WorldWideScience

Sample records for health system performance

  1. A Critique of Health System Performance Measurement.

    Science.gov (United States)

    Lynch, Thomas

    2015-01-01

    Health system performance measurement is a ubiquitous phenomenon. Many authors have identified multiple methodological and substantive problems with performance measurement practices. Despite the validity of these criticisms and their cross-national character, the practice of health system performance measurement persists. Theodore Marmor suggests that performance measurement invokes an "incantatory response" wrapped within "linguistic muddle." In this article, I expand upon Marmor's insights using Pierre Bourdieu's theoretical framework to suggest that, far from an aberration, the "linguistic muddle" identified by Marmor is an indicator of a broad struggle about the representation and classification of public health services as a public good. I present a case study of performance measurement from Alberta, Canada, examining how this representational struggle occurs and what the stakes are. © The Author(s) 2015.

  2. Purchasing to improve health systems performance

    National Research Council Canada - National Science Library

    Robinson, Ray; Jakubowski, Elke; Figueras, Josep

    2005-01-01

    ... as they formulate purchasing strategies so that they can increase effectiveness and improve performance in their own national context An assessment of the intersecting roles of citizens, the government and the providers * * * Written by leading health policy analysts, this book is essential reading for health policy makers, planners and managers as well as resear...

  3. Revisiting Health System Performance Assessment in Africa

    NARCIS (Netherlands)

    Achoki, Tom

    2016-01-01

    Health systems in Africa have long faced a huge burden of disease, amidst pressing resource constraints. However, despite the constraints, the last three decades have seen the region make progress in tackling some of the most critical health challenges. Notably, many countries have registered

  4. Health Care Performance Indicators for Health Information Systems.

    Science.gov (United States)

    Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

    2016-01-01

    Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators.

  5. The Role of Education in Health System Performance

    Science.gov (United States)

    Grignon, Michel

    2008-01-01

    I investigate the role of education on health, using country-level data and the production frontier framework suggested by the World Health Organization (WHO) to assess performances of health care systems. I find that the impact of human capital on health is much smaller than suggested by the WHO frontier model, and the relationship exhibits…

  6. Efficiency performance of China's health care delivery system.

    Science.gov (United States)

    Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

    2017-07-01

    Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

  7. Performance analysis of online health care system | Kohli ...

    African Journals Online (AJOL)

    This paper deals with selection of appropriate indexing techniques applied on MySQL database for a health care system and its related performance issues. The proposed Smart Card based Online Health Care System deals with frequent data storage, exchange and retrieval of data from the database servers. Speed and ...

  8. Equipment performance monitoring in NPP Krsko (Summarized system health report)

    International Nuclear Information System (INIS)

    Djetelic, N.; Cicvaric, D.

    2004-01-01

    Management common goal is safe, reliable, effective, acceptable to public and conservative/cautious operation of NPP Krsko. A set of programs, including Corrective Action Program, Performance Indicators, Operating Experience, Self Assessment and System Health Report, is developed to assist NPP Krsko management in fulfilling those goals. System Health Report is a tool that management can use to quickly assess how selected systems are performing, to determine where additional management attention is required and to determine if appropriate corrective actions have been established. Summarized System Health Report is developed for management's quick overview of systems status, important system malfunctions and problems as well as major changes from previous assessment period. Summarized Report contains nine sections: status difference including brief explanation, selected performance indicators, new equipment problems, functional failures, important problem analyses, action plan for systems with Potential Danger (RED) status, maintenance rule status overview and systems availability (planned and unplanned).(author)

  9. Public health systems under attack in Canada: Evidence on public health system performance challenges arbitrary reform.

    Science.gov (United States)

    Guyon, Ak'ingabe; Perreault, Robert

    2016-10-20

    Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.

  10. Performance Health Monitoring of Large-Scale Systems

    Energy Technology Data Exchange (ETDEWEB)

    Rajamony, Ram [IBM Research, Austin, TX (United States)

    2014-11-20

    This report details the progress made on the ASCR funded project Performance Health Monitoring for Large Scale Systems. A large-­scale application may not achieve its full performance potential due to degraded performance of even a single subsystem. Detecting performance faults, isolating them, and taking remedial action is critical for the scale of systems on the horizon. PHM aims to develop techniques and tools that can be used to identify and mitigate such performance problems. We accomplish this through two main aspects. The PHM framework encompasses diagnostics, system monitoring, fault isolation, and performance evaluation capabilities that indicates when a performance fault has been detected, either due to an anomaly present in the system itself or due to contention for shared resources between concurrently executing jobs. Software components called the PHM Control system then build upon the capabilities provided by the PHM framework to mitigate degradation caused by performance problems.

  11. Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

    Science.gov (United States)

    Pleasant, Andrew

    2014-01-01

    The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health. PMID:25491583

  12. Do Health Systems Have Consistent Performance Across Locations and Is Consistency Associated With Higher Performance?

    Science.gov (United States)

    Crespin, Daniel J; Christianson, Jon B; McCullough, Jeffrey S; Finch, Michael D

    This study addresses whether health systems have consistent diabetes care performance across their ambulatory clinics and whether increasing consistency is associated with improvements in clinic performance. Study data included 2007 to 2013 diabetes care intermediate outcome measures for 661 ambulatory clinics in Minnesota and bordering states. Health systems provided more consistent performance, as measured by the standard deviation of performance for clinics in a system, relative to propensity score-matched proxy systems created for comparison purposes. No evidence was found that improvements in consistency were associated with higher clinic performance. The combination of high performance and consistent care is likely to enhance a health system's brand reputation, allowing it to better mitigate the financial risks of consumers seeking care outside the organization. These results suggest that larger health systems are most likely to deliver the combination of consistent and high-performance care. Future research should explore the mechanisms that drive consistent care within health systems.

  13. System impact research - increasing public health and health care system performance.

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Interventions directed to system features of public health and health care should increase health and welfare of patients and population. To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the

  14. System impact research – increasing public health and health care system performance

    Science.gov (United States)

    Malmivaara, Antti

    2016-01-01

    Abstract Background Interventions directed to system features of public health and health care should increase health and welfare of patients and population. Aims To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs). Methods The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs. Results The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality. Conclusions System Impact Research – creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population.Key messagesThe new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features.SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency

  15. The equity lens in the health care performance evaluation system.

    Science.gov (United States)

    Barsanti, Sara; Nuti, Sabina

    2014-01-01

    The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the 'equity process' by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. Copyright © 2013 John Wiley & Sons, Ltd.

  16. Performance of community health workers:situating their intermediary position within complex adaptive health systems

    OpenAIRE

    Kok, Maryse. C; Broerse, Jacqueline E.W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

    2017-01-01

    Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors. This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment...

  17. Performance scorecard for occupational safety and health management systems

    Directory of Open Access Journals (Sweden)

    Hernâni Veloso Neto

    2012-06-01

    Full Text Available The pro-active and systematic search for best performances should be the two assumptions of any management system, so safety and health management in organizations must also be guided by these same precepts. However, the scientific production evidences that the performance evaluation processes in safety and health continue to be guided, in their essence, by intermittency, reactivity and negativity, which are not consistent with the assumptions referenced above. Therefore, it is essential that health and safety at work management systems (HSW MS are structured from an active and positive viewpoint, focusing on continuous improvement. This implies considering performance evaluation processes that incorporate, on the one hand, monitoring, measuring and verification procedures, and on the other hand, structured matrixes of results that capture the key factors of success, by mobilizing both reactive and proactive indicators. One of the instruments that can fulfill these precepts of health and safety performance evaluation is the SafetyCard, a performance scorecard for HSW MS that we developed and will seek to outline and demonstrate over this paper.

  18. Performance of community health workers : situating their intermediary position within complex adaptive health systems

    NARCIS (Netherlands)

    Kok, Maryse C; Broerse, Jacqueline E W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

    2017-01-01

    Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income

  19. Procurement performance measurement system in the health care industry.

    Science.gov (United States)

    Kumar, Arun; Ozdamar, Linet; Ng, Chai Peng

    2005-01-01

    The rising operating cost of providing healthcare is of concern to health care providers. As such, measurement of procurement performance will enable competitive advantage and provide a framework for continuous improvement. The objective of this paper is to develop a procurement performance measurement system. The paper reviews the existing literature in procurement performance measurement to identify the key areas of purchasing performance. By studying the three components in the supply chain collectively with the resources, procedures and output, a model is been developed. Additionally, a balanced scorecard is proposed by establishing a set of generic measures and six perspectives. A case study conducted at the Singapore Hospital applies the conceptual model to describe the purchasing department and the activities within and outside the department. The results indicate that the material management department has already made a good start in measuring the procurement process through the implementation of the balanced scorecard. There are many data that are collected but not properly collated and utilized. Areas lacking measurement include cycle time of delivery, order processing time, effectiveness, efficiency and reliability. Though a lot of hard work was involved, the advantages of establishing a measurement system outweigh the costs and efforts involved in its implementation. Results of balanced scorecard measurements provide decision-makers with critical information on efficiency and effectiveness of the purchasing department's work. The measurement model developed could be used for any hospital procurement system.

  20. Wearable ballistocardiogram and seismocardiogram systems for health and performance.

    Science.gov (United States)

    Etemadi, Mozziyar; Inan, Omer T

    2018-02-01

    Cardiovascular diseases (CVDs) are prevalent in the US, and many forms of CVD primarily affect the mechanical aspects of heart function. Wearable technologies for monitoring the mechanical health of the heart and vasculature could enable proactive management of CVDs through titration of care based on physiological status as well as preventative wellness monitoring to help promote lifestyle choices that reduce the overall risk of developing CVDs. Additionally, such wearable technologies could be used to optimize human performance in austere environments. This review describes our progress in developing wearable ballistocardiogram (BCG)- and seismocardiogram-based systems for monitoring relative changes in cardiac output, contractility, and blood pressure. Our systems use miniature, low-noise accelerometers to measure the movements of the body in response to the heartbeat and novel machine learning algorithms to provide robustness against motion artifacts and sensor misplacement. Moreover, we have mathematically related wearable BCG signals-representing local, cardiogenic movements of a point on the body-to better understood whole body BCG signals, and thereby improved estimation of key health parameters. We validated these systems with experiments in healthy subjects, studies in patients with heart failure, and measurements in austere environments such as water immersion. The systems can be used in future work as a tool for clinicians and physiologists to measure the mechanical aspects of cardiovascular function outside of clinical settings, and to thereby titrate care for patients with CVDs, provide preventative screening, and optimize performance in austere environments by providing real-time in-depth information regarding performance and risk.

  1. Performance of community health workers: situating their intermediary position within complex adaptive health systems.

    Science.gov (United States)

    Kok, Maryse C; Broerse, Jacqueline E W; Theobald, Sally; Ormel, Hermen; Dieleman, Marjolein; Taegtmeyer, Miriam

    2017-09-02

    Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors.This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in the health sector, and the complexity of the health systems in which they operate. The assessment combines evidence from the international literature on CHW programmes with research outcomes from the 5-year REACHOUT consortium, undertaking implementation research to improve CHW performance in six contexts (two in Asia and four in Africa). A conceptual framework on CHW performance, which explicitly conceptualizes the interface role of CHWs, is presented. Various categories of factors influencing CHW performance are distinguished in the framework: the context, the health system and intervention hardware and the health system and intervention software. Hardware elements of CHW interventions comprise the supervision systems, training, accountability and communication structures, incentives, supplies and logistics. Software elements relate to the ideas, interests, relationships, power, values and norms of the health system actors. They influence CHWs' feelings of connectedness, familiarity, self-fulfilment and serving the same goals and CHWs' perceptions of support received, respect, competence, honesty, fairness and recognition.The framework shines a spotlight on the need for programmes to pay more attention to ideas, interests, relationships, power, values and norms of CHWs, communities, health professionals and other actors in the health system, if CHW performance is to improve.

  2. Performance Measurement Systems in Swedish Health Care Services

    OpenAIRE

    Kollberg, Beata

    2007-01-01

    In the quality management literature, measurements are attributed great importance in improving products and processes. Systems for performance measurement assessing financial and non-financial measurements were developed in the late 1980s and early 1990s. The research on performance measurement systems has mainly been focused on the design of different performance measurement systems. Many authors are occupied with the study of the constructs of measures and developing prescriptive models of...

  3. Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement.

    NARCIS (Netherlands)

    Arah, O.A.; Klazinga, N.S.; Delnoij, D.M.J.; Asbroek, A.H.A. ten; Custers, T.

    2003-01-01

    ISSUES: Countries and international organizations have recently renewed their interest in how health systems perform. This has led to the development of performance indicators for monitoring, assessing, and managing health systems to achieve effectiveness, equity, efficiency, and quality. Although

  4. Conceptual frameworks for health systems performance: a quest for effectiveness, quality, and improvement

    NARCIS (Netherlands)

    Arah, O. A.; Klazinga, N. S.; Delnoij, D. M. J.; ten Asbroek, A. H. A.; Custers, T.

    2003-01-01

    Issues. Countries and international organizations have recently renewed their interest in how health systems perform. This has led to the development of performance indicators for monitoring, assessing, and managing health systems to achieve effectiveness, equity, efficiency, and quality. Although

  5. Determinants of performance of health systems concerning maternal and child health: a global approach.

    Science.gov (United States)

    Pinzón-Flórez, Carlos Eduardo; Fernández-Niño, Julián Alfredo; Ruiz-Rodríguez, Myriam; Idrovo, Álvaro J; Arredondo López, Abel Armando

    2015-01-01

    To assess the association of social determinants on the performance of health systems around the world. A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010. Health determinants with a significant association on child mortality(corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133). Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results.

  6. Health Care Performance and Health Financing Systems in Countries from Central and Eastern Europe

    Directory of Open Access Journals (Sweden)

    Sorin Gabriel ANTON

    2012-02-01

    Full Text Available A common feature of all health systems from emerging economies is the shortage of financial resources. This fact is currently exacerbated by the economic crisis that has led many governments to reconsider the level of public spending in the health sector. Starting from the Romanian experience, the paper aims to highlight the linkage between the performance of the health system and the total health spending for selected countries from Central and Eastern Europe. Romania has the lowest level of health expenditure as percentage of GDP in Europe, even if its growth rate for 2003-2008 was the highest. In addition, empirical evidence shows that these resources are used inefficiently. Despite the increasing resources allocated to the health sector, statistical analysis shows that health system efficiency, as measured by under-5 (child mortality rate, is still low. We use regression analysis based on crosssection data in order to explain the differences in health expenditure and their implication on the system efficiency. Health data have been provided by international organizations. Crosssection regression results suggest that totalhealth spending and GDP per capita are the most important factors explaining differences in health status across Central and Eastern European countries, though other lifestyle factors could play important roles.

  7. Making health system performance measurement useful to policy makers: aligning strategies, measurement and local health system accountability in ontario

    NARCIS (Netherlands)

    Veillard, Jeremy; Huynh, Tai; Ardal, Sten; Kadandale, Sowmya; Klazinga, Niek S.; Brown, Adalsteinn D.

    2010-01-01

    This study examined the experience of the Ontario Ministry of Health and Long-Term Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking

  8. ANALYTIC NETWORK PROCESS AND BALANCED SCORECARD APPLIED TO THE PERFORMANCE EVALUATION OF PUBLIC HEALTH SYSTEMS

    Directory of Open Access Journals (Sweden)

    Marco Aurélio Reis dos Santos

    2015-08-01

    Full Text Available The performance of public health systems is an issue of great concern. After all, to assure people's quality of life, public health systems need different kinds of resources. Balanced Scorecard provides a multi-dimensional evaluation framework. This paper presents the application of the Analytic Network Process and Balanced Scorecard in the performance evaluation of a public health system in a typical medium-sized Southeastern town in Brazil.

  9. Determinants of performance of health systems concerning maternal and child health: a global approach.

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Pinzón-Flórez

    Full Text Available To assess the association of social determinants on the performance of health systems around the world.A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010.Health determinants with a significant association on child mortality(<1year: higher access to water (βa Quartile 4(Q4 vs Quartile 1(Q1 = -6,14; 95%CI: -11,63 to -0,73, sanitation systems, (Q4 vs Q1 = -25,58; 95%CI: -31,91 to -19,25, % measles vaccination coverage (Q4 vs Q1 = -7.35; 95%CI: -10,18 to -4,52, % of births attended by a healthcare professional (Q4 vs Q1 = -7,91; 95%CI: -11,36 to -4,52 and a % of the total health expenditure (Q3 vs Q1 = -2,85; 95%CI: -4,93 to -0,7. Ethnic fragmentation (Q4 vs Q1 = 9,93; 95%CI: -0.03 to 19.89 had a marginal effect. For child mortality<5 years, an association was found for these variables and democratization (not free vs free = 11,23; 95%CI: -0,82 to 23,29, out-of-pocket expenditure (Q1 vs Q4 = 17,71; 95%CI: 5,86 to 29,56. For MMR (Maternal mortality ratio, % of access to water for all the quartiles, % of access to sanitation systems, (Q3 vs Q1 = -171,15; 95%CI: -281,29 to -61, birth attention by a healthcare professional (Q4 vs Q1 = -231,23; 95%CI: -349,32 to -113,15, and having corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133.Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results.

  10. Health financing for universal coverage and health system performance: concepts and implications for policy.

    Science.gov (United States)

    Kutzin, Joseph

    2013-08-01

    Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

  11. Assessing Performance of Botswana’s Public Hospital System: The Use of the World Health Organization Health System Performance Assessment Framework

    Directory of Open Access Journals (Sweden)

    Onalenna Seitio-Kgokgwe

    2014-09-01

    Full Text Available Background Very few studies have assessed performance of Botswana public hospitals. We draw from a large research study assessing performance of the Botswana Ministry of Health (MoH to evaluate the performance of public hospital system using the World Health Organization Health Systems Performance Assessment Framework (WHO HSPAF. We aimed to evaluate performance of Botswana public hospital system; relate findings of the assessment to the potential for improvements in hospital performance; and determine the usefulness of the WHO HSPAF in assessing performance of hospital systems in a developing country. Methods This article is based on data collected from document analysis, 54 key informants comprising senior managers and staff of the MoH (N= 40 and senior officers from stakeholder organizations (N= 14, and surveys of 42 hospital managers and 389 health workers. Data from documents and transcripts were analyzed using content and thematic analysis while data analysis for surveys was descriptive determining proportions and percentages. Results The organizational structure of the Botswana’s public hospital system, authority and decision-making are highly centralized. Overall physical access to health services is high. However, challenges in the distribution of facilities and inpatient beds create inequities and inefficiencies. Capacity of the hospitals to deliver services is limited by inadequate resources. There are significant challenges with the quality of care. Conclusion While Botswana invested considerably in building hospitals around the country resulting in high physical access to services, the organization and governance of the hospital system, and inadequate resources limit service delivery. The ongoing efforts to decentralize management of hospitals to district level entities should be expedited. The WHO HSPAF enabled us to conduct a comprehensive assessment of the public hospital system. Though relatively new, this approach proved

  12. A Conceptual Framework for Evaluation of Public Health and Primary Care System Performance in Iran

    Science.gov (United States)

    Jahanmehr, Nader; Rashidian, Arash; Khosravi, Ardeshir; Farzadfar, Farshad; Shariati, Mohammad; Majdzadeh, Reza; Sari, Ali Akbari; Mesdaghinia, Alireza

    2015-01-01

    Introduction: The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community. Methods: We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies. Results: We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status. Conclusion: The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report. PMID:25946937

  13. A conceptual framework for evaluation of public health and primary care system performance in iran.

    Science.gov (United States)

    Jahanmehr, Nader; Rashidian, Arash; Khosravi, Ardeshir; Farzadfar, Farshad; Shariati, Mohammad; Majdzadeh, Reza; Akbari Sari, Ali; Mesdaghinia, Alireza

    2015-01-26

    The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community. We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies. We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status. The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report.

