Effectiveness of Positive Psychotherapy in Improving Opiate Addicts’ Quality of Life

Directory of Open Access Journals (Sweden)

P Porzoor

2016-02-01

Full Text Available Objective: This study was aimed to assess the effectiveness of positive psychotherapy based on quality of life in improving opiate addicts’ quality of life. Method: A quasi experimental research design long with control group and pre-test, post-test and follow-up was employed for the conduct of this study. All the opiate addicts referring to treatment centers of Ardebil city in 2013 constituted the statistical population of the study and the number of 36 participants was selected as the sample via purposive sampling and randomly assigned into experimental and control groups. Quality-of-life-based psychotherapy was conducted on the experimental group in 8 sessions while the control group received no intervention. Quality of life questionnaire was used for data collection purposes. Results: The results suggested the effectiveness of the intervention in quality of life. Conclusion: This intervention, which is formed from the combination positive psychology and cognitive-behavioral approach, can be used as an effective treatment method.

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.

Effectiveness of the Spirometry 360 Quality Improvement Program for Improving Asthma Care: A Cluster Randomized Trial.

Science.gov (United States)

Mangione-Smith, Rita; Zhou, Chuan; Corwin, Michael J; Taylor, James A; Rice, Fiona; Stout, James W

To determine the effectiveness of the Spirometry 360 distance learning quality improvement (QI) program for enhancing the processes and outcomes of care for children with asthma. Cluster randomized controlled trial involving 25 matched pairs of pediatric primary care practices. Practices were recruited from 2 practice-based research networks: the Slone Center Office-based Research Network at Boston University, Boston, Mass, and the Puget Sound Pediatric Research Network, Seattle, Wash. Study participants included providers from one of the 50 enrolled pediatric practices and 626 of their patients with asthma. Process measures assessed included spirometry test quality and appropriate prescription of asthma controller medications. Outcome measures included asthma-specific health-related quality of life, and outpatient, emergency department, and inpatient utilization for asthma. At baseline, 25.4% of spirometry tests performed in control practices and 50.4% of tests performed in intervention practices were of high quality. During the 6-month postintervention period, 28.7% of spirometry tests performed in control practices and 49.9% of tests performed in intervention practices were of high quality. The adjusted difference-of-differences analysis revealed no intervention effect on spirometry test quality. Adjusted differences-of-differences analysis also revealed no intervention effect on appropriate use of controller medications or any of the parent- or patient-reported outcomes examined. In this study, the Spirometry 360 distance learning QI program was ineffective in improving spirometry test quality or parent- or patient-reported outcomes. QI programs like the one assessed here may need to focus on practices with lower baseline performance levels or may need to be tailored for those with higher baseline performance. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Explaining variation in perceived team effectiveness: Results from eleven quality improvement collaboratives

NARCIS (Netherlands)

M.M.H. Strating (Mathilde); A.P. Nieboer (Anna)

2013-01-01

textabstractAims and objectives. Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Background. Evidence underlying the effectiveness of quality

Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

Science.gov (United States)

Greene, Laurence; Moreo, Kathleen

2015-01-01

Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality

Collaborative quality improvement.

Science.gov (United States)

Luckenbaugh, Amy N; Miller, David C; Ghani, Khurshid R

2017-07-01

Quality improvement collaboratives were developed in many medical and surgical disciplines with the goal of measuring and improving the quality of care provided to patients. The aim of this review is to provide an overview of surgical quality improvement collaboratives, and in particular those aimed at improving urological care. Quality improvement collaboratives collect high-quality data using standardized methodologies, and use the data to provide feedback to physicians and practices, and then implement processes to improve patient outcomes. The largest regional collaborative in urology is the Michigan Urological Surgery Improvement Collaborative (MUSIC). Recent efforts by this group have been focused at understanding variation in care, improving patient selection for treatment, reducing treatment morbidity and measuring and optimizing technical skill. The American Urological Association has also recently launched a national quality registry (AQUA), with an initial focus on prostate cancer care. By understanding factors that result in exemplary performance, quality improvement collaboratives are able to develop best practices around areas of care with high variation that have the potential to improve outcomes and reduce costs. These developments have been made possible by the unique model offered by the collaborative structure with the goal of improving patient care at a population level.

Quality Circles: How Effective Are They in Improving Employee Performance and Attitudes?

Science.gov (United States)

Buch, Kimberly; Raban, Amiram

1990-01-01

Used a quasi-experimental design to assess the effect of a quality circle intervention on behavior and attitudes of 88 employees at a large Midwestern organization. Results provide mixed support for the purported ability of circles to improve work behavior with no change for absenteeism and productivity but positive change for quality of work.…

IMPROVING CONCEPTUAL DESIGN QUALITY

DEFF Research Database (Denmark)

Bush, Stuart; Robotham, Antony John

1999-01-01

designer to identify clear targets for design improvement and to measure the effectiveness of any new solution, whilst attention to QFD ensures customer requirements are still being satisfied.Often, SME's are not aware of many of the best design practices and so are not able to meet the demand......This paper will consider how Quality Function Deployment (QFD) and Design for Manufacture and Assembly (DFMA) processes can be used to improve the design quality of products at the concept stage. We appreciate that both QFD and DFMA are techniques that have been used for some time by mature product...... quality is maintained in design project work. The projects described have been carried out with products manufactured by small to medium sized enterprises (SME's), where we have found significant opportunities for product improvement. The quantitative nature of DFMA analysis results allows the novice...

Effective interventions on service quality improvement in a physiotherapy clinic.

Science.gov (United States)

Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (PService quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

Teaching quality improvement.

Science.gov (United States)

Murray, Marry Ellen; Douglas, Stephen; Girdley, Diana; Jarzemsky, Paula

2010-08-01

Practicing nurses are required to engage in quality improvement work as a part of their clinical practice, but few undergraduate nursing education programs offer course work and applied experience in this area. This article presents a description of class content and teaching strategies, assignments, and evaluation strategies designed to achieve the Quality and Safety Education in Nursing competencies related to quality improvement and interdisciplinary teams. Students demonstrate their application of the quality improvement process by designing and implementing a small-scale quality improvement project that they report in storyboard format on a virtual conference Web site.

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

Science.gov (United States)

Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D

2012-11-01

The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.

What are the effective ways to translate clinical leadership into health care quality improvement?

Science.gov (United States)

McSherry, Robert; Pearce, Paddy

2016-01-01

The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks.

Quality improvement in neurological surgery graduate medical education.

Science.gov (United States)

Parker, Scott L; McGirt, Matthew J; Asher, Anthony L; Selden, Nathan R

2015-04-01

There has been no formal, standardized curriculum for neurosurgical resident education in quality improvement. There are at least 2 reasons to integrate a formalized quality improvement curriculum into resident education: (1) increased emphasis on the relative quality and value (cost-effectiveness) of health care provided by individual physicians, and (2) quality improvement principles empower broader lifelong learning. An integrated quality improvement curriculum should comprise specific goals and milestones at each level of residency training. This article discusses the role and possible implementation of a national program for quality improvement in neurosurgical resident education. Copyright © 2015 Elsevier Inc. All rights reserved.

Preanalytical quality improvement : in quality we trust

OpenAIRE

Lippi, Giuseppe; Becan-McBride, Kathleen; Behulova, Darina; Bowen, Raffick A.; Church, Stephen; Delanghe, Joris; Grankvist, Kjell; Kitchen, Steve; Nybo, Mads; Nauck, Matthias; Nikolac, Nora; Palicka, Vladimir; Plebani, Mario; Sandberg, Sverre; Simundic, Ana-Maria

2013-01-01

Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has been achieved thanks to improvements in both reliability and standardization of analytical techniques, reagents, and instrumentation. Notable advances in information technology, quality control and qu...

Improving Indoor Air Quality

Science.gov (United States)

Usually the most effective way to improve indoor air quality is to eliminate individual sources of pollution or to reduce their emissions. Some sources, like those that contain asbestos, can be sealed or enclosed.

What are the effective ways to translate clinical leadership into health care quality improvement?

Directory of Open Access Journals (Sweden)

McSherry R

2016-02-01

Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

Quality Improvement Initiatives in Inflammatory Bowel Disease.

Science.gov (United States)

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

2017-08-01

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

Bringing quality improvement into the intensive care unit.

Science.gov (United States)

McMillan, Tracy R; Hyzy, Robert C

2007-02-01

During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care. To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives. Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region. The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.

Can Quality Improvement System Improve Childcare Site Performance in School Readiness?

Science.gov (United States)

Ma, Xin; Shen, Jianping; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Watson, Grace

2013-01-01

The authors evaluated the effectiveness of the Quality Improvement System (QIS) developed and implemented by Children's Services Council of Palm Beach County (Florida) as a voluntary initiative to improve the quality of childcare and education. They adopted a growth model approach to investigate whether childcare sites that participated in QIS…

[Quality assurance and quality improvement. Personal experiences and intentions].

Science.gov (United States)

Roche, B G; Sommer, C

1995-01-01

test, formulate hypotheses of cause, test those hypotheses, apply remedies, and assess the effect of remedies. Total employee involvement is critical. A power comes from enabling all employees to become involved in quality improvement. A great advantage of CQI is the prevention orientation of the concept. The CQI permeated a collegial approach, people learn how to work together to improve. CQI is a time consuming procedure. During our travel we learned the definition of quality as the customer satisfaction. To build a CQI concept in employed time but all employed are involved in quality improvement. Applying CQI we could be able to refuse Quality control programs.

Process safety improvement-Quality and target zero

Energy Technology Data Exchange (ETDEWEB)

Van Scyoc, Karl [Det Norske Veritas (U.S.A.) Inc., DNV Energy Solutions, 16340 Park Ten Place, Suite 100, Houston, TX 77084 (United States)], E-mail: karl.van.scyoc@dnv.com

2008-11-15

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

Process safety improvement-Quality and target zero

International Nuclear Information System (INIS)

Van Scyoc, Karl

2008-01-01

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given

Process safety improvement--quality and target zero.

Science.gov (United States)

Van Scyoc, Karl

2008-11-15

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

How to Begin a Quality Improvement Project.

Science.gov (United States)

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

2016-05-06

Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. Copyright © 2016 by the American

Making quality improvement programs more effective.

Science.gov (United States)

Shaw-Taylor, Yoku

2014-01-01

In the past 25 years, and as recent as 2011, all external evaluations of the Quality Improvement Organization (QIO) Program have found its impact to be small or difficult to discern. The QIO program costs about $200 million on average to administer each year to improve quality of healthcare for people of 65 years or older. The program was created to address questionable quality of care. QIOs review how care is provided based on performance measures. The paper aims to discuss these issues. In 2012, the author supported the production of quarterly reports and reviewed internal monitoring and evaluation protocols of the program. The task also required reviewing all previous program evaluations. The task involved many conversations about the complexities of the program, why impact is difficult to discern and possible ways for eventual improvement. Process flow charts were created to simulate the data life cycle and discrete event models were created based on the sequence of data collection and reporting to identify gaps in data flow. The internal evaluation uncovered data gaps within the program. The need for a system of specification rules for data conceptualization, collection, distribution, discovery, analysis and repurposing is clear. There were data inconsistencies and difficulty of integrating data from one instance of measurement to the next. The lack of good and reliable data makes it difficult to discern true impact. The prescription is for a formal data policy or data governance structure to integrate and document all aspects of the data life cycle. The specification rules for governance are exemplified by the Data Documentation Initiative and the requirements published by the Data Governance Institute. The elements are all in place for a solid foundation of the data governance structure. These recommendations will increase the value of program data. The model specifies which agency units must be included in the governance authority and the data team. The

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

Evaluating the Effectiveness of Two Teaching Strategies to Improve Nursing Students' Knowledge, Skills, and Attitudes About Quality Improvement and Patient Safety.

Science.gov (United States)

Maxwell, Karen L; Wright, Vivian H

The purpose of this study was to evaluate two teaching strategies with regard to quality and safety education for nurses content on quality improvement and safety. Two groups (total of 64 students) participated in online learning or online learning in conjunction with a flipped classroom. A pretest/posttest control group design was used. The use of online modules in conjunction with the flipped classroom had a greater effect on increasing nursing students' knowledge of quality improvement than the use of online modules only. There was no statistically significant difference between the groups for safety.

Technical report for effective estimation and improvement of quality system

International Nuclear Information System (INIS)

Kim, Kwan Hyun

2000-06-01

This technical report provides the methods on how to improve the Quality System, in R and D part. This report applies on the quality assurance(QA) programmes of the design, fabrication in nuclear projects. The organization having overall responsibility for the nuclear power item design, preservation, fabrication shall be described in this report in each stage of improvement of QA systems

[Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

Science.gov (United States)

Godény, Sándor

2012-02-05

The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

Using quality measures for quality improvement: the perspective of hospital staff.

Directory of Open Access Journals (Sweden)

Asgar Aghaei Hashjin

Full Text Available RESEARCH OBJECTIVE: This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals. STUDY DESIGN: A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness indicators. POPULATION STUDIED: 93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran. PRINCIPAL FINDINGS: On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05. CONCLUSIONS: There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and

Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project

NARCIS (Netherlands)

Groene, O.; Klazinga, N.; Wagner, C.; Arah, O.A.; Thompson, A.; Bruneau, C.; Suñol, R.

2010-01-01

Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. We propose to study the relationships among organisational quality improvement

Quality improvement - the future begins

International Nuclear Information System (INIS)

Boissy, G.J.

1987-01-01

The comprehensive quality improvement program of the Florida Power and Light Co. is described: management commitment, quality improvement process, quality improvement teams, policy development, and quality in daily work are discussed

Effect of quality of life improvement on type 2 diabetes patients' self-esteem.

Science.gov (United States)

Safavi, Mahboubeh; Samadi, Nasrin; Mahmoodi, Mahmood

2011-09-01

To study the effects of the quality of life (QoL) improvement on their QoL and self-esteem. This was a random controlled clinical trial study on 123 type 2 diabetes patients admitted to the Diabetes Clinic in Imam Khomeini Hospital at Ardebil, Iran from April 2009 to June 2010. The 30-70 years old participants are afflicted with type 2 diabetes, and randomly divided into 2 groups (experimental group n=61, and control group n=62). The questionnaires were composed of sociodemographic status, Farrel & Grant, and Rosenberg's self-esteem questionnaires and the quality of life (QoL) improvement plan was codified to educate and evaluate them. A plow self-esteem (13%) before QOL training, and they had moderate self-esteem after the intervention (39%), however, the control group had moderate self-esteem (62.5%) in the pre-test, and changed to low self-esteem (12.9%) in the post-test, and there was significant difference in the previous and next intervention (pself-esteem, and QOL as improved may help to reduce the side effects of type 2 diabetes process.

Quality improvement in pediatrics: past, present, and future.

Science.gov (United States)

Schwartz, Stephanie P; Rehder, Kyle J

2017-01-01

Almost two decades ago, the landmark report "To Err is Human" compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare. Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations. This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.

Preanalytical quality improvement: in quality we trust.

Science.gov (United States)

Lippi, Giuseppe; Becan-McBride, Kathleen; Behúlová, Darina; Bowen, Raffick A; Church, Stephen; Delanghe, Joris; Grankvist, Kjell; Kitchen, Steve; Nybo, Mads; Nauck, Matthias; Nikolac, Nora; Palicka, Vladimir; Plebani, Mario; Sandberg, Sverre; Simundic, Ana-Maria

2013-01-01

Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has been achieved thanks to improvements in both reliability and standardization of analytical techniques, reagents, and instrumentation. Notable advances in information technology, quality control and quality assurance methods have also assured a valuable contribution for reducing diagnostic errors. Nevertheless, several lines of evidence still suggest that most errors in laboratory diagnostics fall outside the analytical phase, and the pre- and postanalytical steps have been found to be much more vulnerable. This collective paper, which is the logical continuum of the former already published in this journal 2 years ago, provides additional contribution to risk management in the preanalytical phase and is a synopsis of the lectures of the 2nd European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled "Preanalytical quality improvement: in quality we trust" (Zagreb, Croatia, 1-2 March 2013). The leading topics that will be discussed include quality indicators for preanalytical phase, phlebotomy practices for collection of blood gas analysis and pediatric samples, lipemia and blood collection tube interferences, preanalytical requirements of urinalysis, molecular biology hemostasis and platelet testing, as well as indications on best practices for safe blood collection. Auditing of the preanalytical phase by ISO assessors and external quality assessment for preanalytical phase are also discussed.

ELECTRONIC TEXTBOOK AS AN EFFECTIVE TOOL FOR IMPROVING THE QUALITY OF EDUCATION

OpenAIRE

Yuliia M. Shepetko

2011-01-01

The urgency of the material stated in article, is caused by requirements for use of information and communication technologies for educational process, in particular the electronic textbook which can facilitate perception of the information, diversify work forms, interest by technical possibilities. The article aims to proof the necessity of  electronic textbooks use as effective tool for improving the quality of education. Use of the electronic textbook at training will effectively and posit...

The ReACH Collaborative--improving quality home care.

Science.gov (United States)

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

2007-08-01

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

The effect of the SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines on reporting standards in the quality improvement literature: a before-and-after study.

Science.gov (United States)

Howell, Victoria; Schwartz, Amanda Eva; O'Leary, James Daniel; Mc Donnell, Conor

2015-06-01

The SQUIRE (Standards of QUality Improvement Reporting Excellence) guidelines were developed to improve the reporting of quality improvement (QI) projects. The effect of the guidelines on the completeness of reporting in the QI literature is unknown. Our primary objective was to determine if the completeness of reporting in the QI literature has been improved[OUP_CE13] since the introduction of the SQUIRE guidelines. We performed a before-and-after evaluation of QI articles selected from four prominent journals of healthcare quality. Twenty-five articles published in each of two time periods (2006-2008 and 2010-2011) were confirmed to be QI projects using a standardised definition and were independently evaluated by two investigators as an interim evaluation of a planned larger sample. Articles were assessed using 50 statements of the SQUIRE guidelines, and the overall change in the completeness of reporting between the two groups was determined. The value of pimprovement observed in the completeness of reporting of QI projects after the publication of the SQUIRE guidelines, and the study was stopped early. There is potential for improvement in reporting standards, particularly for those guideline items or statements specific to QI projects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Integration of quality improvement and cost-efficiency through industrial improvement techniques

Directory of Open Access Journals (Sweden)

Vink JP

2016-06-01

Full Text Available Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowledge Crema and Verbano’s arguments that patient safety is a basic pillar of quality, upon which we would like to expand by highlighting the clinical effectiveness and patient-reported outcomes, which are the two further crucial components of quality. The arguments made regarding quality improvement techniques and cost efficiency in health care provision are insightful, yet appear to make a distinction between efforts to improve quality, eliminate waste from processes, and cut costs in health care provision. We would argue that in fact these achievements are all closely related and can be achieved simultaneously, if the industrial techniques of quality management are applied adequately.View the original paper by Crema and Verbano.

Antenatal care strengthening for improved quality of care in Jimma, Ethiopia: an effectiveness study.

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Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe; Tilahun, Abebech; Friis, Henrik; Rasch, Vibeke

2015-04-11

Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems and increased overall user satisfaction with ANC) were distal project outcomes. The process of implementation was documented in monthly supervision reports. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. The continued attention to the ANC provision during implementation stimulated increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3.9, 95% CI: 2.6;5.7), laboratory testing (OR for blood tests other than HIV 2.9, 95% CI: 1.9;4.5), health problem identification (OR 1.8, 95% CI: 1.1;3.1), and satisfaction with the service (OR: 0

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

Science.gov (United States)

Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

2015-01-01

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

Practice-level quality improvement interventions in primary care: a review of systematic reviews.

Science.gov (United States)

Irwin, Ryan; Stokes, Tim; Marshall, Tom

2015-11-01

To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews. Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care--the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting. A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions. Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions. Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality

Interventions to improve water quality for preventing diarrhoea.

Science.gov (United States)

Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

2015-10-20

Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces.In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with unimproved water sources (30 studies) and unimproved or unclear sanitation (34 studies). The primary

Data Quality Assessment and Recommendations to Improve the Quality of Hemodialysis Database

Directory of Open Access Journals (Sweden)

Neda Firouraghi

2018-01-01

entering directly HD data or lab results into the database can improve the data quality drastically. Experts' opinion in detecting outliers as a complement to statistical methods can have an effective role in detection of real outliers. For the analysis of HD databases, the relationship between the variables because of their effect on the quality should be focused more to improve the quality of the database.

Effective quality auditing

International Nuclear Information System (INIS)

Sivertsen, Terje

2004-01-01

The present report focuses on how to improve the effectiveness of quality audits and organization-wide quality management. It discusses several concepts related to internal quality auditing, includes guidelines on how to establish auditing as a key process of the organization, and exemplifies its application in the management of quality, strategy, and change. The report follows a line of research documented previously in the reports 'Continuous Improvement of Software Quality' (HWR-584) and 'ISO 9000 Quality Systems for Software Development' (HWR-629). In particular, the concepts of measurement programmes and process improvement cycles, discussed in HWR-584, form the basis for the approach advocated in the present report to the continual improvement of the internal quality audit process. Internal auditing is an important ingredient in ISO 9000 quality systems, and continual improvement of this process is consistent with the process-oriented view of the 2000 revision of the ISO 9000 family (HWR-629). The overall aim of the research is to provide utilities and their system vendors with better tools for quality management in digital I and C projects. The research results are expected to provide guidance to the choice of software engineering practices to obtain a system fulfilling safety requirements at an acceptable cost. For licensing authorities, the results are intended to make the review process more efficient through the use of appropriate measures (metrics), and to be of help in establishing requirements to software quality assurance in digital I and C projects. (Author)

42 CFR 494.110 - Condition: Quality assessment and performance improvement.

Science.gov (United States)

2010-10-01

... facility must maintain and demonstrate evidence of its quality improvement and performance improvement... RENAL DISEASE FACILITIES Patient Care § 494.110 Condition: Quality assessment and performance improvement. The dialysis facility must develop, implement, maintain, and evaluate an effective, data-driven...

Accelerate Water Quality Improvement

Science.gov (United States)

EPA is committed to accelerating water quality improvement and minimizing negative impacts to aquatic life from contaminants and other stressors in the Bay Delta Estuary by working with California Water Boards to strengthen water quality improvement plans.

"Rheum to Improve": Quality Improvement in Outpatient Rheumatology.

Science.gov (United States)

Chow, Shirley L; Shojania, Kaveh G

2017-09-01

The commitment to improve care processes and patient outcomes is a professional mandate for clinicians and is also seen as an operational priority for institutions. Quality improvement now figures in the accreditation of training programs, specialty examinations, and hospital scorecards. Rheumatologists have traditionally focused primarily on quality problems such as guideline adherence; however, improvement goals should also include other aspects of care that are helpful to patients and are professionally rewarding for practitioners. This review makes use of improvement projects in outlining tangible tools rheumatologists can use to resolve quality concerns in their practices.

Clinical Performance Measures and Quality Improvement System Considerations for Dental Education.

Science.gov (United States)

Parkinson, Joseph W; Zeller, Gregory G

2017-03-01

Quality improvement and quality assurance programs are an integral part of providing excellence in health care delivery. The Dental Quality Alliance and the Commission on Dental Accreditation recognize this and have created standards and recommendations to advise health care providers and health care delivery systems, including dental schools, on measuring the quality of the care delivered to patients. Overall health care expenditures have increased, and the Affordable Care Act has made health care, including dentistry, available to more people in the United States. These increases in cost and in the number of patients accessing care contribute to a heightened interest in measurable quality improvement outcomes that reflect efficiency, effectiveness, and overall value. Practitioners and administrators, both in academia and in the "real world," need an understanding of various quality improvement methodologies available in order to select approaches that support effective monitoring of the quality of care delivered. This article compares and contrasts various quality improvement approaches, programs, and systems currently in use in order to assist dental providers and administrators in choosing quality improvement methodologies pertinent to their practice or institution.

Application of improved quality control technology to pressure vessels

International Nuclear Information System (INIS)

Kriedt, F.

1985-01-01

Within the last decade, ASME Boiler and Pressure Vessel Code Section VIII-1 instituted requirements for a formal written quality control system. The results, good and bad, of this requirement are discussed. The effects are far reaching from a national economic standpoint. Quality control technology has improved. These improvements are discussed and compared to existing requirements of the CODE. Recommended improvements are suggested

PROCESS VARIABILITY REDUCTION THROUGH STATISTICAL PROCESS CONTROL FOR QUALITY IMPROVEMENT

Directory of Open Access Journals (Sweden)

B.P. Mahesh

2010-09-01

Full Text Available Quality has become one of the most important customer decision factors in the selection among the competing product and services. Consequently, understanding and improving quality is a key factor leading to business success, growth and an enhanced competitive position. Hence quality improvement program should be an integral part of the overall business strategy. According to TQM, the effective way to improve the Quality of the product or service is to improve the process used to build the product. Hence, TQM focuses on process, rather than results as the results are driven by the processes. Many techniques are available for quality improvement. Statistical Process Control (SPC is one such TQM technique which is widely accepted for analyzing quality problems and improving the performance of the production process. This article illustrates the step by step procedure adopted at a soap manufacturing company to improve the Quality by reducing process variability using Statistical Process Control.

MODERN CONCEPTS OF THE SIX SIGMA METHODOLOGY FOR IMPROVING THE QUALITY

Directory of Open Access Journals (Sweden)

MARGARITA JANESKA

2018-02-01

Full Text Available Product quality is generally accepted as being crucial in today’s industrial business. The traditional aspects of product quality are connected to product design (translating customer demands into attractive features and technical specifications and to the design and specification of high performance production processes with low defect rates. Quality management is the general expression for all actions leading to quality. Quality management is focused on improving customer satisfaction through continuous improvement of processes including the removal of uncertain activities, and continuous improvement of the quality of processes, products and services. The quality management includes four key processes, such as quality planning, quality assurance, quality control and quality costs. The main accent in this paper will be on quality control and the application of one of the quality control tools in order to improve it. Six Sigma is different from other quality improvement concepts in that its framework is comprised of many principles, tools and techniques, which, together with experience, are all integrated and translated into best practices. Bearing in mind that the goal of every company is to work effectively and effectively in the long run, this paper focuses on Six Sigma as a way to continuously improve quality. Namely, this paper emphasizes the key features of the quality of products / services, the Need for the application of Six Sigma for quality assurance, and also a detailed list of tools and techniques that can be used during the implementation of Six Sigma.

Understanding and using quality information for quality improvement: the effect of information presentation.

NARCIS (Netherlands)

Zwijnenberg, N.C.; Hendriks, M.; Delnoij, D.M.J.; Veer, A.J.E. de; Spreeuwenberg, P.; Wagner, C.

2016-01-01

Objective: To examine how information presentation affects the understanding and use of information for quality improvement. Design: An experimental design, testing 22 formats, and showing information on patient safety culture. Formats differed in visualization, outcomes and benchmark

Improving Power Quality in AC Supply Grids

Directory of Open Access Journals (Sweden)

Piotr Fabijański

2015-12-01

Full Text Available This paper describes a digital and actual model of the UPQC (Unified Power Quality Conditioner integrated system for power quality improvement. The UPQC’s design and its connection to an AC supply grid, 1-phase and 3-phase alike, provide effective compensation of unwanted interferences in the waveforms of load supply voltages and non-linear load currents. This article presents an overview of topologies and control strategies. The study of the UPQC confirmed its positive impact on the power quality. The electricity parameters were significantly improved. Total harmonic distortion in supply voltage THDu decreased six-fold to 1.89%, and total harmonic distortion in load current THDi decreased more than ten-fold to 2.38% for a non-linear load (uncontrolled bridge rectifier with load L. Additionally, symmetrisation of supply voltages and reactive power compensation Q of linear load was obtained. The UPQC integrated system for power quality improvement can be used wherever high-quality and PN-EN 50160 standard – compliant electricity is required.

