following instructions from a video tutorial. We show that novice knitters...

  8. Advanced Fuels Campaign 2012 Accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    Not Listed

    2012-11-01

    The Advanced Fuels Campaign (AFC) under the Fuel Cycle Research and Development (FCRD) program is responsible for developing fuels technologies to support the various fuel cycle options defined in the DOE Nuclear Energy Research and Development Roadmap, Report to Congress, April 2010. The fiscal year 2012 (FY 2012) accomplishments are highlighted below. Kemal Pasamehmetoglu is the National Technical Director for AFC.

  9. Process Evaluation and Continuous Improvement in Community Youth Programs

    Directory of Open Access Journals (Sweden)

    Jennifer V. Trachtenberg

    2008-06-01

    Full Text Available A method of using process evaluation to provide improvement plans in order to promote community youth programs is described. The core elements of this method include the following: (1 collection and analysis of baseline data, (2 feedback provided to programs describing their strengths and limitations, (3 programs provided with assistance in preparing improvement plans in regard to their baseline data, and (4 follow-up evaluation assessed program changes based on their improvement plans and baseline data. A case study of an inner-city neighborhood youth center is used to demonstrate this method.

  10. Observations of human factors as a continuous improvement tool

    International Nuclear Information System (INIS)

    Almeida, P.

    2015-01-01

    Principles for Excellence in Human Performance should promote behaviors throughout an organization that support safety and reliable operation of the plant. Such behaviors must be clearly defined, communicated and reinforced by managers, on a continuous basis. To identify if workers behaviors are in compliance with those expected is paramount to have an observations program in place, which in one hand identifies deviations from expectations to correct them, and on the other promotes the desired behaviors through positive reinforcement. (Author)

  11. Measure to succeed: How to improve employee participation in continuous improvement

    Energy Technology Data Exchange (ETDEWEB)

    Jurburg, M.; Viles, E.; Tanco, M.; Mateo, R.; Lleó, A.

    2016-07-01

    Purpose: Achieving employee participation in continuous improvement (CI) systems is considered as one of the success factors for the sustainability of those systems. Yet, it is also very difficult to obtain because of the interaction of many critical factors that affect employee participation. Therefore, finding ways of measuring all these critical factors can help practitioners manage the employee participation process accordingly. Design/methodology/approach: Based upon the existing literature, this paper presents a 4-Phase (9 steps) diagnostic tool to measure the main determinants associated with the implementation of CI systems affecting employee participation in improvement activities. Findings: The tool showed its usefulness to detect the main weaknesses and improvement opportunities for improving employee participation in CI through the application in two different cases. Practical implications: This diagnostic tool could be particularly interesting for companies adopting CI and other excellence frameworks, which usually include a pillar related to people development inside the organization, but do not include tools to diagnose the state of this pillar. Originality/value: This diagnostic tool presents a user’s perspective approach, ensuring that the weaknesses and improvement opportunities detected during the diagnose come directly from the users of the CI system, which in this case are the employees themselves. Given that the final objective is to identify reasons and problems hindering employee participation, adopting this user’s perspective approach seem more relevant than adopting other more traditional approaches, based on gathering information from the CI system itself or from the CI managers.

  12. Measure to succeed: How to improve employee participation in continuous improvement

    International Nuclear Information System (INIS)

    Jurburg, M.; Viles, E.; Tanco, M.; Mateo, R.; Lleó, A.

    2016-01-01

    Purpose: Achieving employee participation in continuous improvement (CI) systems is considered as one of the success factors for the sustainability of those systems. Yet, it is also very difficult to obtain because of the interaction of many critical factors that affect employee participation. Therefore, finding ways of measuring all these critical factors can help practitioners manage the employee participation process accordingly. Design/methodology/approach: Based upon the existing literature, this paper presents a 4-Phase (9 steps) diagnostic tool to measure the main determinants associated with the implementation of CI systems affecting employee participation in improvement activities. Findings: The tool showed its usefulness to detect the main weaknesses and improvement opportunities for improving employee participation in CI through the application in two different cases. Practical implications: This diagnostic tool could be particularly interesting for companies adopting CI and other excellence frameworks, which usually include a pillar related to people development inside the organization, but do not include tools to diagnose the state of this pillar. Originality/value: This diagnostic tool presents a user’s perspective approach, ensuring that the weaknesses and improvement opportunities detected during the diagnose come directly from the users of the CI system, which in this case are the employees themselves. Given that the final objective is to identify reasons and problems hindering employee participation, adopting this user’s perspective approach seem more relevant than adopting other more traditional approaches, based on gathering information from the CI system itself or from the CI managers.

  13. The History and Accomplishments of the LIVESTRONG Young Adult Alliance.

    Science.gov (United States)

    Mathews-Bradshaw, Beth; Johnson, Rebecca; Kaplan, Stuart; Craddock, Kelli; Hayes-Lattin, Brandon

    2011-03-01

    This article outlines the history, background, and accomplishments of the LIVESTRONG Young Adult Alliance. The LIVESTRONG Young Adult Alliance, a program of the Lance Armstrong Foundation, was developed as a vehicle for a strategic plan designed to implement the Adolescent and Young Adult Oncology Progress Review Group (AYAO PRG) recommendations. The AYAO PRG was co-sponsored by Lance Armstrong Foundation and the National Cancer Institute (NCI); both LIVESTRONG and NCI provide strategic oversight and guidance to the Alliance. Highlights and accomplishments: The Alliance accomplishments include the publication of disease-specific retrospective analyses, funding of an AYA cohort study and biorepository proposal, publication of two position statements on guidelines for care of AYAs with cancer and training for AYA oncology health professionals, promotion of an international charter of rights for AYA cancer patients, creation and distribution of a survey to college health professionals, creation and implementation of a Cancer Centers Working Group and Institutional Review Board Toolkit, and continued growth and collaboration through an annual meeting. The growth and success of the Alliance has coincided with the growth of AYA oncology as a field. The collaborative environment of the Alliance draws together a diverse group of individuals united in the effort to increase survival rates and improve the quality of life for adolescents and young adults diagnosed with cancer.

  14. Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center.

    Science.gov (United States)

    Flannery, Alexander H; Thompson Bastin, Melissa L; Montgomery-Yates, Ashley; Hook, Corrine; Cassity, Evan; Eaton, Phillip M; Morris, Peter E

    2018-01-01

    Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.

  15. Professional Learning Communities: Teachers Working Collaboratively for Continuous Improvement

    Science.gov (United States)

    Griffith, Louise Ann

    2009-01-01

    Current research indicates that a professional learning community (PLC) is an effective means for helping teachers to bridge the gap between research and practice. A PLC is a team of educators systematically working together to improve teaching practice and student learning. This study evaluated the PLC formed by teachers at a public elementary…

  16. With Scale in Mind: A Continuous Improvement Model for Implementation

    Science.gov (United States)

    Redding, Christopher; Cannata, Marisa; Taylor Haynes, Katherine

    2017-01-01

    The conventional approach to scaling up educational reforms considers the development and testing phases to be distinct from the work of implementing at scale. Decades of research suggest that this approach yields inconsistent and often disappointing improvements for schools most in need. More recent scholarship on scaling school improvement…

  17. Cyberbullying: Assessment of Student Experience for Continuous Improvement Planning

    Science.gov (United States)

    Strom, Paris S.; Strom, Robert D.; Wingate, Julius J.; Kraska, Marie F.; Beckert, Troy E.

    2012-01-01

    This study examines the use of polling students to improve conditions of learning in their school. Students from three schools (N = 2,006) in Grades 5, 6, 7, and 8 completed an online poll about how cyberbullying affects their personal lives. Principals' impressions about the benefits of student polling are explained along with the Cyberbullying…

  18. Economy of Force: Continuous Process Improvement And The Air Service

    Science.gov (United States)

    2017-06-01

    CPI to fix the delinquent areas. Paragraph 1.5.11.3 states that “Functional Managers will . . . Take appropriate actions to correct identified...the power of data-driven decisions to include Statistical Quality Control (SQL), Acceptable Quality Level (AQL), and the Plan-Do-Check-Act (PDCA... statistical analysis and process improvement from Shewhart while working at Bell Telephone Laboratories, and Deming put his mark on the world when he

  19. Continuous improvement processes using Lean Management tools. A case study

    Directory of Open Access Journals (Sweden)

    Pârv Luminița

    2017-01-01

    Full Text Available The paper describes how Lean Management may be applied in the university setting to improve the management processes. The correlation of didactic, educational and research activities with the stakeholders needs is one of the main objectives of the university. In this respect, an indicator used to analyse a university, for the purposes of fulfilling its mission, respectively for the purposes of streamlining its didactic and scientific activity, is related to the number of graduates on the labour market, acting in their area of specialization. This work presents a best practice of Lean Management at Transilvania University of Brasov, Romania.

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

    Science.gov (United States)

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

    2014-01-01

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

  1. The innovation scorecard for continuous improvement applied to translational science.

    Science.gov (United States)

    Kotarba, Joseph A; Wooten, Kevin

    2017-10-01

    This paper reports on the baseline stage of a qualitative evaluation of the application of the Innovative Scorecard (ISC) to the Clinical and Translational Science Award (CTSA) at the University of Texas Medical Branch (UTMB) at Galveston. The ISC is adopted from the established Balanced Scorecard system for strategic planning and performance management. In formulating the evaluation, we focused on the organizational identity literature. The initial evaluation consisted of a series of semi-structured interviews with 22 participants of the ISC Boot Camp conducted in July 2015. The logic of grounded theory pointed to the clustering of perceptions of the ISC around respondents' occupational locations at UTMB. Administrators anticipate the expansion of planning activities to include a wider range of participants under the current CTSA award period (2015-2020) than under our first CTSA approval period (2009-2014). A common viewpoint among the senior scientists was that the scientific value of their work will continue to speak for itself without requiring the language of business. Junior scientists looked forward to the ISC's emphasis on increasingly horizontal leadership that will give them more access to and more control over their work and resources. Postdocs and senior staff welcomed increased involvement in the total research process at UTMB. The report concludes with strategies for future follow-up.

  2. A calculation technique to improve continuous monitoring of containment integrity

    International Nuclear Information System (INIS)

    Dick, J.E.

    1990-01-01

    The containment envelope of nuclear plants is a passive and extremely effective safety feature. World experience indicates, however, that inadvertent breaches of envelope integrity can go undetected for substantial time periods. Consequently, continuous monitoring of integrity is being closely examined by many containment designers and operators. The most promising approach is to use sensors and systems that automatically measure changes in the mass of air in containment, time integrate any known air mass flow rates across containment boundaries, and perform a mass balance to obtain the air mass leaked. As fluctuations in such measurements are typically too large to enable leakage to be calculated to the desired precision, filtering and statistical techniques must be used to filter out random and time-dependent fluctuations. Current approaches cannot easily deal with nonrandom or systematic fluctuations in the measurements, including pressure changes within the containment. As a result, sampling periods must be kept short, or data measured during periods of varying containment pressure must be discarded. The technique described allows for much longer sampling periods under conditions of fluctuating containment pressure and eliminates the invalidation of data when the containment pressure fluctuation is nonrandom. It should therefore yield a much more precise value for the containment leakage characteristic. It also promises to be able to distinguish the presence of systematic errors unrelated to systematic pressure changes and to establish whether the containment leakage characteristic is laminar or turbulent

  3. Accomplishments Report for the National Strategy for Electronics Stewardship

    Science.gov (United States)

    This page holds the NSES report, which charts the progress and accomplishments of the NSES in addressing sustainable management of electronics and highlights the benefits of continued leadership from the federal government.

  4. Positioning Continuing Education: Boundaries and Intersections between the Domains Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement

    Science.gov (United States)

    Kitto, Simon; Bell, Mary; Peller, Jennifer; Sargeant, Joan; Etchells, Edward; Reeves, Scott; Silver, Ivan

    2013-01-01

    Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the…

  5. Identifying continuous quality improvement publications: what makes an improvement intervention ‘CQI’?

    Science.gov (United States)

    Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie S; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V

    2011-01-01

    Background The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection. Methods As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles. Results Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. ‘Feedback of systematically collected data’ was the most common feature (64%), followed by being at least ‘somewhat’ adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least ‘somewhat’ data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles. Conclusions We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication. PMID:21727199

  6. Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'?

    Science.gov (United States)

    O'Neill, Sean M; Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie S; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V

    2011-12-01

    The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection. As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles. Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. 'Feedback of systematically collected data' was the most common feature (64%), followed by being at least 'somewhat' adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least 'somewhat' data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles. We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication.

  7. Accomplishments and challenges of surgical simulation.

    Science.gov (United States)

    Satava, R M

    2001-03-01

    For nearly a decade, advanced computer technologies have created extraordinary educational tools using three-dimensional (3D) visualization and virtual reality. Pioneering efforts in surgical simulation with these tools have resulted in a first generation of simulators for surgical technical skills. Accomplishments include simulations with 3D models of anatomy for practice of surgical tasks, initial assessment of student performance in technical skills, and awareness by professional societies of potential in surgical education and certification. However, enormous challenges remain, which include improvement of technical fidelity, standardization of accurate metrics for performance evaluation, integration of simulators into a robust educational curriculum, stringent evaluation of simulators for effectiveness and value added to surgical training, determination of simulation application to certification of surgical technical skills, and a business model to implement and disseminate simulation successfully throughout the medical education community. This review looks at the historical progress of surgical simulators, their accomplishments, and the challenges that remain.

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

    Science.gov (United States)

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

    2017-07-01

    Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (pRwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Adhesion improvement of fibres by continuous plasma treatment at atmospheric pressure

    DEFF Research Database (Denmark)

    Kusano, Yukihiro; Løgstrup Andersen, Tom; Sørensen, Bent F.

    2013-01-01

    Carbon fibres and ultra-high-molecular-weight polyethylene (UHMWPE) fibres were continuously treated by a dielectric barrier discharge plasma at atmospheric pressure for adhesion improvement with epoxy resins. The plasma treatment improved wettability, increased the oxygen containing polar...

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

    Science.gov (United States)

    Maurellet-Evrard, S; Daunizeau, A

    2013-06-01

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

  11. Continuous Improvement in the Industrial and Management Systems Engineering Programme at Kuwait University

    Science.gov (United States)

    Aldowaisan, Tariq; Allahverdi, Ali

    2016-01-01

    This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been…

  12. Organizational structure and continuous improvement and learning: Moderating effects of cultural endorsement of participative leadership

    OpenAIRE

    Xiaowen Huang; Joseph C Rode; Roger G Schroeder

    2011-01-01

    Building upon the culturally endorsed implicit theory of leadership, we investigated the moderating effects of national culture on the relationship between organizational structure and continuous improvement and learning. We propose that the relationship between organic organizations (characterized by flat, decentralized structures with a wide use of multifunctional employees) and continuous improvement and learning will be stronger when national cultural endorsement for participative leaders...

  13. A model for continuous improvement at a South African minerals benefication plant

    Directory of Open Access Journals (Sweden)

    Ras, Eugene Ras

    2015-05-01

    Full Text Available South Africa has a variety of mineral resources, and several minerals beneficiation plants are currently in operation. These plants must be operated effectively to ensure that the end-users of its products remain internationally competitive. To achieve this objective, plants need a sustainable continuous improvement programme. Several frameworks for continuous improvement are used, with variable success rates, in beneficiation plants around the world. However, none of these models specifically addresses continuous improvement from a minerals-processing point of view. The objective of this research study was to determine which factors are important for a continuous improvement model at a minerals beneficiation plant, and to propose a new model using lean manufacturing, six sigma, and the theory of constraints. A survey indicated that managers in the industry prefer a model that combines various continuous improvement models.

  14. GESAMP: Two decades of accomplishments

    International Nuclear Information System (INIS)

    Windom, H.L

    1991-01-01

    Many of the uses of the oceans by society may lead potentially to the degradation of the marine environment. Human activities on land lead to the inadvertent or deliberate input of contaminants to the oceans which also may result in marine environmental degradation on local, regional or global scales. Potential impacts on the marine environment of human activities on land and the potential conflicts of society's utilization of the oceans require ongoing global evaluation from a multidisciplinary scientific perspective. This has been recognized for some time by the community of United Nations organizations, eight of which jointly sponsor an interdisciplinary groups of scientists to provide independent advice on existing and potential marine pollution problems. This Group of Experts on the Scientific Aspects of Marine Pollution (GESAMP) was formed two decades ago to serve as a mechanism for encouraging coordination, collaboration and harmonization of activities related to marine pollution of common interest to the co-sponsoring bodies. More recently, GESAMP has expanded its programme to include consideration of the impacts of other human activities, such as coastal development, on the marine environment. The purpose of this booklet is to briefly describe what GESAMP is, how it operates and what it accomplishes

  15. Advanced fuels campaign 2013 accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    Braase, Lori [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hamelin, Doug [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2013-10-01

    The mission of the Advanced Fuels Campaign (AFC) is to perform Research, Development, and Demonstration (RD&D) activities for advanced fuel forms (including cladding) to enhance the performance and safety of the nation’s current and future reactors; enhance proliferation resistance of nuclear fuel; effectively utilize nuclear energy resources; and address the longer-term waste management challenges. This includes development of a state-of-the art Research and Development (R&D) infrastructure to support the use of “goal-oriented science-based approach.” In support of the Fuel Cycle Research and Development (FCRD) program, AFC is responsible for developing advanced fuels technologies to support the various fuel cycle options defined in the Department of Energy (DOE) Nuclear Energy Research and Development Roadmap, Report to Congress, April 2010. Accomplishments made during fiscal year (FY) 2013 are highlighted in this report, which focuses on completed work and results. The process details leading up to the results are not included; however, the technical contact is provided for each section.

  16. Advanced Fuels Campaign FY 2010 Accomplishments Report

    Energy Technology Data Exchange (ETDEWEB)

    Lori Braase

    2010-12-01

    The Fuel Cycle Research and Development (FCRD) Advanced Fuels Campaign (AFC) Accomplishment Report documents the high-level research and development results achieved in fiscal year 2010. The AFC program has been given responsibility to develop advanced fuel technologies for the Department of Energy (DOE) using a science-based approach focusing on developing a microstructural understanding of nuclear fuels and materials. The science-based approach combines theory, experiments, and multi-scale modeling and simulation aimed at a fundamental understanding of the fuel fabrication processes and fuel and clad performance under irradiation. The scope of the AFC includes evaluation and development of multiple fuel forms to support the three fuel cycle options described in the Sustainable Fuel Cycle Implementation Plan4: Once-Through Cycle, Modified-Open Cycle, and Continuous Recycle. The word “fuel” is used generically to include fuels, targets, and their associated cladding materials. This document includes a brief overview of the management and integration activities; but is primarily focused on the technical accomplishments for FY-10. Each technical section provides a high level overview of the activity, results, technical points of contact, and applicable references.

  17. Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

    Science.gov (United States)

    Kakyo, Tracy Alexis; Xiao, Lily Dongxia

    2017-06-01

    Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

  18. An action research study; cultural differences impact how manufacturing organizations receive continuous improvement

    Science.gov (United States)

    Kattman, Braden R.

    National culture and organizational culture impact how continuous improvement methods are received, implemented and deployed by suppliers. Previous research emphasized the dominance of national culture over organizational culture. The countries studied included Poland, Mexico, China, Taiwan, South Korea, Estonia, India, Canada, the United States, the United Kingdom, and Japan. The research found that Canada was most receptive to continuous improvement, with China being the least receptive. The study found that organizational culture was more influential than national culture. Isomorphism and benchmarking is driving continuous-improvement language and methods to be more universally known within business. Business and management practices are taking precedence in driving change within organizations.

  19. Past Accomplishments and Future Challenges

    Science.gov (United States)

    Danielson, Louis; Doolittle, Jennifer; Bradley, Renee

    2005-01-01

    Three broad issues continue to dramatically impact the education of children with specific learning disabilities (SLD): (1) the development and implementation of scientifically defensible methods of identification; (2) the development and implementation of scientific interventions to ensure that children with SLD have access to and make progress…

  20. NPAR program - Status and accomplishments

    International Nuclear Information System (INIS)

    Vora, J.P.

    1991-01-01

    Upon completing the early scoping studies, the US NRC Office of Nuclear Regulatory Research took a lead worldwide in 1985 by publishing a comprehensive program plan for Nuclear Plant aging Research (NPAR). The plan identified significant technical safety issues related to plant aging; discussed a phased approach to aging and life assessment of components systems, and structures; and recommended the utilization of research results for, (i) the selection and the prioritization of components and structures, (ii) where to focus inspection and maintenance, (iii) what type of data collection and record keeping would be useful, (iv) how to perform technical evaluation of mothballed units for reactivation, (v) the determination of risk significance of aging, (vi) the development of technical bases for license renewal and extended plant life considerations, (vii) the ongoing regulatory issues, and (viii) recommendations to the national codes and standards groups involved in activities related to aging. Since the publication of the NPAR program plan in 1985 significant progress has been made in completing the initial phase of the NPAR activities and substantial new initiatives have been undertaken expanding the overall scope. Also, by recognizing the NRC's leadership role for emphasizing the need for aging management significant developments are taking place worldwide in implementing dedicated programs related to understanding and managing aging in older operating nuclear power plants. In fact, in some countries, aging management programs are being implemented now for relatively new plants so as to eventually realize the potential benefits of extended plant life beyond the originally conceived design and service life. This paper briefly describe the major elements of the NPAR program, its status and results or accomplishments. In the process the author emphasizes the need for total industry commitment and participation in implementing programs for understanding and managing

  1. 78 FR 69018 - Improving the Resiliency of Mobile Wireless Communications Networks; Reliability and Continuity...

    Science.gov (United States)

    2013-11-18

    ... consumers value overall network reliability and quality in selecting mobile wireless service providers, they...-125] Improving the Resiliency of Mobile Wireless Communications Networks; Reliability and Continuity... (Reliability NOI) in 2011 to ``initiate a comprehensive examination of issues regarding the reliability...

  2. Government/contractor partnerships for continuous improvement. A Goddard Space Flight Center example

    Science.gov (United States)

    Tagler, Richard C.

    1992-01-01

    The efforts of a government organization and its major contractors to foster a continuous improvement environment which transcends the traditional government/contractor relationship is discussed. This relationship is aimed at communication, partnership, and trust - creating benefits for all involved.

  3. An improved basis for evaluating continued service of Category I concrete structures in nuclear power plants

    International Nuclear Information System (INIS)

    Naus, D.J.; Oland, C.B.; Ellingwood, B.; Mori, Y.; Arndt, E.G.

    1992-01-01

    The Structural Aging (SAG) Program has the overall objective of preparing technical bases for regulatory criteria which will provide the NRC with potential structural safety issues and acceptance criteria for use in nuclear power plant evaluations for continued service. In meeting this objective three primary activities are underway: (1) development of a structural materials information center containing data and information on the variation of concrete and concrete-related material properties over time; (2) establishment of procedures to make quantitative evaluations of the presence, magnitude, and significance of environmental stressors or aging factors that can impact critical component performance, as well as techniques which can be used for repair of degraded concrete structures; and (3) formulation of a quantitative methodology for performing current condition assessments and making reliability-based life predictions of critical concrete structures in nuclear power plants. Accomplishments to date under each of these tasks are presented

  4. Building a Culture of Continuous Quality Improvement in an Academic Radiology Department.

    Science.gov (United States)

    Katzman, Gregory L; Paushter, David M

    2016-04-01

    As we enter a new era of health care in the United States, radiologists must be adequately prepared to prove, and continually improve, our value to our customers. This goal can be achieved in large part by providing high-quality services. Although quality efforts on the national and international levels provide a framework for improving radiologic quality, some of the greatest opportunities for quality improvement can be found at the departmental level, through the implementation of total quality management programs. Establishing such a program requires not only strong leadership and employee engagement, but also a firm understanding of the multiple total quality management tools and continuous quality improvement strategies available. In this article, we discuss key tools and strategies required to build a culture of continuous quality improvement in an academic department, based on our experience. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  5. Improving critical thinking and clinical reasoning with a continuing education course.

    Science.gov (United States)

    Cruz, Dina Monteiro; Pimenta, Cibele Mattos; Lunney, Margaret

    2009-03-01

    Continuing education courses related to critical thinking and clinical reasoning are needed to improve the accuracy of diagnosis. This study evaluated a 4-day, 16-hour continuing education course conducted in Brazil.Thirty-nine nurses completed a pretest and a posttest consisting of two written case studies designed to measure the accuracy of nurses' diagnoses. There were significant differences in accuracy from pretest to posttest for case 1 (p = .008) and case 2 (p = .042) and overall (p = .001). Continuing education courses should be implemented to improve the accuracy of nurses' diagnoses.

  6. The space shuttle program technologies and accomplishments

    CERN Document Server

    Sivolella, Davide

    2017-01-01

    This book tells the story of the Space Shuttle in its many different roles as orbital launch platform, orbital workshop, and science and technology laboratory. It focuses on the technology designed and developed to support the missions of the Space Shuttle program. Each mission is examined, from both the technical and managerial viewpoints. Although outwardly identical, the capabilities of the orbiters in the late years of the program were quite different from those in 1981. Sivolella traces the various improvements and modifications made to the shuttle over the years as part of each mission story. Technically accurate but with a pleasing narrative style and simple explanations of complex engineering concepts, the book provides details of many lesser known concepts, some developed but never flown, and commemorates the ingenuity of NASA and its partners in making each Space Shuttle mission push the boundaries of what we can accomplish in space. Using press kits, original papers, newspaper and magazine articles...

  7. Creating Sustainable Education Projects in Roatán, Honduras through Continuous Process Improvement

    Science.gov (United States)

    Raven, Arjan; Randolph, Adriane B.; Heil, Shelli

    2010-01-01

    The investigators worked together with permanent residents of Roatán, Honduras on sustainable initiatives to help improve the island's troubled educational programs. Our initiatives focused on increasing the number of students eligible and likely to attend a university. Using a methodology based in continuous process improvement, we developed…

  8. Continuous improvement, burnout and job engagement: a study in a Dutch nursing department

    NARCIS (Netherlands)

    Benders, J.G.J.M.; Bleijerveld, H.; Schouteten, R.L.J.

    2017-01-01

    Continuous improvement (CI) programs are potentially powerful means to improve the quality of care. The more positive nurses perceive these programs' effects, the better they may be expected to cooperate. Crucial to this perception is how nurses' quality of working life is affected. We studied this

  9. Using Surveys of Students' Social-Emotional Learning and School Climate for Accountability and Continuous Improvement

    Science.gov (United States)

    Hough, Heather; Kalogrides, Demetra; Loeb, Susanna

    2017-01-01

    The research featured in this paper is part of the CORE-PACE Research Partnership, through which Policy Analysis for California Education (PACE) has partnered with the CORE districts to conduct research designed to support them in continuous improvement while simultaneously helping to improve policy and practice in California and nationwide.…

  10. The RISE Framework: Using Learning Analytics to Automatically Identify Open Educational Resources for Continuous Improvement

    Science.gov (United States)

    Bodily, Robert; Nyland, Rob; Wiley, David

    2017-01-01

    The RISE (Resource Inspection, Selection, and Enhancement) Framework is a framework supporting the continuous improvement of open educational resources (OER). The framework is an automated process that identifies learning resources that should be evaluated and either eliminated or improved. This is particularly useful in OER contexts where the…

  11. Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members.

    Science.gov (United States)

    Brandrud, Aleidis Skard; Schreiner, Ada; Hjortdahl, Per; Helljesen, Gro Sævil; Nyen, Bjørnar; Nelson, Eugene C

    2011-03-01

    The objectives of the Breakthrough Series Collaborative are to close the gap between what we know and what we do, and to contribute to continuous quality improvement (CQI) of healthcare through collaborative learning. The improvement efforts are guided by a systematic approach, combining professional and improvement knowledge. To explore what the improvement teams have learnt from participating in the collaborative and from dealing with promoting and inhibiting factors encountered. Qualitative interviews with 19 team members were conducted in four focus groups, using the Critical Incident Technique. A critical incident is one that makes significant contributions, either positively or negatively, to an activity. The elements of a culture of improvement are revealed by the critical incidents, and reflect the eight domains of knowledge, as a product of collaborative learning. The improvement knowledge and skills of individuals are important elements, but not enough to achieve sustainable changes. 90% of the material reflects the need for a system of CQI to solve the problems that organisations experience in trying to make lasting improvements. A pattern of three success factors for CQI emerges: (1) continuous and reliable information, including measurement, about best and current practice; (2) engagement of everybody in all phases of the improvement work: the patient and family, the leadership, the professional environment and the staff; and (3) an infrastructure based on improvement knowledge, with multidisciplinary teams, available coaching, learning systems and sustainability systems.

  12. How to improve patient satisfaction when patients are already satisfied: a continuous process-improvement approach.

    Science.gov (United States)

    Friesner, Dan; Neufelder, Donna; Raisor, Janet; Bozman, Carl S

    2009-01-01

    The authors present a methodology that measures improvement in customer satisfaction scores when those scores are already high and the production process is slow and thus does not generate a large amount of useful data in any given time period. The authors used these techniques with data from a midsized rehabilitation institute affiliated with a regional, nonprofit medical center. Thus, this article functions as a case study, the findings of which may be applicable to a large number of other healthcare providers that share both the mission and challenges faced by this facility. The methodology focused on 2 factors: use of the unique characteristics of panel data to overcome the paucity of observations and a dynamic benchmarking approach to track process variability over time. By focusing on these factors, the authors identify some additional areas for process improvement despite the institute's past operational success.

  13. CONTINUOUS QUALITY IMPROVEMENT (CQI FRAMEWORK: A CASE OF INDUSTRIAL ENGINEERING DEPARTMENT

    Directory of Open Access Journals (Sweden)

    Tooba Sikander

    2017-06-01

    Full Text Available This paper aims to present an educational framework for outcomes based continuous quality improvement. Well defined program outcomes, program educational objectives and assessment process have been developed to ensure graduates’ outcomes achievement. Direct and indirect tools have been used for assessment process. Course evaluation surveys, alumni surveys, and employer surveys have been deployed for indirect outcome assessment. Exams, quizzes, assignments and projects, on the other hand, have been used for direct outcome assessment. In developed framework, the educational processes committees and facilities committees have been integrated to continuously evaluate and monitor the educational processes. Furthermore, program outcomes and course learning outcomes are proposed to be evaluated and continuously monitored by programs goals committee and continuous course improvement committee respectively. Forms and procedures have been developed to assess student outcomes.

  14. Problem Lah! Learning to Tell the Story of Continuous Assessment and Improvement

    OpenAIRE

    Hanken, Tamera

    2014-01-01

    To succeed organizations rely on the purposeful application of the management functions, planning, organizing, leading and controlling, i.e., assessment. Assessment involves the collection and analysis of service and performance data to inform planning, organizing and leading-- opening the door to a culture of assessment and continuous improvement. Like other organizations responding to ever challenging economies and ever changing customer expectations, libraries are examining continuous impr...

  15. Visual Acuity Improvement in Continuous vs Divided Occlusion in Anisometropic Amblyopia.

    Science.gov (United States)

    Irfani, Irawati; Feriyanto, Feri; Oktarima, Primawita; Kartasasmita, Arief

    2018-01-01

    To compare visual acuity improvement between continuous and split part-time occlusion for the treatment of moderate and severe anisometropic amblyopia. Randomised clinical trials in 6 - 13 y.o children with moderate and severe anisometropic amblyopia. Each patient was consecutively selected with continuous or split part-time occlusion. Best corrected visual acuity's improvement was followed up to six weeks and statistical data were analyzed using chi square and unpaired t-test. Best corrected visual acuity's improvement was comparable between continuous and split part-time occlusion (0.20±0.27 vs 0.21±0.25; p = 0.79). Split part-time occlusion may be considered as an alternative treatment for moderate and severe anisometropic amblyopia treatment.

  16. A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

    Science.gov (United States)

    Mitchell, Olivia; Malatzky, Christina; Bourke, Lisa; Farmer, Jane

    2018-03-23

    The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated. © 2018 National Rural Health Alliance Ltd.

  17. An integrated approach to hospital strategic planning, quality assurance, and continuous quality improvement.

    Science.gov (United States)

    Day, G; Gardner, S; Herba, C

    1995-01-01

    Like many other healthcare organizations today, the authors' facility, a 306-bed acute care community hospital in Michigan, strives to visualize and make a transition from traditional quality assurance to continuous quality improvement. The Juran Trilogy provided the insight that strategic planning, measurement, and continuous improvement must exist side by side. At the authors' facility, this realization resulted in the hospital quality plan, which treats each of these components as part of the foundation for quality. The authors explain this model and the reporting and communication mechanisms that support it.

  18. PDCA cycle as a part of continuous improvement in the production company - a case study

    Directory of Open Access Journals (Sweden)

    Marta Jagusiak-Kocik

    2017-04-01

    Full Text Available The paper presents a case study of the practical use of Deming cycle in a manufacturing company, from the plastics processing industry, from the sector of small and medium-sized enterprises. The paper is a study of literature in the field of continuous improvement and characterized by a cycle of continuous improvement, called the Deming cycle, or PDCA cycle. This cycle was used as a solution to quality problems which occurred during production of photo frames: discolorations and scorches on the surface of the frame. When measures were introduced to reduce the number of nonconformities, a decrease by more than 60% was observed.

  19. The continuous improvement system of nuclear power plant of Laguna Verde

    International Nuclear Information System (INIS)

    Rivera C, A.

    2009-10-01

    This paper describes the continuous improvement system of nuclear power plant of Laguna Verde and the achievements in implementing the same and additionally two study cases are presents. In February 2009 is noteworthy because the World Association of Nuclear Operators we identified as a learning organization, qualification which shows that the continuous improvement system has matured, and this system will expose as I get to learn to capitalize on our own experiences and external experiences diffused by the nuclear industry. In 2007 the management of nuclear power plants integrates its improvement systems and calls it continuous improvement system and is presented in the same extensive report that won the National Quality Award. This system is made up of 5 subsystems operating individually and are also related 1) human performance; 2) referential comparison or benchmarking; 3) self-assessment; 4) corrective action and 5) external operating experience. Five subsystems that plan, generate, capture, manage, communicate and protect the knowledge generated during the processes execution of nuclear power plant of Laguna Verde, as well as from external sources. The target set in 2007 was to increase the intellectual capital to always give response to meeting the security requirements, but creating a higher value to quality, customer, environment protection and society. In brief each of them, highlighting the objective, expectations management, implementation and some benefits. At the end they will describe two study cases selected to illustrate these cases as the organization learns by their continuous improvement system. (Author)

  20. Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians.

    Science.gov (United States)

    Thomas, David C; Johnston, Bree; Dunn, Kathel; Sullivan, Gail M; Brett, Belle; Matzko, Marilyn; Levine, Sharon A

    2006-10-01

    Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.

  1. Modifying the Toyota Production System for continuous performance improvement in an academic children's hospital.

    Science.gov (United States)

    Stapleton, F Bruder; Hendricks, James; Hagan, Patrick; DelBeccaro, Mark

    2009-08-01

    The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

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

    Science.gov (United States)

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

    2016-01-01

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

  3. Transmutation Fuels Campaign FY-09 Accomplishments Report

    Energy Technology Data Exchange (ETDEWEB)

    Lori Braase

    2009-09-01

    This report summarizes the fiscal year 2009 (FY-08) accomplishments for the Transmutation Fuels Campaign (TFC). The emphasis is on the accomplishments and relevance of the work. Detailed description of the methods used to achieve the highlighted results and the associated support tasks are not included in this report.

  4. Management of continual improvement for facilities and activities: A structured approach

    International Nuclear Information System (INIS)

    2006-04-01

    In recent years there has been an upward trend in the safety and operational performance of nuclear installations. Safe, efficient operation is their goal. Continual improvement of the processes of organizations has led to enhanced safety performance and efficiency benefits such as cost reductions and improved cycle times. Many organizations have experienced significant cost improvement largely by or through better financial management and a common drive to reduce costs brought on by commercial pressures. Without the use of a structured methodology to identify and implement improvements, changes to an organization to reduce costs through cutting staff and activities could eventually fail to produce the desired changes and even have a negative effect on safety and overall performance. The following fundamental principles are considered essential to the effective introduction of structured continual improvement: - Long term commitment from senior management throughout the entire organization; - The implementation in the organization of a process management approach such as that advocated by IAEA Safety Standards, ISO 9001, Malcolm Baldridge National Quality Award and European Foundation for Quality Management Business Excellence model; - The alignment of the processes with the objectives of the organization through the organization's business plan; - The utilization by Management of the process information as an input to managing the organization; - The employment of the information derived from the process performance to identify and prioritize the processes that require improvement; - The active participation of all staff of the organization to using its processes in order to contribute to continual process improvement (CPI). This publication defines a structured approach for continual improvement and focuses on the way an organization can improve its processes. It is recognized that there are many different approaches and methods available in the marketplace to

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

    Science.gov (United States)

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

    2018-04-01

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

  6. Can there be mutual support between hospital marketing and continuous quality improvement?

    Science.gov (United States)

    Weiland, D E

    1992-01-01

    Marketing the results of continuous quality improvement in hospitals builds a growing bank of loyal customers in an increasingly competitive and quality-oriented environment: If healthcare institutions want to survive and flourish, they must develop a lasting relationship with their customers. The long-term goal of CQI is to provide quality products and services. If marketing managers can sell these improved services, hospitals will build a solid client foundation.

  7. Continuous Plasma Treatment of Ultra-High-Molecular-Weight Polyethylene (UHMWPE) Fibres for Adhesion Improvement

    DEFF Research Database (Denmark)

    Teodoru, Steluta; Kusano, Yukihiro; Rozlosnik, Noemi

    2009-01-01

    A dielectric barrier discharge in Ar, He, He/O2, N2 or O2 at atmospheric pressure was used for the continuous plasma treatment of UHMWPE fibres. The influence of the input power of the discharge and the gas flow rate on surface modification is studied with the aim of adhesion improvement. Surface...

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

    Science.gov (United States)

    Pietz, Victoria Lynn

    2014-01-01

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

  9. (Mis)Perceptions of Continuing Education: Insights from Knowledge Translation, Quality Improvement, and Patient Safety Leaders

    Science.gov (United States)

    Kitto, Simon C.; Bell, Mary; Goldman, Joanne; Peller, Jennifer; Silver, Ivan; Sargeant, Joan; Reeves, Scott

    2013-01-01

    Introduction: Minimal attention has been given to the intersection and potential collaboration among the domains of continuing education (CE), knowledge translation (KT), quality improvement (QI), and patient safety (PS), despite their overlapping objectives. A study was undertaken to examine leaders' perspectives of these 4 domains and their…

  10. Continuous Improvement: A Way of Integrating Student Enrollment, Advising, and Retention Systems in a Metropolitan University.

    Science.gov (United States)

    Beeler, Karl J.; Moehl, Pamela J.

    1996-01-01

    The University of Missouri-St. Louis has discovered the value of continuous quality improvement methods in upgrading its core student-related administrative processes. As a result, it is increasing efficiency and personalizing a traditionally bureaucratic system of student service. Concurrent goals are to increase retention and decrease time to…

  11. Record of Assessment Moderation Practice (RAMP): Survey Software as a Mechanism of Continuous Quality Improvement

    Science.gov (United States)

    Johnson, Genevieve Marie

    2015-01-01

    In higher education, assessment integrity is pivotal to student learning and satisfaction, and, therefore, a particularly important target of continuous quality improvement. This paper reports on the preliminary development and application of a process of recording and analysing current assessment moderation practices, with the aim of identifying…

  12. Using Reflective Learning to Improve the Impact of Continuing Education in the Context of Work Rehabilitation

    Science.gov (United States)

    Vachon, Brigitte; Durand, Marie-Jose; LeBlanc, Jeannette

    2010-01-01

    Reflective learning has been described as a promising approach for ameliorating the impact of continuing education (CE) programs. However, there are still very few studies that have investigated how occupational therapists use reflection to improve the integration of CE program content in their decision-making processes. The study objectives were…

  13. Demystifying Data: Designing and Implementing Data-Driven Systems and Practices for Continuous Quality Improvement

    Science.gov (United States)

    Krugly, Andrew; Stein, Amanda; Centeno, Maribel G.

    2014-01-01

    Data-based decision making should be the driving force in any early care and education setting. Data usage compels early childhood practitioners and leaders to make decisions on the basis of more than just professional instinct. This article explores why early childhood schools should be using data for continuous quality improvement at various…

  14. Using Data to Drive Success in Educator Prep: Massachusetts and Endicott College Collaborate for Continuous Improvement

    Science.gov (United States)

    Data Quality Campaign, 2016

    2016-01-01

    For educator preparation programs (EPPs) to produce effective teachers, they must engage in a process of continuous improvement using timely, high-quality information about the performance of their respective graduates in the classroom as measured by student outcomes. While states have the capacity to provide this information through their…

  15. Re-Culturing Educator Preparation Programs: A Collaborative Case Study of Continuous Improvement

    Science.gov (United States)

    Snow, Jennifer; Dismuke, Sherry; Zenkert, A. J.; Loffer, Carolyn

    2017-01-01

    Teacher educators at one institution of higher education collaborated to reculture systems for a focus on continuous improvement even within mounting accountability pressures. A framework of social network theory allowed for themes to develop around layered interactions of faculty, processes, and professional capital. Findings focused on people,…

  16. A Study of Leadership and Continuous Improvement at Leadership Preparatory Academy

    Science.gov (United States)

    Medina Araujo, Jacqueline

    2013-01-01

    This capstone project examines how an elementary school principal and her leadership team transformed Leadership Prep Academy in Capital City into a collaborative, high performing community school. This five-year process of continuous improvement involved engaging students, staff, parents, and members of the community in developing a culture of…

  17. Integrating the development of continuous improvement andinnovation capabilities into engineering education

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Kofoed, Lise B.