  14. Canadian and the United States' health care systems performance and governance: elements of convergence.

    Science.gov (United States)

    Globerman, Steven; Hodges, Hart; Vining, Aidan

    2002-01-01

    International comparisons of the organisation and performance of health care sectors are increasingly informing policy makers about potential policies relating to health care. Politicians, academics and critics in both the United States and Canada have compared and contrasted the health care systems in the two countries. Public debate tends to emphasise the differences between the US and Canadian health care systems. But, dramatic differences between the organisation and performances of health care systems of the two countries would be surprising given that most elements of divergence have only emerged in the last fifty years, and that health systems tend to be driven by the same basic economic problems. This paper provides an overview of the main economic efficiency issues that must be addressed by health care delivery systems, as well as statistical and related evidence on both input usage and output performance of the two health care systems. While Canada clearly spends less on health care, it is difficult to conclude that Canada has a more efficient health care system than the United States. In particular, the US population puts greater demands on its national health care system owing to a combination of behavioural patterns and socio-economic disparities that contribute to much higher rates of violent accidents, as well as specific diseases and other health problems. Also, the stylized representation of the US system as being 'market-driven' and the Canadian system as being 'centrally controlled' is, increasingly, inept. Both systems are evolving toward bureaucratic models that rely more on internal competition than market competition for governance. In this respect, economic forces are nudging both systems towards a convergence of structure and performance.

  15. International comparisons of health system performance among OECD countries: opportunities and data privacy protection challenges

    NARCIS (Netherlands)

    Oderkirk, Jillian; Ronchi, Elettra; Klazinga, Niek

    2013-01-01

    Health data constitute a significant resource in most OECD countries that could be used to improve health system performance. Well-intended policies to allay concerns about breaches of confidentiality and to reduce potential misuse of personal health information may be limiting data use. A survey of

  16. The influence of system quality characteristics on health care providers' performance: Empirical evidence from Malaysia.

    Science.gov (United States)

    Mohd Salleh, Mohd Idzwan; Zakaria, Nasriah; Abdullah, Rosni

    The Ministry of Health Malaysia initiated the total hospital information system (THIS) as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider's performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers' performance was expected when the system usage fits with patients' needs that eventually increased their productivity. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  17. Health systems performance in sub-Saharan Africa: governance, outcome and equity.

    Science.gov (United States)

    Olafsdottir, Anna E; Reidpath, Daniel D; Pokhrel, Subhash; Allotey, Pascale

    2011-04-16

    The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health

  18. Health systems performance in sub-Saharan Africa: governance, outcome and equity

    Directory of Open Access Journals (Sweden)

    Pokhrel Subhash

    2011-04-01

    Full Text Available Abstract Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the

  19. Design and Construction for Community Health Service Precision Fund Appropriation System Based on Performance Management.

    Science.gov (United States)

    Gao, Xing; He, Yao; Hu, Hongpu

    2017-01-01

    Allowing for the differences in economy development, informatization degree and characteristic of population served and so on among different community health service organizations, community health service precision fund appropriation system based on performance management is designed, which can provide support for the government to appropriate financial funds scientifically and rationally for primary care. The system has the characteristic of flexibility and practicability, in which there are five subsystems including data acquisition, parameter setting, fund appropriation, statistical analysis system and user management.

  20. The influence of system quality characteristics on health care providers’ performance: Empirical evidence from Malaysia

    Directory of Open Access Journals (Sweden)

    Mohd Idzwan Mohd Salleh

    2016-11-01

    Full Text Available Summary: Background: The Ministry of Health Malaysia initiated the total hospital information system (THIS as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. Methods: Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. Results and conclusions: Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider’s performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers’ performance was expected when the system usage fits with patients’ needs that eventually increased their productivity. Keywords: Electronic health records system, System quality characteristics, Care providers’ performance, Evaluation, Partial least squares-structural equation modeling

  1. Developing a national performance indicator framework for the Dutch health system

    NARCIS (Netherlands)

    ten Asbroek, A. H. A.; Arah, O. A.; Geelhoed, J.; Custers, T.; Delnoij, D. M.; Klazinga, N. S.

    2004-01-01

    Objective. To report on the first phase of the development of a national performance indicator framework for the Dutch health system. Methods. In January 2002, we initiated an informed interactive process with the intended users-policymakers at the Ministry of Health, Welfare and Sport-and academics

  2. Developing a national performance indicator framework for the Dutch health system.

    NARCIS (Netherlands)

    Asbroek, A.H.A. ten; Arah, O.A.; Geelhoed, J.; Custers, J.; Delnoij, D.M.; Klazinga, N.S.

    2004-01-01

    Objective. To report on the first phase of the development of a national performance indicator framework for the Dutch health system. Methods. In January 2002, we initiated an informed interactive process with the intended users-policymakers at the Ministry of Health, Welfare and Sport—and academics

  3. Measuring and managing health system performance: An update from New Zealand.

    Science.gov (United States)

    Chalmers, Linda Maree; Ashton, Toni; Tenbensel, Tim

    2017-08-01

    In July 2016, New Zealand introduced a new approach to measuring and monitoring health system performance. This 'Systems Level Measure Framework' (SLMF) has evolved from the Integrated Performance and Incentive Framework (IPIF) previously reported in this journal. The SLMF is designed to stimulate a 'whole of system' approach that requires inter-organisational collaboration. Local 'Alliances' between government and non-government health sector organisations are responsible for planning and achieving improved health system outcomes such as reducing ambulatory sensitive hospitalisation for young children, and reducing acute hospital bed days. It marks a shift from the previous regime of output and process targets, and from a pay-for-performance approach to primary care. Some elements of the earlier IPIF proposal, such as general practice quality measures, and tiered levels of performance, were not included in the SLM framework. The focus on health system outcomes demonstrates policy commitment to effective integration of health services. However, there remain considerable challenges to successful implementation. An outcomes framework makes it challenging to attribute changes in outcomes to organisational and collaborative strategies. At the local level, the strength and functioning of collaborative relationships between organisations vary considerably. The extent and pace of change may also be constrained by existing funding arrangements in the health system. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  4. [Financing, organization, costs and services performance of the Argentinean health sub-systems.

    Science.gov (United States)

    Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

    2016-01-01

    To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

  5. Health system performance at the district level in Indonesia after decentralization

    Directory of Open Access Journals (Sweden)

    Choi Yoonjoung

    2010-03-01

    Full Text Available Abstract Background Assessments over the last two decades have showed an overall low level of performance of the health system in Indonesia with wide variation between districts. The reasons advanced for these low levels of performance include the low level of public funding for health and the lack of discretion for health system managers at the district level. When, in 2001, Indonesia implemented a radical decentralization and significantly increased the central transfer of funds to district governments it was widely expected that the performance of the health system would improve. This paper assesses the extent to which the performance of the health system has improved since decentralization. Methods We measured a set of indicators relevant to assessing changes in performance of the health system between two surveys in three areas: utilization of maternal antenatal and delivery care; immunization coverage; and contraceptive source and use. We also measured respondents' demographic characteristics and their living circumstances. These measurements were made in population-based surveys in 10 districts in 2002-03 and repeated in 2007 in the same 10 districts using the same instruments and sampling methods. Results The dominant providers of maternal and child health in these 10 districts are in the private sector. There was a significant decrease in birth deliveries at home, and a corresponding increase in deliveries in health facilities in 5 of the 10 districts, largely due to increased use of private facilities with little change in the already low use of public facilities. Overall, there was no improvement in vaccination of mothers and their children. Of those using modern contraceptive methods, the majority obtained them from the private sector in all districts. Conclusions There has been little improvement in the performance of the health system since decentralization occurred in 2001 even though there have also been significant increases in

  6. A novel performance monitoring framework for health research systems: experiences of the National Institute for Health Research in England

    Directory of Open Access Journals (Sweden)

    Hallsworth Michael

    2011-03-01

    Full Text Available Abstract Background The National Institute for Health Research (NIHR was established in 2006 with the aim of creating an applied health research system embedded within the English National Health Service (NHS. NIHR sought to implement an approach for monitoring its performance that effectively linked early indicators of performance with longer-term research impacts. We attempted to develop and apply a conceptual framework for defining appropriate key performance indicators for NIHR. Method Following a review of relevant literature, a conceptual framework for defining performance indicators for NIHR was developed, based on a hybridisation of the logic model and balanced scorecard approaches. This framework was validated through interviews with key NIHR stakeholders and a pilot in one division of NIHR, before being refined and applied more widely. Indicators were then selected and aggregated to create a basket of indicators aligned to NIHR's strategic goals, which could be reported to NIHR's leadership team on a quarterly basis via an oversight dashboard. Results Senior health research system managers and practitioners endorsed the conceptual framework developed and reported satisfaction with the breadth and balance of indicators selected for reporting. Conclusions The use of the hybrid conceptual framework provides a pragmatic approach to defining performance indicators that are aligned to the strategic aims of a health research system. The particular strength of this framework is its capacity to provide an empirical link, over time, between upstream activities of a health research system and its long-term strategic objectives.

  7. A novel performance monitoring framework for health research systems: experiences of the National Institute for Health Research in England.

    Science.gov (United States)

    El Turabi, Anas; Hallsworth, Michael; Ling, Tom; Grant, Jonathan

    2011-03-24

    The National Institute for Health Research (NIHR) was established in 2006 with the aim of creating an applied health research system embedded within the English National Health Service (NHS). NIHR sought to implement an approach for monitoring its performance that effectively linked early indicators of performance with longer-term research impacts. We attempted to develop and apply a conceptual framework for defining appropriate key performance indicators for NIHR. Following a review of relevant literature, a conceptual framework for defining performance indicators for NIHR was developed, based on a hybridisation of the logic model and balanced scorecard approaches. This framework was validated through interviews with key NIHR stakeholders and a pilot in one division of NIHR, before being refined and applied more widely. Indicators were then selected and aggregated to create a basket of indicators aligned to NIHR's strategic goals, which could be reported to NIHR's leadership team on a quarterly basis via an oversight dashboard. Senior health research system managers and practitioners endorsed the conceptual framework developed and reported satisfaction with the breadth and balance of indicators selected for reporting. The use of the hybrid conceptual framework provides a pragmatic approach to defining performance indicators that are aligned to the strategic aims of a health research system. The particular strength of this framework is its capacity to provide an empirical link, over time, between upstream activities of a health research system and its long-term strategic objectives.

  8. China's rural public health system performance: a cross-sectional study.

    Science.gov (United States)

    Tian, Miaomiao; Feng, Da; Chen, Xi; Chen, Yingchun; Sun, Xi; Xiang, Yuanxi; Yuan, Fang; Feng, Zhanchun

    2013-01-01

    In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China's rural public health system performance. The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region. China's rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%. The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.

  9. High performance work systems: the gap between policy and practice in health care reform.

    Science.gov (United States)

    Leggat, Sandra G; Bartram, Timothy; Stanton, Pauline

    2011-01-01

    Studies of high-performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform. The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three casestudy organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia. The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health

  10. International comparisons of health system performance among OECD countries: opportunities and data privacy protection challenges.

    Science.gov (United States)

    Oderkirk, Jillian; Ronchi, Elettra; Klazinga, Niek

    2013-09-01

    Health data constitute a significant resource in most OECD countries that could be used to improve health system performance. Well-intended policies to allay concerns about breaches of confidentiality and to reduce potential misuse of personal health information may be limiting data use. A survey of 20 OECD countries explored the extent to which countries have developed and use personal health data and the reasons why data use may be problematic in some. Countries are divided, with one-half engaged regularly in national data linkage studies to monitor health care quality. Country variation is linked to risk management in granting an exemption to patient consent requirements; in sharing identifiable data among government authorities; and in project approvals and granting access to data. The resources required to comply with data protection requirements is a secondary problem. The sharing of person-level data across borders for international comparisons is rarely reported and there were few examples of studies of health system performance. Laws and policies enabling data sharing and data linkage are needed to strengthen national information infrastructure. To develop international studies comparing health care quality and health system performance, actions are needed to address heterogeneity in data protection practices. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  11. Using a plant health system framework to assess plant clinic performance in Uganda

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Matsiko, Frank B.

    2016-01-01

    and expand, new analytical frameworks and tools are needed to identify factors influencing performance of services and systems in specific contexts, and to guide interventions. In this paper we apply a plant health system framework to assess plant clinic performance, using Uganda as a case study...... factors, influenced by basic operational and financial concerns, inter-institutional relations and public sector policies. Overall, there was a fairly close match between the plant health system attributes and plant clinic performance, suggesting that the framework can help explain system functioning....... A comparative study of plant clinics was carried out between July 2010 and September 2011 in the 12 districts where plant clinics were operating at that time. The framework enabled us to organise multiple issues and identify key features that affected the plant clinics. Clinic performance was, among other...

  12. Measurement of health system performance at district level: A study protocol

    Directory of Open Access Journals (Sweden)

    Atul Sharma

    2018-01-01

    Full Text Available Background: Limited efforts have been observed in low and middle income countries to undertake health system performance assessment at district level. Absence of a comprehensive data collection tool and lack of a standardised single summary measure defining overall performance are some of the main problems. Present study has been undertaken to develop a summary composite health system performance index at district level. Methods: A broad range of indicators covering all six domains as per building block framework were finalized by an expert panel. The domains were classified into twenty sub-domains, with 70 input and process indicators to measure performance. Seven sub-domains for assessing health system outputs and outcomes were identified, with a total of 28 indicators. Districts in Haryana state from north India were selected for the study. Primary and secondary data will be collected from 378 health facilities, district and state health directorate headquarters. Indicators will be normalized, aggregated to generate composite performance index at district level. Domain specific scores will present the quality of individual building block domains in the public health system. Robustness of the results will be checked using sensitivity analysis. Expected impact for public health: The study presents a methodology for comprehensive assessment of all health system domains on basis of input, process, output and outcome indicators which has never been reported from India. Generation of this index will help identify policy and implementation areas of concern and point towards potential solutions. Results may also help understand relationships between individual building blocks and their sub-components.

  13. Health system frameworks and performance indicators in eight countries: A comparative international analysis

    Directory of Open Access Journals (Sweden)

    Jeffrey Braithwaite

    2017-01-01

    Full Text Available Objectives: Performance indicators are a popular mechanism for measuring the quality of healthcare to facilitate both quality improvement and systems management. Few studies make comparative assessments of different countries’ performance indicator frameworks. This study identifies and compares frameworks and performance indicators used in selected Organisation for Economic Co-operation and Development health systems to measure and report on the performance of healthcare organisations and local health systems. Countries involved are Australia, Canada, Denmark, England, the Netherlands, New Zealand, Scotland and the United States. Methods: Identification of comparable international indicators and analyses of their characteristics and of their broader national frameworks and contexts were undertaken. Two dimensions of indicators – that they are nationally consistent (used across the country rather than just regionally and locally relevant (measured and reported publicly at a local level, for example, a health service – were deemed important. Results: The most commonly used domains in performance frameworks were safety, effectiveness and access. The search found 401 indicators that fulfilled the ‘nationally consistent and locally relevant’ criteria. Of these, 45 indicators are reported in more than one country. Cardiovascular, surgery and mental health were the most frequently reported disease groups. Conclusion: These comparative data inform researchers and policymakers internationally when designing health performance frameworks and indicator sets.

  14. Key Element Performance In Occupational Safety And Health Management System In Organization (A Literature

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    Agus Salim Nuzaihan Aras

    2016-01-01

    Full Text Available Setting an effective safety and health management system is crucial in order to reduce problem relating to accident and ill in management organizational. It is involve with multiple level of management and stakeholders who empower the organization to the management in handling the safety and health cases and issues in organizational. It is necessary to prepare a well knowledge about safety and health management systems and preparing the framework for setting a certain scale in measuring its performance in this area. The successful or failure of management does showing the capability of the organization in delivering the responsible to management levels [1]. The problem in safe work issues and practices cause by the management commitment and involvement that create improper safety program and procedures, and this crisis keep continuing till present [2]. This paper describes about key element of safety and health management system and measuring the performance in order to get an effective management system in organization that describes the process in achieving effectiveness in management. The literature review will be conducted through the data collection from research findings and defined the strong character of key element in which focusing on measuring performance. A guide on key element performance in occupational safety and health management system is specifically drawn to prepare for a future research.

  15. Do district health systems perform differently because of their managers? Preliminary insights from Indonesia

    Directory of Open Access Journals (Sweden)

    Augustine Asante

    2015-07-01

    Full Text Available District health systems (DHS are central to the global efforts to improve health outcomes but many remain ineffective. In many lowresource settings, despite the generally weak DHS there is evidence that some districts consistently perform well against the odds, and this is often attributed to the calibre of managers leading such districts and their management and leadership (M&L skills. This paper examines the M&L practices of district health managers in high and low performing districts in Indonesia in an attempt to understand whether the differences in the performance of DHS can be explained, at least in part, by the differences in the performance of their health managers. We employed a mixed methods case study design focusing on two purposefully selected districts. Data were collected in 2011 using questionnaires and in-depth interviews. The preliminary results suggest that M&L practices of managers in the high and low performing districts are similar and provide little explanation for the differences in the performance of the two DHS. Contextual and health system factors offered a much better explanation for the variations in DHS performance.

  16. Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan

    Science.gov (United States)

    Edward, Anbrasi; Kumar, Binay; Kakar, Faizullah; Salehi, Ahmad Shah; Burnham, Gilbert; Peters, David H.

    2011-01-01

    Background In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. Methods and Findings Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0–100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3–84.5, pscorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary PMID:21814499

  17. The Dynamics of Catastrophic and Impoverishing Health Spending in Indonesia: How Well Does the Indonesian Health Care Financing System Perform?

    Science.gov (United States)

    Aji, Budi; Mohammed, Shafiu; Haque, Md Aminul; Allegri, Manuela De

    2017-09-01

    Our study examines the incidence and intensity of catastrophic and impoverishing health spending in Indonesia. A panel data set was used from 4 waves of the Indonesian Family Life Surveys 1993, 1997, 2000, and 2007. Catastrophic health expenditure was measured by calculating the ratio of out-of-pocket payments to household income. Then, we calculated poverty indicators as a measure of impoverishing spending in the health care financing system. Head count, overshoot, and mean positive overshoot for each given threshold in 2000 were lower than other surveyed periods; otherwise, fraction headcount in 2007 of households were the higher. Between 1993 and 2007, the percentage of households in poverty decreased, both in gross and net of health payments. However, in each year, the percentages of households in poverty using net health payments were higher than the gross. The estimates of poverty gap, normalized poverty gap, and normalized mean positive gap decreased across the survey periods. The health care financing system performance has shown positive evidence for financial protection offerings. A sound relationship between improvements of health care financing performance and the existing health reform demonstrated a mutual reinforcement, which should be maintained to promote equity and fairness in health care financing in Indonesia.

  18. Comparing health system performance assessment and management approaches in the Netherlands and Ontario, Canada

    NARCIS (Netherlands)

    Tawfik-Shukor, Ali R.; Klazinga, Niek S.; Arah, Onyebuchi A.

    2007-01-01

    BACKGROUND: Given the proliferation and the growing complexity of performance measurement initiatives in many health systems, the Netherlands and Ontario, Canada expressed interests in cross-national comparisons in an effort to promote knowledge transfer and best practise. To support this

  19. Comparing health system performance assessment and management approaches in the Netherlands and Ontario, Canada

    NARCIS (Netherlands)

    A.R. Tawfik-Shukor (Ali); N.S. Klazinga (Niek); O.A. Arah (Onyebuchi)

    2007-01-01

    textabstractBackground: Given the proliferation and the growing complexity of performance measurement initiatives in many health systems, the Netherlands and Ontario, Canada expressed interests in cross-national comparisons in an effort to promote knowledge transfer and best practise. To support

  20. Exploring Health System Responsiveness in Ambulatory Care and Disease Management and its Relation to Other Dimensions of Health System Performance (RAC) - Study Design and Methodology.