Understanding and using quality information for quality improvement : The effect of information presentation

NARCIS (Netherlands)

Zwijnenberg, N.C.; Hendriks, M.; Delnoij, D.; De Veer, A.J.; Spreeuwenberg, P.; Wagner, C.

2016-01-01

Objective To examine how information presentation affects the understanding and use of information for quality improvement. Design An experimental design, testing 22 formats, and showing information on patient safety culture. Formats differed in visualization, outcomes and benchmark information.

Self-reported Improvement in Side Effects and Quality of Life With Integrative Medicine in Breast Cancer Patients.

Science.gov (United States)

Hack, Carolin C; Hackl, Janina; Hüttner, Nina B M; Langemann, Hanna; Schwitulla, Judith; Dietzel-Drentwett, Svenja; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-05-01

Although the demand from patients for integrative medicine is increasing, complementary medicine services are still quite heterogeneous and have not been incorporated into clinical routine. The aim of this study was to systematically evaluate improvements in side effects and quality of life associated with a hospital-based integrative medicine program in the modern breast cancer patient care setting. In a cross-sectional study, integrative health counseling and treatment were evaluated in women with breast cancer. Over a 15-month period, data for 75 patients from an integrative medicine consultancy service with standardized operating procedures were collected at the University Breast Center for Franconia. At baseline, the patients answered a questionnaire on their medical history, symptoms, and the treatment goals they were hoping to achieve with integrative medicine. In the follow-up, patient-reported outcomes related to side effects of conventional cancer treatment and patients' quality of life were analyzed. Among 60 patients with the therapy goal of reducing the side effects of conventional treatment, 46 (76.7%) were successful. Among 57 patients hoping to improve disease-related quality of life, 46 (82%) reported success. Whereas patients with metastatic disease achieved a reduction in the side effects of conventional therapy, quality-of-life improvements were predominantly achieved by patients with a good treatment prognosis. Breast cancer patients benefit from the counseling and treatment provided with integrative medicine in all phases of tumor disease. Integrative treatment services should be included as part of patient care in clinical routine work to offer patients the maximum quality of care and safety with complementary therapies.

A System That Works: Highlights of Effective Intervention Strategies in a Quality Improvement System

Science.gov (United States)

Sinisterra, Diana; Baker, Stephen

2010-01-01

This paper describes one approach to quality improvement efforts: the Quality Improvement System (QIS) implemented by Prime Time Palm Beach County (Prime Time) in Palm Beach County, Florida. Prime Time's QIS is recognized as one promising systemic effort to improve quality in the afterschool field (Yohalem, Granger, & Pittman, 2009). As a…

Evolution and outcomes of a quality improvement program.

Science.gov (United States)

Thor, Johan; Herrlin, Bo; Wittlöv, Karin; Øvretveit, John; Brommels, Mats

2010-01-01

The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it. The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations. Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees. Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied. This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.

Structured data quality reports to improve EHR data quality.

Science.gov (United States)

Taggart, Jane; Liaw, Siaw-Teng; Yu, Hairong

2015-12-01

To examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs. The intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices. The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets. Birth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (pImprovement was greatest with allergies. There was no significant change in duplicate records. SDQRs and feedback sessions support general practitioners and practice managers to focus on improving the recording of patient information. However, improved practice DQ, was not sufficient to meet RACGP targets. Randomised controlled studies are required to evaluate strategies to improve data quality and any associated improved safety and quality of care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

GENETICS AND MOLECULAR BIOLOGY AND PIG MEAT QUALITY IMPROVEMENT

Directory of Open Access Journals (Sweden)

J. BULLA

2007-05-01

Full Text Available The main goals in pig breeding have for many years been to improve growth rate, feedconversion and carcass composition. There have been less efforts to improve meat qualityparameters (WHC, pH, tenderness, colour etc. but the main contribution has been areduction of stress susceptibility and PSE meat. Unfortunately, the quantitative geneticapproach has yielded few clues regarding the fundamental genetic changes that accompaniedthe selection of animal for superior carcass attributes. While mapping efforts are makingsignificant major effects on carcass and his quality composition DNA test would be availableto detect some positive or negative alleles. There are clear breed effects on meat quality,which in some cases are fully related to the presence of a single gene with major effect (RYR1,MYF4, H-FABP, LEPR, IGF2. Molecular biology methods provides excellent opportunitiesto improve meat quality in selection schemes within breeds and lines. Selection on majorgenes will not only increase average levels of quality but also decrease variability (ei increaseuniformity. The aim of this paper is to discuss there genetic and non-genetic opportunities.

GENETICS AND MOLECULAR BIOLOGY AND PIG MEAT QUALITY IMPROVEMENT

Directory of Open Access Journals (Sweden)

BULLA, J.

2007-01-01

Full Text Available The main goals in pig breeding have for many years been to improve growth rate, feedconversion and carcass composition. There have been less efforts to improve meat qualityparameters (WHC, pH, tenderness, colour etc. but the main contribution has been areduction of stress susceptibility and PSE meat. Unfortunately, the quantitative geneticapproach has yielded few clues regarding the fundamental genetic changes that accompaniedthe selection of animal for superior carcass attributes. While mapping efforts are makingsignificant major effects on carcass and his quality composition DNA test would be availableto detect some positive or negative alleles. There are clear breed effects on meat quality,which in some cases are fully related to the presence of a single gene with major effect (RYR1,MYF4, H-FABP, LEPR, IGF2. Molecular biology methods provides excellent opportunitiesto improve meat quality in selection schemes within breeds and lines. Selection on majorgenes will not only increase average levels of quality but also decrease variability (ei increaseuniformity. The aim of this paper is to discuss there genetic and non-genetic opportunities.

Using Quality Improvement to Improve Internal and External Coordination and Referrals.

Science.gov (United States)

Cain, Katherine L; Collins, Ragan P

As part of accreditation, Public Health Accreditation Board site visitors recommended that the New Orleans Health Department strengthen its quality improvement program. With support from the Public Health Accreditation Board, the New Orleans Health Department subsequently embarked on a data-driven planning process through which it prioritized quality improvement projects for 2016. One of these projects aimed to improve referrals to New Orleans Health Department's direct services programs from local clinics and hospitals to better provide our most vulnerable residents with a continuum of care. After completing a cause-and-effect analysis, we implemented a solution involving increased outreach to health care institutions and saw annual participation increase in 3 out of 4 of our programs. We leveraged this work to successfully apply for funding to create a centralized referral system, which will facilitate partnerships among local health and human service agencies and improve access to services. This is one example of how accreditation has benefited our health department and our community. We have found that the accreditation process promotes a culture of quality and helps health departments identify and address areas for improvement.

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.

Science.gov (United States)

Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

2015-10-01

While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Small cause - big effect: improvement in interface design results in improved data quality - a multicenter crossover study.

Science.gov (United States)

Ahlbrandt, Janko; Henrich, Michael; Hartmann, Bernd A; Bundschuh, Bettina B; Schwarz, Julia; Klasen, Joachim; Röhrig, Rainer

2012-01-01

In Germany the core data set for anesthesia version 3.0 was recently introduced for external quality assurance, which includes five surgical tracer procedures. We found a low rate of correctly documented tracers when compared to procedure data (OPS-Codes) documented separately. Examination revealed that the graphical user interface (GUI) contravened the dialogue principles as defined in EN ISO 9241-110. We worked with the manufacturer to implement small improvements and roll out the software. A crossover study was conducted at a university hospital and a municipal hospital chain with five hospitals. All study sites and surgical tracer procedures combined, we found an improvement from 42% to 65% (pbig effect small changes to the GUI can have on data quality. They also raise the question, if highly flexible and parameterized clinical documentation systems are suited to achieve high usability. Finding the right balance between GUIs designed by usability experts and the flexibility of parameterization by administrators will be a difficult task for the future and subject to further research.

Soil quality improvement through conversion to sprinkler irrigation

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Conversion from furrow to sprinkler irrigation is a recommended conservation practice for improved water use efficiency (and/or erosion control), but effects on soil quality indicators were unknown. Several soil quality indicators were therefore quantified within a northwestern U.S. Conservation Eff...

Short- and long-term effects of a quality improvement collaborative on diabetes management

Directory of Open Access Journals (Sweden)

Niessen Louis W

2010-11-01

Full Text Available Abstract Introduction This study examined the short- and long-term effects of a quality improvement collaborative on patient outcomes, professional performance, and structural aspects of chronic care management of type 2 diabetes in an integrated care setting. Methods Controlled pre- and post-intervention study assessing patient outcomes (hemoglobin A1c, cholesterol, blood pressure, weight, blood lipid levels, and smoking status, professional performance (guideline adherence, and structural aspects of chronic care management from baseline up to 24 months. Analyses were based on 1,861 patients with diabetes in six intervention and nine control regions representing 37 general practices and 13 outpatient clinics. Results Modest but significant improvement was seen in mean systolic blood pressure (decrease by 4.0 mm Hg versus 1.6 mm Hg and mean high density lipoprotein levels (increase by 0.12 versus 0.03 points at two-year follow up. Positive but insignificant differences were found in hemoglobin A1c (0.3%, cholesterol, and blood lipid levels. The intervention group showed significant improvement in the percentage of patients receiving advice and instruction to examine feet, and smaller reductions in the percentage of patients receiving instruction to monitor blood glucose and visiting a dietician annually. Structural aspects of self-management and decision support also improved significantly. Conclusions At a time of heightened national attention toward diabetes care, our results demonstrate a modest benefit of participation in a multi-institutional quality improvement collaborative focusing on integrated, patient-centered care. The effects persisted for at least 12 months after the intervention was completed. Trial number http://clinicaltrials.gov Identifier: NCT 00160017

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

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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…

Effects of Aqua Exercises Towards Improving The Quality of Life (QoL) of Obese Women in Malaysia

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Karim, Noor Liyana Binti; Jalil, Asma Diyana binti Abd; Hasri, Noor Haninah Binti; Rahman, Hezlin Aryani Binti Abd; Shari, Maisarah Binti; Idris, Nur Izzati Binti

2018-05-01

Aqua exercise is a form of water exercise, done in the water which is beneficial for weight loss as well as improving the quality of life. It is suitable for all age group and fitness levels whereby due to the water buoyancy makes it easier to perform exercises especially for obese and knee-injured people. However, there was not much study done to measure the effectiveness of the aqua exercises in improving the quality life. Thus, this study aims to investigate and compare the effectiveness of aqua exercises towards obese women within eight domains of the Quality of Life (QoL). This study uses the 36-Items Short Form Health Survey (SF-36) questionnaire and a purposive sample of 61 participants to measure the effectiveness of the aqua exercise before and after 36 days of aqua workout. As the nature of the data collected was not normally distributed, hence the Wilcoxon signed rank test was used as the statistical method of analysis. The findings of this study showed that there was a significant difference between the overall QoL pre and post since the p-value physical functioning, general health, social functioning, mental health, and health transition were the domains showing significant difference between the pre and post-test (p-value < 0.05), and where majority of the participants showed a significant improvement after the aqua workouts. Thus, it can be concluded that aqua exercises is effective in improving the general QoL of obese women.

[Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients].

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Gómez Marcos, Manuel A; García Ortiz, Luis; González Elena, Luis Javier; Sánchez Rodríguez, Angel

2006-05-31

To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. Quasi-experimental study. Primary care. Two urban health centres. A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.

Workers' Objectives in Quality Improvement.

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Brossard, Michel

1990-01-01

A case study of quality circles in an appliance factory found that circle members and nonmembers obtained better working conditions by improving quality through the direct impact of their work on the company's market position. The study of the quality improvement process shows that workers seek more than psychological rewards for their…

STANDPOINT OF THE TOP MANAGEMENT ABOUT THE EFFECTS OF INTRODUCED QUALITY SYSTEM AND CONTINUATION AF ACTIVITIES OF ITS IMPROVEMENT

Directory of Open Access Journals (Sweden)

Sabahudin Jasarevic

2015-06-01

Full Text Available There are number of obstacles on a challenging road to the effectiveness and business and organizational excellence. One of the most difficult ones is human (not understanding of the constant flux of change. Such is the case when it comes to development of quality management system. Will the quality be either a problem or resource of some organization depends above all on the basic standpoint towards quality that exists in the organization. Many authors underline that implementation of quality management system and obtaining ISO 9000 certificate is not an easy task, but also emphasize that its maintenance and improvement is much more difficult task. The greatest number of problems that occur during the realization of project of quality management system as well as its improvement are the result of misunderstanding of the essence of standard, that is its principles. On of these principles is Leadership too, that is the role of Top Management. Managers at the highest levels are certainly the most responsible for establishing the vision and guiding organization in all business aspects, including Quality Management and Quality Management System. This work presents results of research conducted on the top management in 204 organizations with introduced quality system. Results show views of top management about the effects of introduced quality system as well as about future steps in terms of improving the same.

Quality Improvement in Anesthesiology - Leveraging Data and Analytics to Optimize Outcomes.

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Valentine, Elizabeth A; Falk, Scott A

2018-03-01

Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions. Audit and feedback strategies are effective in facilitating positive change. Copyright © 2017 Elsevier Inc. All rights reserved.

Creating Quality Improvement Culture in Public Health Agencies

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

2014-01-01

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

Creating quality improvement culture in public health agencies.

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

2014-01-01

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

Quality Improvement in Athletic Health Care.

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Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

2017-11-01

  Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

[Audit and feedback, and continuous quality improvement strategies to improve the quality of care for type 2 diabetes: a systematic review of literature].

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Vecchi, Simona; Agabiti, Nera; Mitrova, Susanna; Cacciani, Laura; Amato, Laura; Davoli, Marina; Bargagli, Anna Maria

2016-01-01

we analysed evidence on effective interventions to improve the quality of care and management in patients with diabetes type 2. This review focuses particularly on audit and feedback intervention, targeted to healthcare providers, and continuous quality improvement (CQI) involving health professionals and health care systems, respectively. we searched The Cochrane Library, PubMed, and EMBASE (search period: January 2005-December 2015) to identify systematic reviews (SR) and randomized controlled trials (RCTs) considering patients' outcomes and process measures as quality indicators in diabetes care. Selection of studies and data extraction were carried out independently by two reviewers. Methodological quality of individual studies was assessed using the checklist «Assessment of methodological quality of systematic review» (AMSTAR) and the Cochrane's tool, respectively. We produced summaries of results for each study design. the search process resulted in 810 citations. One SR and 7 RCTs that compared any intervention in which audit and feedback and CQI was a component vs. other interventions were selected. The SR found that audit and feedback activity was associated with improvements of glycaemic (mean difference: 0.26; 95%CI 0.08;0.44) and cholesterol control (mean difference: 0.03; 95%CI -0.04;0.10). CQI interventions were not associated with an improvement of quality of diabetes care. The RCTs considered in this review compared a broad range of interventions including feedback as unique activity or as part of more complex strategies. The methodological quality was generally poor in all the included trials. the available evidence suggests that audit and feedback and CQI improve quality of care in diabetic patients, although the effect is small and heterogeneous among process and outcomes indicators.

Prioritizing quality improvement in general surgery.

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Schilling, Peter L; Dimick, Justin B; Birkmeyer, John D

2008-11-01

Despite growing interest in quality improvement, uncertainty remains about which procedures offer the most room for improvement in general surgery. In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery. Using data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP), we identified all patients undergoing a general surgery procedure in 2005 and 2006 (n=129,233). Patients were placed in 36 distinct procedure groups based on Current Procedural Terminology codes. We first examined procedure groups according to their relative contribution to overall morbidity and mortality. We then assessed procedure groups according to their contribution to overall excess length of stay. Ten procedure groups alone accounted for 62% of complications and 54% of excess hospital days. Colectomy accounted for the greatest share of adverse events, followed by small intestine resection, inpatient cholecystectomy, and ventral hernia repair. In contrast, several common procedures contributed little to overall morbidity and mortality. For example, outpatient cholecystectomy, breast procedures, thyroidectomy, parathyroidectomy, and outpatient inguinal hernia repair together accounted for 34% of procedures, but only 6% of complications (and only 4% of major complications). These same procedures accounted for surgery. Focusing quality improvement efforts on these procedures may be an effective strategy for improving patient care and reducing cost.

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta.

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Buttigieg, Sandra Catherine; Dey, Prasanta Kumar; Cassar, Mary Rose

2016-01-01

The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital. The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital. The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit. PRACTICAL/IMPLICATIONS: The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been

Sustainability in the AAP Bronchiolitis Quality Improvement Project.

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Shadman, Kristin A; Ralston, Shawn L; Garber, Matthew D; Eickhoff, Jens; Mussman, Grant M; Walley, Susan C; Rice-Conboy, Elizabeth; Coller, Ryan J

2017-11-01

Adherence to American Academy of Pediatrics (AAP) bronchiolitis clinical practice guideline recommendations improved significantly through the AAP's multiinstitutional collaborative, the Bronchiolitis Quality Improvement Project (BQIP). We assessed sustainability of improvements at participating institutions for 1 year following completion of the collaborative. Twenty-one multidisciplinary hospital-based teams provided monthly data for key inpatient bronchiolitis measures during baseline and intervention bronchiolitis seasons. Nine sites provided data in the season following completion of the collaborative. Encounters included children younger than 24 months who were hospitalized for bronchiolitis without comorbid chronic illness, prematurity, or intensive care. Changes between baseline-, intervention-, and sustainability-season data were assessed using generalized linear mixed-effects models with site-specific random effects. Differences between hospital characteristics, baseline performance, and initial improvement between sites that did and did not participate in the sustainability season were compared. A total of 2275 discharges were reviewed, comprising 995 baseline, 877 intervention, and 403 sustainability- season encounters. Improvements in all key bronchiolitis quality measures achieved during the intervention season were maintained during the sustainability season, and orders for intermittent pulse oximetry increased from 40.6% (95% confidence interval [CI], 22.8-61.1) to 79.2% (95% CI, 58.0- 91.3). Sites that did and did not participate in the sustainability season had similar characteristics. BQIP participating sites maintained improvements in key bronchiolitis quality measures for 1 year following the project's completion. This approach, which provided an evidence-based best-practice toolkit while building the quality-improvement capacity of local interdisciplinary teams, may support performance gains that persist beyond the active phase of the

Do Clinical Practice Guidelines Improve Quality?

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Baldassari, Cristina M

2017-07-01

Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

Quality and Efficiency Improvement Tools for Every Radiologist.

Science.gov (United States)

Kudla, Alexei U; Brook, Olga R

2018-03-20

In an era of value-based medicine, data-driven quality improvement is more important than ever to ensure safe and efficient imaging services. Familiarity with high-value tools enables all radiologists to successfully engage in quality and efficiency improvement. In this article, we review the model for improvement, strategies for measurement, and common practical tools with real-life examples that include Run chart, Control chart (Shewhart chart), Fishbone (Cause-and-Effect or Ishikawa) diagram, Pareto chart, 5 Whys, and Root Cause Analysis. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

SQIMSO: Quality Improvement for Small Software Organizations

OpenAIRE

Rabih Zeineddine; Nashat Mansour

2005-01-01

Software quality improvement process remains incomplete if it is not initiated and conducted through a wide improvement program that considers process quality improvement, product quality improvement and evolution of human resources. But, small software organizations are not capable of bearing the cost of establishing software process improvement programs. In this work, we propose a new software quality improvement model for small organizations, SQIMSO, based on three ...

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

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

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

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)

Quality improvement and emerging global health priorities

Science.gov (United States)

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

2018-01-01

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

Domains associated with successful quality improvement in healthcare - a nationwide case study.

Science.gov (United States)

Brandrud, Aleidis Skard; Nyen, Bjørnar; Hjortdahl, Per; Sandvik, Leiv; Helljesen Haldorsen, Gro Sævil; Bergli, Maria; Nelson, Eugene C; Bretthauer, Michael

2017-09-13

There is a distinct difference between what we know and what we do in healthcare: a gap that is impairing the quality of the care and increasing the costs. Quality improvement efforts have been made worldwide by learning collaboratives, based on recognized continual improvement theory with limited scientific evidence. The present study of 132 quality improvement projects in Norway explores the conditions for improvement from the perspectives of the frontline healthcare professionals, and evaluates the effectiveness of the continual improvement method. An instrument with 25 questions was developed on prior focus group interviews with improvement project members who identified features that may promote or inhibit improvement. The questionnaire was sent to 189 improvement projects initiated by the Norwegian Medical Association, and responded by 70% (132) of the improvement teams. A sub study of their final reports by a validated instrument, made us able to identify the successful projects and compare their assessments with the assessments of the other projects. A factor analysis with Varimax rotation of the 25 questions identified five domains. A multivariate regression analysis was used to evaluate the association with successful quality improvements. Two of the five domains were associated with success: Measurement and Guidance (p = 0.011), and Professional environment (p = 0.015). The organizational leadership domain was not associated with successful quality improvements (p = 0.26). Our findings suggest that quality improvement projects with good guidance and focus on measurement for improvement have increased likelihood of success. The variables in these two domains are aligned with improvement theory and confirm the effectiveness of the continual improvement method provided by the learning collaborative. High performing professional environments successfully engaged in patient-centered quality improvement if they had access to: (a) knowledge of best

ELECTRONIC TEXTBOOK AS AN EFFECTIVE TOOL FOR IMPROVING THE QUALITY OF EDUCATION

Directory of Open Access Journals (Sweden)

Yuliia M. Shepetko

2011-02-01

Full Text Available The urgency of the material stated in article, is caused by requirements for use of information and communication technologies for educational process, in particular the electronic textbook which can facilitate perception of the information, diversify work forms, interest by technical possibilities. The article aims to proof the necessity of  electronic textbooks use as effective tool for improving the quality of education. Use of the electronic textbook at training will effectively and positively affect process of preparation of students taking into account the means of organization of educational process, structure, methodological requirements. Application of the electronic textbook at training will promote the further development of informative motivation of students.

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.

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

A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

Science.gov (United States)

Barasa, Edwine W; Ayieko, Philip; Cleary, Susan; English, Mike

2012-01-01

To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale. Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3. Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be cost-effective

A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

Directory of Open Access Journals (Sweden)

Edwine W Barasa

Full Text Available To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+ strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale.Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals with a partial intervention (n = 4 hospitals. Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$. Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06 in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18 in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31 per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY averted by scaling up would vary between US$39.8 and US$398.3.Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be

Accounting for quality: on the relationship between accounting and quality improvement in healthcare.

Science.gov (United States)

Pflueger, Dane

2015-04-23

Accounting-that is, standardized measurement, public reporting, performance evaluation and managerial control-is commonly seen to provide the core infrastructure for quality improvement in healthcare. Yet, accounting successfully for quality has been a problematic endeavor, often producing dysfunctional effects. This has raised questions about the appropriate role for accounting in achieving quality improvement. This paper contributes to this debate by contrasting the specific way in which accounting is understood and operationalized for quality improvement in the UK National Health Service (NHS) with findings from the broadly defined 'social studies of accounting' literature and illustrative examples. This paper highlights three significant differences between the way that accounting is understood to operate in the dominant health policy discourse and recent healthcare reforms, and in the social studies of accounting literature. It shows that accounting does not just find things out, but makes them up. It shows that accounting is not simply a matter of substance, but of style. And it shows that accounting does not just facilitate, but displaces, control. The illumination of these differences in the way that accounting is conceptualized helps to diagnose why accounting interventions often fail to produce the quality improvements that were envisioned. This paper concludes that accounting is not necessarily incompatible with the ambition of quality improvement, but that it would need to be understood and operationalized in new ways in order to contribute to this end. Proposals for this new way of advancing accounting are discussed. They include the cultivation of overlapping and even conflicting measures of quality, the evaluation of accounting regimes in terms of what they do to practice, and the development of distinctively skeptical calculative cultures.

THE CUBAN ENTERPRISE, COMPETITIVENESS, IMPROVEMENT BUSINESS AND QUALITY

Directory of Open Access Journals (Sweden)

Andrés Fernández-Companioni

2016-01-01

Full Text Available This article offers some reflections on the Cuban enterprise, its business process improvement and competitiveness that firms must have in entering the world market. It analyzes the economic policies of the last two Congresses of the Communist Party of Cuba that give importance to the role of the Cuban socialist state enterprise system. It conceptualizes the category: business. Knowledge of the categories: effectiveness, efficiency, effectiveness, competitiveness, quality and productivity must for Cuban entrepreneurs. To increase export capacity, we must address a number of factors such as quality and product innovation, the price level depends on the productivity of the inflation differential between countries and other factors with indirect effects on competitiveness, and service quality or corporate image. Are some of the mistakes made in business development in the country. Relate some of the quality awards granted in the world and which should aim to achieve the necessary visibility in international business. Relate some of the quality awards that are granted in the world and which should aim for Cuban entrepreneurs to achieve the necessary visibility in international business. It provides a table that lists the entities Award Winning Quality in Cuba until 2008. It shows a country ranking of the indicators of global competitiveness generated annually by The Global Competitiveness Report. Reasoning about the causes that led to the business improvement process (SPE (Legislative Decree 252 and Decree 281. 

Quality and productivity improvement program (PPKP) from alumni perspective

Science.gov (United States)

Ruza, Nadiah; Mustafa, Zainol

2013-04-01

Defining the quality of the university education system is not easy. Institutions of higher education, through curriculum are hoped to provide the knowledge, wisdom and personality of students. It is questionable of how far Quality and Productivity Improvement Program (PPKP) are capable to ensure the courses offered relevant and effective in preparing the students for job market. The effectiveness of a university to undertake responsibilities and the impact given to students even after they graduate can be a measure of education quality at university. So, the quality of education can be enhanced and improved from time to time. In general, this study is aims to determine the effectiveness of PPKP's education system from the perspective of their alumni as well as their satisfaction and the importance level based on how PPKP be able to meet their needs. In overall, summary of open-ended questions from the questionnaire, Importance-Performance analysis and correlation analysis were conducted for this study. Based on result, it appears that there are still some deficiencies that can be improve, particularly in terms of teaching skills and PPKP's relationships with external organizations to enable knowledge be channel effectively. Importance-Performance analysis highlights some topics or courses that should be offered by PPKP based on their importance in industrial practice. Summary of the results of correlation analysis was found that women are more positive and not too demanding compared to men. In addition, it is found that the responsibilities and workload of the older generations, higher income and a high level of experience demands them to use and practice what they have learned during their studies at PPKP. Results of this study are hoped could be used to improve the quality of education system at PPKP.

Effectiveness of teaching quality improvement to clinicians: a systematic review.