    2007-01-01

    In this paper, a study is presented in which engineering students at a Danish university developed Continuous Improvement (CI) and innovation capabilities through action research and experientiallearning methods. The paper begins with a brief overview of the literature on CI and innovation...

  18. Building district-level capacity for continuous improvement in maternal and newborn health.

    Science.gov (United States)

    Stover, Kim Ethier; Tesfaye, Solomon; Frew, Aynalem Hailemichael; Mohammed, Hajira; Barry, Danika; Alamineh, Lamesgin; Teshome, Abebe; Hepburn, Kenneth; Sibley, Lynn M

    2014-01-01

    The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop woreda (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other woredas, dubbed "lead" woredas. Community-level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care. Surveys and in-depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated woreda culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes. Respondents reported significant positive changes in many areas of woreda culture and leadership, including involving a cross-section of community stakeholders (increased from 3.0 to 4.6 on 5-point Likert scale), using improvement data for decision making (2.8-4.4), using locally developed and tested solutions to improve CMNH care (2.5-4.3), demonstrating a commitment to improve the health of women and newborns (2.6-4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6-4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the woredas. The themes of community empowerment and focused improvement emerged strongly from the interviews. MaNHEP was able to build capacity for continuous improvement and develop lead woredas. The

  19. Continuous improvement in manufacturing and inspection of fuel; Mejora continua en fabricacion e inspeccion de combustible

    Energy Technology Data Exchange (ETDEWEB)

    Domingon, A.; Ruiz, R.

    2015-07-01

    The manufacturing and inspection process of fuel assemblies in ENUSA is characterized by its robustness acquired over the last thirty years of experience in manufacturing. The reliability of these processes is based on a qualified processes and continuous improvement in the design and upgrading of equipment and optimization of software and manufacturing processes. Additionally, management and quality control systems have been improved in both software and measuring business objectives. this article emphasizes the improvements made over the past five years in management, production and inspection of fuel assemblies. (Author)

  20. Development of a method of continuous improvement of services using the Business Intelligence tools

    Directory of Open Access Journals (Sweden)

    Svetlana V. Kulikova

    2018-01-01

    Full Text Available The purpose of the study was to develop a method of continuous improvement of services using the Business Intelligence tools.Materials and methods: the materials are used on the concept of the Deming Cycle, methods and Business Intelligence technologies, Agile methodology and SCRUM.Results: the article considers the problem of continuous improvement of services and offers solutions using methods and technologies of Business Intelligence. In this case, the purpose of this technology is to solve and make the final decision regarding what needs to be improved in the current organization of services. In other words, Business Intelligence helps the product manager to see what is hidden from the “human eye” on the basis of received and processed data. Development of a method based on the concept of the Deming Cycle and Agile methodologies, and SCRUM.The article describes the main stages of development of method based on activity of the enterprise. It is necessary to fully build the Business Intelligence system in the enterprise to identify bottlenecks and justify the need for their elimination and, in general, for continuous improvement of the services. This process is represented in the notation of DFD. The article presents a scheme for the selection of suitable agile methodologies.The proposed concept of the solution of the stated objectives, including methods of identification of problems through Business Intelligence technology, development of the system for troubleshooting and analysis of results of the introduced changes. The technical description of the project is given.Conclusion: following the work of the authors there was formed the concept of the method for the continuous improvement of the services, using the Business Intelligence technology with the specifics of the enterprises, offering SaaS solutions. It was also found that when using this method, the recommended development methodology is SCRUM. The result of this scientific

  1. A continuous quality improvement program to focus a college of pharmacy on programmatic advancement.

    Science.gov (United States)

    Hall, Philip D; Dipiro, Joseph T; Rowen, Randall C; McNair, David

    2013-08-12

    To enhance the achievement of a college of pharmacy's goals for education, research, and service missions by implementing an excellence program based on the Studer Group model for continuous quality improvement. The Studer model was combined with university strategic planning for a comprehensive quality-improvement program that was implemented over 5 years. The program included identifying and measuring key performance indicators, establishing specific "pillar" goals, aligning behaviors with goals and values, and training leaders. Assessment of key performance indicators over 5 years demonstrated progress toward achieving college goals for student and faculty satisfaction, research funding, numbers of students seeking formal postgraduate training, and private giving. Implementation of a continuous quality-improvement program based on the Studer program enabled the college to focus on and meet its yearly and strategic goals for all components of its mission.

  2. Independent assessment to continue improvement: Implementing statistical process control at the Hanford Site

    International Nuclear Information System (INIS)

    Hu, T.A.; Lo, J.C.

    1994-11-01

    A Quality Assurance independent assessment has brought about continued improvement in the PUREX Plant surveillance program at the Department of Energy's Hanford Site. After the independent assessment, Quality Assurance personnel were closely involved in improving the surveillance program, specifically regarding storage tank monitoring. The independent assessment activities included reviewing procedures, analyzing surveillance data, conducting personnel interviews, and communicating with management. Process improvement efforts included: (1) designing data collection methods; (2) gaining concurrence between engineering and management, (3) revising procedures; and (4) interfacing with shift surveillance crews. Through this process, Statistical Process Control (SPC) was successfully implemented and surveillance management was improved. The independent assessment identified several deficiencies within the surveillance system. These deficiencies can be grouped into two areas: (1) data recording and analysis and (2) handling off-normal conditions. By using several independent assessment techniques, Quality Assurance was able to point out program weakness to senior management and present suggestions for improvements. SPC charting, as implemented by Quality Assurance, is an excellent tool for diagnosing the process, improving communication between the team members, and providing a scientific database for management decisions. In addition, the surveillance procedure was substantially revised. The goals of this revision were to (1) strengthen the role of surveillance management, engineering and operators and (2) emphasize the importance of teamwork for each individual who performs a task. In this instance we believe that the value independent assessment adds to the system is the continuous improvement activities that follow the independent assessment. Excellence in teamwork between the independent assessment organization and the auditee is the key to continuing improvement

  3. How Visual Management for Continuous Improvement Might Guide and Affect Hospital Staff: A Case Study.

    Science.gov (United States)

    Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Westerlund, Hugo; Sandahl, Christer; Thor, Johan

    2015-01-01

    Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.

  4. Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

    Science.gov (United States)

    Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

    2018-05-01

    To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

  5. Ongoing Evaluation of Clinical Ethics Consultations as a Form of Continuous Quality Improvement.

    Science.gov (United States)

    Volpe, Rebecca

    2017-01-01

    Ongoing evaluation of a clinical ethics consultation service (ECS) allows for continuous quality improvement, a process-based, data-driven approach for improving the quality of a service. Evaluations by stakeholders involved in a consultation can provide real-time feedback about what is working well and what might need to be improved. Although numerous authors have previously presented data from research studies on the effectiveness of clinical ethics consultation, few ECSs routinely send evaluations as an ongoing component of their everyday clinical activities. The primary purpose of this article is to equip and encourage others to engage in ongoing evaluation of their own ECS. Toward that end, the following resources are shared: (1) the survey tool used to gather the evaluation data, (2) the procedure used to elicit and collate responses, and (3) how the resulting data are used to support continuous quality improvement and justify the continued financial support of the ECS to hospital administration. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

  6. Keeping the "continuous" in continuous quality improvement: exploring perceived outcomes of CQI program use in community pharmacy.

    Science.gov (United States)

    Boyle, Todd A; Bishop, Andrea C; Duggan, Kellie; Reid, Carolyn; Mahaffey, Thomas; MacKinnon, Neil J; Mahaffey, Amelia

    2014-01-01

    Given the significant potential of continuous quality improvement (CQI) programs in enhancing overall levels of patient safety, community pharmacies in North America are under increasing pressure to have a formal and documented CQI program in place. However, while such initiatives may seem great on paper, in practice the outcomes of such programs to community pharmacy practice remain unclear. To explore the perceived outcomes identified by community pharmacies that adopted and actively used a standardized (i.e., common across pharmacies) CQI program for at least 1 year and to develop a framework for how such outcomes were achieved. A multi-site study of SafetyNET-Rx, a standardized and technologically sophisticated (e.g., online reporting of medication errors to a national database) CQI program, involving community pharmacies in Nova Scotia, Canada, was performed. During the summer and fall of 2011, 22 interviews were conducted with the CQI facilitators in 12 Nova Scotia community pharmacies; equally split between independent/banners and corporate chains. Of the CQI facilitators, 14 were pharmacists, while the remaining eight were pharmacy technicians. Thematic analysis following the procedures presented by Braun and Clarke was adopted to identify and explore the major outcomes. Results of the thematic analysis highlighted a number of perceived outcomes from the use of a standardized CQI program in community pharmacies, specifically: (1) perceived reduction in the number of medication errors that were occurring in the pharmacy, (2) increased awareness/confidence of individual actions related to dispensing, (3) increased understanding of the dispensing and related processes/workflow, (4) increased openness to talking about medication errors among pharmacy staff, and (5) quality and safety becoming more entrenched in the workflow (e.g., staff is more aware of their roles and responsibilities in patient safety and confident that the dispensing processes are safe and

  7. Evolution of Technology for Continuous Renal Replacement Therapy: Forty Years of Improvement.

    Science.gov (United States)

    Ronco, Claudio

    2018-01-01

    Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance. These problems were solved by the introduction of continuous arteriovenous hemodiafiltration and continuous arteriovenous hemodialysis, where uremic control could be achieved by increasing countercurrent dialysate flow rates to 1.5 or 2 L/h as necessary, or by venovenous techniques utilizing a double-lumen central venous catheter for vascular access. Thus, continuous venovenous hemofiltration replaced CAVH because of its improved performance and safety. From the initial adoptive technology, specific machines have been designed to permit safe and reliable performance of the therapy. These new machines have progressively undergone a series of technological steps that have resulted in the evolution of highly sophisticated equipment utilized today. A significant number of advances have taken place since the time continuous renal replacement therapy was initiated. In particular, there have been successful experiments with high-volume hemofiltration and high-permeability hemofiltration. The additional and combined use of sorbent has also been tested successfully. Progress has been made in the technology as well as the understanding of the pathophysiology of acute kidney injury. Today, new biomaterials and new devices are available and new frontiers are on the horizon. Although improvements have been made, a lot remains to be done. Critical care nephrology is expected to further evolve in the near future, especially in the area of information and

  8. Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study.

    Science.gov (United States)

    Bodicoat, Danielle H; Mundet, Xavier; Gray, Laura J; Cos, Xavier; Davies, Melanie J; Khunti, Kamlesh; Cano, Juan-Franciso

    2014-12-01

    Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus. © 2014 John Wiley & Sons, Ltd.

  9. The association between event learning and continuous quality improvement programs and culture of patient safety.

    Science.gov (United States)

    Mazur, Lukasz; Chera, Bhishamjit; Mosaly, Prithima; Taylor, Kinley; Tracton, Gregg; Johnson, Kendra; Comitz, Elizabeth; Adams, Robert; Pooya, Pegah; Ivy, Julie; Rockwell, John; Marks, Lawrence B

    2015-01-01

    To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions (p continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  10. Organisational learning and continuous improvement of health and safety in certified manufacturers

    DEFF Research Database (Denmark)

    Granerud, Lise; Rocha, Robson Sø

    2011-01-01

    and raise goals within health and safety on a continuous basis. The article examines how certified occupational and health management systems influence this process to evaluate how far they hinder or support learning. It presents a model with which it is possible to identify and analyse improvement......Certified management systems have increasingly been applied by firms in recent decades and now cover the management of health and safety, principally through the OHSAS 18001 standard. In order to become certified, firms must not only observe the relevant legislation, but also improve performance...... processes. The model is applied to five cases from a qualitative study of Danish manufacturers with certified health and safety management systems. The cases illustrate the wide variation in health and safety management among certified firms. Certification is found to support lower levels of continuous...

  11. Implementing a Course Review Process for a Continuous Quality Improvement Model for a Medical School Curriculum.

    Science.gov (United States)

    Ward, Cassandra S; Andrade, Amy; Walker-Winfree, Lena

    2018-01-01

    In 1901, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, visited 155 medical schools in the United States and Canada to assess medical education. Flexner's recommendations became the foundation for the Liaison Committee on Medical Education accreditation, a voluntary, peer-reviewed quality assurance process to determine whether a medical education program meets established standards. The Meharry Medical College School of Medicine, a historically Black college/university (HBCU) established the Office of Curriculum Evaluation and Effectiveness in 2013 to ensure the consistent monitoring of the medical education program's compliance with accreditation standards. The motto and logo, LCME 24/7, highlight the school's emphasis on meeting accreditation standards. The school uses the 1994 Plan-Do-Study-Act Cycle for Learning and Improvement for continuous review of course content, outcomes, and evaluations. This process identifies strengths, challenges, and opportunities for innovative steps for continuous quality improvements to the curriculum.

  12. Continuous improvement, burnout and job engagement: a study in a Dutch nursing department.

    Science.gov (United States)

    Benders, Jos; Bleijerveld, Hans; Schouteten, Roel

    2017-10-01

    Continuous improvement (CI) programs are potentially powerful means to improve the quality of care. The more positive nurses perceive these programs' effects, the better they may be expected to cooperate. Crucial to this perception is how nurses' quality of working life is affected. We studied this in a nursing department, using the job demands-resources model. We found that two job demands improved, and none of the job resources. Job engagement did not change significantly, while the burnout risk decreased slightly. Overall, the nurses felt the impact to be small yet the changes were in a positive direction. CI can thus be used to improve nurses' working lives and, by restructuring the work processes, the quality of care. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  13. Air quality continued to improve in 2014, but progress are still needed

    International Nuclear Information System (INIS)

    Le Moullec, Aurelie

    2015-09-01

    The improvement in air quality that began some years ago continued. Average concentrations of pollutants decreased and exceedance of thresholds for protection of health was observed in fewer areas. Progress was, notably, the result of efforts made to reduce emissions, something made more difficult by the number and variety of sources of pollution. These improvements were, however, fragile as they were partially dependent on weather conditions. 2014 was, thus, marked by an important episode of particulate pollution. In addition, the progress made was not sufficient to bring France into full compliance with European standards, as was also the case for other European countries. (author)

  14. The continuous improvement in quality management for nuclear fuel manufacturing in CNNC

    International Nuclear Information System (INIS)

    Wang Xiaoling

    2004-01-01

    The nuclear fuel plant has been keeping good records in quality. Only one pot failure has been found in the fuels loaded in the reactors at more than ten years. The paper describes quality management in nuclear fuel manufacturing and focuses on the continuous improvement on quality system and process by running the quality management system, process by quality control group, and data analyze, the requirements and the improvements for the quality system, the measurement system and the standardization system, the importance of clearance system. It also describes the future plans in quality management

  15. Development of a team-based framework for conducting self-assessment of Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Gertsen, Frank; Boer, Harry

    2004-01-01

    The study presented in this article is based on two basic premises. First, successful continuous improvement (CI) is dependent on shop floor level involvement and participation in improvement efforts. Second, the term "self-assessment" clearly implies that those whose performance is being measured......, and who are involved in conducting the assessment process. Excerpts from longitudinal case studies in a single Danish manufacturing organization demonstrate how teams involved in the process of conducting self-assessment of CI developed a better understanding of the basic principles of CI. Furthermore...

  16. Embracing technology? Using change management strategies to improve the use of continuous lateral rotation therapy.

    Science.gov (United States)

    Cybulski, Pamela; Zantinge, Johanna; Abbott-McNeil, Deanna

    2006-01-01

    The purpose of this quality improvement initiative was to improve the utilization of continuous lateral rotation therapy (CLRT) in a nine-bed community hospital ICU within the context of a nurse-driven protocol. Nursing focus groups, analyzed using a strength, weakness, opportunity, threat (SWOT) approach, resulted in the implementation of four interventions over seven weeks. Change management strategies guided all aspects of the project. Results showed a modest increase in the utilization of CLRT. This initiative demonstrates that change management strategies may assist with the incorporation of technology into nursing practice by increasing empowerment and creating an attachment to and responsibility for outcomes.

  17. Using measures to guide the continuous improvement journey: a partnership between quality assurance and toxicology.

    Science.gov (United States)

    Gentry, P E; Sites, D L

    1994-03-01

    It has been said that you cannot improve what you cannot measure. At Eli Lilly and Company, measurement is one of the five pillars of Total Quality. Quality Assurance and Toxicology have partnered in the use of measures to drive improvements in both areas. Quality Assurance and Toxicology have embarked on a journey in Total Quality to achieve customer satisfaction and drive continuous improvement. Measurement in the research and development world has traditionally not been well received. Contrary to popular belief, we have found that many processes can be measured in the research and development environment. Measurement is critical to the continuous improvement of processes because improvements are made using data. In Quality Assurance and Toxicology, the initial measures were put in place to gather baseline data. As we learned from our measures, we customized them to align with all of our processes. This article describes the journey of measuring Quality Assurance and Toxicology, including highlights of implementation strategies and lessons learned along the way.

  18. Organizational learning perspective on continuous improvement and innovation in product realization

    DEFF Research Database (Denmark)

    Møller, Christina Villefrance

    with cross-functional collaboration in solving problems that subsequently restraining continuous improvement and innovation (CII) in product realization. This research project apply an organizational learning perspective on cross-functional problem solving in product realization processes. The research...... project has two main objectives, first to develop and test a CIIprogram that integrates cross-functional work practices into product realization. The second objective is to enhance understanding of organizational learning processes in cross-functional and multilevel settings within manufacturing....

  19. Overcoming institutional challenges through continuous professionalism improvement: the University of Washington experience.

    Science.gov (United States)

    Fryer-Edwards, Kelly; Van Eaton, Erik; Goldstein, Erika A; Kimball, Harry R; Veith, Richard C; Pellegrini, Carlos A; Ramsey, Paul G

    2007-11-01

    The University of Washington (UW) School of Medicine is in the midst of an emerging ecology of professionalism. This initiative builds on prior work focusing on professionalism at the student level and moves toward the complete integration of a culture of professionalism within the UW medical community of including staff, faculty, residents, and students. The platform for initiating professionalism as institutional culture is the Committee on Continuous Professionalism Improvement, established in November 2006. This article reviews three approaches to organizational development used within and outside medicine and highlights features that are useful for enhancing an institutional culture of professionalism: organizational culture, safety culture, and appreciative inquiry. UW Medicine has defined professional development as a continuous process, built on concrete expectations, using mechanisms to facilitate learning from missteps and highlighting strengths. To this end, the school of medicine is working toward improvements in feedback, evaluation, and reward structures at all levels (student, resident, faculty, and staff) as well as creating opportunities for community dialogues on professionalism issues within the institution. Throughout all the Continuous Professionalism Improvement activities, a two-pronged approach to cultivating a culture of professionalism is taken: celebration of excellence and attention to accountability.

  20. Learning science as a potential new source of understanding and improvement for continuing education and continuing professional development.

    Science.gov (United States)

    Van Hoof, Thomas J; Doyle, Terrence J

    2018-01-15

    Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education.

  1. Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children.

    Science.gov (United States)

    McAullay, Daniel; McAuley, Kimberley; Bailie, Ross; Mathews, Veronica; Jacoby, Peter; Gardner, Karen; Sibthorpe, Beverly; Strobel, Natalie; Edmond, Karen

    2018-02-01

    To determine whether participation in the continuous quality improvement (CQI) Audit and Best Practice for Chronic Disease programme improved care and outcomes for Indigenous children. Data were collected from 59 Australian primary health-care centres providing services to Indigenous people and participating in the programme (February 2008 and December 2013). Indigenous children aged less than 2 years and centres that completed three or more consecutive annual audits within the 6-year study period were included. Crude and adjusted logistic generalised estimating equation models were used to examine the effect of year of audit on the delivery of care. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Outcomes were related to age-relevant health issues, including prevention and early intervention. These included administrative, health check, anticipatory guidance and specific health issues. During the audit period, there were 2360 files from 59 centres. Those that had a recall recorded, improved from 84 to 95% (OR 2.44, 95% CI 1.44-4.11). Hearing assessments improved from 52 to 89% (OR 1.37, 95% CI 1.22-1.54). Improvement in anticipatory guidance, treatment and follow-up of medical conditions was almost universal. We documented significant improvements in quality of care of Indigenous children. Outcomes and their corresponding treatment and follow-ups improved over time. This appears to be related to services participating in annual CQI activities. However, these services may be more committed to CQI than others and therefore possibly better performing. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  2. Adhesion improvement of fibres by continuous plasma treatment at atmospheric pressure

    Energy Technology Data Exchange (ETDEWEB)

    Kusano, Y.; Andersen, Tom L.; Soerensen, B.F.; Toftegaard, H.L.; Teodoru, S. [Technical Univ. of Denmark. DTU Wind Energy, Risoe Campus, Roskilde (Denmark); Hansen, Charles M. [Hoersholm (Denmark)

    2013-09-01

    Carbon fibres and ultra-high-molecular-weight polyethylene (UHMWPE) fibres were continuously treated by a dielectric barrier discharge plasma at atmospheric pressure for adhesion improvement with epoxy resins. The plasma treatment improved wettability, increased the oxygen containing polar functional groups at the surface, and subsequently improved adhesion to the epoxy and fracture resistance of epoxy composites. Hansen solubility parameters (HSP), quantitatively describing physical interactions among molecules, were measured for the UHMWPE fibre surfaces. The result identifies two distinct types of surfaces in both the plasma treated and the untreated fibres. One type is typical of polyethylene polymers while the other is characteristic of the oxygenated surface at much higher values of HSP. (Author)

  3. Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement.

    Science.gov (United States)

    Srofenyoh, Emmanuel; Ivester, Thomas; Engmann, Cyril; Olufolabi, Adeyemi; Bookman, Laurel; Owen, Medge

    2012-01-01

    To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into "bundles" based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009. During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (Pcontinuous quality improvement were developed and employed. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Continuous improvement process and waste reduction through a QFD tool: the case of a metallurgic plant

    Directory of Open Access Journals (Sweden)

    Leoni Pentiado Godoy

    2013-05-01

    Full Text Available This paper proposes the use of QFD for the continuous improvement of production processes and waste reduction actions. To collect the information we used the simple observation and questionnaire with closed questions applied to employees, representing 88.75% of the population that works in the production processes of an industry of metal-mechanic sector, located inRio Grandedo Sul. QFD is an effective method of quality planning, because it provides a diagnosis that underpins the definition of improvement actions aimed at combating waste. Actions were set providing improved communication between the sectors, enabling the delivery of products with specifications that meet customer requirements, on time and the right amounts, at a minimum cost and satisfaction of those involved with the company. The implementation of these actions reduces waste, minimizes the extra work, maximizes effective labor and increases profitability.

  5. An improved method of continuous LOD based on fractal theory in terrain rendering

    Science.gov (United States)

    Lin, Lan; Li, Lijun

    2007-11-01

    With the improvement of computer graphic hardware capability, the algorithm of 3D terrain rendering is going into the hot topic of real-time visualization. In order to solve conflict between the rendering speed and reality of rendering, this paper gives an improved method of terrain rendering which improves the traditional continuous level of detail technique based on fractal theory. This method proposes that the program needn't to operate the memory repeatedly to obtain different resolution terrain model, instead, obtains the fractal characteristic parameters of different region according to the movement of the viewpoint. Experimental results show that the method guarantees the authenticity of landscape, and increases the real-time 3D terrain rendering speed.

  6. Kaizen - continuous improvement of high voltage products; Kaizen - kontinuierliche Verbesserung bei Hochspannungsprodukten

    Energy Technology Data Exchange (ETDEWEB)

    Schwarz, M. [ABB Calor Emag Schaltanlagen AG, Hanau-Grossauheim (Germany); Goessmann, T. [ABB Calor Emag Schaltanlagen AG, Mannheim (Germany)

    1999-07-12

    In the actual global competition only the company can survive who cares for the continuous improvement of all business activities. The ABB Calor Emag Schaltanlagen AG at his production site in Hanau-Grossauheim has installed a specific improvement programm called KVP what is based on the ideas of Kaizen. Aim is the improvement of processes, mainly in production, concerning quality, dates, costs and environment by activating all colleagues. (orig.) [Deutsch] Im heutigen globalen Wettbewerb kann sich nur der behaupten, der sich kontinuierlich in allen Unternehmensbereichen weiterentwickelt. Die ABB Calor Emag Schaltanlagen AG hat in ihrem Werk Hanau-Grossauheim nach den Ideen des Kaizen ein werkspezifisches Programm zur kontinuierlichen Verbesserung der Prozesse in der Fertigung eingefuehrt. Ziel ist die stetige Verbesserung von Fertigungsparametern, wie Qualitaet, Termine, Kosten und Umwelt unter Einbeziehung aller Mitarbeiter. (orig.)

  7. Method and apparatus for improved melt flow during continuous strip casting

    Science.gov (United States)

    Follstaedt, Donald W.; King, Edward L.; Schneider, Ken C.

    1991-11-12

    The continuous casting of metal strip using the melt overflow process is improved by controlling the weir conditions in the nozzle to provide a more uniform flow of molten metal across the width of the nozzle and reducing the tendency for freezing of metal along the interface with refractory surfaces. A weir design having a sloped rear wall and tapered sidewalls and critical gap controls beneath the weir has resulted in the drastic reduction in edge tearing and a significant improvement in strip uniformity. The floor of the container vessel is preferably sloped and the gap between the nozzle and the rotating substrate is critically controlled. The resulting flow patterns observed with the improved casting process have reduced thermal gradients in the bath, contained surface slag and eliminated undesirable solidification near the discharge area by increasing the flow rates at those points.

  8. Role of continual environmental performance improvement in achieving sustainability in uranium production

    International Nuclear Information System (INIS)

    Jarrell, J.P.; Chad, G.M.S.

    2002-01-01

    Although the term sustainable development is commonly used today, there is not yet a commonly accepted definition. Various ways of measuring sustainability have been proposed. To show how these issues are being effectively addressed in modern uranium developments, we will review some methods of defining the environmental component of sustainable development in the mining and mineral-processing sector. Environmental impacts associated with uranium extraction and processing in modern facilities are modest. Air and water emissions are well controlled. Waste materials are subject to comprehensive management programmes. The size of the impacted area is smaller than in other energy sectors, providing good opportunity to minimize land impact. Experience over the past three decades facilitated gradual, persistent, but cumulatively significant environmental improvements in the uranium production sector. Cameco's uranium mining and processing facilities exemplify these improvements. These improvements can be expected to continue, supporting our argument of Cameco's environmental sustainability. (author)

  9. Indigenous health: effective and sustainable health services through continuous quality improvement.

    Science.gov (United States)

    Bailie, Ross S; Si, Damin; O'Donoghue, Lyn; Dowden, Michelle

    2007-05-21

    The Australian government's Healthy for Life program is supporting capacity development in Indigenous primary care using continuous quality improvement (CQI) techniques. An important influence on the Healthy for Life program has been the ABCD research project. The key features contributing to the success of the project are described. The ABCD research project: uses a CQI approach, with an ongoing cycle of gathering data on how well organisational systems are functioning, and developing and then implementing improvements; is guided by widely accepted principles of community-based research, which emphasise participation; and adheres to the principles and values of Indigenous health research and service delivery. The potential for improving health outcomes in Aboriginal and Torres Strait Islander communities using a CQI approach should be strengthened by clear clinical and managerial leadership, supporting service organisations at the community level, and applying participatory-action principles.

  10. Employees Motivation and Openness for Continuous Improvement: Comparative Study in Polish and Japanese Companies

    Directory of Open Access Journals (Sweden)

    Stadnicka Dorota

    2017-09-01

    Full Text Available Currently, companies must change and evolve to keep pace with the changing environment, customers’ requirements and to be better than their competitors. The changes result from the need to adapt the products to new customers’ requirements as well as to maintain competitive prices of their products. Therefore, companies should be flexible to guarantee short lead time and minimalize their costs to offer a good price for the customers. At the same time, companies should create good work environment for their employees in order to get them involved in improvement processes. In order to survive and develop companies should motivate and involve their employees into a continuous improvement process in different areas of the company. Unfortunately, as based on the companies’ practice and previous research, in many cases employees are not willing to engage in the company development. Continuous improvement is the basis of the philosophy of Quality Management and Lean Manufacturing, which come from Toyota Production System (TPS. The TPS eventually spread throughout the world, and it is held up as an example of the proper management of a production system. The assumptions of TPS system were used to build systems in other companies, but not always with the same success as it was in Toyota. For this reason, the authors of this paper seek to answer the question of whether there are differences in engagement in a continuous improvement process between employees in a Japanese company and a Polish company operating in the same industry and realizing the similar manufacturing. In order to verify this, the research was conducted in two manufacturing companies which operate in the automotive industry. The results of the study and their analysis are presented in the work.

  11. Using Surgeon-Specific Outcome Reports and Positive Deviance for Continuous Quality Improvement.

    Science.gov (United States)

    Ivanovic, Jelena; Anstee, Caitlin; Ramsay, Tim; Gilbert, Sebastien; Maziak, Donna E; Shamji, Farid M; Sundaresan, R Sudhir; Villeneuve, P James; Seely, Andrew J E

    2015-10-01

    Using the thoracic morbidity and mortality classification to document all postoperative adverse events between October 2012 and February 2014, we created surgeon-specific outcome reports (SSORs) to promote self-assessment and to implement a divisional continuous quality improvement (CQI) program, on the construct of positive deviance, to improve individual surgeon's clinical performance. Mixed-methods study within a division of six thoracic surgeons, involving (1) development of real-time, Web-based, risk-adjusted SSORs; (2) implementation of CQI seminars (n = 6; September 2013 to June 2014) for evaluation of results, collegial discussion on quality improvement based on identification of positive outliers, and selection of quality indicators for future discussion; and (3) in-person interviews to identify facilitators and barriers to using SSORs and CQI. Interview transcripts were analyzed using thematic analysis. Interviews revealed enthusiastic support for SSORs as a means to improve patient care through awareness of personal outcomes with blinded divisional comparison for similar operations and diseases, and apply the learning objectives to continuous professional development and maintenance of certification. Perceived limitations of SSORs included difficulty measuring surgeon expertise, limited understanding of risk adjustment, resistance to change, and belief that knowledge of sensitive data could lead to punitive actions. All surgeons believed CQI seminars led to collegial discussions, whereas perceived limitations included quorum participation and failing to circle back on actionable items. Real-time performance feedback using SSORs can motivate surgeons to improve their practice, and CQI seminars offer the opportunity to review and interpret results and address issues in a supportive environment. Whether SSORs and CQI can lead to improvements in rates of postoperative adverse events is a matter of ongoing research. Copyright © 2015 The Society of Thoracic

  12. Promoting Continuous Quality Improvement in the Alabama Child Health Improvement Alliance Through Q-Sort Methodology and Learning Collaboratives.

    Science.gov (United States)

    Fifolt, Matthew; Preskitt, Julie; Rucks, Andrew; Corvey, Kathryn; Benton, Elizabeth Cason

    Q-sort methodology is an underutilized tool for differentiating among multiple priority measures. The authors describe steps to identify, delimit, and sort potential health measures and use selected priority measures to establish an overall agenda for continuous quality improvement (CQI) activities within learning collaboratives. Through an iterative process, the authors vetted a list of potential child and adolescent health measures. Multiple stakeholders, including payers, direct care providers, and organizational representatives sorted and prioritized measures, using Q-methodology. Q-methodology provided the Alabama Child Health Improvement Alliance (ACHIA) an objective and rigorous approach to system improvement. Selected priority measures were used to design learning collaboratives. An open dialogue among stakeholders about state health priorities spurred greater organizational buy-in for ACHIA and increased its credibility as a statewide provider of learning collaboratives. The integrated processes of Q-sort methodology, learning collaboratives, and CQI offer a practical yet innovative way to identify and prioritize state measures for child and adolescent health and establish a learning agenda for targeted quality improvement activities.

  13. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

    Science.gov (United States)

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

    2014-10-01

    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  14. Improvement production of bacterial cellulose by semi-continuous process in molasses medium.

    Science.gov (United States)

    Cakar, Fatih; Ozer, Işılay; Aytekin, A Özhan; Sahin, Fikrettin

    2014-06-15

    Bacterial cellulose (BC) has unique properties such as structural, functional, physical and chemical. The mass production of BC for industrial application has recently become attractive to produce more economical and high productive cellulose. In this study, to improve the productivity of bacterial cellulose (BC), BC production by Gluconacetobacter xylinus FC01 was investigated in molasses medium with static semi-continuous operation mode. Cell dry weight, polysaccharide, sugar and cellulose concentrations were monitored and cellulose was characterized by Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM). The highest cellulose yield (1.637 g/L) was obtained in SCP50-7d, which molasses of 1/2 ratio for 7 days by static semi-continuous operation mode. The results show that BC can be highly produced by G. xylinus in molasses with static semi-continuous process than batch process. We claimed that low-cost medium with semi-continuous operation mode in static culture is a good candidate for industrial scale BC productions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Light Water Reactor Sustainability Accomplishments Report

    Energy Technology Data Exchange (ETDEWEB)

    McCarthy, Kathryn A. [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-02-01

    Welcome to the 2014 Light Water Reactor Sustainability (LWRS) Program Accomplishments Report, covering research and development highlights from 2014. The LWRS Program is a U.S. Department of Energy research and development program to inform and support the long-term operation of our nation’s commercial nuclear power plants. The research uses the unique facilities and capabilities at the Department of Energy national laboratories in collaboration with industry, academia, and international partners. Extending the operating lifetimes of current plants is essential to supporting our nation’s base load energy infrastructure, as well as reaching the Administration’s goal of reducing greenhouse gas emissions to 80% below 1990 levels by the year 2050. The purpose of the LWRS Program is to provide technical results for plant owners to make informed decisions on long-term operation and subsequent license renewal, reducing the uncertainty, and therefore the risk, associated with those decisions. In January 2013, 104 nuclear power plants operated in 31 states. However, since then, five plants have been shut down (several due to economic reasons), with additional shutdowns under consideration. The LWRS Program aims to minimize the number of plants that are shut down, with R&D that supports long-term operation both directly (via data that is needed for subsequent license renewal), as well indirectly (with models and technology that provide economic benefits). The LWRS Program continues to work closely with the Electric Power Research Institute (EPRI) to ensure that the body of information needed to support SLR decisions and actions is available in a timely manner. This report covers selected highlights from the three research pathways in the LWRS Program: Materials Aging and Degradation, Risk-Informed Safety Margin Characterization, and Advanced Instrumentation, Information, and Control Systems Technologies, as well as a look-ahead at planned activities for 2015. If you

  16. Advanced Fuels Campaign FY 2014 Accomplishments Report

    Energy Technology Data Exchange (ETDEWEB)

    Braase, Lori [Idaho National Lab. (INL), Idaho Falls, ID (United States). INL Systems Analyses; May, W. Edgar [Idaho National Lab. (INL), Idaho Falls, ID (United States). INL Systems Analyses

    2014-10-01

    accident conditions than traditional fuel systems. AFC management and integration activities included continued support for international collaborations, primarily with France, Japan, the European Union, Republic of Korea, and China, as well as various working group and expert group activities in the Organization for Economic Cooperation and Development Nuclear Energy Agency (OECD-NEA) and the International Atomic Energy Agency (IAEA). Three industry-led Funding Opportunity Announcements (FOAs) and two university-led Integrated Research Projects (IRPs), funded in 2013, made significant progress in fuels and materials development. All are closely integrated with AFC and Accident Tolerant Fuels (ATF) research. Accomplishments made during fiscal year (FY) 2014 are highlighted in this report, which focuses on completed work and results. The process details leading up to the results are not included; however, the lead technical contact is provided for each section.

  17. Engineering Accomplishments in the Construction of NCSX

    International Nuclear Information System (INIS)

    G. H. Neilson; P.J. Heitzenroeder; B.E. Nelson; W.T. Reiersen; A. Brooks; T.G. Brown; J.H. Chrzanowski; M.J. Cole; F. Dahlgren; T. Dodson; L.E. Dudek; R.A. Ellis; H.M. Fan; P.J. Fogarty; K.D. Freudenberg; P.L. Goranson; J.H. Harris; M.R. Kalish; G. Labik; J.F. Lyon; N. Pomphrey; C.D. Priniski; S. Raftopoulos; D.J. Rej; W.R. Sands; R.T. Simmons; B.E. Stratton; R.L. Strykowsky; M.E. Viola; D.E. Williamson; M.C. Zarnstorff

    2008-01-01

    The National Compact Stellarator Experiment (NCSX) was designed to test a compact, quasiaxisymmetric stellarator configuration. Flexibility and accurate realization of its complex 3D geometry were key requirements affecting the design and construction. While the project was terminated before completing construction, there were significant engineering accomplishments in design, fabrication, and assembly. The design of the stellarator core device was completed. All of the modular coils, toroidal field coils, and vacuum vessel sectors were fabricated. Critical assembly steps were demonstrated. Engineering advances were made in the application of CAD modeling, structural analysis, and accurate fabrication of complex-shaped components and subassemblies. The engineering accomplishments of the project are summarized

  18. Improvements of PKU PMECRIS for continuous hundred hours CW proton beam operation

    International Nuclear Information System (INIS)

    Peng, S. X.; Ren, H. T.; Zhang, T.; Zhang, J. F.; Xu, Y.; Guo, Z. Y.; Zhang, A. L.; Chen, J. E.

    2016-01-01

    In order to improve the source stability, a long term continuous wave (CW) proton beam experiment has been carried out with Peking University compact permanent magnet 2.45 GHz ECR ion source (PKU PMECRIS). Before such an experiment a lot of improvements and modifications were completed on the source body, the Faraday cup and the PKU ion source test bench. At the beginning of 2015, a continuous operation of PKU PMECRIS for 306 h with more than 50 mA CW beam was carried out after success of many short term tests. No plasma generator failure or high voltage breakdown was observed during that running period and the proton source reliability is near 100%. Total beam availability, which is defined as 35-keV beam-on time divided by elapsed time, was higher than 99% [S. X. Peng et al., Chin. Phys. B 24(7), 075203 (2015)]. A re-inspection was performed after another additional 100 h operation (counting time) and no obvious sign of component failure was observed. Counting the previous source testing time together, this PMECRs longevity is now demonstrated to be greater than 460 h. This paper is mainly concentrated on the improvements for this long term experiment

  19. Improvements of PKU PMECRIS for continuous hundred hours CW proton beam operation

    Science.gov (United States)

    Peng, S. X.; Zhang, A. L.; Ren, H. T.; Zhang, T.; Zhang, J. F.; Xu, Y.; Guo, Z. Y.; Chen, J. E.

    2016-02-01

    In order to improve the source stability, a long term continuous wave (CW) proton beam experiment has been carried out with Peking University compact permanent magnet 2.45 GHz ECR ion source (PKU PMECRIS). Before such an experiment a lot of improvements and modifications were completed on the source body, the Faraday cup and the PKU ion source test bench. At the beginning of 2015, a continuous operation of PKU PMECRIS for 306 h with more than 50 mA CW beam was carried out after success of many short term tests. No plasma generator failure or high voltage breakdown was observed during that running period and the proton source reliability is near 100%. Total beam availability, which is defined as 35-keV beam-on time divided by elapsed time, was higher than 99% [S. X. Peng et al., Chin. Phys. B 24(7), 075203 (2015)]. A re-inspection was performed after another additional 100 h operation (counting time) and no obvious sign of component failure was observed. Counting the previous source testing time together, this PMECRs longevity is now demonstrated to be greater than 460 h. This paper is mainly concentrated on the improvements for this long term experiment.

  20. Improvements of PKU PMECRIS for continuous hundred hours CW proton beam operation

    Energy Technology Data Exchange (ETDEWEB)

    Peng, S. X., E-mail: sxpeng@pku.edu.cn; Ren, H. T.; Zhang, T.; Zhang, J. F.; Xu, Y.; Guo, Z. Y. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); Zhang, A. L.; Chen, J. E. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); University of Chinese Academy of Sciences, Beijing 100049 (China)

    2016-02-15

    In order to improve the source stability, a long term continuous wave (CW) proton beam experiment has been carried out with Peking University compact permanent magnet 2.45 GHz ECR ion source (PKU PMECRIS). Before such an experiment a lot of improvements and modifications were completed on the source body, the Faraday cup and the PKU ion source test bench. At the beginning of 2015, a continuous operation of PKU PMECRIS for 306 h with more than 50 mA CW beam was carried out after success of many short term tests. No plasma generator failure or high voltage breakdown was observed during that running period and the proton source reliability is near 100%. Total beam availability, which is defined as 35-keV beam-on time divided by elapsed time, was higher than 99% [S. X. Peng et al., Chin. Phys. B 24(7), 075203 (2015)]. A re-inspection was performed after another additional 100 h operation (counting time) and no obvious sign of component failure was observed. Counting the previous source testing time together, this PMECRs longevity is now demonstrated to be greater than 460 h. This paper is mainly concentrated on the improvements for this long term experiment.