    Science.gov (United States)

    Röttger, Julia; Blümel, Miriam; Engel, Susanne; Grenz-Farenholtz, Brigitte; Fuchs, Sabine; Linder, Roland; Verheyen, Frank; Busse, Reinhard

    2015-05-20

    The responsiveness of a health system is considered to be an intrinsic goal of health systems and an essential aspect in performance assessment. Numerous studies have analysed health system responsiveness and related concepts, especially across different countries and health systems. However, fewer studies have applied the concept for the evaluation of specific healthcare delivery structures and thoroughly analysed its determinants within one country. The aims of this study are to assess the level of perceived health system responsiveness to patients with chronic diseases in ambulatory care in Germany and to analyse the determinants of health system responsiveness as well as its distribution across different population groups. The target population consists of chronically ill people in Germany, with a focus on patients suffering from type 2 diabetes and/or from coronary heart disease (CHD). Data comes from two different sources: (i) cross-sectional survey data from a postal survey and (ii) claims data from a German sickness fund. Data from both sources will be linked at an individual-level. The postal survey has the purpose of measuring perceived health system responsiveness, health related quality of life, experiences with disease management programmes (DMPs) and (subjective) socioeconomic background. The claims data consists of information on (co)morbidities, service utilization, enrolment within a DMP and sociodemographic characteristics, including the type of residential area. RAC is one of the first projects linking survey data on health system responsiveness at individual level with claims data. With this unique database, it will be possible to comprehensively analyse determinants of health system responsiveness and its relation to other aspects of health system performance assessment. The results of the project will allow German health system decision-makers to assess the performance of nonclinical aspects of healthcare delivery and their determinants in two

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

    Science.gov (United States)

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

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

  2. Assessing the Performance of Imaging Health Systems in Five Selected Hospitals in Uganda

    Directory of Open Access Journals (Sweden)

    Michael G Kawooya

    2012-01-01

    Full Text Available Objectives : The first objective of the study was to develop an index termed as the ′Imaging Coverage′ (IC, for measuring the performance of the imaging health systems. This index together with the Hospital-Based Utilization (HBU would then be calculated for five Ugandan hospitals. Second, was to relate the financial resources and existing health policy to the performance of the imaging systems. Materials and Methods: This was a cross-sectional survey employing the triangulation methodology, conducted in Mulago National Referral Hospital. The qualitative study used cluster sampling, in-depth interviews, focus group discussions, and self-administered questionnaires to explore the non-measurable aspects of the imaging systems′ performances. Results: The IC developed and tested as an index for the imaging system′s performance was 36%. General X-rays had the best IC followed by ultrasound. The Hospital-Based Utilization for the five selected hospitals was 186 per thousand and was the highest for general radiography followed by ultrasound. Conclusion: The IC for the five selected hospitals was 36% and the HBU was 186 per thousand, reflecting low performance levels, largely attributable to inadequate funding. There were shortfalls in imaging requisitions and inefficiencies in the imaging systems, financing, and health policy. Although the proportion of inappropriate imaging was small, reducing this inappropriateness even further would lead to a significant total saving, which could be channeled into investigating more patients. Financial resources stood out as the major limitation in attaining the desired performance and there is a need to increase budget funding so as to improve the performance of the imaging health systems.

  3. Private sector participation and health system performance in sub-saharan Africa.

    Science.gov (United States)

    Yoong, Joanne; Burger, Nicholas; Spreng, Connor; Sood, Neeraj

    2010-10-07

    The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. We examine the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. We also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance) and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment. Greater participation is associated with favorable intermediate outcomes in terms of access and equity. While these results do not establish a causal link between private sector participation and health system performance, they suggest that there is no deleterious link between private sector participation and health system performance in SSA.

  4. The health professions and the performance of future health systems in low-income countries: support or obstacle?

    Science.gov (United States)

    Dussault, Gilles

    2008-05-01

    This paper discusses the present and future role of the health professions in health services delivery systems in low-income countries. Unlike richer countries, most low-income countries do not have a tradition of labour market regulation and the capacity of the professions themselves to regulate the provision of health services by their members tends to be weak. The paper looks at the impact of professional monopolies on the performance of health services delivery systems, e.g. equity of access, effectiveness of services, efficiency in the use of scarce resources, responsiveness to users' needs, including protection against the financial impact of utilising health services. It identifies issues which policy-makers face in relation to opening the health labour market while guaranteeing the safety and security of services provided by professionals. The suggestion is made that a "social contract", granting privileges of practice in exchange of a commitment to actively maintain and enhance the quality of their services, may be a viable course of action. This would require that the actors in the policy process collaborate in strengthening the capacity of regulatory agencies to perform their role.

  5. A multistate examination of partnership activity among local public health systems using the National Public Health Performance Standards.

    Science.gov (United States)

    Barnes, Priscilla A; Curtis, Amy B; Hall-Downey, Laura; Moonesinghe, Ramal

    2012-01-01

    This study examines whether partnership-related measures in the second version of the National Public Health Performance Standards (NPHPS) are useful in evaluating level of activity as well as identifying latent constructs that exist among local public health systems (LPHSs). In a sample of 110 LPHSs, descriptive analysis was conducted to determine frequency and percentage of 18 partnership-related NPHPS measures. Principal components factor analysis was conducted to identify unobserved characteristics that promote effective partnerships among LPHSs. Results revealed that 13 of the 18 measures were most frequently reported at the minimal-moderate level (conducted 1%-49% of the time). Coordination of personal health and social services to optimize access (74.6%) was the most frequently reported measure at minimal-moderate levels. Optimal levels (conducted >75% of the time) were reported most frequently in 2 activities: participation in emergency preparedness coalitions and local health departments ensuring service provision by working with state health departments (67% and 61% of respondents, respectively) and the least optimally reported activity was review partnership effectiveness (4% of respondents). Factor analysis revealed categories of partnership-related measures in 4 domains: resources and activities contributing to relationship building, evaluating community leadership activities, research, and state and local linkages to support public health activities. System-oriented public health assessments may have questions that serve as proxy measures to examine levels of interorganizational partnerships. Several measures from the NPHPS were useful in establishing a national baseline of minimal and optimal activity levels as well as identifying factors to enhance the delivery of the 10 essential public health services among organizations and individuals in public health systems.

  6. Exploring the state of health and safety management system performance measurement in mining organizations.

    Science.gov (United States)

    Haas, Emily Joy; Yorio, Patrick

    2016-03-01

    Complex arguments continue to be articulated regarding the theoretical foundation of health and safety management system (HSMS) performance measurement. The culmination of these efforts has begun to enhance a collective understanding. Despite this enhanced theoretical understanding, however, there are still continuing debates and little consensus. The goal of the current research effort was to empirically explore common methods to HSMS performance measurement in mining organizations. The purpose was to determine if value and insight could be added into the ongoing approaches of the best ways to engage in health and safety performance measurement. Nine site-level health and safety management professionals were provided with 133 practices corresponding to 20 HSMS elements, each fitting into the plan, do, check, act phases common to most HSMS. Participants were asked to supply detailed information as to how they (1) assess the performance of each practice in their organization, or (2) would assess each practice if it were an identified strategic imperative. Qualitative content analysis indicated that the approximately 1200 responses provided could be described and categorized into interventions , organizational performance , and worker performance . A discussion of how these categories relate to existing indicator frameworks is provided. The analysis also revealed divergence in two important measurement issues; (1) quantitative vs qualitative measurement and reporting; and (2) the primary use of objective or subjective metrics. In lieu of these findings we ultimately recommend a balanced measurement and reporting approach within the three metric categories and conclude with suggestions for future research.

  7. Changes in Local Public Health System Performance Before and After Attainment of National Accreditation Standards.

    Science.gov (United States)

    Ingram, Richard C; Mays, Glen P; Kussainov, Nurlan

    The aim of this study is to investigate the impact of Public Health Accreditation Board (PHAB) accreditation on the delivery of public health services and on participation from other sectors in the delivery of public health services in local public health systems. This study uses a longitudinal repeated measures design to identify differences between a cohort of public health systems containing PHAB-accredited local health departments and a cohort of public health systems containing unaccredited local health departments. It uses data spanning from 2006 to 2016. This study examines a cohort of local public health systems that serves large populations and contains unaccredited and PHAB-accredited local health departments. Data in this study were collected from the directors of health departments that include local public health systems followed in the National Longitudinal Study of Public Health Systems. The intervention examined is PHAB accreditation. The study focuses on 4 areas: the delivery of core public health services, local health department contribution toward these services, participation in the delivery of these services by other members of the public health system, and public health system makeup. Prior to the advent of accreditation, public health systems containing local health departments that were later accredited by PHAB appear quite similar to their unaccredited peers. Substantial differences between the 2 cohorts appear to manifest themselves after the advent of accreditation. Specifically, the accredited cohort seems to offer a broader array of public health services, involve more partners in the delivery of those services, and enjoy a higher percentage of comprehensive public health systems. The results of this study suggest that accreditation may yield significant benefits and may help public health systems develop the public health system capital necessary to protect and promote the public's health.

  8. Decentralization and health system performance - a focused review of dimensions, difficulties, and derivatives in India.

    Science.gov (United States)

    Panda, Bhuputra; Thakur, Harshad P

    2016-10-31

    One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of 'decision space' at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of 'trust', 'convenience' and 'mutual benefits' to explain, define and measure components of governance in health. In the emerging 'continuum of health services' model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them. This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations

  9. Decentralization and health system performance – a focused review of dimensions, difficulties, and derivatives in India

    Directory of Open Access Journals (Sweden)

    Bhuputra Panda

    2016-10-01

    Full Text Available Abstract Introduction One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of ‘decision space’ at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of ‘trust’, ‘convenience’ and ‘mutual benefits’ to explain, define and measure components of governance in health. In the emerging ‘continuum of health services’ model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc. through the prism of decentralization in the first place, and in establishing directed relationships among them. Methods This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Results Evaluation of local decision making and its effect on health system performance has been

  10. Health system professionals, attitude towards necessary criteria for hospitals managers, performance assessment

    Directory of Open Access Journals (Sweden)

    ali janati

    2012-09-01

    Materials and Methods: This study was a qualitative research with thematic analysis method. By using semi structured questionnaire with 2 health system experts interview was conducted and 20 experts participated in focus group discussion. After each interview and group discussion withdrawals were checked with participants. The initial interviews were analyzed by two faculty members and then were combined. Results: 7 main themes about necessary criteria for hospital managers, performance assessment were obtained from experts, views. These themes are: skills related to planning, organization and staff performance management, leadership, information management, clinical governance and performance indicators. Conclusion: All participants in the study had a history of hospital management therefore their comments will be an effective step in identifying the criteria for making hospital managers, performance assessment tool. In addition to Professionals, perspectives and studies done in other countries, in order to design this kind of tools, it is necessary to adjust the obtained findings according to the local hospital conditions.

  11. A preliminary assessment of financial stability, efficiency, health systems and health outcomes using performance-based contracts in Belize.

    Science.gov (United States)

    Bowser, Diana M; Figueroa, Ramon; Natiq, Laila; Okunogbe, Adeyemi

    2013-01-01

    Over the last 10 years, Belize has implemented a National Health Insurance (NHI) program that uses performance-based contracts with both public and private facilities to improve financial sustainability, efficiency and service provision. Data were collected at the facility, district and national levels in order to assess trends in financial sustainability, efficiency payments, year-end bonuses and health system and health outcomes. A difference-in-difference approach was used to assess the difference in technical efficiency between private and public facilities. The results show that per capita spending on services provided by the NHI program has decreased over the period 2006-2009 from BZ$177 to BZ$136. The private sector has achieved higher levels of technical efficiency, but lower percentages of efficiency and year-end bonus payments. Districts with contracts through the NHI program showed greater improvements in facility births, nurse density, reducing maternal mortality, diabetes deaths and morbidity from bronchitis, emphysema and asthma than districts without contracts over the period 2006-2010. This preliminary assessment of Belize's pay-for-performance system provides some positive results, however further research is needed to use the lessons learned from Belize to implement similar reforms in other systems.

  12. Performance and Health Test Procedure for Grid Energy Storage Systems: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Baggu, Murali M [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Smith, Kandler A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Friedl, Andrew [San Diego Gas and Electric; Bialek, Thomas [San Diego Gas and Electric; Schimpe, Michael Robert [Technical University of Munich

    2017-07-27

    A test procedure to evaluate the performance and health of field installations of grid-connected battery energy storage systems (BESS) is described. Performance and health metrics captured in the procedures are: Round-trip efficiency, Standby losses, Response time/accuracy, and Useable Energy/ State of Charge at different discharge/charge rates over the system's lifetime. The procedures are divided into Reference Performance Tests, which require the system to be put in a test mode and are to be conducted in intervals, and Real-time Monitoring tests, which collect data during normal operation without interruption. The procedures can be applied on a wide array of BESS with little modifications and can thus support BESS operators in the management of BESS field installations with minimal interruption and expenditures.can be applied on a wide array of BESS with little modifications and can thus support BESS operators in the management of BESS field installations with minimal interruption and expenditures.

  13. Performance-Based Financing to Strengthen the Health System in Benin: Challenging the Mainstream Approach

    Directory of Open Access Journals (Sweden)

    Elisabeth Paul

    2018-01-01

    Full Text Available Background Performance-based financing (PBF is often proposed as a way to improve health system performance. In Benin, PBF was launched in 2012 through a World Bank-supported project. The Belgian Development Agency (BTC followed suit through a health system strengthening (HSS project. This paper analyses and draws lessons from the experience of BTC-supported PBF alternative approach – especially with regards to institutional aspects, the role of demand-side actors, ownership, and cost-effectiveness – and explores the mechanisms at stake so as to better understand how the “PBF package” functions and produces effects. Methods An exploratory, theory-driven evaluation approach was adopted. Causal mechanisms through which PBF is hypothesised to impact on results were singled out and explored. This paper stems from the co-authors’ capitalisation of experiences; mixed methods were used to collect, triangulate and analyse information. Results are structured along Witter et al framework. Results Influence of context is strong over PBF in Benin; the policy is donor-driven. BTC did not adopt the World Bank’s mainstream PBF model, but developed an alternative approach in line with its HSS support programme, which is grounded on existing domestic institutions. The main features of this approach are described (decentralised governance, peer review verification, counter-verification entrusted to health service users’ platforms, as well as its adaptive process. PBF has contributed to strengthen various aspects of the health system and led to modest progress in utilisation of health services, but noticeable improvements in healthcare quality. Three mechanisms explaining observed outcomes within the context are described: comprehensive HSS at district level; acting on health workers’ motivation through a complex package of incentives; and increased accountability by reinforcing dialogue with demand-side actors. Cost-effectiveness and

  14. Performance Analysis of Hospital Information System of the National Health Insurance Corporation Ilsan Hospital

    Science.gov (United States)

    Han, Jung Mi; Boo, Eun Hee; Kim, Jung A; Yoon, Soo Jin; Kim, Seong Woo

    2012-01-01

    Objectives This study evaluated the qualitative and quantitative performances of the newly developed information system which was implemented on November 4, 2011 at the National Health Insurance Corporation Ilsan Hospital. Methods Registration waiting time and changes in the satisfaction scores for the key performance indicators (KPI) before and after the introduction of the system were compared; and the economic effects of the system were analyzed by using the information economics approach. Results After the introduction of the system, the waiting time for registration was reduced by 20%, and the waiting time at the internal medicine department was reduced by 15%. The benefit-to-cost ratio was increased to 1.34 when all intangible benefits were included in the economic analysis. Conclusions The economic impact and target satisfaction rates increased due to the introduction of the new system. The results were proven by the quantitative and qualitative analyses carried out in this study. This study was conducted only seven months after the introduction of the system. As such, a follow-up study should be carried out in the future when the system stabilizes. PMID:23115744

  15. Health care needs of children with Down syndrome and impact of health system performance on children and their families.

    Science.gov (United States)

    Phelps, Randall A; Pinter, Joseph D; Lollar, Donald J; Medlen, Joan Guthrie; Bethell, Christina D

    2012-04-01

    The functional, financial, and social impact on families of children with Down syndrome (DS) in the United States and the role of the US health care system in ameliorating these impacts have not been well characterized. We sought to describe the demographic characteristics and functional difficulties of these children and to determine whether children with DS, compared with children with "intellectual disability" (ID) generally, and compared with other "children and youth with special health care needs" (CYSHCN), are more or less likely to receive health care that meets quality standards related to care coordination and to have their health care service needs met. This study analyzed data from the 2005-2006 National Survey of Children with Special Health Care Needs (n = 40,723). Children and youth aged 0 to 17 years with special health care need (CYSHCN) who experience DS (n = 395) and/or IDs (n = 4252) were compared with each other and other CYSHCN on a range of functioning, family impact, and health care quality variables using bivariate and multivariate methods. Data were weighted to represent all CYSHCN in the United States. Compared with CYSHCN without DS, children with DS were significantly less likely to receive comprehensive care within a medical home (29.7% vs 47.3%; p work due to their child's health needs (23.5% vs 55.1%; p performance was poorer for children with DS compared with those with ID and no DS after adjustment for family income, prevalence on most aspects of quality of care and family impacts evaluated were similar for these 2 groups. In this study, the families of children with DS, and ID generally, are burdened disproportionately when compared with other CYSHCN, reflecting the combination of impairments intrinsic to DS and ID and impacts of suboptimal medical care coordination and social support.

  16. Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health.

    Science.gov (United States)

    Alshamsan, Riyadh; Lee, John Tayu; Rana, Sangeeta; Areabi, Hasan; Millett, Christopher

    2017-09-01

    Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.

  17. Combined Regional Investments Could Substantially Enhance Health System Performance And Be Financially Affordable.

    Science.gov (United States)

    Homer, Jack; Milstein, Bobby; Hirsch, Gary B; Fisher, Elliott S

    2016-08-01

    Leaders across the United States face a difficult challenge choosing among possible approaches to transform health system performance in their regions. The ReThink Health Dynamics Model simulates how alternative scenarios could unfold through 2040. This article compares the likely consequences if four interventions were enacted in layered combinations in a prototypical midsize US city. We estimated the effects of efforts to deliver higher-value care; reinvest savings and expand global payment; enable healthier behaviors; and expand socioeconomic opportunities. Results suggest that there may be an effective and affordable way to unlock much greater health and economic potential, ultimately reducing severe illness by 20 percent, lowering health care costs by 14 percent, and improving economic productivity by 9 percent. This would require combined investments in clinical and population-level initiatives, coupled with financial agreements that reduce incentives for costly care and reinvest a share of the savings to ensure adequate long-term financing. Project HOPE—The People-to-People Health Foundation, Inc.