Science.gov (United States)

Boonyasai, Romsai T; Windish, Donna M; Chakraborti, Chayan; Feldman, Leonard S; Rubin, Haya R; Bass, Eric B

2007-09-05

Accreditation requirements mandate teaching quality improvement (QI) concepts to medical trainees, yet little is known about the effectiveness of teaching QI. To perform a systematic review of the effectiveness of published QI curricula for clinicians and to determine whether teaching methods influence the effectiveness of such curricula. The electronic literature databases of MEDLINE, EMBASE, CINAHL, and ERIC were searched for English-language articles published between January 1, 1980, and April 30, 2007. Experts in the field of QI were queried about relevant studies. Two independent reviewers selected studies for inclusion if the curriculum taught QI principles to clinicians and the evaluation used a comparative study design. Information about the features of each curriculum, its use of 9 principles of adult learning, and the type of educational and clinical outcomes were extracted. The relationship between the outcomes and the number of educational principles used was assessed. Of 39 studies that met eligibility criteria, 31 described team-based projects; 37 combined didactic instruction with experiential learning. The median number of adult learning principles used was 7 (range, 2-8). Evaluations included 22 controlled trials (8 randomized and 14 nonrandomized) and 17 pre/post or time series studies. Fourteen studies described educational outcomes (attitudes, knowledge, or skills or behaviors) and 28 studies described clinical process or patient outcomes. Nine of the 10 studies that evaluated knowledge reported only positive effects but only 2 of these described a validated assessment tool. The 6 assessments of attitudes found mixed results. Four of the 6 studies on skill or behavior outcomes reported only positive effects. Eight of the 28 studies of clinical outcomes reported only beneficial effects. Controlled studies were more likely than other studies to report mixed or null effects. Only 4 studies evaluated both educational and clinical outcomes

The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

DEFF Research Database (Denmark)

Meacock, R.; Kristensen, Søren Rud; Sutton, M.

2014-01-01

Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered......, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the 13m pound total programme costs. By generating approximately 5200 quality-adjusted life years and 4.4m...

Moving up the Ladder: How Do States Deliver Quality Improvement Supports within Their Quality Rating and Improvement Systems? Brief

Science.gov (United States)

Holod, Aleksandra; Faria, Ann-Marie; Weinberg, Emily; Howard, Eboni

2015-01-01

As national attention has increasingly focused on the potential for high-quality early childhood education (ECE) to improve children's school readiness, states have developed quality rating and improvement systems (QRISs) to document the quality of ECE programs, support systematic quality improvement, and provide clear information to families…

Using Quality Tools and Methodologies to Improve a Hospital's Quality Position.

Science.gov (United States)

Branco, Daniel; Wicks, Angela M; Visich, John K

2017-01-01

The authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.

Improving the Quality of Think-Alouds

Science.gov (United States)

Ness, Molly; Kenny, MaryBeth

2016-01-01

An essential element in teaching children to effectively comprehend text is the use of teacher-led think alouds. This article presents a three-step model to improve the quality and quantity of think alouds in K-6 classrooms. The article follows elementary teachers who planned, implemented, transcribed, and reflected upon think aloud lessons to…

The impact of leadership qualities on quality management improvement

Directory of Open Access Journals (Sweden)

Ph. D. Radoslaw Wolniak

2011-05-01

Full Text Available Currently, the importance of leadership is considered more and more often in quality management. The need of an appropriate leader has been already emphasized in ISO 9000 standards, in TQM philosophy as well as in different models of improvement which are used in the methodologies of prizing quality. Yet, it is in the concept of TQL where the attitude based on the need of leadership in an organization has achieved its best-developed, full shape. On the basis of the conducted studies, the following publication presents the analysis of the dependence between leadership qualities of managers and the improvement of quality management. There has been an attempt to define the qualities, which a manager being responsible for quality management, should have.

The impact of leadership qualities on quality management improvement

Directory of Open Access Journals (Sweden)

Radoslaw Wolniak

2011-12-01

Full Text Available Currently, the importance of leadership is considered more and more often in quality management. The need of an appropriate leader has been already emphasized in ISO 9000 standards, in TQM philosophy as well as in different models of improvement which are used in the methodologies of prizing quality. Yet, it is in the concept of TQL where the attitude based on the need of leadership in an organization has achieved its best-developed, full shape. On the basis of the conducted studies, the following publication presents the analysis of the dependence between leadership qualities of managers and the improvement of quality management. There has been an attempt to define the qualities, which a manager being responsible for quality management, should have.

Study on Software Quality Improvement based on Rayleigh Model and PDCA Model

OpenAIRE

Ning Jingfeng; Hu Ming

2013-01-01

As the software industry gradually becomes mature, software quality is regarded as the life of a software enterprise. This article discusses how to improve the quality of software, applies Rayleigh model and PDCA model to the software quality management, combines with the defect removal effectiveness index, exerts PDCA model to solve the problem of quality management objectives when using the Rayleigh model in bidirectional quality improvement strategies of software quality management, a...

Achieving Improvement Through Nursing Home Quality Measurement

OpenAIRE

Harris, Yael; Clauser, Steven B.

2002-01-01

CMS has initiated the Nursing Home Quality Initiative (NHQI) to improve the quality of nursing home care. Central to the NHQI is the public reporting of nursing home quality measures that serve as the basis for the Initiative's communication and quality improvement program. This article provides an overview of the NHQI, focusing on the role of nursing home quality measures in achieving improvements in nursing home care. We also describe the evolution of quality measurement in nursing homes, a...

Improving quality of care among patients hospitalised with schizophrenia

DEFF Research Database (Denmark)

Jørgensen, Mette; Mainz, Jan; Svendsen, Marie Louise

2015-01-01

BACKGROUND: The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS: To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD: In a nationwide population.......27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42). CONCLUSIONS: Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark. DECLARATION OF INTEREST: None. COPYRIGHT...

Efficiency Improvement and Quality Initiatives Application in Financial Institutions

Directory of Open Access Journals (Sweden)

MSc. Ajtene Avdullahi

2015-06-01

Full Text Available Financial institutions in today’s economy have no longer the luxury to improve profit simply by increasing revenue. These firms, due to the significant measuring reductions in the financial services industry needed to improve operational efficiencies and merely support existing processes with fewer resources. This paper explains the benefits of Lean, Six Sigma, Total Quality Management and Lean Six Sigma that have improved organization's performance, by cutting costs and waste, improving their products or services, increasing profitability as well as enhancing customer satisfaction. The applicability of quality management practices in financial institutions in Kosovo is presented and also their efficiency and effectiveness. By analyzing data from Raiffeisen Bank Kosovo, this paper highlights the benefits of Individual and Micro companies customer segment as the result of organizational change and successful application of quality initiatives from financial institutions in Kosovo.

Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

Directory of Open Access Journals (Sweden)

Cathy Kande

2014-01-01

Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

Practical Approaches to Quality Improvement for Radiologists.

Science.gov (United States)

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

What are the most effective strategies for improving quality and safety of health care?

Science.gov (United States)

Scott, I

2009-06-01

There is now a plethora of different quality improvement strategies (QIS) for optimizing health care, some clinician/patient driven, others manager/policy-maker driven. Which of these are most effective remains unclear despite expressed concerns about potential for QIS-related patient harm and wasting of resources. The objective of this study was to review published literature assessing the relative effectiveness of different QIS. Data sources comprising PubMed Clinical Queries, Cochrane Library and its Effective Practice and Organization of Care database, and HealthStar were searched for studies of QIS between January 1985 and February 2008 using search terms based on an a priori QIS classification suggested by experts. Systematic reviews of controlled trials were selected in determining effect sizes for specific QIS, which were compared as a narrative meta-review. Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes than manager/policy-maker driven QIS. The most effective strategies (>10% absolute increase in appropriate care or equivalent measure) included clinician-directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small-group case discussions, and patient-mediated clinician reminders. Pay-for-performance schemes directed to clinician groups and organizational process redesign were modestly effective. Other manager/policy-maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness. QIS are heterogeneous and methodological flaws in much of the evaluative literature limit validity and generalizability of results. Based on current best available evidence

Local body cooling to improve sleep quality and thermal comfort in a hot environment.

Science.gov (United States)

Lan, L; Qian, X L; Lian, Z W; Lin, Y B

2018-01-01

The effects of local body cooling on thermal comfort and sleep quality in a hot environment were investigated in an experiment with 16 male subjects. Sleep quality was evaluated subjectively, using questionnaires completed in the morning, and objectively, by analysis of electroencephalogram (EEG) signals that were continuously monitored during the sleeping period. Compared with no cooling, the largest improvement in thermal comfort and sleep quality was observed when the back and head (neck) were both cooled at a room temperature of 32°C. Back cooling alone also improved thermal comfort and sleep quality, although the effects were less than when cooling both back and head (neck). Mean sleep efficiency was improved from 84.6% in the no cooling condition to 95.3% and 92.8%, respectively, in these conditions, indicating good sleep quality. Head (neck) cooling alone slightly improved thermal comfort and subjective sleep quality and increased Stage N3 sleep, but did not otherwise improve sleep quality. The results show that local cooling applied to large body sections (back and head) could effectively maintain good sleep and improve thermal comfort in a hot environment. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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.

Study on the Thermal Effects and Air Quality Improvement of Green Roof

Directory of Open Access Journals (Sweden)

Heng Luo

2015-03-01

Full Text Available Heat island phenomenon and air quality deterioration issues are two major problems that have occurred during the process of urbanization, especially in developing countries. A number of measures have been proposed, among which roof greening is considered as a promising one due to its outstanding performance in thermal effects as well as air quality improvement. A self-maintenance system, termed the Green Roof Manager (GRM, which comprises the irrigation and shadowing subsystems, is proposed in this paper, focusing on the automatic and reliable operation of the roof greening system rather than exploiting new plant species. A three month long experiment was set up, resulting in the observation that a 14.7% of, on average, temperature reduction can be achieved in summer after deploying the GRM system. During a 24-hour monitoring experiment the PM2.5 concentrations above the GRM was reduced by up to 14.1% over the bare roof.

Genetic options for improving fodder yield and quality in forage sorghum

Directory of Open Access Journals (Sweden)

C. Aruna

2015-01-01

Full Text Available Improving yield and quality of fodder from forage sorghum is important, especially in the semi-arid tropics, where sorghum is a major source of fodder. The aim of this work was to understand the genetic basis of fodder yield and quality traits, and character associations, and to estimate combining ability of the parents. The experiment was carried out during 2 successive rainy seasons using 10 parents crossed in a half-diallel design. Significant differences among the genotypes for fodder yield, quality and cell wall constituents were observed. Important quality traits, crude protein and digestibility (IVOMD, were not correlated with fodder yield, indicating the potential to improve yield and quality simultaneously in forage sorghum. General combining ability and specific combining ability variances showed that, for almost all characters, both additive and non-additive gene effects were important, with a predominance of non-additive effects. Parental lines SEVS4, HC308 and UPMC503 were good general combiners for yield and quality. The brown midrib lines, EC582508 and EC582510, were good general combiners for low lignin and high IVOMD. Strategies for improving forage sorghum to suit animal and biofuel industries are discussed.Keywords: Digestibility, crude protein, ADL, diallel analysis, gene effects.DOI: 10.17138/TGFT(349-58

Quality Improvement and Learning in Productive Systems

OpenAIRE

Charles H. Fine

1986-01-01

Recent interest in product quality suggests that effort devoted to improving the quality of manufactured products may reduce unit costs. This conjecture---that improving quality can lower costs---challenges the traditional assumption that unit costs increase with increased quality assurance activities and has significant implications for quality management. By introducing the idea of a quality-based learning curve, this paper links the previously disjoint literatures of quality control and le...

Improving care at cystic fibrosis centers through quality improvement.

Science.gov (United States)

Kraynack, Nathan C; McBride, John T

2009-10-01

Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. Copyright Thieme Medical Publishers.

Statistical methods for quality improvement

National Research Council Canada - National Science Library

Ryan, Thomas P

2011-01-01

...."-TechnometricsThis new edition continues to provide the most current, proven statistical methods for quality control and quality improvementThe use of quantitative methods offers numerous benefits...

Improving data quality in the linked open data: a survey

Science.gov (United States)

Hadhiatma, A.

2018-03-01

The Linked Open Data (LOD) is “web of data”, a different paradigm from “web of document” commonly used today. However, the huge LOD still suffers from data quality problems such as completeness, consistency, and accuracy. Data quality problems relate to designing effective methods both to manage and to retrieve information at various data quality levels. Based on review from papers and journals, addressing data quality requires some standards functioning to (1) identification of data quality problems, (2) assessment of data quality for a given context, and (3) correction of data quality problems. However, mostly the methods and strategies dealing with the LOD data quality were not as an integrative approach. Hence, based on those standards and an integrative approach, there are opportunities to improve the LOD data quality in the term of incompleteness, inaccuracy and inconsistency, considering to its schema and ontology, namely ontology refinement. Moreover, the term of the ontology refinement means that it copes not only to improve data quality but also to enrich the LOD. Therefore, it needs (1) a standard for data quality assessment and evaluation which is more appropriate to the LOD; (2) a framework of methods based on statistical relational learning that can improve the correction of data quality problems as well as enrich the LOD.

Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects.

Science.gov (United States)

Andersson Hagiwara, Magnus; Andersson Gäre, Boel; Elg, Mattias

2016-01-01

To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

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

Science.gov (United States)

Conrad, Douglas A; Perry, Lisa

2009-01-01

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

Improving image quality of parallel phase-shifting digital holography

International Nuclear Information System (INIS)

Awatsuji, Yasuhiro; Tahara, Tatsuki; Kaneko, Atsushi; Koyama, Takamasa; Nishio, Kenzo; Ura, Shogo; Kubota, Toshihiro; Matoba, Osamu

2008-01-01

The authors propose parallel two-step phase-shifting digital holography to improve the image quality of parallel phase-shifting digital holography. The proposed technique can increase the effective number of pixels of hologram twice in comparison to the conventional parallel four-step technique. The increase of the number of pixels makes it possible to improve the image quality of the reconstructed image of the parallel phase-shifting digital holography. Numerical simulation and preliminary experiment of the proposed technique were conducted and the effectiveness of the technique was confirmed. The proposed technique is more practical than the conventional parallel phase-shifting digital holography, because the composition of the digital holographic system based on the proposed technique is simpler.

IMPROVING THE QUALITY OF MAINTENANCE PROCESSES USING INFORMATION TECHNOLOGY

Directory of Open Access Journals (Sweden)

Zora Arsovski

2008-06-01

Full Text Available In essence, process of maintaining equipment is a support process, because it indirectly contributes to operational ability of the production process necessary for the supply chain of the new value. Taking into account increased levels of automatization and quality, this proces s becomes more and more significant and for some branches of industry, even crucial. Due to the fact that the quality of the entire process is more and more dependent on the maintenance process, these processes must be carefully designed and effectively im plemented. There are various techniques and approaches at our disposal, such as technical, logistical and intensive application of the information - communication technologies. This last approach is presented in this work. It begins with organizational goa ls, especially quality objectives. Then, maintenance processes and integrated information system structures are defined. Maintenance process quality and improvement processes are defined using a set of performances, with a special emphasis placed on effectiveness and quality economics. At the end of the work, information system for improving maintenance economics is structured. Besides theoretical analysis, work also presents results authors obtained analyzing food industry, metal processing industry an d building materials industry.

Healthcare quality in Ghana : Improving healthcare quality and health worker motivation to promote sustainable health insurance

NARCIS (Netherlands)

Alhassan, R.K.

2017-01-01

This thesis is about promoting a sustainable National Health Insurance Scheme (NHIS) in Ghana through improved client-centred quality care and effective community engagement in quality care assessment. The thesis comprises of two main parts. Part one reports on findings from baseline surveys

Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

Science.gov (United States)

Jardim, Kevin P.

Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

Catalytic quality improvement of waste polyolefin originated fractions

Directory of Open Access Journals (Sweden)

Tóth O.

2018-03-01

Full Text Available The demand for alternative fuels having low greenhouse gases emission is continuously growing worldwide. Therefore it is preferred to produce new, waste originated components. One option is the recycling of plastic waste with cracking. The produced hydrocarbon fraction is not suitable for fuels thus it is important to improve its quality. The aim of our experimental work was to study the quality improvement of this cracked fraction (PPCGO and crude oil based middle distillates (different composition with co-processing. Our goal was to produce high quality diesel fuel blending components. We studied the effect of process parameters on the quality of products. Ni (2.3% Mo (11.0% P (2.3%/Al2O3 catalyst was used. During the experiments we studied the hydrogenation of olefins, saturation of aromatics and desulphurization. The hydrogenation of olefins was practically complete at 300°C. It took place at significantly higher speed than the desulphurization reactions. In case of light gas oil feedstock the products had significantly lower sulphur contents; below 10 mg/kg already at 340°C. We determined that the cracked fraction had beneficial effect on the performance properties of the products. In case of all feedstock combinations, we found process parameters which can be used to produce high-quality diesel fuel blending components on the tested catalyst.

Distributed power quality improvement in residential microgrids

DEFF Research Database (Denmark)

Naderi Zarnaghi, Yahya; Hosseini, Seyed Hossein; Ghassem Zadeh, Saeid

2017-01-01

The importance of power quality issue on micro grids and also the changing nature of power system distortions will lead the future power systems to use distributed power quality improvement (DPQI) devices. One possible choice of these DPQIs are multifunctional DGs that could compensate some...... harmonics in the location of generation and prevent the harmonics to enter main power grid. In this paper a control method based on virtual harmonic impedance is presented for these multifunctional DGs and the effect of the location of these DGs on compensation procedure is studied with simulating...

Quality improvement through multiple response optimization

International Nuclear Information System (INIS)

Noorossana, R.; Alemzad, H.

2003-01-01

The performance of a product is often evaluated by several quality characteristics. Optimizing the manufacturing process with respect to only one quality characteristic will not always lead to the optimum values for other characteristics. Hence, it would be desirable to improve the overall quality of a product by improving quality characteristics, which are considered to be important. The problem consists of optimizing several responses using multiple objective decision making approach and design of experiments. A case study will be discussed to show the application of the proposal method

Power theories for improved power quality

CERN Document Server

Pasko, Marian

2012-01-01

Power quality describes a set of parameters of electric power and the load’s ability to function properly under specific conditions. It is estimated that problems relating to power quality costs the European industry hundreds of billions of Euros annually. In contrast, financing for the prevention of these problems amount to fragments of these costs. Power Theories for Improved Power Quality addresses this imbalance by presenting and assessing a range of methods and problems related to improving the quality of electric power supply. Focusing particularly on active compensators and the DSP based control algorithms, Power Theories for Improved Power Quality introduces the fundamental problems of electrical power. This introduction is followed by chapters which discuss: •‘Power theories’ including their historical development and application to practical problems, •operational principles of active compensator’s DSP control based algorithms using examples and results from laboratory research, and •t...

The effectiveness of non-pharmacological interventions in improvement of sleep quality among non-remissive cancer patients: A systematic review of randomized trials

Directory of Open Access Journals (Sweden)

Fatmawati Fadli

2016-12-01

Full Text Available Statistical results estimated that most of non-remissive cancer patients face sleep problem and experience the symptoms of insomnia throughout and after the completion of cancer treatment. The purpose of this review was to compare the effectiveness between several types of non-pharmacological interventions and standard care or treatment to improve the sleep quality among non-remissive cancer patients. All randomized studies focused on non-pharmacological interventions to improve sleep quality among non-remissive cancer patients were included. Thirteen studies were selected with a total of 1,617 participants. The results found that only four interventions were significantly effective to improve sleep quality among non-remissive cancer patients, included cognitive behavioral therapy, relaxation and guided imagery program, self-care behavior education program, and energy and sleep enhancement program.

Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials.

Science.gov (United States)

Anderson, Niall; Ozakinci, Gozde

2018-03-27

Long-term conditions may negatively impact multiple aspects of quality of life including physical functioning and mental wellbeing. The rapid systematic review aimed to examine the effectiveness of psychological interventions to improve quality of life in people with long-term conditions to inform future healthcare provision and research. EBSCOhost and OVID were used to search four databases (PsychInfo, PBSC, Medline and Embase). Relevant papers were systematically extracted by one researcher using the predefined inclusion/exclusion criteria based on titles, abstracts, and full texts. Randomized controlled trial psychological interventions conducted between 2006 and February 2016 to directly target and assess people with long-term conditions in order to improve quality of life were included. Interventions without long-term condition populations, psychological intervention and/or patient-assessed quality of life were excluded. From 2223 citations identified, 6 satisfied the inclusion/exclusion criteria. All 6 studies significantly improved at least one quality of life outcome immediately post-intervention. Significant quality of life improvements were maintained at 12-months follow-up in one out of two studies for each of the short- (0-3 months), medium- (3-12 months), and long-term (≥ 12 months) study duration categories. All 6 psychological intervention studies significantly improved at least one quality of life outcome immediately post-intervention, with three out of six studies maintaining effects up to 12-months post-intervention. Future studies should seek to assess the efficacy of tailored psychological interventions using different formats, durations and facilitators to supplement healthcare provision and practice.

Long-term effectiveness of a quality improvement program for patients with type 2 diabetes in general practice.

NARCIS (Netherlands)

Renders, C.M.; Valk, G.D.; Franse, L.V.; Schellevis, F.; Eijk, J.T.M. van; Wal, G. van der

2001-01-01

OBJECTIVE— To assess the long-term effectiveness of a quality improvement program on care provided and patient outcomes in patients with diabetes. RESEARCH DESIGN AND METHODS— A nonrandomized trial was performed with 312 patients with type 2 diabetes in the intervention group and 77 patients with

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

Science.gov (United States)

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

2018-01-01

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

Control options for river water quality improvement: a case study of ...

African Journals Online (AJOL)

Using a simple conceptual dynamic river water quality model, the effects of different basin-wide water quality management options on downstream water quality improvements in a semi-arid river, the Crocodile River (South Africa) were investigated. When a river is impacted by high rates of freshwater withdrawal (in its ...

Quality improvement in hospitals: how much does it reduce healthcare costs?

Science.gov (United States)

Jones, S B

1995-01-01

The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

Unwanted facial hair removal with laser treatment improves quality of life of patients.

Science.gov (United States)

Maziar, Ali; Farsi, Nader; Mandegarfard, Manijeh; Babakoohi, Shahab; Gorouhi, Farzam; Dowlati, Yahya; Firooz, Alireza

2010-02-01

Unwanted facial hair can have adverse psychological effects on women and reduce their quality of life. To assess the effects of unwanted facial hair removal with laser on improving quality of life. In this study, 70 patients treated for unwanted facial hair by laser were assessed by Dermatology Life Quality Index (DLQI) questionnaire on admission and 3 months later after three sessions of laser treatment. The DLQI score before treatment was 9.42 +/- 5.99, which was reduced to 3.12 +/- 3.40 after laser treatment (p facial hair removal with laser can improve the quality of life of patients.

Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

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Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

2014-03-01

The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.

The quality infrastructure measuring, analyzing, and improving library services

CERN Document Server

Murphy, Sarah Anne

2013-01-01

Summarizing specific tools for measuring service quality alongside tips for using these tools most effectively, this book helps libraries of all kinds take a programmatic approach to measuring, analyzing, and improving library services.

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

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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.

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

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

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

A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life.

Directory of Open Access Journals (Sweden)

Tara Kidd

Full Text Available Self-management interventions have become increasingly popular in the management of long-term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS.To examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS.A structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925.The review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms.Although the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement.

Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

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Palmer Laura

2003-05-01

Full Text Available Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs that led quality improvement efforts in nursing homes from the six pilot states. Results QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. Conclusion The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.

Effects of a proposed quality improvement process in the proportion of the reported ultrasound findings unsupported by stored images.

Science.gov (United States)

Schenone, Mauro; Ziebarth, Sarah; Duncan, Jose; Stokes, Lea; Hernandez, Angela

2018-02-05

To investigate the proportion of documented ultrasound findings that were unsupported by stored ultrasound images in the obstetric ultrasound unit, before and after the implementation of a quality improvement process consisting of a checklist and feedback. A quality improvement process was created involving utilization of a checklist and feedback from physician to sonographer. The feedback was based on findings of the physician's review of the report and images using a check list. To assess the impact of this process, two groups were compared. Group 1 consisted of 58 ultrasound reports created prior to initiation of the process. Group 2 included 65 ultrasound reports created after process implementation. Each chart was reviewed by a physician and a sonographer. Findings considered unsupported by stored images by both reviewers were used for analysis, and the proportion of unsupported findings was compared between the two groups. Results are expressed as mean ± standard error. A p value of improvement process implementation. Thus, we present a simple yet effective quality improvement process to reduce unsupported ultrasound findings.

Use of natural isotopes and groundwater quality for improved ...

African Journals Online (AJOL)

2006-07-21

Jul 21, 2006 ... Use of natural isotopes and groundwater quality for improved recharge ..... the environmental impact and the effectiveness of clean-up measures is ..... VEGTER JR and FOSTER MBJ (1990) The Hydrogeology of Dolomitic.

The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews

NARCIS (Netherlands)

Kringos, Dionne S.; Sunol, Rosa; Wagner, Cordula; Mannion, Russell; Michel, Philippe; Klazinga, Niek S.; Groene, Oliver; Lombarts, M. J. M. H.; Plochg, T.; Lopez, M. A.; Secanell, M.; Sunol, R.; Vallejo, P.; Bartels, P.; Kristensen, S.; Michel, P.; Saillour-Glenisson, F.; Vlcek, F.; Car, M.; Jones, S.; Klaus, E.; Bottaro, S.; Garel, P.; Saluvan, M.; Bruneau, C.; Depaigne-Loth, A.; Shaw, C.; Hammer, A.; Ommen, O.; Pfaff, H.; Groene, O.; Botje, D.; Wagner, C.; Kutaj-Wasikowska, H.; Kutryba, B.; Escoval, A.; Lívio, A.; Eiras, M.; Franca, M.; Leite, I.; Almeman, F.; Kus, H.; Ozturk, K.; Mannion, R.; Arah, O. A.; Dersarkissian, M.; Thompson, C. A.; Wang, A.; Thompson, A.

2015-01-01

It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual

Needs and Opportunities to Improve the Operational Quality of Forwarding Companies

Directory of Open Access Journals (Sweden)

Dovilė Kontautaitė

2013-04-01

Full Text Available It is essential for forwarding companies to improve their activity by improving their internal and external processes in order to provide for a client an estimated basic and added value and effectively manage the flow of information in the general logistic supply chain. The article analyses the concepts of quality management and activity process, emphasising the main process of a forwarding enterprise and the demand to optimise the activity establishing quality management systems. The scientific literature analysis assists in the provision of quality assessment indicators of forwarding companies and ascertaining quality management systems that are suitable for transport companies.Article in Lithuanian

Improving Quality of Shoe Soles Product using Six Sigma

Science.gov (United States)

Jesslyn Wijaya, Athalia; Trusaji, Wildan; Akbar, Muhammad; Ma’ruf, Anas; Irianto, Dradjad

2018-03-01

A manufacture in Bandung produce kind of rubber-based product i.e. trim, rice rollers, shoe soles, etc. After penetrating the shoe soles market, the manufacture has met customer with tight quality control. Based on the past data, defect level of this product was 18.08% that caused the manufacture’s loss of time and money. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control (DMAIC). In the design phase, the object’s problem and definition were defined. Delphi method was also used in this phase to identify critical factors. In the measure phase, the existing process stability and sigma quality level were measured. Fishbone diagram and failure mode and effect analysis (FMEA) were used in the next phase to analyse the root cause and determine the priority issues. Improve phase was done by designing alternative improvement strategy using 5W1H method. Some improvement efforts were identified, i.e. (i) modifying design of the hanging rack, (ii) create pantone colour book and check sheet, (iii) provide pedestrian line at compound department, (iv) buying stop watch, and (v) modifying shoe soles dies. Some control strategies for continuous improvement were proposed such as SOP or reward and punishment system.