  1. A System for Continual Quality Improvement of Normal Tissue Delineation for Radiation Therapy Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Breunig, Jennifer; Hernandez, Sophy; Lin, Jeffrey; Alsager, Stacy; Dumstorf, Christine; Price, Jennifer; Steber, Jennifer; Garza, Richard; Nagda, Suneel; Melian, Edward; Emami, Bahman [Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois (United States); Roeske, John C., E-mail: jroeske@lumc.edu [Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois (United States)

    2012-08-01

    Purpose: To implement the 'plan-do-check-act' (PDCA) cycle for the continual quality improvement of normal tissue contours used for radiation therapy treatment planning. Methods and Materials: The CT scans of patients treated for tumors of the brain, head and neck, thorax, pancreas and prostate were selected for this study. For each scan, a radiation oncologist and a diagnostic radiologist, outlined the normal tissues ('gold' contours) using Radiation Therapy Oncology Group (RTOG) guidelines. A total of 30 organs were delineated. Independently, 5 board-certified dosimetrists and 1 trainee then outlined the same organs. Metrics used to compare the agreement between the dosimetrists' contours and the gold contours included the Dice Similarity Coefficient (DSC), and a penalty function using distance to agreement. Based on these scores, dosimetrists were re-trained on those organs in which they did not receive a passing score, and they were subsequently re-tested. Results: Passing scores were achieved on 19 of 30 organs evaluated. These scores were correlated to organ volume. For organ volumes <8 cc, the average DSC was 0.61 vs organ volumes {>=}8 cc, for which the average DSC was 0.91 (P=.005). Normal tissues that had the lowest scores included the lenses, optic nerves, chiasm, cochlea, and esophagus. Of the 11 organs that were considered for re-testing, 10 showed improvement in the average score, and statistically significant improvement was noted in more than half of these organs after education and re-assessment. Conclusions: The results of this study indicate the feasibility of applying the PDCA cycle to assess competence in the delineation of individual organs, and to identify areas for improvement. With testing, guidance, and re-evaluation, contouring consistency can be obtained across multiple dosimetrists. Our expectation is that continual quality improvement using the PDCA approach will ensure more accurate treatments and dose

  2. A System for Continual Quality Improvement of Normal Tissue Delineation for Radiation Therapy Treatment Planning

    International Nuclear Information System (INIS)

    Breunig, Jennifer; Hernandez, Sophy; Lin, Jeffrey; Alsager, Stacy; Dumstorf, Christine; Price, Jennifer; Steber, Jennifer; Garza, Richard; Nagda, Suneel; Melian, Edward; Emami, Bahman; Roeske, John C.

    2012-01-01

    Purpose: To implement the “plan-do-check-act” (PDCA) cycle for the continual quality improvement of normal tissue contours used for radiation therapy treatment planning. Methods and Materials: The CT scans of patients treated for tumors of the brain, head and neck, thorax, pancreas and prostate were selected for this study. For each scan, a radiation oncologist and a diagnostic radiologist, outlined the normal tissues (“gold” contours) using Radiation Therapy Oncology Group (RTOG) guidelines. A total of 30 organs were delineated. Independently, 5 board-certified dosimetrists and 1 trainee then outlined the same organs. Metrics used to compare the agreement between the dosimetrists' contours and the gold contours included the Dice Similarity Coefficient (DSC), and a penalty function using distance to agreement. Based on these scores, dosimetrists were re-trained on those organs in which they did not receive a passing score, and they were subsequently re-tested. Results: Passing scores were achieved on 19 of 30 organs evaluated. These scores were correlated to organ volume. For organ volumes <8 cc, the average DSC was 0.61 vs organ volumes ≥8 cc, for which the average DSC was 0.91 (P=.005). Normal tissues that had the lowest scores included the lenses, optic nerves, chiasm, cochlea, and esophagus. Of the 11 organs that were considered for re-testing, 10 showed improvement in the average score, and statistically significant improvement was noted in more than half of these organs after education and re-assessment. Conclusions: The results of this study indicate the feasibility of applying the PDCA cycle to assess competence in the delineation of individual organs, and to identify areas for improvement. With testing, guidance, and re-evaluation, contouring consistency can be obtained across multiple dosimetrists. Our expectation is that continual quality improvement using the PDCA approach will ensure more accurate treatments and dose assessment in

  3. [Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

    Science.gov (United States)

    Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

    2010-01-01

    To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

  4. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

    Science.gov (United States)

    Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

    1995-01-01

    OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult

  5. Continuous Improvement and the Safety Case for the Waste Isolation Pilot Plant Geologic Repository - 13467

    Energy Technology Data Exchange (ETDEWEB)

    Van Luik, Abraham; Patterson, Russell; Nelson, Roger [US Department of Energy, Carlsbad Field Office, 4021 S. National parks Highway, Carlsbad, NM 88220 (United States); Leigh, Christi [Sandia National Laboratories Carlsbad Operations, 4100 S. National parks Highway, Carlsbad, NM 88220 (United States)

    2013-07-01

    The Waste Isolation Pilot Plant (WIPP) is a geologic repository 2150 feet (650 m) below the surface of the Chihuahuan desert near Carlsbad, New Mexico. WIPP permanently disposes of transuranic waste from national defense programs. Every five years, the U.S. Department of Energy (DOE) submits an application to the U.S. Environmental Protection Agency (EPA) to request regulatory-compliance re-certification of the facility for another five years. Every ten years, DOE submits an application to the New Mexico Environment Department (NMED) for the renewal of its hazardous waste disposal permit. The content of the applications made by DOE to the EPA for re-certification, and to the NMED for permit-renewal, reflect any optimization changes made to the facility, with regulatory concurrence if warranted by the nature of the change. DOE points to such changes as evidence for its having taken seriously its 'continuous improvement' operations and management philosophy. Another opportunity for continuous improvement is to look at any delta that may exist between the re-certification and re-permitting cases for system safety and the consensus advice on the nature and content of a safety case as being developed and published by the Nuclear Energy Agency's Integration Group for the Safety Case (IGSC) expert group. DOE at WIPP, with the aid of its Science Advisor and teammate, Sandia National Laboratories, is in the process of discerning what can be done, in a reasonably paced and cost-conscious manner, to continually improve the case for repository safety that is being made to the two primary regulators on a recurring basis. This paper will discuss some aspects of that delta and potential paths forward to addressing them. (authors)

  6. A story of success: continuous quality improvement in cystic fibrosis care in the USA.

    Science.gov (United States)

    Quon, Bradley S; Goss, Christopher H

    2011-12-01

    Continuous quality improvement (CQI) in healthcare can be described as a reiterative approach to improving processes to reduce unexpected variation in health outcomes. CQI represents one model to achieve quality improvement (QI) and has long been recognized as a key to success in the manufacturing industry with companies like Toyota leading the way. Healthcare, and specifically pulmonary, critical care and sleep medicine represent ideal settings for the application of CQI. This opinion piece will describe QI and CQI initiatives in the US Cystic fibrosis (CF) population. QI in CF care in the United States has been ongoing since inception of the US CF Foundation (CFF) in 1955. This effort has included work to improve the quality of clinical care provided at CF centers and work to improve clinical outcomes in CF. More recently, QI methods have been applied to the conduct of clinical research. The CF community has become a leader in the area of QI and has pointed out the opportunities for others to follow in the area of lung diseases.

  7. Impact of continuous quality improvement initiatives on clinical outcomes in peritoneal dialysis.

    Science.gov (United States)

    Yu, Yusheng; Zhou, Yan; Wang, Han; Zhou, Tingting; Li, Qing; Li, Taoyu; Wu, Yan; Liu, Zhihong

    2014-06-01

    We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal dialysis (PD). In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 (control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place. Peritonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy. After implementation of the CQI initiative, the peritonitis rate declined to 1 episode in 77.25 patient-months from 1 episode in 22.86 patient-months. Ultrasound parameters of cardiac structure were generally unchanged in the CQI group, but significant increases in cardiothoracic ratio and interventricular septal thickness were observed in the control group (both p improve technique survival rates: 95.6%, 92.6%, and 92.6% in the CQI group compared with 89.6%, 79.2%, and 76.8% in the control group (p improve the quality of therapy and its outcomes. Copyright © 2014 International Society for Peritoneal Dialysis.

  8. Environmental assessment, continual improvement and adaptive management within the AREVA sustainable development framework

    International Nuclear Information System (INIS)

    Rosaasen, A.; Frostad, S.

    2006-01-01

    COGEMA Resources Inc. (which is part of the AREVA Group) is a Canadian company with its head office in Saskatoon, Saskatchewan. It owns and operates mining and milling facilities in northern Saskatchewan, which produce uranium concentrate. The McClean Lake Operation commenced production in 1999 and its environmental management system represents an integrated approach to environmental assessment, continual improvement and adaptive management based on operational results. In Canada, sustainable development is promoted through the application of the Canadian Environmental Assessment Act (CEAA). Environmental Assessment (EA) is a planning tool, which incorporates environmental considerations before irrevocable decisions are taken. The basic tenet of the Act is the determination of whether the potential environmental effects of a project are adverse, significant and likely, taking into consideration mitigation measures. Thus, project planning and design entails an iterative process that incorporates mitigation measures to minimize potentially significant adverse effects. As part of the EA process conservative approaches are taken to predict potential effects. Several important elements are generated through the EA process including: a set of environmental effects predictions, a compliance and environmental effects monitoring program, a follow-up program to address uncertainties in the prediction of environmental effects, and the identification of contingency measures that could be implemented should non-conservative assumptions be identified in the original assessment framework. The challenge is to integrate each of these elements into the environmental management framework of the operating facility and develop an iterative mechanism to evaluate operational performance relative to what was originally predicted. In Saskatchewan, a requirement of operational licenses is the periodic evaluation of the 'Status of the Environment' surrounding operational facilities. These

  9. POSSIBILITIES AND LIMITS OF THE CYCLE OF CONTINUOUS IMPROVEMENT -PDCA AS AN ELEMENT OF LEARNING

    Directory of Open Access Journals (Sweden)

    Celso Machado Junior

    2013-08-01

    Full Text Available The aim of this study is to investigate the possibilities and limits of the use of continuous improvement cycle, PDCA, as a tool that contributes to the development of individual learning in the organization. It is a qualitative, descriptive end uses the case study as a method. It was observed that the practice proposed by PDCA, can be used in the process of knowledge creation in line with the authors in the field, constituting a form of knowledge management within the organization, enabling the creation of tacit knowledge and its explicit transformation were not observed limits for their use.

  10. Continual summing-up, deepening the related researches and improving the interventional nursing

    International Nuclear Information System (INIS)

    Xu Xiufang; Zhang Xiumei; Ding Yue

    2011-01-01

    With the development of the medical technique in the field of clinical interventional radiology, the relevant interventional nursing team has also gradually grown and expanded. At present, there are certain differences in the development situation of interventional nursing between China and foreign countries. The experts in nursing fields in China should learn the matured experience from abroad to open up the features and superiorities of Chinese interventional nursing. Therefore, the nursing workers in China should continually to make summing-up, exert oneself to deepen the related researches and effectively improve the interventional nursing level. (authors)

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

    Science.gov (United States)

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

    2018-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Janya McCalman

    2018-03-01

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

  13. Improving physiotherapy services to Indigenous children with physical disability: Are client perspectives missed in the continuous quality improvement approach?

    Science.gov (United States)

    Greenstein, Caroline; Lowell, Anne; Thomas, David Piers

    2016-06-01

    To compare the outcomes of two cycles of continuous quality improvement (CQI) at a paediatric physiotherapy service with findings from interviews with clients and their carers using the service. Case study based at one paediatric physiotherapy service Community-based paediatric allied health service in Northern Australia. Forty-nine clinical records and four staff at physiotherapy service, five Indigenous children with physical disability aged 8-21 years, and nine carers of Indigenous children aged 0-21 years (current or previous clients). The CQI process based on the Audit and Best Practice for Chronic Disease involved a clinical audit; a workshop where clinicians assessed their health care systems, identified weaknesses and strengths, and developed goals and strategies for improvement; and reassessment through a second audit and workshop. Twelve open-ended, in-depth interviews were conducted with previous or current clients selected through purposive and theoretical sampling. CQI and interview results were then compared. Comparison of findings from the two studies Both CQI and interview results highlighted service delivery flexibility and therapists' knowledge, support and advocacy as service strengths, and lack of resources and a child-friendly office environment as weaknesses. However, the CQI results reported better communication and client input into the service than the interview results. The CQI process, while demonstrating improvements in clinical and organisational aspects of the service, did not always reflect or address the primary concerns of Indigenous clients and underlined the importance of including clients in the CQI process. © 2015 National Rural Health Alliance Inc.

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

    Science.gov (United States)

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

    2018-01-01

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

  15. Overview of LAMPF and its accomplishments

    International Nuclear Information System (INIS)

    Rosen, L.

    1978-04-01

    The report presented is from a talk given at a Los Alamos Scientific Laboratory colloquium on October 4, 1977, in which the history, technological accomplishments, present status, and scientific program at the Clinton P. Anderson Meson Physics Facility (LAMPF) were reviewed

  16. Biomass Program 2007 Accomplishments - Full Report

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2009-10-27

    The Office of Energy Efficiency and Renewable Energy's (EERE’s) Biomass Program works with industry, academia and its national laboratory partners on a balanced portfolio of research in biomass feedstocks and conversion technologies. This document provides Program accomplishments for 2007.

  17. Biomass Program 2007 Accomplishments - Report Introduction

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2009-10-27

    The Office of Energy Efficiency and Renewable Energy's (EERE’s) Biomass Program works with industry, academia and its national laboratory partners on a balanced portfolio of research in biomass feedstocks and conversion technologies. This document provides the introduction to the 2007 Program Accomplishments Report.

  18. Improvement of two-way continuous-variable quantum key distribution using optical amplifiers

    International Nuclear Information System (INIS)

    Zhang, Yi-Chen; Yu, Song; Gu, Wanyi; Li, Zhengyu; Sun, Maozhu; Peng, Xiang; Guo, Hong; Weedbrook, Christian

    2014-01-01

    The imperfections of a receiver's detector affect the performance of two-way continuous-variable (CV) quantum key distribution (QKD) protocols and are difficult to adjust in practical situations. We propose a method to improve the performance of two-way CV-QKD by adding a parameter-adjustable optical amplifier at the receiver. A security analysis is derived against a two-mode collective entangling cloner attack. Our simulations show that the proposed method can improve the performance of protocols as long as the inherent noise of the amplifier is lower than a critical value, defined as the tolerable amplifier noise. Furthermore, the optimal performance can approach the scenario where a perfect detector is used. (paper)

  19. Continuous Auditory Feedback of Eye Movements: An Exploratory Study toward Improving Oculomotor Control

    Directory of Open Access Journals (Sweden)

    Eric O. Boyer

    2017-04-01

    Full Text Available As eye movements are mostly automatic and overtly generated to attain visual goals, individuals have a poor metacognitive knowledge of their own eye movements. We present an exploratory study on the effects of real-time continuous auditory feedback generated by eye movements. We considered both a tracking task and a production task where smooth pursuit eye movements (SPEM can be endogenously generated. In particular, we used a visual paradigm which enables to generate and control SPEM in the absence of a moving visual target. We investigated whether real-time auditory feedback of eye movement dynamics might improve learning in both tasks, through a training protocol over 8 days. The results indicate that real-time sonification of eye movements can actually modify the oculomotor behavior, and reinforce intrinsic oculomotor perception. Nevertheless, large inter-individual differences were observed preventing us from reaching a strong conclusion on sensorimotor learning improvements.

  20. Evaluating online continuing medical education seminars: evidence for improving clinical practices.

    Science.gov (United States)

    Weston, Christine M; Sciamanna, Christopher N; Nash, David B

    2008-01-01

    The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.

  1. Modular Approach for Continuous Cell-Level Balancing to Improve Performance of Large Battery Packs: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Muneed ur Rehman, M.; Evzelman, M.; Hathaway, K.; Zane, R.; Plett, G. L.; Smith, K.; Wood, E.; Maksimovic, D.

    2014-10-01

    Energy storage systems require battery cell balancing circuits to avoid divergence of cell state of charge (SOC). A modular approach based on distributed continuous cell-level control is presented that extends the balancing function to higher level pack performance objectives such as improving power capability and increasing pack lifetime. This is achieved by adding DC-DC converters in parallel with cells and using state estimation and control to autonomously bias individual cell SOC and SOC range, forcing healthier cells to be cycled deeper than weaker cells. The result is a pack with improved degradation characteristics and extended lifetime. The modular architecture and control concepts are developed and hardware results are demonstrated for a 91.2-Wh battery pack consisting of four series Li-ion battery cells and four dual active bridge (DAB) bypass DC-DC converters.

  2. Continuing Improvement in the Planetary Ephemeris with VLBA Observations of Cassini

    Science.gov (United States)

    Jones, Dayton L.; Folkner, William M.; Jacobson, Robert A.; Jacobs, Christopher S.; Romney, Jonathan D.; Dhawan, Vivek; Fomalont, Edward B.

    2016-06-01

    During the past decade a continuing series of measurements of the barycentric position of the Saturn system in the inertial International Celestial Reference Frame (ICRF) has led to a significant improvement in our knowledge of Saturn's orbit. This in turn has improved the current accuracy and time range of the solar system ephemeris produced and maintained by the Jet Propulsion Laboratory. Our observing technique involves high-precision astrometry of the radio signal from Cassini with the NRAO Very Long Baseline Array, combined with solutions for the orbital motion of Cassini about the Saturn barycenter from Doppler tracking by the Deep Space Network. Our VLBA astrometry is done in a phase-referencing mode, providing nrad-level relative positions between Cassini and angularly nearby extragalactic radio sources. The positions of those reference radio sources are tied to the ICRF through dedicated VLBI observations by several groups around the world. We will present recent results from our astrometric observations of Cassini through early 2016. This program will continue until the end of the Cassini mission in 2017, although future improvement in Saturn's orbit will be more incremental because we have already covered more that a quarter of Saturn's orbital period. The Juno mission to Jupiter, which will orbit Jupiter for about 1.5 years starting in July 2016, will provide an excellent opportunity for us to apply the same VLBA astrometry technique to improve the orbit of Jupiter by a factor of several. The National Radio Astronomy Observatory is a facility of the National Science Foundation operated under cooperative agreement by Associated Universities, Inc. This work made use of the Swinburne University of Technology software correlator, developed as part of the Australian Major National Research Facilities Program and operated under license. Part of this research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under contract

  3. Ergonomics, quality and continuous improvement--conceptual and empirical relationships in an industrial context.

    Science.gov (United States)

    Eklund, J

    1997-10-01

    This paper reviews the literature comparing the fields of ergonomics and quality, mainly in an industrial context, including mutual influences, similarities and differences. Relationships between ergonomics and the factors: work conditions, product design, ISO 9000, continuous improvements and TQM are reviewed in relation to the consequence, application, and process domains. The definitions of ergonomics and quality overlap substantially. Quality deficiencies, human errors and ergonomics problems often have the same cause, which in many cases can be traced to the design of work, workplace and environment e.g. noise, light, postures, loads, pace and work content. In addition, the possibility of performing to a high standard at work is an important prerequisite for satisfaction and well-being. Contradictions between the two fields have been identified in the view of concepts such as standardization, reduction of variability and copying of best practice, requiring further research. The field of quality would gain by incorporating ergonomics knowledge, especially in the areas of work design and human capability, since these factors are decisive for human performance and also therefore the performance of the systems involved. The field of ergonomics, on the other hand, would benefit from developing a stronger emphasis on methodologies and structures for improvement processes, including a clearer link with leadership and company strategies. Just as important is a further development of practicable participative ergonomics methods and tools for use at workplaces by the workers themselves, in order to integrate the top-down and the bottom-up processes and achieve better impact. Using participative processes for problem-solving and continuous improvement, focusing ergonomics and quality jointly has a great potential for improving working conditions and quality results simultaneously, and satisfying most of the interested parties.

  4. Dissemination of performance information and continuous improvement: A narrative systematic review.

    Science.gov (United States)

    Lemire, Marc; Demers-Payette, Olivier; Jefferson-Falardeau, Justin

    2013-01-01

    Developing a performance measure and reporting the results to support decision making at an individual level has yielded poor results in many health systems. The purpose of this paper is to highlight the factors associated with the dissemination of performance information that generate and support continuous improvement in health organizations. A systematic data collection strategy that includes empirical and theoretical research published from 1980 to 2010, both qualitative and quantitative, was performed on Web of Science, Current Contents, EMBASE and MEDLINE. A narrative synthesis method was used to iteratively detail explicative processes that underlie the intervention. A classification and synthesis framework was developed, drawing on knowledge transfer and exchange (KTE) literature. The sample consisted of 114 articles, including seven systematic or exhaustive reviews. Results showed that dissemination in itself is not enough to produce improvement initiatives. Successful dissemination depends on various factors, which influence the way collective actors react to performance information such as the clarity of objectives, the relationships between stakeholders, the system's governance and the available incentives. This review was limited to the process of knowledge dissemination in health systems and its utilization by users at the health organization level. Issues related to improvement initiatives deserve more attention. Knowledge dissemination goes beyond better communication and should be considered as carefully as the measurement of performance. Choices pertaining to intervention should be continuously prompted by the concern to support organizational action. While considerable attention was paid to the public reporting of performance information, this review sheds some light on a more promising avenue for changes and improvements, notably in public health systems.

  5. [Study of continuous quality improvement for clinical laboratory processes via the platform of Hospital Group].

    Science.gov (United States)

    Song, Wenqi; Shen, Ying; Peng, Xiaoxia; Tian, Jian; Wang, Hui; Xu, Lili; Nie, Xiaolu; Ni, Xin

    2015-05-26

    The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children's Hospital Group in order to improve the quality of pediatric clinical laboratories. Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action). The questionnaire survey and inter-laboratory comparison was conducted to find the existing problems, to analyze reasons, to set forth quality targets and to put them into practice. Then, targeted training was conducted to 15 children's hospitals and the second questionnaire survey, self examinations by the clinical laboratories was performed. At the same time, the Group's online internal quality control platform was established. Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA. Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program. In addition, standardization of performance verification was also improved, especially with the comparable verification rate of precision and internal laboratory results up to 100%. In terms of instrument calibration and mandatory diagnostic rates, only three out of the 15 hospitals (20%) failed to pass muster in 2014 from 46.67% (seven out of the 15 hospitals) in 2013. The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC, RBC, Hb, Plt and Hct) of all the 15 laboratories accounted for 1.2% (2/165) in 2014, a marked decrease from 9.6% (14/145) in 2013. While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five. The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013, up 160%. The quality improvement program for

  6. Can continuous scans in orthogonal planes improve diagnostic performance of shear wave elastography for breast lesions?

    Science.gov (United States)

    Yang, Pan; Peng, Yulan; Zhao, Haina; Luo, Honghao; Jin, Ya; He, Yushuang

    2015-01-01

    Static shear wave elastography (SWE) is used to detect breast lesions, but slice and plane selections result in discrepancies. To evaluate the intraobserver reproducibility of continuous SWE, and whether quantitative elasticities in orthogonal planes perform better in the differential diagnosis of breast lesions. One hundred and twenty-two breast lesions scheduled for ultrasound-guided biopsy were recruited. Continuous SWE scans were conducted in orthogonal planes separately. Quantitative elasticities and histopathology results were collected. Reproducibility in the same plane and diagnostic performance in different planes were evaluated. The maximum and mean elasticities of the hardest portion, and standard deviation of whole lesion, had high inter-class correlation coefficients (0.87 to 0.95) and large areas under receiver operation characteristic curve (0.887 to 0.899). Without loss of accuracy, sensitivities had increased in orthogonal planes compared with single plane (from 73.17% up to 82.93% at most). Mean elasticity of whole lesion and lesion-to-parenchyma ratio were significantly less reproducible and less accurate. Continuous SWE is highly reproducible for the same observer. The maximum and mean elasticities of the hardest portion and standard deviation of whole lesion are most reliable. Furthermore, the sensitivities of the three parameters are improved in orthogonal planes without loss of accuracies.

  7. Continuous Improvement in Battery Testing at the NASA/JSC Energy System Test Area

    Science.gov (United States)

    Boyd, William; Cook, Joseph

    2003-01-01

    The Energy Systems Test Area (ESTA) at the Lyndon B. Johnson Space Center in Houston, Texas conducts development and qualification tests to fulfill Energy System Division responsibilities relevant to ASA programs and projects. EST A has historically called upon a variety of fluid, mechanical, electrical, environmental, and data system capabilities spread amongst five full-service facilities to test human and human supported spacecraft in the areas of propulsion systems, fluid systems, pyrotechnics, power generation, and power distribution and control systems. Improvements at ESTA are being made in full earnest of offering NASA project offices an option to choose a thorough test regime that is balanced with cost and schedule constraints. In order to continue testing of enabling power-related technologies utilized by the Energy System Division, an especially proactive effort has been made to increase the cost effectiveness and schedule responsiveness for battery testing. This paper describes the continuous improvement in battery testing at the Energy Systems Test Area being made through consolidation, streamlining, and standardization.

  8. X-rays taken by radiologists. Influence on a continuous quality improvement process?

    International Nuclear Information System (INIS)

    Kurtz, C.; Freiburg Univ.; Czapp, W.; Trampe, I.; Leppek, R.; Klose, K.J.

    2000-01-01

    Purpose: To evaluate how the training of radiology residents in taking radiographs influences the work of radiographers and the established quality standards. Methods: A first year radiology resident was trained for 4 weeks in focusing and exposure techniques by radiographers. In a second period the resident took 582 radiograms, which were compared with those taken by technicians for error estimation on a daily basis. During a third period the radiographs were produced in a contest between the resident and a skilled radiographer. Errors were analysed by two independent experts according to established guidelines of the German Medical Association. Results: At the beginning of the second period the average error rate of the resident was 11.9% as compared to 8.9% in the technicians team, in the following month 9.2% versus 15.9%. In the third period no relevant difference in errors could be observed. Finally, unexpected quality improvements were implemented like an improved standardization of focusing and exposure techniques as well as dose reduction. Conclusions: Radiology residents easily learn focusing and exposure techniques and achieve comparable results as radiographers within a short period of time. The additionally achieved knowledge improves the technical process of taking radiographs. We recommend to include a two plane radiography training period in the curriculum of radiology residents. It reinforces the radiologist's role in continuous quality improvements of the diagnostic process. (orig.) [de

  9. Safety implications of standardized continuous quality improvement programs in community pharmacy.

    Science.gov (United States)

    Boyle, Todd A; Ho, Certina; Mackinnon, Neil J; Mahaffey, Thomas; Taylor, Jeffrey M

    2013-06-01

    Standardized continuous quality improvement (CQI) programs combine Web-based technologies and standardized improvement processes, tools, and expectations to enable quality-related events (QREs) occurring in individual pharmacies to be shared with pharmacies in other jurisdictions. Because standardized CQI programs are still new to community pharmacy, little is known about how they impact medication safety. This research identifies key aspects of medication safety that change as a result of implementing a standardized CQI program. Fifty-three community pharmacies in Nova Scotia, Canada, adopted the SafetyNET-Rx standardized CQI program in April 2010. The Institute for Safe Medication Practices (ISMP) Canada's Medication Safety Self-Assessment (MSSA) survey was administered to these pharmacies before and 1 year into their use of the SafetyNET-Rx program. The nonparametric Wilcoxon signed-rank test was used to explore where changes in patient safety occurred as a result of SafetyNETRx use. Significant improvements occurred with quality processes and risk management, staff competence, and education, and communication of drug orders and other information. Patient education, environmental factors, and the use of devices did not show statistically significant changes. As CQI programs are designed to share learning from QREs, it is reassuring to see that the largest improvements are related to quality processes, risk management, staff competence, and education.

  10. Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation.

    Science.gov (United States)

    Harvey, Gillian; Lynch, Elizabeth

    2017-01-01

    Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as "tailoring" the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified.

  11. Increasing the use of 'smart' pump drug libraries by nurses: a continuous quality improvement project.

    Science.gov (United States)

    Harding, Andrew D

    2012-01-01

    The use of infusion pumps that incorporate "smart" technology (smart pumps) can reduce the risks associated with receiving IV therapies. Smart pump technology incorporates safeguards such as a list of high-alert medications, soft and hard dosage limits, and a drug library that can be tailored to specific patient care areas. Its use can help to improve patient safety and to avoid potentially catastrophic harm associated with medication errors. But when one independent community hospital in Massachusetts switched from older mechanical pumps to smart pumps, it neglected to assign an "owner" to oversee the implementation process. One result was that nurses were using the smart pump library for only 37% of all infusions.To increase pump library usage percentage-thereby reducing the risks associated with infusion and improving patient safety-the hospital undertook a continuous quality improvement project over a four-month period in 2009. With the involvement of direct care nurses, and using quantitative data available from the smart pump software, the nursing quality and pharmacy quality teams identified ways to improve pump and pump library use. A secondary goal was to calculate the hospital's return on investment for the purchase of the smart pumps. Several interventions were developed and, on the first of each month, implemented. By the end of the project, pump library usage had nearly doubled; and the hospital had completely recouped its initial investment.

  12. Continuous quality improvement process pin-points delays, speeds STEMI patients to life-saving treatment.

    Science.gov (United States)

    2011-11-01

    Using a multidisciplinary team approach, the University of California, San Diego, Health System has been able to significantly reduce average door-to-balloon angioplasty times for patients with the most severe form of heart attacks, beating national recommendations by more than a third. The multidisciplinary team meets monthly to review all cases involving patients with ST-segment-elevation myocardial infarctions (STEMI) to see where process improvements can be made. Using this continuous quality improvement (CQI) process, the health system has reduced average door-to-balloon times from 120 minutes to less than 60 minutes, and administrators are now aiming for further progress. Among the improvements instituted by the multidisciplinary team are the implementation of a "greeter" with enough clinical expertise to quickly pick up on potential STEMI heart attacks as soon as patients walk into the ED, and the purchase of an electrocardiogram (EKG) machine so that evaluations can be done in the triage area. ED staff have prepared "STEMI" packets, including items such as special IV tubing and disposable leads, so that patients headed for the catheterization laboratory are prepared to undergo the procedure soon after arrival. All the clocks and devices used in the ED are synchronized so that analysts can later review how long it took to complete each step of the care process. Points of delay can then be targeted for improvement.

  13. Continuous improvement in the Netherlands: current practices and experiences in Dutch manufacturing industry (awarded with ANBAR Citation of excellence)

    NARCIS (Netherlands)

    Gieskes, J.F.B.; Baudet, F.C.M.; Baudet, Frank; Schuring, R.W.; Boer, Harm

    1997-01-01

    In order to get insight into the current continuous-improvement practices in European industry, EuroCINet carried out a survey in its member countries. In this article, continuous-improvement activities in a sample of 135 Dutch industrial companies are described. The results show that CI is a

  14. Continuous positive airway pressure improves gait control in severe obstructive sleep apnoea: A prospective study.

    Directory of Open Access Journals (Sweden)

    Sébastien Baillieul

    Full Text Available Severe obstructive sleep apnoea (OSA can lead to neurocognitive alterations, including gait impairments. The beneficial effects of continuous positive airway pressure (CPAP on improving excessive daytime sleepiness and daily functioning have been documented. However, a demonstration of CPAP treatment efficacy on gait control is still lacking. This study aims to test the hypothesis that CPAP improves gait control in severe OSA patients.In this prospective controlled study, twelve severe OSA patients (age = 57.2±8.9 years, body mass index = 27.4±3.1 kg·m-2, apnoea-hypopnoea index = 46.3±11.7 events·h-1 and 10 healthy matched subjects were included. Overground gait parameters were recorded at spontaneous speed and stride time variability, a clinical marker of gait control, was calculated. To assess the role of executive functions in gait and postural control, a dual-task paradigm was applied using a Stroop test as secondary cognitive task. All assessments were performed before and after 8 weeks of CPAP treatment.Before CPAP treatment, OSA patients had significantly larger stride time variability (3.1±1.1% vs 2.1±0.5% and lower cognitive performances under dual task compared to controls. After CPAP treatment, stride time variability was significantly improved and no longer different compared to controls. Cognitive performance under dual task also improved after CPAP treatment.Eight weeks of CPAP treatment improves gait control of severe OSA patients, suggesting morphological and functional cerebral improvements. Our data provide a rationale for further mechanistic studies and the use of gait as a biomarker of OSA brain consequences.

  15. Breaking continuous potato cropping with legumes improves soil microbial communities, enzyme activities and tuber yield

    Science.gov (United States)

    Qin, Shuhao; Yeboah, Stephen; Cao, Li; Zhang, Junlian; Shi, Shangli; Liu, Yuhui

    2017-01-01

    This study was conducted to explore the changes in soil microbial populations, enzyme activity, and tuber yield under the rotation sequences of Potato–Common vetch (P–C), Potato–Black medic (P–B) and Potato–Longdong alfalfa (P–L) in a semi–arid area of China. The study also determined the effects of continuous potato cropping (without legumes) on the above mentioned soil properties and yield. The number of bacteria increased significantly (p continuous cropping soils, respectively compared to P–C rotation. The highest fungi/bacteria ratio was found in P–C (0.218), followed by P–L (0.184) and then P–B (0.137) rotation over the different cropping years. In the continuous potato cropping soils, the greatest fungi/bacteria ratio was recorded in the 4–year (0.4067) and 7–year (0.4238) cropping soils and these were significantly higher than 1–year (0.3041), 2–year (0.2545) and 3–year (0.3030) cropping soils. Generally, actinomycetes numbers followed the trend P–L>P–C>P–B. The P–L rotation increased aerobic azotobacters in 2–year (by 26% and 18%) and 4–year (40% and 21%) continuous cropping soils compared to P–C and P–B rotation, respectively. Generally, the highest urease and alkaline phosphate activity, respectively, were observed in P–C (55.77 mg g–1) and (27.71 mg g–1), followed by P–B (50.72 mg mg–1) and (25.64 mg g–1) and then P–L (41.61 mg g–1) and (23.26 mg g–1) rotation. Soil urease, alkaline phosphatase and hydrogen peroxidase activities decreased with increasing years of continuous potato cropping. On average, the P–B rotation significantly increased (p improve soil biology environment, alleviate continuous cropping obstacle and increase potato tuber yield in semi–arid region. PMID:28463981

  16. Continuous Flushing of the Bladder in Rodents Reduces Artifacts and Improves Quantification in Molecular Imaging

    Directory of Open Access Journals (Sweden)

    Steven Deleye

    2014-07-01

    Full Text Available In this study, we evaluated the partial volume effect (PVE of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG tracer accumulation in the bladder on the positron emission tomographic (PET image quantification in mice and rats suffering from inflammatory bowel disease. To improve the accuracy, we implemented continuous bladder flushing procedures. Female mice and rats were scanned using microPET/computed tomography (CT at baseline and after induction of acute colitis by injecting 2,4,6-trinitrobenzene sulfonic acid (TNBS intrarectally. During the scans, the bladder was continuously flushed in one group, whereas in the other group, no bladder flushing was performed. As a means of in vivo and ex vivo validation of the inflammation, animals also underwent colonoscopy and were sacrificed for gamma counting (subpopulation and to score the colonic damage both micro- and macroscopically as well as biochemically. At baseline, the microPET signal in the colon of both mice and rats was significantly higher in the nonflushed group compared to the flushed group, caused by the PVE of tracer activity in the bladder. Hence, the colonoscopy and postmortem analyses showed no significant differences at baseline between the flushed and nonflushed animals. TNBS induced significant colonic inflammation, as revealed by colonoscopic and postmortem scores, which was not detected by microPET in the mice without bladder flushing, again because of spillover of bladder activity in the colonic area. MicroPET in bladder-flushed animals did reveal a significant increase in 18F-FDG uptake. Correlations between microPET and colonoscopy, macroscopy, microscopy, and myeloperoxidase yielded higher Spearman rho values in mice with continuously flushed bladders during imaging. Comparable, although somewhat less pronounced, results were shown in the rat. Continuous bladder flushing reduced image artifacts and is mandatory for accurate image quantification in the pelvic region for both mice

  17. Building Capacity for the Continuous Improvement of Health-Promoting Schools

    Science.gov (United States)

    Hoyle, Tena B.; Samek, Beverly B.; Valois, Robert F.

    2008-01-01

    Background: There has been much educational verbosity over the past decade related to building capacity for effective schools. However, there seems to be a scarcity of clarification about what is meant by school capacity building or how to accomplish and sustain this process. This article describes the preexisting conditions and ongoing processes…

  18. Material Recover and Waste Form Development--2016 Accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    Todd, Terry A. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Vienna, John [Idaho National Lab. (INL), Idaho Falls, ID (United States); Paviet, Patricia [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-12-01

    The Material Recovery and Waste Form Development (MRWFD) Campaign under the U.S. Department of Energy (DOE) Fuel Cycle Technologies (FCT) Program is responsible for developing advanced separation and waste form technologies to support the various fuel cycle options defined in the DOE Nuclear Energy Research and Development Roadmap, Report to Congress (April 2010). This MRWFD accomplishments report summarizes the results of the research and development (R&D) efforts performed within MRWFD in Fiscal Year (FY) 2016. Each section of the report contains an overview of the activities, results, technical point of contact, applicable references, and documents produced during the FY. This report briefly outlines campaign management and integration activities but primarily focuses on the many technical accomplishments of FY 2016. The campaign continued to use an engineering-driven, science-based approach to maintain relevance and focus.

  19. Advanced Fuels Campaign FY 2011 Accomplishments Report

    Energy Technology Data Exchange (ETDEWEB)

    Not Listed

    2011-11-01

    One of the major research and development (R&D) areas under the Fuel Cycle Research and Development (FCRD) program is advanced fuels development. The Advanced Fuels Campaign (AFC) has the responsibility to develop advanced fuel technologies for the Department of Energy (DOE) using a science-based approach focusing on developing a microstructural understanding of nuclear fuels and materials. Accomplishments made during fiscal year (FY 20) 2011 are highlighted in this report, which focuses on completed work and results. The process details leading up to the results are not included; however, the technical contact is provided for each section. The order of the accomplishments in this report is consistent with the AFC work breakdown structure (WBS).

  20. Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge.

    Science.gov (United States)

    Wagner, Anjuli D; Mugo, Cyrus; Bluemer-Miroite, Shay; Mutiti, Peter M; Wamalwa, Dalton C; Bukusi, David; Neary, Jillian; Njuguna, Irene N; O'Malley, Gabrielle; John-Stewart, Grace C; Slyker, Jennifer A; Kohler, Pamela K

    2017-07-01

    To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA). CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya. Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI -0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02-0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI -0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746). CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.

  1. Continuous quality improvement in a Maltese hospital using logical framework analysis.

    Science.gov (United States)

    Buttigieg, Sandra C; Gauci, Dorothy; Dey, Prasanta

    2016-10-10

    Purpose The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital. Design/methodology/approach This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively. Research limitations/implications This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement. Originality/value LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.

  2. Accomplish the Application Area in Cloud Computing

    OpenAIRE

    Bansal, Nidhi; Awasthi, Amit

    2012-01-01

    In the cloud computing application area of accomplish, we find the fact that cloud computing covers a lot of areas are its main asset. At a top level, it is an approach to IT where many users, some even from different companies get access to shared IT resources such as servers, routers and various file extensions, instead of each having their own dedicated servers. This offers many advantages like lower costs and higher efficiency. Unfortunately there have been some high profile incidents whe...

  3. Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.

    Science.gov (United States)

    Ruscic, Katarina J; Grabitz, Stephanie D; Rudolph, Maíra I; Eikermann, Matthias

    2017-06-01

    Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.

  4. Improvement in Physical Activity in Persons With Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure.

    Science.gov (United States)

    Jean, Raymonde E; Duttuluri, Manideep; Gibson, Charlisa D; Mir, Sadaf; Fuhrmann, Katherine; Eden, Edward; Supariwala, Azhar

    2017-03-01

    Exercise improves sleep quality, yet people with untreated obstructive sleep apnea (OSA) may engage in less physical activity (PA) due to fatigue and daytime sleepiness. We examined changes in PA and sleep quality before and after treatment with continuous positive airway pressure (CPAP) in OSA patients. In this prospective longitudinal study, persons with a primary diagnosis of OSA were enrolled at a community-based hospital in New York City. At 3 time intervals pre- and post-CPAP (3-8 months), we measured sleep quality using validated questionnaires, perceived PA using the International Physical Activity Questionnaire (IPAQ), and actual PA using pedometer steps per day. We sought to investigate how CPAP use and changes in sleep quality impacted the number of steps taken, as recorded in pedometer steps. In total, 62 patients were enrolled in the study from March 2012 to July 2014. In all, patients averaged 53 years of age, and 26 patients (42%) were female. Among all participants, 86% of persons had moderate to severe sleep apnea (AHI ≥15). Approximately 73% of participants were compliant with CPAP use. Poor sleep quality correlated with lower actual PA (P = .004) at baseline. At 3 and 7 months, there was significant improvement in sleep quality (Δ -2.63 ± 3.4 and Δ -3.5 ± 3.8; P improvement in sleep quality and actual PA.

  5. Basic Energy Sciences: Summary of Accomplishments

    Science.gov (United States)

    1990-05-01

    For more than four decades, the Department of Energy, including its predecessor agencies, has supported a program of basic research in nuclear- and energy-related sciences, known as Basic Energy Sciences. The purpose of the program is to explore fundamental phenomena, create scientific knowledge, and provide unique user'' facilities necessary for conducting basic research. Its technical interests span the range of scientific disciplines: physical and biological sciences, geological sciences, engineering, mathematics, and computer sciences. Its products and facilities are essential to technology development in many of the more applied areas of the Department's energy, science, and national defense missions. The accomplishments of Basic Energy Sciences research are numerous and significant. Not only have they contributed to Departmental missions, but have aided significantly the development of technologies which now serve modern society daily in business, industry, science, and medicine. In a series of stories, this report highlights 22 accomplishments, selected because of their particularly noteworthy contributions to modern society. A full accounting of all the accomplishments would be voluminous. Detailed documentation of the research results can be found in many thousands of articles published in peer-reviewed technical literature.