  18. Performance evaluation of hospitals that provide care in the public health system, Brazil.

    Science.gov (United States)

    Ramos, Marcelo Cristiano de Azevedo; da Cruz, Lucila Pedroso; Kishima, Vanessa Chaer; Pollara, Wilson Modesto; de Lira, Antônio Carlos Onofre; Couttolenc, Bernard François

    2015-01-01

    OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

  19. Performance evaluation of hospitals that provide care in the public health system, Brazil

    Directory of Open Access Journals (Sweden)

    Marcelo Cristiano de Azevedo Ramos

    2015-01-01

    Full Text Available OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities, 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

  20. Public satisfaction as a measure of health system performance: a study of nine countries in the former Soviet Union.

    Science.gov (United States)

    Footman, Katharine; Roberts, Bayard; Mills, Anne; Richardson, Erica; McKee, Martin

    2013-09-01

    Measurement of health system performance increasingly includes the views of healthcare users, yet little research has focussed on general population satisfaction with health systems. This study is the first to examine public satisfaction with health systems in the former Soviet Union (fSU). Data were derived from two related studies conducted in 2001 and 2010 in nine fSU countries, using nationally representative cross-sectional surveys. The prevalence of health system satisfaction in each country was compared for 2001 and 2010. Patterns of satisfaction were further examined by comparing satisfaction with the health system and other parts of the public sector, and the views of health care users and non-users. Potential determinants of population satisfaction were explored using logistic regression. For all countries combined, the level of satisfaction with health systems increased from 19.4% in 2001 to 40.6% in 2010, but varied considerably by country. Changes in satisfaction with the health system were similar to changes with the public sector, and non-users of healthcare were slightly more likely to report satisfaction than users. Characteristics associated with higher satisfaction include younger age, lower education, higher economic status, rural residency, better health status, and higher levels of political trust. Our results suggest that satisfaction can provide useful insight into public opinion on health system performance, particularly when used in conjunction with other subjective measures of satisfaction with government performance. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  1. Performance of the local health system and contingent influences in Northeast-Brazil: breaking vicious and virtuous circles

    Directory of Open Access Journals (Sweden)

    Regianne Leila Rolim Medeiros

    2013-11-01

    Full Text Available Organizational theory has long emphasized the importance of contingent, environmental influences on organizational performance. Similarly, research has demonstrated the importance of local political culture and informal management on the performance of the local health system, establishing vicious and virtuous circles of influence that contribute to increasing inequalities in performance among decentralized local health systems. A longitudinal ethnography studied the relationship between these elements in the same rural municipality in Northeast Brazil after a four-year interval. The second study found the local health system performance much improved. Two main factors appear to have interacted to bring this about: leadership vision and power to implement of one individual; professionalization of the local health system by hiring a significant number of senior health staff. The origins of these influences combine initiatives at local, state and federal levels.

  2. A novel method for measuring health care system performance: experience from QIDS in the Philippines.

    Science.gov (United States)

    Solon, Orville; Woo, Kimberly; Quimbo, Stella A; Shimkhada, Riti; Florentino, Jhiedon; Peabody, John W

    2009-05-01

    Measuring and monitoring health system performance is important albeit controversial. Technical, logistic and financial challenges are formidable. We introduced a system of measurement, which we call Q, to measure the quality of hospital clinical performance across a range of facilities. This paper describes how Q was developed, implemented in hospitals in the Philippines and how it compares with typical measures. Q consists of measures of clinical performance, patient satisfaction and volume of physician services. We evaluate Q using experimental data from the Quality Improvement Demonstration Study (QIDS), a randomized policy experiment. We determined its responsiveness over time and to changes in structural measures such as staffing and supplies. We also examined the operational costs of implementing Q. Q was sustainable, minimally disruptive and readily grafted into existing routines in 30 hospitals in 10 provinces semi-annually for a period of 2(1/2) years. We found Q to be more responsive to immediate impacts of policy change than standard structural measures. The operational costs totalled USD2133 or USD305 per assessment per site. Q appears to be an achievable assessment tool that is a comprehensive and responsive measure of system level quality at a limited cost in resource-poor settings.

  3. Profile of the appendectomies performed in the Brazilian Public Health System

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    FERNANDA DOS SANTOS

    Full Text Available ABSTRACT Objective: to analyze the profile of appendectomies performed in the Brazilian Public Health System (SUS and to compare the laparoscopic and laparotomic techniques of appendectomy. Methods: This work used information from DataSus from 2008 to 2014 (http://datasus.saude.gov.br. We compared the data of patients submitted to laparotomic appendectomy with those submitted to laparoscopic one. Results: when comparing the total growth of appendectomies, the laparoscopic route increased 279.7%, while the increase in laparotomic surgery was 25% (p <0.001 in the study period. With regard to medical and hospital costs, laparoscopic appendectomy accounted for only 2.6% of the total expenditure on appendectomies performed by the Unified Health System (SUS hospitals, with an average cost 7.6% lower than that of laparotomy procedures, but without statistical significance. The mortality rate was 57.1% lower in the laparoscopic approach when compared with laparotomy. Conclusion: there has been a significant increase in the laparoscopic route in the treatment of appendicitis, but the method is still rarely used in SUS patients. The costs of laparoscopic appendectomy were similar to those observed in laparotomic access.

  4. Evaluation of the performance of national health systems in 2004-2011: An analysis of 173 countries.

    Science.gov (United States)

    Sun, Daxin; Ahn, Haksoon; Lievens, Tomas; Zeng, Wu

    2017-01-01

    In an effort to improve health service delivery and achieve better health outcomes, the World Health Organization (WHO) has called for improved efficiency of health care systems to better use the available funding. This study aims to examine the efficiency of national health systems using longitudinal country-level data. Data on health spending per capita, infant mortality rate (IMR), under 5 mortality rate (U5MR), and life expectancy (LE) were collected from or imputed for 173 countries from 2004 through 2011. Data envelopment analyses were used to evaluate the efficiency and regression models were constructed to examine the determinants of efficiency. The average efficiency of the national health system, when examined yearly, was 78.9%, indicating a potential saving of 21.1% of health spending per capita to achieve the same level of health status for children and the entire population, if all countries performed as well as their peers. Additionally, the efficiency of the national health system varied widely among countries. On average, Africa had the lowest efficiency of 67%, while West Pacific countries had the highest efficiency of 86%. National economic status, HIV/AIDS prevalence, health financing mechanisms and governance were found to be statistically associated with the efficiency of national health systems. Taking health financing as an example, a 1% point increase of social security expenses as a percentage of total health expenditure correlated to a 1.9% increase in national health system efficiency. The study underscores the need to enhance efficiency of national health systems to meet population health needs, and highlights the importance of health financing and governance in improving the efficiency of health systems, to ultimately improve health outcomes.

  5. The impact of health system reform plan on the hospital\\'s performance indicators of Lorestan University of Medical Sciences

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    Reza Dadgar

    2017-10-01

    Conclusion: The health system  reform plan has been positive changes in indicators of hospital performance. Therefore, while considering the current trend of continuous improvement, the continuity of the project was advised based on the results of this study.

  6. Is the Colombian health system reform improving the performance of public hospitals in Bogotá?

    Science.gov (United States)

    McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena

    2003-06-01

    Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data

  7. The Dimensions of health system performance evaluation with emphasis on the coverage of the vulnerable groups in Iran

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    Shahri S ,

    2016-05-01

    Full Text Available Evaluation is an integral part of any executive job and activity using of information measurable improvement is followed in administrative activities as a main aim . This study was conducted with aim of determine factors evaluating the performance of health systems based on structural equation modeling. In this descriptive analytical and practical. This study was conducted during 2015. 419 experts participated in this study. Data collection was conducted through researcher made questionnaire. Validity of the questionnaire in the way of their content validity and reliability by using Cronbach's alpha coefficient (0.94 was confirmed. Data were analyzed using the software SPSS 22 and LISREL 8.8. Findings revealed that variable healthcare service delivery with impact factor 0.79 is the most important factor affecting the assessment of health system performance and variable equitable access to health services was in second place with impact factor of 0.72 after variable of health care delivery. Variables stewardship, financial resources, protection against financial risks and resource generation respectively with impact factor of 0.69, 0.58, 0.58 and 0.54 in evaluating the performance of the health system was in third place to sixth. Considering the dimensions of health system performance can be pay evaluating the performance tailored to conditions in the country in order to the objectives of the health system

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

    Science.gov (United States)

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

    2017-12-01

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

  9. A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran.

    Science.gov (United States)

    Tabrizi, Jafar Sadegh; Gholipour, Kamal; Iezadi, Shabnam; Farahbakhsh, Mostafa; Ghiasi, Akbar

    2018-01-01

    The aim was to design a district health management performance framework for Iran's healthcare system. The mixed-method study was conducted between September 2015 and May 2016 in Tabriz, Iran. In this study, the indicators of district health management performance were obtained by analyzing the 45 semi-structured surveys of experts in the public health system. Content validity of performance indicators which were generated in qualitative part were reviewed and confirmed based on content validity index (CVI). Also content validity ratio (CVR) was calculated using data acquired from a survey of 21 experts in quantitative part. The result of this study indicated that, initially, 81 indicators were considered in framework of district health management performance and, at the end, 53 indicators were validated and confirmed. These indicators were classified in 11 categories which include: human resources and organizational creativity, management and leadership, rules and ethics, planning and evaluation, district managing, health resources management and economics, community participation, quality improvement, research in health system, health information management, epidemiology and situation analysis. The designed framework model can be used to assess the district health management and facilitates performance improvement at the district level.

  10. A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran

    Directory of Open Access Journals (Sweden)

    Jafar Sadegh Tabrizi

    2018-04-01

    Full Text Available The aim was to design a district health management performance framework for Iran’s healthcare system. The mixed-method study was conducted between September 2015 and May 2016 in Tabriz, Iran. In this study, the indicators of district health management performance were obtained by analyzing the 45 semi-structured surveys of experts in the public health system. Content validity of performance indicators which were generated in qualitative part were reviewed and confirmed based on content validity index (CVI. Also content validity ratio (CVR was calculated using data acquired from a survey of 21 experts in quantitative part. The result of this study indicated that, initially, 81 indicators were considered in framework of district health management performance and, at the end, 53 indicators were validated and confirmed. These indicators were classified in 11 categories which include: human resources and organizational creativity, management and leadership, rules and ethics, planning and evaluation, district managing, health resources management and economics, community participation, quality improvement, research in health system, health information management, epidemiology and situation analysis. The designed framework model can be used to assess the district health management and facilitates performance improvement at the district level.

  11. The Effects of Uniquely-Processed Titanium on Biological Systems: Implications for Human Health and Performance

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    David S. Rowlands

    2014-01-01

    Full Text Available Titanium is biocompatible and widely utilized in a variety of applications. Recently, titanium in pico-nanometer scale and soluble form (Aqua Titan has expanded its use to applied human health and performance. The purpose of this article is to review the current evidence associated with specific physiological responses to Aqua Titan-treated materials. In vitro studies have shown that application of Aqua Titan can modify membrane potential and long-term potentiation in isolated hippocampal neurons, suggesting reduced pain memory as a possible mechanism for reported analgesia. Proximal contact with Aqua Titan-treated titanium increased gene expression, protein synthesis, cell growth and adhesion in normal cultured muscle and bone cells, suggesting application for Aqua Titan in clinical implant procedures and wound healing. Evidence for beneficial effects on neuromuscular control of muscle-tendon function and improvements in running economy in human athletes was seen when Aqua Titan-treated tape was applied to the human triceps surae following fatigue induced by prior strenuous exercise. Finally, behavioral responses and effects on the autonomic nervous system to environmental exposure suggest Aqua Titan may promote a mild relaxant, or stress-suppressive response. Together, data suggest exposure to Aqua Titan-treated materials modulates aspects of growth and function in neuronal and other musculoskeletal cells with possible benefits to musculotendinous recovery from exercise and to the systemic response to stress.

  12. Network Performance and Coordination in the Health, Education, Telecommunications System. Satellite Technology Demonstration, Technical Report No. 0422.

    Science.gov (United States)

    Braunstein, Jean; Janky, James M.

    This paper describes the network coordination for the Health, Education, Telecommunications (HET) system. Specifically, it discusses HET network performance as a function of a specially-developed coordination system which was designed to link terrestrial equipment to satellite operations centers. Because all procedures and equipment developed for…

  13. Medicaid management information systems performance standards: Health Care Financing Administration. Notice with comment period.

    Science.gov (United States)

    1981-06-30

    This notice contains performance standards (review elements and factors). We are required by section 1903(r)(6)(E) of the Social Security Act to notify all States of proposed procedures, standards, and other requirements at least one quarter prior to the fiscal year in which the procedures, standards, and other requirements will be used for Medicaid Management Information Systems reapproval reviews. This Notice meets that statutory requirements. By October 1, 1981, we will use the performance standards and existing systems requirements when conducting the annual review of State system performance.

  14. The international performance of healthcare systems in population health: capabilities of pooled cross-sectional time series methods.

    Science.gov (United States)

    Reibling, Nadine

    2013-09-01

    This paper outlines the capabilities of pooled cross-sectional time series methodology for the international comparison of health system performance in population health. It shows how common model specifications can be improved so that they not only better address the specific nature of time series data on population health but are also more closely aligned with our theoretical expectations of the effect of healthcare systems. Three methodological innovations for this field of applied research are discussed: (1) how dynamic models help us understand the timing of effects, (2) how parameter heterogeneity can be used to compare performance across countries, and (3) how multiple imputation can be used to deal with incomplete data. We illustrate these methodological strategies with an analysis of infant mortality rates in 21 OECD countries between 1960 and 2008 using OECD Health Data. Copyright © 2013 The Author. Published by Elsevier Ireland Ltd.. All rights reserved.

  15. Health Promotion and Preventive Contents Performed During Reproduction System Learning; Observation in Senior High School

    Science.gov (United States)

    Yuniarti, E.; Fadilah, M.; Darussyamsu, R.; Nurhayati, N.

    2018-04-01

    The higher numbers of cases around sexual behavioral deviance on adolescence are significantly related to their knowledge level about the health of the reproduction system. Thus, teenagers, especially school-aged, have to receive the complete information which emphasizes on recognize promotion and prevention knowledge. This article aims to describe information about health promotion and prevention, which delivered by the teacher in Senior High School learning process on topic reproduction system. The data gained through focused observation using observation sheet and camera recorder. Further, data analyzed descriptively. The result show promotion and preventive approach have been inadequately presented. There are two reasons. Firstly, the promotion and preventive value are not technically requested in the final assessment. The second, the explanation tend to refer to consequences existed in the term of the social and religious norm rather than a scientific basis. It can be concluded suggestion to promote health reproduction and prevent the risk of health reproduction need to be implemented more practice with a scientific explanation which is included in a specific program for adolescence reproductive health improvement.

  16. Patients' Perceptions on the Performance of a Local Health System to Eliminate Leprosy, Paraná State, Brazil

    Science.gov (United States)

    Pieri, Flávia Meneguetti; Touso, Michelle Mosna; Rodrigues, Ludmila Barbosa Bandeira; Yamamura, Mellina; Pinto, Ione Carvalho; Dessunti, Elma Mathias; Crispim, Juliane de Almeida; Ramos, Antônio Carlos Vieira; Arroyo, Luiz Henrique; Neto, Marcelino Santos; Garcia, Maria Concebida da Cunha; Popolin, Marcela Paschoal; Silveira, Tatiane Ramos dos Santos; Arcêncio, Ricardo Alexandre

    2014-01-01

    Background In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. Methodology/Principal Findings A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. Conclusions/Significance The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem. PMID:25412349

  17. Effect of Personal Response Systems on Student Perception and Academic Performance in Courses in a Health Sciences Curriculum

    Science.gov (United States)

    FitzPatrick, Kathleen A.; Finn, Kevin E.; Campisi, Jay

    2011-01-01

    To increase student engagement, active participation, and performance, personal response systems (clickers) were incorporated into six lecture-based sections of four required courses within the Health Sciences Department major curriculum: freshman-level Anatomy and Physiology I and II, junior-level Exercise Physiology, and senior-level Human…

  18. Integrating views on support for mid-level health worker performance: a concept mapping study with regional health system actors in rural Guatemala.

    Science.gov (United States)

    Hernández, Alison R; Hurtig, Anna-Karin; Dahlblom, Kjerstin; San Sebastián, Miguel

    2015-10-08

    Mid-level health workers are on the front-lines in underserved areas in many LMICs, and their performance is critical for improving the health of vulnerable populations. However, improving performance in low-resource settings is complex and highly dependent on the organizational context of local health systems. This study aims to examine the views of actors from different levels of a regional health system in Guatemala on actions to support the performance of auxiliary nurses, a cadre of mid-level health workers with a prominent role in public sector service delivery. A concept mapping study was carried out to develop an integrated view on organizational support and identify locally relevant strategies for strengthening performance. A total of 93 regional and district managers, and primary and secondary care health workers participated in generating ideas on actions needed to support auxiliary nurses' performance. Ideas were consolidated into 30 action items, which were structured through sorting and rating exercises, involving a total of 135 of managers and health workers. Maps depicting participants' integrated views on domains of action and dynamics in sub-groups' interests were generated using a sequence of multivariate statistical analyses, and interpreted by regional managers. The combined input of health system actors provided a multi-faceted view of actions needed to support performance, which were organized in six domains, including: Communication and coordination, Tools to orient work, Organizational climate of support, Motivation through recognition, Professional development and Skills development. The nature of relationships across hierarchical levels was identified as a cross-cutting theme. Pattern matching and go-zone maps indicated directions for action based on areas of consensus and difference across sub-groups of actors. This study indicates that auxiliary nurses' performance is interconnected with the performance of other health system actors who

  19. Ukraine: health system review.

    Science.gov (United States)

    Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica

    2015-03-01

    This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  20. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation

    Science.gov (United States)

    2013-01-01

    Background Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. Methods This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. Results The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. Conclusions The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars

  1. Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation.

    Science.gov (United States)

    Witter, Sophie; Toonen, Jurrien; Meessen, Bruno; Kagubare, Jean; Fritsche, György; Vaughan, Kelsey

    2013-09-29

    Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within

  2. High-performance work systems in health care, part 3: the role of the business case.

    Science.gov (United States)

    Song, Paula H; Robbins, Julie; Garman, Andrew N; McAlearney, Ann Scheck

    2012-01-01

    Growing evidence suggests the systematic use of high-performance work practices (HPWPs), or evidence-based management practices, holds promise to improve organizational performance, including improved quality and efficiency, in health care organizations. However, little is understood about the investment required for HPWP implementation, nor the business case for HPWP investment. The aim of this study is to enhance our understanding about organizations' perspectives of the business case for HPWP investment, including reasons for and approaches to evaluating that investment. We used a multicase study approach to explore the business case for HPWPs in U.S. health care organizations. We conducted semistructured interviews with 67 key informants across five sites. All interviews were recorded, transcribed, and subjected to qualitative analysis using both deductive and inductive methods. The organizations in our study did not appear to have explicit financial return expectations for investments in HPWPs. Instead, the HPWP investment was viewed as an important factor contributing to successful execution of the organization's strategic priorities and a means for competitive differentiation in the market. Informants' characterizations of the HPWP investment did not involve financial terms; rather, descriptions of these investments as redeployment of existing resources or a shift of managerial time redirected attention from cost considerations. Evaluation efforts were rare, with organizations using broad organizational metrics to justify HPWP investment or avoiding formal evaluation altogether. Our findings are consistent with prior studies that have found that health care organizations have not systematically evaluated the financial outcomes of their quality-related initiatives or tend to forget formal business case analysis for investments they may perceive as "inevitable." In the absence of a clearly described association between HPWPs and outcomes or some other external

  3. Methods to stimulate national and sub-national benchmarking through international health system performance comparisons: a Canadian approach.

    Science.gov (United States)

    Veillard, Jeremy; Moses McKeag, Alexandra; Tipper, Brenda; Krylova, Olga; Reason, Ben

    2013-09-01

    This paper presents, discusses and evaluates methods used by the Canadian Institute for Health Information to present health system performance international comparisons in ways that facilitate their understanding by the public and health system policy-makers and can stimulate performance benchmarking. We used statistical techniques to normalize the results and present them on a standardized scale facilitating understanding of results. We compared results to the OECD average, and to benchmarks. We also applied various data quality rules to ensure the validity of results. In order to evaluate the impact of the public release of these results, we used quantitative and qualitative methods and documented other types of impact. We were able to present results for performance indicators and dimensions at national and sub-national levels; develop performance profiles for each Canadian province; and show pan-Canadian performance patterns for specific performance indicators. The results attracted significant media attention at national level and reactions from various stakeholders. Other impacts such as requests for additional analysis and improvement in data timeliness were observed. The methods used seemed attractive to various audiences in the Canadian context and achieved the objectives originally defined. These methods could be refined and applied in different contexts. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  4. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators.