Improving and monitoring air quality.

Science.gov (United States)

DuPont, André

2018-05-01

Since the authorization of the Clean Air Act Amendments of 1990, the air quality in the USA has significantly improved because of strong public support. The lessons learned over the last 25 years are being shared with the policy analysts, technical professionals, and scientist who endeavor to improve air quality in their communities. This paper will review how the USA has achieved the "high" standard of air quality that was envisioned in the early 1990s. This document will describe SO 2 gas emission reduction technology and highlight operation of emission monitoring technology. This paper describes the basic process operation of an air pollution control scrubber. A technical review of measures required to operate and maintain a large-scale pollution control system will be described. Also, the author explains how quality assurance procedures in performance of continuous emission monitoring plays a significant role in reducing air pollution.

Effect of joint traction on functional improvement and quality of life in patients with severe knee osteoarthritis

Directory of Open Access Journals (Sweden)

Sedigheh Sadat Naeimee

2012-07-01

Full Text Available Background and aim: Osteoarthritis (OA is the most prevalent joint disease in adults around the world and its incidence rises with age. Patients with severe knee osteoarthritis often complain of pain and severe functional disability. Most of conservative treatments used in this group of patients induce poor improvements. This study evaluated the effect of joint traction on quality of life of patients with severe knee osteoarthritis.Materials and Methods: In this clinical trial study, forty female patients with severe knee OA were randomly assigned to two following groups; common physiotherapy treatment and common physiotherapy treatment accompanied by knee distraction. Quality of life was evaluated pre- and post-treatment and also one month follow-up using the Knee injury and Osteoarthritis Outcome Score (KOOS questionnaire.Results: Common physiotherapy treatment accompanied by knee distraction resulted in significantly better quality of life post-treatment and at 1month follow-up, compared to common physiotherapy treatment alone (P<0.01.Conclusion: Common physiotherapy treatment accompanied by knee distraction induces significant improvement in quality of life in patients with severe knee osteoarthritis compared to common physiotherapy treatment alone.

Impact of quality improvement in tuberculosis laboratories in low- and lower-middle-income countries: a systematic review.

Science.gov (United States)

Olaru, I D; Albert, H; Zallet, J; Werner, U-E; Ahmed, N; Rieder, H L; Salfinger, M; Kranzer, K

2018-03-01

The effect of quality improvement measures on the performance of diagnostic tuberculosis (TB) laboratories in low- and lower-middle-income countries is not known, and is the subject of this review. Three databases were searched for quality improvement studies presenting data on performance parameters before and after the implementation of quality improvement interventions. Twenty-one studies were included in this review. Quality improvement measures were most frequently implemented by an external organization; settings targeted ranged from microscopy centers, hospitals, districts, regional and national reference laboratories. Quality improvement interventions and outcome measurements were highly heterogeneous. Most studies investigated interventions aimed at improving smear microscopy (n = 17). Two studies evaluated comprehensive quality improvement measures (n = 2) and another three studies focused on mycobacterial culture and drug susceptibility testing. Most studies showed an improvement in outcomes measured on before-after or time trend analysis. Quality improvement measures implemented in TB laboratories showed a positive impact on various outcomes. Due to the high heterogeneity of outcome reporting and interventions and the low quality of the studies, the effect size was not clear. Identification of standardized quality indicators and their link to the quality of patient care would improve knowledge in this field.

The Effectiveness of Psychodrama in Improving Quality of Life among Opiate-dependent Male Patients

Directory of Open Access Journals (Sweden)

Saeed Dehnavi

2016-05-01

Full Text Available The current paper aimed to investigate the effectiveness of psychodrama therapy in the improvement of the quality of life(QOL for opiate-dependent male patients. It was aquasi-experimental research study, using pre-and posttesting plan with a control group. A total of 30 individuals were selected among male clients with opiate dependence, who were referred to addiction treatment clinics in Kermanshah (Iran and successfully passed the detoxification programs, by a convenience sampling technique. The subjects were randomly placed into two experimental and control groups. The experimental group participated in a twelve-session psychodrama therapy plan for 6 weeks, while the control group received no intervention. In order to collect data, the SF-36 questionnaire was applied. Data analysis was performed by analysis of covariance (ANCOVA. The ANCOVA results revealed that there is a significant difference between two groups in the post-test stage. As seen from the findings, the psychodrama intervention can be used as an effective modality to enhance the quality of life among male patients with opiate dependence.

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

Science.gov (United States)

Severens, J

2003-01-01



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

[QUIPS: quality improvement in postoperative pain management].

Science.gov (United States)

Meissner, Winfried

2011-01-01

Despite the availability of high-quality guidelines and advanced pain management techniques acute postoperative pain management is still far from being satisfactory. The QUIPS (Quality Improvement in Postoperative Pain Management) project aims to improve treatment quality by means of standardised data acquisition, analysis of quality and process indicators, and feedback and benchmarking. During a pilot phase funded by the German Ministry of Health (BMG), a total of 12,389 data sets were collected from six participating hospitals. Outcome improved in four of the six hospitals. Process indicators, such as routine pain documentation, were only poorly correlated with outcomes. To date, more than 130 German hospitals use QUIPS as a routine quality management tool. An EC-funded parallel project disseminates the concept internationally. QUIPS demonstrates that patient-reported outcomes in postoperative pain management can be benchmarked in routine clinical practice. Quality improvement initiatives should use outcome instead of structural and process parameters. The concept is transferable to other fields of medicine. Copyright © 2011. Published by Elsevier GmbH.

Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness.

Science.gov (United States)

Pickett, Karen; Loveman, Emma; Kalita, Neelam; Frampton, Geoff K; Jones, Jeremy

2015-10-01

Inflammatory skin diseases include a broad range of disorders. For some people, these conditions lead to psychological comorbidities and reduced quality of life (QoL). Patient education is recommended in the management of these conditions and may improve QoL. To assess the clinical effectiveness and cost-effectiveness of educational interventions to improve health-related quality of life (HRQoL) in people with chronic inflammatory skin diseases. Twelve electronic bibliographic databases, including The Cochrane Library, MEDLINE and EMBASE, were searched to July 2014. Bibliographies of retrieved papers were searched and an Advisory Group contacted. Systematic reviews were conducted following standard methodologies. Clinical effectiveness studies were included if they were undertaken in people with a chronic inflammatory skin condition. Educational interventions that aimed to, or could, improve HRQoL were eligible. Studies were required to measure HRQoL, and other outcomes such as disease severity were also included. Randomised controlled trials (RCTs) or controlled clinical trials were eligible. For the review of cost-effectiveness, studies were eligible if they were full economic evaluations, cost-consequence or cost analyses. Seven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions. There were few similarities in the interventions (e.g. the delivery mode, the topics covered, the duration of the education), which precluded any quantitative synthesis. Follow-up ranged from 4 weeks to 12 months, samples sizes were generally small and, overall, the study quality was poor. There appeared to be positive effects on HRQoL in participants with psoriasis in one trial, but no difference between groups in another trial in which participants had less severe

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda.

Science.gov (United States)

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-03-31

This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

Randomised controlled trial of the effectiveness of using foot reflexology to improve quality of sleep amongst Taiwanese postpartum women.

Science.gov (United States)

Li, Chia-Yen; Chen, Su-Chiu; Li, Chung-Yi; Gau, Meei-Ling; Huang, Chiu-Mieh

2011-04-01

to examine the effectiveness of using foot reflexology to improve sleep quality in postpartum women. randomised controlled trial, conducted at two postpartum centres in northern Taiwan. 65 postpartum women reporting poor quality of sleep were recruited from July 2007 to December 2007. participants were assigned randomly to either an intervention or a control group. Participants in both groups received the same care except for reflexology therapy. The intervention group received a single 30-minute foot reflexology session at the same time each evening for five consecutive days. Sessions were administered by a certified nurse reflexologist. MEASURES AND FINDINGS: the outcome measure was the Pittsburgh sleep quality index (PSQI), and this was performed at baseline and post test. Mean PQSI scores for both groups declined over time between baseline and post test. Using a generalised estimation equation to control several confounding variables, the changes in mean PSQI were found to be significantly lower in the intervention group (β=-2.24, standard error=0.38, pfoot reflexology in the postnatal period significantly improved the quality of sleep. midwives should evaluate maternal sleep quality and design early intervention programmes to improve quality of sleep in order to increase maternal biopsychosocial well-being. Midwives interested in complementary therapies should be encouraged to obtain training in reflexology and to apply it in clinical settings if it is allowed. Copyright © 2009 Elsevier Ltd. All rights reserved.

The use of maca (Lepidium meyenii) to improve semen quality: A systematic review.

Science.gov (United States)

Lee, Myeong Soo; Lee, Hye Won; You, Sooseong; Ha, Ki-Tae

2016-10-01

The aim of this review was to assess the evidence for the effectiveness of maca (Lepidium meyenii) in improving semen quality. We searched 11 databases from their inception to March 2016 and included all clinical trials on the improvement of semen quality parameters in infertile and healthy men, regardless of the study design or the type of maca. The risk of bias for each study was assessed using the Cochrane criteria. The selection of studies, data extraction, and validation were performed independently by the first two authors. Discrepancies were resolved through discussion by the same two authors. Five studies - 3 randomized clinical trials (RCTs) and 2 uncontrolled observational studies (UOSs) - met all of the inclusion criteria. One RCT found favorable effects of maca on sperm mobility in infertile men. The two other RCTs showed positive effects of maca on several semen quality parameters in healthy men. The two UOSs also suggested favorable effects of maca on semen quality. The results of our systematic review provide suggestive evidence for the effectiveness of maca in improving semen quality. However, the total number of trials, the total sample size, and the risk of bias of the included studies prevent the drawing firm conclusions. More rigorous studies are warranted. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effectiveness of prolonged-release melatonin in Improving Quality of Sleep in Patients Aged 55 or Over

Directory of Open Access Journals (Sweden)

G. V. Kovrov

2016-01-01

Full Text Available Objective: to evaluate the efficacy of prolonged-release melatonin used in routine practice to improve sleep quality in Russian patients over 55 years of age.Patients and methods. The results of the multicenter open-label observational study of Circadin (prolonged-release melatonin efficiency for treatment of insomnia in 36 patients older than 55 yeare presented. The drug was administered at a dose of 2 mg one-two hours before bedtime for 3 weeks.Results. Treatment with Circadin resulted in statistically significant (p<0.0001 according to pared t-test (95% CI: 4.8; 7.3 improvement of the sleep quality: the mean value of the modified subjective sleep characteristics scale increased from 11.8±2.6 points at baseline to 17.8±2.3 points after 3 weeks of treatment. The modified Questionnaire Scoring Subjective Characteristics of Sleep was grade from 0 (very bad to 20 (very good taking into account: the amount of time required to fall asleep, the sleep duration, the number of night awakenings and the general well-being in the morning. An increase of 6 points on a scale from 0 to 20 was considered as clinically relevant. A greater effect was observed in patients with severely impaired sleep quality as well as with low level of depression and anxiety and absence of cognitive impairment. Upon completion of Circadin treatment there were statistically significant improvement (p<0.0001 of attention (the mean value of the symbol-digit coding test increased from 34.2±9.7 to 37.3±10.6 points and memory (the median value of the short-term verbal memory test increased from 4 points at baseline to 5 points at the study end, p=0.0069.The drug had a good safety profile; only one adverse event related to study medication (allergic rush was registered in the study. The absolute majority (91.7% of the study patients considered Circadin treatment as either effective or very effective.Conclusion. Taking into consideration the good safety profile of this drug

Improving the Supply Chain and Food Quality of Professionally Prepared Meals

DEFF Research Database (Denmark)

Adler-Nissen, Jens; Akkerman, R.; Frosch, Stina

2013-01-01

of the meal production in order to transfer labour-intensive operations from the kitchens to the industry; 2) Systemic use of a new concept: thawing during distribution, which improves shelf-life and reduces waste; 3) Supply chain modelling to improve delivery schedules and reduce environmental impact......An increasing share of the daily meals served in Europe is prepared out-of-home by professionals in foodservice. The quality of such meals is highly debated. This paper presents and discusses obstacles to improving quality in a cost-effective way and suggests solutions: 1) Modularisation...

How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

Science.gov (United States)

Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula

2009-09-01

Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

42 CFR 441.474 - Quality assurance and improvement plan.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assurance and improvement plan. 441.474... improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State... pursue opportunities for system improvement. (b) The quality assurance and improvement plan shall also...

Effectiveness of Cognitive-Behavioral Group Therapy on Improving Quality of Life in Opiate Addicts under Methadone Maintenance Treatment

Directory of Open Access Journals (Sweden)

Fereshteh Momeni

2013-04-01

Full Text Available Objective: This study was aimed to assess the effectiveness of cognitive- behavioral group therapy on improvement of quality of life in opiate patients under methadone maintenance treatment. Method: This was a semi experimental study using control group also pre-test, post-test and follow-up. Thirty six patients on MMT were selected between the entire opiate addicts referred to Iranian national center for addiction studies within judgmental sampling and were randomly assigned into experimental and control groups. They were all administered the WHOQOL-BREF. In experimental group, cognitive behavior group therapy was performed in 8 sessions and the control group was registered in the waiting list for the CBGT. Findings: Data analysis revealed that the mean WHOQOL-BREF score in the experimental group had significant higher increase when compared with that of the control group. But it wasn’t significant in follow up. Conclusion: Results demonstrated the effectiveness of cognitive–behavior group therapy On improvement of quality of life of opiate addicts on MMT in short term but didn’t seem to be effective in long term.

Improving quality and the assurance of quality in the design and construction of nuclear power plants: a report to Congress

International Nuclear Information System (INIS)

Altman, W.; Ankrum, T.; Brach, W.

1984-05-01

A study was conducted of existing and alternative programs for improving quality and the assurance of quality in the design and construction of commercial nuclear power plants. A primary focus of the study was to determine the underlying causes of major quality-related problems in the construction of some nuclear power plants and the untimely detection and correction of these problems. The study concluded that the root cause for major quality-related problems was the failure or inability of some utility managements to effectively implement a management system that ensured adequate control over all aspects of the project. These management shortcoming arose in part from inexperience on the part of some project teams in the construction of nuclear power plants. NRC's past licensing and inspection practices did not adequately screen construction permit applicants for overall capability to manage or provide effective management oversight over the construction project. The study recommends a number of improvements in industry and NRC programs. For industry, the study recommends self-imposed rising standards of excellence, treatment of quality assurance as a management tool, not a substitute for management, improved trend analysis and identification of root causes of quality problems, and a program of comprehensive third party audits of present and future construction projects. To improve NRC programs, the study recommends a heavier emphasis on team inspections and resident inspectors, an enhanced review of new applicant's capabilities to construct commercial nuclear power plants, more attention to management issues, improved diagnostic and trending capabilities, improved quality and quality assurance for operating reactors, and development of guidance to facilitate the prioritization of quality assurance measures commensurate with the importance of plant structures, systems, and components to the achievement of safety

Methodology of quality improvement projects for the Texas Medicare population.

Science.gov (United States)

Pendergrass, P W; Abel, R L; Bing, M; Vaughn, R; McCauley, C

1998-07-01

The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.

A Systems Thinking Approach To The Sustainability Of Quality Improvement Programmes

Directory of Open Access Journals (Sweden)

Van Dyk, Dirk Johannes

2014-05-01

Full Text Available The challenge for organisations to continually provide the best return on investment for their shareholders has become increasingly difficult through globalisation of the market place. There are many responses a company could make to these challenges for example, new product development, increased market capitalisation, cost reduction initiatives, and quality management. This last response focuses on, but is not restricted to, customer satisfaction, continuous improvement, and environmental impact. Continuous improvement addresses waste in the business design and manufacturing processes, which could lead to improved profit margins. The sustainability of quality improvement programmes remains a challenge. Causality can be studied, using Six Sigma tools, to relate cause and effect. But these tools do not always allow the user to study and understand feedback from other factors, such as soft human issues, in the improvement process system, typically referred to as feedback causality. System dynamics may improve this understanding. Quality improvement programmes in the heavy engineering manufacturing environment are not researched to the same degree as those in the automotive manufacturing environment. The purpose of this paper is to share results from research into the sustainability of quality improvement programmes, and the development of an appropriate system dynamics model, using qualitative case study data gathered and coded in a heavy engineering manufacturing environment.

The effect of cognitive–behavioral stress management training on improving psychological symptoms and quality of life in nurses

Directory of Open Access Journals (Sweden)

Leila Bahmanzadeh

2017-11-01

Full Text Available As a stressful profession, nursing deals with different aspects of human health and illness, and stress can threaten nurses’ health and performance. As a result, using preventive stress management programs seems necessary. The present study aimed to evaluate the effectiveness of cognitive–behavioral stress management training in improving psychological symptoms (stress, anxiety, and depression and quality of life in nurses. The design of this study was quasi-experimental with pretest-posttest and a control group. The statistical population comprised all nurses working in Bandar Abbas Shari'ati Hospital. The study sample included all 30 nurses selected through convenience sampling method. They equally and randomly were divided into experiment and control groups. Depression, anxiety, and stress scale and the Farsi version of WHOQOL-BREF were used to collect data. The results showed there was a significant difference between pretest and posttest of experimental group in the mean scores of stress, anxiety, and quality of life; however, there was no significant difference in depression. Control group mean scores did not show a significant difference between pretest and posttest. There was no significant difference between the control and experimental groups before intervention in stress, anxiety, depression, and quality of life. The findings of this study suggest that, as a useful clinical intervention, stress management skill training is an effective way to improve mental distress and quality of life.

The probable effect of integrated reporting on audit quality

Directory of Open Access Journals (Sweden)

Tamer A. El Nashar

2016-06-01

Full Text Available This paper examines a probable effect of integrated reporting on improving the audit quality of organizations. I correlate the hypothesis of this paper in relation to the current trends of protecting the economies, the financial markets and the societies. I predict an improvement of the audit quality, as a result to an estimated percentage of organizations’ reliance on the integrated reporting in their accountability perspective. I used a decision tree and a Bayes’ theorem approach, to predict the probabilities of the significant effect on improving the auditing quality. I find the overall result of this paper, indicates that the probability of organizations to rely on the integrated reporting by a significant percentage, predicts also a significant improvement in audit quality.

Cognitive-behavioral therapy improves the quality of life of patients with acromegaly.

Science.gov (United States)

Kunzler, Lia Silvia; Naves, Luciana Ansaneli; Casulari, Luiz Augusto

2018-06-01

The delayed diagnosis, altered body image, and clinical complications associated with acromegaly impair quality of life. To assess the efficacy of the cognitive-behavioral therapy (CBT) technique "Think Healthy" to increase the quality of life of patients with acromegaly. This non-randomized clinical trial examined ten patients with acromegaly (nine women and one man; mean age, 55.5 ± 8.4 years) from a convenience sample who received CBT. The intervention included nine weekly group therapy sessions. The quality of life questionnaire the 36-Item Short Form Survey (SF-36) and the Beck Depression Inventory (BDI) were administered during the pre- and post-intervention phases. The Wilcoxon signed-rank test was performed to assess the occurrence of significant differences. According to the SF-36, the general health domain significantly improved (d'  = - 0.264; p = 0.031). The mental health domain improved considerably (d'  = - 1.123; p = 0.012). Physical functioning showed a non-significant trend toward improvement (d'  = - 0.802; p = 0.078), although four of the five patients who showed floor effects improved and remained at this level. Regarding emotional well-being, five patients showed floor effects and four improved, and the condition did not change among any of the four patients who showed ceiling effects. No significant changes were found with regard to the other domains. No significant differences in the BDI were found before or after the intervention. The technique presented herein effectively improved the quality of life of patients with acromegaly with different levels of disease activity, type, and treatment time.

Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review.

Science.gov (United States)

Das, Ashis; Gopalan, Saji S; Chandramohan, Daniel

2016-04-14

Pay for Performance (P4P) mechanisms to health facilities and providers are currently being tested in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). This paper reviews the existing evidence on the effect of P4P program on quality of MCH care in LMICs. A systematic review of literature was conducted according to a registered protocol. MEDLINE, Web of Science, and Embase were searched using the key words maternal care, quality of care, ante natal care, emergency obstetric and neonatal care (EmONC) and child care. Of 4535 records retrieved, only eight papers met the inclusion criteria. Primary outcome of interest was quality of MCH disaggregated into structural quality, process quality and outcomes. Risk of bias across studies was assessed through a customized quality checklist. There were four controlled before after intervention studies, three cluster randomized controlled trials and one case control with post-intervention comparison of P4P programs for MCH care in Burundi, Democratic Republic of Congo, Egypt, the Philippines, and Rwanda. There is some evidence of positive effect of P4P only on process quality of MCH. The effect of P4P on delivery, EmONC, post natal care and under-five child care were not evaluated in these studies. There is weak evidence for P4P's positive effect on maternal and neonatal health outcomes and out-of-pocket expenses. P4P program had a few negative effects on structural quality. P4P is effective to improve process quality of ante natal care. However, further research is needed to understand P4P's impact on MCH and their causal pathways in LMICs. PROSPERO registration number CRD42014013077 .

IMPROVING EMISSION INVENTORIES FOR EFFECTIVE AIR-QUALITY MANAGMENT ACROSS NORTH AMERICA - A NARSTO ASSESSMENT

Science.gov (United States)

The NARSTO Ozone and Particulate Matter Assessments emphasized that emission inventories are critical to the success of air quality management programs and that emissions inventories in Canada, Mexico, and the United States need improvement to meet expectations for quality, timel...

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

Goal hierarchy: Improving asset data quality by improving motivation

Energy Technology Data Exchange (ETDEWEB)

Unsworth, Kerrie, E-mail: Kerrie.unsworth@uwa.edu.au [UWA Business School, University of Western Australia, Crawley, WA 6009 (Australia); Adriasola, Elisa; Johnston-Billings, Amber; Dmitrieva, Alina [UWA Business School, University of Western Australia, Crawley, WA 6009 (Australia); Hodkiewicz, Melinda [School of Mechanical Engineering, University of Western Australia, Crawley, WA 6009 (Australia)

2011-11-15

Many have recognized the need for high quality data on assets and the problems in obtaining them, particularly when there is a need for human observation and manual recording. Yet very few have looked at the role of the data collectors themselves in the data quality process. This paper argues that there are benefits to more fully understanding the psychological factors that lay behind data collection and we use goal hierarchy theory to understand these factors. Given the myriad of potential reasons for poor-quality data it has previously proven difficult to identify and successfully deploy employee-driven interventions; however, the goal hierarchy approach looks at all of the goals that an individual has in their life and the connections between them. For instance, does collecting data relate to whether or not they get a promotion? Stay safe? Get a new job? and so on. By eliciting these goals and their connections we can identify commonalities across different groups, sites or organizations that can influence the quality of data collection. Thus, rather than assuming what the data collectors want, a goal hierarchy approach determines that empirically. Practically, this supports the development of customized interventions that will be much more effective and sustainable than previous efforts. - Highlights: > We need to consider psychological aspects of data collectors to improve data quality. > We show how goal hierarchy theory furthers understanding. > Looks at the multiple goals of each individual to determine their behavior.

Goal hierarchy: Improving asset data quality by improving motivation

International Nuclear Information System (INIS)

Unsworth, Kerrie; Adriasola, Elisa; Johnston-Billings, Amber; Dmitrieva, Alina; Hodkiewicz, Melinda

2011-01-01

Many have recognized the need for high quality data on assets and the problems in obtaining them, particularly when there is a need for human observation and manual recording. Yet very few have looked at the role of the data collectors themselves in the data quality process. This paper argues that there are benefits to more fully understanding the psychological factors that lay behind data collection and we use goal hierarchy theory to understand these factors. Given the myriad of potential reasons for poor-quality data it has previously proven difficult to identify and successfully deploy employee-driven interventions; however, the goal hierarchy approach looks at all of the goals that an individual has in their life and the connections between them. For instance, does collecting data relate to whether or not they get a promotion? Stay safe? Get a new job? and so on. By eliciting these goals and their connections we can identify commonalities across different groups, sites or organizations that can influence the quality of data collection. Thus, rather than assuming what the data collectors want, a goal hierarchy approach determines that empirically. Practically, this supports the development of customized interventions that will be much more effective and sustainable than previous efforts. - Highlights: → We need to consider psychological aspects of data collectors to improve data quality. → We show how goal hierarchy theory furthers understanding. → Looks at the multiple goals of each individual to determine their behavior.

Use of Pressure Activation in Food Quality Improvement.

Science.gov (United States)

Shigematsu, Toru

2015-01-01

Beside intensive studies on inactivation microorganisms by high hydrostatic pressure (HP) for food storage, pressure effects on property of food materials have also been studied based on knowledge in pressure effect on biomolecules. Pressure effects on biological membranes and mass transfer in cellular biological materials and on enzyme activity would give an idea that HP treatment can introduce two types of activations into food materials: improved mass transfer and enzyme activity. Studies focusing on these pressure activations on food materials were then reviewed. Rice flour with an exclusively fine mean particle size and small starch damage was obtained due to improved water absorption properties and/or enzyme activity by HP. HP treatment increased of free amino acids and γ-aminobutyric acid (GABA) in rice and soybeans due to improved proteolysis and amino acid metabolism. Improvement of antioxidant activity and alteration of polyphenolic-compounds composition in food materials were also demonstrated by HP treatment. The HP-induced activations on food materials could contribute towards processing technologies for food quality improvement.

Quality improvement in basic histotechnology: the lean approach.

Science.gov (United States)

Clark, David

2016-01-01

Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems.

Improving PSA quality of KSNP PSA model

International Nuclear Information System (INIS)

Yang, Joon Eon; Ha, Jae Joo

2004-01-01

In the RIR (Risk-informed Regulation), PSA (Probabilistic Safety Assessment) plays a major role because it provides overall risk insights for the regulatory body and utility. Therefore, the scope, the level of details and the technical adequacy of PSA, i.e. the quality of PSA is to be ensured for the successful RIR. To improve the quality of Korean PSA, we evaluate the quality of the KSNP (Korean Standard Nuclear Power Plant) internal full-power PSA model based on the 'ASME PRA Standard' and the 'NEI PRA Peer Review Process Guidance.' As a working group, PSA experts of the regulatory body and industry also participated in the evaluation process. It is finally judged that the overall quality of the KSNP PSA is between the ASME Standard Capability Category I and II. We also derive some items to be improved for upgrading the quality of the PSA up to the ASME Standard Capability Category II. In this paper, we show the result of quality evaluation, and the activities to improve the quality of the KSNP PSA model

Modalities of hemodialysis: Quality improvement

Directory of Open Access Journals (Sweden)

Ayman Karkar

2012-01-01

Full Text Available Hemodialysis (HD treatment had, over many years, improved the survival rate of patients with end-stage renal disease. However, standard or conventional HD prescription is far from being optimal in replacing the function of normal kidneys. Its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins results in inter- and intra-dialysis complications and an unacceptably high rate of cardiovascular morbidity and mortality. Efficiency of HD can be improved by increasing blood and dialysate flow rates, dialyzer size and surface area and duration and frequency of dialysis sessions. Home HD, where short daily or long slow nocturnal HD sessions can conveniently be performed, provides an excellent option for quality of life improvement and reduction in morbidity and mortality. Recent innovations in the specifications of HD machines and improvement in dialysis membranes characteristics and water treatment technology paved the way for achieving quality HD. These advancements have resulted in efficient implementation of adsorption, diffusion and/or convection principles using adsorption HD, hemofiltration, hemodiafiltration (HDF and online HDF modalities in order to achieve optimum HD. Implementation of these innovations resulted in better quality care achievements in clinical practice and reduction in morbidity and mortality rates among HD patients.