  6. A combined continuous and interval aerobic training improves metabolic syndrome risk factors in men

    Directory of Open Access Journals (Sweden)

    Sari-Sarraf V

    2015-05-01

    Full Text Available Vahid Sari-Sarraf,1 Akbar Aliasgarzadeh,2 Mohammad-Mahdi Naderali,3 Hamid Esmaeili,1 Ebrahim K Naderali4 1Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tabriz, 2Bone Research Centre, Endocrine Unit, Department of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 3The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, 4Faculty of Science, Liverpool Hope University, Liverpool, UK Abstract: Individuals with metabolic syndrome have significantly higher risk of cardiovascular disease and type 2 diabetes leading to premature death mortality. Metabolic syndrome has a complex etiology; thus, it may require a combined and multi-targeted aerobic exercise regimen to improve risk factors associated with it. Therefore, the aim of this study was to evaluate the effect of combined continuous and interval aerobic training on patients with metabolic syndrome. Thirty adult male with metabolic syndrome (54±8 years were randomly divided into two groups: test training group (TTG; n=15 and control group (CG; n=15. Subjects in TTG performed combined continuous and interval aerobic training using a motorized treadmill three times per week for 16 weeks. Subjects in CG were advised to continue with their normal activities of life. Twenty-two men completed the study (eleven men in each group. At the end of the study, in TTG, there were significant (for all, P<0.05 reductions in total body weight (-3.2%, waist circumference (-3.43 cm, blood pressure (up to -12.7 mmHg, and plasma insulin, glucose, and triacylglyceride levels. Moreover, there were significant (for all, P<0.05 increases VO2max (-15.3% and isometric strength of thigh muscle (28.1% and high-density lipoprotein in TTG. None of the above indices were changed in CG at the end of 16-week study period. Our study suggests that adoption of a 16-week combined continuous and interval aerobic training regimen in men

  7. Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis.

    Science.gov (United States)

    Johnson, Karin G; Ziemba, Alexis M; Garb, Jane L

    2013-02-01

    We aimed to identify clinical features in patients with severe headaches that predicted obstructive sleep apnea (OSA) and determine clinical and sleep study characteristics that predicted headache improvement with continuous positive airway pressure (CPAP). Many patients with headaches complain of sleep symptoms and have OSA. There is often improvement of headaches with CPAP treatment. We conducted a retrospective chart review of all patients referred to adult neurology clinic for headaches and sent for polysomnography between January 2008 and December 2009. Follow-up ranged from 18 to 42 months. Eighty-two headache patients (70 females, 12 males) were studied. Mean age was 45±13 years (females 45±13, males 43±11) and mean body mass index was 32±9. Headache types included 17% chronic migraine without aura, 22% episodic migraine without aura, 32% migraine with aura, 21% tension-type headache, 6% chronic post-traumatic headache, 11% medication overuse headache, and 7% other types. All patients were receiving standard treatment for their headaches by their neurologist. Fifty-two patients (63%) had OSA. Increasing age, female gender, and chronic migraine without aura were predictive of OSA. Of the patients with OSA, 33 (63%) used CPAP and 27 (82%) were adherent to CPAP. Headache improvement was reported by 40 patients (49%) due to either standard medical therapy or CPAP. Patients with OSA who were CPAP adherent (21/27) were more likely to have improvement in headaches than patients intolerant of CPAP (2/6), those that did not try CPAP (8/19), and those who did not have OSA (16/30) (P=.045). Of the 33 patients who used CPAP, 13 reported improvement in headaches specifically due to CPAP therapy and 10 additional patients noted benefit in sleep symptoms. The presence of witnessed apneas (P=.045) and male gender (P=.021) predicted improvement in headaches due to CPAP. Headache patients should be evaluated for the presence of OSA. Treating OSA improves headaches in some

  8. Continuous quality improvement: a shared governance model that maximizes agent-specific knowledge.

    Science.gov (United States)

    Burkoski, Vanessa; Yoon, Jennifer

    2013-01-01

    Motivate, Innovate, Celebrate: an innovative shared governance model through the establishment of continuous quality improvement (CQI) councils was implemented across the London Health Sciences Centre (LHSC). The model leverages agent-specific knowledge at the point of care and provides a structure aimed at building human resources capacity and sustaining enhancements to quality and safe care delivery. Interprofessional and cross-functional teams work through the CQI councils to identify, formulate, execute and evaluate CQI initiatives. In addition to a structure that facilitates collaboration, accountability and ownership, a corporate CQI Steering Committee provides the forum for scaling up and spreading this model. Point-of-care staff, clinical management and educators were trained in LEAN methodology and patient experience-based design to ensure sufficient knowledge and resources to support the implementation.

  9. A Marketing approach on how continuous processes improvement can contribute to hotel business Organic Growth

    Directory of Open Access Journals (Sweden)

    Ioana-Simona IVASCIUC

    2015-12-01

    Full Text Available Generating sustainable growth and profits is like finding a unicorn for most managers. Organic growth should be considered as an alternative for long-term growth in the hotel business. Designing the service process to deliver what customers expect from the hotel offer is a crucial component of encounter marketing. Hotels need to embrace the changes and ensure that their internal processes are aligned not just to current trends, but also to the expected future changes. Keeping up with global changes and trends of any kind, evaluating their impact on your business, continuous improving of the services using PDCA cycle, Six Sigma or Lean principles, are the keys to long-term organic growth.

  10. Achieving continuous improvement in reductions in foodborne listeriosis: A risk-based approach

    DEFF Research Database (Denmark)

    Gram, Lone

    2005-01-01

    likely due to consumption of contaminated soft cheeses such as queso fresco and queso blanco. The International Life Sciences Institute Risk Science Institute Expert Panel concluded that certain foods pose a high risk for causing listeriosis. High-risk foods have all of the following properties: (1) have...... the potential for contamination with L. monocytogenes; (2) support the growth of L. monocytogenes to high numbers; (3) are ready to eat; (4) require refrigeration; and (5) are stored for an extended period of time. Control strategies are needed in the food chain from preharvest through consumption to minimize...... the likelihood that food will become contaminated by L. monocytogenes and to prevent the growth of the organism to high numbers. The Expert Panel identified three main strategies for ensuring continuous improvement in reducing foodborne listeriosis: (1) preventing contamination of foods with L. monocytogenes; (2...

  11. Indicators of the management for the continuous improvement of the radiological safety in a radioactive facility

    International Nuclear Information System (INIS)

    Amador B, Z. H.

    2006-01-01

    The use of safety indicators is common in the nuclear industry. In this work the implementation of indicators for the efficiency analysis of the radiological safety management system of a radioactive installation is presented. Through the same ones the occupational exposure, the training Y authorization of the personnel, the control of practices Y radioactive inventory, the results of the radiological surveillance, the occurrence of radiological events, the aptitude of the monitoring equipment, the management of the radioactive waste, the public exposure, the audits Y the costs of safety are evaluated. Its study is included in the periodic training of the workers. Without this interrelation it is not possible to maintain the optimization of the safety neither to achieve a continuous improvement. (Author)

  12. THEORY OF REASONED ACTION FOR CONTINUOUS IMPROVEMENT CAPABILITIES: A BEHAVIORAL APPROACH

    Directory of Open Access Journals (Sweden)

    Janaina Siegler

    2012-09-01

    Full Text Available The importance of interaction between Operations Management (OM and Human Behavior has been recently re-addressed. This paper introduced the Reasoned Action Theory suggested by Froehle and Roth (2004 to analyze Operational Capabilities exploring the suitability of this model in the context of OM. It also seeks to discuss the behavioral aspects of operational capabilities from the perspective of organizational routines. This theory was operationalized using Fishbein and Ajzen (F/A behavioral model and a multi-case strategy was employed to analyze the Continuous Improvement (CI capability. The results posit that the model explains partially the CI behavior in an operational context and some contingency variables might influence the general relationsamong the variables involved in the F/A model. Thus intention might not be the determinant variable of behavior in this context.

  13. Technical integrity and continuous improvement: Key to survival beyond the nineties

    International Nuclear Information System (INIS)

    Thorogood, J.L.

    1994-01-01

    Drilling decisions made before a rig reaches location make a significant contribution to an oil company's financial success. Of value to the company is not the ability to drill wells, but the ability to plan with confidence in the knowledge of what is possible. In spite of this, operators have tended to over-work day to day decisions about drilling out of proportion to their significance. Recognition of this fact has resulted in the present wave of contracting initiatives. A major challenge for the industry is to achieve the necessary transfer of responsibility without compromising the operator's license to operate. These changes will compel the service sector to develop a new culture of technical integrity and continuous improvement. To operate safely, measure performance and manage drilling risk, the transformation will oblige the service sector to adopt many technologies presently owned by oil companies

  14. Organizational climate survey: management model tool on continuous improvement promotion in Finantial Institutional Environment

    Directory of Open Access Journals (Sweden)

    Alex Amancio da Silva

    2016-06-01

    Full Text Available The organizational climate survey has been an important tool in the corporate world, the way in which the institutions can assess and ascertain through the results, the degree of satisfaction of its employees and look through plan of action, achieve better results in both performance and production. Through an empirical research, exploratory qualitative research, with collection of secondary data, it was found that the implementation of the organizational climate survey, "Speak Frankly" from Itaú Unibanco, it could analyze data and make a plan of effective action aiming at continuous improvement in the organizational environment, serving as personnel management model. The results were favorable in the period from year 2012 to 2014 with an increase of the degree of satisfaction in four 4% and maintained excellent adherence to answer questions reaching 90% the number of employees.

  15. A toolbox for safety instrumented system evaluation based on improved continuous-time Markov chain

    Science.gov (United States)

    Wardana, Awang N. I.; Kurniady, Rahman; Pambudi, Galih; Purnama, Jaka; Suryopratomo, Kutut

    2017-08-01

    Safety instrumented system (SIS) is designed to restore a plant into a safe condition when pre-hazardous event is occur. It has a vital role especially in process industries. A SIS shall be meet with safety requirement specifications. To confirm it, SIS shall be evaluated. Typically, the evaluation is calculated by hand. This paper presents a toolbox for SIS evaluation. It is developed based on improved continuous-time Markov chain. The toolbox supports to detailed approach of evaluation. This paper also illustrates an industrial application of the toolbox to evaluate arch burner safety system of primary reformer. The results of the case study demonstrates that the toolbox can be used to evaluate industrial SIS in detail and to plan the maintenance strategy.

  16. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

  17. Engineering Ethics Education on the Basis of Continuous Education to Improve Communication Ability

    Science.gov (United States)

    Takahara, Kenji; Kajiwara, Toshinori

    The paper proposes the engineering ethics education method for students on the basis of continuous education to improve communication ability. First, through a debate, the students acquire the fundamental skills required to marshal their arguments, to construct the rebuttals and to summarize the debates. Secondly, the students study the fundamental techniques to make a presentation on technical subjects related to electrical engineering. Following these classes, in the lecture of engineering ethics, the students probe the cause of each accident and consider the better means for avoiding such an accident, each other. In most cases, the students can express right and commonsensical opinions from an ethical standpoint. However, they can hardly make judgments when the situations such as the human relations in the above accidents are set concretely. During the engineering ethics class, the students come to know that human relations behind the case make the ethical matters more complicated. Furthermore, they come to understand that facilitating daily communications with co-workers and/or bosses is very important in order to avoid the accidents. The recognition of the students is just the results of the continuous education through three years. It can be said that the engineering ethics education thus constructed makes the students raise such spontaneous awareness and their ethical qualities as engineers.

  18. Can outcome-based continuing medical education improve performance of immigrant physicians?

    Science.gov (United States)

    Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

    2011-01-01

    Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  19. Issues and Challenges in the Establishment of Continuous Improvement in Vietnam

    Directory of Open Access Journals (Sweden)

    Phuong Anh Nguyen

    2015-10-01

    Full Text Available A better understanding of Vietnamese management is important for both practitioners and academics because of the huge and continuing growth of business activity in Vietnam. In particular, information about the Vietnamese use of continuous improvement (CI practices is valuable because these have underpinned the success of both western and Asian companies in recent decades. Using the case-study method based on over 60 in-depth interviews with executives, managers, supervisors, and employees of nine leading companies in Vietnam and information gathered from discussions with 440 business and non-business leaders, practitioners, and academics, this paper shows that Vietnamese organizations face numerous challenges when implementing and sustaining CI practices. The findings highlight the tendency of Vietnamese organizations to pursue “shortcut” strategies that prevent them from competing higher up the value-added chain. Maintaining “face” is vital to the Vietnamese and this is a major cultural challenge for organizations in their CI efforts. The paper recommends that Vietnamese organizations address these challenges by pursuing CI more aggressively and investing in human resource development to build capabilities for the future. The Vietnamese government, which is the main engine of change in the country, should promote the use of CI by funding education and training in its methods.

  20. A Hierarchical structure of key performance indicators for operation management and continuous improvement in production systems.

    Science.gov (United States)

    Kang, Ningxuan; Zhao, Cong; Li, Jingshan; Horst, John A

    2016-01-01

    Key performance indicators (KPIs) are critical for manufacturing operation management and continuous improvement (CI). In modern manufacturing systems, KPIs are defined as a set of metrics to reflect operation performance, such as efficiency, throughput, availability, from productivity, quality and maintenance perspectives. Through continuous monitoring and measurement of KPIs, meaningful quantification and identification of different aspects of operation activities can be obtained, which enable and direct CI efforts. A set of 34 KPIs has been introduced in ISO 22400. However, the KPIs in a manufacturing system are not independent, and they may have intrinsic mutual relationships. The goal of this paper is to introduce a multi-level structure for identification and analysis of KPIs and their intrinsic relationships in production systems. Specifically, through such a hierarchical structure, we define and layer KPIs into levels of basic KPIs, comprehensive KPIs and their supporting metrics, and use it to investigate the relationships and dependencies between KPIs. Such a study can provide a useful tool for manufacturing engineers and managers to measure and utilize KPIs for CI.

  1. An Improved Real-Coded Population-Based Extremal Optimization Method for Continuous Unconstrained Optimization Problems

    Directory of Open Access Journals (Sweden)

    Guo-Qiang Zeng

    2014-01-01

    Full Text Available As a novel evolutionary optimization method, extremal optimization (EO has been successfully applied to a variety of combinatorial optimization problems. However, the applications of EO in continuous optimization problems are relatively rare. This paper proposes an improved real-coded population-based EO method (IRPEO for continuous unconstrained optimization problems. The key operations of IRPEO include generation of real-coded random initial population, evaluation of individual and population fitness, selection of bad elements according to power-law probability distribution, generation of new population based on uniform random mutation, and updating the population by accepting the new population unconditionally. The experimental results on 10 benchmark test functions with the dimension N=30 have shown that IRPEO is competitive or even better than the recently reported various genetic algorithm (GA versions with different mutation operations in terms of simplicity, effectiveness, and efficiency. Furthermore, the superiority of IRPEO to other evolutionary algorithms such as original population-based EO, particle swarm optimization (PSO, and the hybrid PSO-EO is also demonstrated by the experimental results on some benchmark functions.

  2. Kaizen Award in Romania: the KAIZEN™ way in obtaining the continuous improvement success

    Directory of Open Access Journals (Sweden)

    Bratu Julien

    2017-07-01

    Full Text Available In the times when the economic performance and sustainable management are representing two of the most challenging characteristics of the business environment, there are some methods and techniques that passed the test of time. The great majority of companies are using in the present the KAIZEN™ Business System, a system of management which has been expanding in all over the world, by having and implying the power of continuous improvement and standardization. Having as “role-model” the well-known Toyota Production System, KAIZEN™ Business System has become the fundamental way of managing a business, which led to the creation of personalized management systems for companies. In Romania, it was also developed the Kaizen by Harmony concept, as an approach of KAIZEN™ Business System, its results being highly appreciated at the international level. In the daily challenging task of changing the paradigms and mentalities, several companies succeeded in understanding the importance of KAIZEN™ Business System and have been applying the Kaizen by Harmony concept ever since. Their results are impressive, few companies reaching to the international benchmark level in their fields of activity and becoming leaders of the Romanian or European markets. Therefore, the Kaizen Award in Romania has become the proper way of acknowledging their results and efforts to strive for excellence in the endless cycle of the continuous improvement. The aim of this paper is to describe the competitive advantage offered by KAIZEN™ Business System and Kaizen by Harmony, in strong correlation with the practical approach of the case-studies representing the amazing stories of the Kaizen Award in Romania winners until the present moment. The use of these best practices will underline once again some important business characteristics that must exist in every company, for it to become and remain competitive.

  3. Accuracy of subcutaneous continuous glucose monitoring in critically ill adults: improved sensor performance with enhanced calibrations.

    Science.gov (United States)

    Leelarathna, Lalantha; English, Shane W; Thabit, Hood; Caldwell, Karen; Allen, Janet M; Kumareswaran, Kavita; Wilinska, Malgorzata E; Nodale, Marianna; Haidar, Ahmad; Evans, Mark L; Burnstein, Rowan; Hovorka, Roman

    2014-02-01

    Accurate real-time continuous glucose measurements may improve glucose control in the critical care unit. We evaluated the accuracy of the FreeStyle(®) Navigator(®) (Abbott Diabetes Care, Alameda, CA) subcutaneous continuous glucose monitoring (CGM) device in critically ill adults using two methods of calibration. In a randomized trial, paired CGM and reference glucose (hourly arterial blood glucose [ABG]) were collected over a 48-h period from 24 adults with critical illness (mean±SD age, 60±14 years; mean±SD body mass index, 29.6±9.3 kg/m(2); mean±SD Acute Physiology and Chronic Health Evaluation score, 12±4 [range, 6-19]) and hyperglycemia. In 12 subjects, the CGM device was calibrated at variable intervals of 1-6 h using ABG. In the other 12 subjects, the sensor was calibrated according to the manufacturer's instructions (1, 2, 10, and 24 h) using arterial blood and the built-in point-of-care glucometer. In total, 1,060 CGM-ABG pairs were analyzed over the glucose range from 4.3 to 18.8 mmol/L. Using enhanced calibration median (interquartile range) every 169 (122-213) min, the absolute relative deviation was lower (7.0% [3.5, 13.0] vs. 12.8% [6.3, 21.8], P<0.001), and the percentage of points in the Clarke error grid Zone A was higher (87.8% vs. 70.2%). Accuracy of the Navigator CGM device during critical illness was comparable to that observed in non-critical care settings. Further significant improvements in accuracy may be obtained by frequent calibrations with ABG measurements.

  4. Economic Impact of a Peritoneal Dialysis Continuous Quality Improvement Program in Colombia.

    Science.gov (United States)

    Makhija, Dilip U; Walton, Surrey M; Mora, Juan P; Sanabria, Rafael M

    2017-01-01

    ♦ BACKGROUND: There is little information regarding the financial burden of peritonitis and the economic impact of continuous quality improvement (CQI) programs in peritoneal dialysis (PD) patients. The objectives of this study were to measure the costs of peritonitis, and determine the net savings of a PD CQI program in Colombia. ♦ METHODS: The Renal Therapy Services (RTS) network in Colombia, along with Coomeva EPS, provided healthcare resource utilization data for PD patients with and without peritonitis between January 2012 and December 2013. Propensity score matching and regression analysis were performed to estimate the incremental cost of peritonitis. Patient months at risk, episodes of peritonitis pre- and post-CQI, and costs of CQI were obtained. Annual net savings of the CQI program were estimated based on the number of peritonitis events prevented. ♦ RESULTS: The incremental cost of a peritonitis episode was $250. In an 8-year period, peritonitis decreased from 1,837 episodes per 38,596 patient-months in 2006 to 841 episodes per 50,910 patient-months in 2014. Overall, the CQI program prevented an estimated 10,409 episodes of peritonitis. The cost of implementing the CQI program was $147,000 in the first year and $119,000 annually thereafter. Using a five percent discount rate, the net present value of the program was $1,346,431, with an average annual net savings of $207,027. The return on investment (i.e. total savings-program cost/program cost) of CQI was 169%. ♦ CONCLUSION: Continuous quality improvement initiatives designed to reduce rates of peritonitis have a strong potential to generate cost savings. Copyright © 2017 International Society for Peritoneal Dialysis.

  5. MARSite-MARMARA SUPERSITE: Accomplishments and Outlook

    Science.gov (United States)

    Meral Ozel, Nurcan; Necmioglu, Ocal; Ergintav, Semih; Oguz Ozel, Asım; Italiano, Franco; Favali, Paolo; Bigarre, Pascal; Cakir, Ziyadin; Geli, Louis; Aochi, Hideo; Bossu, Remy; Zulfikar, Can; Sesetyan, Karin

    2017-04-01

    MARsite Project, funded under FP7-ENV.2012 6.4-2 (Grant 308417) and successfully implemented to Marmara Region during 2014-2016 indicated that focusing on the monitoring of the region and the integration of data from land, sea and space and the processing of this composed data based on sound earth-science research is an effective tool for mitigating damage from future earthquakes. This was achieved by monitoring the earthquake hazard through the ground-shaking and forecast maps, short- and long-term earthquake rate forecasting and time-dependent seismic hazard maps to make important risk-mitigation decisions regarding building design, insurance rates, land-use planning, and public-policy issues that need to balance safety and economic and social interests. MARSite has demonstrated the power of the use of different sensors in the assessment of the earthquake hazard. In addition to the more than 30 scientific publication within the MARsite Project framework, a multidisciplinary innovative borehole seismic observatory and a dilatometer have been installed within MARSite where its a data can be used for a range of seismic studies. Due to the encouraging results obtained from this experiment, it was determined that in the future likely smaller number of stations will be required reducing the cost of national seismic networks. The technical infrastructure of the continuous GPS stations of MAGNET network has been updated within MARSite. Tsunami hazard studies in MARSite in Marmara Sea showed that the tsunami hazard in the Marmara Region is primarily due to submarine landslides triggered by an earthquake and a conceptual Tsunami Early Warning System in the Marmara region strongly coupled with the strong ground motion and existing Earthquake Early Warning System was developed. The existing Earthquake Early Warning and Rapid Response system in the Marmara Region was improved and the installation and test of a pilot seismic landslide monitoring system was taken place in the

  6. Acupuncture attenuates hyperglycaemia and improves ovarian function in female rats subjected to continuous light exposure.

    Science.gov (United States)

    Kang, Xuezhi; Jia, Lina; Li, Yaming; Zhang, Xu

    2017-10-01

    Exposure to unnatural light cycles is increasingly associated with obesity and the metabolic syndrome. The purpose of this study was to examine the effects of electroacupuncture (EA) on glucose metabolism and ovarian function in female rats subjected to long-term continuous light exposure. Female Sprague-Dawley rats (n=24) were divided into three experimental groups: an LD group that was maintained under a normal light-dark cycle (healthy control); an LL group that was exposed to continuous light for 21 weeks but remained untreated; and an LL+EA group that received EA at ST36 and SP6 during weeks 17 to 21 of continuous light exposure. Oestrous cycles of female rats kept in a continuously lit environment for 21 weeks were disordered and polycystic ovarian syndrome (PCOS)-like changes occurred, accompanied by increased fasting blood glucose (6.23±0.33 vs 5.27±0.40 mmol/L in week 17, p=0.015) and reduced fasting levels of serum testosterone (0.07±0.018 vs 0.12±0.058 ng/L, p=0.043) and insulin (0.89±0.20 vs 1.43±0.46 ng/L, p=0.006). After 5 weeks of EA treatment at ST36 and SP6, ovarian cycle disruption was mitigated and blood glucose levels showed a gradual decline (5.18±0.37 vs 5.80±0.55 mmol/L, p=0.017; and 5.73±0.31 vs 6.62±0.13 mmol/L, p=0.004; in the fourth and fifth weeks of EA treatment, respectively). EA also attenuated the reductions otherwise seen in serum insulin and testosterone levels. Prolonged exposure to light can lead to a decline in ovarian and pancreatic function. EA at ST36 and SP6 may reduce abnormally elevated blood glucose levels and improve ovarian and pancreatic hormone levels. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Organizational learning and continuous quality improvement: examining the impact on nursing home performance.

    Science.gov (United States)

    Rondeau, Kent V; Wagar, Terry H

    2002-01-01

    Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporAte culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.

  8. Improvement for enhancing effectiveness of universal power system (UPS) continuous testing process

    Science.gov (United States)

    Sriratana, Lerdlekha

    2018-01-01

    This experiment aims to enhance the effectiveness of the Universal Power System (UPS) continuous testing process of the Electrical and Electronic Institute by applying work scheduling and time study methods. Initially, the standard time of testing process has not been considered that results of unaccurate testing target and also time wasting has been observed. As monitoring and reducing waste time for improving the efficiency of testing process, Yamazumi chart and job scheduling theory (North West Corner Rule) were applied to develop new work process. After the improvements, the overall efficiency of the process possibly increased from 52.8% to 65.6% or 12.7%. Moreover, the waste time could reduce from 828.3 minutes to 653.6 minutes or 21%, while testing units per batch could increase from 3 to 4 units. Therefore, the number of testing units would increase from 12 units up to 20 units per month that also contribute to increase of net income of UPS testing process by 72%.

  9. Employing continuous quality improvement in community-based substance abuse programs.

    Science.gov (United States)

    Chinman, Matthew; Hunter, Sarah B; Ebener, Patricia

    2012-01-01

    This article aims to describe continuous quality improvement (CQI) for substance abuse prevention and treatment programs in a community-based organization setting. CQI (e.g., plan-do-study-act cycles (PDSA)) applied in healthcare and industry was adapted for substance abuse prevention and treatment programs in a community setting. The authors assessed the resources needed, acceptability and CQI feasibility for ten programs by evaluating CQI training workshops with program staff and a series of three qualitative interviews over a nine-month implementation period with program participants. The CQI activities, PDSA cycle progress, effort, enthusiasm, benefits and challenges were examined. Results indicated that CQI was feasible and acceptable for community-based substance abuse prevention and treatment programs; however, some notable resource challenges remain. Future studies should examine CQI impact on service quality and intended program outcomes. The study was conducted on a small number of programs. It did not assess CQI impact on service quality and intended program outcomes. Practical implications- This project shows that it is feasible to adapt CQI techniques and processes for community-based programs substance abuse prevention and treatment programs. These techniques may help community-based program managers to improve service quality and achieve program outcomes. This is one of the first studies to adapt traditional CQI techniques for community-based settings delivering substance abuse prevention and treatment programs.

  10. Does an outcome-based approach to continuing medical education improve physicians' competences in rational prescribing?

    Science.gov (United States)

    Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Dastgiri, Saeed; Hult, Hakan; Dahlgren, Lars Owe; Wahlstrom, Rolf

    2009-11-01

    Continuing medical education (CME) is compulsory in Iran, and traditionally it is lecture-based, which is mostly not successful. Outcome-based education has been proposed for CME programs. To evaluate the effectiveness of an outcome-based educational intervention with a new approach based on outcomes and aligned teaching methods, on knowledge and skills of general physicians (GPs) working in primary care compared with a concurrent CME program in the field of "Rational prescribing". The method used was cluster randomized controlled design. All GPs working in six cities in one province in Iran were invited to participate. The cities were matched and randomly divided into an intervention arm for education on rational prescribing with an outcome-based approach, and a control arm for a traditional program on the same topic. Knowledge and skills were assessed using a pre- and post-test, including case scenarios. In total, 112 GPs participated. There were significant improvements in knowledge and prescribing skills after the training in the intervention arm as well as in comparison with the changes in the control arm. The overall intervention effect was 26 percentage units. The introduction of an outcome-based approach in CME appears to be effective when creating programs to improve GPs' knowledge and skills.

  11. Continued improvement of cardiovascular mortality in Hungary - impact of increased cardio-metabolic prescriptions

    Directory of Open Access Journals (Sweden)

    Jozan Peter

    2010-07-01

    Full Text Available Abstract Background During the last 35 years the poor ranking of Hungary on the list of life expectancy at birth among European countries, has not changed. In 1970 our lag behind the leading European countries was the smallest. The gap was growing between 1970 and 1993 but from 1994 onwards the life expectancy at birth in Hungary has increased continuously and somewhat faster than in other European countries. The aim of this study was to analyze the association between decreasing cardiovascular mortality rates, as a main cause of death and the increase in cardio-metabolic prescriptions and possible changes in lifestyle behavior. Methods Analyses were conducted on national data concerning cardiovascular mortality and the number of cardio-metabolic drug prescription per capita. The association between yearly rates of cardiovascular events and changes in antihypertensive, antilipidemic and antidiabetic prescription rates was analyzed. The changes in other cardiovascular risk factors, like lifestyle were also considered. Results We observed a remarkable decline of mortality due to stroke and acute myocardial infarction (AMI. The fall was significantly associated with all prescription rates. The proportion of each treatment type responsible for suppression of specific mortality rates is different. All treatment types comparably improved stroke mortality, while antilipidemic therapy improved AMI outcome. Conclusions These results emphasize the importance of a comprehensive strategy that maximizes the population coverage of effective treatments. Hungary appears to be at the beginning of the fourth stage of epidemiologic transition, i.e. it has entered the stage of delayed chronic noninfectious diseases.

  12. Continuous Quadrupole Magnetic Separation of Islets during Digestion Improves Purified Porcine Islet Viability.

    Science.gov (United States)

    Weegman, Bradley P; Kumar Sajja, Venkata Sunil; Suszynski, Thomas M; Rizzari, Michael D; Scott Iii, William E; Kitzmann, Jennifer P; Mueller, Kate R; Hanley, Thomas R; Kennedy, David J; Todd, Paul W; Balamurugan, Appakalai N; Hering, Bernhard J; Papas, Klearchos K

    2016-01-01

    Islet transplantation (ITx) is an emerging and promising therapy for patients with uncontrolled type 1 diabetes. The islet isolation and purification processes require exposure to extended cold ischemia, warm-enzymatic digestion, mechanical agitation, and use of damaging chemicals for density gradient separation (DG), all of which reduce viable islet yield. In this paper, we describe initial proof-of-concept studies exploring quadrupole magnetic separation (QMS) of islets as an alternative to DG to reduce exposure to these harsh conditions. Three porcine pancreata were split into two parts, the splenic lobe (SPL) and the combined connecting/duodenal lobes (CDL), for paired digestions and purifications. Islets in the SPL were preferentially labeled using magnetic microparticles (MMPs) that lodge within the islet microvasculature when infused into the pancreas and were continuously separated from the exocrine tissue by QMS during the collection phase of the digestion process. Unlabeled islets from the CDL were purified by conventional DG. Islets purified by QMS exhibited significantly improved viability (measured by oxygen consumption rate per DNA, p < 0.03) and better morphology relative to control islets. Islet purification by QMS can reduce the detrimental effects of prolonged exposure to toxic enzymes and density gradient solutions and substantially improve islet viability after isolation.

  13. Continuous Quadrupole Magnetic Separation of Islets during Digestion Improves Purified Porcine Islet Viability

    Directory of Open Access Journals (Sweden)

    Bradley P. Weegman

    2016-01-01

    Full Text Available Islet transplantation (ITx is an emerging and promising therapy for patients with uncontrolled type 1 diabetes. The islet isolation and purification processes require exposure to extended cold ischemia, warm-enzymatic digestion, mechanical agitation, and use of damaging chemicals for density gradient separation (DG, all of which reduce viable islet yield. In this paper, we describe initial proof-of-concept studies exploring quadrupole magnetic separation (QMS of islets as an alternative to DG to reduce exposure to these harsh conditions. Three porcine pancreata were split into two parts, the splenic lobe (SPL and the combined connecting/duodenal lobes (CDL, for paired digestions and purifications. Islets in the SPL were preferentially labeled using magnetic microparticles (MMPs that lodge within the islet microvasculature when infused into the pancreas and were continuously separated from the exocrine tissue by QMS during the collection phase of the digestion process. Unlabeled islets from the CDL were purified by conventional DG. Islets purified by QMS exhibited significantly improved viability (measured by oxygen consumption rate per DNA, p<0.03 and better morphology relative to control islets. Islet purification by QMS can reduce the detrimental effects of prolonged exposure to toxic enzymes and density gradient solutions and substantially improve islet viability after isolation.

  14. APPLICATION OF QC TOOLS FOR CONTINUOUS IMPROVEMENT IN AN EXPENSIVE SEAT HARDFACING PROCESS USING TIG WELDING

    Directory of Open Access Journals (Sweden)

    Mohammed Yunus

    2016-09-01

    Full Text Available The present study is carried out to improve quality level by identifying the prime reasons of the quality related problems in the seat hardfacing process involving the deposition of cobalt based super alloy in I.C. Engine valves using TIG welding process. During the Process, defects like stellite deposition overflow, head melt, non-uniform stellite merging, etc., are observed and combining all these defects, the rejection level was in top position in Forge shop. We use widely referred QC tools of the manufacturing field to monitor the complete operation and continuous progressive process improvement to ensure ability and efficiency of quality management system of any firm. The work aims to identify the various causes for the rejection by the detailed study of the operation, equipment, materials and the various process parameters that are very important to get defects-free products. Also, to evolve suitable countermeasures for reducing the rejection percentage using seven QC tools. To further understand and validate the obtained results, we need to address other studies related to motivations, advantages, and disadvantages of applying quality control tools.

  15. Integrating Quality Improvement and Continuing Professional Development: A Model From the Mental Health Care System.

    Science.gov (United States)

    Sockalingam, Sanjeev; Tehrani, Hedieh; Lin, Elizabeth; Lieff, Susan; Harris, Ilene; Soklaridis, Sophie

    2016-04-01

    To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.

  16. Continuous Calibration Improvement in Solar Reflective Bands: Landsat 5 Through Landsat 8

    Science.gov (United States)

    Mishra, Nischal; Helder, Dennis; Barsi, Julia; Markham, Brian

    2016-01-01

    Launched in February 2013, the Operational Land Imager (OLI) on-board Landsat 8 continues to perform exceedingly well and provides high science quality data globally. Several design enhancements have been made in the OLI instrument relative to prior Landsat instruments: pushbroom imaging which provides substantially improved Signal-to-Noise Ratio (SNR), spectral bandpasses refinement to avoid atmospheric absorption features, 12 bit data resolution to provide a larger dynamic range that limits the saturation level, a set of well-designed onboard calibrators to monitor the stability of the sensor. Some of these changes such as refinements in spectral bandpasses compared to earlier Landsats and well-designed on-board calibrator have a direct impact on the improved radiometric calibration performance of the instrument from both the stability of the response and the ability to track the changes. The on-board calibrator lamps and diffusers indicate that the instrument drift is generally less than 0.1% per year across the bands. The refined bandpasses of the OLI indicate that temporal uncertainty of better than 0.5% is possible when the instrument is trended over vicarious targets such as Pseudo Invariant Calibration Sites (PICS), a level of precision that was never achieved with the earlier Landsat instruments. The stability measurements indicated by on-board calibrators and PICS agree much better compared to the earlier Landsats, which is very encouraging and bodes well for the future Landsat missions too.

  17. Evaluation of a guided continuous quality improvement program in community pharmacies.

    Science.gov (United States)

    Chinthammit, Chanadda; Rupp, Michael T; Armstrong, Edward P; Modisett, Tara; Snead, Rebecca P; Warholak, Terri L

    2017-01-01

    The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. This study aims to assess changes in attitudes toward patient safety culture and frequency of quality-related event (QRE) reporting after guided implementation of a continuous quality improvement (CQI) program in a panel of community pharmacies in the United States (U.S.). Twenty-one community pharmacies volunteered to participate in the project and were randomly assigned to intervention or control groups. Pharmacy staff in the intervention group received guided training to ensure full implementation of a CQI program while those in the control group partially implemented the program. Pharmacy staff in both groups completed retrospective pre-post safety culture questionnaires and reported medication errors and near misses that occurred in their practices. Rasch analysis was applied to assess questionnaire validity and reliability and to confirm if the ordinal level data approximated interval level measures. Paired t-tests and repeated measure analysis of covariance tests were subsequently used to compare observed changes in the attitudes of subjects and frequency of QREs reporting in intervention and control groups. Sixty-nine employees completed the questionnaire, a 43.9% response rate. Improvement in attitudes toward patient safety was statistically significant in the intervention group in six domains: staff, training, and skill ( p  = 0.017); patient counseling ( p  = 0.043); communication about mistakes ( p  continuous improvement ( p  < 0.001); and overall patient safety perceptions ( p  = 0.033). No significant differences were observed in QRE reporting rates between intervention and control groups. However, differences were observed in the types of QREs reported (e.g., incorrect safety cap) and the point in the prescription processing workflow where a QRE was detected (e.g., partner check station, and drug

  18. The discursive accomplishment of regimes of automobility

    DEFF Research Database (Denmark)

    Lindegaard, Laura Bang

    2016-01-01

    conceptualisation of mobility, I address impacts of thought schemes and structures on current social and political discourses of mobility as I discuss and demonstrate how rationalities of advanced liberalism co-constitute a car-dependent way of living. Drawing on both studies of governmentality and ethnomethodology...... case study in a decentralised Danish village that demonstrates how citizens accomplish the rationalities that co-constitute their car-dependent mobility in discursive interaction. During the time of the case study (2010-11), the village was engaged in an energy village project, and the study...

  19. Sandia technology engineering and science accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    1993-03-01

    Sandia is a DOE multiprogram engineering and science laboratory with major facilities at Albuquerque, New Mexico, and Livermore, California, and a test range near Tonapah, Nevada. We have major research and development responsibilities for nuclear weapons, arms control, energy, the environment, economic competitiveness, and other areas of importance to the needs of the nation. Our principal mission is to support national defense policies by ensuring that the nuclear weapon stockpile meets the highest standards of safety, reliability, security, use control, and military performance. Selected unclassified technical activities and accomplishments are reported here. Topics include advanced manufacturing technologies, intelligent machines, computational simulation, sensors and instrumentation, information management, energy and environment, and weapons technology.

  20. Accomplishments and needs in safety research

    International Nuclear Information System (INIS)

    Beckjord, E.S.

    1988-01-01

    My purpose today is to review recent accomplishments in water reactor safety research and to point out important tasks that remain to be done. I will also comment on the changes of focus that I see ahead in reactor safety research. I speak from a U.S. perspective on the subject, but note that the program of the U.S. Nuclear Regulatory Commission and also that of the U.S. industry's Electric Power Research Institute include many international collaborative research efforts. Without any doubt, nuclear safety research today is international in scope, and the collaborative movement is gaining in strength

  1. Advanced Fuels Campaign FY 2015 Accomplishments Report

    Energy Technology Data Exchange (ETDEWEB)

    Braase, Lori Ann [Idaho National Lab. (INL), Idaho Falls, ID (United States); Carmack, William Jonathan [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-10-29

    The mission of the Advanced Fuels Campaign (AFC) is to perform research, development, and demonstration (RD&D) activities for advanced fuel forms (including cladding) to enhance the performance and safety of the nation’s current and future reactors; enhance proliferation resistance of nuclear fuel; effectively utilize nuclear energy resources; and address the longer-term waste management challenges. This report is a compilation of technical accomplishment summaries for FY-15. Emphasis is on advanced accident-tolerant LWR fuel systems, advanced transmutation fuels technologies, and capability development.

  2. Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

    Science.gov (United States)

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

    2016-07-01

    Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

  3. Improved vascularization of planar membrane diffusion devices following continuous infusion of vascular endothelial growth factor.

    Science.gov (United States)

    Trivedi, N; Steil, G M; Colton, C K; Bonner-Weir, S; Weir, G C

    2000-01-01

    Improving blood vessel formation around an immunobarrier device should improve the survival of the encapsulated tissue. In the present study we investigated the formation of new blood vessels around a planar membrane diffusion device (the Baxter Theracyte System) undergoing a continuous infusion of vascular endothelial growth factor through the membranes and into the surrounding tissue. Each device (20 microl) had both an inner immunoisolation membrane and an outer vascularizing membrane. Human recombinant vascular endothelial growth factor-165 was infused at 100 ng/day (low dose: n = 6) and 500 ng/day (high dose: n = 7) for 10 days into devices implanted s.c. in Sprague-Dawley rats; noninfused devices transplanted for an identical period were used as controls (n = 5). Two days following the termination of VEGF infusion, devices were loaded with 20 microl of Lispro insulin (1 U/kg) and the kinetics of insulin release from the lumen of the device was assessed. Devices were then explanted and the number of blood vessels (capillary and noncapillary) was quantified using morphometry. High-dose vascular endothelial growth factor infusion resulted in two- to threefold more blood vessels around the device than that obtained with the noninfused devices and devices infused with low-dose vascular endothelial growth factor. This increase in the number of blood vessels was accompanied by a modest increase in insulin diffusion from the device in the high-dose vascular endothelial growth factor infusion group. We conclude that vascular endothelial growth factor can be used to improve blood vessel formation adjacent to planar membrane diffusion devices.

  4. Bordetella Pertussis virulence factors in the continuing evolution of whooping cough vaccines for improved performance.