    Science.gov (United States)

    Von Pressentin, Klaus B; Mash, Bob J; Esterhuizen, Tonya M

    2017-04-28

    The supply of appropriate health workers is a key building block in the World Health Organization's model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. All 52 South African health districts were included as units of analysis. An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician's circle of control may be better positioned to demonstrate a measurable impact in the short term.

  5. HEALTH SYSTEMS

    International Development Research Centre (IDRC) Digital Library (Canada)

    many levels, and underscores the fact that health ... The health of mothers and their children depends on the status of women. INSIGHT ... tions find fertile ground when poverty ... Dr Gita Sen, Professor of Public Policy at the Indian Institute.

  6. Slovenia: Health System Review.

    Science.gov (United States)

    Albreht, Tit; Pribakovic Brinovec, Radivoje; Josar, Dusan; Poldrugovac, Mircha; Kostnapfel, Tatja; Zaletel, Metka; Panteli, Dimitra; Maresso, Anna

    2016-06-01

    This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the population has improved over the last few decades. While life expectancy for both men and women is similar to EU averages, morbidity and mortality data show persistent disparities between regions, and mortality from external causes is particularly high. Satisfaction with health care delivery is high, but recently waiting times for some outpatient specialist services have increased. Greater focus on preventive measures is also needed as well as better care coordination, particularly for those with chronic conditions. Despite having relatively high levels of co-payments for many services covered by the universal compulsory health insurance system, these expenses are counterbalanced by voluntary health insurance, which covers 95% of the population liable for co-payments. However, Slovenia is somewhat unique among social health insurance countries in that it relies almost exclusively on payroll contributions to fund its compulsory health insurance system. This makes health sector revenues very susceptible to economic and labour market fluctuations. A future challenge will be to diversify the resource base for health system funding and thus bolster sustainability in the longer term, while preserving service delivery and quality of care. Given changing demographics and morbidity patterns, further challenges include restructuring the funding and provision of long-term care and enhancing health system efficiency through reform of purchasing and provider-payment systems. World Health Organization 2016 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  7. Effect of a ceiling fan ventilation system on finishing young bulls' health, behaviour and growth performance.

    Science.gov (United States)

    Magrin, L; Brscic, M; Lora, I; Rumor, C; Tondello, L; Cozzi, G; Gottardo, F

    2017-06-01

    This research aimed at assessing the effects of a ceiling fan ventilation system on health, feeding, social behaviour and growth response of finishing young bulls fattened indoors during a mild summer season. A total of 69 Charolais young bulls were housed in six pens without any mechanical ventilation system (Control) and in six pens equipped with ceiling fans. The experimental period lasted 98 days from June until mid-September 2014. Four experimental days were considered in order to assess the effect of the ventilation system under two different microclimatic conditions: 2 alert days at monthly interval with temperature humidity index (THI) between 75 and 78, and 2 normal days with THI⩽74. Health and behaviour of the bulls were evaluated through 8-h observation sessions starting after morning feed delivery. The study was carried out during a rather cool summer with a climate average THI of 68.9 and 4 days with average THI>75. Despite these mild climate conditions, ceiling fans lowered litter moisture and acted as a preventive measure for bulls' dirtiness (odd ratio=47.9; 95% CI 19.6 to 117.4). The risk of abnormal breathing was increased for Control bulls (odd ratio=40.7; 95% CI 5.4 to 304.2). When exposed to alert THI conditions, respiration rate and panting scores increased and rumination duration dropped in Control bulls compared with bulls provided with a ceiling fan. During observations under alert THI, bulls spent less time eating, more time being inactive and consumed more water compared with normal THI conditions. Bulls' daily dry matter intake measured during the observation sessions decreased on alert compared with normal THI days (Pbehaviour (rumination, lying down and drinking water) and respiration rate, however. The lack of a significant improvement of bulls' growth response should not discourage beef farmers from using ceiling fans in indoor systems, considering the likely increase in frequency and intensity of heat waves in the planet

  8. A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal.

    Science.gov (United States)

    Johnston, Sharon; Hogel, Matthew

    2016-05-01

    In 2004, Canada's First Ministers committed to reforms that would shape the future of the Canadian healthcare landscape. These agreements included commitments to improved performance reporting within the primary healthcare system. The aim of this paper was to review the state of primary healthcare performance reporting after the public reporting mandate agreed to a decade ago in the Action Plan for Health System Renewal of 2003 expired. A grey literature search was performed to identify reports released by the governmental and independent reporting bodies across Canada. No province, or the federal government, met their performance reporting obligations from the 2004 accords. Although the indicators required to report on in the 2004 Accord no longer reflect the priorities of patients, policy makers and physicians, provinces are also failing to report on these priorities. Canada needs better primary healthcare performance reporting to enable accountability and improvement within and across provinces. Despite the national mandate to improve public health system reporting, an opportunity to learn from the diverse primary healthcare reforms, underway across Canada for the past decade, has already been lost. Copyright © 2016 Longwoods Publishing.

  9. Malta: Health system review.

    Science.gov (United States)

    Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan

    2014-01-01

    This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  10. France: Health System Review.

    Science.gov (United States)

    Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

    2015-01-01

    This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending. World Health Organization 2015 (acting as the host organization for, and secretariat of, the

  11. Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation.

    Science.gov (United States)

    Rejeb, Olfa; Pilet, Claire; Hamana, Sabri; Xie, Xiaolan; Durand, Thierry; Aloui, Saber; Doly, Anne; Biron, Pierre; Perrier, Lionel; Augusto, Vincent

    2018-06-01

    Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

  12. Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system

    Directory of Open Access Journals (Sweden)

    Malaz A Boustani

    2010-05-01

    Full Text Available Malaz A Boustani1,2,3,4, Stephanie Munger1,2, Rajesh Gulati3,4, Mickey Vogel4, Robin A Beck3,4, Christopher M Callahan1,2,3,41Indiana University Center for Aging Research, 2Regenstrief Institute Inc., 3Indiana University School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, 4Indiana University Medical Group-Primary Care; Indianapolis, IN USAAbstract: Complexity science suggests that our current health care delivery system acts as a complex adaptive system (CAS. Such systems represent a dynamic and flexible network of individuals who can coevolve with their ever changing environment. The CAS performance fluctuates and its members’ interactions continuously change over time in response to the stress generated by its surrounding environment. This paper will review the challenges of intervening and introducing a planned change into a complex adaptive health care delivery system. We explore the role of the “reflective adaptive process” in developing delivery interventions and suggest different evaluation methodologies to study the impact of such interventions on the performance of the entire system. We finally describe the implementation of a new program, the Aging Brain Care Medical Home as a case study of our proposed evaluation process.Keywords: complexity, aging brain, implementation, complex adaptive system, sustained change, care delivery

  13. Real-Time Distribution Feeder Performance Monitoring, Advisory Control, and Health Management System

    Energy Technology Data Exchange (ETDEWEB)

    Stoupis, James; Mousavi, Mirrasoul

    2014-09-30

    provides this time and helps accelerate service restoration ultimately. To demonstrate the effectiveness of this feature, a demo system using substation data alone was set up to compare the minutes saved over a period of 22 months for two feeders where the real-time notification system has been deployed. The metric used for performance assessment is the time difference between the actual outage time from the OMS versus the time the notification email was received on the operators desk. Over the period of 22 months, we have accumulated over 7600 minutes (32 hours) ahead of actual outage time compared to the OMS timestamps. The significance of this analysis is that it shows the potential to reduce the SAIDI minutes and directly impact utility performance in terms of outage duration. If deployed at scale, it would have a significant impact on system reliability. To put this number in perspective, it would be helpful to assign a dollar figure to the potential savings that could be realized. According to the host utility, the average cost for each customer-minute-out (CMO) is approximately $0.30 across the operating company. This includes both direct and indirect costs such as bad press. The outage data over the previous 4 years show that the average customer count on primary/tap level outages is about 56. Accordingly, the total minutes saved amounts to 425,600 CMOs on the average. This would in turn result in a potential cost savings figure of $127,680 for two feeders alone over the period of performance. This empirical evidence validates the strong value proposition of the project that was contemplated at the onset and its potential impact to reduce outage duration in support of DOE’s goal of 20%

  14. Switzerland: Health System Review.

    Science.gov (United States)

    De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

    2015-01-01

    This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

  15. Performance-based financing with GAVI health system strengthening funding in rural Cambodia: a brief assessment of the impact.

    Science.gov (United States)

    Matsuoka, Sadatoshi; Obara, Hiromi; Nagai, Mari; Murakami, Hitoshi; Chan Lon, Rasmey

    2014-07-01

    Though Cambodia made impressive gains in immunization coverage between the years 2000 and 2005, it recognized several health system challenges to greater coverage of immunization and sustainability. The Global Alliance for Vaccines and Immunization (GAVI) opened a Health System Strengthening (HSS) funding window in 2006. To address the health system challenges, Cambodia has been receiving the GAVI HSS fund since October 2007. The major component of the support is performance-based financing (PBF) for maternal, neonatal and child health (MNCH) services. To examine the impact of the PBF scheme on MNCH services and administrative management in rural Cambodia. Quantitative and qualitative studies were conducted in Kroch Chhmar Operational District (OD), Cambodia. Quantitative analyses were conducted on the trends of the numbers of MNCH services. A brief analysis was conducted using qualitative data. After the commencement of the PBF support, the volume of MNCH services was significantly boosted. In addition, strengthened financial and operational management was observed in the study area. However, the quality of the MNCH services was not ensured. Technical assistance, rather than the PBF scheme, was perceived by stakeholders to play a vital role in increasing the quality of the services. To improve the quality of the health services provided, it is better to include indicators on the quality of care in the PBF scheme. Mutual co-operation between PBF models and technical assistance may ensure better service quality while boosting the quantity. A robust but feasible data validation mechanism should be in place, as a PBF could incentivize inaccurate reporting. The capacity for financial management should be strengthened in PBF recipient ODs. To address the broader aspects of MNCH, a balanced input of resources and strengthening of all six building blocks of a health system are necessary. Published by Oxford University Press in association with The London School of Hygiene

  16. Austria: health system review.

    Science.gov (United States)

    Hofmarcher, Maria M; Quentin, Wilm

    2013-01-01

    This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry

  17. High-performance work systems in health care management, part 2: qualitative evidence from five case studies.

    Science.gov (United States)

    McAlearney, Ann Scheck; Garman, Andrew N; Song, Paula H; McHugh, Megan; Robbins, Julie; Harrison, Michael I

    2011-01-01

    : A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety. : The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements. : Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis. : In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover). : These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify

  18. The Role of HSE management System in Improving health, safety and environment performance in an Oil Organization

    Directory of Open Access Journals (Sweden)

    SS. Alizadeh

    2006-10-01

    Full Text Available Background and aims   Nowadays, organisations: trying to utilize HSE system, To establish an appropriate system in the line of maintenance and promotion of healthy work environment without any accidents, injuries, and pollution.  HSE management system is a tool to control and improve the performance of health and safety  and environment in all development programs of industrial and other structural organizations. This is in fact an integrated system, so that all human financial and equipment resources will support each other to provide a healthy and convenience environment with no any accident and injuries.   Methods   In this case study all components of an HSE management system is review briefly and explain the role of this system in accident reduction rate and work efficiency in an oil company in the Persian Golf.Three years activities of HSE system in this company been studied, using all  reports and any related documents. Different variances as indicators had been defined with which  the annual performance of the HSE system, of the company have been evaluated.   Results   The results show that there are significant improvement in health, safety and environment during the period of 2001-2003 as HSE system implemented.  The rate of LTIF decreased from 0.69 in 2001 to 0.5 in 2003 or FAR decreased from 2.2 in 2001 to  0.7 in 2003, and the air pollution of SO 2 decreased from 397 T. in 2001 to 309T. in 2003.   Conclusion   This study indicated that although the number of employees, number of working hours and number of projects increased significantly during the years 2001 to 2003, but the rate of  different related indicators decreased such as LTIF, TRIR, FAR and pollutants like SO 2 , Co 2 , No  and CH4.

  19. Estonia: health system review.

    Science.gov (United States)

    Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

    2013-01-01

    This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  20. Generation and evaluation of an indicator of the health system's performance in maternal and reproductive health in Colombia: An ecological study.

    Science.gov (United States)

    Pinzón-Flórez, Carlos Eduardo; Fernandez-Niño, Julian Alfredo; Cardenas-Cardenas, Luz Mery; Díaz-Quijano, Diana Marcela; Ruiz-Rodriguez, Myriam; Reveiz, Ludovic; Arredondo-López, Armando

    2017-01-01

    To generate and evaluate an indicator of the health system's performance in the area of maternal and reproductive health in Colombia. An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator's score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator's behavior was found to have an association with the unsatisfied basic needs index and women's education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

  1. Generation and evaluation of an indicator of the health system's performance in maternal and reproductive health in Colombia: An ecological study.

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Pinzón-Flórez

    Full Text Available To generate and evaluate an indicator of the health system's performance in the area of maternal and reproductive health in Colombia.An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator's score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable.The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35. The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4. The poorest performance (Q1 occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator's behavior was found to have an association with the unsatisfied basic needs index and women's education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively. According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9; performance was a mediating variable.The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

  2. Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment.

    Science.gov (United States)

    Canavati, Sara E; Lawpoolsri, Saranath; Quintero, Cesia E; Nguon, Chea; Ly, Po; Pukrittayakamee, Sasithon; Sintasath, David; Singhasivanon, Pratap; Peeters Grietens, Koen; Whittaker, Maxine Anne

    2016-05-20

    Village malaria workers (VMWs) and mobile malaria workers (MMWs) are a critical component of Cambodia's national strategy to eliminate Plasmodium falciparum malaria by 2025. Since 2004, VMWs have been providing malaria diagnosis through the use of rapid diagnostic tests and free-of-charge artemisinin-based combination therapy in villages more than 5 km away from the closest health facility. They have also played a key role in the delivery of behaviour change communication interventions to this target population. This study aimed to assess the job performance of VMWs/MMWs, and identify challenges they face, which may impede elimination efforts. A mixed-methods assessment was conducted in five provinces of western Cambodia. One hundred and eighty five VMW/MMW participants were surveyed using a structured questionnaire. Qualitative data was gathered through a total of 60 focus group discussions and 65 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis. Overall, VMWs/MMWs met or exceeded the expected performance levels (80 %). Nevertheless, some performance gaps were identified. Misconceptions regarding malaria transmission and prevention were found among workers. The recommended approach for malaria treatment, directly-observed treatment (DOT), had low implementation rates. Stock-outs, difficulties in reaching out to migrant and mobile populations, insufficient means of transportation and dwindling worker satisfaction also affected job performance. VMW/MMW job performance must be increased from 80 to 100 % in order to achieve elimination. In order to do this, it is recommended for the national malaria programme to eliminate worker malaria knowledge gaps. Barriers to DOT implementation and health system failures also need to be addressed. The VMW programme should be expanded on several fronts in order to tackle remaining performance gaps. Findings from this evaluation are useful to inform the planning of future

  3. A framework for performance and data quality assessment of Radio Frequency IDentification (RFID) systems in health care settings.

    Science.gov (United States)

    van der Togt, Remko; Bakker, Piet J M; Jaspers, Monique W M

    2011-04-01

    RFID offers great opportunities to health care. Nevertheless, prior experiences also show that RFID systems have not been designed and tested in response to the particular needs of health care settings and might introduce new risks. The aim of this study is to present a framework that can be used to assess the performance of RFID systems particularly in health care settings. We developed a framework describing a systematic approach that can be used for assessing the feasibility of using an RFID technology in a particular healthcare setting; more specific for testing the impact of environmental factors on the quality of RFID generated data and vice versa. This framework is based on our own experiences with an RFID pilot implementation in an academic hospital in The Netherlands and a literature review concerning RFID test methods and current insights of RFID implementations in healthcare. The implementation of an RFID system within the blood transfusion chain inside a hospital setting was used as a show case to explain the different phases of the framework. The framework consists of nine phases, including an implementation development plan, RFID and medical equipment interference tests, data accuracy- and data completeness tests to be run in laboratory, simulated field and real field settings. The potential risks that RFID technologies may bring to the healthcare setting should be thoroughly evaluated before they are introduced into a vital environment. The RFID performance assessment framework that we present can act as a reference model to start an RFID development, engineering, implementation and testing plan and more specific, to assess the potential risks of interference and to test the quality of the RFID generated data potentially influenced by physical objects in specific health care environments. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. How high-performance work systems drive health care value: an examination of leading process improvement strategies.

    Science.gov (United States)

    Robbins, Julie; Garman, Andrew N; Song, Paula H; McAlearney, Ann Scheck

    2012-01-01

    As hospitals focus on increasing health care value, process improvement strategies have proliferated, seemingly faster than the evidence base supporting them. Yet, most process improvement strategies are associated with work practices for which solid evidence does exist. Evaluating improvement strategies in the context of evidence-based work practices can provide guidance about which strategies would work best for a given health care organization. We combined a literature review with analysis of key informant interview data collected from 5 case studies of high-performance work practices (HPWPs) in health care organizations. We explored the link between an evidence-based framework for HPWP use and 3 process improvement strategies: Hardwiring Excellence, Lean/Six Sigma, and Baldrige. We found that each of these process improvement strategies has not only strengths but also important gaps with respect to incorporating HPWPs involving engaging staff, aligning leaders, acquiring and developing talent, and empowering the front line. Given differences among these strategies, our analyses suggest that some may work better than others for individual health care organizations, depending on the organizations' current management systems. In practice, most organizations implementing improvement strategies would benefit from including evidence-based HPWPs to maximize the potential for process improvement strategies to increase value in health care.

  5. Performance Assessment in Management: an application to the health care system of the Brazilian Navy

    Directory of Open Access Journals (Sweden)

    Marcelino José Jorge

    2013-08-01

    Full Text Available Budgetary restrictions have become much more binding for the Brazilian Navy and both users’ access to health services provided by the Navy Health Service as well as hospitals’ access to new technologies appears to be endangered. This paper aims to evaluate the efficiency of naval hospitals in the light of these concerns, with a view toward designing better managerial tools to enhance health services in the Brazilian Navy. The paper presents an application of Data Envelopment Analysis (DEA to the study of productive efficiency in selected hospital units of the Brazilian Navy in order to suggest improvements on the use of productive resources by the Navy Health Service. Productive efficiency of hospital units located throughout the country are measured and compared. Data Envelopment Analysis models were used to calculate an efficient frontier for the seven naval hospitals assessed and to identify the group of relatively efficient naval hospitals which were used as benchmarks for calculating the pro-efficiency operation plans for the inefficient units.

  6. Simulation and Performance Analysis of Lithium Battery Bank Mounted on the Hybrid Power System for Mobile Public Health Center

    Science.gov (United States)

    Busono, Pratondo; Kartini, Evvy

    2013-07-01

    Mobile medical clinic has been proposed to serve homeless people, people in the disaster area or in the remote area where no health service exist. At that site, a number of essential services such as primary health care, general health screening, medical treatment and emergency/rescue operations are required. Such services usually requires on board electrical equipments such as refrigerators, komputer, power tools and medical equipments. To supply such electrical equipments, it needs extra auxiliary power sources, in addition of standard automotive power supply. The auxiliary power source specifically design to supply non automotive load which may have similar configuration, but usually uses high power alternator rated and larger deep cycle on board battery bank. This study covers the modeling and dynamic simulation of auxiliary power source/battery to supply the medical equipment and other electrical equipments on board. It consists a variable speed diesel generator set, photovoltaic (PV) generator mounted on the roof of the car, a rechargable battery bank. As an initial step in the system design, a simulation study was performed. The simulation is conducted in the system level. Simulation results shows that dynamical behaviour by means of current density, voltage and power plot over a chosen time range, and functional behaviour such as charging and discharging characteristic of the battery bank can be obtained.