A quality improvement management model for renal care.

Science.gov (United States)

Vlchek, D L; Day, L M

1991-04-01

The purpose of this article is to explore the potential for applying the theory and tools of quality improvement (total quality management) in the renal care setting. We believe that the coupling of the statistical techniques used in the Deming method of quality improvement, with modern approaches to outcome and process analysis, will provide the renal care community with powerful tools, not only for improved quality (i.e., reduced morbidity and mortality), but also for technology evaluation and resource allocation.

Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda.

Science.gov (United States)

Manzi, Anatole; Nyirazinyoye, Laetitia; Ntaganira, Joseph; Magge, Hema; Bigirimana, Evariste; Mukanzabikeshimana, Leoncie; Hirschhorn, Lisa R; Hedt-Gauthier, Bethany

2018-02-23

Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments. Completeness of danger sign assessments was measured by expert nurse mentors using standardized observation checklists. Checklists completed from October 2010 to May 2011 (n = 330) were used as baseline measurement and checklists completed between February and November 2012 (12-15 months after the start of MESH-QI implementation) were used for follow-up. We used a mixed-effects linear regression model to assess the effect of the MESH-QI intervention on the danger sign assessment score, controlling for potential confounders and the clustering of effect at the health center level. Complete assessment of all danger signs improved from 2.1% at baseline to 84.2% after MESH-QI (p ANC screening items. After controlling for potential confounders, the improvement in danger sign assessment score was significant. However, the effect of the MESH-QI was different by intervention district and type of observed ANC visit. In Southern Kayonza District, the increase in the danger sign assessment score was 6.28 (95% CI: 5.59, 6.98) for non-first ANC visits and 5.39 (95% CI: 4.62, 6.15) for first ANC visits. In Kirehe District, the increase in danger sign assessment score was 4.20 (95% CI: 3.59, 4.80) for non-first ANC visits and 3.30 (95% CI: 2.80, 3.81) for first ANC visits. Assessment of critical danger signs improved under MESH-QI, even when controlling for nurse-mentees' education level and previous training in focused ANC. MESH

Management systems, patient quality improvement, resource availability, and substance abuse treatment quality.

Science.gov (United States)

Fields, Dail; Roman, Paul M; Blum, Terry C

2012-06-01

To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007-2008. Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. © Health Research and Educational Trust.

Beam quality improvement by population-dynamic-coupled combined guiding effect in end-pumped Nd:YVO4 laser oscillator

Science.gov (United States)

Shen, Yijie; Gong, Mali; Fu, Xing

2018-05-01

Beam quality improvement with pump power increasing in an end-pumped laser oscillator is experimentally realized for the first time, to the best of our knowledge. The phenomenon is caused by the population-dynamic-coupled combined guiding effect, a comprehensive theoretical model of which has been well established, in agreement with the experimental results. Based on an 888 nm in-band dual-end-pumped oscillator using four tandem Nd:YVO4 crystals, the output beam quality of M^2= 1.1/1.1 at the pump power of 25 W is degraded to M^2 = 2.5/1.8 at 75 W pumping and then improved to M^2= 1.8/1.3 at 150 W pumping. The near-TEM_{00} mode is obtained with the highest continuous-wave output power of 72.1 W and the optical-to-optical efficiency of 48.1%. This work demonstrates great potential to further scale the output power of end-pumped laser oscillator while keeping good beam quality.

Does enhanced regulation improve EIA report quality? Lessons from South Africa

International Nuclear Information System (INIS)

Sandham, L.A.; Heerden, A.J. van; Jones, C.E.; Retief, F.P.; Morrison-Saunders, A.N.

2013-01-01

Recently, various EIA systems have been subjected to system review processes with a view to improve performance. Many of these reviews resulted in some form of legislative reform. The South African Environmental Impact Assessment (EIA) regulations were modified in 2006 with the express intent to improve EIA effectiveness. In order to evaluate to what extent the desired outcome was achieved, the quality of EIA reports produced under the 2006 regulations was investigated for comparative analysis with the preceding regime. A sample of EIA reports from the two legislative regimes was reviewed using an adapted version of a well established method known colloquially as the “Lee and Colley” review package. Despite some improvements in certain aspects, overall report quality has decreased slightly from the 1997 EIA regime. It therefore appears that the modifications to the regulations, often heralded as the solution to improvements in performance have not resulted in improved quality of EIA reports. - Highlights: ► EIA regulations in South Africa were revised and became more comprehensive in 2006. ► The report quality of a sample of EIAs was reviewed using the Lee and Colley review package. ► Report quality showed a slight decline from the previous regulatory regime. ► EIA good practice needs flexibility rather than over-detailed regulation.

Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

Science.gov (United States)

Kesteloot, K; Voet, N

1998-12-01

Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

45 CFR 1304.60 - Deficiencies and quality improvement plans.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Deficiencies and quality improvement plans. 1304... must correct the deficiency either immediately or pursuant to a Quality Improvement Plan. (c) An Early... Improvement Plan must submit to the responsible HHS official a Quality Improvement Plan specifying, for each...

Improving patient safety through quality assurance.

Science.gov (United States)

Raab, Stephen S

2006-05-01

Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. To review some of the anatomic pathology laboratory patient safety quality assurance practices. Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives. Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics. Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.

Brief educational interventions to improve performance on novel quality metrics in ambulatory settings in Kenya: A multi-site pre-post effectiveness trial.

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Korom, Robert Ryan; Onguka, Stephanie; Halestrap, Peter; McAlhaney, Maureen; Adam, Mary

2017-01-01

The quality of primary care delivered in resource-limited settings is low. While some progress has been made using educational interventions, it is not yet clear how to sustainably improve care for common acute illnesses in the outpatient setting. Management of urinary tract infection is particularly important in resource-limited settings, where it is commonly diagnosed and associated with high levels of antimicrobial resistance. We describe an educational programme targeting non-physician health care providers and its effects on various clinical quality metrics for urinary tract infection. We used a series of educational interventions including 1) formal introduction of a clinical practice guideline, 2) peer-to-peer chart review, and 3) peer-reviewed literature describing local antimicrobial resistance patterns. Interventions were conducted for clinical officers (N = 24) at two outpatient centers near Nairobi, Kenya over a one-year period. The medical records of 474 patients with urinary tract infections were scored on five clinical quality metrics, with the primary outcome being the proportion of cases in which the guideline-recommended antibiotic was prescribed. The results at baseline and following each intervention were compared using chi-squared tests and unpaired two-tailed T-tests for significance. Logistic regression analysis was used to assess for possible confounders. Clinician adherence to the guideline-recommended antibiotic improved significantly during the study period, from 19% at baseline to 68% following all interventions (Χ2 = 150.7, p quality score also improved significantly from an average of 2.16 to 3.00 on a five-point scale (t = 6.58, p educational interventions can dramatically improve the quality of care for routine acute illnesses in the outpatient setting. Measurement of quality metrics allows for further targeting of educational interventions depending on the needs of the providers and the community. Further study is needed to expand

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

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

2015-07-01

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

Measuring, evaluating and improving hospital quality parameters/dimensions--an integrated healthcare quality approach.

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Zineldin, Mosad; Camgöz-Akdağ, Hatice; Vasicheva, Valiantsina

2011-01-01

This paper aims to examine the major factors affecting cumulative summation, to empirically examine the major factors affecting satisfaction and to address the question whether patients in Kazakhstan evaluate healthcare similarly or differently from patients in Egypt and Jordan. A questionnaire, adapted from previous research, was distributed to Kazakhstan inpatients. The questionnaire contained 39 attributes about five newly-developed quality dimensions (5Qs), which were identified to be the most relevant attributes for hospitals. The questionnaire was translated into Russian to increase the response rate and improve data quality. Almost 200 usable questionnaires were returned. Frequency distribution, factor analysis and reliability checks were used to analyze the data. The three biggest concerns for Kazakhstan patients are: infrastructure; atmosphere; and interaction. Hospital staffs concern for patients' needs, parking facilities for visitors, waiting time and food temperature were all common specific attributes, which were perceived as concerns. These were shortcomings in all three countries. Improving health service quality by applying total relationship management and the 5Qs model together with a customer-orientation strategy is recommended. Results can be used by hospital staff to reengineer and redesign creatively their quality management processes and help move towards more effective healthcare quality strategies. Patients in three countries have similar concerns and quality perceptions. The paper describes a new instrument and method. The study assures relevance, validity and reliability, while being explicitly change-oriented. The authors argue that patient satisfaction is a cumulative construct, summing satisfaction as five different qualities (5Qs): object; processes; infrastructure; interaction and atmosphere.

Dynamic Evaluation of Water Quality Improvement Based on Effective Utilization of Stockbreeding Biomass Resource

Directory of Open Access Journals (Sweden)

Jingjing Yan

2014-11-01

Full Text Available The stockbreeding industry is growing rapidly in rural regions of China, carrying a high risk to the water environment due to the emission of huge amounts of pollutants in terms of COD, T-N and T-P to rivers. On the other hand, as a typical biomass resource, stockbreeding waste can be used as a clean energy source by biomass utilization technologies. In this paper, we constructed a dynamic linear optimization model to simulate the synthetic water environment management policies which includes both the water environment system and social-economic situational changes over 10 years. Based on the simulation, the model can precisely estimate trends of water quality, production of stockbreeding biomass energy and economic development under certain restrictions of the water environment. We examined seven towns of Shunyi district of Beijing as the target area to analyse synthetic water environment management policies by computer simulation based on the effective utilization of stockbreeding biomass resources to improve water quality and realize sustainable development. The purpose of our research is to establish an effective utilization method of biomass resources incorporating water environment preservation, resource reutilization and economic development, and finally realize the sustainable development of the society.

Benchmarking and audit of breast units improves quality of care.

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van Dam, P A; Verkinderen, L; Hauspy, J; Vermeulen, P; Dirix, L; Huizing, M; Altintas, S; Papadimitriou, K; Peeters, M; Tjalma, W

2013-01-01

Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on "QIs and breast cancer" and "benchmarking and breast cancer care", and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload.

Electronic health records improve clinical note quality.

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Burke, Harry B; Sessums, Laura L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W

2015-01-01

The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (pquality scores significantly improved over the 5-year time interval. The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

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

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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).

How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

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OʼRourke, Hannah M; Fraser, Kimberly D

2016-01-01

Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

Effective non-drug interventions for improving outcomes and quality of maternal health care in sub-Saharan Africa: a systematic review.

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Wekesah, Frederick M; Mbada, Chidozie E; Muula, Adamson S; Kabiru, Caroline W; Muthuri, Stella K; Izugbara, Chimaraoke O

2016-08-15

Many interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA). Currently, however, systematic information on the effectiveness of these interventions remains scarce. We conducted a systematic review of published evidence on non-drug interventions that reported effectiveness in improving outcomes and quality of care in maternal health in SSA. African Journals Online, Bioline, MEDLINE, Ovid, Science Direct, and Scopus databases were searched for studies published in English between 2000 and 2015 and reporting on the effectiveness of interventions to improve quality and outcomes of maternal health care in SSA. Articles focusing on interventions that involved drug treatments, medications, or therapies were excluded. We present a narrative synthesis of the reported impact of these interventions on maternal morbidity and mortality outcomes as well as on other dimensions of the quality of maternal health care (as defined by the Institute of Medicine 2001 to comprise safety, effectiveness, efficiency, timeliness, patient centeredness, and equitability). Seventy-three studies were included in this review. Non-drug interventions that directly or indirectly improved quality of maternal health and morbidity and mortality outcomes in SSA assumed a variety of forms including mobile and electronic health, financial incentives on the demand and supply side, facility-based clinical audits and maternal death reviews, health systems strengthening interventions, community mobilization and/or peer-based programs, home-based visits, counseling and health educational and promotional programs conducted by health care providers, transportation and/or communication and referrals for emergency obstetric care, prevention of mother-to-child transmission of HIV, and task shifting interventions. There was a preponderance of single facility and community-based studies whose effectiveness was difficult to assess. Many non-drug interventions have been

A comprehensive method for GNSS data quality determination to improve ionospheric data analysis.

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Kim, Minchan; Seo, Jiwon; Lee, Jiyun

2014-08-14

Global Navigation Satellite Systems (GNSS) are now recognized as cost-effective tools for ionospheric studies by providing the global coverage through worldwide networks of GNSS stations. While GNSS networks continue to expand to improve the observability of the ionosphere, the amount of poor quality GNSS observation data is also increasing and the use of poor-quality GNSS data degrades the accuracy of ionospheric measurements. This paper develops a comprehensive method to determine the quality of GNSS observations for the purpose of ionospheric studies. The algorithms are designed especially to compute key GNSS data quality parameters which affect the quality of ionospheric product. The quality of data collected from the Continuously Operating Reference Stations (CORS) network in the conterminous United States (CONUS) is analyzed. The resulting quality varies widely, depending on each station and the data quality of individual stations persists for an extended time period. When compared to conventional methods, the quality parameters obtained from the proposed method have a stronger correlation with the quality of ionospheric data. The results suggest that a set of data quality parameters when used in combination can effectively select stations with high-quality GNSS data and improve the performance of ionospheric data analysis.

Continuous quality improvement in the ambulatory endoscopy center.

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Johanson, John F

2002-04-01

What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit

Technological measures to improve automotive product quality

OpenAIRE

Gladkov, V.; Kruglov, S.

2010-01-01

The paper examines the basic technological measures aimed at improving product quality in automotive industry. While paying due attention to solving organizational and technological problems, including the development of certification systems for production processes, it is also necessary to improve the technical standards of specific technologies, equipment and materials as they largely determine product quality. Special emphasis is given to the importance of improving the production of auto...

Quality Tools and TRIZ Based Quality Improvement Case Study at PT ‘X’ A Plastic Moulding Manufacturing Industry

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Wirawan, Christina; Chandra, Fory

2016-02-01

Theory of Inventive Problem Solving (TRIZ) is a creative encouraging problem solving method. TRIZ is prepared by Altshuller for product design. Altshuller prepared contradiction matrix and suggestion to solve contradictions usually occur in product design. This paper try to combine TRIZ with quality tools such as Pareto and Fault Tree Analysis (FTA) to solve contradiction in quality improvement problem, neither than product design problem. Pareto used to identify defect priority, FTA used to analysis and identify root cause of defect. When there is contradiction in solving defect causes, TRIZ used to find creative problem solving. As a case study, PT ’X’, a plastic molding manufacturing industry was taken. PT ‘X’ using traditional press machine to produce plastic thread cone. There are 5 defect types that might occur in plastic thread cone production, incomplete form, dirty, mottle, excessive form, rugged. Research about quality improvement effort using DMAIC at PT ‘X’ have been done by Fory Candra. From this research, defect types, priority, root cause from FTA, recommendation from FMEA. In this research, from FTA reviewed, contradictions found among causes troublesome quality improvement efforts. TRIZ used to solve the contradictions and quality improvement effort can be made effectively.

Are data from national quality registries used in quality improvement at Swedish hospital clinics?

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Fredriksson, Mio; Halford, Christina; Eldh, Ann Catrine; Dahlström, Tobias; Vengberg, Sofie; Wallin, Lars; Winblad, Ulrika

2017-11-01

To investigate the use of data from national quality registries (NQRs) in local quality improvement as well as purported key factors for effective clinical use in Sweden. Comparative descriptive: a web survey of all Swedish hospitals participating in three NQRs with different levels of development (certification level). Heads of the clinics and physician(s) at clinics participating in the Swedish Stroke Register (Riksstroke), the Swedish National Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) and the Swedish Lung Cancer Registry (NLCR). Individual and unit level use of NQRs in local quality improvement, and perceptions on data quality, organizational conditions and user motivation. Riksstroke data were reported as most extensively used at individual and unit levels (x̅ 17.97 of 24 and x̅ 27.06 of 35). Data quality and usefulness was considered high for the two most developed NQRs (x̅ 19.86 for Riksstroke and x̅ 19.89 for GallRiks of 25). Organizational conditions were estimated at the same level for Riksstroke and GallRiks (x̅ 12.90 and x̅ 13.28 of 20) while the least developed registry, the NLCR, had lower estimates (x̅ 10.32). In Riksstroke, the managers requested registry data more often (x̅ 15.17 of 20). While there were significant differences between registries in key factors such as management interest, use of NQR data in local quality improvement seems rather prevalent, at least for Riksstroke. The link between the registry's level of development and factors important for routinization of innovations such as NQRs needs investigation. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Framing quality improvement tools and techniques in healthcare the case of improvement leaders' guides.

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Millar, Ross

2013-01-01

The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings. The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England. Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches. The paper provides an important contribution in furthering our understanding of framing the "social act" of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

IMPROVEMENTS IN THE QUALITY OF COURIER DELIVERY

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Jacek Karcz

2016-06-01

Full Text Available The functioning of courier companies is a vital component of modern trade. E-commerce services are changing the way of shopping. Along with them, also courier services change and become more advance. Customers of courier companies become more aware of quality, which they should expect from supplier of these services. The article presents the result of the research of the effectiveness and the timelines of deliveries realized by one of the terminals of a leading courier operator in Poland. The survey involved 55 courier routes over the course of 10 business days. The author analyses weak points of the supply chain and presents two solutions, which may improve quality of delivery processes.

QUALITY IMPROVEMENT MODEL AT THE MANUFACTURING PROCESS PREPARATION LEVEL

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Dusko Pavletic

2009-12-01

Full Text Available The paper expresses base for an operational quality improvement model at the manufacturing process preparation level. A numerous appropriate related quality assurance and improvement methods and tools are identified. Main manufacturing process principles are investigated in order to scrutinize one general model of manufacturing process and to define a manufacturing process preparation level. Development and introduction of the operational quality improvement model is based on a research conducted and results of methods and tools application possibilities in real manufacturing processes shipbuilding and automotive industry. Basic model structure is described and presented by appropriate general algorithm. Operational quality improvement model developed lays down main guidelines for practical and systematic application of quality improvements methods and tools.

Improving couples' quality of life through a Web-based prostate cancer education intervention.

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Song, Lixin; Rini, Christine; Deal, Allison M; Nielsen, Matthew E; Chang, Hao; Kinneer, Patty; Teal, Randall; Johnson, David C; Dunn, Mary W; Mark, Barbara; Palmer, Mary H

2015-03-01

To evaluate the feasibility and acceptability of a newly developed web-based, couple-oriented intervention called Prostate Cancer Education and Resources for Couples (PERC). Quantitative, qualitative, mixed-methods approach. Oncology outpatient clinics at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center at UNC–Chapel Hill. 26 patients with localized prostate cancer (PCa) and their partners. Pre- and postpilot quantitative assessments and a postpilot qualitative interview were conducted. General and PCa-specific symptoms, quality of life, psychosocial factors, PERC’s ease of use, and web activities. Improvement was shown in some PCa-specific and general symptoms (small effect sizes for patients and small-to-medium effect sizes for partners), overall quality of life, and physical and social domains of quality of life for patients (small effect sizes). Web activity data indicated high PERC use. Qualitative and quantitative analyses indicated that participants found PERC easy to use and understand,as well as engaging, of high quality, and relevant. Overall, participants were satisfied with PERC and reported that PERC improved their knowledge about symptom management and communication as a couple. PERC was a feasible, acceptable method of reducing the side effects of PCa treatment–related symptoms and improving quality of life. PERC has the potential to reduce the negative impacts of symptoms and enhance quality of life for patients with localized PCa and their partners, particularly for those who live in rural areas and have limited access to post-treatment supportive care.

Implementing a user-driven online quality improvement toolkit for cancer care.

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Luck, Jeff; York, Laura S; Bowman, Candice; Gale, Randall C; Smith, Nina; Asch, Steven M

2015-05-01

Peer-to-peer collaboration within integrated health systems requires a mechanism for sharing quality improvement lessons. The Veterans Health Administration (VA) developed online compendia of tools linked to specific cancer quality indicators. We evaluated awareness and use of the toolkits, variation across facilities, impact of social marketing, and factors influencing toolkit use. A diffusion of innovations conceptual framework guided the collection of user activity data from the Toolkit Series SharePoint site and an online survey of potential Lung Cancer Care Toolkit users. The VA Toolkit Series site had 5,088 unique visitors in its first 22 months; 5% of users accounted for 40% of page views. Social marketing communications were correlated with site usage. Of survey respondents (n = 355), 54% had visited the site, of whom 24% downloaded at least one tool. Respondents' awareness of the lung cancer quality performance of their facility, and facility participation in quality improvement collaboratives, were positively associated with Toolkit Series site use. Facility-level lung cancer tool implementation varied widely across tool types. The VA Toolkit Series achieved widespread use and a high degree of user engagement, although use varied widely across facilities. The most active users were aware of and active in cancer care quality improvement. Toolkit use seemed to be reinforced by other quality improvement activities. A combination of user-driven tool creation and centralized toolkit development seemed to be effective for leveraging health information technology to spread disease-specific quality improvement tools within an integrated health care system. Copyright © 2015 by American Society of Clinical Oncology.

Split Nitrogen Application Improves Wheat Baking Quality by Influencing Protein Composition Rather Than Concentration.

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Xue, Cheng; Auf'm Erley, Gunda Schulte; Rossmann, Anne; Schuster, Ramona; Koehler, Peter; Mühling, Karl-Hermann

2016-01-01

The use of late nitrogen (N) fertilization (N application at late growth stages of wheat, e.g., booting, heading or anthesis) to improve baking quality of wheat has been questioned. Although it increases protein concentration, the beneficial effect on baking quality (bread loaf volume) needs to be clearly understood. Two pot experiments were conducted aiming to evaluate whether late N is effective under controlled conditions and if these effects result from increased N rate or N splitting. Late N fertilizers were applied either as additional N or split from the basal N at late boot stage or heading in the form of nitrate-N or urea. Results showed that late N fertilization improved loaf volume of wheat flour by increasing grain protein concentration and altering its composition. Increasing N rate mainly enhanced grain protein quantitatively. However, N splitting changed grain protein composition by enhancing the percentages of gliadins and glutenins as well as certain high molecular weight glutenin subunits (HMW-GS), which led to an improved baking quality of wheat flour. The late N effects were greater when applied as nitrate-N than urea. The proportions of glutenin and x-type HMW-GS were more important than the overall protein concentration in determining baking quality. N splitting is more effective in improving wheat quality than the increase in the N rate by late N, which offers the potential to cut down N fertilization rates in wheat production systems.

Split nitrogen application improves wheat baking quality by influencing protein composition rather than concentration

Directory of Open Access Journals (Sweden)

Cheng eXue

2016-06-01

Full Text Available The use of late nitrogen (N fertilization (N application at late growth stages of wheat, e.g. booting, heading or anthesis to improve baking quality of wheat has been questioned. Although it increases protein concentration, the beneficial effect on baking quality (bread loaf volume needs to be clearly understood. Two pot experiments were conducted aiming to evaluate whether late N is effective under controlled conditions and if these effects result from increased N rate or N splitting. Late N fertilizers were applied either as additional N or split from the basal N at late boot stage or heading in the form of nitrate-N or urea. Results showed that late N fertilization improved loaf volume of wheat flour by increasing grain protein concentration and altering its composition. Increasing N rate mainly enhanced grain protein quantitatively. However, N splitting changed grain protein composition by enhancing the percentages of gliadins and glutenins as well as certain high molecular weight glutenin subunits (HMW-GS, which led to an improved baking quality of wheat flour. The late N effects were greater when applied as nitrate-N than urea. The proportions of glutenin and x-type HMW-GS were more important than the overall protein concentration in determining baking quality. N splitting is more effective in improving wheat quality than the increase in the N rate by late N, which offers the potential to cut down N fertilization rates in wheat production systems.

Quality control of physician-performed mammography. Importance of original attempts to improve quality

International Nuclear Information System (INIS)

Nakayama, Takashi; Terada, Hiroshi; Kotsuma, Yoshikazu

2006-01-01

In order to perform effective breast cancer screening with mammography, family doctors should be encouraged to participate. At institutions without specific radiology technicians, physicians themselves are required to perform mammography and operate the equipment, otherwise it is difficult to consistently obtain good-quality mammograms. Our institutions have been given a grade ''A'' evaluation by the Central Committee for Quality Control of Mammographic Screening (CCQCMS), due largely to our own efforts and promotion. Here we report our experience in solving a number of problems that occurred during the establishment of our system. We used the SEPIO standard mammography apparatus with a MD-100/CM-H screen/filter system, and developed films using a TCX-202 automatic film processor. Problems due to asymmetry of the bilateral breasts and lack of retroglandular fat tissue space and inframammary folds seen on our initial mammograms were overcome by placing marks at the postion of the AEC sensor, and at both ends and the center of the film on a bucky table. We simplified the markers by removing several complicated ones. We tried to rectify areas of the image that were obscured due to the difference in size between the inside of the cassette and the screen. Physicians and a radiology technician attended a mammography study course once weekly, and attempted to improve the quality of mammograms and our reading ability by obtaining advice from members of the CCQCMS. Manufacturers responded with considerable delay to our attempt to overcome the troublesome appearance of numerous microcalfication-like artifact shadows caused by screens. In conclusion, in order to perform effective breast cancer screening with mammography, we must obtain mammograms of good quality, for which it is necessary to always try to seek new ways of improving. At the same time, manufacturers need to respond quickly to queries and problems related to quality control. (author)

A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals.

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Whitfill, Travis; Gawel, Marcie; Auerbach, Marc

2017-07-17

The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12

Does enhanced regulation improve EIA report quality? Lessons from South Africa

Energy Technology Data Exchange (ETDEWEB)

Sandham, L.A., E-mail: luke.sandham@nwu.ac.za [Environmental Assessment Research Group, School of Geo and Spatial Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520 (South Africa); Heerden, A.J. van [Environmental Assessment Research Group, School of Geo and Spatial Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520 (South Africa); Jones, C.E. [School of Environment and Development, University of Manchester, Oxford Road, Manchester, M13 9PL (United Kingdom); Retief, F.P.; Morrison-Saunders, A.N. [Environmental Assessment Research Group, School of Geo and Spatial Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520 (South Africa)

2013-01-15

Recently, various EIA systems have been subjected to system review processes with a view to improve performance. Many of these reviews resulted in some form of legislative reform. The South African Environmental Impact Assessment (EIA) regulations were modified in 2006 with the express intent to improve EIA effectiveness. In order to evaluate to what extent the desired outcome was achieved, the quality of EIA reports produced under the 2006 regulations was investigated for comparative analysis with the preceding regime. A sample of EIA reports from the two legislative regimes was reviewed using an adapted version of a well established method known colloquially as the 'Lee and Colley' review package. Despite some improvements in certain aspects, overall report quality has decreased slightly from the 1997 EIA regime. It therefore appears that the modifications to the regulations, often heralded as the solution to improvements in performance have not resulted in improved quality of EIA reports. - Highlights: Black-Right-Pointing-Pointer EIA regulations in South Africa were revised and became more comprehensive in 2006. Black-Right-Pointing-Pointer The report quality of a sample of EIAs was reviewed using the Lee and Colley review package. Black-Right-Pointing-Pointer Report quality showed a slight decline from the previous regulatory regime. Black-Right-Pointing-Pointer EIA good practice needs flexibility rather than over-detailed regulation.