    Science.gov (United States)

    Dorji, Dorji; Mooi, Frits; Yantorno, Osvaldo; Deora, Rajendar; Graham, Ross M; Mukkur, Trilochan K

    2018-02-01

    Despite high vaccine coverage, whooping cough caused by Bordetella pertussis remains one of the most common vaccine-preventable diseases worldwide. Introduction of whole-cell pertussis (wP) vaccines in the 1940s and acellular pertussis (aP) vaccines in 1990s reduced the mortality due to pertussis. Despite induction of both antibody and cell-mediated immune (CMI) responses by aP and wP vaccines, there has been resurgence of pertussis in many countries in recent years. Possible reasons hypothesised for resurgence have ranged from incompliance with the recommended vaccination programmes with the currently used aP vaccine to infection with a resurged clinical isolates characterised by mutations in the virulence factors, resulting in antigenic divergence with vaccine strain, and increased production of pertussis toxin, resulting in dampening of immune responses. While use of these vaccines provide varying degrees of protection against whooping cough, protection against infection and transmission appears to be less effective, warranting continuation of efforts in the development of an improved pertussis vaccine formulations capable of achieving this objective. Major approaches currently under evaluation for the development of an improved pertussis vaccine include identification of novel biofilm-associated antigens for incorporation in current aP vaccine formulations, development of live attenuated vaccines and discovery of novel non-toxic adjuvants capable of inducing both antibody and CMI. In this review, the potential roles of different accredited virulence factors, including novel biofilm-associated antigens, of B. pertussis in the evolution, formulation and delivery of improved pertussis vaccines, with potential to block the transmission of whooping cough in the community, are discussed.

  5. Continuous sea-level reconstructions beyond the Pleistocene: improving the Mediterranean sea-level method

    Science.gov (United States)

    Grant, K.; Rohling, E. J.; Amies, J.

    2017-12-01

    Sea-level (SL) reconstructions over glacial-interglacial timeframes are critical for understanding the equilibrium response of ice sheets to sustained warming. In particular, continuous and high-resolution SL records are essential for accurately quantifying `natural' rates of SL rise. Global SL changes are well-constrained since the last glacial maximum ( 20,000 years ago, ky) by radiometrically-dated corals and paleoshoreline data, and fairly well-constrained over the last glacial cycle ( 150 ky). Prior to that, however, studies of ice-volume:SL relationships tend to rely on benthic δ18O, as geomorphological evidence is far more sparse and less reliably dated. An alternative SL reconstruction method (the `marginal basin' approach) was developed for the Red Sea over 500 ky, and recently attempted for the Mediterranean over 5 My (Rohling et al., 2014, Nature). This method exploits the strong sensitivity of seawater δ18O in these basins to SL changes in the relatively narrow and shallow straits which connect the basins with the open ocean. However, the initial Mediterranean SL method did not resolve sea-level highstands during Northern Hemisphere insolation maxima, when African monsoon run-off - strongly depleted in δ18O - reached the Mediterranean. Here, we present improvements to the `marginal basin' sea-level reconstruction method. These include a new `Med-Red SL stack', which combines new probabilistic Mediterranean and Red Sea sea-level stacks spanning the last 500 ky. We also show how a box model-data comparison of water-column δ18O changes over a monsoon interval allows us to quantify the monsoon versus SL δ18O imprint on Mediterranean foraminiferal carbonate δ18O records. This paves the way for a more accurate and fully continuous SL reconstruction extending back through the Pliocene.

  6. Fully automated whole-head segmentation with improved smoothness and continuity, with theory reviewed.

    Directory of Open Access Journals (Sweden)

    Yu Huang

    Full Text Available Individualized current-flow models are needed for precise targeting of brain structures using transcranial electrical or magnetic stimulation (TES/TMS. The same is true for current-source reconstruction in electroencephalography and magnetoencephalography (EEG/MEG. The first step in generating such models is to obtain an accurate segmentation of individual head anatomy, including not only brain but also cerebrospinal fluid (CSF, skull and soft tissues, with a field of view (FOV that covers the whole head. Currently available automated segmentation tools only provide results for brain tissues, have a limited FOV, and do not guarantee continuity and smoothness of tissues, which is crucially important for accurate current-flow estimates. Here we present a tool that addresses these needs. It is based on a rigorous Bayesian inference framework that combines image intensity model, anatomical prior (atlas and morphological constraints using Markov random fields (MRF. The method is evaluated on 20 simulated and 8 real head volumes acquired with magnetic resonance imaging (MRI at 1 mm3 resolution. We find improved surface smoothness and continuity as compared to the segmentation algorithms currently implemented in Statistical Parametric Mapping (SPM. With this tool, accurate and morphologically correct modeling of the whole-head anatomy for individual subjects may now be feasible on a routine basis. Code and data are fully integrated into SPM software tool and are made publicly available. In addition, a review on the MRI segmentation using atlas and the MRF over the last 20 years is also provided, with the general mathematical framework clearly derived.

  7. Fully automated whole-head segmentation with improved smoothness and continuity, with theory reviewed.

    Science.gov (United States)

    Huang, Yu; Parra, Lucas C

    2015-01-01

    Individualized current-flow models are needed for precise targeting of brain structures using transcranial electrical or magnetic stimulation (TES/TMS). The same is true for current-source reconstruction in electroencephalography and magnetoencephalography (EEG/MEG). The first step in generating such models is to obtain an accurate segmentation of individual head anatomy, including not only brain but also cerebrospinal fluid (CSF), skull and soft tissues, with a field of view (FOV) that covers the whole head. Currently available automated segmentation tools only provide results for brain tissues, have a limited FOV, and do not guarantee continuity and smoothness of tissues, which is crucially important for accurate current-flow estimates. Here we present a tool that addresses these needs. It is based on a rigorous Bayesian inference framework that combines image intensity model, anatomical prior (atlas) and morphological constraints using Markov random fields (MRF). The method is evaluated on 20 simulated and 8 real head volumes acquired with magnetic resonance imaging (MRI) at 1 mm3 resolution. We find improved surface smoothness and continuity as compared to the segmentation algorithms currently implemented in Statistical Parametric Mapping (SPM). With this tool, accurate and morphologically correct modeling of the whole-head anatomy for individual subjects may now be feasible on a routine basis. Code and data are fully integrated into SPM software tool and are made publicly available. In addition, a review on the MRI segmentation using atlas and the MRF over the last 20 years is also provided, with the general mathematical framework clearly derived.

  8. Space Shuttle Program Primary Avionics Software System (PASS) Success Legacy -Major Accomplishments and Lessons Learned

    Science.gov (United States)

    Orr, James K.

    2010-01-01

    This presentation has shown the accomplishments of the PASS project over three decades and highlighted the lessons learned. Over the entire time, our goal has been to continuously improve our process, implement automation for both quality and increased productivity, and identify and remove all defects due to prior execution of a flawed process in addition to improving our processes following identification of significant process escapes. Morale and workforce instability have been issues, most significantly during 1993 to 1998 (period of consolidation in aerospace industry). The PASS project has also consulted with others, including the Software Engineering Institute, so as to be an early evaluator, adopter, and adapter of state-of-the-art software engineering innovations.

  9. Improving appropriate use of echocardiography and single-photon emission computed tomographic myocardial perfusion imaging: a continuous quality improvement initiative.

    Science.gov (United States)

    Johnson, Thomas V; Rose, Geoffrey A; Fenner, Deborah J; Rozario, Nigel L

    2014-07-01

    Appropriate use criteria for cardiovascular imaging have been published, but compliance in practice has been incomplete, with persistent high rates of inappropriate use. The aim of this study was to show the efficacy of a continuous quality improvement (CQI) initiative to favorably influence the appropriate use of outpatient transthoracic echocardiography and single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) in a large cardiovascular practice. In this prospective study, a multiphase CQI initiative was implemented, and its impact on ordering patterns for outpatient transthoracic echocardiography and SPECT MPI was assessed. Between November and December 2010, a baseline analysis of the application of appropriate use criteria to indications for outpatient transthoracic echocardiographic studies (n = 203) and SPECT MPI studies (n = 205) was performed, with studies categorized as "appropriate," "inappropriate," "uncertain," or "unclassified." The CQI initiative was then begun, with (1) clinician education, including didactic lectures and case-based presentations with audience participation; (2) system changes in ordering processes, with redesigned image ordering forms; and (3) peer review and feedback. A follow-up analysis was then performed between June and August 2012, with categorization of indications for transthoracic echocardiographic studies (n = 206) and SPECT MPI studies (n = 206). At baseline, 73.9% of echocardiographic studies were categorized as appropriate, 16.7% as inappropriate, 5.9% as uncertain, and 3.4% as unclassified. Similarly, for SPECT MPI studies 71.7% were categorized as appropriate, 18.5% as inappropriate, 7.8% as uncertain, and 1.9% as unclassified. Separate analysis of the two most important categories, appropriate and inappropriate, demonstrated a significant improvement after the CQI initiative, with a 63% reduction in inappropriate echocardiographic studies (18.5% vs 6.9%, P = .0010) and a 46% reduction

  10. Improving the provision of pregnancy care for Aboriginal and Torres Strait Islander women: a continuous quality improvement initiative.

    Science.gov (United States)

    Gibson-Helm, Melanie E; Rumbold, Alice R; Teede, Helena J; Ranasinha, Sanjeeva; Bailie, Ross S; Boyle, Jacqueline A

    2016-05-24

    Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics. Longitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors. Women attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use: baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR):3.0, 95 % confidence interval (CI):2.2-4.1], two = 91 % (OR:5.1, 95 % CI:3.3-7.8), three = 93 % (OR:6.3, 95 % CI:3.1-13), four = 95 % (OR:11, 95 % CI:4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (β = 6.8, 95 % CI:0.25-13), nutrition counselling (β = 8.3, 95 % CI:3.1-13), and folate prescription (β = 7.9, 95 % CI:2.6-13). Participation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care

  11. Water activity control: a way to improve the efficiency of continuous lipase esterification.

    Science.gov (United States)

    Colombié, S; Tweddell, R J; Condoret, J S; Marty, A

    1998-11-05

    During continuous lipase-catalyzed oleic acid esterification by ethanol in n-hexane, the oleic acid conversion, initially at 95%, decreases to 20% after 2 h. This decrease is caused by the accumulation of the water produced in the course of the reaction in the packed-bed reactor (PBR). In order to improve the PBR efficiency, it is necessary to evacuate the water produced. In this study, different approaches have been tested to control the water content in the PBR during continuous esterification. The first approach consisted in improving the water solubility by increasing the reaction medium polarity. The addition of polar additives to n-hexane, the use of more polar solvents, and the use of solvent-free reaction medium were tested as a means to favor the water evacuation from the PBR. First of all, the use ofn-hexane supplemented with acetone (3 M) or 2-methyl-2-propanol (1 M) enabled the conversion to be maintained at higher values than those obtained in pure n-hexane. The replacement of n-hexane by a more polar solvent, like the 5-methyl-2-hexanone, resulted in the same effect. In all cases, conversions at steady-state were always less than 95%, as obtained in pure n-hexane. This is explained by a decrease in the enzyme activity due to the increase in the medium polarity. Nevertheless, an increase in enzyme quantity allowed 90% conversion to be maintained during 1 week using 3 M acetone amended n-hexane. Good results (a steady-state conversion of about 80%) were obtained when esterification was carried out in a solvent-free reaction medium containing 2 M 2-methyl-2-propanol as a polar additive. The second approach consisted in the evaporation of the accumulated water by use of an intermittent airflow. Although this process did not enable constant esterification rate to be maintained, it did enable the initial conversion (95%) to be restored intermittently. Copyright 1998 John Wiley & Sons, Inc.

  12. The program of continuous improvements in factory in Juzbado; El programa de mejora continua en la Fabrica de Juzbado

    Energy Technology Data Exchange (ETDEWEB)

    Prieto, M.

    2015-07-01

    This articles describes the historical development of the continuous improvement program at Juzbado Factory, since its beginning to nowadays. The evolution throughout the ideas of Total Quality, ISO, EFQM, Six Sigma, and so on, leading to the present situation in which all these tools and methodologies live together is shown. all this has led to a philosophy and business culture focused on safety, quality and continuous improvement. (Author)

  13. Quality Improvement of Nasal Continuous Positive Airway Pressure Therapy in Neonatal Intensive Care Unit.

    Science.gov (United States)

    Chen, Chien-Yi; Chou, An-Kuo; Chen, Yu-Lien; Chou, Hung-Chieh; Tsao, Po-Nien; Hsieh, Wu-Shiun

    2017-06-01

    Nasal continuous positive airway pressure (NCPAP) therapy is widely used in neonates, but the clinical practice varies. However, nursing practice differs among individuals, and an inappropriate application method may delay the respiratory therapy, influence the beneficial effect of NCPAP, and increase complications. We introduced a quality improvement project to expedite the application of NCPAP therapy and decrease the incidence of nasal trauma. A new strategy of mobile NCPAP cart with prepacked fixation kits and a written protocol was implemented from April 2006. All medical staff answered a questionnaire to assess their basic knowledge before and after intensive training. The records of the patients who were treated with NCPAP from October 2005 to November 2006 were reviewed. Fifty-nine medical staff were involved in the project, and their mean score for the questionnaire improved from 69.2 points to 98.3 points after training. From October 2005 to November 2006, 113 infants were recruited in total and 82 of them were admitted after the protocol was implemented. The NCPAP cart dramatically shortened the preparation time (from 520 seconds to 72 seconds) and the application time (from 468 seconds to 200 seconds). The use of the nursing protocol significantly decreased the incidence of nasal trauma in the study population (45.2% vs. 19.6%, p = 0.006), but not in infants with a birth weight of < 1000 g. Risk factors for nasal skin trauma included lower gestational age and birth weight, longer duration of NCPAP use, and lack of standardized nursing care. The mobile NCPAP cart with prepacked fixation kits is a practical way of expediting the initiation of NCPAP therapy. The written nursing protocol decreased the incidence of nasal trauma in infants, except for those with an extremely low birth weight. Copyright © 2016. Published by Elsevier B.V.

  14. Accreditation of Medical Education Programs: Moving From Student Outcomes to Continuous Quality Improvement Measures.

    Science.gov (United States)

    Blouin, Danielle; Tekian, Ara

    2018-03-01

    Accreditation of undergraduate medical education programs aims to ensure the quality of medical education and promote quality improvement, with the ultimate goal of providing optimal patient care. Direct linkages between accreditation and education quality are, however, difficult to establish. The literature examining the impact of accreditation predominantly focuses on student outcomes, such as performances on national examinations. However, student outcomes present challenges with regard to data availability, comparability, and contamination.The true impact of accreditation may well rest in its ability to promote continuous quality improvement (CQI) within medical education programs. The conceptual model grounding this paper suggests accreditation leads medical schools to commit resources to and engage in self-assessment activities that represent best practices of CQI, leading to the development within schools of a culture of CQI. In line with this model, measures of the impact of accreditation on medical schools need to include CQI-related markers. The CQI orientation of organizations can be measured using validated instruments from the business and management fields. Repeated determinations of medical schools' CQI orientation at various points throughout their accreditation cycles could provide additional evidence of the impact of accreditation on medical education. Strong CQI orientation should lead to high-quality medical education and would serve as a proxy marker for the quality of graduates and possibly for the quality of care they provide.It is time to move away from a focus on student outcomes as measures of the impact of accreditation and embrace additional markers, such as indicators of organizational CQI orientation.

  15. Continuous quality improvement in daily clinical practice: a proof of concept study.

    Directory of Open Access Journals (Sweden)

    Jonathan A Lorch

    Full Text Available Continuous Quality Improvement (CQI is an iterative process of: planning to improve a product or process, plan implementation, analyzing and comparing results against those expected, and corrective action on differences between actual and expected results. It is little used in clinical medicine. Anemia, a complex problem in End Stage Renal Disease patients, served to test the ability of an unique electronic medical record (EMR optimized for daily care to empower CQI in practice. We used data collected during daily care, stored in the EMR, and organized to display temporal relationships between clinical, laboratory, and therapeutic events. Our aims were optimal hemoglobin with minimum epoetin, and maintaining stable hemoglobin and epoetin. The study was done on 250 patients treated by maintenance hemodialysis (HD, receiving epoetin prior to February 1, 2010 and followed to July 31, 2011. Repleting iron, ensuring iron sufficiency, slow epoetin reduction, and decision support tools enabling data display over long periods in patient-centered reports were key elements. Epoetin dose, adjusted 6-8 weekly, was based on current clinical conditions and past responses. Hemoglobin increased by months 1-2; epoetin decreased from month 4. By months 16-18, epoetin had decreased 42% to 9,720 units/week while hemoglobin increased 8% to 123.6 g/L. Hemoglobin and epoetin were stable from month 7 onward. New epoetin orders decreased 83%. Transferrin saturation increased after the study start. Individual patient hemoglobin variation decreased by 23%, range by 27%. Mortality, 11.78 per 100 patient years, was 42% less than United States dialysis patient mortality. Allowable epoetin charges decreased by $15.33 per treatment and were $22.88 less than current Medicare allowance. The study validates the hypothesis that an EMR optimized for daily patient care can empower CQI in clinical medicine and serve to monitor medical care quality and cost.

  16. Continuous positive air pressure improves orthonasal olfactory function of patients with obstructive sleep apnea.

    Science.gov (United States)

    Walliczek-Dworschak, Ute; Cassel, Werner; Mittendorf, Luisa; Pellegrino, Robert; Koehler, Ulrich; Güldner, Christian; Dworschak, Philipp Otto Georg; Hildebrandt, Olaf; Daniel, Hanna; Günzel, Thomas; Teymoortash, Afshin; Hummel, Thomas

    2017-06-01

    Recent studies have suggested that patients with obstructive sleep apnea (OSA) might be affected by olfactory impairment. However, more evidence is needed on the effect that OSA has on the chemical senses (olfaction and gustatory) of these patients, and whether continuous positive airway pressure (CPAP) treatment might help to reverse possible impairment. A prospective study was conducted with 44 OSA patients (17 female and 27 male, mean age 54 ± 9.9 years) who were diagnosed via polysomnography and eligible for CPAP treatment. Orthonasal olfactory and gustatory function was measured with the extended Sniffin' Sticks test battery and "taste strips," respectively, before and after CPAP treatment. Baseline olfaction was decreased in OSA patients and after CPAP therapy olfactory scores (odor threshold-discrimination-identification score [TDI]: baseline 29.4 ± 4.11 after CPAP 32.3 ± 4.82; p = 0.001; odor threshold [THR]: baseline 5.28 ± 1.69 after CPAP 6.78 ± 2.61; p = 0.000; odor identification [ID]: baseline 12.9 ± 1.95 after CPAP 13.6 ± 1.33; p = 0.013) improved significantly. In contrast, neither baseline taste function in OSA patients nor gustatory function after treatment seemed to be affected. Orthonasal olfactory function in patients with OSA improves under CPAP therapy; however, gustatory function is not impaired in OSA patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea.

    Science.gov (United States)

    Serrano-Pariente, J; Plaza, V; Soriano, J B; Mayos, M; López-Viña, A; Picado, C; Vigil, L

    2017-05-01

    Continuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention-to-treat basis. The mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P obstructive sleep apnea syndrome. © 2016 The Authors. Allergy published by John Wiley & Sons Ltd.

  18. Identification of Barriers Towards Change and Proposal to Institutionalize Continuous Improvement Programs in Manufacturing Operations

    Directory of Open Access Journals (Sweden)

    Alvair Silveira Torres Jr.

    2011-06-01

    Full Text Available A multi case research unfolded into a study in a sample of Brazilian manufacturing companies concerning their Continuous Improvement (CI program in manufacturing operations. Stakeholders interviews and performance analyses were conducted. The study aims to analyze the existence or absence of the institutionalization of a CI culture in manufacturing operations, identify barriers and difficulties within the process and propose a model for change. As a result of the research, it was observed that despite the considerable motivation of staff, rapid gains of the company and superior results during the early phases of the CI program, time and again such results were either not upheld or faded out over time, delivering no significant mid-term or long term results, due to poor management of changes. This happened mainly as a result of lack of strategic alignment at all levels of the organization, translated in measureable activities and projects, coached and mentored by the middle and upper management throughout the implementation and maintenance of the program. The selected cases showed a declining in performance after two years of CI program start up. Learning, union and process ownership among participants by means of interactions, are necessary to absorb and incorporate changes, instead of merely "smart words" .

  19. Hearing the voices of women in war through continuous quality improvement.

    Science.gov (United States)

    Farrell, M; Farrell, J D

    1998-04-01

    During the war in Bosnia-Herzegovina (BIH), the infrastructure of the health care system was destroyed and health officials, health care providers, and women experienced the war from their own perspectives. Using the principles of continuous quality improvement (CQI), these perspectives were honored and served as the basis for an international training program to hear the voices of women in war and the concerns of those who cared for them. With the results of a comprehensive national survey of all partners, the World Health Organization's European Regional Office held a five-day workshop that used CQI methods. The facilitators and 18 nurses, midwives, and physicians from six cantons developed interventions to address the women's needs, as detailed from the women's stories and from the professional perspectives of governmental authorities and health providers. The effort illustrates the ways in which the principles and tools of CQI can be used to capture the needs of the users of the services with those responsible for restructuring the health service and those with overall responsibility for the health of woman throughout the country.

  20. Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

    Science.gov (United States)

    Hunt, Priscillia; Hunter, Sarah B; Levan, Deborah

    2017-06-01

    Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI. Copyright © 2017. Published by Elsevier Inc.

  1. Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare

    Science.gov (United States)

    Schwartz, Robert; Cohen, Joanna; Manson, Heather; Scott, Fran

    2017-01-01

    Context: Evidence of the effect of continuous quality improvement (CQI) in public health and valid tools to judge that such effects are not fully formed. Objective: The objective was to adapt and apply Shortell et al.'s (1998) four dimensions of CQI in an examination of a public health accountability and performance management initiative in Ontario, Canada. Methods: In total, 24 semi-structured, in-depth interviews were conducted with informants from public health units and the Ministry of Health and Long-Term Care. A web survey of public health managers in the province was also carried out. Results: A mix of facilitators and barriers was identified. Leadership and organizational cultures, conducive to CQI success were evident. However, limitations in performance measurement and managerial discretion were key barriers. Conclusion: The four dimensions of CQI provided insight into both facilitators and barriers of CQI adoption in public health. Future research should compare the outcomes of public health CQI initiatives to the framework's stated facilitators and barriers. PMID:28277203

  2. High efficient and continuous surface modification of carbon fibers with improved tensile strength and interfacial adhesion

    Science.gov (United States)

    Sun, Jingfeng; Zhao, Feng; Yao, Yue; Jin, Zhen; Liu, Xu; Huang, Yudong

    2017-08-01

    Most of the surface modification technologies for carbon fibers, no matter in laboratory scale or for commercial manufacture, are accompanied by a simultaneous decrease in tensile strength. In this paper, a feasible and high efficient strategy for carbon fiber treatment which could obviously improve both tensile strength and interfacial adhesion was proposed. Continuously moving carbon fibers were treated with atmospheric helium plasma for 1 min, followed by a 5 min pyrolytic carbon deposition using ethanol as precursor at 800 °C. The effects of the new approach were characterized by SEM, AFM, nanoindentation, XPS, Raman, wettability analysis, single fiber tensile strength testing and single fiber pull-out testing. After modification, pyrolytic carbon coating was deposited on the fiber surface uniformly, and the roughness and surface energy increased significantly. The single fiber tensile testing results indicate that the resulting fiber strength increased 15.7%, rising from 3.13 to 3.62 GPa. Meanwhile, the interfacial shear strength of its epoxy composites increased from 65.3 to 83.5 MPa. The comparative studies of carbon fibers modified with commercial anodic oxidation and sizing were also carried out. The results demonstrate that the new method can be utilized in the carbon fiber manufacture process and is more efficient than the traditional approaches.

  3. Sirolimus formulation with improved pharmacokinetic properties produced by a continuous flow method.

    Science.gov (United States)

    Solymosi, Tamás; Angi, Réka; Basa-Dénes, Orsolya; Ránky, Soma; Ötvös, Zsolt; Glavinas, Hristos; Filipcsei, Genovéva; Heltovics, Gábor

    2015-08-01

    The oral bioavailability of Sirolimus is limited by poor dissolution of the compound in the gastrointestinal tract resulting in a low bioavailability and large inter-individual differences in blood levels. Several different formulation approaches were applied to overcome these disadvantageous pharmacokinetic properties including the marketed oral solution and a tablet form containing wet milled nanocrystals. These approaches deliver improved pharmacokinetics, yet, they share the characteristics of complex production method and composition. We have developed a nanostructured Sirolimus formulation prepared by the controlled continuous flow precipitation of the compound from its solution in the presence of stabilizers. We have shown that contrary to the batch production the process could be easily intensified and scaled up; apparently the uniformity of the precipitation is heavily dependent on the production parameters, most likely the mixing of the solvent and antisolvent. We compared the physicochemical and pharmacokinetic properties of the nanostructured formula with the marketed nanoformula. We found that our method produces particles in the size range of less than 100nm. The solid form redispersed instantaneously in water and in biorelevant media. Both the solid form and the redispersed colloid solution showed excellent stability even in accelerated test conditions. The oral administration of the nanostructured formula resulted in faster absorption, higher exposure and higher trough concentrations when compared to the marked form. These advantageous properties could allow the development of solid oral Sirolimus formulae with lower strength and gel based topical delivery systems. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare.

    Science.gov (United States)

    Price, Alex; Schwartz, Robert; Cohen, Joanna; Manson, Heather; Scott, Fran

    2017-02-01

    Evidence of the effect of continuous quality improvement (CQI) in public health and valid tools to judge that such effects are not fully formed. The objective was to adapt and apply Shortell et al.'s (1998) four dimensions of CQI in an examination of a public health accountability and performance management initiative in Ontario, Canada. In total, 24 semi-structured, in-depth interviews were conducted with informants from public health units and the Ministry of Health and Long-Term Care. A web survey of public health managers in the province was also carried out. A mix of facilitators and barriers was identified. Leadership and organizational cultures, conducive to CQI success were evident. However, limitations in performance measurement and managerial discretion were key barriers. The four dimensions of CQI provided insight into both facilitators and barriers of CQI adoption in public health. Future research should compare the outcomes of public health CQI initiatives to the framework's stated facilitators and barriers. Copyright © 2017 Longwoods Publishing.

  5. The potential of Arachis pintoi biomass to improve quality of soil continuously used for cassava cropping

    Directory of Open Access Journals (Sweden)

    N. Muddarisna

    2014-01-01

    Full Text Available A field experiment that was aimed to elucidate the effects of application of Arachis pintoi biomass and animal dung on quality of soil continuously used for cassava cropping was conducted at Jatikerto Village, Kromengan District of Malang Regency. Eight treatments tested were 100% NPK inorganic fertilizer, 100 kg N Arachis pintoi/ha, (3 100 kg N chicken dung/ ha, 100 kg N cow dung /ha, 100 kg N goat dung /ha, 100 kg N Arachis pintoi + chicken dung /ha, 100 kg N Arachis pintoi + cow dung /ha, and 100 kg N Arachis pintoi + goat dung /ha. Monitoring quality of top soil (0-20 cm was carried out at planting time and 3 months after planting. Soil samples were collected and analyzed for chemical and physical properties. Yield of cassava was measured at 6 months after planting. Results of this study showed that application of organic fertilizer in forms of green manure (Arachis pintoi biomass, and animal dung significantly improved physical and chemical properties of soil. Application of 50% NPK combined with organic manures did not significantly gave different tuber yield with that of 100% NPK.

  6. APPLICATION OF FAILURE MODE & EFFECT ANALYSIS (FMEA FOR CONTINUOUS QUALITY IMPROVEMENT - MULTIPLE CASE STUDIES IN AUTOMOBILE SMES

    Directory of Open Access Journals (Sweden)

    Jigar Doshi

    2017-06-01

    Full Text Available Failure Mode and Effects Analysis (FMEA is a quality tool used to identify potential failures and related effects on processes and products, so continuous improvement in quality can be achieved by reducing them. The purpose of this research paper is to showcase the contribution of FMEA to achieve Continuous Quality Improvement (CQI by multiple case study research. The outcome research conducted by implementing FMEA; one of the Auto Core Tools (ACTs, in the automobile Small and Medium Enterprises (SMEs in Gujarat, India is presented in this paper which depict various means of Continuous Quality Improvements. The case study based research was carried out in four automobile SMEs; all of them are supplied to automotive Original Equipment Manufacturer (OEM. The FMEA was implemented with the help of Cross Functional Team (CFT to identify the potential failure modes and effects, in overall effect on Continuous Quality Improvement. The outcome of FMEA at four companies' reveals the scope of improvement exists in the manufacturing process. Implementation of those improvement points shows the definite signs of continuous improvement of the quality of process and product as well. The FMEA and subsequent implementations had reduced the quality rejections around 3% to 4% in case companies.

  7. Health and environmental research. Summary of accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    1984-04-01

    This is a short account of a 40-year-old health and environmental research program performed in national laboratories, universities, and research institutes. Under the sponsorship of the federal agencies that were consecutively responsible for the national energy mission, this research program has contributed to the understanding of the human health and environmental effects of emergining energy technologies. In so doing, it has also evolved several nuclear techniques for the diagnosis and treatment of human ills. The form of this presentation is through examples of significant, tangible accomplishments in each of these areas at certain times to illustrate the role and impact of the research program. The narrative of this research program concludes with a perspective of its past and a prospectus on its future.

  8. Accomplishments under the Airport Improvement Program: Fiscal Year 1988

    Science.gov (United States)

    1988-01-01

    WIND (PRIMARY) INDICATOR; SECURITY FENCING HOLBROOK 02 $22,766 CONDUCT MASTER PLAN UPDATE HOLBROOK MUNICIPAL (GENERAL AVIATION) KAYENTA 03 $1,238,484...CONSTRUCT RUNWAY, TAXIWAY, APRON AND KAYENTA ACCESS ROAD; INSTALL RUNWAY AND TAXIWAY (GENERAL AVIATION) LIGHTING SYSTEM, VISUAL APPROACH INDICATOR

  9. Accomplishments Under the Airport Improvement Program. Fiscal year 1987.

    Science.gov (United States)

    1987-01-01

    PREPARATION); GRAND CANYON NATIONAL PARK ACQUIRE LAND FOR APPROACHES; INSTALL (PRIMARY) FENCING KAYENTA 02 $561,695 CONSTRUCT NEW RUNWAY, TAXIWAY AND...APRON KAYENTA (SITE PREPARATION) (GENERAL AVIATION) KINGMAN 04 $138,411 INSTALL RUNWAY LIGHTING, TAXIWAY MOHAVE COUNTY GUIDANCE SIGNS AND VISUAL APPROACH

  10. Randomized Trial of the Availability, Responsiveness and Continuity (ARC) Organizational Intervention for Improving Youth Outcomes in Community Mental Health Programs

    Science.gov (United States)

    Glisson, Charles; Hemmelgarn, Anthony; Green, Philip; Williams, Nathaniel J.

    2013-01-01

    Objectives: The primary objective of the study was to assess whether the Availability, Responsiveness and Continuity (ARC) organizational intervention improved youth outcomes in community based mental health programs. The second objective was to assess whether programs with more improved organizational social contexts following the 18-month ARC…

  11. Implementation of Total Employee Involvement as Part of a Continuous Improvement Program at a Fortune 500 Company

    Science.gov (United States)

    Carlson, Kathy Lynn

    2012-01-01

    Over the last several decades, Continuous Improvement (CI) type initiatives have been implemented in companies across the United States to improve quality, reduce process variation, eliminate waste and ultimately reduce costs. Approximately five years ago, one particular Fortune 500 company implemented CI in its manufacturing facilities. A key…

  12. Survey of sustainability of continuous improvement systems: a comparison of two manufacturing communities in Spain and Mexico

    Directory of Open Access Journals (Sweden)

    Carmen Jaca

    2011-04-01

    Full Text Available Purpose: During the last 50 years industrial companies have adopted continuous improvement systems to improve their competitiveness. However, the maintenance of improvement systems is not an easy matter. Some companies, after an initial period of one to two years, abandon the system for various reasons. This article aims to examine the level of application of Continuous Improvement Systems and the factors which support sustainability over time in two different regions.Design/methodology/approach: In order to obtain a comparative result between two different regions, a survey was conducted in two industrial zones—one in the north of Spain and another in Mexico—that are important industrial clusters these countries. The study was conducted through the analysis of survey data. Specifically, the survey was directed at large industrial enterprises who had participated in activities supported by local foundations for the promotion of quality and improvement.Findings and Originality/value: We suggest the following three keys for sustainable improvement: greater involvement of task forces in the improvement program, a PDCA improvement cycle for improvement and a clear purpose for continuous improvement, integration of the continuous improvement system in the organization, and the establishment of indicators associated with the system.Research limitations/implications: The comparative study focused on only two industrial zones in Spain and Mexico. In that sense, the findings of the research are limited to the Basque zone and geographical zone of Toluca-Lerma.Practical implications: Some of the companies have started to apply some continuous improvement techniques in a sustainability way. Therefore, these findings could be very useful for general and operation managers that are involved in continuous improvement systems in industrial companies in Spain and Mexico.Social implications: As a consequence, slow and small transformations in certain

  13. Personalized medicine: CCO's vision, accomplishments and future plans.

    Science.gov (United States)

    Guo, Jennifer; Kamel-Reid, Suzanne; Rutherford, Michael; Hart, Jennifer; Melamed, Saul; Pollett, Aaron

    2015-01-01

    Personalized medicine is a rapidly expanding field, with the potential to improve patient care. Its benefits include increasing efficiency in cancer screening, diagnosis and treatment through early detection, targeted therapy and identifying individuals with an underlying genetic risk for cancer or adverse outcomes. Through the work of Cancer Care Ontario (CCO)'s Pathology and Laboratory Medicine Program, a number of initiatives have been undertaken to support developments in personalized medicine. In keeping with the momentum of recent accomplishments, CCO has led the formation of the Personalized Medicine Steering Committee to develop a comprehensive provincial genetics strategy for the future of cancer care. Copyright © 2014 Longwoods Publishing.

  14. Paediatric ED BiPAP continuous quality improvement programme with patient analysis: 2005-2013.

    Science.gov (United States)

    Abramo, Thomas; Williams, Abby; Mushtaq, Samaiya; Meredith, Mark; Sepaule, Rawle; Crossman, Kristen; Burney Jones, Cheryl; Godbold, Suzanne; Hu, Zhuopei; Nick, Todd

    2017-01-16

    In paediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory rate (RR), less airflow and shortened inspiratory breath time. In certain asthmatics, aerosols are ineffective due to their inadequate ventilation. Bilevel positive airway pressure (BiPAP) in acute paediatric asthmatics can be an effective treatment. BiPAP works by unloading fatigued inspiratory muscles, a direct bronchodilation effect, offsetting intrinsic PEEP and recruiting collapsed alveoli that reduces the patient's work of breathing and achieves their total lung capacity quicker. Unfortunately, paediatric emergency department (PED) BiPAP is underused and quality analysis is non-existent. A PED BiPAP Continuous Quality Improvement Program (CQIP) from 2005 to 2013 was evaluated using descriptive analytics for the primary outcomes of usage, safety, BiPAP settings, therapeutics and patient disposition. PED BiPAP CQIP descriptive analytics. Academic PED. 1157 patients. A PED BiPAP CQIP from 2005 to 2013 for the usage, safety, BiPAP settings, therapeutic response parameters and patient disposition was evaluated using descriptive analytics. Safety, usage, compliance, therapeutic response parameters, BiPAP settings and patient disposition. 1157 patients had excellent compliance without complications. Only 6 (0.5%) BiPAP patients were intubated. BiPAP median settings: IPAP 18 (16,20) cm H 2 O range 12-28; EPAP 8 cmH 2 O (8,8) range 6-10; inspiratory-to-expiratory time (I:E) ratio 1.75 (1.5,1.75). Pediatric Asthma Severity score and RR decreased (pimproved therapeutics times, very low intubations and decreased PICU admissions. CQIP analysis demonstrated that using a higher IPAP, low EPAP with longer I:E optimises the patient's BiPAP settings and showed a significant improvement in PAS, RR and tidal volume. Bi

  15. Pulsatile operation of a continuous-flow right ventricular assist device (RVAD) to improve vascular pulsatility.

    Science.gov (United States)

    Ng, Boon C; Kleinheyer, Matthias; Smith, Peter A; Timms, Daniel; Cohn, William E; Lim, Einly

    2018-01-01

    Despite the widespread acceptance of rotary blood pump (RBP) in clinical use over the past decades, the diminished flow pulsatility generated by a fixed speed RBP has been regarded as a potential factor that may lead to adverse events such as vasculature stiffening and hemorrhagic strokes. In this study, we investigate the feasibility of generating physiological pulse pressure in the pulmonary circulation by modulating the speed of a right ventricular assist device (RVAD) in a mock circulation loop. A rectangular pulse profile with predetermined pulse width has been implemented as the pump speed pattern with two different phase shifts (0% and 50%) with respect to the ventricular contraction. In addition, the performance of the speed modulation strategy has been assessed under different cardiovascular states, including variation in ventricular contractility and pulmonary arterial compliance. Our results indicated that the proposed pulse profile with optimised parameters (Apulse = 10000 rpm and ωmin = 3000 rpm) was able to generate pulmonary arterial pulse pressure within the physiological range (9-15 mmHg) while avoiding undesirable pump backflow under both co- and counter-pulsation modes. As compared to co-pulsation, stroke work was reduced by over 44% under counter-pulsation, suggesting that mechanical workload of the right ventricle can be efficiently mitigated through counter-pulsing the pump speed. Furthermore, our results showed that improved ventricular contractility could potentially lead to higher risk of ventricular suction and pump backflow, while stiffening of the pulmonary artery resulted in increased pulse pressure. In conclusion, the proposed speed modulation strategy produces pulsatile hemodynamics, which is more physiologic than continuous blood flow. The findings also provide valuable insight into the interaction between RVAD speed modulation and the pulmonary circulation under various cardiovascular states.

  16. Implementation of a continuous quality improvement program reduces the occurrence of peritonitis in PD.

    Science.gov (United States)

    Wang, Jianwen; Zhang, Hao; Liu, Jun; Zhang, Ke; Yi, Bin; Liu, Yan; Liu, Jishi; Zhang, Xianming; Ji, Ying

    2014-08-01

    To investigate the causes of peritonitis in patients with peritoneal dialysis (PD) using continuous quality improvement (CQI) to develop effective interventions and reduce the occurrence of peritonitis. A quality control team consisting of 10 members, including the department head, four nephrologists and four nurses, all specialized in PD care, and the head nurse, was established at the Peritoneal Dialysis Center of the Third Xiangya Hospital of Central South University. All patients with peritonitis occurring between 1 July 2010 and 31 December 2011 (pre-CQI period) were analyzed and compared with data obtained between January 2012 (implementation of CQI) and March 2013 to investigate possible causes of peritonitis and to develop corresponding interventions. Fishbone analysis, including laboratory parameters, was carried out monthly. Gastrointestinal tract dysfunction, nonstandard procedures and malnutrition were found to be the top three risk factors for peritonitis. Gastrointestinal tract dysfunction was the likely cause of peritonitis in 42.8% of the subjects before CQI and 36.0% after CQI (p<0.05). Nonstandard procedures were the cause of peritonitis in 33.3% of the subjects before CQI and 24.0% after CQI (p<0.05). The overall incidence of peritonitis reduced from once every 40.1 patient months before the CQI to once every 70.8 patient months after CQI (p<0.05). The incidence of Gram-positive bacteria peritonitis reduced from once every 96.9 patients per month before CQI to once every 209.1 patient months after CQI (p<0.05), whereas the incidence of Gram-negative bacteria peritonitis reduced from once every 234.2 patient months before CQI to once every 292.8 patient months after CQI. CQI can effectively reduce the occurrence of PD-related peritonitis.

  17. Implicit and Explicit Knowledge Both Improve Dual Task Performance in a Continuous Pursuit Tracking Task.

    Science.gov (United States)

    Ewolds, Harald E; Bröker, Laura; de Oliveira, Rita F; Raab, Markus; Künzell, Stefan

    2017-01-01

    The goal of this study was to investigate the effect of predictability on dual-task performance in a continuous tracking task. Participants practiced either informed (explicit group) or uninformed (implicit group) about a repeated segment in the curves they had to track. In Experiment 1 participants practices the tracking task only, dual-task performance was assessed after by combining the tracking task with an auditory reaction time task. Results showed both groups learned equally well and tracking performance on a predictable segment in the dual-task condition was better than on random segments. However, reaction times did not benefit from a predictable tracking segment. To investigate the effect of learning under dual-task situation participants in Experiment 2 practiced the tracking task while simultaneously performing the auditory reaction time task. No learning of the repeated segment could be demonstrated for either group during the training blocks, in contrast to the test-block and retention test, where participants performed better on the repeated segment in both dual-task and single-task conditions. Only the explicit group improved from test-block to retention test. As in Experiment 1, reaction times while tracking a predictable segment were no better than reaction times while tracking a random segment. We concluded that predictability has a positive effect only on the predictable task itself possibly because of a task-shielding mechanism. For dual-task training there seems to be an initial negative effect of explicit instructions, possibly because of fatigue, but the advantage of explicit instructions was demonstrated in a retention test. This might be due to the explicit memory system informing or aiding the implicit memory system.