  7. A "next generation" ethics committee. St. Joseph Health system has integrated performance-improvement features into its ethics work.

    Science.gov (United States)

    Murphy, Kevin

    2006-01-01

    Understanding the limitations that accompany the traditional model of ethics committees, St. Joseph Health System (SJHS), Orange, CA, has been working to integrate ethics expertise and quality-improvement methodology into its "Next Generation Model" (NG Model) for such committees. However, moving from a traditional structure to the NG Model (introduced to SJHS facilities in 1999) brought some challenges, not the least of which was a deep-rooted culture of resistance to change. Following a 2004 audit of how the NG model was working, some common challenges were identified. To deal with those challenges, SJHS developed some tools and techniques that have helped ease the ongoing transition. These tools have helped the system's ethics committees address such issues as collaboration for the sake of organizational integration, setting goals, and measuring performance of various ethics roles.

  8. Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs.

    Science.gov (United States)

    Ngo, Diana K L; Sherry, Tisamarie B; Bauhoff, Sebastian

    2017-02-01

    Pay-for-performance (P4P) programmes have been introduced in numerous developing countries with the goal of increasing the provision and quality of health services through financial incentives. Despite the popularity of P4P, there is limited evidence on how providers achieve performance gains and how P4P affects health system quality by changing structural inputs. We explore these two questions in the context of Rwanda's 2006 national P4P programme by examining the programme's impact on structural quality measures drawn from international and national guidelines. Given the programme's previously documented success at increasing institutional delivery rates, we focus on a set of delivery-specific and more general structural inputs. Using the programme's quasi-randomized roll-out, we apply multivariate regression analysis to short-run facility data from the 2007 Service Provision Assessment. We find positive programme effects on the presence of maternity-related staff, the presence of covered waiting areas and a management indicator and a negative programme effect on delivery statistics monitoring. We find no effects on a set of other delivery-specific physical resources, delivery-specific human resources, delivery-specific operations, general physical resources and general human resources. Using mediation analysis, we find that the positive input differences explain a small and insignificant fraction of P4P's impact on institutional delivery rates. The results suggest that P4P increases provider availability and facility operations but is only weakly linked with short-run structural health system improvements overall. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Evaluation of the Quality of Occupational Health and Safety Management Systems Based on Key Performance Indicators in Certified Organizations.

    Science.gov (United States)

    Mohammadfam, Iraj; Kamalinia, Mojtaba; Momeni, Mansour; Golmohammadi, Rostam; Hamidi, Yadollah; Soltanian, Alireza

    2017-06-01

    Occupational Health and Safety Management Systems are becoming more widespread in organizations. Consequently, their effectiveness has become a core topic for researchers. This paper evaluates the performance of the Occupational Health and Safety Assessment Series 18001 specification in certified companies in Iran. The evaluation is based on a comparison of specific criteria and indictors related to occupational health and safety management practices in three certified and three noncertified companies. Findings indicate that the performance of certified companies with respect to occupational health and safety management practices is significantly better than that of noncertified companies. Occupational Health and Safety Assessment Series 18001-certified companies have a better level of occupational health and safety; this supports the argument that Occupational Health and Safety Management Systems play an important strategic role in health and safety in the workplace.

  10. The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

    Science.gov (United States)

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

    2012-01-01

    This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

  11. Connected motorcycle system performance.

    Science.gov (United States)

    2016-01-15

    This project characterized the performance of Connected Vehicle Systems (CVS) on motorcycles based on two key components: global positioning and wireless communication systems. Considering that Global Positioning System (GPS) and 5.9 GHz Dedicated Sh...

  12. Hospital System Performance within Veterans Affairs

    Data.gov (United States)

    Department of Veterans Affairs — Strategic Analytics for Improvement and Learning Value Model or SAIL, is a system for summarizing hospital system performance within Veterans Health Administration...

  13. Why performance-based contracting failed in Uganda--an "open-box" evaluation of a complex health system intervention.

    Science.gov (United States)

    Ssengooba, Freddie; McPake, Barbara; Palmer, Natasha

    2012-07-01

    Performance-based contracting (PBC) is a tool that links rewards to attainment of measurable performance targets. Significant problems remain in the methods used to evaluate this tool. The primary focus of evaluations on the effects of PBC (black-box) and less attention to how these effects arise (open-box) generates suboptimal policy learning. A black-box impact evaluation of PBC pilot by the Development Research Group of the World Bank (DRG) and the Ministry of Health (MOH) concluded that PBC was ineffective. This paper reports a theory-based case study intended to clarify how and why PBC failed to achieve its objectives. To explain the observed PBC implementation and responses of participants, this case study employed two related theories i.e. complex adaptive system and expectancy theory respectively. A prospective study trailed the implementation of PBC (2003-2006) while collecting experiences of participants at district and hospital levels. Significant problems were encountered in the implementation of PBC that reflected its inadequate design. As problems were encountered, hasty adaptations resulted in a de facto intervention distinct from the one implied at the design stage. For example, inadequate time was allowed for the selection of service targets by the health centres yet they got 'locked-in' to these poor choices. The learning curve and workload among performance auditors weakened the validity of audit results. Above all, financial shortfalls led to delays, short-cuts and uncertainty about the size and payment of bonuses. The lesson for those intending to implement similar interventions is that PBC should not be attempted 'on the cheap'. It requires a plan to boost local institutional and technical capacities of implementers. It also requires careful consideration of the responses of multiple actors - both insiders and outsiders to the intended change process. Given the costs and complexity of PBC implementation, strengthening conventional approaches

  14. Health System Measurement Project

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed...

  15. An Overview of Turkish Healthcare System after Health Transformation Program: Main Successes, Performance Assessment, Further Challenges, and Policy Options

    Directory of Open Access Journals (Sweden)

    Kadir GÜRSOY

    2015-02-01

    Full Text Available Turkish healthcare system has been stated to show significant improvements regarding wider access to healthcare facilities, and the quality and efficiency through the introduction of Health Transformation Program launched in 2003. While the old system relied on differing provisions and financing and lacked behind many developed nations in terms of health outcomes, the new system achieved nearly universal coverage and many health outcomes enhanced significantly. Health expenditures rose to 5.4% of GDP in 2013 from 4.8% in 1998. Furthermore, Turkey provided both better financial protection for the poor against high health expenditures, and equity in access to health care across the population. However, Turkey still faces new challenges to catch other developed countries to have better health and further improve financial sustainability. To reach these targets, Turkey needs to further implement new policy options for reform such as combating informal economy, allocating more on health resources, designing incentive- based payment methods, adopting gate keeping system and referral chain, developing capacity to deploy health technology assessments in reimbursement decisions, and ensuring the hospital autonomy.

  16. System performance optimization

    International Nuclear Information System (INIS)

    Bednarz, R.J.

    1978-01-01

    The System Performance Optimization has become an important and difficult field for large scientific computer centres. Important because the centres must satisfy increasing user demands at the lowest possible cost. Difficult because the System Performance Optimization requires a deep understanding of hardware, software and workload. The optimization is a dynamic process depending on the changes in hardware configuration, current level of the operating system and user generated workload. With the increasing complication of the computer system and software, the field for the optimization manoeuvres broadens. The hardware of two manufacturers IBM and CDC is discussed. Four IBM and two CDC operating systems are described. The description concentrates on the organization of the operating systems, the job scheduling and I/O handling. The performance definitions, workload specification and tools for the system stimulation are given. The measurement tools for the System Performance Optimization are described. The results of the measurement and various methods used for the operating system tuning are discussed. (Auth.)

  17. A framework for performance and data quality assessment of Radio Frequency IDentification (RFID) systems in health care settings

    NARCIS (Netherlands)

    van der Togt, Remko; Bakker, Piet J. M.; Jaspers, Monique W. M.

    2011-01-01

    Objective: RFID offers great opportunities to health care. Nevertheless, prior experiences also show that RFID systems have not been designed and tested in response to the particular needs of health care settings and might introduce new risks. The aim of this study is to present a framework that can

  18. Canada: Health system review.

    Science.gov (United States)

    Marchildon, Gregory

    2013-01-01

    Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and

  19. System Performance and Testing

    NARCIS (Netherlands)

    Frei, U.; Oversloot, H.

    2004-01-01

    This chapter compares and contrasts the system performance of two widely used solar thermal systems using testing and simulation programs. Solar thermal systems are used in many countries for heating domestically used water. In addition to the simple thermosiphon systems, better designed pumped

  20. Market competition, ownership, payment systems and the performance of health care providers - a panel study among Finnish occupational health services providers.

    Science.gov (United States)

    Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

    2013-10-01

    Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provider and prices are market determined. The price regulation of public providers was abolished in 1995. We had data on providers from 1992, 1995, 1997, 2000 and 2004. The unbalanced panel consisted of 1145 providers and 4059 observations. Our results show that in more competitive markets providers in general offered a higher share of medical care compared to preventive services. The association between unit prices and revenues and market environment varied according to the provider type. For-profit providers had lower prices and revenues in markets with numerous providers. The public providers in more competitive regions were more sensitive to react to the abolishment of their price regulation by raising their prices. Employer governed providers had weaker association between unit prices or revenues and competition. The market share of for-profit providers was negatively associated with productivity, which was the only sign of market spillovers we found in our study.

  1. Greece: Health system review.

    Science.gov (United States)

    Economou, Charalambos

    2010-01-01

    financing and equity in access to health care services. Efficiency is in question due to the lack of incentives to improve performance in the public sector. Mechanisms for needs assessment and priority-setting are underdeveloped and, as a consequence, the regional distribution of health resources is unequal. Centralization of the system is coupled with a lack of planning and coordination, and limited managerial and administrative capacity. In addition, the oversupply of physicians, the absence of a referral system, and irrational pricing and reimbursement policies are factors encouraging under-the-table payments and the black economy. These shortcomings result in low satisfaction with the health care system expressed by citizens. The landmark in the development of the Greek health care system was the creation of the national health system (ESY) in 1983. This report describes the development of the ESY at the structural level and generally, the process of implementing reforms. The strategic targets of health reform initiatives have been to structure a unified health care sector along the lines of the original ESY proposal and to cope with current inefficiencies. However, the three reforms attempted in the 1990s were never fully implemented, while the ambitious reform project of the period 2000–2004, which provided for the regionalization of the system, new management structures, prospective reimbursement, new employment conditions for hospital doctors, modernization of public health services and reorganization of primary health care, was abolished after the elections of 2004 and a change in government. While the new strategy, launched in 2005 with the stated aims of securing the financial viability of the health care system in the short term and its sustainability in the long term, addressed specific weaknesses, it has been rather controversial: the introduction of a centralized administrative public procurement system, the development of public–private partnerships

  2. Evaluation of the Quality of Occupational Health and Safety Management Systems Based on Key Performance Indicators in Certified Organizations

    OpenAIRE

    Iraj Mohammadfam; Mojtaba Kamalinia; Mansour Momeni; Rostam Golmohammadi; Yadollah Hamidi; Alireza Soltanian

    2017-01-01

    Background: Occupational Health and Safety Management Systems are becoming more widespread in organizations. Consequently, their effectiveness has become a core topic for researchers. This paper evaluates the performance of the Occupational Health and Safety Assessment Series 18001 specification in certified companies in Iran. Methods: The evaluation is based on a comparison of specific criteria and indictors related to occupational health and safety management practices in three certified...

  3. The Dutch Health Care Performance Report: seven years of health care performance assessment in the Netherlands

    NARCIS (Netherlands)

    van den Berg, Michael J.; Kringos, Dionne S.; Marks, Lisanne K.; Klazinga, Niek S.

    2014-01-01

    In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality,

  4. Using a model of the performance measures in Soft Systems Methodology (SSM) to take action: a case study in health care

    NARCIS (Netherlands)

    Kotiadis, K.; Tako, A.; Rouwette, E.A.J.A.; Vasilakis, C.; Brennan, J.; Gandhi, P.; Wegstapel, H.; Sagias, F.; Webb, P.

    2013-01-01

    This paper uses a case study of a multidisciplinary colorectal cancer team in health care to explain how a model of performance measures can lead to debate and action in Soft System Methodology (SSM). This study gives a greater emphasis and role to the performance measures than currently given in

  5. Henry Ford Health Systems

    Science.gov (United States)

    Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.

  6. Measuring health system strengthening: application of the balanced scorecard approach to rank the baseline performance of three rural districts in Zambia.

    Directory of Open Access Journals (Sweden)

    Wilbroad Mutale

    Full Text Available INTRODUCTION: There is growing interest in health system performance and recently WHO launched a report on health systems strengthening emphasising the need for close monitoring using system-wide approaches. One recent method is the balanced scorecard system. There is limited application of this method in middle- and low-income countries. This paper applies the concept of balanced scorecard to describe the baseline status of three intervention districts in Zambia. METHODOLOGY: The Better Health Outcome through Mentoring and Assessment (BHOMA project is a randomised step-wedged community intervention that aims to strengthen the health system in three districts in the Republic of Zambia. To assess the baseline status of the participating districts we used a modified balanced scorecard approach following the domains highlighted in the MOH 2011 Strategic Plan. RESULTS: Differences in performance were noted by district and residence. Finance and service delivery domains performed poorly in all study districts. The proportion of the health workers receiving training in the past 12 months was lowest in Kafue (58% and highest in Luangwa district (77%. Under service capacity, basic equipment and laboratory capacity scores showed major variation, with Kafue and Luangwa having lower scores when compared to Chongwe. The finance domain showed that Kafue and Chongwe had lower scores (44% and 47% respectively. Regression model showed that children's clinical observation scores were negatively correlated with drug availability (coeff -0.40, p = 0.02. Adult clinical observation scores were positively association with adult service satisfaction score (coeff 0.82, p = 0.04 and service readiness (coeff 0.54, p = 0.03. CONCLUSION: The study applied the balanced scorecard to describe the baseline status of 42 health facilities in three districts of Zambia. Differences in performance were noted by district and residence in most domains with finance and service

  7. Measuring health system strengthening: application of the balanced scorecard approach to rank the baseline performance of three rural districts in Zambia.

    Science.gov (United States)

    Mutale, Wilbroad; Godfrey-Fausset, Peter; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Chintu, Namwinga; Balabanova, Dina; Spicer, Neil; Ayles, Helen

    2013-01-01

    There is growing interest in health system performance and recently WHO launched a report on health systems strengthening emphasising the need for close monitoring using system-wide approaches. One recent method is the balanced scorecard system. There is limited application of this method in middle- and low-income countries. This paper applies the concept of balanced scorecard to describe the baseline status of three intervention districts in Zambia. The Better Health Outcome through Mentoring and Assessment (BHOMA) project is a randomised step-wedged community intervention that aims to strengthen the health system in three districts in the Republic of Zambia. To assess the baseline status of the participating districts we used a modified balanced scorecard approach following the domains highlighted in the MOH 2011 Strategic Plan. Differences in performance were noted by district and residence. Finance and service delivery domains performed poorly in all study districts. The proportion of the health workers receiving training in the past 12 months was lowest in Kafue (58%) and highest in Luangwa district (77%). Under service capacity, basic equipment and laboratory capacity scores showed major variation, with Kafue and Luangwa having lower scores when compared to Chongwe. The finance domain showed that Kafue and Chongwe had lower scores (44% and 47% respectively). Regression model showed that children's clinical observation scores were negatively correlated with drug availability (coeff -0.40, p = 0.02). Adult clinical observation scores were positively association with adult service satisfaction score (coeff 0.82, p = 0.04) and service readiness (coeff 0.54, p = 0.03). The study applied the balanced scorecard to describe the baseline status of 42 health facilities in three districts of Zambia. Differences in performance were noted by district and residence in most domains with finance and service delivery performing poorly in all study districts. This tool could

  8. Measuring Health System Strengthening: Application of the Balanced Scorecard Approach to Rank the Baseline Performance of Three Rural Districts in Zambia

    Science.gov (United States)

    Mutale, Wilbroad; Godfrey-Fausset, Peter; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Chintu, Namwinga; Balabanova, Dina; Spicer, Neil; Ayles, Helen

    2013-01-01

    Introduction There is growing interest in health system performance and recently WHO launched a report on health systems strengthening emphasising the need for close monitoring using system-wide approaches. One recent method is the balanced scorecard system. There is limited application of this method in middle- and low-income countries. This paper applies the concept of balanced scorecard to describe the baseline status of three intervention districts in Zambia. Methodology The Better Health Outcome through Mentoring and Assessment (BHOMA) project is a randomised step-wedged community intervention that aims to strengthen the health system in three districts in the Republic of Zambia. To assess the baseline status of the participating districts we used a modified balanced scorecard approach following the domains highlighted in the MOH 2011 Strategic Plan. Results Differences in performance were noted by district and residence. Finance and service delivery domains performed poorly in all study districts. The proportion of the health workers receiving training in the past 12 months was lowest in Kafue (58%) and highest in Luangwa district (77%). Under service capacity, basic equipment and laboratory capacity scores showed major variation, with Kafue and Luangwa having lower scores when compared to Chongwe. The finance domain showed that Kafue and Chongwe had lower scores (44% and 47% respectively). Regression model showed that children's clinical observation scores were negatively correlated with drug availability (coeff −0.40, p = 0.02). Adult clinical observation scores were positively association with adult service satisfaction score (coeff 0.82, p = 0.04) and service readiness (coeff 0.54, p = 0.03). Conclusion The study applied the balanced scorecard to describe the baseline status of 42 health facilities in three districts of Zambia. Differences in performance were noted by district and residence in most domains with finance and service delivery

  9. Real Time Supervisors and Monitors for Performing Health Monitoring and Fault Detection for Systems Operating in Multiple Regimes

    National Research Council Canada - National Science Library

    Jaw, Link

    2003-01-01

    In this Phase I STTR, SMI and ARL have developed a Real Time Supervisor for fault detection and system reconfiguration in a team of micro UAVs, that are tasked to perform a team mission like surveillance or rendezvous...

  10. Croatia: health system review.

    Science.gov (United States)

    Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

    2014-01-01

    of the MHI scheme are broad, patients must pay towards the costs of many goods and services, and the right to free health care services has been systematically reduced since 2003, although with exemptions for vulnerable population groups. Configuration of capital and human resources in the health care sector could be improved: for example, homes for the elderly and infirm persons operate close to maximum capacity; psychiatric care in the community is not well developed; and there are shortages of certain categories of medical professionals, including geographical imbalances. Little research is available on the policy process of health care reforms in Croatia. However, it seems that reforms often lack strategic foundations and or projections that could be analysed and scrutinized by the public, and evaluation of reform outcomes is lacking. The overall performance of the health care system seems to be good, given the amount of resources available. However, there is a lack of data to assess it properly. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  11. Denmark: Health system review

    DEFF Research Database (Denmark)

    Juul, Annegrete; Krasnik, Allan; Rudkjøbing, Andreas

    The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery...... of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health...... system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability)....

  12. How Do Countries' Health Information Systems Perform in Assessing Asylum Seekers' Health Situation? Developing a Health Information Assessment Tool on Asylum Seekers (HIATUS) and Piloting It in Two European Countries.

    Science.gov (United States)

    Bozorgmehr, Kayvan; Goosen, Simone; Mohsenpour, Amir; Kuehne, Anna; Razum, Oliver; Kunst, Anton E

    2017-08-08

    Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods : Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson's rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0-97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results : In the independent rating, Pearson's rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio

  13. Human Performance Evaluation System

    International Nuclear Information System (INIS)

    Hardwick, R.J. Jr.