A repeated short educational intervention improves asthma control and quality of life.

Science.gov (United States)

Plaza, Vicente; Peiró, Meritxell; Torrejón, Montserrat; Fletcher, Monica; López-Viña, Antolín; Ignacio, José María; Quintano, José Antonio; Bardagí, Santiago; Gich, Ignasi

2015-11-01

We assessed the effectiveness of an asthma educational programme based on a repeated short intervention (AEP-RSI) to improve asthma control (symptom control and future risk) and quality of life. A total of 230 adults with mild-to-moderate persistent uncontrolled asthma participated in a 1-year cluster randomised controlled multicentre study. The AEP-RSI was given in four face-to-face sessions at 3-month intervals, and included administration of a written personalised action plan and training on inhaler technique. Centres were randomised to the AEP-RSI (intervention) group or usual clinical practice group. Specialised centres using a standard educational programme were the gold standard group. A significant improvement in the Asthma Control Test score was observed in all three groups (pQuality of Life Questionnaire scores (0.95±1.04 and 0.89±0.84 versus 0.52±0.97, respectively). The AEP-RSI was effective in improving asthma symptom control, future risk and quality of life. Copyright ©ERS 2015.

Quality Rating and Improvement System State Evaluations and Research

Science.gov (United States)

Ferguson, Daniel

2016-01-01

A quality rating and improvement system (QRIS) is a method used by states and local jurisdictions to assess the level of quality of child care and early education programs, improve quality, and convey quality ratings to parents and other consumers. A typical QRIS incorporates the following components: quality standards for participating providers;…

Assessment of and Improvement Strategies for the Housing of Healthy Elderly: Improving Quality of Life

Directory of Open Access Journals (Sweden)

I-Ming Feng

2018-03-01

Full Text Available Global population is aging, particularly in developed countries and cities. Through the “Friendly Elderly Cities” and “Aging in Place” initiatives, various countries are making great efforts to improve the welfare and quality of life of the elderly, with the aim of catering to the physical and spiritual health as well as social welfare of the elderly. In this regard, the improvement of the housing environment of the elderly is one of the key factors in their quality of life and health. This study aims to effectively assess and improve the housing environment of the elderly in order to enhance their quality of life; it also aims to contribute the knowledge about improving elderly housing by applying an assessment framework using expert interviews and data collected from relevant literature. Using a mixed Multi-Criteria Decision Analysis model, a combination of the DEMATEL (Decision Making Trial and Evaluation Laboratory-based ANP (Analytic Network Process (DANP and the modified VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR methods, and the investigations and assessments in the case study, this study proposes strategies and directions for improving elderly housing. The study results indicate that, as distinct from using traditional methodologies where the hypothesis criteria are mutually independent, the proposed hybrid model (examining real-life problems by considering the mutual influences of factors identifies a priority sequence wherein emphasis is placed on improving ventilation and air quality rather than adjustment of temperature. The systemic way of thinking shifts the focus from the most apparent problems to the root cause of the problems. Doing so avoids any mismatch of resource allocation in decision-making and thus maximizes the efficiency and sustainability of the improvement.

Nationwide quality improvement in lung cancer care

DEFF Research Database (Denmark)

Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell

2013-01-01

To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....

Laboratory quality improvement in Thailand's northernmost provinces.

Science.gov (United States)

Kanitvittaya, S; Suksai, U; Suksripanich, O; Pobkeeree, V

2010-01-01

In Thailand nearly 1000 public health laboratories serve 65 million people. A qualified indicator of a good quality laboratory is Thailand Medical Technology Council certification. Consequently, Chiang Rai Regional Medical Sciences Center established a development program for laboratory certification for 29 laboratories in the province. This paper seeks to examine this issue. The goal was to improve laboratory service quality by voluntary participation, peer review, training and compliance with standards. The program consisted of specific activities. Training and workshops to update laboratory staffs' quality management knowledge were organized. Staff in each laboratory performed a self-assessment using a standard check-list to evaluate ten laboratory management areas. Chiang Rai Regional Medical Sciences Center staff supported the distribution of quality materials and documents. They provided calibration services for laboratory equipment. Peer groups performed an internal audit and successful laboratories received Thailand Medical Technology Council certification. By December 2007, eight of the 29 laboratories had improved quality sufficiently to be certified. Factors that influenced laboratories' readiness for quality improvement included the number of staff, their knowledge, budget and staff commitment to the process. Moreover, the support of each hospital's laboratory working group or network was essential for success. There was no clear policy for supporting the program. Laboratories voluntarily conducted quality management using existing resources. A bottom-up approach to this kind of project can be difficult to accomplish. Laboratory professionals can work together to illustrate and highlight outcomes for top-level health officials. A top-down, practical approach would be much less difficult to implement. Quality certification is a critical step for laboratory staff, which also encourages them to aspire to international quality standards like ISO. The

Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

Science.gov (United States)

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

Quality Function Deployment Application for Improving Quality of Education in Business Schools

Science.gov (United States)

Sagnak, Muhittin; Ada, Nesrin; Kazancoglu, Yigit; Tayaksi, Cansu

2017-01-01

There is an increasing competition between universities globally to attract students. At this point, to compete, it is imperative for the universities to improve the quality of education provided for their stakeholders, including students, parents, and employers. For improving the quality of education, first of all, the universities should make…

IMPROVING QUALITY MANAGEMENT IN PANIFICATION

Directory of Open Access Journals (Sweden)

Cornelia Petroman

2010-12-01

Full Text Available Consumers of panification products (as well as consumers of any other type of product or service are concerned about the quality of the products they purchase. Implementing the quality management system in the food industry is not compulsory, but it can bring about numerous, palpable benefits, particularly in reducing the amount of acryl amide. It is a modern system allowing the management analysis aiming at checking and reaching the goals to define new objectives, and the continuous improvement of the quality of processes and products.

Teaching Quality Improvement Through a Book Club

Directory of Open Access Journals (Sweden)

Benjamin Doolittle

2015-12-01

Full Text Available Introduction: Quality Improvement projects are an important part of residency education in the United States and are required for accreditation by the Accreditation Council for Graduate Medical Education. Participation in standard chart-based quality improvement had failed to generate excitement among residents in our program. The objective of our innovation was to inspire interest in quality improvement among our residents. Methods: Our residency program instituted a book discussion group. Attendance and participation of attendees was recorded, and residents were sent a follow-up survey one month after the activity to gauge their impressions. Results: Out of 16 residents in the program, 12 attended the discussion group, and all attendees participated in the discussion. The follow-up survey revealed that 10/11 (91% of respondents had read at least part of the book and 11/11 (100% wanted to have another book discussion group in the upcoming year. Conclusion: We believe that the use of a book discussion group can be a novel, inspiring strategy to teach quality improvement in a residency program.

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

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

2016-06-01

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

Title IV Quality Control Project, Stage II. Management Option II: Delivery System Quality Improvements.

Science.gov (United States)

Advanced Technology, Inc., Reston, VA.

Stage Two of the Title IV Quality Control Project is an integrated study of quality in five related Federal financial aid programs for postsecondary students. Section 1 of the paper establishes a framework for defining quality improvements, in order to identify the types of changes that would tend to improve quality across all facets of the…

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.

Engaging Clinical Nurses in Quality Improvement Projects.

Science.gov (United States)

Moore, Susan; Stichler, Jaynelle F

2015-10-01

Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. Copyright 2015, SLACK Incorporated.

40 CFR 63.175 - Quality improvement program for valves.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Quality improvement program for valves... alternative quality improvement programs specified in paragraphs (d) and (e) of this section. The decision to... § 63.168 and § 63.175. (1) If the owner or operator elects to continue the quality improvement program...

Quality measurement and improvement in liver transplantation.

Science.gov (United States)

Mathur, Amit K; Talwalkar, Jayant

2018-06-01

There is growing interest in the quality of health care delivery in liver transplantation. Multiple stakeholders, including patients, transplant providers and their hospitals, payers, and regulatory bodies have an interest in measuring and monitoring quality in the liver transplant process, and understanding differences in quality across centres. This article aims to provide an overview of quality measurement and regulatory issues in liver transplantation performed within the United States. We review how broader definitions of health care quality should be applied to liver transplant care models. We outline the status quo including the current regulatory agencies, public reporting mechanisms, and requirements around quality assurance and performance improvement (QAPI) activities. Additionally, we further discuss unintended consequences and opportunities for growth in quality measurement. Quality measurement and the integration of quality improvement strategies into liver transplant programmes hold significant promise, but multiple challenges to successful implementation must be addressed to optimise value. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Increased office productivity through improved indoor air quality

DEFF Research Database (Denmark)

Fanger, Povl Ole

2002-01-01

Control of indoor pollution sources and ventilation are both means of improving indoor air quality. Three independent experiments have recently documented that removing a pollution source or increasing the ventilation rate will improve perceived air quality, reduce the intensity of several Sick...... with the air quality was reduced by either measure. The quantitative relationsh8ip was 1.1% change in performance per 10% dissatisfied, in the range 25-70% dissatisifed, or 0.5% change in performance per 1 decipol (dp), in the range 2-13 dp. Significant improvements in performance occurred only when......, future developments in HVCAC technology may include "personalized air ", new ways of improving the quality of supply air (e.g., by filtration), more extensive use of heat recovery from exhaust air and systematic selection of low-polluting building and furnishing materials....

Evaluation of a Quality Improvement Resource for Public Health Practitioners.

Science.gov (United States)

Porterfield, Deborah S; Marcial, Laura H; Brown, Stephen; Throop, Cynthia; Pina, Jamie

Quality improvement is a critical mechanism to manage public health agency performance and to strengthen accountability for public funds. The objective of this study was to evaluate a relatively new quality improvement resource, the Public Health Quality Improvement Exchange (PHQIX), a free online communication platform dedicated to making public health quality improvement information accessible to practitioners. We conducted an internet-based survey of registered PHQIX users (n = 536 respondents) in 2013 and key informant interviews with PHQIX frequent users (n = 21) in 2014, in the United States. We assessed use of the PHQIX website, user engagement and satisfaction, communication and knowledge exchange, use of information, and impact on quality improvement capacity and accreditation readiness. Of 462 respondents, 369 (79.9%) browsed quality improvement initiatives, making it the most commonly used site feature, and respondents described PHQIX as a near-unique source for real-world quality improvement examples. Respondents were satisfied with the quality and breadth of topics and relevance to their settings (average satisfaction scores, 3.9-4.1 [where 5 was the most satisfied]). Of 407 respondents, 237 (58.2%) said that they had put into practice information learned on PHQIX, and 209 of 405 (51.6%) said that PHQIX had helped to improve quality improvement capacity. Fewer than half of respondents used the commenting function, the Community Forum, and the Ask an Expert feature. Findings suggest that PHQIX, particularly descriptions of the quality improvement initiatives, is a valued resource for public health practitioners. Users reported sharing information with colleagues and applying what they learned to their own work. These findings may relate to other efforts to disseminate quality improvement knowledge.

Auditor tenure and auditor change: does mandatory auditor rotation improve audit quality?

OpenAIRE

M. Cameran; A. Prencipe; M. Trombetta

2009-01-01

We test the effects of auditor tenure and auditor change on audit quality in a unique mandatory audit firm rotation environment, where the rotation rule has been effective for more than 20 years. We first study the effect of audit tenure on audit quality. Our results show that audit quality—measured in terms of earnings management—tends to improve rather than worsen over time. We also examine the effects of voluntary auditor change vs. those resulting from mandatory auditor changes. Our resul...

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.

Quality improvement – rival or ally of practice development?

Directory of Open Access Journals (Sweden)

Gavin Lavery

2016-05-01

Full Text Available The majority of nurses, doctors, allied health professionals and other healthcare staff possess a strong desire to provide the best possible care and experience for their patients. Unfortunately, this sometimes falls short of what was planned or intended (Institute of Medicine, 2001, p 23. The gap between care intended and care delivered can be explained by problems with systems and processes and/or people and culture. The narrowing of this gap is the focus of many strategies, methodologies and approaches. Practice development is described as ‘an activity focused on developing people and practice for the ultimate purpose of achieving high-quality person-centred care’ and a ‘methodology that aims to achieve effective workplace cultures that are person-centred’ (Shaw, 2012; Manley et al., 2014. Practice development undoubtedly has a strong focus on people and culture and the potential to change processes and systems. Another approach, widely referred to as quality improvement, aims to improve safety, effectiveness and person-centredness in healthcare using principles proven effective in other industries such as manufacturing – notably car manufacturing (Toyota, oil production, nuclear power and aviation. The fundamental principles of quality improvement for healthcare include making care reliable (every patient receiving care as intended every time, using well-designed processes and reducing variation (agreeing a consistent way to provide care. At first glance this may appear to be an approach suited only to systems and processes. However, better processes, designed by those who use them, resulting in fewer errors and less re-working or working around problems, can reduce stress on staff, offer greater job satisfaction with improved morale and free up time to provide person-centred care. In his report, A Promise to Learn – a Commitment to Act (2013, p 24, Professor Don Berwick says: ‘Mastery of quality and patient safety sciences and

IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS.

Science.gov (United States)

Rai, Arti K

2013-11-24

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office ("PTO") could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software.

Quality improvement strategies and tools: A comparative analysis between Italy and the United States.

Science.gov (United States)

Villa, Stefano; Restuccia, Joseph D; Anessi-Pessina, Eugenio; Rizzo, Marco Giovanni; Cohen, Alan B

2018-01-01

Italian and American hospitals, in two different periods, have been urged by external circumstances to extensively redesign their quality improvement strategies. This paper, through the use of a survey administered to chief quality officers in both countries, aims to identify commonalities and differences between the two systems and to understand which approaches are effective in improving quality of care. In both countries chief quality officers report quality improvement has become a strategic priority, clinical governance approaches, and tools-such as disease-specific quality improvement projects and clinical pathways-are commonly used, and there is widespread awareness that clinical decision making must be supported by protocols and guidelines. Furthermore, the study clearly outlines the critical importance of adopting a system-wide approach to quality improvement. To this extent Italy seems lagging behind compared to US in fact: (i) responsibilities for different dimensions of quality are spread across different organizational units; (ii) quality improvement strategies do not typically involve administrative staff; and (iii) quality performance measures are not disseminated widely within the organization but are reported primarily to top management. On the other hand, in Italy chief quality officers perceive that the typical hospital organizational structure, which is based on clinical directories, allows better coordination between clinical specialties than in the United States. In both countries, the results of the study show that it is not the single methodology/model that makes the difference but how the different quality improvement strategies and tools interact to each other and how they are coherently embedded with the overall organizational strategy.

Framework for pharmacy services quality improvement--a bridge to cross the quality chasm. Part I. The opportunity and the tool.

Science.gov (United States)

Curtiss, Frederic R; Fry, Richard N; Avey, Steven G

2004-01-01

To review the literature on the subject of quality improvement principles and methods applied to pharmacy services and to describe a framework for current and future efforts in pharmacy services quality improvement and effective drug therapy management. The Academy of Managed Care Pharmacy produced the Catalog of Pharmacy Quality Indicators in 1997, followed by the Summary of National Pharmacy Quality Measures in February 1999. In April 2002, AMCP introduced Pharmacy's Framework for Drug Therapy Management in the 21st Century. The Framework documents include a self-assessment tool that details more than 250 specific "components" that describe tasks, behaviors, skills, functions, duties, and responsibilities that contribute to meeting customer expectations for effective drug therapy management. There are many opportunities for quality improvement in clinical, service, and cost outcomes related to drug therapy management. These may include patient safety; incidence of medical errors; adverse drug events; patient adherence to therapy; attainment of target goals of blood pressure, glucose, and lipid levels; risk reduction for adverse cardiac events and osteoporotic-related fractures; patient satisfaction; risk of hospitalization or mortality; and cost of care. Health care practitioners can measure improvements in health care quality in several ways including (a) a better patient outcome at the same cost, (b) the same patient outcome at lower cost, (c) a better patient outcome at lower cost, or (d) a significantly better patient outcome at moderately higher cost. Measurement makes effective management possible. A framework of component factors (e.g., tasks) is necessary to facilitate changes in the key processes and critical factors that will help individual practitioners and health care systems meet customer expectations in regard to drug therapy, thus improving these outcomes. Quality improvement in health care services in the United States will be made in incremental

Improvements in geomagnetic observatory data quality

DEFF Research Database (Denmark)

Reda, Jan; Fouassier, Danielle; Isac, Anca

2011-01-01

between observatories and the establishment of observatory networks has harmonized standards and practices across the world; improving the quality of the data product available to the user. Nonetheless, operating a highquality geomagnetic observatory is non-trivial. This article gives a record...... of the current state of observatory instrumentation and methods, citing some of the general problems in the complex operation of geomagnetic observatories. It further gives an overview of recent improvements of observatory data quality based on presentation during 11th IAGA Assembly at Sopron and INTERMAGNET...

CMS Nonpayment Policy, Quality Improvement, and Hospital-Acquired Conditions: An Integrative Review.

Science.gov (United States)

Bae, Sung-Heui

This integrative review synthesized evidence on the consequences of the Centers for Medicare & Medicaid Services (CMS) nonpayment policy on quality improvement initiatives and hospital-acquired conditions. Fourteen articles were included. This review presents strong evidence that the CMS policy has spurred quality improvement initiatives; however, the relationships between the CMS policy and hospital-acquired conditions are inconclusive. In future research, a comprehensive model of implementation of the CMS nonpayment policy would help us understand the effectiveness of this policy.

Physical Activity Improves Quality of Life

Science.gov (United States)

... It Works Healthy Workplace Food and Beverage Toolkit Physical activity improves quality of life Updated:Mar 2,2015 ... proven to improve both mental and physical health. Physical activity boosts mental wellness. Regular physical activity can relieve ...

Quality improvement in neurology: AAN Parkinson disease quality measures

Science.gov (United States)

Cheng, E.M.; Tonn, S.; Swain-Eng, R.; Factor, S.A.; Weiner, W.J.; Bever, C.T.

2010-01-01

Background: Measuring the quality of health care is a fundamental step toward improving health care and is increasingly used in pay-for-performance initiatives and maintenance of certification requirements. Measure development to date has focused on primary care and common conditions such as diabetes; thus, the number of measures that apply to neurologic care is limited. The American Academy of Neurology (AAN) identified the need for neurologists to develop measures of neurologic care and to establish a process to accomplish this. Objective: To adapt and test the feasibility of a process for independent development by the AAN of measures for neurologic conditions for national measurement programs. Methods: A process that has been used nationally for measure development was adapted for use by the AAN. Topics for measure development are chosen based upon national priorities, available evidence base from a systematic literature search, gaps in care, and the potential impact for quality improvement. A panel composed of subject matter and measure development methodology experts oversees the development of the measures. Recommendation statements and their corresponding level of evidence are reviewed and considered for development into draft candidate measures. The candidate measures are refined by the expert panel during a 30-day public comment period and by review by the American Medical Association for Current Procedural Terminology (CPT) II codes. All final AAN measures are approved by the AAN Board of Directors. Results: Parkinson disease (PD) was chosen for measure development. A review of the medical literature identified 258 relevant recommendation statements. A 28-member panel approved 10 quality measures for PD that included full specifications and CPT II codes. Conclusion: The AAN has adapted a measure development process that is suitable for national measurement programs and has demonstrated its capability to independently develop quality measures. GLOSSARY

Improving local air quality in cities: To tree or not to tree?

International Nuclear Information System (INIS)

Vos, Peter E.J.; Maiheu, Bino; Vankerkom, Jean; Janssen, Stijn

2013-01-01

Vegetation is often quoted as an effective measure to mitigate urban air quality problems. In this work we demonstrate by the use of computer models that the air quality effect of urban vegetation is more complex than implied by such general assumptions. By modelling a variety of real-life examples we show that roadside urban vegetation rather leads to increased pollutant concentrations than it improves the air quality, at least locally. This can be explained by the fact that trees and other types of vegetation reduce the ventilation that is responsible for diluting the traffic emitted pollutants. This aerodynamic effect is shown to be much stronger than the pollutant removal capacity of vegetation. Although the modelling results may be subject to a certain level of uncertainty, our results strongly indicate that the use of urban vegetation for alleviating a local air pollution hotspot is not expected to be a viable solution. Highlights: ► We model the impact of roadside urban vegetation on the local air quality. ► Vegetation in general lowers the wind speed thereby reducing the ventilation. ► In general roadside urban vegetation does not appear to decrease concentrations. ► Roadside urban trees have a pronounced detrimental effect on the local air quality. ► City planners and policy makers need to be better informed about this topic. -- Rather than improving the local air quality, our results suggest that roadside urban vegetation increases the pollutant concentrations at the footpath

Ninety to Nothing: a PDSA quality improvement project.

Science.gov (United States)

Prybutok, Gayle Linda

2018-05-14

Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.

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…

Food price policies improve diet quality while increasing socioeconomic inequalities in nutrition

Science.gov (United States)

2014-01-01

Background Prices are an important determinant of food choices. Consequently, food price policies (subsidies and/or taxes) are proposed to improve the nutritional quality of diets. The aim of the present study was to explore the impact of food price policies on the expenditures and nutritional quality of the food baskets chosen by low- and medium-income households. Methods Experimental economics was used to examine two price manipulations: i) a fruit and vegetable price subsidy named “fruit and vegetables condition”; ii) a healthy-product subsidy coupled with an unhealthy-product tax named “nutrient profile condition”. The nutrient profiling system called SAIN,LIM was used. This system classifies each individual food according to its overall nutritional quality which then allows for a food item to be taxed or subsidized. Women from low- (n = 95) and medium-incomes (n = 33) selected a daily food basket, first, at current prices and then at manipulated prices. The redistributive effects of experimental conditions were assessed by comparing the extent of savings induced by subsidies and of costs generated by the tax on the two income groups. Energy density (kcal/100 g), free sugars (% energy) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. Results At baseline (before price manipulations), low-income women selected less expensive and less healthy baskets than medium-income ones. After price manipulations expenditures for both income group decreased significantly, whereas, the nutritional quality improved (energy density decreased, the MAR increased). Additionally, the redistributive effects were less favourable for low-income women and their nutritional quality improvements from baseline were significantly lower. Conclusion Low-income women derived fewer financial and nutritional benefits from implemented food subsidies and taxes than medium-income women. This outcome suggests that food price policies may improve diet

Food price policies improve diet quality while increasing socioeconomic inequalities in nutrition.

Science.gov (United States)

Darmon, Nicole; Lacroix, Anne; Muller, Laurent; Ruffieux, Bernard

2014-05-20

Prices are an important determinant of food choices. Consequently, food price policies (subsidies and/or taxes) are proposed to improve the nutritional quality of diets. The aim of the present study was to explore the impact of food price policies on the expenditures and nutritional quality of the food baskets chosen by low- and medium-income households. Experimental economics was used to examine two price manipulations: i) a fruit and vegetable price subsidy named "fruit and vegetables condition"; ii) a healthy-product subsidy coupled with an unhealthy-product tax named "nutrient profile condition". The nutrient profiling system called SAIN,LIM was used. This system classifies each individual food according to its overall nutritional quality which then allows for a food item to be taxed or subsidized. Women from low- (n = 95) and medium-incomes (n = 33) selected a daily food basket, first, at current prices and then at manipulated prices. The redistributive effects of experimental conditions were assessed by comparing the extent of savings induced by subsidies and of costs generated by the tax on the two income groups. Energy density (kcal/100 g), free sugars (% energy) and the mean adequacy ratio (MAR) were used as nutritional quality indicators. At baseline (before price manipulations), low-income women selected less expensive and less healthy baskets than medium-income ones. After price manipulations expenditures for both income group decreased significantly, whereas, the nutritional quality improved (energy density decreased, the MAR increased). Additionally, the redistributive effects were less favourable for low-income women and their nutritional quality improvements from baseline were significantly lower. Low-income women derived fewer financial and nutritional benefits from implemented food subsidies and taxes than medium-income women. This outcome suggests that food price policies may improve diet quality while increasing socio

Towards improvement in quality assurance

International Nuclear Information System (INIS)

1987-03-01

This first document in the series of the International Nuclear Safety Advisory Group (INSAG) Technical Notes is a general guideline for the establishment of effective quality assurance procedures at nuclear facilities. It sets out primary requirements such as quality objectives, methods for measuring the effectiveness of the quality assurance programme, priority of activities in relation to importance of safety of items, motivation of personnel

Statewide Quality Improvement Initiative to Reduce Early Elective Deliveries and Improve Birth Registry Accuracy.

Science.gov (United States)

Kaplan, Heather C; King, Eileen; White, Beth E; Ford, Susan E; Fuller, Sandra; Krew, Michael A; Marcotte, Michael P; Iams, Jay D; Bailit, Jennifer L; Bouchard, Jo M; Friar, Kelly; Lannon, Carole M

2018-04-01

To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio. Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects. Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2-3.2%, Pinitiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80-90%, P=.017; wave 2: 80-100%, P=.002; wave 3: 75-100%, Pinitiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.

ISO certification pays off in quality improvement

International Nuclear Information System (INIS)

Vermeer, F.J.G.

1992-01-01

This paper reports that by obtaining and maintaining International Standards Organization (ISO) 9001 certification, a company can improve its quality control system, cut waste, and motivate its employees. In so doing it improves its competitive position in both international and domestic markets. The success of a number of countries (notably Japan) in the world markets has focused the attention of the industrialized countries on improving quality levels and striving for a unified, worldwide quality standard. This has been particularly true in Europe; with several countries competing in a single market, a common quality standard has been a highly desirable goal for decades. One of the first multinational quality standards evolved in the European Community, which is estimated to become a single market with a gross national product of $4.5 trillion by 1992. As a consequence, in 1987 the International Standards Organization created ISO 9000, a single standard to ensure uniform quality in products and services offered with this growing market. U.S. petroleum and natural gas companies must recognize and implement the ISO 9000 standards or possibly lose international markets. If the present worldwide trend towards ISO 9000 continues (and there is no reason to believe that it will not), the standards will be just as important in the domestic market

Implementation research to improve quality of maternal and newborn health care, Malawi.

Science.gov (United States)

Brenner, Stephan; Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

2017-07-01

To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities' essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants' adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care.

Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

DEFF Research Database (Denmark)

Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe

2015-01-01

and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. METHODS: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included...... in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems....... The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. RESULTS: The continued attention to the ANC provision during implementation stimulated...

Quality Improvement Practices and Trends

DEFF Research Database (Denmark)

Dahlgaard, Jens J.; Hartz, Ove; Edgeman, Rick L.

1998-01-01

professor, as well as key individuals from various industries. In addition to the above activities, Rick will be working with the European Foundation for Quality Management on their "European Master's Programme in Total Quality Management." That program involves a consortium of European universities. Rick......The following article, "Quality Improvement Practices and Trends in Denmark," is the first in a series of papers arranged for and co-authored by Dr. Rick L. Edgeman. Rick is a member of QE's Editorial Board and is on sabbatical from Colorado State University. During the year, Rick and his family...... has begun the process of developing a comparable consortium of American universities for the same purpose-- an activity which is cosponsored by the Education Division of the American Society for Quality (ASQ)....