  18. Evaluation of the BD BACTEC FX blood volume monitoring system as a continuous quality improvement measure.

    Science.gov (United States)

    Coorevits, L; Van den Abeele, A-M

    2015-07-01

    The yield of blood cultures is proportional to the volume of blood cultured. We evaluated an automatic blood volume monitoring system, recently developed by Becton Dickinson within its BACTEC EpiCenter module, that calculates mean volumes of negative aerobic bottles and generates boxplots and histograms. First, we evaluated the filling degree of 339 aerobic glass blood cultures by calculating the weight-based volume for each bottle. A substantial amount of the bottles (48.3%) were inadequately filled. Evaluation of the accuracy of the monitoring system showed a mean bias of -1.4 mL (-15.4%). Additional evaluation, using the amended software on 287 aerobic blood culture bottles, resulted in an acceptable mean deviation of -0.3 mL (-3.3%). The new software version was also tested on 200 of the recently introduced plastic bottles, which will replace the glass bottles in the near future, showing a mean deviation of +2.8 mL (+26.7%). In conclusion, the mean calculated volumes can be used for the training of a single phlebotomist. However, filling problems appear to be masked when using them for phlebotomist groups or on wards. Here, visual interpretation of boxplots and histograms can serve as a useful tool to observe the spread of the filling degrees and to develop a continuous improvement program. Re-adjustment of the software has proven to be necessary for use with plastic bottles. Due to our findings, BD has developed further adjustments to the software for validated use with plastic bottles, which will be released soon.

  19. Improved peak detection in mass spectrum by incorporating continuous wavelet transform-based pattern matching.

    Science.gov (United States)

    Du, Pan; Kibbe, Warren A; Lin, Simon M

    2006-09-01

    A major problem for current peak detection algorithms is that noise in mass spectrometry (MS) spectra gives rise to a high rate of false positives. The false positive rate is especially problematic in detecting peaks with low amplitudes. Usually, various baseline correction algorithms and smoothing methods are applied before attempting peak detection. This approach is very sensitive to the amount of smoothing and aggressiveness of the baseline correction, which contribute to making peak detection results inconsistent between runs, instrumentation and analysis methods. Most peak detection algorithms simply identify peaks based on amplitude, ignoring the additional information present in the shape of the peaks in a spectrum. In our experience, 'true' peaks have characteristic shapes, and providing a shape-matching function that provides a 'goodness of fit' coefficient should provide a more robust peak identification method. Based on these observations, a continuous wavelet transform (CWT)-based peak detection algorithm has been devised that identifies peaks with different scales and amplitudes. By transforming the spectrum into wavelet space, the pattern-matching problem is simplified and in addition provides a powerful technique for identifying and separating the signal from the spike noise and colored noise. This transformation, with the additional information provided by the 2D CWT coefficients can greatly enhance the effective signal-to-noise ratio. Furthermore, with this technique no baseline removal or peak smoothing preprocessing steps are required before peak detection, and this improves the robustness of peak detection under a variety of conditions. The algorithm was evaluated with SELDI-TOF spectra with known polypeptide positions. Comparisons with two other popular algorithms were performed. The results show the CWT-based algorithm can identify both strong and weak peaks while keeping false positive rate low. The algorithm is implemented in R and will be

  20. The sustainability of improvements from continuing professional development in pharmacy practice and learning behaviors.

    Science.gov (United States)

    McConnell, Karen J; Delate, Thomas; Newlon, Carey L

    2015-04-25

    To assess the long-term sustainability of continuing professional development (CPD) training in pharmacy practice and learning behaviors. This was a 3-year posttrial survey of pharmacists who had participated in an unblinded randomized controlled trial of CPD. The online survey assessed participants' perceptions of pharmacy practice, learning behaviors, and sustainability of CPD. Differences between groups on the posttrial survey responses and changes from the trial's follow-up survey to the posttrial survey responses within the intervention group were compared. Of the 91 pharmacists who completed the original trial, 72 (79%) participated in the sustainability survey. Compared to control participants, a higher percentage of intervention participants reported in the sustainability survey that they had utilized the CPD concept (45.7% vs 8.1%) and identified personal learning objectives (68.6% vs 43.2%) during the previous year. Compared to their follow-up survey responses, lower percentages of intervention participants reported identifying personal learning objectives (94.3% vs 68.6%), documenting their learning plan (82.9% vs 22.9%) and participating in learning by doing (42.9% vs 14.3%) in the sustainability survey. In the intervention group, many of the improvements to pharmacy practice items were sustained over the 3-year period but were not significantly different from the control group. Sustainability of a CPD intervention over a 3-year varied. While CPD-trained pharmacists reported utilizing CPD concepts at a higher rate than control pharmacists, their CPD learning behaviors diminished over time.

  1. Do social functioning and symptoms improve with continuation antidepressant treatment of persistent depressive disorder? An observational study.

    Science.gov (United States)

    Hellerstein, David J; Hunnicutt-Ferguson, Kallio; Stewart, Jonathan W; McGrath, Patrick J; Keller, Samantha; Peterson, Bradley S; Chen, Ying

    2017-03-01

    To determine efficacy of continued treatment with the serotonin norepinephrine reuptake inhibitor duloxetine on symptom reduction and functional improvement in outpatients with dysthymia. Fifty outpatients with DSM-IV-TR diagnosed dysthymia who had participated in a 10 week double-blind, placebo-controlled study of duloxetine received open treatment for three months. Nineteen duloxetine responders continued duloxetine, 24 patients initially treated with placebo started open duloxetine treatment, and 7 duloxetine non-responders were treated with desvenlafaxine or bupropion, selected by clinician choice. Patients continuing duloxetine maintained symptom improvement, 84% meeting response and 63% remission criteria at week 22. Patients initially treated with placebo showed similarly high levels of response (83%) and remission (62%) at week 22, and most duloxetine non-responders subsequently responded to other antidepressants. Duloxetine-continuation patients improved modestly between weeks 10 and 22 on measures of social and cognitive functioning and temperament. Despite this improvement concurrently across several functional domains, 66.7% of patients continuing duloxetine remained in the impaired range of functioning according to the Social Adjustment Scale (SAS). Continued duloxetine treatment appears to be effective in maintaining symptom response in dysthymic disorder, and has positive effects on social functioning. However, the majority of patients do not show normalization of functioning, even when controlling for remission status. Additional treatments should be considered to target residual impairments in social functioning in mood remitted patients with persistent depressive disorder. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Sense of agency in continuous action: Assistance-induced performance improvement is self-attributed even with knowledge of assistance.

    Science.gov (United States)

    Inoue, Kazuya; Takeda, Yuji; Kimura, Motohiro

    2017-02-01

    In a task involving continuous action to achieve a goal, the sense of agency increases with an improvement in task performance that is induced by unnoticed computer assistance. This study investigated how explicit instruction about the existence of computer assistance affects the increase of sense of agency that accompanies performance improvement. Participants performed a continuous action task in which they controlled the direction of motion of a dot to a goal by pressing keys. When instructions indicated the absence of assistance, the sense of agency increased with performance improvement induced by computer assistance, replicating previous findings. Interestingly, this increase of sense of agency was also observed even when instructions indicated the presence of assistance. These results suggest that even when a plausible cause of performance improvement other than one's own action exists, the improvement can be misattributed to one's own control of action, resulting in an increased sense of agency. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. International Research Results and Accomplishments From the International Space Station

    Science.gov (United States)

    Ruttley, Tara M.; Robinson, Julie A.; Tate-Brown, Judy; Perkins, Nekisha; Cohen, Luchino; Marcil, Isabelle; Heppener, Marc; Hatton, Jason; Tasaki, Kazuyuki; Umemura, Sayaka; hide

    2016-01-01

    In 2016, the International Space Station (ISS) partnership published the first-ever compilation of international ISS research publications resulting from research performed on the ISS through 2011. The International Space Station Research Accomplishments: An Analysis of Results From 2000-2011 is a collection of summaries of over 1,200 journal publications that describe ISS research in the areas of biology and biotechnology; Earth and space science; educational activities and outreach; human research; physical sciences; technology development and demonstration; and, results from ISS operations. This paper will summarize the ISS results publications obtained through 2011 on behalf of the ISS Program Science Forum that is made up of senior science representatives across the international partnership. NASA's ISS Program Science office maintains an online experiment database (www.nasa.gov/issscience) that tracks and communicates ISS research activities across the entire ISS partnership, and it is continuously updated. It captures ISS experiment summaries and results and includes citations to the journals, conference proceedings, and patents as they become available. The International Space Station Research Accomplishments: An Analysis of Results From 2000-2011 is a testament to the research that was underway even as the ISS laboratory was being built. It reflects the scientific knowledge gained from ISS research, and how it impact the fields of science in both space and traditional science disciplines on Earth. Now, during a time when utilization is at its busiest, and with extension of the ISS through at least 2024, the ISS partners work together to track the accomplishments and the new knowledge gained in a way that will impact humanity like no laboratory on Earth. The ISS Program Science Forum will continue to capture and report on these results in the form of journal publications, conference proceedings, and patents. We anticipate that successful ISS research will

  4. Harnessing the genetics of the modern dairy cow to continue improvements in feed efficiency.

    Science.gov (United States)

    VandeHaar, M J; Armentano, L E; Weigel, K; Spurlock, D M; Tempelman, R J; Veerkamp, R

    2016-06-01

    Feed efficiency, as defined by the fraction of feed energy or dry matter captured in products, has more than doubled for the US dairy industry in the past 100 yr. This increased feed efficiency was the result of increased milk production per cow achieved through genetic selection, nutrition, and management with the desired goal being greater profitability. With increased milk production per cow, more feed is consumed per cow, but a greater portion of the feed is partitioned toward milk instead of maintenance and body growth. This dilution of maintenance has been the overwhelming driver of enhanced feed efficiency in the past, but its effect diminishes with each successive increment in production relative to body size and therefore will be less important in the future. Instead, we must also focus on new ways to enhance digestive and metabolic efficiency. One way to examine variation in efficiency among animals is residual feed intake (RFI), a measure of efficiency that is independent of the dilution of maintenance. Cows that convert feed gross energy to net energy more efficiently or have lower maintenance requirements than expected based on body weight use less feed than expected and thus have negative RFI. Cows with low RFI likely digest and metabolize nutrients more efficiently and should have overall greater efficiency and profitability if they are also healthy, fertile, and produce at a high multiple of maintenance. Genomic technologies will help to identify these animals for selection programs. Nutrition and management also will continue to play a major role in farm-level feed efficiency. Management practices such as grouping and total mixed ration feeding have improved rumen function and therefore efficiency, but they have also decreased our attention on individual cow needs. Nutritional grouping is key to helping each cow reach its genetic potential. Perhaps new computer-driven technologies, combined with genomics, will enable us to optimize management for

  5. Material Recovery and Waste Form Development FY 2015 Accomplishments Report

    Energy Technology Data Exchange (ETDEWEB)

    Todd, Terry Allen [Idaho National Lab. (INL), Idaho Falls, ID (United States); Braase, Lori Ann [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-11-01

    The Material Recovery and Waste Form Development (MRWFD) Campaign under the U.S. Department of Energy (DOE) Fuel Cycle Technologies (FCT) Program is responsible for developing advanced separation and waste form technologies to support the various fuel cycle options defined in the DOE Nuclear Energy Research and Development Roadmap, Report to Congress, April 2010. The FY 2015 Accomplishments Report provides a highlight of the results of the research and development (R&D) efforts performed within the MRWFD Campaign in FY-14. Each section contains a high-level overview of the activities, results, technical point of contact, applicable references, and documents produced during the fiscal year. This report briefly outlines campaign management and integration activities, but primarily focuses on the many technical accomplishments made during FY-15. The campaign continued to utilize an engineering driven-science-based approach to maintain relevance and focus. There was increased emphasis on development of technologies that support near-term applications that are relevant to the current once-through fuel cycle.

  6. Improvement of two-way continuous variable quantum cryptography by using additional noise

    International Nuclear Information System (INIS)

    Wang Minjie; Pan Wei

    2010-01-01

    The performance of quantum key distribution such as one-way continuous variable protocols, can be increased by adding some noise on the reference side of error correction in the error-correction phase. For this reason, we here study this possibility in the case of two-way continuous variable system. Finally, the numerical results show that the using of additional noise gives two-way schemes better security performance in terms of secret key rates and resistance to channel excess noise.

  7. Melhoria contínua no ambiente ISO 9001:2000: estudo de caso em duas empresas do setor automobilístico Continuous improvement in ISO 9001:2000 enviroment: case study in two companies of automotive sector

    Directory of Open Access Journals (Sweden)

    Rodrigo Valio Dominguez Gonzalez

    2007-12-01

    Full Text Available Este artigo avalia como duas empresas certificadas pela norma ISO 9001:2000, fornecedoras do setor automobilístico, realizam atividades de melhoria contínua em seus sistemas produtivos. É evidente que diferentes empresas apresentam diferenças quanto à condução de programas de melhoria contínua, e ainda, a motivação para a certificação neste sistema da qualidade também influi na amplitude e constância da melhoria dos processos. Nesse sentido, o artigo analisa como as organizações pesquisadas desenvolvem e estruturam internamente a melhoria contínua, enfatizando a organização do setor produtivo, o modelo de gestão e os principais programas e ferramentas utilizados.This article evaluate how two companies certified by the norm ISO 9001:2000, supplier of the automotive sector, accomplish continuous improvement activities in its productive processes. It is obvious that the different industrials environments, presented by the companies in particular, shows differences in relation to the conduction of the continuous improvement programs, and also, the stimulus to get the certification in this quality system which also inspires in the amplitude and constancy of the processes improvement. At this way, the article analyses how the researched organizations develop and organize internally the continuous improvement, emphasizing the production organization, improvement management model and programs and techniques used to these activities.

  8. Predicting core losses and efficiency of SRM in continuous current mode of operation using improved analytical technique

    International Nuclear Information System (INIS)

    Parsapour, Amir; Dehkordi, Behzad Mirzaeian; Moallem, Mehdi

    2015-01-01

    In applications in which the high torque per ampere at low speed and rated power at high speed are required, the continuous current method is the best solution. However, there is no report on calculating the core loss of SRM in continuous current mode of operation. Efficiency and iron loss calculation which are complex tasks in case of conventional mode of operation is even more involved in continuous current mode of operation. In this paper, the Switched Reluctance Motor (SRM) is modeled using finite element method and core loss and copper loss of SRM in discontinuous and continuous current modes of operation are calculated using improved analytical techniques to include the minor loop losses in continuous current mode of operation. Motor efficiency versus speed in both operation modes is obtained and compared. - Highlights: • Continuous current method for Switched Reluctance Motor (SRM) is explained. • An improved analytical technique is presented for SRM core loss calculation. • SRM losses in discontinuous and continuous current operation modes are presented. • Effect of mutual inductances on SRM performance is investigated

  9. Predicting core losses and efficiency of SRM in continuous current mode of operation using improved analytical technique

    Energy Technology Data Exchange (ETDEWEB)

    Parsapour, Amir, E-mail: amirparsapour@gmail.com [Department of Electrical Engineering, University of Isfahan, Isfahan (Iran, Islamic Republic of); Dehkordi, Behzad Mirzaeian, E-mail: mirzaeian@eng.ui.ac.ir [Department of Electrical Engineering, University of Isfahan, Isfahan (Iran, Islamic Republic of); Moallem, Mehdi, E-mail: moallem@cc.iut.ac.ir [Department of Electrical Engineering, Isfahan University of Technology, Isfahan (Iran, Islamic Republic of)

    2015-03-15

    In applications in which the high torque per ampere at low speed and rated power at high speed are required, the continuous current method is the best solution. However, there is no report on calculating the core loss of SRM in continuous current mode of operation. Efficiency and iron loss calculation which are complex tasks in case of conventional mode of operation is even more involved in continuous current mode of operation. In this paper, the Switched Reluctance Motor (SRM) is modeled using finite element method and core loss and copper loss of SRM in discontinuous and continuous current modes of operation are calculated using improved analytical techniques to include the minor loop losses in continuous current mode of operation. Motor efficiency versus speed in both operation modes is obtained and compared. - Highlights: • Continuous current method for Switched Reluctance Motor (SRM) is explained. • An improved analytical technique is presented for SRM core loss calculation. • SRM losses in discontinuous and continuous current operation modes are presented. • Effect of mutual inductances on SRM performance is investigated.

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

    Science.gov (United States)

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

    2018-03-01

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

  11. Selection of indicators for continuous monitoring of patient safety: recommendations of the project 'safety improvement for patients in Europe'

    DEFF Research Database (Denmark)

    Kristensen, Solvejg; Mainz, Jan; Bartels, Paul

    2009-01-01

    such as culture, infections, surgical complications, medication errors, obstetrics, falls and specific diagnostic areas. CONCLUSION: The patient safety indicators recommended present a set of possible measures of patient safety. One of the future perspectives of implementing patient safety indicators...... for systematic monitoring is that it will be possible to continuously estimate the prevalence and incidence of patient safety quality problems. The lesson learnt from quality improvement is that it will pay off in terms of improving patient safety....

  12. Life Improvement of Pot Hardware in Continuous Hot Dipping Processes Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Xingbo Liu

    2006-01-18

    The process of continuous galvanizing of rolled sheet steel includes immersion into a bath of molten zinc/aluminum alloy. The steel strip is dipped in the molten bath through a series of driving motors and rollers which control the speed and tension of the strip, with the ability to modify both the amount of coating applied to the steel as well as the thickness and width of the sheet being galvanized. There are three rolls used to guide the steel strip through the molten metal bath. The rolls that operate in the molten Zn/Al are subject to a severely corrosive environment and require frequent changing. The performance of this equipment, the metallic hardware submerged in the molten Zn/Al bath, is the focus of this research. The primary objective of this research is to extend the performance life of the metallic hardware components of molten Zn/Al pot hardware by an order of magnitude. Typical galvanizing operations experience downtimes on the order of every two weeks to change the metallic hardware submerged in the molten metal bath. This is an expensive process for industry which takes upwards of 3 days for a complete turn around to resume normal operation. Each roll bridle consists of a sink, stabilizer, and corrector roll with accompanying bearing components. The cost of the bridle rig with all components is as much as $25,000 dollars just for materials. These inefficiencies are of concern to the steel coating companies and serve as a potential market for many materials suppliers. This research effort served as a bridge between the market potential and industry need to provide an objective analytical and mechanistic approach to the problem of wear and corrosion of molten metal bath hardware in a continuous sheet galvanizing line. The approach of the investigators was to provide a means of testing and analysis that was both expeditious and cost effective. The consortium of researchers from West Virginia University and Oak Ridge National Laboratory developed

  13. Lunabotics Mining Competition: Inspiration Through Accomplishment

    Science.gov (United States)

    Mueller, Robert P.

    2011-01-01

    NASA's Lunabotics Mining Competition is designed to promote the development of interest in space activities and STEM (Science, Technology, Engineering, and Mathematics) fields. The competition uses excavation, a necessary first step towards extracting resources from the regolith and building bases on the moon. The unique physical properties of lunar regolith and the reduced 1/6th gravity, vacuum environment make excavation a difficult technical challenge. Advances in lunar regolith mining have the potential to significantly contribute to our nation's space vision and NASA space exploration operations. The competition is conducted annually by NASA at the Kennedy Space Center Visitor Complex. The teams that can use telerobotic or autonomous operation to excavate a lunar regolith geotechnical simulant, herein after referred to as Black Point-1 (or BP-1) and score the most points (calculated as an average of two separate 10-minute timed competition attempts) will eam points towards the Joe Kosmo Award for Excellence and the scores will reflect ranking in the on-site mining category of the competition. The minimum excavation requirement is 10.0 kg during each competition attempt and the robotic excavator, referred to as the "Lunabot", must meet all specifications. This paper will review the achievements of the Lunabotics Mining Competition in 2010 and 2011, and present the new rules for 2012. By providing a framework for robotic design and fabrication, which culminates in a live competition event, university students have been able to produce sophisticated lunabots which are tele-operated. Multi-disciplinary teams are encouraged and the extreme sense of accomplishment provides a unique source of inspiration to the participating students, which has been shown to translate into increased interest in STEM careers. Our industrial sponsors (Caterpillar, Newmont Mining, Harris, Honeybee Robotics) have all stated that there is a strong need for skills in the workforce related

  14. Some History and Accomplishments of the IUSS

    Science.gov (United States)

    Brevik, Eric C.; Hartemink, Alfred E.

    2013-04-01

    Urban Soils) and three standing committees (Committee on awards and prizes, Committee on budget and finances, and Committee on statutes and byelaws). Membership in ISSS/IUSS increased from around 550 after WWII to over 60,000 today. The IUSS also provides Honorary Membership to soil scientists who have significant accomplishments in the field; to date 87 soil scientists have been so recognized from all over the globe. The IUSS is the most important global link to the world's leading soil science and soil scientists.

  15. A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

    Science.gov (United States)

    Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

    2018-02-21

    Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p improving RSI intubation performance in a large air medical company.

  16. Continuous desalting of refolded protein solution improves capturing in ion exchange chromatography: A seamless process.

    Science.gov (United States)

    Walch, Nicole; Jungbauer, Alois

    2017-06-01

    Truly continuous biomanufacturing processes enable an uninterrupted feed stream throughout the whole production without the need for holding tanks. We have utilized microporous anion and cation exchangers into which only salts, but not proteins, can penetrate into the pores for desalting of protein solutions, while diafiltration or dilution is usually employed for feed adjustments. Anion exchange and cation exchange chromatography columns were connected in series to remove both anions and cations. To increase operation performance, a continuous process was developed comprised of four columns. Continuous mode was achieved by staggered cycle operation, where one set of columns, consisting of one anion exchange and one cation exchange column, was loaded during the regeneration of the second set. Refolding, desalting and subsequent ion exchange capturing with a scFv as the model protein was demonstrated. The refolding solution was successfully desalted resulting in a consistent conductivity below 0.5 mS/cm from initial values of 10 to 11 mS/cm. With continuous operation process time could be reduced by 39% while productivity was increased to 163% compared to batch operation. Desalting of the protein solution resulted in up to 7-fold higher binding capacities in the subsequent ion exchange capture step with conventional protein binding resins. © 2017 The Authors. Biotechnology Journal published by WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  17. Improvement of the mechanical and frictional properties of steels by continuous and pulsed ion irradiation

    International Nuclear Information System (INIS)

    Romanov, I.G.

    1992-01-01

    Effect of continuous and powerful pulsed ion beams (PIB) on structural, mechanical, tribological properties and surface morphology of steels were investigated. The results obtained demonstrate the significant influence of ion irradiation type on microhardness, friction coefficient, wear resistance and surface roughness characteristics. Friction coefficient variation in irradiated steels is interpreted within the framework of an adhesion-deformation model

  18. Continuous quality improvement based on Lean Six Sigma in manufacturing small and medium sized enterprises

    NARCIS (Netherlands)

    Timans, Werner

    2014-01-01

    Kleine en middelgrote bedrijven uit de maakindustrie ervaren toenemende eisen met betrekking tot de kwaliteit van producten en processen. Om in competitie te blijven is voortdurend verbeteren van cruciaal belang, en de Lean Six Sigma benadering biedt veelbelovende mogelijkheden om continu verbeteren

  19. Direct Measurement and Evaluation for Mechanical Engineering Programme Outcomes: Impact on Continuous Improvement

    Science.gov (United States)

    Tahir, Mohd Faizal Mat; Khamis, Nor Kamaliana; Wahid, Zaliha; Ihsan, Ahmad Kamal Ariffin Mohd; Ghani, Jaharah Ab; Sabri, Mohd Anas Mohd; Sajuri, Zainuddin; Abdullah, Shahrum; Sulong, Abu Bakar

    2013-01-01

    Universiti Kebangsaan Malaysia (UKM) is a research university that continuously undergoes an audit and accreditation process for the management of its courses. The Faculty of Engineering and the Built Environment (FKAB) is subjected to such processes, one of them is the auditing conducted by the Engineering Accreditation Council (EAC), which gives…

  20. Continuous water-quality monitoring to improve lake management at Lake Mattamuskeet National Wildlife Refuge

    Science.gov (United States)

    Michelle Moorman; Tom Augspurger

    2016-01-01

    The U.S. Fish and Wildlife Service has partnered with U.S. Geological Survey to establish 2 continuous water-quality monitoring stations at Lake Mattamuskeet. Stations on the east and west side of the lake measure water level, clarity, dissolved oxygen, pH, temperature, salinity, and conductivity.

  1. No More "Magic Aprons": Longitudinal Assessment and Continuous Improvement of Customer Service at the University of North Dakota Libraries

    Science.gov (United States)

    Clark, Karlene T.; Walker, Stephanie R.

    2017-01-01

    The University of North Dakota (UND) Libraries have developed a multi-award winning Customer Service Program (CSP) involving longitudinal assessment and continuous improvement. The CSP consists of iterative training modules; constant reinforcement of Customer Service Principles with multiple communication strategies and tools, and incentives that…

  2. A Model of Continuous Improvement in High Schools: A Process for Research, Innovation Design, Implementation, and Scale

    Science.gov (United States)

    Cohen-Vogel, Lora; Cannata, Marisa; Rutledge, Stacey A.; Socol, Allison Rose

    2016-01-01

    This chapter describes a model for continuous improvement that guides the work of the National Center on Scaling Up Effective Schools, or NCSU. NCSU is a research and development center funded by the Institute for Education Sciences, the research arm of the United States Department of Education. At the core of the Center's work is an innovative…

  3. The Handover Project: Improving the continuity of patient care through identification and implementation of novel patient handoff processes in Europe

    NARCIS (Netherlands)

    Drachsler, Hendrik; Kicken, Wendy; Van der Klink, Marcel; Stoyanov, Slavi; Boshuizen, Els

    2011-01-01

    Drachsler, H., Kicken, W., Van der Klink, M., Stoyanov, S., & Boshuizen, H. P. A. (2011, 21 March). The Handover project: Improving the continuity of patient care through identification and implementation of novel patient handoff processes in Europe. Presentation at Learning Networks meeting,

  4. Continuous Improvement in the Public School Context: Understanding How Educators Respond to Plan-Do-Study-Act Cycles

    Science.gov (United States)

    Tichnor-Wagner, Ariel; Wachen, John; Cannata, Marisa; Cohen-Vogel, Lora

    2017-01-01

    The last 5 years have witnessed growing support amongst government institutions and educational foundations for applying continuous improvement research (CIR) in school settings. CIR responds to the challenge of implementing effective educational innovations at scale by working with practitioners in local contexts to understand "what works,…

  5. Continuous Improvement in the Public School Context: Understanding Educator Responses to Plan-Do-Study-Act Cycles

    Science.gov (United States)

    Tichnor-Wagner, Ariel; Wachen, John; Cannata, Marisa; Cohen-Vogel, Lora

    2017-01-01

    The last 5 years have witnessed growing support amongst government institutions and educational foundations for applying continuous improvement research (CIR) in school settings. CIR responds to the challenge of implementing effective educational innovations at scale by working with practitioners in local contexts to understand ''what works, for…

  6. The Use of System Thinking Concepts in Order to Assure Continuous Improvement of Project Based Learning Courses

    Science.gov (United States)

    Arantes do Amaral, Joao Alberto; Gonçalves, Paulo

    2015-01-01

    This case study describes a continuous improvement experience, conducted from 2002 to 2014 in Sao Paulo, Brazil, within 47 Project-Based Learning MBA courses, involving approximately 1,400 students. The experience report will focus on four themes: (1) understanding the main dynamics present in MBA courses; (2) planning a systemic intervention in…

  7. Interval-Valued Hesitant Fuzzy Multiattribute Group Decision Making Based on Improved Hamacher Aggregation Operators and Continuous Entropy

    Directory of Open Access Journals (Sweden)

    Jun Liu

    2017-01-01

    Full Text Available Under the interval-valued hesitant fuzzy information environment, we investigate a multiattribute group decision making (MAGDM method with continuous entropy weights and improved Hamacher information aggregation operators. Firstly, we introduce the axiomatic definition of entropy for interval-valued hesitant fuzzy elements (IVHFEs and construct a continuous entropy formula on the basis of the continuous ordered weighted averaging (COWA operator. Then, based on the Hamacher t-norm and t-conorm, the adjusted operational laws for IVHFEs are defined. In order to aggregate interval-valued hesitant fuzzy information, some new improved interval-valued hesitant fuzzy Hamacher aggregation operators are investigated, including the improved interval-valued hesitant fuzzy Hamacher ordered weighted averaging (I-IVHFHOWA operator and the improved interval-valued hesitant fuzzy Hamacher ordered weighted geometric (I-IVHFHOWG operator, the desirable properties of which are discussed. In addition, the relationship among these proposed operators is analyzed in detail. Applying the continuous entropy and the proposed operators, an approach to MAGDM is developed. Finally, a numerical example for emergency operating center (EOC selection is provided, and comparative analyses with existing methods are performed to demonstrate that the proposed approach is both valid and practical to deal with group decision making problems.

  8. Using a predictive model of clinician intention to improve continuing health professional education on cancer survivorship.

    Science.gov (United States)

    Buriak, S E; Potter, J; Bleckley, M Kathryn

    2015-01-01

    Cancer survivorship is a chronic disease that places patients in limbo between oncologists and primary care clinicians. Strategies have been proposed to ease the shift in coordination of care, including broad-based educational outreach to primary care providers. Guided by the theory of planned behavior (TPB), predictors of intention to provide survivorship care, including credentials, experience, perception of barriers, and personal survivorship status, were evaluated using logistic regression with a cohort of physicians, nurse practitioners, and registered nurses participating in an unprecedented online continuing medical education/continuing education survivorship care course. Results showed that physicians were significantly less likely to express intent to provide survivorship care (odds ratio [OR] = .237, p = .0001) compared to the other groups. Overall, clinicians with 6-10 years of experience were 3 times more likely to express intent to provide survivorship care (OR = 2.86, p = .045) than those with less or more experience. When clinicians perceived the presence of a barrier, they were nearly twice as likely to have diminished intent (OR = 1.89, p = .035). Most participants (66%; n = 1185) selected two barriers: lack of survivorship care plans and treatment summaries (45.4%; n = 821) and lack of education (20.1%; n = 364). Barriers to the delivery of survivorship care can influence clinicians' intention to provide survivorship care, which varied by years of experience in this study. Interdisciplinary educational strategies featuring midcareer provider champions who have successfully incorporated survivorship care and can offer specific solutions to these barriers are recommended for future interventions. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  9. [Progress in improvement of continuous monoculture cropping problem in Panax ginseng by controlling soil-borne disease management].

    Science.gov (United States)

    Wang, Rui; Dong, Lin-Lin; Xu, Jiang; Chen, Jun-Wen; Li, Xi-Wen; Chen, Shi-Lin

    2016-11-01

    The continuous monoculture cropping problem severely has hindered the land resource of Panax ginseng cultivation and threatened the sustainable development of ginseng industry. There are comprehensive factors causing the continuous monoculture cropping problem, such as deterioration of soil physical and chemical properties, accumulation of allelochemical, increase of pesticide residue and heavy metal, imbalance of rhizospheric micro-ecosystem, and increase of soil-borne diseases. Among soil-borne disease was one of the key factors. More than 40 soil-borne diseases have been reported in the ginseng cultivation, especially, the diseases were more serious in the ginseng replanting land. Here main soil-borne diseases and their prevention way have been summarized, and we try to provide the effective improvement strategy of continuous monoculture cropping problem focusing on the disease control and offer reference for overcoming the ginseng continuous monoculture cropping problem. Copyright© by the Chinese Pharmaceutical Association.

  10. Nuclear power-accomplishments and prospects

    International Nuclear Information System (INIS)

    Anon.

    1989-01-01

    Nuclear energy is probably unique in being an international endeavor. The US was correct in 1973 in embracing nuclear energy, and is correct even today in continuing to champion and push this technology. Several major events justify this view. They include: the world's growing dependence on oil and America's increasing dependence on the unstable Middle East; steady high growth in electricity demand; culminated in this summer's record peak demands across the country, and while it was a hot summer, most of that increased demand was industrial activity-economic activity-not due to heat and renewed emphasis on the environment. The job of nuclear utilities and manufacturers is to work with continuity towards greater reliability, safety, and economy of our plants as they exist today. Nuclear power offers clear objective advantages if one is able to look beyond the illusions of the immediate situation. Taipower believes that nuclear power should be the major energy resource for Taiwan in the future. The first problem facing Taipower is the long lead time required for project approval. The second problem Taipower faces is the difficulty in obtaining a public consensus. Three main rational and irrational reasons are decisive for this future development of nuclear energy in Germany: energy structure, economics, and public acceptance. The use of nuclear energy is ethically not irresponsible, but it is ethically irresponsible not to use nuclear energy. A lot of modifications on the European plants have taken place to try to minimize the chance of having an accident and, in case it should happen, to limit the consequences. Another problem is waste deposits. As long as there is no answer to this question, the public will continue to debate on this issue

  11. Provider-Payer Partnerships as an Engine for Continuous Quality Improvement.

    Science.gov (United States)

    Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay

    2018-03-01

    The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

  12. Cementitious Barriers Partnership Accomplishments And Relevance To The DOE Complex

    International Nuclear Information System (INIS)

    Burns, H.; Langton, C.; Flach, G.; Kosson, D.

    2010-01-01

    The Cementitious Barriers Partnership (CBP) was initiated to reduce risk and uncertainties in the performance assessments that directly impact U.S. Department of Energy (DOE) environmental cleanup and closure programs. The CBP is supported by the DOE Office of Environmental Management (DOE-EM) and has been specifically addressing the following critical EM program needs: (i) the long-term performance of cementitious barriers and materials in nuclear waste disposal facilities and (ii) increased understanding of contaminant transport behavior within cementitious barrier systems to support the development and deployment of adequate closure technologies. To accomplish this, the CBP has two initiatives: (1) an experimental initiative to increase understanding of changes in cementitious materials over long times (> 1000 years) over changing conditions and (2) a modeling initiative to enhance and integrate a set of computational tools validated by laboratory and field experimental data to improve understanding and prediction of the long-term performance of cementitious barriers and waste forms used in nuclear applications. In FY10, the CBP developed the initial phase of an integrated modeling tool that would serve as a screening tool which could help in making decisions concerning disposal and tank closure. The CBP experimental programs are underway to validate this tool and provide increased understanding of how CM changes over time and under changing conditions. These initial CBP products that will eventually be enhanced are anticipated to reduce the uncertainties of current methodologies for assessing cementitious barrier performance and increase the consistency and transparency of the DOE assessment process. These tools have application to low activity waste forms, high level waste tank closure, D and D and entombment of major nuclear facilities, landfill waste acceptance criteria, and in-situ grouting and immobilization of vadose zone contamination. This paper

  13. An Experimental Investigation to Facilitate an Improvement in the Design of an Electromagnetic Continuous Casting Mould

    Directory of Open Access Journals (Sweden)

    Lintao Zhang

    2016-04-01

    Full Text Available An electromagnetic continuous casting mould designed is proposed with a non-uniform slit distribution structure. This design has aimed to reduce the number of slits so that the mould’s strength is enhanced, whilst maintaining a similar metallurgy effect. In this paper, the metallurgy effect for the designed mould is investigated through the magnetic field distribution along the casting direction, the uniformity feature in the vicinity of the meniscus region, the temperature variation of the molten alloy pool and the mould wall. The results show that the designed mould achieved a similar effect as compared to the original mould; however, the configuration is simplified. This research highlights the topic of mould structure optimization, which would enable the Electromagnetic continuous casting (EMCC technique to be utilized with greater ease by industry.

  14. Continuous light-emitting Diode (LED) lighting for improving food quality

    OpenAIRE

    Lu, C; Bian, Z

    2016-01-01

    Lighting-emitting diodes (LEDs) have shown great potential for plant growth and development, with higher luminous efficiency and positive impact compared with other artificial lighting. The combined effects of red/blue or/and green, and white LED light on plant growth and physiology, including chlorophyll fluorescence, nitrate content and phytochemical concentration before harvest, were investigated. The results showed that continuous light (CL)\\ud exposure at pre-harvest can effectively redu...

  15. An improved simplified model predictive control algorithm and its application to a continuous fermenter

    Directory of Open Access Journals (Sweden)

    W. H. Kwong

    2000-06-01

    Full Text Available The development of a new simplified model predictive control algorithm has been proposed in this work. The algorithm is developed within the framework of internal model control, and it is easy to understanding and implement. Simulation results for a continuous fermenter, which show that the proposed control algorithm is robust for moderate variations in plant parameters, are presented. The algorithm shows a good performance for setpoint tracking.

  16. Study on improvement of continuous hydrogen production by photosynthetic biofilm in interior illuminant reactor.

    Science.gov (United States)

    Liu, Wenhui; Yuan, Linjiang; Wei, Bo

    2016-09-01

    In the present study, a new type of interior optical fiber illuminating reactor was developed for H2 production to solve the problem of luminous intensity attenuation at the center portion of a reactor, and an immobilization technique was used to enhance the stability of a continuous hydrogen production process with attached photosynthetic bacteria, using glucose as a sole carbon substrate for the indigenous photosynthetic bacteria (PSB) Rhodopseudomonas palustris SP-6. Results of the experiments showed that the interior optical fiber illuminating reactor produces H2 more efficiently and productively than the exterior light source reactor, with the cumulative H2 production, the maximum H2 production rate and H2 yield increased by 813ml, 11.3ml l-1 h-1 and 22.3%, respectively. The stability of the product of continuous hydrogen was realized by immobilizing PSB on the surface of powder active carbon(PAC). After adding the dosage of 2.0g l-1 PAC, the continuous steady operation of H2 production gave a high H2 yield of 1.398 mol H2 mol-1 glucose and an average H2 production rate of 35.1ml l-1 h-1 illuminating with a single interior optical fiber light source. Meanwhile, a higher H2 yield of 1.495 mol H2 mol-1 glucose and an average H2 production rate of 38.7ml l-1 h-1 were attained illuminating with a compound lamp in the continuous H2 production for 20 days.

  17. Framework for Continuous Assessment and Improvement of Occupational Health and Safety Issues in Construction Companies

    OpenAIRE

    Mahmoudi, Shahram; Ghasemi, Fakhradin; Mohammadfam, Iraj; Soleimani, Esmaeil

    2014-01-01

    Background: Construction industry is among the most hazardous industries, and needs a comprehensive and simple-to-administer tool to continuously assess and promote its health and safety performance. Methods: Through the study of various standard systems (mainly Health, Safety, and Environment Management System; Occupational Health and Safety Assessment Series 180001; and British Standard, occupational health and safety management systems-Guide 8800), seven main elements were determined fo...

  18. A summary of deliberations on strategic planning for continuous quality improvement in laboratory medicine.

    Science.gov (United States)

    Grzybicki, Dana Marie; Shahangian, Shahram; Pollock, Anne M; Raab, Stephen S

    2009-03-01

    On September 24-26, 2007, the Centers for Disease Control and Prevention convened the 2007 Institute on Critical Issues in Health Laboratory Practice: Managing for Better Health to develop an action plan for change for the immediate and long-term future. A wide variety of stakeholders, including pathologists, pathologist extenders, clinicians, and researchers, examined means to improve laboratory service communication, quality parameters, and potential future laboratory contributions to health care. In this summary document, we present the identified gaps, barriers, and proposed action plans for improvement for laboratory medicine in the 6 quality domains identified by the Institute of Medicine: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. Five major recommendations emerged from concluding discussions and included focusing on preanalytic and postanalytic processes as areas of potential quality improvement and recruiting a multidisciplinary group of nonlaboratory stakeholders to work with laboratory personnel to achieve improvement goals.

  19. Improvement of Inventory Control Using Continuous Review Policy in A Local Hospital at Bandung City, Indonesia

    Directory of Open Access Journals (Sweden)

    Fina Hafnika

    2016-12-01

    Full Text Available Abstract. This research was aimed to analyze the excess inventories issue in pharmacy and medical equipment unit at a local hospital in Bandung which affected the service level of the hospital. As one of the busy hospital in Java, proven by the higher amount of the patient/year than in other average Java typical hospital, the hospital needs to concern about the pharmaceutical and medical equipment inventories in order to fulfill patients’ needs and in the same time keeping the inventory level under control. Therefore, an inventory control evaluation was conducted to determine the appropriate number of inventories and time of order to avoid the excessive goods in central warehouse of the hospital. By using probabilistic inventory model and continuous review policy, the pharmaceutical inventory in the hospital was calculated to compare the ideal and actual amount of the average inventory level (AIL. ABC (Always, Better, Control classification also classified in this research to identify the proper item which potentially can be reduced from the inventory. From the analysis, we have discovered that the hospital potentially able to reduce almost Rp 830 million or 57% from the overstock inventory level by using continuous review policy as the basis of inventory control calculation system. Keywords: Continuous review policy, inventory control, EOQ, ROP, AIL

  20. Continuous microwave pasteurization of a vegetable smoothie improves its physical quality and hinders detrimental enzyme activity.

    Science.gov (United States)

    Arjmandi, Mitra; Otón, Mariano; Artés, Francisco; Artés-Hernández, Francisco; Gómez, Perla A; Aguayo, Encarna

    2017-01-01

    The effect of a pasteurization treatment at 90 ± 2 ℃ for 35 s provided by continuous microwave under different doses (low power/long time and high power/short time) or conventional pasteurization on the quality of orange-colored smoothies and their changes throughout 45 days of storage at 5 ℃ was investigated. A better color retention of the microwave pasteurization- treated smoothie using high power/short time than in conventionally processed sample was evidenced by the stability of the hue angle. The continuous microwave heating increased the viscosity of the smoothie more than the conventional pasteurization in comparison with non-treated samples. Lower residual enzyme activities from peroxidase, pectin methylesterase and polygalacturonase were obtained under microwave heating, specifically due to the use of higher power/shorter time. For this kind of smoothie, polygalacturonase was the more thermo-resistant enzyme and could be used as an indicator of pasteurization efficiency. The use of a continuous semi-industrial microwave using higher power and shorter time, such as 1600 W/206 s and 3600 W/93 s, resulted in better quality smoothies and greater enzyme reduction than conventional thermal treatment. © The Author(s) 2016.