    1985-01-01

    Operating nuclear power plants requires high standards of performance, extensive training and responsive management. Despite our best efforts inappropriate human actions do occur, but they can be managed. An extensive review of License Event Reports (LERs) was conducted which indicated continual inadequacy in human performance and in evaluation of root causes. Of some 31,000 LERs, about 5,000 or 16% were directly attributable to inappropriate actions. A recent analysis of 87 Significant Event Reports (issued by INPO in 1983) identified inappropriate actions as being the most frequent root cause (44% of the total). A more recent analysis of SERs issued in 1983 and 1984 indicate that 52% of the root causes were attributed to human performance. The Human Performance Evaluation System (HPES) is a comprehensive, coordinated utility/industry system for evaluating and reporting human performance situtations. HPES is a result of the realization that current reporting system provide limited treatment of human performance and rarely provide adequate information about root causes of inappropriate actions by individuals. The HPES was implemented to identify and eliminate root causes of inappropriate actions

  14. High-performance work systems in health care management, part 1: development of an evidence-informed model.

    Science.gov (United States)

    Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan

    2011-01-01

    : Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.

  15. [The Hospital Information System of the Brazilian National Unified Health System: a preliminary evaluation of performance in monitoring RhD hemolytic disease of the newborn].

    Science.gov (United States)

    Lobato, Gustavo; Reichenheim, Michael Eduardo; Coeli, Claudia Medina

    2008-03-01

    This study aimed to evaluate the adequacy of the Hospital Information System of the National Unified Health System (SIH-SUS) in identifying cases of RhD hemolytic disease of the newborn (HDN) at the Fernandes Figueira Institute (IFF/FIOCRUZ) from 1998 to 2003. Neonatal records, data from the Medical Archives, and AIH (Hospital Admissions Authorization Form) data consolidated in the SIH-SUS were analyzed. Cases were identified according to the following fields: principal diagnosis, secondary diagnosis, and procedure performed. During the period studied, 194 cases of HDN were diagnosed. The Medical Archives registered 148 newborns with HDN, however only 147 AIHs were issued and 145 consolidated in the SIH-SUS. Among these 145 cases, 84 cited HDN as the principal diagnosis, while secondary diagnosis identified 38 additional cases and the procedures performed failed to identify any further cases. Thus, the SIH-SUS identified only 122 (62.9%) of the 194 cases of HDN treated at the IFF/FIOCRUZ. Although it is necessary to evaluate other units, the SIH-SUS does not appear to be reliable for monitoring HDN. Additional studies are essential for employing secondary administrative data in the context of epidemiological surveillance.

  16. The effect of Health, Safety and Environment Management System (HSE-MS on the improvement of safety performance indices in Urea and Ammonia Kermanshah Petrochemical Company

    Directory of Open Access Journals (Sweden)

    M. S. Poursoleiman

    2015-09-01

    .Conclusion: The implementation of Health, Safety and the Environment Management System caused a reduction in accidents and its consequences and most of the safety performance indices in the entire process cycle of Kermanshah Petrochemical Company. Overall, safety condition has been improved considerably.

  17. High performance systems

    Energy Technology Data Exchange (ETDEWEB)

    Vigil, M.B. [comp.

    1995-03-01

    This document provides a written compilation of the presentations and viewgraphs from the 1994 Conference on High Speed Computing given at the High Speed Computing Conference, {open_quotes}High Performance Systems,{close_quotes} held at Gleneden Beach, Oregon, on April 18 through 21, 1994.

  18. Belgium: Health system review.

    Science.gov (United States)

    Gerkens, Sophie; Merkur, Sherry

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care. World Health Organization 2010, on behalf of the European Observatory on health systems and Policies.

  19. Atmospheric detritiation system performance

    International Nuclear Information System (INIS)

    Longhurst, G.R.; Jalbert, R.A.; Rossmassler, R.L.

    1989-01-01

    An investigation of the performance of atmospheric detritiation systems and of possible ways for improving their performance was undertaken. Small-scale experiments demonstrated that system performance is strongly dependent on catalyst bed temperature. That may be helped by addition of protium to the process gas stream, but added protium at constant temperature does not increase conversion to HTO. Collection of the HTO on dry sieve with residual HTO fraction of less than one part in 10/sup 7/ was observed. Ways suggested for improvement in collection of HTO on molecular sieve beds include adding H/sub 2/O to the stream entering the molecular sieve and premoistening of the sieve with H/sub 2/O. While these improvement schemes may reduce HTO emissions they increase the amount of tritiated waste that must be handled

  20. Atmospheric detritiation system performance

    International Nuclear Information System (INIS)

    Longhurst, G.R.; Jalbert, R.A.; Rossmassler, R.L.; Los Alamos National Lab., NM; Princeton Univ., NJ

    1988-01-01

    An investigation of the performance of atmospheric detritiation systems and of possible ways for improving their performance was undertaken. Small-scale experiments demonstrated that system performance is strongly dependent on catalyst bed temperature. That may be helped by addition of protium to the process gas stream, but added protium at constant temperature does not increase conversion to HTO. Collection of the HTO on dry sieve with residual HTO fraction of less than one part in 10 7 was observed. Ways suggested for improvement in collection of HTO on molecular sieve beds include adding H 2 O to the stream entering the molecular sieve and premoistening of the sieve with H 2 O. While these improvement schemes may reduce HTO emissions they increase the amount of tritiated waste that must be handled. 13 refs., 4 figs

  1. Health care delivery systems.

    NARCIS (Netherlands)

    Stevens, F.; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

  2. A comparison of hierarchical cluster analysis and league table rankings as methods for analysis and presentation of district health system performance data in Uganda.

    Science.gov (United States)

    Tashobya, Christine K; Dubourg, Dominique; Ssengooba, Freddie; Speybroeck, Niko; Macq, Jean; Criel, Bart

    2016-03-01

    In 2003, the Uganda Ministry of Health introduced the district league table for district health system performance assessment. The league table presents district performance against a number of input, process and output indicators and a composite index to rank districts. This study explores the use of hierarchical cluster analysis for analysing and presenting district health systems performance data and compares this approach with the use of the league table in Uganda. Ministry of Health and district plans and reports, and published documents were used to provide information on the development and utilization of the Uganda district league table. Quantitative data were accessed from the Ministry of Health databases. Statistical analysis using SPSS version 20 and hierarchical cluster analysis, utilizing Wards' method was used. The hierarchical cluster analysis was conducted on the basis of seven clusters determined for each year from 2003 to 2010, ranging from a cluster of good through moderate-to-poor performers. The characteristics and membership of clusters varied from year to year and were determined by the identity and magnitude of performance of the individual variables. Criticisms of the league table include: perceived unfairness, as it did not take into consideration district peculiarities; and being oversummarized and not adequately informative. Clustering organizes the many data points into clusters of similar entities according to an agreed set of indicators and can provide the beginning point for identifying factors behind the observed performance of districts. Although league table ranking emphasize summation and external control, clustering has the potential to encourage a formative, learning approach. More research is required to shed more light on factors behind observed performance of the different clusters. Other countries especially low-income countries that share many similarities with Uganda can learn from these experiences. © The Author 2015

  3. Enterprise performance measurement systems

    Directory of Open Access Journals (Sweden)

    Milija Bogavac

    2014-10-01

    Full Text Available Performance measurement systems are an extremely important part of the control and management actions, because in this way a company can determine its business potential, its market power, potential and current level of business efficiency. The significance of measurement consists in influencing the relationship between the results of reproduction (total volume of production, value of production, total revenue and profit and investments to achieve these results (factors of production spending and hiring capital in order to achieve the highest possible quality of the economy. (The relationship between the results of reproduction and investment to achieve them quantitatively determines economic success as the quality of the economy. Measuring performance allows the identification of the economic resources the company has, so looking at the key factors that affect its performance can help to determine the appropriate course of action.

  4. Poland health system review.

    Science.gov (United States)

    Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard

    2011-01-01

    Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures

  5. Bulgaria health system review.

    Science.gov (United States)

    Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout

    2012-01-01

    In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health

  6. The effect of Health, Safety and Environment Management System (HSE-MS on the improvement of safety performance indices in Urea and Ammonia Kermanshah Petrochemical Company

    Directory of Open Access Journals (Sweden)

    M. S. Poursoleiman

    2015-09-01

    Full Text Available Introduction: Work-related accidents may cause damage to people, environment and lead to waste of time and money. Health, Safety and Environment Management System has been developed in order to reduce accidents. This study aimed to investigate the effect of implementation of this system on reduction of the accidents and its consequences and also on the safety performance indices in Kermanshah Petrochemical Company. Material and Method: In this study, records of accidents were collected by OSHA incident report form 301 over 4 years. Following, the mean annual accidents and its consequences and safety performance indices were calculated and reported. Then, using statistical analysis, the impacts of two years implementation of this system on the accidents and its consequences and safety performance indices were evaluated. Result: The results showed that the implementation of HSE system was significantly correlated with Frequency Severity Indicator, Accident Severity Rate, lost days, minor accidents and total incidents (P-value 0.05. Conclusion: The implementation of Health, Safety and the Environment Management System caused a reduction in accidents and its consequences and most of the safety performance indices in the entire process cycle of Kermanshah Petrochemical Company. Overall, safety condition has been improved considerably.

  7. Circumpolar Inuit health systems.

    Science.gov (United States)

    Ellsworth, Leanna; O'Keeffe, Annmaree

    2013-01-01

    The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic - Canada, Greenland, USA (Alaska) and Russia (Chukotka). In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska) and Russia (Chukotka) and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Literature review. It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems' effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of comparison in terms of methodology and timing of the available data

  8. NASA Human Health and Performance Strategy

    Science.gov (United States)

    Davis, Jeffrey R.

    2012-01-01

    In May 2007, what was then the Space Life Sciences Directorate, issued the 2007 Space Life Sciences Strategy for Human Space Exploration. In January 2012, leadership and key directorate personnel were once again brought together to assess the current and expected future environment against its 2007 Strategy and the Agency and Johnson Space Center goals and strategies. The result was a refined vision and mission, and revised goals, objectives, and strategies. One of the first changes implemented was to rename the directorate from Space Life Sciences to Human Health and Performance to better reflect our vision and mission. The most significant change in the directorate from 2007 to the present is the integration of the Human Research Program and Crew Health and Safety activities. Subsequently, the Human Health and Performance Directorate underwent a reorganization to achieve enhanced integration of research and development with operations to better support human spaceflight and International Space Station utilization. These changes also enable a more effective and efficient approach to human system risk mitigation. Since 2007, we have also made significant advances in external collaboration and implementation of new business models within the directorate and the Agency, and through two newly established virtual centers, the NASA Human Health and Performance Center and the Center of Excellence for Collaborative Innovation. Our 2012 Strategy builds upon these successes to address the Agency's increased emphasis on societal relevance and being a leader in research and development and innovative business and communications practices. The 2012 Human Health and Performance Vision is to lead the world in human health and performance innovations for life in space and on Earth. Our mission is to enable optimization of human health and performance throughout all phases of spaceflight. All HH&P functions are ultimately aimed at achieving this mission. Our activities enable

  9. Circumpolar Inuit health systems

    Directory of Open Access Journals (Sweden)

    Leanna Ellsworth

    2013-08-01

    Full Text Available Background . The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska and Russia (Chukotka. In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective . To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska and Russia (Chukotka and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design . Literature review. Results . It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of

  10. Body condition scores at calving and their association with dairy cow performance and health in semiarid environment under two cooling systems

    Directory of Open Access Journals (Sweden)

    Mohamed A.B. Mandour

    2015-02-01

    Full Text Available Under tropical environments cow’s body condition at calving may influence productivity and health performance. Therefore, the current research evaluated the impact of body condition score (BCS at calving on milk production traits and health problems of primiparous and multiparous cows raised under two cooling systems in semi-arid environment. Milk yield parameters and health disorders data at different parities were obtained from 1700 Holstein cows, which were managed under Korral Kool (KKC and fan (FC cooling systems in Saudi Arabia. The results revealed that KKC system induced high level of milk production improvement (305TM, days in milk, daily milk yield (P<0.05 compared to FC, especially in multiparous cows. There was an advantage of the high BCS group under KKC system over the FC system for peak yield and period. Cows from both cooling systems having moderate BCS outdid the other groups for total milk yield. Low BCS primiparous cows reared under KKC system were the most to suffer from stillbirth (18%, and calving ease (26.1% in winter, while high BCS were the most to be treated for mastitis (8.5% in summer. On the other hand, spring calved multiparous cows raised under FC system suffered more from lameness (21.57% - high BCS and milk fever (4.4% - moderate BCS. Further, cows having moderate BCS kept under KKC system had the highest incidence of lameness (62.2%, and abomasum displacement (4.4%. In conclusion, achieving correct BCS at calving and cooling system is important to avoid calving subsequent lactation performance and metabolic disease losses.

  11. The internal and external customer focused process improvement and the performance analysis studies in health care systems

    International Nuclear Information System (INIS)

    Tekin, P.; Erol, R.

    2017-01-01

    Purpose: The main contribution of this paper is to generate an optimum solution for capacity planning and appointment scheduling issues, which are frequently encountered in clinical flows with various route and treatment periods at dental hospitals. Design/methodology/approach: It is essential to define the system well in order to ensure that the working staff and patients use their time very efficiently and that the process flows continuously. By having examined a sample healthcare system through the help of a study addressed in such context, studies on process improvement in line with the dissatisfactions of the working staff and patients have been carried out. Within the scope of the study, the operation of 7 Departments in a dental hospital undergoing a treatment process have been reviewed and examined. The problems encountered as result of the observations made are discussed in detail, and formerly and recently designed system performance analyses are conducted by having performed the respective process improvement studies. The relevant samplings of this study are modeled via the Arena Simulation Program. The data of the previous four months is used in the parameters, which are used through the modellings. The system data are entered by taking into account seasonal characteristics of the data. Findings: The analyses are made as a consequence of such study that has been addressed, it is established that the efficiency of the internal customers of the hospital increases substantially, and that the waiting durations of the dental patients decrease and in turn, the external customer satisfaction increases drastically. Research limitations/implications: Under the scope of the present study, 7 different treatment processes are analysed in a dental hospital in Cukurova Region with a significant patient potential. The treatment clinics present in the hospital are radiology, periodontology, surgery, treatment, orthodontics and prosthesis. These clinics run their own

  12. The internal and external customer focused process improvement and the performance analysis studies in health care systems

    Energy Technology Data Exchange (ETDEWEB)

    Tekin, P.; Erol, R.

    2017-07-01

    Purpose: The main contribution of this paper is to generate an optimum solution for capacity planning and appointment scheduling issues, which are frequently encountered in clinical flows with various route and treatment periods at dental hospitals. Design/methodology/approach: It is essential to define the system well in order to ensure that the working staff and patients use their time very efficiently and that the process flows continuously. By having examined a sample healthcare system through the help of a study addressed in such context, studies on process improvement in line with the dissatisfactions of the working staff and patients have been carried out. Within the scope of the study, the operation of 7 Departments in a dental hospital undergoing a treatment process have been reviewed and examined. The problems encountered as result of the observations made are discussed in detail, and formerly and recently designed system performance analyses are conducted by having performed the respective process improvement studies. The relevant samplings of this study are modeled via the Arena Simulation Program. The data of the previous four months is used in the parameters, which are used through the modellings. The system data are entered by taking into account seasonal characteristics of the data. Findings: The analyses are made as a consequence of such study that has been addressed, it is established that the efficiency of the internal customers of the hospital increases substantially, and that the waiting durations of the dental patients decrease and in turn, the external customer satisfaction increases drastically. Research limitations/implications: Under the scope of the present study, 7 different treatment processes are analysed in a dental hospital in Cukurova Region with a significant patient potential. The treatment clinics present in the hospital are radiology, periodontology, surgery, treatment, orthodontics and prosthesis. These clinics run their own

  13. LANSCE target system performance

    International Nuclear Information System (INIS)

    Russell, G.J.; Gilmore, J.S.; Robinson, H.; Legate, G.L.; Bridge, A.; Sanchez, R.J.; Brewton, R.J.; Woods, R.; Hughes, H.G. III

    1989-01-01

    We measured neutron beam fluxes at LANSCE using gold foil activation techniques. We did an extensive computer simulation of the as-built LANSCE Target/Moderator/Reflector/Shield geometry. We used this mockup in a Monte Carlo calculation to predict LANSCE neutronic performance for comparison with measured results. For neutron beam fluxes at 1 eV, the ratio of measured data to calculated varies from ∼0.6-0.9. The computed 1 eV neutron leakage at the moderator surface is 3.9 x 10 10 n/eV-sr-s-μA for LANSCE high-intensity water moderators. The corresponding values for the LANSCE high-resolution water moderator and the liquid hydrogen moderator are 3.3 and 2.9 x 10 10 , respectively. LANSCE predicted moderator intensities (per proton) for a tungsten target are essentially the same as ISIS predicted moderator intensities for a depleted uranium target. The calculated LANSCE steady state unperturbed thermal (E 13 n/cm 2 -s. The unique LANSCE split-target/flux-trap-moderator system is performing exceedingly well. The system has operated without a target or moderator change for over three years at nominal proton currents of ∼25 μA of 800-MeV protons. (author)

  14. The management system of health information CAFAM IPS : a look at the current status and propose new actions to improve its performance

    Directory of Open Access Journals (Sweden)

    Javier Andrés Urrego Varela

    2015-11-01

    Full Text Available The information management is a very important factor to organize the processes taking place in a company and for complex systems function in a most harmonious way possible. This work intends to present the diagnosis was performed to determine the extent of the problem environment management system of information on the health sub CAFAM , describing internal and external factors that might influence the construction of a future SGIS . We conclude that there is much to do in terms of organizing a CAFAM IPS SGI in Health , but are also given the objective and subjective conditions for progress in the development of this system to contribute to the development of the company.

  15. Health Information Systems

    International Development Research Centre (IDRC) Digital Library (Canada)

    the technology and expertise to process and share ... services. GEHS supports efforts that reach beyond healthcare institutions to capture evidence ... Health information systems are a foundation for quality care, and can increase accountability ...

  16. EVA Health and Human Performance Benchmarking Study

    Science.gov (United States)

    Abercromby, A. F.; Norcross, J.; Jarvis, S. L.

    2016-01-01

    Multiple HRP Risks and Gaps require detailed characterization of human health and performance during exploration extravehicular activity (EVA) tasks; however, a rigorous and comprehensive methodology for characterizing and comparing the health and human performance implications of current and future EVA spacesuit designs does not exist. This study will identify and implement functional tasks and metrics, both objective and subjective, that are relevant to health and human performance, such as metabolic expenditure, suit fit, discomfort, suited postural stability, cognitive performance, and potentially biochemical responses for humans working inside different EVA suits doing functional tasks under the appropriate simulated reduced gravity environments. This study will provide health and human performance benchmark data for humans working in current EVA suits (EMU, Mark III, and Z2) as well as shirtsleeves using a standard set of tasks and metrics with quantified reliability. Results and methodologies developed during this test will provide benchmark data against which future EVA suits, and different suit configurations (eg, varied pressure, mass, CG) may be reliably compared in subsequent tests. Results will also inform fitness for duty standards as well as design requirements and operations concepts for future EVA suits and other exploration systems.

  17. System health monitoring

    International Nuclear Information System (INIS)

    Reneke, J.A.; Fryer, M.O.