Improving high resolution retinal image quality using speckle illumination HiLo imaging.

Science.gov (United States)

Zhou, Xiaolin; Bedggood, Phillip; Metha, Andrew

2014-08-01

Retinal image quality from flood illumination adaptive optics (AO) ophthalmoscopes is adversely affected by out-of-focus light scatter due to the lack of confocality. This effect is more pronounced in small eyes, such as that of rodents, because the requisite high optical power confers a large dioptric thickness to the retina. A recently-developed structured illumination microscopy (SIM) technique called HiLo imaging has been shown to reduce the effect of out-of-focus light scatter in flood illumination microscopes and produce pseudo-confocal images with significantly improved image quality. In this work, we adopted the HiLo technique to a flood AO ophthalmoscope and performed AO imaging in both (physical) model and live rat eyes. The improvement in image quality from HiLo imaging is shown both qualitatively and quantitatively by using spatial spectral analysis.

The quality improvement attitude survey: Development and preliminary psychometric characteristics.

Science.gov (United States)

Dunagan, Pamela B

2017-12-01

To report the development of a tool to measure nurse's attitudes about quality improvement in their practice setting and to examine preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Human factors such as nursing attitudes of complacency have been identified as root causes of sentinel events. Attitudes of nurses concerning use of Quality and Safety Education for nurse's competencies can be most challenging to teach and to change. No tool has been developed measuring attitudes of nurses concerning their role in quality improvement. A descriptive study design with preliminary psychometric evaluation was used to examine the preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Registered bedside clinical nurses comprised the sample for the study (n = 57). Quantitative data were analysed using descriptive statistics and Cronbach's alpha reliability. Total score and individual item statistics were evaluated. Two open-ended items were used to collect statements about nurses' feelings regarding their experience in quality improvement efforts. Strong support for the internal consistency reliability and face validity of the Quality Improvement Nursing Attitude Scale was found. Total scale scores were high indicating nurse participants valued Quality and Safety Education for Nurse competencies in practice. However, item-level statistics indicated nurses felt powerless when other nurses deviate from care standards. Additionally, the sample indicated they did not consistently report patient safety issues and did not have a feeling of value in efforts to improve care. Findings suggested organisational culture fosters nurses' reporting safety issues and feeling valued in efforts to improve care. Participants' narrative comments and item analysis revealed the need to generate new items for the Quality Improvement Nursing Attitude Scale focused on nurses' perception of their importance in quality and

Brief educational interventions to improve performance on novel quality metrics in ambulatory settings in Kenya: A multi-site pre-post effectiveness trial

Science.gov (United States)

Onguka, Stephanie; Halestrap, Peter; McAlhaney, Maureen; Adam, Mary

2017-01-01

Background The quality of primary care delivered in resource-limited settings is low. While some progress has been made using educational interventions, it is not yet clear how to sustainably improve care for common acute illnesses in the outpatient setting. Management of urinary tract infection is particularly important in resource-limited settings, where it is commonly diagnosed and associated with high levels of antimicrobial resistance. We describe an educational programme targeting non-physician health care providers and its effects on various clinical quality metrics for urinary tract infection. Methods We used a series of educational interventions including 1) formal introduction of a clinical practice guideline, 2) peer-to-peer chart review, and 3) peer-reviewed literature describing local antimicrobial resistance patterns. Interventions were conducted for clinical officers (N = 24) at two outpatient centers near Nairobi, Kenya over a one-year period. The medical records of 474 patients with urinary tract infections were scored on five clinical quality metrics, with the primary outcome being the proportion of cases in which the guideline-recommended antibiotic was prescribed. The results at baseline and following each intervention were compared using chi-squared tests and unpaired two-tailed T-tests for significance. Logistic regression analysis was used to assess for possible confounders. Findings Clinician adherence to the guideline-recommended antibiotic improved significantly during the study period, from 19% at baseline to 68% following all interventions (Χ2 = 150.7, p < 0.001). The secondary outcome of composite quality score also improved significantly from an average of 2.16 to 3.00 on a five-point scale (t = 6.58, p < 0.001). Interventions had different effects at different clinical sites; the primary outcome of appropriate antibiotic prescription was met 83% of the time at Penda Health, and 50% of the time at AICKH, possibly reflecting

Does mentoring new peer reviewers improve review quality? A randomized trial

Directory of Open Access Journals (Sweden)

Houry Debra

2012-08-01

Full Text Available Abstract Background Prior efforts to train medical journal peer reviewers have not improved subsequent review quality, although such interventions were general and brief. We hypothesized that a manuscript-specific and more extended intervention pairing new reviewers with high-quality senior reviewers as mentors would improve subsequent review quality. Methods Over a four-year period we randomly assigned all new reviewers for Annals of Emergency Medicine to receive our standard written informational materials alone, or these materials plus a new mentoring intervention. For this program we paired new reviewers with a high-quality senior reviewer for each of their first three manuscript reviews, and asked mentees to discuss their review with their mentor by email or phone. We then compared the quality of subsequent reviews between the control and intervention groups, using linear mixed effects models of the slopes of review quality scores over time. Results We studied 490 manuscript reviews, with similar baseline characteristics between the 24 mentees who completed the trial and the 22 control reviewers. Mean quality scores for the first 3 reviews on our 1 to 5 point scale were similar between control and mentee groups (3.4 versus 3.5, as were slopes of change of review scores (-0.229 versus -0.549 and all other secondary measures of reviewer performance. Conclusions A structured training intervention of pairing newly recruited medical journal peer reviewers with senior reviewer mentors did not improve the quality of their subsequent reviews.

Reproductive health services in Malawi: an evaluation of a quality improvement intervention.

Science.gov (United States)

Rawlins, Barbara J; Kim, Young-Mi; Rozario, Aleisha M; Bazant, Eva; Rashidi, Tambudzai; Bandazi, Sheila N; Kachale, Fannie; Sanghvi, Harshad; Noh, Jin Won

2013-01-01

suggest that the PQI intervention increased the number of Caesarean sections, but showed no impact on other indicators of service utilisation and skilled care. the PQI intervention showed a positive impact on the quality of reproductive health services. The effects of the intervention on service utilisation had likely not yet been fully realized, since none of the facilities had achieved national recognition before the evaluation. Staff turnover needs to be reduced to maximise the effectiveness of the intervention. the PQI intervention evaluated here offers an effective way to improve the quality of health services in low-resource settings and should continue to be scaled up in Malawi. Copyright © 2011 Elsevier Ltd. All rights reserved.

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.

Context in Quality of Care: Improving Teamwork and Resilience.

Science.gov (United States)

Tawfik, Daniel S; Sexton, John Bryan; Adair, Kathryn C; Kaplan, Heather C; Profit, Jochen

2017-09-01

Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Benefits of improved water quality: a discrete choice analysis of freshwater recreational demands

OpenAIRE

R S Tay; P S McCarthy

1994-01-01

Discrete choice methodologies are increasingly being used to estimate multiple-sites recreational demands and evaluate the welfare effects of alternative environmental policies aimed at water quality improvements. In this study the authors use 1985 data on Indiana anglers to estimate a multinomial logit model of destination choice and compute the benefits of alternative water quality improvements. In general, the results indicate that anglers are reasonably sensitive to changes in water quali...

Quality improvement teaching at medical school: a student perspective

OpenAIRE

Nair, Pooja; Barai, Ishani; Prasad, Sunila; Gadhvi, Karishma

2016-01-01

Pooja Nair, Ishani Barai, Sunila Prasad, Karishma Gadhvi Department of Medicine, Imperial College School of Medicine, Imperial College London, London, UK Abstract: Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school. Keywords: quality improvement, medical school, patient safety, patient satisfaction, medical student, clinical audit

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

Service innovation through social robot engagement to improve dementia care quality.

Science.gov (United States)

Chu, Mei-Tai; Khosla, Rajiv; Khaksar, Seyed Mohammad Sadegh; Nguyen, Khanh

2017-01-01

Assistive technologies, such as robots, have proven to be useful in a social context and to improve the quality of life for people with dementia (PwD). This study aims to show how the engagement between two social robots and PwD in Australian residential care facilities can improve care quality. An observational method is adopted in the research methodology to discover behavioural patterns during interactions between the robots and PwD. This observational study has undertaken to explore the improvement arising from: (1) approaching social baby-face robots (AR), (2) experiencing pleasure engaging with the robots (P), (3) interacting with the robots (IR), and (4) interacting with others (IO). The findings show that social robots can improve diversion therapy service value to PwD through sensory enrichment, positive social engagement, and entertainment. More than 11,635 behavioral reactions, such as facial expressions and gestures, from 139 PwD over 5 years were coded, in order to identify the engagement effectiveness between PwD and two social robots named Sophie and Jack. The results suggest that these innovative social robots can improve the quality of care for people suffering from dementia.

The process of managerial control in quality improvement initiatives.

Science.gov (United States)

Slovensky, D J; Fottler, M D

1994-11-01

The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

Assessment and improvement of sound quality in cochlear implant users.

Science.gov (United States)

Caldwell, Meredith T; Jiam, Nicole T; Limb, Charles J

2017-06-01

Cochlear implants (CIs) have successfully provided speech perception to individuals with sensorineural hearing loss. Recent research has focused on more challenging acoustic stimuli such as music and voice emotion. The purpose of this review is to evaluate and describe sound quality in CI users with the purposes of summarizing novel findings and crucial information about how CI users experience complex sounds. Here we review the existing literature on PubMed and Scopus to present what is known about perceptual sound quality in CI users, discuss existing measures of sound quality, explore how sound quality may be effectively studied, and examine potential strategies of improving sound quality in the CI population. Sound quality, defined here as the perceived richness of an auditory stimulus, is an attribute of implant-mediated listening that remains poorly studied. Sound quality is distinct from appraisal, which is generally defined as the subjective likability or pleasantness of a sound. Existing studies suggest that sound quality perception in the CI population is limited by a range of factors, most notably pitch distortion and dynamic range compression. Although there are currently very few objective measures of sound quality, the CI-MUSHRA has been used as a means of evaluating sound quality. There exist a number of promising strategies to improve sound quality perception in the CI population including apical cochlear stimulation, pitch tuning, and noise reduction processing strategies. In the published literature, sound quality perception is severely limited among CI users. Future research should focus on developing systematic, objective, and quantitative sound quality metrics and designing therapies to mitigate poor sound quality perception in CI users. NA.

Strategies to improve quality of childbirth care

Directory of Open Access Journals (Sweden)

farahnaz Changaee

2015-01-01

Full Text Available Background: Access to affordable and quality health care is one of the most important ways for reducing maternal and child mortality. The purpose of this study was to provide strategies to promote the quality of care during childbirth in Lorestan province in 2011. Materials and Methods: This research was a mixed method (quantitative, qualitative, study in which quality of 200 care during childbirth in hospitals of Lorestan Province were evaluated. Data gathered through self-made tools (Checklists prepared according to the guidelines of the ministry of health. Descriptive statistics and SPSS software were used to data analysis.In the second part of the study which was qualitative, interview with service providers, hospital officials and high-ranking officials of Lorestan university of medical sciences (decision makers was used to discuss strategies to improve the quality of care. Results: The results showed that the care of the first stage delivery in %54.5, second stage %57 and third stage 66% were in accordance with the desired status and care in this three stages was of moderate quality. Based on the interviews, the officials who are in charge of Lorestan university of medical sciences, proposed strategies such as financial incentives and in-service training of midwives as suitable strategies to improve quality of services. Conclusion: According to the results, strategies such as financial incentives, increased use of private sector services to reduce the workload of the public sector and increase of quality and use of more in-service training, to improve the quality of services, are recommended.

Asan medical information system for healthcare quality improvement.

Science.gov (United States)

Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

2010-09-01

This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

An Internet-Based Physical Activity Intervention to Improve Quality of Life of Inactive Older Adults

DEFF Research Database (Denmark)

Broekhuizen, Karen; de Gelder, Jelle; Wijsman, Carolien A

2016-01-01

BACKGROUND: Increasing physical activity is a viable strategy for improving both the health and quality of life of older adults. OBJECTIVE: The aim of this study was to assess if an Internet-based intervention aimed to increase physical activity was effective in improving quality of life of inact...

The Relationship between Quality Measurement and Efficiency Improvement in Health Care Systems

OpenAIRE

Gilbert Roland; Dr. Jane Marry Gill

2017-01-01

Quality measurement in health care organisation is most often considered as measures for cost-saving and error reduction in the clinical procedures. The concept of quality measurement in health care organisations is the analysis of effectiveness and accuracy in procedures for patients’ diagnosis and treatment. This study aimed to find the relationship between quality measurement and efficiency improvements in the healthcare sector of Mauritius. This was executed by using mixed methodological ...

Does Medical Malpractice Law Improve Health Care Quality?

Science.gov (United States)

Frakes, Michael; Jena, Anupam B.

2016-01-01

We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability’s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards. PMID:28479642

Effectiveness of UK provider financial incentives on quality of care: a systematic review.

Science.gov (United States)

Mandavia, Rishi; Mehta, Nishchay; Schilder, Anne; Mossialos, Elias

2017-11-01

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK. © British Journal of General Practice 2017.

Quality improvement teaching at medical school: a student perspective

Directory of Open Access Journals (Sweden)

Nair P

2016-03-01

Full Text Available Pooja Nair, Ishani Barai, Sunila Prasad, Karishma Gadhvi Department of Medicine, Imperial College School of Medicine, Imperial College London, London, UK Abstract: Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school. Keywords: quality improvement, medical school, patient safety, patient satisfaction, medical student, clinical audit

Quality Improvement Processes in Obesity Surgery Lead to Higher Quality and Value, Lower Costs.

Science.gov (United States)

Brousseau, Holli; Pohl, Dieter

2017-03-01

In the era of changes in the evaluation of medical services and performance, the Centers for Medicare and Medicaid Services (CMS) has determined that the key components are quality, value, and clinical practice improvement (MACRA). Weight Loss Surgery, also called Bariatric or Obesity Surgery, has been at the forefront of quality improvement and quality reporting through the Center of Excellence Program since 2005. As a result, weight loss surgery is now as safe as gallbladder surgery.1 Even within this culture of quality and safety, improvements are still possible, as described in this article. [Full article available at http://rimed.org/rimedicaljournal-2017-03.asp].

Approaching the Practice Quality Improvement Project in Interventional Radiology.

Science.gov (United States)

Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M

2015-12-01

An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

A Novel Mesh Quality Improvement Method for Boundary Elements

Directory of Open Access Journals (Sweden)

Hou-lin Liu

2012-01-01

Full Text Available In order to improve the boundary mesh quality while maintaining the essential characteristics of discrete surfaces, a new approach combining optimization-based smoothing and topology optimization is developed. The smoothing objective function is modified, in which two functions denoting boundary and interior quality, respectively, and a weight coefficient controlling boundary quality are taken into account. In addition, the existing smoothing algorithm can improve the mesh quality only by repositioning vertices of the interior mesh. Without destroying boundary conformity, bad elements with all their vertices on the boundary cannot be eliminated. Then, topology optimization is employed, and those elements are converted into other types of elements whose quality can be improved by smoothing. The practical application shows that the worst elements can be eliminated and, with the increase of weight coefficient, the average quality of boundary mesh can also be improved. Results obtained with the combined approach are compared with some common approach. It is clearly shown that it performs better than the existing approach.

Systematic Quality Improvement in Medicine: Everyone Can Do It

Directory of Open Access Journals (Sweden)

Mark L. Zeidel

2011-07-01

Full Text Available In this brief review, written from the perspective of a physician-leader who has fostered the development of comprehensive quality improvement efforts at two academic medical centers, I review the need for improvement, some conceptual barriers that must be overcome, the goals of a comprehensive quality improvement (QI effort, some of the results we have obtained, and some observations on how to develop a culture of continuous improvement in an academic medical center. The mandate for quality improvement is clear; current healthcare is wasteful and error-prone, leading to excessive morbidity and mortality and unsustainably high costs. Successful quality improvement requires the abandonment of two paradigms: the craft model of medical practice and the notion that many forms of harm to patients are not preventable. I will describe how dramatic improvement has been achieved in reducing, by up to 10-fold, rates of central line infections, ventilator-associated pneumonias, peritonitis in peritoneal dialysis patients, and mortality due to cardiac arrest in hospital. I will describe as well how these methods can improve access to out-patient clinics dramatically and enhance the reliability and safety of hand-offs between covering physicians. To develop and maintain systematic quality improvement in all phases of medical care we must articulate a culture in which: everyone working at the medical center makes improvements every day; front-line staff, who know best how the work is done, are empowered to improve the processes of care; and multidisciplinary teams create the protocols that reduce variation that is due to physician preference, leaving only the variation required by the individual needs of patients. I will review as well the crucial elements of education of trainees and faculty members needed to guide and sustain a culture of quality. Finally, I will add some observations on how oversight boards and medical center leaders can help create

Systematic quality improvement in medicine: everyone can do it.

Science.gov (United States)

Zeidel, Mark L

2011-07-01

In this brief review, written from the perspective of a physician-leader who has fostered the development of comprehensive quality improvement efforts at two academic medical centers, I review the need for improvement, some conceptual barriers that must be overcome, the goals of a comprehensive quality improvement (QI) effort, some of the results we have obtained, and some observations on how to develop a culture of continuous improvement in an academic medical center. The mandate for quality improvement is clear; current healthcare is wasteful and error-prone, leading to excessive morbidity and mortality and unsustainably high costs. Successful quality improvement requires the abandonment of two paradigms: the craft model of medical practice and the notion that many forms of harm to patients are not preventable. I will describe how dramatic improvement has been achieved in reducing, by up to 10-fold, rates of central line infections, ventilator-associated pneumonias, peritonitis in peritoneal dialysis patients, and mortality due to cardiac arrest in hospital. I will describe as well how these methods can improve access to out-patient clinics dramatically and enhance the reliability and safety of hand-offs between covering physicians. To develop and maintain systematic quality improvement in all phases of medical care we must articulate a culture in which: everyone working at the medical center makes improvements every day; front-line staff, who know best how the work is done, are empowered to improve the processes of care; and multidisciplinary teams create the protocols that reduce variation that is due to physician preference, leaving only the variation required by the individual needs of patients. I will review as well the crucial elements of education of trainees and faculty members needed to guide and sustain a culture of quality. Finally, I will add some observations on how oversight boards and medical center leaders can help create systematic quality

Preventing falls in assisted living: Results of a quality improvement pilot study.

Science.gov (United States)

Zimmerman, Sheryl; Greene, Angela; Sloane, Philip D; Mitchell, Madeline; Giuliani, Carol; Nyrop, Kirsten; Walsh, Edith

Residents of assisted living (AL) communities are at high risk for falls, which result in negative outcomes and high health care costs. Adapting effective falls prevention programs for AL quality improvement (QI) has the potential to reduce falls, improve resident quality of life, and reduce costs. This project tested the feasibility and outcomes of an evidence-based multi-component QI program, the Assisted Living Falls Prevention and Monitoring Program (AL-FPMP). Resident posture and gait improved, likely due to exercise and/or physical therapy. Effective falls prevention QI programs can be implemented in AL, and are advised to (1) establish and maintain a falls team to create a culture focused on the reduction of falls risk; (2) teach staff to assess residents using the Morse Falls Scale to increase their awareness of residents' falls risk and improvement; and (3) modify existing exercise programs to address balance and lower body strength. Copyright © 2016 Elsevier Inc. All rights reserved.

40 CFR 64.8 - Quality improvement plan (QIP) requirements.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement plan (QIP... PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a.... (iii) Appropriate improvements to control methods. (iv) Other steps appropriate to correct control...

Evaluating the state of quality-improvement science through evidence synthesis: insights from the closing the quality gap series.

Science.gov (United States)

McDonald, Kathryn M; Schultz, Ellen M; Chang, Christine

2013-01-01

The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI). We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.

Improving embryo quality in assisted reproduction

NARCIS (Netherlands)

Mantikou, E.

2013-01-01

The goal of this thesis was to improve embryo quality in assisted reproductive technologies by gaining more insight into human preimplantation embryo development and by improving in vitro culture conditions. To do so, we investigated an intriguing feature of the human preimplantation embryo, i.e.

Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders.

Science.gov (United States)

Ramsawh, Holly J; Bomyea, Jessica; Stein, Murray B; Cissell, Shadha H; Lang, Ariel J

2016-01-01

Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.

Voltage Quality Improvement Using Solar Photovoltaic Systems

Directory of Open Access Journals (Sweden)

Denisa Galzina

2015-06-01

This paper briefly shows the methods of power quality improvement, and then the results of on-site power quality measurements in the grid before and after the connection of the solar photovoltaic system.

Crystal quality analysis and improvement using x-ray topography

International Nuclear Information System (INIS)

Maj, J.; Goetze, K.; Macrander, A.; Zhong, Y.; Huang, X.; Maj, L.

2008-01-01

The Topography X-ray Laboratory of the Advanced Photon Source (APS) at Argonne National Laboratory operates as a collaborative effort with APS users to produce high performance crystals for APS X-ray beamline experiments. For many years the topography laboratory has worked closely with an on-site optics shop to help ensure the production of crystals with the highest quality, most stress-free surface finish possible. It has been instrumental in evaluating and refining methods used to produce high quality crystals. Topographical analysis has shown to be an effective method to quantify and determine the distribution of stresses, to help identify methods that would mitigate the stresses and improve the Rocking curve, and to create CCD images of the crystal. This paper describes the topography process and offers methods for reducing crystal stresses in order to substantially improve the crystal optics.

Quality improvement in clinical documentation: does clinical governance work?

Directory of Open Access Journals (Sweden)

Dehghan M

2013-12-01

Full Text Available Mahlegha Dehghan,1 Dorsa Dehghan,2 Akbar Sheikhrabori,3 Masoume Sadeghi,4 Mehrdad Jalalian5 1Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, 2Department of Pediatric Nursing, School of Nursing and Midwifery, Islamic Azad University Kerman Branch, Kerman, 3Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, 4Research Center for Modeling in Health, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 5Electronic Physician Journal, Mashhad, Iran Introduction: The quality of nursing documentation is still a challenge in the nursing profession and, thus, in the health care industry. One major quality improvement program is clinical governance, whose mission is to continuously improve the quality of patient care and overcome service quality problems. The aim of this study was to identify whether clinical governance improves the quality of nursing documentation. Methods: A quasi-experimental method was used to show nursing documentation quality improvement after a 2-year clinical governance implementation. Two hundred twenty random nursing documents were assessed structurally and by content using a valid and reliable researcher made checklist. Results: There were no differences between a nurse's demographic data before and after 2 years (P>0.05 and the nursing documentation score did not improve after a 2-year clinical governance program. Conclusion: Although some efforts were made to improve nursing documentation through clinical governance, these were not sufficient and more attempts are needed. Keywords: nursing documentation, clinical governance, quality improvement, nursing record

Advances in public health accreditation readiness and quality improvement: evaluation findings from the National Public Health Improvement Initiative.

Science.gov (United States)

McLees, Anita W; Thomas, Craig W; Nawaz, Saira; Young, Andrea C; Rider, Nikki; Davis, Mary

2014-01-01

Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). Evaluate the extent to which NPHII awardees have achieved program goals. NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. NPHII performance improvement managers or principal investigators. Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

Quality improvement tools and processes.

Science.gov (United States)

Lau, Catherine Y

2015-04-01

The Model for Improvement and the Plan-Do-Study-Act cycle is a popular quality improvement (QI) tool for health care providers to successfully lead QI projects and redesign care processes. This tool has several distinct components that must be addressed in sequence to organize and critically evaluate improvement activities. Unlike other health sciences clinical research, QI projects and research are based on dynamic hypotheses that develop into observable, serial tests of change with continuous collection and feedback of performance data to stakeholders. Copyright © 2015 Elsevier Inc. All rights reserved.

Improvement of image quality using interpolated projection data estimation method in SPECT

International Nuclear Information System (INIS)

Takaki, Akihiro; Soma, Tsutomu; Murase, Kenya; Kojima, Akihiro; Asao, Kimie; Kamada, Shinya; Matsumoto, Masanori

2009-01-01

General data acquisition for single photon emission computed tomography (SPECT) is performed in 90 or 60 directions, with a coarse pitch of approximately 4-6 deg for a rotation of 360 deg or 180 deg, using a gamma camera. No data between adjacent projections will be sampled under these circumstances. The aim of the study was to develop a method to improve SPECT image quality by generating lacking projection data through interpolation of data obtained with a coarse pitch such as 6 deg. The projection data set at each individual degree in 360 directions was generated by a weighted average interpolation method from the projection data acquired with a coarse sampling angle (interpolated projection data estimation processing method, IPDE method). The IPDE method was applied to the numerical digital phantom data, actual phantom data and clinical brain data with Tc-99m ethyle cysteinate dimer (ECD). All SPECT images were reconstructed by the filtered back-projection method and compared with the original SPECT images. The results confirmed that streak artifacts decreased by apparently increasing a sampling number in SPECT after interpolation and also improved signal-to-noise (S/N) ratio of the root mean square uncertainty value. Furthermore, the normalized mean square error values, compared with standard images, had similar ones after interpolation. Moreover, the contrast and concentration ratios increased their effects after interpolation. These results indicate that effective improvement of image quality can be expected with interpolation. Thus, image quality and the ability to depict images can be improved while maintaining the present acquisition time and image quality. In addition, this can be achieved more effectively than at present even if the acquisition time is reduced. (author)

What makes British general practitioners take part in a quality improvement scheme?

Science.gov (United States)

Spooner, A; Chapple, A; Roland, M

2001-07-01

To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.

Transferring skills in quality collaboratives focused on improving patient logistics

NARCIS (Netherlands)

J.W.M. Weggelaar-Jansen (Anne Marie); J.D.H. van Wijngaarden (Jeroen)

2018-01-01

textabstractA quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to

Project Hanford management contract quality improvement project management plan; TOPICAL

International Nuclear Information System (INIS)

ADAMS, D.E.

1999-01-01

On July 13, 1998, the U.S. Department of Energy, Richland Operations Office (DOE-RL) Manager transmitted a letter to Fluor Daniel Hanford, Inc. (FDH) describing several DOE-RL identified failed opportunities for FDH to improve the Quality Assurance (QA) Program and its implementation. In addition, DOE-RL identified specific Quality Program performance deficiencies. FDH was requested to establish a periodic reporting mechanism for the corrective action program. In a July 17, 1998 response to DOE-RL, FDH agreed with the DOE concerns and committed to perform a comprehensive review of the Project Hanford Management Contract (PHMC) QA Program during July and August, 1998. As a result, the Project Hanford Management Contract Quality Improvement Plan (QIP) (FDH-3508) was issued on October 21, 1998. The plan identified corrective actions based upon the results of an in-depth Quality Program Assessment. Immediately following the scheduled October 22, 1998, DOE Office of Enforcement and Investigation (EH-10) Enforcement Conference, FDH initiated efforts to effectively implement the QIP corrective actions. A Quality Improvement Project (QI Project) leadership team was assembled to prepare a Project Management Plan for this project. The management plan was specifically designed to engage a core team and the support of representatives from FDH and the major subcontractors (MSCs) to implement the QIP initiatives; identify, correct, and provide feedback as to the root cause for deficiency; and close out the corrective actions. The QI Project will manage and communicate progress of the process

Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

Science.gov (United States)

Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

2011-04-01

Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

Effect of joint traction on functional improvement and quality of life in patients with severe knee osteoarthritis

OpenAIRE

Sedigheh Sadat Naeimee; Abbas Rahimi; Mehdi Rezaee; Alireza Akbarzadeh Baghban; Khosro Khademi Kalantari; ُSomayeh Mahmoudi Aghdam

2012-01-01

Background and aim: Osteoarthritis (OA) is the most prevalent joint disease in adults around the world and its incidence rises with age. Patients with severe knee osteoarthritis often complain of pain and severe functional disability. Most of conservative treatments used in this group of patients induce poor improvements. This study evaluated the effect of joint traction on quality of life of patients with severe knee osteoarthritis.Materials and Methods: In this clinical trial study, forty f...

Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques.

Science.gov (United States)

Bayani, Azadeh; Langarizadeh, Mostafa; Radmard, Amir Reza; Nejad, Ahmadreza Farzaneh

2016-12-01

Liver ultrasound images are so common and are applied so often to diagnose diffuse liver diseases like fatty liver. However, the low quality of such images makes it difficult to analyze them and diagnose diseases. The purpose of this study, therefore, is to improve the contrast and quality of liver ultrasound images. In this study, a number of image contrast enhancement algorithms which are based on fuzzy logic were applied to liver ultrasound images - in which the view of kidney is observable - using Matlab2013b to improve the image contrast and quality which has a fuzzy definition; just like image contrast improvement algorithms using a fuzzy intensification operator, contrast improvement algorithms applying fuzzy image histogram hyperbolization, and contrast improvement algorithms by fuzzy IF-THEN rules. With the measurement of Mean Squared Error and Peak Signal to Noise Ratio obtained from different images, fuzzy methods provided better results, and their implementation - compared with histogram equalization method - led both to the improvement of contrast and visual quality of images and to the improvement of liver segmentation algorithms results in images. Comparison of the four algorithms revealed the power of fuzzy logic in improving image contrast compared with traditional image processing algorithms. Moreover, contrast improvement algorithm based on a fuzzy intensification operator was selected as the strongest algorithm considering the measured indicators. This method can also be used in future studies on other ultrasound images for quality improvement and other image processing and analysis applications.

The effectiveness of wellness coaching for improving quality of life.

Science.gov (United States)

Clark, Matthew M; Bradley, Karleah L; Jenkins, Sarah M; Mettler, Emily A; Larson, Brent G; Preston, Heather R; Liesinger, Juliette T; Werneburg, Brooke L; Hagen, Philip T; Harris, Ann M; Riley, Beth A; Olsen, Kerry D; Vickers Douglas, Kristin S

2014-11-01

To learn more about the potential psychosocial benefits of wellness coaching. Although wellness coaching is increasing in popularity, there are few published outcome studies. In a single-cohort study design, 100 employees who completed the 12-week wellness coaching program were of a mean age of 42 years, 90% were women, and most were overweight or obese. Three areas of psychosocial functioning were assessed: quality of life (QOL; 5 domains and overall), depressive symptoms (Patient Health Questionnaire-9), and perceived stress level (Perceived Stress Scale-10). Participants were recruited from January 1, 2011, through December 31, 2011; data were collected up to July 31, 2012, and were analyzed from August 1, 2012, through October 31, 2013. These 100 wellness coaching completers exhibited significant improvements in all 5 domains of QOL and overall QOL (Pcoaching, and they maintained these improvements at the 24-week follow-up. In this single-arm cohort study (level 2b evidence), participating in wellness coaching was associated with improvement in 3 key areas of psychosocial functioning: QOL, mood, and perceived stress level. The results from this single prospective cohort study suggest that these areas of functioning improve after participating in wellness coaching; however, randomized clinical trials involving large samples of diverse individuals are needed to establish level 1 evidence for wellness coaching. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

How to Measure and Interpret Quality Improvement Data.

Science.gov (United States)

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

2016-05-06

This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting. Copyright © 2016 by the American Society of Nephrology.

Benchmarking as an Instrument for Improvement of Quality Management in Higher Education

Directory of Open Access Journals (Sweden)

Narimantas Kazimieras Paliulis

2015-06-01

Full Text Available Conditioned by globalisation and constant change, higher education institutions (HEIs are forced to pursue new instruments for quality assurance in higher education. States seem to pursue this aim by attempting to create an efficiently operating system of higher education that satisfies needs of diverse societal groups. Quality dimension is the most important element of efficient and effective higher education. From the perspective of a state, assessment and monitoring of quality are instruments for the management of processes of higher education. The article substantiates these statements using the evolution of the dimension of quality in the European and Lithuanian higher education in the course of the Bologna Process. The article also presents a benchmarking method and discusses its development and application tendencies in business organisations. Also, it looks at possibilities to apply this method in higher education. The main aim of this article is to explore benchmarking as an effective instrument for the improvement of performance quality in HEIs and complement the already implemented quality management systems. Another aim is to suggest this method to national agencies for quality assurance in higher education for monitoring and analysis of qualitative changes on the systematic level. The object of the article is the improvement of performance quality in HEIs. Benchmarking is proposed for the use in higher education on the institutional level as an instrument that complements presently introduced quality management systems in Lithuanian HEIs. This way, it will contribute to the formation of the culture of quality in higher education.

Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review.

Science.gov (United States)

Smaggus, Andrew; Mrkobrada, Marko; Marson, Alanna; Appleton, Andrew

2018-01-01

The quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals. Relevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically. The final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research. These results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds. © Article author(s) (or their

Improvement in the quality of the catering service of a rehabilitation hospital.

Science.gov (United States)

Donini, L M; Castellaneta, E; De Guglielmi, S; De Felice, M R; Savina, C; Coletti, C; Paolini, M; Cannella, C

2008-02-01

Malnutrition due to undernutrition or overnutrition is highly prevalent in hospital in-patients and it decisively conditions patients clinical outcome. One of the most influencing factors of malnutrition in hospitalized patients is--at least in part--the Catering Service Quality. Is to verify, over a 5 year period, the course of the quality of the institutional Catering Service, verifying the effectiveness of the quality improvement process used. Quality control was performed by objective (meal order accuracy, proper distribution of food in trolleys, route time from the kitchen to the ward and time of food distribution, food weight and temperature, waste assessment) and subjective assessment (quality was measured by giving the patients a questionnaire after meals). The survey included: 572 meals and 591 interviews. A significant amount of "qualitative" errors (lack of respect for patient preferences or at the moment of supplying the food trolley) have been found. Over the time and the amount of patients that wasted a considerable amount of the portion served was considerably reduced food temperature have been improved. Also patient satisfaction with menu variability, portion size, temperature and cooking quality improved over time. The overall ratings of meals under observation improved too in fact, positive opinions ranged from 18% in 2002 to 48.3% in 2006. Ongoing research and quality verification, which include all catering service workers, yields a constant improvement in quality. Patients in healthcare settings should receive a service they appreciates, but it should be--at the same time--correct from a nutritional point of view. For this reason, it is necessary a continuous mediation between customers satisfaction and nutritionists work, dieticians and nursing staff. From this point of view the educational approach becomes essential to feed patient compliance to dietetic treatment that will continue after discharge.

Internal Resources to Improve the Quality of Higher Education

Directory of Open Access Journals (Sweden)

Tatyana V. Zak

2016-03-01

Full Text Available The article deals with the situation in the Russian higher education system. The factors affecting the improvement of the quality of higher education are analyzed. The emphasis is on mass universities. The main obstacles to improving the quality of education in these institutions are the Institute of collective reputation and the high costs of the struggle for improving the quality of education.The necessity of focusing on the actuation of the internal resources to improve the quality associated with the change in the educational process: giving students the right to choose the timing exams and training period at university. The implementation of the proposed measures will reduce the opportunity costs associated with quality improvement activities. The proposed change in the organization of the learning process opens the possibility to estimate the activity of universities in terms of medium-term implementation of educational programs. The use of this indicator will not only combine the two different targets of universities, but also to minimize the costs of opportunistic behavior of teachers and management.

Is the implementation of quality improvement methods in hospitals subject to the neighbourhood effect?

Science.gov (United States)

Yu, Tsung-Hsien; Chung, Kuo-Piao

2014-06-01

Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. This is a retrospective questionnaire-based survey. All medical centres, regional hospitals and district teaching hospitals in Taiwan. Directors or persons in charge of implementing QI methods in hospitals. None. The breadth and depth of QI method implementation. Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending.

Science.gov (United States)

Song, Zirui; Rose, Sherri; Chernew, Michael E; Safran, Dana Gelb

2017-01-01

As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations. Project HOPE—The People-to-People Health Foundation, Inc.

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.

Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 2: methodological quality and effects.

Science.gov (United States)

Johansen, Monika Alise; Berntsen, Gro K Rosvold; Schuster, Tibor; Henriksen, Eva; Horsch, Alexander

2012-10-03

We conducted in two parts a systematic review of randomized controlled trials (RCTs) on electronic symptom reporting between patients and providers to improve health care service quality. Part 1 reviewed the typology of patient groups, health service innovations, and research targets. Four innovation categories were identified: consultation support, monitoring with clinician support, self-management with clinician support, and therapy. To assess the methodological quality of the RCTs, and summarize effects and benefits from the methodologically best studies. We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles between 1990 and November 2011. Risk of bias and feasibility were judged according to the Cochrane recommendation, and theoretical evidence and preclinical testing were evaluated according to the Framework for Design and Evaluation of Complex Interventions to Improve Health. Three authors assessed the risk of bias and two authors extracted the effect data independently. Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions. Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of participants and personnel. We excluded 12

42 CFR 422.153 - Use of quality improvement organization review information.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Use of quality improvement organization review... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.153 Use of quality improvement organization review information. CMS will acquire from quality...

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

Science.gov (United States)

Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

San Francisco Bay Water Quality Improvement Fund

Science.gov (United States)

EPAs grant program to protect and restore San Francisco Bay. The San Francisco Bay Water Quality Improvement Fund (SFBWQIF) has invested in 58 projects along with 70 partners contributing to restore wetlands, water quality, and reduce polluted runoff.,

Public health dental hygiene: an option for improved quality of care and quality of life.

Science.gov (United States)

Olmsted, Jodi L; Rublee, Nancy; Zurkawski, Emily; Kleber, Laura

2013-10-01

The purpose of this research was to document quality of life (QoL) and quality of care (QoC) measures for families receiving care from dental hygienists within public health departments, and to consider if oral health for families with economic disparities and cultural differences was improved. A descriptive research study using a retrospective record review was conducted considering QoC. A review of state epid "Do preventive oral health programs based in local health departments provide quality care services, thus impacting QoL for underserved populations?" A dental hygienist working in public health made significant contributions to improving access to care and QoL in a rural, socioeconomically disadvantaged community. A total of 2,364 children received education, 1,745 received oral screenings and 1,511 received dental sealants. Of these, 804 children with caries were referred, with 463 receiving restorations and follow-up care. QoL metrics basis assessed Health Outcomes & Health Determinants. Initial QoL data was ranked in the bottom half of the state, while 70% of original determinant data was also ranked in the bottom half of reported metrics. Dental hygienists in public health settings can positively affect patients offering preventive care outreach services. Education and sealant placement were considered effective as measured by access, delivery and, when required, referral for restorative care. Improvement in QoL for individuals was noted through improved health outcomes and determinant metrics.

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.

Monitoring outcomes with relational databases: does it improve quality of care?

Science.gov (United States)

Clemmer, Terry P

2004-12-01

There are 3 key ingredients in improving quality of medial care: 1) using a scientific process of improvement, 2) executing the process at the lowest possible level in the organization, and 3) measuring the results of any change reliably. Relational databases when used within these guidelines are of great value in these efforts if they contain reliable information that is pertinent to the project and used in a scientific process of quality improvement by a front line team. Unfortunately, the data are frequently unreliable and/or not pertinent to the local process and is used by persons at very high levels in the organization without a scientific process and without reliable measurement of the outcome. Under these circumstances the effectiveness of relational databases in improving care is marginal at best, frequently wasteful and has the potential to be harmful. This article explores examples of these concepts.

Infrastructure for large-scale quality-improvement projects: early lessons from North Carolina Improving Performance in Practice.

Science.gov (United States)

Newton, Warren P; Lefebvre, Ann; Donahue, Katrina E; Bacon, Thomas; Dobson, Allen

2010-01-01

Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3) quality-improvement consultants (QICs), or practice facilitators; (4) learning networks; and (5) alignment of incentives. We emphasized a community-based strategy and developing a statewide infrastructure. Results are reported from the first 2 years of the North Carolina Improving Performance in Practice (IPIP) project. A coalition was formed to include professional societies, North Carolina AHEC, Community Care of North Carolina, insurers, and other organizations. Wave One started with 18 practices in 2 of 9 regions of the state. Quality-improvement consultants recruited practices. Over 80 percent of practices attended all quarterly regional meetings. In 9 months, almost all diabetes measures improved, and a bundled asthma measure improved from 33 to 58 percent. Overall, the magnitude of improvement was clinically and statistically significant (P = .001). Quality improvements were maintained on review 1 year later. Wave Two has spread to 103 practices in all 9 regions of the state, with 42 additional practices beginning the enrollment process. Large-scale health care quality improvement is feasible, when broadly supported by statewide leadership and community infrastructure. Practice-collected data and lack of a control group are limitations of the study design. Future priorities include maintaining improved sustainability for practices and communities. Our long-term goal is to transform all 2000 primary-care practices in our state.

Quality improvement process pilot project at Gallagher station

International Nuclear Information System (INIS)

Vondielingen, D.E.

1992-01-01

A Quality Improvement Process was piloted at Gallagher station in 1990 to address issues of two Electric System Strategy Group (ESSG) goals. Darrell McElravy headed a group to address quality, productivity and prove and Judy Rushing headed a group to address innovation and recognition. These groups combined when a process was identified that could address both issues. The process was designed for PSI Energy by Business Incentives and is an incentive-based quality improvement process that seeks employee involvement to identify inhibitors t performance and to establish a method to eliminate the problem. Performance goals were also established that help focus efforts to improve performance and reward employees for their efforts

[Prospective DRG coding : Improvement in cost-effectiveness and documentation quality of in-patient hospital care].

Science.gov (United States)

Geuss, S; Jungmeister, A; Baumgart, A; Seelos, R; Ockert, S

2018-02-01

In prospective reimbursement schemes a diagnosis-related group (DRG) is assigned to each case according to all coded diagnoses and procedures. This process can be conducted retrospectively after (DC) or prospectively during the hospitalization (PC). The use of PC offers advantages in terms of cost-effectiveness and documentation quality without impairing patient safety. A retrospective analysis including all DRG records and billing data from 2012 to 2015 of a surgical department was carried out. The use of PC was introduced into the vascular surgery unit (VS) in September 2013, while the remaining surgical units (RS) stayed with DC. Analysis focused on differences between VS and RS before and after introduction of PC. Characteristics of cost-effectiveness were earnings (EBIT-DA), length of stay (LOS), the case mix index (CMI) and the productivity in relation to the DRG benchmark (productivity index, PI). The number of recorded diagnoses/procedures (ND/NP) was an indicator for documentation quality. A total of 1703 cases with VS and 27,679 cases with RS were analyzed. After introduction of PC the EBIT-DA per case increased in VS but not in RS (+3342 Swiss francs vs. +84, respectively, p  0.05) and the LOS was more reduced in VS than in RS (-0.36 days vs. -0.03 days, p > 0.005). The PI increased in VS but decreased in RS (+0.131 vs. -0.032, p DRG benchmark, i. e. increasing the PI. The increasing ND indicates an improvement in documentation quality.

Air quality environmental assessment of the Horseshoe Bay Terminal Improvement Project

Energy Technology Data Exchange (ETDEWEB)

NONE

2001-09-01

The proposed improvement project for British Columbia's Horseshoe Bay Ferry Terminal incorporates specific measures to protect the air quality of the area, the environment and public health. The ferry terminal handles over 2.5 million vehicles and 7 million passengers per year. The upgrades are intended to improve terminal operations, increase safety and reduce traffic congestion through residential and commercial portions of the Horseshoe Bay area as well as Highway 99 traffic. The toll booths will be relocated about 25 m further away from the nearby elementary school to further protect air quality at the school. A study was conducted in which vehicular emissions from the operation of the ferry terminal prior to the proposed improvement project were modelled to predict the effect of vehicular emissions on ambient air quality levels in the area and to ensure that maximum acceptable objectives are met for gaseous air pollutants, including carbon monoxide, carbon dioxide, nitrous oxides, as well as inhalable and fine particulates. The British Columbia Ferry Corp. will work jointly with the Greater Vancouver Regional District to install continuous monitors for at least one year after the project is completed. Based on the analysis of the report, the air quality in the Horseshoe Bay area would not suffer major adverse environmental or public health affects from the proposed improvement project.

Working alliance, real relationship, session quality, and client improvement in psychodynamic psychotherapy: A longitudinal actor partner interdependence model.

Science.gov (United States)

Kivlighan, Dennis M; Hill, Clara E; Gelso, Charles J; Baumann, Ellen

2016-03-01

We used the Actor Partner Interdependence Model (APIM; Kashy & Kenny, 2000) to examine the dyadic associations of 74 clients and 23 therapists in their evaluations of working alliance, real relationship, session quality, and client improvement over time in ongoing psychodynamic or interpersonal psychotherapy. There were significant actor effects for both therapists and clients, with the participant's own ratings of working alliance and real relationship independently predicting their own evaluations of session quality. There were significant client partner effects, with clients' working alliance and real relationship independently predicting their therapists' evaluations of session quality. The client partner real relationship effect was stronger in later sessions than in earlier sessions. Therapists' real relationship ratings (partner effect) were a stronger predictor of clients' session quality ratings in later sessions than in earlier sessions. Therapists' working alliance ratings (partner effect) were a stronger predictor of clients' session quality ratings when clients made greater improvement than when clients made lesser improvement. For clients' session outcome ratings, there were complex three-way interactions, such that both Client real relationship and working alliance interacted with client improvement and time in treatment to predict clients' session quality. These findings strongly suggest both individual and partner effects when clients and therapists evaluate psychotherapy process and outcome. Implications for research and practice are discussed. (c) 2016 APA, all rights reserved).

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

Science.gov (United States)

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas

2017-07-01

validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost.

Effectiveness of green infrastructure for improvement of air quality in urban street canyons.

Science.gov (United States)

Pugh, Thomas A M; Mackenzie, A Robert; Whyatt, J Duncan; Hewitt, C Nicholas

2012-07-17

Street-level concentrations of nitrogen dioxide (NO(2)) and particulate matter (PM) exceed public health standards in many cities, causing increased mortality and morbidity. Concentrations can be reduced by controlling emissions, increasing dispersion, or increasing deposition rates, but little attention has been paid to the latter as a pollution control method. Both NO(2) and PM are deposited onto surfaces at rates that vary according to the nature of the surface; deposition rates to vegetation are much higher than those to hard, built surfaces. Previously, city-scale studies have suggested that deposition to vegetation can make a very modest improvement (street canyons. This study shows that increasing deposition by the planting of vegetation in street canyons can reduce street-level concentrations in those canyons by as much as 40% for NO(2) and 60% for PM. Substantial street-level air quality improvements can be gained through action at the scale of a single street canyon or across city-sized areas of canyons. Moreover, vegetation will continue to offer benefits in the reduction of pollution even if the traffic source is removed from city centers. Thus, judicious use of vegetation can create an efficient urban pollutant filter, yielding rapid and sustained improvements in street-level air quality in dense urban areas.

Do Energy Efficiency Standards Improve Quality? Evidence from a Revealed Preference Approach

Energy Technology Data Exchange (ETDEWEB)

Houde, Sebastien [Univ. of Maryland, College Park, MD (United States); Spurlock, C. Anna [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2015-06-01

Minimum energy efficiency standards have occupied a central role in U.S. energy policy for more than three decades, but little is known about their welfare effects. In this paper, we employ a revealed preference approach to quantify the impact of past revisions in energy efficiency standards on product quality. The micro-foundation of our approach is a discrete choice model that allows us to compute a price-adjusted index of vertical quality. Focusing on the appliance market, we show that several standard revisions during the period 2001-2011 have led to an increase in quality. We also show that these standards have had a modest effect on prices, and in some cases they even led to decreases in prices. For revision events where overall quality increases and prices decrease, the consumer welfare effect of tightening the standards is unambiguously positive. Finally, we show that after controlling for the effect of improvement in energy efficiency, standards have induced an expansion of quality in the non-energy dimension. We discuss how imperfect competition can rationalize these results.

Coaching and Quality Assistance in Quality Rating Improvement Systems: Approaches Used by TA Providers to Improve Quality in Early Care and Education Programs and Home-Based Settings

Science.gov (United States)

Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine

2012-01-01

Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…

The low cost of quality improvements in the electricity distribution sector of Brazil

International Nuclear Information System (INIS)

Corton, Maria Luisa; Zimmermann, Aneliese; Phillips, Michelle Andrea

2016-01-01

We analyze the impact of introducing output-based incentives in the price-cap regulatory regime of the Brazilian electricity distribution sector. We focus on the trade-off between operating costs and quality improvement, hypothesizing a positive relationship. Operating costs include maintenance and repair expenses. The regulator sets limits for service continuity and non-technical energy losses in each regulatory period. Service continuity refers to the average length of interruptions in electricity distribution. Non-technical losses refer to losses due to factors specific to the distribution segment. Quality incentives include peer-pressure and penalties/rewards for compliance with minimum quality standards. We model operating costs using a GMM framework to acknowledge endogeneity of variables. The model is dynamic given the inclusion of regulatory lags to recognize past cost behavior. Findings reveal a small trade-off between costs and quality. We conclude that quality improvements are not costly relative to the potential savings from complying with quality standards. We also find that the impact on operating costs is larger when energy losses increase compared to the cost effect due to increases in duration of outages. These findings suggest areas of attention in managerial decision making, and serve as valuable information to the regulator in tailoring quality incentives for this sector. - Highlights: • The article focuses on the impact of quality improvements on operating costs. • We find a very small tradeoff between quality improvements and operating costs. • We find the impact of a large share of electricity losses on costs larger compared to the impact of longer outages. • The results serve the regulator to adjust incentives for quality improvement. • The results serve the regulator in tailoring regulatory values for electricity losses and outages.

Effects of the EQUIP quasi-experimental study testing a collaborative quality improvement approach for maternal and newborn health care in Tanzania and Uganda.

Science.gov (United States)

Waiswa, P; Manzi, F; Mbaruku, G; Rowe, A K; Marx, M; Tomson, G; Marchant, T; Willey, B A; Schellenberg, J; Peterson, S; Hanson, C

2017-07-18

Quality improvement is a recommended strategy to improve implementation levels for evidence-based essential interventions, but experience of and evidence for its effects in low-resource settings are limited. We hypothesised that a systemic and collaborative quality improvement approach covering district, facility and community levels, supported by report cards generated through continuous household and health facility surveys, could improve the implementation levels and have a measurable population-level impact on coverage and quality of essential services. Collaborative quality improvement teams tested self-identified strategies (change ideas) to support the implementation of essential maternal and newborn interventions recommended by the World Health Organization. In Tanzania and Uganda, we used a plausibility design to compare the changes over time in one intervention district with those in a comparison district in each country. Evaluation included indicators of process, coverage and implementation practice analysed with a difference-of-differences and a time-series approach, using data from independent continuous household and health facility surveys from 2011 to 2014. Primary outcomes for both countries were birth in health facilities, breastfeeding within 1 h after birth, oxytocin administration after birth and knowledge of danger signs for mothers and babies. Interpretation of the results considered contextual factors. The intervention was associated with improvements on one of four primary outcomes. We observed a 26-percentage-point increase (95% CI 25-28%) in the proportion of live births where mothers received uterotonics within 1 min after birth in the intervention compared to the comparison district in Tanzania and an 8-percentage-point increase (95% CI 6-9%) in Uganda. The other primary indicators showed no evidence of improvement. In Tanzania, we saw positive changes for two other outcomes reflecting locally identified improvement topics. The

Using complaints to enhance quality improvement: developing an analytical tool.

Science.gov (United States)

Hsieh, Sophie Yahui

2012-01-01

This study aims to construct an instrument for identifying certain attributes or capabilities that might enable healthcare staff to use complaints to improve service quality. PubMed and ProQuest were searched, which in turn expanded access to other literature. Three paramount dimensions emerged for healthcare quality management systems: managerial, operational, and technical (MOT). The paper reveals that the managerial dimension relates to quality improvement program infrastructure. It contains strategy, structure, leadership, people and culture. The operational dimension relates to implementation processes: organizational changes and barriers when using complaints to enhance quality. The technical dimension emphasizes the skills, techniques or information systems required to achieve successfully continuous quality improvement. The MOT model was developed by drawing from the relevant literature. However, individuals have different training, interests and experiences and, therefore, there will be variance between researchers when generating the MOT model. The MOT components can be the guidelines for examining whether patient complaints are used to improve service quality. However, the model needs testing and validating by conducting further research before becoming a theory. Empirical studies on patient complaints did not identify any analytical tool that could be used to explore how complaints can drive quality improvement. This study developed an instrument for identifying certain attributes or capabilities that might enable healthcare professionals to use complaints and improve service quality.

Improving Quality of Seal Leak Test Product using Six Sigma

Science.gov (United States)

Luthfi Malik, Abdullah; Akbar, Muhammad; Irianto, Dradjad

2016-02-01

Seal leak test part is a polyurethane material-based product. Based on past data, defect level of this product was 8%, higher than the target of 5%. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control. In the design phase, a Delphi method was used to identify factors that were critical to quality. In the measure phase, stability and process capability was measured. Fault tree analysis (FTA) and failure mode and effect analysis (FMEA) were used in the next phase to analize the root cause and to determine the priority issues. Improve phase was done by compiling, selecting, and designing alternative repair. Some improvement efforts were identified, i.e. (i) making a checklist for maintenance schedules, (ii) making written reminder form, (iii) modifying the SOP more detail, and (iv) performing a major service to the vacuum machine. To ensure the continuity of improvement efforts, some control activities were executed, i.e. (i) controlling, monitoring, documenting, and setting target frequently, (ii) implementing reward and punishment system, (iii) adding cleaning tool, and (iv) building six sigma organizational structure.

Improving Quality of Seal Leak Test Product using Six Sigma

International Nuclear Information System (INIS)

Malik, Abdullah Luthfi; Akbar, Muhammad; Irianto, Dradjad

2016-01-01

Seal leak test part is a polyurethane material-based product. Based on past data, defect level of this product was 8%, higher than the target of 5%. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control. In the design phase, a Delphi method was used to identify factors that were critical to quality. In the measure phase, stability and process capability was measured. Fault tree analysis (FTA) and failure mode and effect analysis (FMEA) were used in the next phase to analize the root cause and to determine the priority issues. Improve phase was done by compiling, selecting, and designing alternative repair. Some improvement efforts were identified, i.e. (i) making a checklist for maintenance schedules, (ii) making written reminder form, (iii) modifying the SOP more detail, and (iv) performing a major service to the vacuum machine. To ensure the continuity of improvement efforts, some control activities were executed, i.e. (i) controlling, monitoring, documenting, and setting target frequently, (ii) implementing reward and punishment system, (iii) adding cleaning tool, and (iv) building six sigma organizational structure. (paper)

Designing a Clinical Data Warehouse Architecture to Support Quality Improvement Initiatives.