  1. Improvement of Oxygenation in Severe Acute Respiratory Distress Syndrome With High-Volume Continuous Veno-venous Hemofiltration.

    Science.gov (United States)

    Yang, Wenmin; Hong, Jie; Zeng, Qiyi; Tao, Jianping; Chen, Feiyan; Dang, Run; Liang, Yufeng; Wu, Zhiyuan; Yang, Yiyu

    2016-01-01

    The efficacy and therapeutic mechanisms of continuous renal replacement therapy (CRRT) for improvement of oxygenation in acute respiratory distress syndrome (ARDS) remain controversial. These questions were addressed by retrospective analysis of severe ARDS patients admitted to the pediatric intensive care unit of our hospital from 2009 to 2015 who received high-volume continuous veno-venous hemofiltration during mechanical ventilation. There was a significant improvement in partial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) 24 hours after CRRT onset compared with baseline (median change = 51.5; range = -19 to 450.5; P Improvement in oxygenation is likely related to both restoration of fluid balance and clearance of inflammatory mediators.

  2. The continuous improvement of the Internal Audits Process assurance the effective compliance of ISO 17025:2005 requirements

    Directory of Open Access Journals (Sweden)

    Carina Di Candia

    2011-04-01

    Full Text Available Continuous Improvement Process started in LATU in 1996. The Impact was so important that covered all the organization. Nowadays LATU has almost all its processes certificated and most than 200 tests accredited. The Internal Audits process began in 1996 with an annual planning for all the laboratory's areas. For the UKAS accreditation in 1998, LATU improves the internal audits planning auditing not only the system but also the tests. In 1999 LATU was certified by SQS and accredited the calibrations by DKD. Since 2004 internal audits was managed as a process; in order to that was defined objectives, indicators, achievements and the necessary resources of the internal audit programme and process. The internal audit programme has a pre defined tri annual planning that includes all the laboratory areas. The results of the measures obtained till now demonstrate the improvement in the internal audit and all the laboratory processes. Auditors final staff increase their technical competence. As a consequence of managing the internal audits as a process, the internal communication has an important relevance to feedback the continuous improvement of the laboratory. This was evidence in a decrease of the documentaries non conformities, improvement of the calibrations and maintenance programme, optimization trainings and qualifications of the staff, common internal trainings, creation of a quality assurance team to improvement the tests control, improvement in the relationship with the support areas. Most of this requirements are included in ISO 17025:2005; that assurance the effective compliance of this standard.

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

    Science.gov (United States)

    Barnas, Kim

    2011-09-01

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

  4. Sandia Technology engineering and science accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    This report briefly discusses the following research being conducted at Sandia Laboratories: Advanced Manufacturing -- Sandia technology helps keep US industry in the lead; Microelectronics-Sandia`s unique facilities transform research advances into manufacturable products; Energy -- Sandia`s energy programs focus on strengthening industrial growth and political decisionmaking; Environment -- Sandia is a leader in environmentally conscious manufacturing and hazardous waste reduction; Health Care -- New biomedical technologies help reduce cost and improve quality of health care; Information & Computation -- Sandia aims to help make the information age a reality; Transportation -- This new initiative at the Labs will help improve transportation, safety,l efficiency, and economy; Nonproliferation -- Dismantlement and arms control are major areas of emphasis at Sandia; and Awards and Patents -- Talented, dedicated employees are the backbone of Sandia`s success.

  5. INPP safety upgrade programme. Accomplishments and progress

    International Nuclear Information System (INIS)

    Vaisnys, P.

    1996-01-01

    The safety upgrade programme consists of the following parts: Post Chernobyl immediate modifications undertaken to remove obvious deficiencies discovered in the course of analysis of the main causes of Chernobyl accident; Modifications to remove gaps in safety provision discovered as a result of safety assessment investigations; Modifications to remove evident discrepancies in respect to internationally accepted standard. As it follows from above the deep safety investigations were undertaken to put their findings into concrete improvement programme

  6. Continuous Exercise but Not High Intensity Interval Training Improves Fat Distribution in Overweight Adults

    Directory of Open Access Journals (Sweden)

    Shelley E. Keating

    2014-01-01

    Full Text Available Objective. The purpose of this study was to assess the effect of high intensity interval training (HIIT versus continuous aerobic exercise training (CONT or placebo (PLA on body composition by randomized controlled design. Methods. Work capacity and body composition (dual-energy X-ray absorptiometry were measured before and after 12 weeks of intervention in 38 previously inactive overweight adults. Results. There was a significant group × time interaction for change in work capacity (P<0.001, which increased significantly in CONT (23.8±3.0% and HIIT (22.3±3.5% but not PLA (3.1±5.0%. There was a near-significant main effect for percentage trunk fat, with trunk fat reducing in CONT by 3.1±1.6% and in PLA by 1.1±0.4%, but not in HIIT (increase of 0.7±1.0% (P=0.07. There was a significant reduction in android fat percentage in CONT (2.7±1.3% and PLA (1.4±0.8% but not HIIT (increase of 0.8±0.7% (P=0.04. Conclusion. These data suggest that HIIT may be advocated as a time-efficient strategy for eliciting comparable fitness benefits to traditional continuous exercise in inactive, overweight adults. However, in this population HIIT does not confer the same benefit to body fat levels as continuous exercise training.

  7. Improving indoor conditions of a Thai-style mushroom house by means of an evaporative cooler and continuous ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Thepa, S.; Kirtikara, K.; Hirunlabh, J.; Khedari, J. [King Mongkut' s Univ. of Technology, School of Energy and Materials, Bangkok (Thailand)

    1999-07-01

    The paper discusses the effect of an evaporative cooling process and continuous ventilation for improving the indoor conditions of a conventional Thai-style mushroom house. A numerical model describing the behaviour of the Thai-style mushroom house model was developed. It was validated by comparing its output with that of the experiment of a small model of a mushroom house. It was found that the combination of evaporative cooling and continuous ventilation reduced the temperature and increased the relative humidity of air inside a mushroom house that is suitable for growing Lentinus. (Author)

  8. Improvement in a degassing chamber with continuous operation and arrangement for distillation sublimation, etc

    Energy Technology Data Exchange (ETDEWEB)

    Lurmann, F

    1881-05-25

    The degassing chambers shown in Patent 13,021 are combined with a receiver. Through arrangement of more roomy sucking openings for the distillation products, a continual partial recovery of the coke oven gases rich in different valuable constituents is attained. Arches lie over the degassing chamber and extend to the gas-burning rooms; to prevent their burning through. They remain directly in communication with the atmosphere and are on the top of the gasification room above the final arches. The charging of the various degassing rooms can be carried out by the usual charging apparatus, which runs lengthwise on rails on the degassing chambers.

  9. The potential of Arachis pintoi biomass to improve quality of soil continuously used for cassava cropping

    OpenAIRE

    N. Muddarisna; S. Prijono

    2014-01-01

    A field experiment that was aimed to elucidate the effects of application of Arachis pintoi biomass and animal dung on quality of soil continuously used for cassava cropping was conducted at Jatikerto Village, Kromengan District of Malang Regency. Eight treatments tested were 100% NPK inorganic fertilizer, 100 kg N Arachis pintoi/ha, (3) 100 kg N chicken dung / ha, 100 kg N cow dung /ha, 100 kg N goat dung /ha, 100 kg N Arachis pintoi + chicken dung /ha, 100 kg N Arachis pintoi + cow dung /h...

  10. [Student evaluation of anesthesiological teaching: steering instrument of a continuous improvement process].

    Science.gov (United States)

    Wittmann, M; Boehm, O; Thiessen, N; Hoeft, A; Knuefermann, P; Baumgarten, G

    2012-07-01

    The amendment to the higher education act ("Hochschulrahmengesetz") of 1998 postulates an evaluation of teaching for quality assurance. Hence, in the winter semester of 2004 the University Medical Center of Bonn introduced a semester questionnaire for students to evaluate the quality of teaching (EVALON). This evaluation is designed to be an objective benchmarking tool which is used for the distribution of university funds. It is also a steering instrument for direct improvement of teaching in clinical subjects. The aim of this study was to investigate, whether EVALON improved the quality of teaching between 2006 and 2010 and whether the department of anesthesiology improved its ranking in comparison with the other participating institutes. Data from the EVALON questionnaire from the years 2006-2010 were analyzed for improvements in the quality of teaching in anesthesiology. This study focused on three essential contents of the EVALON questionnaire (structural content and organizational procedure of lectures and seminars, course presentation), which were used for the generation of a ranking list of all participating medical institutes and departments. On the basis of these results, 12.5% of the funding was assigned for educational purposes. There was an average return rate of the questionnaires of 74.5%. A significant increase in the overall assessment score of 43.4% could be observed from 5.3 in the summer semester of 2006 to 7.6 in the winter semester of 2009/10. The evaluation score for the department of anesthesiology concerning structural content of seminars and lectures increased by 79% from 4.8 in 2006 to 8.6 in 2010. The quality of organizational procedure was evaluated with a score of 4.9 in 2006 and improved by 74% to 8.5 in 2010. The course presentation skills of the teachers as evaluated by EVALON improved by 61% from a score of 5.2 in 2006 to 8.4 in 2010. In comparison with all other participating medical institutes the department of anesthesiology

  11. Continuous Energy Improvement in Motor Driven Systems - A Guidebook for Industry

    Energy Technology Data Exchange (ETDEWEB)

    Gilbert A. McCoy and John G. Douglass

    2014-02-01

    This guidebook provides a step-by-step approach to developing a motor system energy-improvement action plan. An action plan includes which motors should be repaired or replaced with higher efficiency models, recommendations on maintaining a spares inventory, and discussion of improvements in maintenance practices. The guidebook is the successor to DOE’s 1997 Energy Management for Motor Driven Systems. It builds on its predecessor publication by including topics such as power transmission systems and matching driven equipment to process requirements in addition to motors.

  12. Continuous improvement for the firm's competitiveness: implementation of a new management model

    Directory of Open Access Journals (Sweden)

    Rabia Azzemou

    2018-01-01

    Full Text Available To get ready for the hard international competition, firms have to convince themselves of the pressing necessity of optimizing its competitiveness factors. In this perspective, this article proposes a general model of management system of firms through the implementation of tools of Lean Manu-facturing. This method establishes an approach to introduce an action plan to improve the perfor-mance of a firm. Knowing that the Algerian firms do not escape the constraints of competitiveness, the adopted model is applied to two strategic firms of the Algerian industry and the final result gives a series of measures to improve their competitiveness and their performances, simultaneously.

  13. Implementing 'Continuous Improvement' in the U.S. Nuclear Regulatory Commission's Decommissioning Program

    International Nuclear Information System (INIS)

    Orlando, D. A.; Buckley, J. T.; Johnson, R. L.; Gillen, D. M.

    2006-01-01

    The United States Nuclear Regulatory Commission's (US NRC's) comprehensive decommissioning program encompasses the decommissioning of all US NRC licensed facilities, ranging from the termination of routine licenses for sealed sources, to the closure of complex materials sites and nuclear power reactor facilities. Of the approximately 200 materials licenses that are terminated each year, most are routine and require little, if any, remediation to meet the US NRC unrestricted release criteria. However, some present technical and policy challenges that require large expenditures of resources, including a few complex materials sites that have requested license termination under the restricted-use provisions of 10 CFR 20.1403. Fiscal constraints to reduce budgeted resources in the decommissioning program, as well as concerns over the time to complete the decommissioning process have led to actions to improve the program and use resources more efficiently. In addition, the US NRC's Strategic Plan requires efforts to identify and implement improvements to US NRC programs in order to improve efficiency, effectiveness, timeliness, and openness, of the US NRC's activities, while maintaining the necessary focus on safety. Decommissioning regulations, and more recently the analysis of several issues associated with implementing those regulations, also have been significant catalysts for improvements in the decommissioning program. Actions in response to these catalysts have resulted in a program focused on the management of complex sites in a comprehensive, consistent, and risk-informed manner, as opposed to the past practice of focusing on sites deemed to be problematic. This paper describes the current status of the decommissioning of US NRC-licensed nuclear facilities, including an overview of recent decommissioning project completion efforts. It provides a detailed summary of past, current, and future improvements in the US NRC decommissioning program including the

  14. Recent Accomplishments in Laser-Photovoltaic Wireless Power Transmission

    Science.gov (United States)

    Fikes, John C.; Henley, Mark W.; Mankins, John C.; Howell, Joe T.; Fork, Richard L.; Cole, Spencer T.; Skinner, Mark

    2003-01-01

    Wireless power transmission can be accomplished over long distances using laser power sources and photovoltaic receivers. Recent research at AMOS has improved our understanding of the use of this technology for practical applications. Research by NASA, Boeing, the University of Alabama-Huntsville, the University of Colorado, Harvey Mudd College, and the Naval Postgraduate School has tested various commercial lasers and photovoltaic receiver configurations. Lasers used in testing have included gaseous argon and krypton, solid-state diodes, and fiber optic sources, at wavelengths ranging from the visible to the near infra-red. A variety of Silicon and Gallium Arsenide photovoltaic have been tested with these sources. Safe operating procedures have been established, and initial tests have been conducted in the open air at AMOS facilities. This research is progressing toward longer distance ground demonstrations of the technology and practical near-term space demonstrations.

  15. The efficacy of a continuous quality improvement (CQI) method in a radiological department: comparison with non-CQI control material

    International Nuclear Information System (INIS)

    Laurila, J.; Standertskjoeld-Nordenstam, C.G.; Suramo, I.; Tolppanen, E.M.; Tervonen, O.; Korhola, O.; Brommels, M.

    2000-01-01

    To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department. Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at the OUH (Oulu University Hospital) with a traditional management process. For the CQI project, a team was formed to evaluate the process with flow-charts, cause and effect diagrams, Pareto analysis and control charts. Interventions to improve the process were based on the results of these analyses. The team at the HUCH implemented the following changes: A radiologist was added to the evening shift between 15:00 - 22:00 and a radiographer was moved from the morning shift to 15:00 - 22:00. A clear improvement was achieved in the turn-around time, but in the follow-up some of the gains were lost. Only minimal changes were achieved at the OUH, where the intervention was based on traditional management processes. CQI was an effective method for improving the quality of performance of a radiology department compared with ordinary management methods, but some of this improvement may be subsequently lost without a continuous measurement system

  16. SWAT2: The improved SWAT code system by incorporating the continuous energy Monte Carlo code MVP

    International Nuclear Information System (INIS)

    Mochizuki, Hiroki; Suyama, Kenya; Okuno, Hiroshi

    2003-01-01

    SWAT is a code system, which performs the burnup calculation by the combination of the neutronics calculation code, SRAC95 and the one group burnup calculation code, ORIGEN2.1. The SWAT code system can deal with the cell geometry in SRAC95. However, a precise treatment of resonance absorptions by the SRAC95 code using the ultra-fine group cross section library is not directly applicable to two- or three-dimensional geometry models, because of restrictions in SRAC95. To overcome this problem, SWAT2 which newly introduced the continuous energy Monte Carlo code, MVP into SWAT was developed. Thereby, the burnup calculation by the continuous energy in any geometry became possible. Moreover, using the 147 group cross section library called SWAT library, the reactions which are not dealt with by SRAC95 and MVP can be treated. OECD/NEA burnup credit criticality safety benchmark problems Phase-IB (PWR, a single pin cell model) and Phase-IIIB (BWR, fuel assembly model) were calculated as a verification of SWAT2, and the results were compared with the average values of calculation results of burnup calculation code of each organization. Through two benchmark problems, it was confirmed that SWAT2 was applicable to the burnup calculation of the complicated geometry. (author)

  17. Using a Client Survey to Support Continuous Improvement: An Australian Case Study in Managing Change

    Science.gov (United States)

    Besch, Janice

    2014-01-01

    With the arrival of online survey tools that are low-cost, readily available and easy to administer, all organizations have access to one of the most effective mechanisms for determining quality improvement priorities and measuring progress towards achieving those priorities over time. This case study outlines the use made of this simple tool by a…

  18. A Practical Approach To Identify and Solve Problems: Continuous Improvement Strategies.

    Science.gov (United States)

    Burgess, Michael; And Others

    The current pressures of reduced government funding, lower enrollments, and greater scrutiny by governing boards require institutions of higher education to redesign processes and systems to survive. Despite resistance to Total Quality Management (TQM) in academia, it can provide the tools to implement systemic change and quality improvement.…

  19. Student Voices Speak Quality Assurance: Continual Improvement in Online Social Work Education

    Science.gov (United States)

    Secret, Mary; Bentley, Kia J.; Kadolph, Jessie C.

    2016-01-01

    As social work education expands instruction through the rise of distance education, educators seek new ways to improve quality in online courses. Quality assurance standards and student feedback offer valuable insights to ensure satisfying and effective online learning experiences. An examination of these two assessment approaches concurrently in…

  20. Improving Genetics Education in Graduate and Continuing Health Professional Education: Workshop Summary

    Science.gov (United States)

    Berger, Adam C.; Johnson, Samuel G.; Beachy, Sarah H.; Olson, Steve

    2015-01-01

    Many health care providers do not have either the knowledge or the tools they need in order to apply genetic information in their day-to-day practices. This lack of support is contributing to a substantial delay in the translation of genetic research findings, when appropriate, into improvement in patient outcomes within the health care system.…

  1. Upward Appraisal: A Tool for the Continuous Improvement of Library Managers' Skills.

    Science.gov (United States)

    Stein, Joan E.

    Effective management and the importance of feedback in relation to improvement are becoming critical issues for libraries. Upward appraisal evaluates managers' performance based on input from their staff, rather than the traditional top-down evaluation format in which a manager is evaluated solely by their superior. This paper discusses the…

  2. Continuous Improvement in Online Education: Documenting Teaching Effectiveness in the Online Environment through Observations

    Science.gov (United States)

    Purcell, Jennifer W.; Scott, Heather I.; Mixson-Brookshire, Deborah

    2017-01-01

    Teaching observations are commonly used among educators to document and improve teaching effectiveness. Unfortunately, the necessary protocols and supporting infrastructure are not consistently available for faculty who teach online. This paper presents a brief literature review and reflective narratives of educators representing online education…

  3. Major accomplishments of America's nuclear rocket program (ROVER)

    International Nuclear Information System (INIS)

    Finseth, J.L.

    1991-01-01

    The United States embarked on a program to develop nuclear rocket engines in 1955. This program was known as project Rover. Initially nuclear rockets were considered as a potential backup for intercontinental ballistic missile propulsion but later proposed applications included both a lunar second stage as well as use in manned-Mars flights. Under the Rover program, 19 different reactors were built and tested during the period of 1959-1969. Additionally, several cold flow (non-fuelled) reactors were tested as well as a nuclear fuels test cell. The Rover program was terminated in 1973, due to budget constraints and an evolving political climate. The Rover program would have led to the development of a flight engine had the program continued through a logical continuation. The Rover program was responsible for a number of technological achievements. The successful operation of nuclear rocket engines on a system level represents the pinnacle of accomplishment. This paper will discuss the engine test program as well as several subsystems

  4. A tribute to the life and accomplishments of Birdwell Finlayson.

    Science.gov (United States)

    Yeung, Lawrence L; Vieweg, Johannes W; Khan, Saeed R; Newman, Robert C; Dahm, Philipp

    2008-03-01

    Birdwell Finlayson was a talented researcher and clinician whose pioneering work in the field of urolithiasis led him to worldwide prominence in urology. We researched his life and accomplishments to provide a historical account of his career. The archives of the Department of Urology and the University of Florida Health Science Center Library were searched for publications, photographs and other records relating to Doctor Finlayson. Additionally, we interviewed many of his friends and colleagues for more information. Birdwell Finlayson was born in Pocatello Bannock, Idaho. He completed a urology residency and obtained a Ph.D. in biophysics at the University of Chicago. In 1967 he joined the faculty at the University of Florida. His interest in understanding the fundamentals of stone formation led to the discovery that crystal retention at a site of nephron injury was essential for stone formation. This fixed particle hypothesis continues to serve to as the foundation for urolithiasis research today. His computer model EQUIL is the gold standard for calculating urinary supersaturation with respect to kidney stone formation. Finlayson was 1 of the 6 original coinvestigators for shock wave lithotripsy in the United States. He is also remembered for his wit and his love of aeronautics, as he was a flight instructor and stunt pilot. Finlayson died unexpectedly of idiopathic hypertrophic cardiomyopathy on July 22, 1988. Birdwell Finlayson was an internationally renowned surgeon and stone disease expert whose research continues to serve as the basis of urolithiasis research at the University of Florida and worldwide.

  5. Accelerator mass spectrometry - accomplishments and challenges

    International Nuclear Information System (INIS)

    Elmore, David

    2002-01-01

    Full text: AMS techniques and applications have advanced significantly since the first radiocarbon measurements in 1977. The list of nuclides in routine use includes 10 Be, 14 C, 26 Al, 36 Cl, 41 Ca, and 129 I. Cosmogenic radionuclides now have important applications in the study of earth surface processes and events. Recent biomedical studies include tracing aluminum as a toxic element and as an adjuvant in vaccines, radiocarbon as a tracer for tissue implants, and calcium loss from bones. Improvements in AMS performance for these and new nuclides result from automation, better ion sources, higher energies, and better isobar separation techniques

  6. Building a Foundation of Continuous Improvement in a Rapidly Changing Environment: The Dartmouth-Hitchcock Value Institute Experience.

    Science.gov (United States)

    McGrath, Susan P; Blike, George T

    2015-10-01

    A performance improvement competency development program, known as the Value Institute (VI), was established at Dartmouth-Hitchcock (D-H; Lebanon, New Hampshire) in 2011 to develop a performance improvement-focused workforce and systems capable of meeting the challenges of creating a sustainable health system. A tiered competency development program that provides patient safety, health care quality, and improvement science education, and an execution support infrastructure that enables access to performance improvement tools for all employees, comprise the core of the VI. At 20 months after the launch of the first VI classes, more than 10% of all employees were trained to the Yellow Belt level, and approximately 1.5% of all employees became advanced practitioners (Green Belts or Black Belts). Improvement projects have focused on both clinical and business process optimization, as well as regulatory and accreditation compliance and patient safety. Project savings during the two years of operation have exceeded the investment of resources to establish this long-term performance improvement capability by 2.5 times. The D-H VI model promotes multidisciplinary team-based learning, incremental skill development, and access to a common continuous improvement vocabulary and method for all employees-all key to building the teams and momentum needed for successful execution of improvement work and to maintain outcomes. Initial outcomes, represented by organizational spread, project execution status, participants' feedback scores, and return on investment estimates, suggest that robust team-based learning combined with coaching provides sufficient depth and breadth of learning and effective opportunities to gain practical experience in continuous improvement.

  7. Does continuous use of metformin throughout pregnancy improve pregnancy outcomes in women with polycystic ovarian syndrome?

    Science.gov (United States)

    Nawaz, Fauzia Haq; Khalid, Roha; Naru, Tahira; Rizvi, Javed

    2008-10-01

    Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies in women of reproductive age. It is associated with hyperinsulinemia and insulin resistance which is further aggravated during pregnancy. This mechanism has a pivotal role in the development of various complications during pregnancy. In the past few years, metformin, an insulin sensitizer, has been extensively evaluated for induction of ovulation. Its therapeutic use during pregnancy is, however, a recent strategy and is a debatable issue. At present, evidence is inadequate to support the long-term use of insulin-sensitizing agents during pregnancy. It is a challenge for both clinicians and researchers to provide good evidence of the safety of metformin for long-term use and during pregnancy. This study aimed to evaluate pregnancy outcomes in women with PCOS who conceived while on metformin treatment, and continued the medication for a variable length of time during pregnancy. This case-control study was conducted from January 2005 to December 2006 at the antenatal clinics of the Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan. The sample included 137 infertile women with PCOS; of these, 105 conceived while taking metformin (cases), while 32 conceived spontaneously without metformin (controls). Outcomes were measured in three groups of cases which were formed according to the duration of use of metformin during pregnancy. Comparison was made between these groups and women with PCOS who conceived spontaneously. All 137 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed up during their course of pregnancy; data forms were completed once they had delivered. Cases were divided into three groups: group A, 40 women who stopped metformin between 4-16 weeks of pregnancy; group B, 20 women who received metformin up until 32 weeks of gestation; and group C; 45 women who continued metformin throughout pregnancy. All

  8. Precision improvement of frequency-modulated continuous-wave laser ranging system with two auxiliary interferometers

    Science.gov (United States)

    Shi, Guang; Wang, Wen; Zhang, Fumin

    2018-03-01

    The measurement precision of frequency-modulated continuous-wave (FMCW) laser distance measurement should be proportional to the scanning range of the tunable laser. However, the commercial external cavity diode laser (ECDL) is not an ideal tunable laser source in practical applications. Due to the unavoidable mode hopping and scanning nonlinearity of the ECDL, the measurement precision of FMCW laser distance measurements can be substantially affected. Therefore, an FMCW laser ranging system with two auxiliary interferometers is proposed in this paper. Moreover, to eliminate the effects of ECDL, the frequency-sampling method and mode hopping influence suppression method are employed. Compared with a fringe counting interferometer, this FMCW laser ranging system has a measuring error of ± 20 μm at the distance of 5.8 m.

  9. Good performance in Japan is proof of continuing safety and reliability improvement practice

    International Nuclear Information System (INIS)

    Sumi, Y.

    1987-01-01

    Nuclear power is a vital energy supply source for both security and economy for such countries as Japan whose sources of energy are dependent on imported materials. This is the very reason why Japan gives her national priority to the improvement of nuclear power safety and reliability. As of the end of 1986, total nuclear power capacity owned and operated by private utility companies in Japan amounted to 24521 MW with 32 units sharing -- 19% of the total generating capacity. Moreover, during 1986 these units scored a remarkably high capacity factor of 76.2% and shared almost 28% of the nationwide electric power production, thereby contributing to a considerable saving of imported sources of energy. This outstanding record has been achieved by the parties concerned who dedicated themselves to furthering nuclear plant safety and reliability improvement. In this connection, this paper summarizes those key factors contributing to the good nuclear power plant performance of the Kansai Electric Power Company

  10. A continuous quality improvement project to reduce medication error in the emergency department.

    Science.gov (United States)

    Lee, Sara Bc; Lee, Larry Ly; Yeung, Richard Sd; Chan, Jimmy Ts

    2013-01-01

    Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED. In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems. Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work. This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

  11. Improving the 5th Formers’ Continuous Writing Skills through the Creative Writing Module

    Directory of Open Access Journals (Sweden)

    Mohana Ram Murugiah

    2013-07-01

    Full Text Available Writing is a complex task. The development of students’ writing skill depends on the teacher’s teaching strategy and also the materials used in the writing lesson. In the present study, the effectiveness of a creative writing module was examined that was designed to improve the writing skill of a group of excellent students. It was added with explicit teaching strategies. The selected group of students were students who were in the excellent group but lacked creativity and vocabulary in their writing. The creative writing module was designed to help these students. Students’ improvement was observed through observation in the classrooms during the lessons and through writing task as well as interviews. Two observations were made. One was before the creative writing project was started and another after the completion of the entire task of the module. The interview was carried out to learn about the students’ perception of the module and how do they find the module has helped them.  The result of the research showed that students have shown a great level of improvement in their writing skills. The outcome of this present study could be useful to assist language instructors in helping proficient learners to undergo a more effective second language learning experience.

  12. Improved Particle Swarm Optimization with a Collective Local Unimodal Search for Continuous Optimization Problems

    Science.gov (United States)

    Arasomwan, Martins Akugbe; Adewumi, Aderemi Oluyinka

    2014-01-01

    A new local search technique is proposed and used to improve the performance of particle swarm optimization algorithms by addressing the problem of premature convergence. In the proposed local search technique, a potential particle position in the solution search space is collectively constructed by a number of randomly selected particles in the swarm. The number of times the selection is made varies with the dimension of the optimization problem and each selected particle donates the value in the location of its randomly selected dimension from its personal best. After constructing the potential particle position, some local search is done around its neighbourhood in comparison with the current swarm global best position. It is then used to replace the global best particle position if it is found to be better; otherwise no replacement is made. Using some well-studied benchmark problems with low and high dimensions, numerical simulations were used to validate the performance of the improved algorithms. Comparisons were made with four different PSO variants, two of the variants implement different local search technique while the other two do not. Results show that the improved algorithms could obtain better quality solution while demonstrating better convergence velocity and precision, stability, robustness, and global-local search ability than the competing variants. PMID:24723827

  13. The role of the continuous improvement tools of procesess in building relationships in supply chain

    Directory of Open Access Journals (Sweden)

    Maciej Urbaniak

    2015-03-01

    Full Text Available Background: The aim of this paper is to determine the importance of the quality management and environmental management systems as well as operational improvement tools (such as TPS, Six Sigma, and Lean Management in building partnerships in supply chain. Methods: This paper contains the results of survey in companies operating in Poland and an analysis of the requirements for suppliers in the implementation of the quality and environmental management systems elements as well as recommendation for them to implement process improvement tools (such as elements of the TPS, the concept of Lean Management and Six Sigma methodologies. Results: The results of the survey and the analysis of the examples show that companies that are buyers in the B2B market often define the very individualized to suppliers needs through detailed specifications defining the requirements for quality assurance, performance increases, (for example, shortening implementation cycles, efficiency (cost reduction, safety, reducing the negative impact on the environment. Conclusions: The effectiveness of the action on improving the quality of processes and products by building relationships with suppliers depends largely on the support provided to them. To achieve these objectives many companies introduce special development programs for suppliers.

  14. Cardiorespiratory dynamics measured from continuous ECG monitoring improves detection of deterioration in acute care patients: A retrospective cohort study

    Science.gov (United States)

    Clark, Matthew T.; Calland, James Forrest; Enfield, Kyle B.; Voss, John D.; Lake, Douglas E.; Moorman, J. Randall

    2017-01-01

    Background Charted vital signs and laboratory results represent intermittent samples of a patient’s dynamic physiologic state and have been used to calculate early warning scores to identify patients at risk of clinical deterioration. We hypothesized that the addition of cardiorespiratory dynamics measured from continuous electrocardiography (ECG) monitoring to intermittently sampled data improves the predictive validity of models trained to detect clinical deterioration prior to intensive care unit (ICU) transfer or unanticipated death. Methods and findings We analyzed 63 patient-years of ECG data from 8,105 acute care patient admissions at a tertiary care academic medical center. We developed models to predict deterioration resulting in ICU transfer or unanticipated death within the next 24 hours using either vital signs, laboratory results, or cardiorespiratory dynamics from continuous ECG monitoring and also evaluated models using all available data sources. We calculated the predictive validity (C-statistic), the net reclassification improvement, and the probability of achieving the difference in likelihood ratio χ2 for the additional degrees of freedom. The primary outcome occurred 755 times in 586 admissions (7%). We analyzed 395 clinical deteriorations with continuous ECG data in the 24 hours prior to an event. Using only continuous ECG measures resulted in a C-statistic of 0.65, similar to models using only laboratory results and vital signs (0.63 and 0.69 respectively). Addition of continuous ECG measures to models using conventional measurements improved the C-statistic by 0.01 and 0.07; a model integrating all data sources had a C-statistic of 0.73 with categorical net reclassification improvement of 0.09 for a change of 1 decile in risk. The difference in likelihood ratio χ2 between integrated models with and without cardiorespiratory dynamics was 2158 (p value: <0.001). Conclusions Cardiorespiratory dynamics from continuous ECG monitoring detect

  15. Indicators for continuous quality improvement for otitis media in primary health care for Aboriginal and Torres Strait Islander children.

    Science.gov (United States)

    Sibthorpe, Beverly; Agostino, Jason; Coates, Harvey; Weeks, Sharon; Lehmann, Deborah; Wood, Marianne; Lannigan, Francis; McAullay, Daniel

    2017-04-01

    Otitis media is a common, generally self-limiting childhood illness that can progress to severe disease and have lifelong sequelae, including hearing loss and developmental delays. Severe disease is disproportionately prevalent among Aboriginal and Torres Strait Islander children. Primary health care is at the frontline of appropriate prevention and treatment. Continuous quality improvement in the prevention and management of important causes of morbidity in client populations is accepted best practice in primary health care and now a requirement of Australian Government funding to services providing care for Aboriginal and Torres Strait Islander children. To date, there have been no indicators for continuous quality improvement in the prevention and management of otitis media and its sequelae in primary health care. Through an expert group consensus process, seven evidence-based indicators, potentially extractable from electronic health records, have been developed. The development process and indicators are described.

  16. Practice Change From Intermittent Medication Boluses to Bolusing From a Continuous Infusion in Pediatric Critical Care: A Quality Improvement Project.

    Science.gov (United States)

    Hochstetler, Jessica L; Thompson, A Jill; Ball, Natalie M; Evans, Melissa C; Frame, Shaun C; Haney, A Lauren; Little, Amelia K; O'Donnell, Jaime L; Rickett, Bryna M; Mack, Elizabeth H

    2018-04-12

    To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. This is a pre- and postimplementation quality improvement study. An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion. Change in practice from administering bolus doses from an automated dispensing machine to administering bolus medications from continuous infusion in PICUs. Timing studies were conducted pre- and post implementation in 29 and 26 occurrences, respectively. The median time from the decision to give a bolus until it began infusing decreased by 169 seconds (p 0.05). Annualized cost avoidance was $124,160. Implementation of bolus medications from continuous infusion in PICUs significantly decreased time to begin a bolus dose and increased nursing satisfaction. The practice change also improved medication utilization without negatively impacting patient safety.

  17. Feasibility of a novel participatory multi-sector continuous improvement approach to enhance food security in remote Indigenous Australian communities

    Directory of Open Access Journals (Sweden)

    J. Brimblecombe

    2017-12-01

    Conclusion: A multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into community governance structures with adequate resourcing is an imperative.

  18. Daily Management System of the Henry Ford Production System: QTIPS to Focus Continuous Improvements at the Level of the Work.

    Science.gov (United States)

    Zarbo, Richard J; Varney, Ruan C; Copeland, Jacqueline R; D'Angelo, Rita; Sharma, Gaurav

    2015-07-01

    To support our Lean culture of continuous improvement, we implemented a daily management system designed so critical metrics of operational success were the focus of local teams to drive improvements. We innovated a standardized visual daily management board composed of metric categories of Quality, Time, Inventory, Productivity, and Safety (QTIPS); frequency trending; root cause analysis; corrective/preventive actions; and resulting process improvements. In 1 year (June 2013 to July 2014), eight laboratory sections at Henry Ford Hospital employed 64 unique daily metrics. Most assessed long-term (>6 months), monitored process stability, while short-term metrics (1-6 months) were retired after successful targeted problem resolution. Daily monitoring resulted in 42 process improvements. Daily management is the key business accountability subsystem that enabled our culture of continuous improvement to function more efficiently at the managerial level in a visible manner by reviewing and acting based on data and root cause analysis. Copyright© by the American Society for Clinical Pathology.

  19. Operational Improvements of Continuous Process with Tools of Lean Production - A Case Study in a Brazilian Petrochemical

    Directory of Open Access Journals (Sweden)

    Francisco Uchoa Passos

    2013-06-01

    Full Text Available This study seeks to evaluate operational improvements in Brazilian petrochemical company Braskem, which has been using lean production management tools to monitor its processes. There was some improvement in plant efficiency, measured from the beginning of implementation of management tools Six Sigma and TPM. Thus, we investigated three efficiency indicators considered by the company of great importance for the competitiveness of the business: the physical loss of products, plant’s energy efficiency, and the utilization rate of assets. The differences observed in these indicators, before and after the use of the tools, were tested for its statistical significance, which revealed that the physical losses of ethylene and plant’s energy efficiency improved, almost reaching the performance considered as class world. As for the utilization rate of assets, although it has evolved positively, still is at a considerable distance from that performance standard. By registering operational improvements in a continuous process plant, with lean production tools, this study indicates that these instruments, even if they have no causal relation with the improvements, are suitable for continuous processes and could have a much broader use, oriented, first of all, by the general approach of process optimization and, somehow, regardless of the nature of productive activity.

  20. MANUFACTURING AND CONTINUOUS IMPROVEMENT PERFORMANCE LEVEL IN PLANTS OF MEXICO; A COMPARATIVE ANALYSIS AMONG LARGE AND MEDIUM SIZE PLANTS

    OpenAIRE

    Carlos Monge; Jesús Cruz

    2015-01-01

    A random and statistically significant sample of 40 medium (12) and large (28) manufacturing plants of Apodaca, Mexico were surveyed using a structured and validated questionnaire to investigate the level of implementation of lean manufacturing, sustainable manufacturing, continuous improvement and operational efficiency and environmental responsibility in them, it is important to mention it was found that performance in the mentioned philosophies, on the two categories of plants is low, howe...

  1. Continuous improvement in pursuit of quality (presidential address to the Midland Institute Branch of the Institute of Mining Engineers)

    Energy Technology Data Exchange (ETDEWEB)

    Siddall, R G [British Coal Corporation (United Kingdom). South Yorkshire Group

    1993-03-01

    The author considers that quality must be a central element in the future strategy of the UK coal mining industry. This quality approach should be all embracing and extend beyond physical performance to include safety, effective use of capital, customer satisfaction, environmental pressures and overall image. The address discusses, the current position in British Coal; strategic planning; the need for continuous improvement; and productivity and production problems.

  2. Continuous biohydrogen production using cheese whey: Improving the hydrogen production rate

    Energy Technology Data Exchange (ETDEWEB)

    Davila-Vazquez, Gustavo; Cota-Navarro, Ciria Berenice; Razo-Flores, Elias [Division de Ciencias Ambientales, Instituto Potosino de Investigacion Cientifica y Tecnologica, Camino a la Presa San Jose 2055, Lomas 4a seccion, C.P. 78216, San Luis Potosi, S.L.P (Mexico); Rosales-Colunga, Luis Manuel; de Leon-Rodriguez, Antonio [Division de Biologia Molecular, Instituto Potosino de Investigacion Cientifica y Tecnologica, Camino a la Presa San Jose 2055, Lomas 4a seccion, C.P. 78216, San Luis Potosi, S.L.P (Mexico)

    2009-05-15

    Due to the renewed interest in finding sustainable fuels or energy carriers, biohydrogen (Bio-H{sub 2}) from biomass is a promising alternative. Fermentative Bio-H{sub 2} production was studied in a continuous stirred tank reactor (CSTR) operated during 65.6 d with cheese whey (CW) as substrate. Three hydraulic retention times (HRTs) were tested (10, 6 and 4 h) and the highest volumetric hydrogen production rate (VHPR) was attained with HRT of 6 h. Therefore, four organic loading rates (OLRs) at a fixed HRT of 6 h were tested thereafter, being: 92.4, 115.5, 138.6 and 184.4 g lactose/L/d. The highest VHPR (46.61 mmol H{sub 2}/L/h) and hydrogen molar yield (HMY) of 2.8 mol H{sub 2}/mol lactose were found at an OLR of 138.6 g lactose/L/d; a sharp fall in VHPR occurred at an OLR of 184.4 g lactose/L/d. Butyric, propionic and acetic acids were the main soluble metabolites found, with butyric-to-acetic ratios ranging from 1.0 to 2.4. Bacterial community was identified by partial sequence analysis of the 16S rRNA and polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE). The results showed that at HRT of 10 h and 6 h were dominated by the Clostridium genus. The VHPR attained in this study is the highest reported value for a CSTR system using CW as substrate with anaerobic sludge as inoculum and represents a 33-fold increase compared to a previous study. Thus, it was demonstrated that continuous fermentative Bio-H{sub 2} production from CW can be significantly enhanced by an appropriate selection of parameters such as HRT and OLR. Enhancements in VHPR are significant because it is a critical parameter to determine the full-scale practical application of fermentation technologies that will be used for sustainable and clean energy generation. (author)

  3. Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement.

    Science.gov (United States)

    Dupont, Corinne; Occelli, Pauline; Deneux-Tharaux, Catherine; Touzet, Sandrine; Duclos, Antoine; Bouvier-Colle, Marie-Hélène; Rudigoz, René-Charles; Huissoud, Cyril

    2014-07-01

    Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement To use statistical process control charts to describe trends in the prevalence of severe postpartum haemorrhage after vaginal delivery. This assessment was performed 7 years after we initiated a continuous quality improvement programme that began with regular criteria-based audits Observational descriptive study, in a French maternity unit in the Rhône-Alpes region. Quarterly clinical audit meetings to analyse all cases of severe postpartum haemorrhage after vaginal delivery and provide feedback on quality of care with statistical process control tools. The primary outcomes were the prevalence of severe PPH after vaginal delivery and its quarterly monitoring with a control chart. The secondary outcomes included the global quality of care for women with severe postpartum haemorrhage, including the performance rate of each recommended procedure. Differences in these variables between 2005 and 2012 were tested. From 2005 to 2012, the prevalence of severe postpartum haemorrhage declined significantly, from 1.2% to 0.6% of vaginal deliveries (pcontrol limits, that is, been out of statistical control. The proportion of cases that were managed consistently with the guidelines increased for all of their main components. Implementation of continuous quality improvement efforts began seven years ago and used, among other tools, statistical process control charts. During this period, the prevalence of severe postpartum haemorrhage after vaginal delivery has been reduced by 50%. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Continuous Improvements to East Coast Abort Landings for Space Shuttle Aborts

    Science.gov (United States)

    Butler, Kevin D.

    2003-01-01

    Improvement initiatives in the areas of guidance, flight control, and mission operations provide increased capability for successful East Coast Abort Landings (ECAL). Automating manual crew procedures in the Space Shuttle's onboard guidance allows faster and more precise commanding of flight control parameters needed for successful ECALs. Automation also provides additional capability in areas not possible with manual control. Operational changes in the mission concept allow for the addition of new landing sites and different ascent trajectories that increase the regions of a successful landing. The larger regions of ECAL capability increase the safety of the crew and Orbiter.

  5. [AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care].

    Science.gov (United States)

    2011-01-01

    in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. the AMD Annals approach can be considered as a case model for

  6. TEACH Kitchen: A Chronological Review of Accomplishments

    Science.gov (United States)

    Chae, Jung Hee; Ansa, Benjamin E.; Smith, Selina A.

    2017-01-01

    Background The Eating and Cooking Healthy (TEACH) Kitchen was founded at the Medical College of Georgia in 2015 as a nutrition-based intervention to combat the high prevalence of obesity and obesity-related chronic diseases in the area of Augusta, Georgia. Despite the importance of diet in the management of chronic diseases, inadequate nutrition education among patients and healthcare providers presents a barrier. The purpose of TEACH Kitchen is to address this gap. Methods TEACH Kitchen is as a student-led initiative that promotes healthy cooking among medical students and patients with chronic diseases. Healthy nutrition and cooking classes are held during the academic year. Participants spend four weeks on each of four modules: obesity, hypertension, hyperlipidemia, and diabetes mellitus. Data collection, which began in January 2017, is currently on going. TEACH Kitchen has collaborated with Augusta University, Sodexo, and Kohl’s. Results Currently, TEACH Kitchen has enrolled 14 patients and 6 children. Anticipated results include measurements of pre-and post-intervention changes in knowledge, attitudes, beliefs, and competence in nutrition, as well as differences in clinical indicators, including body mass index, blood pressure, lipid profile, and HbA1c. Conclusions TEACH Kitchen is the first medical school-based nutrition/cooking education initiative in Augusta, Georgia. It provides patients and medical students with hands-on healthy nutrition/cooking experience with the goal of decreasing the prevalence and improving the outcome of obesity-related diseases. PMID:28890945

  7. Clinical audit as a tool of continuous improvement of quality in radiology

    International Nuclear Information System (INIS)

    Horvathova, M.; Nikodemova, D.; Prikazska, M.

    2008-01-01

    Medical diagnosis and treatment including X -rays, nuclear medicine and radiotherapy , are the largest man-made sources of radiation exposure. The medical use of ionising radiation continues to expand, and is moving towards more complex procedures entailing higher exposures. Directive 97/43/EURATOM, on health protection of individuals against the dangers of ionizing radiation in relation to medical exposures acknowledged that medical practices using ionizing radiation are developing rapidly and that they are from a radiation protection point of view of regulatory concern. Our contribution summarizes the main recommendations of the Guidelines and the major problems of implementation of Clinical audits in Slovakia, which are: Incomplete national legislation for clinical audit; Methods of financing; Lack of formal framework of auditing; Poor understanding of the purpose and contents of clinical audits; Lack of criteria for the standards of good practices; Difficulty to employ sufficient number of auditors; Insufficient time available for auditors; Lack of specific training of auditors; Need of technological modernization of radiology equipment to meet quality standards. The need for harmonization of clinical audits has been recognized by all countries which replied to the questionnaire, including Slovakia and therefore it should be implemented in radiation protection regulations of Health ministry. (authors)

  8. Improving Continuous-Variable Measurement-Device-Independent Multipartite Quantum Communication with Optical Amplifiers*

    Science.gov (United States)

    Guo, Ying; Zhao, Wei; Li, Fei; Huang, Duan; Liao, Qin; Xie, Cai-Lang

    2017-08-01

    The developing tendency of continuous-variable (CV) measurement-device-independent (MDI) quantum cryptography is to cope with the practical issue of implementing scalable quantum networks. Up to now, most theoretical and experimental researches on CV-MDI QKD are focused on two-party protocols. However, we suggest a CV-MDI multipartite quantum secret sharing (QSS) protocol use the EPR states coupled with optical amplifiers. More remarkable, QSS is the real application in multipartite CV-MDI QKD, in other words, is the concrete implementation method of multipartite CV-MDI QKD. It can implement a practical quantum network scheme, under which the legal participants create the secret correlations by using EPR states connecting to an untrusted relay via insecure links and applying the multi-entangled Greenberger-Horne-Zeilinger (GHZ) state analysis at relay station. Even if there is a possibility that the relay may be completely tampered, the legal participants are still able to extract a secret key from network communication. The numerical simulation indicates that the quantum network communication can be achieved in an asymmetric scenario, fulfilling the demands of a practical quantum network. Additionally, we illustrate that the use of optical amplifiers can compensate the partial inherent imperfections of detectors and increase the transmission distance of the CV-MDI quantum system.

  9. Framework for continuous assessment and improvement of occupational health and safety issues in construction companies.

    Science.gov (United States)

    Mahmoudi, Shahram; Ghasemi, Fakhradin; Mohammadfam, Iraj; Soleimani, Esmaeil

    2014-09-01

    Construction industry is among the most hazardous industries, and needs a comprehensive and simple-to-administer tool to continuously assess and promote its health and safety performance. Through the study of various standard systems (mainly Health, Safety, and Environment Management System; Occupational Health and Safety Assessment Series 180001; and British Standard, occupational health and safety management systems-Guide 8800), seven main elements were determined for the desired framework, and then, by reviewing literature, factors affecting these main elements were determined. The relative importance of each element and its related factors was calculated at organizational and project levels. The provided framework was then implemented in three construction companies, and results were compared together. THE RESULTS OF THE STUDY SHOW THAT THE RELATIVE IMPORTANCE OF THE MAIN ELEMENTS AND THEIR RELATED FACTORS DIFFER BETWEEN ORGANIZATIONAL AND PROJECT LEVELS: leadership and commitment are the most important elements at the organization level, whereas risk assessment and management are most important at the project level. The present study demonstrated that the framework is easy to administer, and by interpreting the results, the main factors leading to the present condition of companies can be determined.

  10. Clinical audit as a tool of continuous improvement of quality in radiology

    International Nuclear Information System (INIS)

    Horvathova, M.; Nikodemova, D.; Prikazska, M.

    2009-01-01

    Medical diagnosis and treatment including X -rays, nuclear medicine and radiotherapy , are the largest man-made sources of radiation exposure. The medical use of ionising radiation continues to expand, and is moving towards more complex procedures entailing higher exposures. Directive 97/43/EURATOM, on health protection of individuals against the dangers of ionizing radiation in relation to medical exposures acknowledged that medical practices using ionizing radiation are developing rapidly and that they are from a radiation protection point of view of regulatory concern. Our contribution summarizes the main recommendations of the Guidelines and the major problems of implementation of Clinical audits in Slovakia, which are: Incomplete national legislation for clinical audit; Methods of financing; Lack of formal framework of auditing; Poor understanding of the purpose and contents of clinical audits; Lack of criteria for the standards of good practices; Difficulty to employ sufficient number of auditors; Insufficient time available for auditors; Lack of specific training of auditors; Need of technological modernization of radiology equipment to meet quality standards. The need for harmonization of clinical audits has been recognized by all countries which replied to the questionnaire, including Slovakia and therefore it should be implemented in radiation protection regulations of Health ministry. (authors)

  11. Factors Influencing Continuous Quality Improvement Programme In Government Hospitals Of Sri Lanka

    Directory of Open Access Journals (Sweden)

    Somatunga L C

    2015-06-01

    Full Text Available Abstract Health care systems are accountable to their patients and society to provide quality cost effective care and to seek ways to improve that care. By doing this positive patient outcomes are ensured. Those factors which affect the delivery of a good service have to be identified. It is important to determine whether the environment of an organization type of hospitals plays an important role in determining the implementation of quality improvement programmes Methodology This was a hospital-based descriptive cross-sectional survey carried out in selected hospitals in Sri Lanka. Sixteen Line Ministry Hospitals where Quality Management Units are already in place were selected for the study. Staff working in these hospitals including doctors nurses and allied health staff was included. The data was collected using a self-administered questionnaire. The questionnaire was repeated after three weeks. Findings A total of 378 participants responded in the study. This study identified top management commitment training teamwork physical structure and monitoring system as independent variables that influence the CQI implementation programme. All the participants rated lower for teamwork and felt that teamwork had little influence on CQI programme implementation. The type of hospital has not influenced the implementation of CQI programme.

  12. Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals.

    Science.gov (United States)

    Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia

    2015-01-01

    Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, pcontrol group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (pcontrol group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.

  13. Continuous renal replacement therapy improves renal recovery from acute renal failure.

    Science.gov (United States)

    Jacka, Michael J; Ivancinova, Xenia; Gibney, R T Noel

    2005-03-01

    Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery. We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student's t test, and multiple logistic regression as appropriate. 116 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial. Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.

  14. Improvement of tsunami detection in timeseries data of GPS buoys with the Continuous Wavelet Transform

    Science.gov (United States)

    Chida, Y.; Takagawa, T.

    2017-12-01

    The observation data of GPS buoys which are installed in the offshore of Japan are used for monitoring not only waves but also tsunamis in Japan. The real-time data was successfully used to upgrade the tsunami warnings just after the 2011 Tohoku earthquake. Huge tsunamis can be easily detected because the signal-noise ratio is high enough, but moderate tsunami is not. GPS data sometimes include the error waveforms like tsunamis because of changing accuracy by the number and the position of GPS satellites. To distinguish the true tsunami waveforms from pseudo-tsunami ones is important for tsunami detection. In this research, a method to reduce misdetections of tsunami in the observation data of GPS buoys and to increase the efficiency of tsunami detection was developed.Firstly, the error waveforms were extracted by using the indexes of position dilution of precision, reliability of GPS satellite positioning and satellite number for calculation. Then, the output from this procedure was used for the Continuous Wavelet Transform (CWT) to analyze the time-frequency characteristics of error waveforms and real tsunami waveforms.We found that the error waveforms tended to appear when the accuracy of GPS buoys positioning was low. By extracting these waveforms, it was possible to decrease about 43% error waveforms without the reduction of the tsunami detection rate. Moreover, we found that the amplitudes of power spectra obtained from the error waveforms and real tsunamis were similar in the component of long period (4-65 minutes), on the other hand, the amplitude in the component of short period (< 1 minute) obtained from the error waveforms was significantly larger than that of the real tsunami waveforms. By thresholding of the short-period component, further extraction of error waveforms became possible without a significant reduction of tsunami detection rate.

  15. Continuous improvement of operation and maintenance conditions of french PWR nuclear islands

    International Nuclear Information System (INIS)

    Bitsch, D.

    1985-05-01

    Improvement of the nuclear island design, to facilitate maintenance and working conditions during plant shutdown, has been a subject of particular attention within the French PWR program. Standardization and industrial concentration created an unusually favourable context for approaching this objective. Progress efforts supported by the feedback of actual operating experience were pursued in the areas of plant layout-equipment installation, and on the design and technology of the component themselves. The progress efforts on the design and technology of the components were pursued along several paths including: - the resistance increase of specific parts submitted to various forms of in-service damage, - the reduction of the extent and duration of work during plant outages and - the reduction of the Occupational Radiation Exposure (ORE), one of the most important axes of development, through the appropriate selection of less releasing materials, the implementation of more efficient decontamination systems and by the use of robots

  16. EFFECTIVENESS OF INTERVAL EXERCISE VERSUS CONTINUOUS EXERCISE TO IMPROVE EXERCISE TOLERANCE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE SUBJECTS

    Directory of Open Access Journals (Sweden)

    G. Swathi

    2015-12-01

    Full Text Available Background: COPD is characterized by chronic airflow limitation and a range of pathological changes in the lung. Chronic inflammation causes structural changes and narrowing of the small airways and destruction of lung parenchyma, leads to the loss of alveolar attachments to the small airways and decreases lung elastic recoil; in turn these changes diminish the expiration and the work of breathing is increased. Scarcity of evidence on continuous and interval exercises is forcing researchers conduct studies on effectiveness of interval exercise with continuous exercise on exercise tolerance in subjects with COPD. Methods: 60 subjects were selected by lottery method. All the subjects were explained about the condition and mode of assessment and written informed consent were obtained from them and divided into 2 groups interval training group and continuous exercise training group and subjects were scheduled to attend exercise session 5 days a week for 4 weeks with exercise duration 20 min’s with cycle ergometer. Outcome measure: six minute walk test and heart rate. Results: On observing the means of post test parameters of experimental group A and experimental group B Independent t-test was done and the P- value is >0.05 .It shows a no significant difference between the two groups. Conclusion: The results had shown that both interval exercise group and continuous exercise group who received four weeks of therapy has improved significantly on pre and post test values within the groups but when compared between these groups there is no statistical significance noted. So this study concluded that there is no significant difference between interval exercise group and continuous exercise group in improving exercise tolerance among COPD subjects.

  17. Improvement of formability for fabricating thin continuously corrugated structures in sheet metal forming process

    International Nuclear Information System (INIS)

    Choi, Sung Woo; Park, Sang Hu; Park, Seong Hun; Ha, Man Yeong; Jeong, Ho Seung; Cho, Jong Rae

    2012-01-01

    A stamping process is widely used for fabricating various sheet metal parts for vehicles, airplanes, and electronic devices by the merit of low processing cost and high productivity. Recently, the use of thin sheets with a corrugated structure for sheet metal parts has rapidly increased for use in energy management devices, such as heat exchangers, separators in fuel cells, and many others. However, it is not easy to make thin corrugated structures directly using a single step stamping process due to their geometrical complexity and very thin thickness. To solve this problem, a multi step stamping (MSS) process that includes a heat treatment process to improve formability is proposed in this work: the sequential process is the initial stamping, heat treatment, and final shaping. By the proposed method, we achieved successful results in fabricating thin corrugated structures with an average thickness of 75μm and increased formability of about 31% compared to the single step stamping process. Such structures can be used in a plate-type heat exchanger requiring low weight and a compact shape

  18. WATTec '92. Innovation in the 21st century: Excellence through continuous improvement

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    WATTec '92 will concentrate on five areas of major importance in today's world: Training and Education - What can be done to meet future needs and ensure that new technology is applied in the workplace? What innovative approaches can be taken to interest young people in careers in science and engineering? Productivity - What is the role of the scientist and engineer in the factory of the future? What must be done by large industries and small manufacturers to compete in the global economy? What innovative steps can be taken to make the most of our nation's resources and advantages while reducing disadvantages relative to others in the global economy? Technology - What are the technologies of the future and how will we use, share, understand and adopt these technologies? And how do we transfer them, not only within an individual business or institution, but to laboratories, educators, and others? How do we extend America's record for inventiveness while improving commercialization and work leadership in the technologies we create? Resources - What are the materials that will shape the world and how will they shape the technical profession in the 21st Century? How do we make the most of our natural resources, conserving them for best uses while protecting the environment and meeting the demands of international competition? The Nineteenth Annual WATTec Conference and Exhibition will focus on these and related questions in wide-ranging sessions sponsored by more than 40 technical professional societies. Papers within the scope of the Energy Data Base have been processed separately

  19. Continuous improvement in national ART standards by the RTAC accreditation system in Australia and New Zealand.

    Science.gov (United States)

    Harrison, Keith; Peek, John; Chapman, Michael; Bowman, Mark

    2017-02-01

    Assisted reproductive technology (ART) clinics in Australia and New Zealand are accredited and licensed against a Code of Practice audited by certifying bodies accredited by the Joint Accreditation System for Australia and New Zealand (JAS-ANZ). The system is administered by the Reproductive Technology Accreditation Committee (RTAC) of the Fertility Society of Australia. To review the incidence of variances and findings identified by certifying bodies in Australian and New Zealand ART clinics within the currency of a single version of the Code of Practice. Retrospective analysis of certifying body findings against the RTAC Code of Practice incorporating 15 Critical Criteria audited annually and 16 Good Practice Criteria including a Quality Management System audited over a three year cycle. The incidence of clinics with variances against the Critical Criteria fell from 77 to 14% over two years, as did the mean number of variances per clinic which fell from 1.54 to 0.14. Implementation of the RTAC accreditation system in Australia and New Zealand has contributed to steady improvement in standards and a reduction in risk in ART treatments. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  20. Continuous improvement of the regulatory framework for the control of medical exposure

    International Nuclear Information System (INIS)

    Larcher, Ana M.; Ortiz Lopez, Pedro; Arias, Cesar; Marechal, Maria H.; Hernandez Alvarez, Ramon; Ferrer Garcia, Natividad; Castaneda Mucino, Antonia; Faller, Blanca

    2008-01-01

    One of the key elements to guide the improvement of the regulatory control is the availability of a self-assessment tool for regulatory performance. Although there is general guidance on self-assessment for regulators and users (IAEA), there is a need for more specific advice on how to address challenges and difficulties faced by regulatory bodies, when regulating radiation protection of patients. Examples of these challenges are the need for regulatory initiatives, in cooperation with health and education authorities, professional bodies and equipment suppliers, and to put in place necessary elements that are beyond responsibility of individual user of radiation, to enable them compliance with safety standards. Purpose: Within the programme of the Ibero American Forum of Nuclear and Radiation Safety Regulatory Organizations, a project to develop such a self-assessment tool for the regulatory control of medical exposure has been designed. Method: National experiences in transposing and enforcing the international radiation safety standards, as to how the requirements are included in national regulations are reviewed. Further, difficulties to the implementation of safety requirements are analyzed and a self-assessment approach and possible regulatory solutions a are presented. Results and discussion: In this study the following documents are being produced: 1) transposition of international requirements into national regulations in the six countries of the Forum, 2) difficulties to implement and enforce the requirements, 3) guidance on self-assessment of regulatory framework for medical exposure, 4) suggested contribution to the revision of international radiation safety standards. (author)

  1. Continuous Improvement of the Regulatory Framework for the Control of Medical Exposure

    International Nuclear Information System (INIS)

    Larcher, A.M.; Ortiz lopez, Pedro; Arias, Cesar; Marechal, Maria H.; Hernandez Alvarez, Ramon; Ferrer Garcia, Natividad; Castaneda Mucino, Antonia; Faller, Blanca

    2011-01-01

    Background: One of the key elements to guide the improvement of the regulatory control is the availability of a self-assessment tool for regulatory performance. Although there is general guidance on self-assessment for regulators and users (IAEA), there is a need for specific advice on how to address challenges and difficulties faced by regulatory bodies, when regulating radiation protection of patients. Examples of these challenges are the need of regulatory initiatives, in cooperation with health and education authorities, professional bodies and equipment suppliers, and to put in place necessary elements that are beyond responsibility of individual users of radiation, to enable them compliance with safety standards. Purpose: within the programme of the Ibero American Forum of Nuclear and Radiation Safety Regulatory Organizations, a project to develop such a self assessment tool for the regulatory control of medical exposure has been designed. Method: national experiences in transposing and enforcing the international radiation safety standards, as to how the requirements are included in national regulations are reviewed. Further, difficulties to the implementation of safety requirements are included in national regulations are analyzed and a self assessment approach and possible regulatory solutions are presented. Results and discussion: in tis study the following documents are being produced: 1) Transposition of international requirements into national regulations in the six countries of the Forum, 2) difficulties to implement and enforce the requirements, 3) guidance on self assessment of regulatory framework for medical exposure, 4) suggested contribution to the revision of international radiation safety standards. (authors)

  2. Promoting employee health by integrating health protection, health promotion, and continuous improvement: a longitudinal quasi-experimental intervention study.

    Science.gov (United States)

    von Thiele Schwarz, Ulrica; Augustsson, Hanna; Hasson, Henna; Stenfors-Hayes, Terese

    2015-02-01

    To test the effects of integrating health protection and health promotion with a continuous improvement system (Kaizen) on proximal employee outcomes (health promotion, integration, and Kaizen) and distal outcomes (workability, productivity, self-rated health and self-rated sickness absence). Twelve units in a county hospital in Sweden were randomized to control or intervention groups using a quasiexperimental study design. All staff (approximately 500) provided self-ratings in questionnaires at baseline, and a 12- and 24-month follow-up (response rate, 79% to 87.5%). There was a significant increase in the proximal outcomes over time in the intervention group compared with the control group, and a trend toward improvement in the distal outcomes workability and productivity. Integration seems to promote staff engagement in health protection and promotion, as well as to improve their understanding of the link between work and health.

  3. Nursing assessment of continuous vital sign surveillance to improve patient safety on the medical/surgical unit.

    Science.gov (United States)

    Watkins, Terri; Whisman, Lynn; Booker, Pamela

    2016-01-01

    Evaluate continuous vital sign surveillance as a tool to improve patient safety in the medical/surgical unit. Failure-to-rescue is an important measure of hospital quality. Patient deterioration is often preceded by changes in vital signs. However, continuous multi-parameter vital sign monitoring may decrease patient safety with an abundance of unnecessary alarms. Prospective observational study at two geographically disperse hospitals in a single hospital system. A multi-parameter vital sign monitoring system was installed in a medical/surgical unit in Utah and one in Alabama providing continuous display of SpO2, heart rate, blood pressure and respiration rate on a central station. Alarm thresholds and time to alert annunciations were set based on prior analysis of the distribution of each vital sign. At the end of 4 weeks, nurses completed a survey on their experience. An average alert per patient, per day was determined retrospectively from the saved vital signs data and knowledge of the alarm settings. Ninety-two per cent of the nurses agreed that the number of alarms and alerts were appropriate; 54% strongly agreed. On average, both units experienced 10·8 alarms per patient, per day. One hundred per cent agreed the monitor provided valuable patient data that increased patient safety; 79% strongly agreed. Continuous, multi-parameter patient monitoring could be performed on medical/surgical units with a small and appropriate level of alarms. Continuous vital sign assessment may have initiated nursing interventions that prevented failure-to-rescue events. Nurses surveyed unanimously agreed that continuous vital sign surveillance will help enhance patient safety. Nursing response to abnormal vital signs is one of the most important levers in patient safety, by providing timely recognition of early clinical deterioration. This occurs through diligent nursing surveillance, involving assessment, interpretation of data, recognition of a problem and meaningful

  4. Using the Continuous Improvement Process to optimize opencast mining operations; Nutzung des kontinuierlichen Verbesserungsprozesses zur Optimierung des Tagebaubetriebs

    Energy Technology Data Exchange (ETDEWEB)

    Oster, Arthur [RWE Power AG, Eschweiler (Germany). Tagebau Inden

    2011-11-15

    The value chain in the energy industry has changed over the last few years. Several stages, such as energy trading, have gained in significance while the character of others, for instance electricity generation, has changed. RWE Power is actively participating in shaping this change process and is a driving force of change. One focus of RWE Power's strategic alignment is on a highly efficient and integrated core business in lignite mining and lignite-based electricity generation. The Continuous Improvement Process ''immer:besser'' (getting better) ensures the continuous achievement and development of operational and commercial excellence in our daily operations. As a corporate culture this determines the requirements to be met by entrepreneurial ideas. It also ensures an increase in performance as well as cost reduction in our daily business. Obtaining cost reductions and efficiency increases with the aid of the Continuous Improvement Process as a kind of value-adding self-renewal process to ensure that lignite remains competitive, forms the basis for further increases in profitability and growth.

  5. Crystal and Particle Engineering Strategies for Improving Powder Compression and Flow Properties to Enable Continuous Tablet Manufacturing by Direct Compression.

    Science.gov (United States)

    Chattoraj, Sayantan; Sun, Changquan Calvin

    2018-04-01

    Continuous manufacturing of tablets has many advantages, including batch size flexibility, demand-adaptive scale up or scale down, consistent product quality, small operational foot print, and increased manufacturing efficiency. Simplicity makes direct compression the most suitable process for continuous tablet manufacturing. However, deficiencies in powder flow and compression of active pharmaceutical ingredients (APIs) limit the range of drug loading that can routinely be considered for direct compression. For the widespread adoption of continuous direct compression, effective API engineering strategies to address power flow and compression problems are needed. Appropriate implementation of these strategies would facilitate the design of high-quality robust drug products, as stipulated by the Quality-by-Design framework. Here, several crystal and particle engineering strategies for improving powder flow and compression properties are summarized. The focus is on the underlying materials science, which is the foundation for effective API engineering to enable successful continuous manufacturing by the direct compression process. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  6. Proposals for an effective application of the continuous improvement at the ININ according to the IAEA 50-C/SG-Q new code

    International Nuclear Information System (INIS)

    Cardenas A, B.M.; Olivares O, L.A.

    1997-01-01

    This work contains the requirements of continuous improvement contained in the IAEA new code Q uality assurance for safety in nuclear power plants and other nuclear installations, code 50-C/SG-Q. Assuming that it was the base for to elaborate the review No. 5 of the Quality assurance plan at ININ, it was done an analysis to give proposals for the application of continuous improvement in effective way. The relevant points which must be taken in account at the continuous improvement process are: Direction responsibility, involucring of all personnel, process planning, education and training, elaboration of improvement projects, investigation of processes which can be improved, continuation of the improvement process and its evaluation. With the implantation of an effective continuous improvement system it will be obtained to get a better quality and a more efficient safety. (Author)

  7. Improving Continuing Professional Development opportunities for radiographers: A single centre evaluation

    International Nuclear Information System (INIS)

    Stevens, Barry J.; Wade, Demetri

    2017-01-01

    Purpose: This study aimed to identify current barriers to CPD and generate ideas for strategies to overcome these issues. Further aims were to gather an overview of respondents' understanding and opinions of CPD. Methods: An online survey was used to acquire information from departmental band 5 and band 6 radiographers. Descriptive statistical analysis and thematic analysis were performed to understand demographics and individuals' behaviours and experiences. Findings: Radiographers (n = 33) were sent an invitation via email providing a response rate of 75.8% (n = 25), with 20 females (80%) and 5 males (20%). 52% (n = 13) dedicate less than three hours a month. Participants highlighted time restraint as their biggest barrier to CPD. They also indicated a reluctance to use their own time to undertake work-related learning, despite exhibiting positive attitudes towards CPD. Radiographers see CPD as a vital and necessary, career-long learning process and they recognise the impacts on service provision. The notion of dedicated study time was unanimously suggested as the best approach to increase commitment to CPD. Conclusion: Radiographers demonstrated positive opinions of CPD, yet it was evident that many are not undertaking activities during their own time and it was acknowledged that opportunities during work time are limited. The provision of study time in work was suggested as an approach to improve radiographer's opportunities to complete CPD. Training sessions underlining the necessity of CPD in maintaining registration, what constitutes CPD and reinforcement of the benefits of systematic recording of CPD should be provided. - Highlights: • 80% believe they do not do enough CPD, 52% dedicate less than 3 h a month. • Radiographers are aware of the positive impact of learning on development. • Training should be given as a strategy to address radiographers' CPD inactivity. • The overarching theme relating to barriers to CPD is

  8. ARE WE A LEARNING ORGANISATION? AN ASSESSMENT MODEL FOR CONTINUOUS IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    C.C. Van Waveren

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: It is generally agreed that one way for organisations to be competitive in the new global economy is by embracing the principles of Peter Senge’s “The Fifth Discipline” and becoming “learning organisations”. The literature on the nature of learning organisations is extensive, but few of the discussions break through the philosophical barrier and actually address practical ways in which organisations can move away from traditional organisation thinking models and become learning organisations. This paper discusses a 9-S framework and an accompanying measurement model that can be used by organisations to determine whether they are learning organisations, and if not, where and how they need to improve. The framework is based on the Hitt 8-S framework, and the measurement model takes the form of a series of weighted questions and results that graphically represent how successful an organisation has been in its quest to become a learning organisation. A practical implementation of the measurement model that focuses on the planning aspect of organisational management is included in the paper.

    AFRIKAANSE OPSOMMING: Vir ’n organisasie om kompeterend in ’n wereldekonomie te wees, word daar algemeen aanvaar dat die organisasie sekere leergerigtheidseienskappe moet bemeester soos beskryf in Peter Senge se boek “The Fifth Discipline”. Omvattende literatuur oor die leergerigtheidseienskappe van organisasies bestaan, maar daar is egter min inligting oor praktiese maniere om ’n tradisionele organisasie na 'n leergerigtheidsorganisasie oor te skakel. Hierdie artikel bespreek ’n 9-S raamwerk asook ’n gepaardgaande evalueringsmodel wat gebruik kan word om ’n organisasie te meet aan sekere leergerigtheidseienskappe. Die raamwerk is gebaseer op die Hitt 8-S raamwerk en die evalueringsmodel maak gebruik van geweegde vrae waarvan die resultate grafies vertoon word om die sukses van leergerigtheid in die organisasie

  9. Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

    Science.gov (United States)

    Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

    2015-01-01

    Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of

  10. Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda.

    Science.gov (United States)

    Byabagambi, John; Marks, Pamela; Megere, Humphrey; Karamagi, Esther; Byakika, Sarah; Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

    2015-01-01

    Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the "good" range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring "good" rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.

  11. Increasing Pap smear rates at an urban Aboriginal Community Controlled Health Service through translational research and continuous quality improvement.

    Science.gov (United States)

    Dorrington, Melanie S; Herceg, Ana; Douglas, Kirsty; Tongs, Julie; Bookallil, Marianne

    2015-01-01

    This article describes translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS). Rapid Plan-Do-Study-Act (PDSA) cycles were conducted, informed by client surveys, a data collection tool, focus groups and internal research. There was a statistically significant increase in Pap smear numbers during PDSA cycles, continuing at 10 months follow up. The use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. Community and service collaboration should be at the core of research in Aboriginal and Torres Strait Islander health settings. This model is transferrable to other settings and other health issues.

  12. A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africa.

    Science.gov (United States)

    Horwood, Christiane; Butler, Lisa; Barker, Pierre; Phakathi, Sifiso; Haskins, Lyn; Grant, Merridy; Mntambo, Ntokozo; Rollins, Nigel

    2017-06-13

    Community health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. However, there is limited evidence of effective mentoring and supervision approaches for CHWs. This is a cluster randomised controlled trial to investigate the effectiveness of a continuous quality improvement (CQI) intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Thirty CHW supervisors were randomly allocated to intervention (n = 15) and control (n = 15) arms. Four CHWs were randomly selected from those routinely supported by each supervisor (n = 60 per arm). In the intervention arm, these four CHWs and their supervisor formed a quality improvement team. Intervention CHWs received a 2-week training in WHO Community Case Management followed by CQI mentoring for 12 months (preceded by 3 months lead-in to establish QI processes). Baseline and follow-up surveys were conducted with mothers of infants Improved training and CQI-based mentoring of CHWs can improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers' knowledge and infant feeding practices. ClinicalTrials.Gov NCT01774136.

  13. Radiation safety infrastructure in developing countries: a proactive approach for integrated and continuous improvement

    International Nuclear Information System (INIS)

    Mrabit, Khammar

    2008-01-01

    The International Atomic Energy Agency (the Agency) is authorized, by its statute, to establish or adopt safety standards for the protection of health and minimization of danger to life and property, and to provide for their application to its own operations as well as to operations under its control or supervision. The Agency has been assisting, since the mid 1960 's, its Member States through mainly its Technical Cooperation Programme (TCP) to improve their national radiation safety infrastructures. However up to the early nineties, assistance was specific and mostly ad hoc and did not systematically utilize an integrated and harmonized approach to achieving effective and sustainable national radiation safety infrastructures in Member States. An unprecedented and integrated international cooperative effort was launched by the Agency in 1994 to establish and/or upgrade the national radiation safety infrastructure in more than 90 countries within the framework of its TCP through the so-called Model project on upgrading radiation protection infrastructure. In this project proactive co-operation with Member States was used in striving towards achieving an effective and sustainable radiation safety infrastructure, compatible with the International basic safety standards for protection against ionizing radiation and for the safety of radiation sources (the BSS) and related standards. Extension to include compatibility with the guidance of the Code of Conduct on the Safety and Security of Radioactive Sources occurred towards the end of the Model Project in December 2004, and with the more recent ensuing follow up projects that started in 2005. The Model Project started with 5 countries in 1994 and finished with 91 countries in 2004. Up to the end of 2007 more than one hundred Member States had been participating in follow up projects covering six themes - namely: legislative and regulatory infrastructure; occupational radiation protection; radiation protection in

  14. Sustainable MSD prevention: management for continuous improvement between prevention and production. Ergonomic intervention in two assembly line companies.

    Science.gov (United States)

    Caroly, S; Coutarel, F; Landry, A; Mary-Cheray, I

    2010-07-01

    To increase output and meet customers' needs, companies have turned to the development of production management systems: Kaizen, one piece flow, Kanban, etc. The aim of such systems is to accelerate decisions, react to environmental issues and manage various productions. In the main, this type of management system has led to the continuous improvement of production performance. Consequently, such production management systems can have unexpected negative effects on operators' health and safety. Conversely, regulation and control systems focusing on work-related risks have obliged firms to implement health and safety management systems such as OHSAS 18001. The purpose of this type of system, also based on continuous improvement, is to reduce risks, facilitate work-related activities and identify solutions in terms of equipment and tools. However, the prevention actions introduced through health and safety systems often result in other unexpected and unwanted effects on production. This paper shows how companies can improve the way they are run by taking into account both types of management system. Copyright 2010 Elsevier Ltd. All rights reserved.

  15. Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units: A 15-year experience.

    Science.gov (United States)

    Chao, Chien-Ming; Lai, Chih-Cheng; Chan, Khee-Siang; Cheng, Kuo-Chen; Ho, Chung-Han; Chen, Chin-Ming; Chou, Willy

    2017-07-01

    We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube. We measured the outcome as the annual event and the rate of UE. During this 15-year period, there were 1404 episodes of UE, with 44,015 episodes of mechanical ventilation (MV) (319,158 ventilator-days). The overall rate of UE was 3.19/100 ventilated patients (4.40/1000 ventilator-days). In 2001, there were 188 episodes of UE and the rate of UE was 6.82/100 ventilated patients or 9.0/1000 ventilator-days. After this continue quality improvement project had been implemented, the annual number of episodes of UE declined to 27, and the rate fell to 0.95/100 ventilated patients or 1.36/1000 ventilator-days in 2015. Overall, the trend analysis showed the change was significant with P continuously and effectively reduced using multidisciplinary and sequential quality improvement interventions.

  16. Feasibility of a novel participatory multi-sector continuous improvement approach to enhance food security in remote Indigenous Australian communities.

    Science.gov (United States)

    Brimblecombe, J; Bailie, R; van den Boogaard, C; Wood, B; Liberato, S C; Ferguson, M; Coveney, J; Jaenke, R; Ritchie, J

    2017-12-01

    Food insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia. A longitudinal comparative multi-site case study, the Good Food Systems Good Food for All Project, was conducted (2009-2013) with four Aboriginal communities. Continuous improvement meetings were held in each community. Data from project documents and store sales were used to assess feasibility according to engagement, uptake and sustainability of action, and impact on community diet, as well as identifying conditions facilitating or hindering these. Engagement was established where: the community perceived a need for the approach; where trust was developed between the community and facilitators; where there was community stability; and where flexibility was applied in the timing of meetings. The approach enabled stakeholders in each community to collectively appraise the community food system and plan action. Actions that could be directly implemented within available resources resulted from developing collaborative capacity. Actions requiring advocacy, multi-sectoral involvement, commitment or further resources were less frequently used. Positive shifts in community diet were associated with key areas where actions were implemented. A multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into

  17. Improvement of thoracic aortic vasoreactivity by continuous and intermittent exercise in high-fat diet-induced obese rats.

    Science.gov (United States)

    Liu, Hongpeng; Yang, Zhen; Hu, Jian; Luo, Yan; Zhu, Lingqin; Yang, Huifang; Li, Guanghua

    2015-07-01

    The aim of the present study was to explore the effects of continuous and intermittent exercise on the thoracic aortic vasoreactivity and free radical metabolism in rats fed with a high-fat diet (HD). Sprague-Dawley (SD) rats were randomly divided into four groups (n=8, each group): Conventional diet (CD), HD, HD with continuous exercise (HCE) and HD with intermittent exercise (HIE). HCE rats swam once/day for 90 min; HIE rats performed swimming exercises 3 times/day, 30 min each time with an interval of 4 h. In these two groups, the exercise was conducted 5 days a week for 8 weeks. Rats in the CD and HD groups were fed without swimming training. At the end of the exercise, all the rats were sacrificed and the blood, thoracic aorta and myocardium were collected immediately. The thoracic aortic vasoreactivity, the plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), superoxide dismutase (SOD), malondialdehyde (MDA) and vascular endothelial nitric oxide synthase (eNOS) gene expression were measured. Compared to the control group, in the HD group the enhanced contractile response of the thoracic aortic rings to noradrenaline (NA) was observed (Pimprove the activity of the thoracic aorta in obese rats, which may be associated with enhanced antioxidant enzyme activity and reduced free radical generating. Additionally, intermittent exercise is better than the continuous exercise in improving the thoracic aorta vasoreactivity.

  18. Improvement of continuous subcutaneous insulin infusion on patients with type 2 diabetes mellitus by 3-dimensional speckle tracking echocardiography.

    Science.gov (United States)

    Luo, Hong-Xia; Zhou, Xiao-Ling; Kou, Hong-Ju; Ni, Xian-Wei; Wu, Qing; Zou, Chun-Peng; Wu, Dao-Zhu; Liu, Yong-Fang

    2018-03-01

    Three-dimensional speckle tracking echocardiography (3D-STE) was used to evaluate the improvement of continuous subcutaneous insulin infusion on the left ventricular (LV) systolic function of patients with type 2 diabetes mellitu (T2DM). We recruited T2DM patients (38 cases, diabetic group) and healthy volunteers (35 cases, control group) to collect LV full volume imaging. TomTec software was used for calculating LV global longitudinal strain (LVGLS), global circumferential strain (LVGCS), peak twist (LVTW), peak apical rotation (LVPAR), ejection fraction (LVEF), and torsion (LVT). All indices were re-tested 2 weeks later after intensive treatment of insulin pump. LVGLS, LVGCS, LVTW and LVPAR in diabetic group were significantly decreased than control group. LVGLS and LVGCS in pre-treatment diabetic group were significantly increased than post-treatment. LVGLS, LVGCS, LVTW and LVPAR had correlations among control, pre-treatment and post-treatment diabetic groups. There were no significant differences in LVEDV, LVESV, LVEF, LVT and R-R. LV systolic function of patients with T2DM complicated with microangiopathy was improved after treatment of continuous subcutaneous insulin infusion. In addition, therapeutic effect could be accurately evaluated by 3D-STE which had vital clinical application.

  19. Evaluating the impact of continuous quality improvement methods at hospitals in Tanzania: a cluster-randomized trial.

    Science.gov (United States)

    Kamiya, Yusuke; Ishijma, Hisahiro; Hagiwara, Akiko; Takahashi, Shizu; Ngonyani, Henook A M; Samky, Eleuter

    2017-02-01

    To evaluate the impact of implementing continuous quality improvement (CQI) methods on patient's experiences and satisfaction in Tanzania. Cluster-randomized trial, which randomly allocated district-level hospitals into treatment group and control group, was conducted. Sixteen district-level hospitals in Kilimanjaro and Manyara regions of Tanzania. Outpatient exit surveys targeting totally 3292 individuals, 1688 in the treatment and 1604 in the control group, from 3 time-points between September 2011 and September 2012. Implementation of the 5S (Sort, Set, Shine, Standardize, Sustain) approach as a CQI method at outpatient departments over 12 months. Cleanliness, waiting time, patient's experience, patient's satisfaction. The 5S increased cleanliness in the outpatient department, patients' subjective waiting time and overall satisfaction. However, negligible effects were confirmed for patient's experiences on hospital staff behaviours. The 5S as a CQI method is effective in enhancing hospital environment and service delivery; that are subjectively assessed by outpatients even during the short intervention period. Nevertheless, continuous efforts will be needed to connect CQI practices with the further improvement in the delivery of quality health care. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  20. Improved Minimum Entropy Filtering for Continuous Nonlinear Non-Gaussian Systems Using a Generalized Density Evolution Equation

    Directory of Open Access Journals (Sweden)

    Jinliang Xu

    2013-06-01

    Full Text Available This paper investigates the filtering problem for multivariate continuous nonlinear non-Gaussian systems based on an improved minimum error entropy (MEE criterion. The system is described by a set of nonlinear continuous equations with non-Gaussian system noises and measurement noises. The recently developed generalized density evolution equation is utilized to formulate the joint probability density function (PDF of the estimation errors. Combining the entropy of the estimation error with the mean squared error, a novel performance index is constructed to ensure the estimation error not only has small uncertainty but also approaches to zero. According to the conjugate gradient method, the optimal filter gain matrix is then obtained by minimizing the improved minimum error entropy criterion. In addition, the condition is proposed to guarantee that the estimation error dynamics is exponentially bounded in the mean square sense. Finally, the comparative simulation results are presented to show that the proposed MEE filter is superior to nonlinear unscented Kalman filter (UKF.