    1995-01-01

    Well designed large systems include many instrument taking data. These data are used in a variety of ways. They are used to control the system and its components, to monitor system and component health, and often for historical or financial purposes. This paper discusses a new method of using data from low level instrumentation to monitor system and component health. The method uses the covariance of instrument outputs to calculate a measure of system change. The method involves no complicated modeling since it is not a parameter estimation algorithm. The method is iterative and can be implemented on a computer in real time. Examples are presented for a metal lathe and a high efficiency particulate air (HEPA) filter. It is shown that the proposed method is quite sensitive to system changes such as wear out and failure. The method is useful for low level system diagnostics and fault detection

  18. LIFE EXPECTANCY AND THE HEALTHY LIFE OF A POPULATION – A CONSONANT VECTOR OF ECONOMIC PERFORMANCE, PUBLIC HEALTH SYSTEM AND MORAL VALUES

    Directory of Open Access Journals (Sweden)

    Mihai Luchian

    2015-03-01

    Full Text Available The performance of the therapeutical act depends on the personal training and optimum interdisciplinary cooperation of the medical staff involved, representing dynamic elements directly supported by adequate logistic means –medical technique and implements, drugs, procedures, etc. Considered from a dialectic perspective, all such factors of force are made up and are mainly and conjunctly manifested at the level of an elevated (ethic-moral and juridical deontological and normative level. The cooperative vectors of interest may be protected and increased by means of some key factors characteristic to the system of public health assurance, implicitly of the functional medical structures, for attaining the major goal of consolidating general health condition, alongwith the strategic factors for promoting a healthy, really economically and socially performant life of the population to come.

  19. Czechoslovakia's changing health care system.

    Science.gov (United States)

    Raffel, M W; Raffel, N K

    1992-01-01

    Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services.

  20. Cost-Benefit Performance of Robotic Surgery Compared with Video-Assisted Thoracoscopic Surgery under the Japanese National Health Insurance System.

    Science.gov (United States)

    Kajiwara, Naohiro; Patrick Barron, James; Kato, Yasufumi; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2015-01-01

    Medical economics have significant impact on the entire country. The explosion in surgical techniques has been accompanied by questions regarding actual improvements in outcome and cost-effectiveness, such as the da Vinci(®) Surgical System (dVS) compared with conventional video-assisted thoracic surgery (VATS). To establish a medical fee system for robot-assisted thoracic surgery (RATS), which is a system not yet firmly established in Japan. This study examines the cost benefit performance (CBP) based on medical fees compared with VATS and RATS under the Japanese National Health Insurance System (JNHIS) introduced in 2012. The projected (but as yet undecided) price in the JNHIS would be insufficient if institutions have less than even 200 dVS cases per year. Only institutions which perform more than 300 dVS operations per year would obtain a positive CBP with the projected JNHIS reimbursement. Thus, under the present conditions, it is necessary to perform at least 300 dVS operations per year in each institution with a dVS system to avoid financial deficit with current robotic surgical management. This may hopefully encourage a downward price revision of the dVS equipment by the manufacture which would result in a decrease in the cost per procedure.

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

    Science.gov (United States)

    Nedza, Susan M

    2009-12-01

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

  2. High-Performance Operating Systems

    DEFF Research Database (Denmark)

    Sharp, Robin

    1999-01-01

    Notes prepared for the DTU course 49421 "High Performance Operating Systems". The notes deal with quantitative and qualitative techniques for use in the design and evaluation of operating systems in computer systems for which performance is an important parameter, such as real-time applications......, communication systems and multimedia systems....

  3. Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia.

    Science.gov (United States)

    Peters, Sanne A E; Dunford, Elizabeth; Jones, Alexandra; Ni Mhurchu, Cliona; Crino, Michelle; Taylor, Fraser; Woodward, Mark; Neal, Bruce

    2017-07-05

    The Health Star Rating (HSR) is an interpretive front-of-pack labelling system that rates the overall nutritional profile of packaged foods. The algorithm underpinning the HSR includes total sugar content as one of the components. This has been criticised because intrinsic sugars naturally present in dairy, fruits, and vegetables are treated the same as sugars added during food processing. We assessed whether the HSR could better discriminate between core and discretionary foods by including added sugar in the underlying algorithm. Nutrition information was extracted for 34,135 packaged foods available in The George Institute's Australian FoodSwitch database. Added sugar levels were imputed from food composition databases. Products were classified as 'core' or 'discretionary' based on the Australian Dietary Guidelines. The ability of each of the nutrients included in the HSR algorithm, as well as added sugar, to discriminate between core and discretionary foods was estimated using the area under the curve (AUC). 15,965 core and 18,350 discretionary foods were included. Of these, 8230 (52%) core foods and 15,947 (87%) discretionary foods contained added sugar. Median (Q1, Q3) HSRs were 4.0 (3.0, 4.5) for core foods and 2.0 (1.0, 3.0) for discretionary foods. Median added sugar contents (g/100 g) were 3.3 (1.5, 5.5) for core foods and 14.6 (1.8, 37.2) for discretionary foods. Of all the nutrients used in the current HSR algorithm, total sugar had the greatest individual capacity to discriminate between core and discretionary foods; AUC 0.692 (0.686; 0.697). Added sugar alone achieved an AUC of 0.777 (0.772; 0.782). A model with all nutrients in the current HSR algorithm had an AUC of 0.817 (0.812; 0.821), which increased to 0.871 (0.867; 0.874) with inclusion of added sugar. The HSR nutrients discriminate well between core and discretionary packaged foods. However, discrimination was improved when added sugar was also included. These data argue for inclusion of added

  4. Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon.

    Directory of Open Access Journals (Sweden)

    Vanderson Souza Sampaio

    Full Text Available A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Amazon. The aim of this study was to analyze the profile of spider bites reported in the state of Amazonas in the Western Brazilian Amazon, and to investigate potential risk factors associated with severity of envenomation.We used a case-control study in order to identify factors associated with spider bite severity in the Western Brazilian Amazon from 2007 to 2014. Patients evolving to any severity criteria were considered cases and those with non-severe bites were included in the control group. All variables were retrieved from the official Brazilian reporting systems. Socioeconomical and environmental components were also included in a multivariable analysis in order to identify ecological determinants of incidence and severity. A total of 1,181 spider bites were recorded, resulting in an incidence of 4 cases per 100,000 person/year. Most of the spider bites occurred in males (65.8%. Bites mostly occurred in rural areas (59.5%. The most affected age group was between 16 and 45 years old (50.9%. A proportion of 39.7% of the bites were related to work activities. Antivenom was prescribed to 39% of the patients. Envenomings recorded from urban areas [Odds ratio (OR = 0.40 (95%CI = 0.30-0.71; pmedian [OR = 0.64 (95%CI = 0.39-0.75; p300 km away from the state capital Manaus [OR = 1.90 (95%CI = 1.28-2.40; p300 km away from the state capital Manaus [OR = 1.53 (95%CI = 1.15-2.02; p = 0.003] and living in a municipality with a MHSPI 300 km away from the state capital Manaus could be contributing factors to higher severity of spider envenomings in this area, as well as to antivenom underdosage.

  5. Incorporating Added Sugar Improves the Performance of the Health Star Rating Front-of-Pack Labelling System in Australia

    Science.gov (United States)

    Peters, Sanne A. E.; Jones, Alexandra; Crino, Michelle; Taylor, Fraser; Woodward, Mark; Neal, Bruce

    2017-01-01

    Background: The Health Star Rating (HSR) is an interpretive front-of-pack labelling system that rates the overall nutritional profile of packaged foods. The algorithm underpinning the HSR includes total sugar content as one of the components. This has been criticised because intrinsic sugars naturally present in dairy, fruits, and vegetables are treated the same as sugars added during food processing. We assessed whether the HSR could better discriminate between core and discretionary foods by including added sugar in the underlying algorithm. Methods: Nutrition information was extracted for 34,135 packaged foods available in The George Institute’s Australian FoodSwitch database. Added sugar levels were imputed from food composition databases. Products were classified as ‘core’ or ‘discretionary’ based on the Australian Dietary Guidelines. The ability of each of the nutrients included in the HSR algorithm, as well as added sugar, to discriminate between core and discretionary foods was estimated using the area under the curve (AUC). Results: 15,965 core and 18,350 discretionary foods were included. Of these, 8230 (52%) core foods and 15,947 (87%) discretionary foods contained added sugar. Median (Q1, Q3) HSRs were 4.0 (3.0, 4.5) for core foods and 2.0 (1.0, 3.0) for discretionary foods. Median added sugar contents (g/100 g) were 3.3 (1.5, 5.5) for core foods and 14.6 (1.8, 37.2) for discretionary foods. Of all the nutrients used in the current HSR algorithm, total sugar had the greatest individual capacity to discriminate between core and discretionary foods; AUC 0.692 (0.686; 0.697). Added sugar alone achieved an AUC of 0.777 (0.772; 0.782). A model with all nutrients in the current HSR algorithm had an AUC of 0.817 (0.812; 0.821), which increased to 0.871 (0.867; 0.874) with inclusion of added sugar. Conclusion: The HSR nutrients discriminate well between core and discretionary packaged foods. However, discrimination was improved when added sugar was

  6. [Impact of mid-level management and support on the performance of a district health system in the Democratic Republic of the Congo].

    Science.gov (United States)

    Kahindo, M J B; Schirvel, C; Karemere, H; Mitangala, P; Wodon, A; Porignon, D

    2011-04-01

    The aim of this study was to assess the contribution of mid-level management and support practices to the overall performance of a district healthcare system. This case study was carried out in the North Kivu Province of the Democratic Republic of the Congo. It was based on analysis of (i) preventive and curative healthcare services and (ii) management and support practices provided from 2000 to 2008. In response to recurring sociopolitical unrest since 1992, the mid-level health system (provincial level) in North Kivu has strengthened management and support practices. The main goals have been to optimize allocation of interventions by external emergency organizations and integration of specialized program activities, to harmonize intervention techniques implemented by external partners, to standardize supervision of sanitary districts with regard to care provider skills, and to adapt strategic options defined by the Ministry of Health to the provincial level. Using this comprehensive approach, the performance of the North Kivu Province in terms of curative and preventive care has exceeded the national average since 2001. Between 2001 and 2008, use of curative services progressed from 0.36 to 0.50 new cases/capita/year. Positive results have also been recorded for infrastructure coverage, essential medicine stock, health information system, and emergency preparedness. Stronger mid-level management and support practices have improved care activities in the health district while protecting the population from unstructured interventions by emergency organizations or specialized programs. A comprehensive management approach has also improved the resilience of the district and increased its contribution to Millennium Development Goals.

  7. Performance systems and social capital

    DEFF Research Database (Denmark)

    Rasmussen, Grane Mikael Gregaard; Edwards, Kasper

    2014-01-01

    Performance systems and social capital are considered mutually exclusive. Contemporary studies show that social capital is essential in generating performance improvement. This raises an important question: “How do performance systems and social capital correspond?” This study draws on findings...... from a study on implementation of a performance system in Danish construction. The results show causalities between implementing the performance system and the emergence of social capital in construction projects. Results indicate that performance systems and social capital is not mutually exclusive...

  8. Portable Health Algorithms Test System

    Science.gov (United States)

    Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.

    2010-01-01

    A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.

  9. Inspection system performance test procedure

    International Nuclear Information System (INIS)

    Jensen, C.E.

    1995-01-01

    This procedure establishes requirements to administer a performance demonstration test. The test is to demonstrate that the double-shell tank inspection system (DSTIS) supplied by the contractor performs in accordance with the WHC-S-4108, Double-Shell Tank Ultrasonic Inspection Performance Specification, Rev. 2-A, January, 1995. The inspection system is intended to provide ultrasonic (UT) and visual data to determine integrity of the Westinghouse Hanford Company (WHC) site underground waste tanks. The robotic inspection system consists of the following major sub-systems (modules) and components: Mobile control center; Deployment module; Cable management assembly; Robot mechanism; Ultrasonic testing system; Visual testing system; Pneumatic system; Electrical system; and Control system

  10. Evaluation of the Quality of Occupational Health and Safety Management Systems Based on Key Performance Indicators in Certified Organizations

    Directory of Open Access Journals (Sweden)

    Iraj Mohammadfam

    2017-06-01

    Conclusion: Occupational Health and Safety Assessment Series 18001-certified companies have a better level of occupational health and safety; this supports the argument that Occupational Health and Safety Management Systems play an important strategic role in health and safety in the workplace.

  11. Reforma integral para mejorar el desempeño del sistema de salud en México Comprehensive reform to improve health system performance in Mexico

    Directory of Open Access Journals (Sweden)

    Julio Frenk

    2007-01-01

    . Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH, which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance, the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

  12. Measuring name system health

    NARCIS (Netherlands)

    Casalicchio, Emiliano; Caselli, Marco; Coletta, Alessio; Di Blasi, Salvatore; Fovino, Igor Nai; Butts, Jonathan; Shenoi, Sujeet

    2012-01-01

    Modern critical infrastructure assets are exposed to security threats arising from their use of IP networks and the Domain Name System (DNS). This paper focuses on the health of DNS. Indeed, due to the increased reliance on the Internet, the degradation of DNS could have significant consequences for

  13. Health system reform.

    Science.gov (United States)

    Ortolon, Ken

    2009-06-01

    A vote on reforming the nation's health care system seems likely this summer as President Obama makes good on a campaign pledge. Although the Democratic leadership in Congress appears ready to push through reform legislation before the next election, TMA and AMA leaders say very little is known about what that "reform" likely will look like.

  14. LIGO sensing system performance

    CERN Document Server

    Landry, M

    2002-01-01

    The optical sensing subsystem of a LIGO interferometer is described. The system includes two complex interferometric sensing schemes to control test masses in length and alignment. The length sensing system is currently employed on all LIGO interferometers to lock coupled cavities on resonance. Auto-alignment is to be accomplished by a wavefront-sensing scheme which automatically corrects for angular fluctuations of the test masses. Improvements in lock stability and duration are noted when the wavefront auto-alignment system is employed. Preliminary results from the commissioning of the 2 km detector in Washington are shown.

  15. PROLOGUE : Health Information System

    OpenAIRE

    Tomar, Shivanjali

    2013-01-01

    Prologue is a health information system developed for underserved communities in Bihar, India. It is aimed at helping people living in poverty and with low literacy to take the right steps to manage their and their family’s health. Bihar suffers from one of the worst healthcare records in the country. This is as much due to the lack of access to the right information as it is due to the economic condition of the region. The inaccessibility of information is aggravated by the complex social se...

  16. Hybrid Modeling Improves Health and Performance Monitoring

    Science.gov (United States)

    2007-01-01

    Scientific Monitoring Inc. was awarded a Phase I Small Business Innovation Research (SBIR) project by NASA's Dryden Flight Research Center to create a new, simplified health-monitoring approach for flight vehicles and flight equipment. The project developed a hybrid physical model concept that provided a structured approach to simplifying complex design models for use in health monitoring, allowing the output or performance of the equipment to be compared to what the design models predicted, so that deterioration or impending failure could be detected before there would be an impact on the equipment's operational capability. Based on the original modeling technology, Scientific Monitoring released I-Trend, a commercial health- and performance-monitoring software product named for its intelligent trending, diagnostics, and prognostics capabilities, as part of the company's complete ICEMS (Intelligent Condition-based Equipment Management System) suite of monitoring and advanced alerting software. I-Trend uses the hybrid physical model to better characterize the nature of health or performance alarms that result in "no fault found" false alarms. Additionally, the use of physical principles helps I-Trend identify problems sooner. I-Trend technology is currently in use in several commercial aviation programs, and the U.S. Air Force recently tapped Scientific Monitoring to develop next-generation engine health-management software for monitoring its fleet of jet engines. Scientific Monitoring has continued the original NASA work, this time under a Phase III SBIR contract with a joint NASA-Pratt & Whitney aviation security program on propulsion-controlled aircraft under missile-damaged aircraft conditions.

  17. Control and Health Monitoring of Variable Speed Wind Power Generation Systems; Period of Performance: 10 July 1997 - 10 July 2000

    Energy Technology Data Exchange (ETDEWEB)

    Song, Y. D.; Bikdash, M.; Schulz, M. J.

    2001-09-01

    This document reports accomplishments on variable speed control, furling analysis, and health monitoring of wind turbines. There are three parts, prepared by Song, Bikdash, and Schulz, respectively. The first part discusses variable-speed control of wind turbines, exploring a memory-based method for wind speed prediction and wind turbine control. The second part addresses the yaw dynamics of wind turbines, including modeling, analysis, and control. The third part of the report discusses new analytical techniques that were developed and tested to detect initial damage to prevent failures of wind turbine rotor blades.

  18. Comparing Performance of Public and Cooperative Health Centers

    Directory of Open Access Journals (Sweden)

    Mostafa Farahbakhsh

    2012-04-01

    Full Text Available Background: Health cooperatives in similar structure of health network in Iran, give primary health cares to defined population with supervisory of public sector. Materials and method: This study compares health system performance between public (PHC and cooperative (CHC health centers. Results: Client's satisfaction was 4.14 in CHC and 3.9 in PHC in 5 point Likert scale. The mean for daily health services of CHC and PHC were 110.8 and 85 respectively. Conclusion: Health cooperatives are appropriate strategy for downsizing of government in health sector

  19. The impact of water exchange rate on the health and performance of rainbow trout Oncorhynchus mykiss in recirculation aquaculture systems

    Science.gov (United States)

    Fish mortality in recirculating aquaculture systems (RAS) has been observed by the authors to increase when RAS are managed at low makeup water exchange rates with relatively high feed loading. The precise etiology of this elevated mortality was unknown, all typical water quality parameters were wit...

  20. Shiva laser system performance

    International Nuclear Information System (INIS)

    Glaze, J.; Godwin, R.O.; Holzrichter, J.F.

    1978-01-01

    On November 18, 1977, after four years of experimentation, innovation, and construction, the Shiva High Energy Laser facility produced 10.2 kJ of focusable laser energy delivered in a 0.95 ns pulse. The Shiva laser, with its computer control system and delta amplifiers, demonstrated its versatility on May 18, 1978, when the first 20-beam target shot with delta amplifiers focused 26 TW on a target and produced a yield of 7.5 x 10 9 neutrons

  1. Performance analysis of switching systems

    NARCIS (Netherlands)

    Berg, van den R.A.

    2008-01-01

    Performance analysis is an important aspect in the design of dynamic (control) systems. Without a proper analysis of the behavior of a system, it is impossible to guarantee that a certain design satisfies the system’s requirements. For linear time-invariant systems, accurate performance analyses are

  2. Health Information Systems.

    Science.gov (United States)

    Sirintrapun, S Joseph; Artz, David R

    2015-06-01

    This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Total System Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Yong Soo; Kang, Chul Hyung; Lee, Youn Myoung; Han, Ji Woong; Choi, Jong Won; Hahn, Pil Soo; Park, Jeong Hwa; Jeong, Mi Seon

    2007-06-15

    Based on the KAERI FEP list developed through the previous studies, the KAERI FEP Encyclopedia has been developed. Current version is 1.0 which includes all relevant FEPs to compose of two references and all alternative scenarios. Many interaction FEPs between scenario defining FEP(SDF) are created throughout the study. FEPs are classified into many Integrated FEP(IFEP) which eventually become the elements of the RES matrix. The FEAS program one of the component of the KAERI's CYPRUS information system is added to develop the FEP, RES, AC, AMF and finally scenarios. It assists to create transparent way to deal with assessment from the stage of the planning of the R and D to the final stage of the external audit and regulatory body review. Even though MASCOT-K and compartment analysis codes such as AMBER, GoldSim and Ecolego are excellent for TSPA they by in heritage possess a certain limitation especially to identify a proper migration cross sectional area when a relatively big component intersects with a tiny one such as a fracture. It is truly 3D phenomena in nature. MDPSA code is developed which is expected to overcome limitations in compartment models while successfully deals with natural disruptive events. The R and D target for the TSPA is to develop the sufficient scenarios and their variation cases to understand the safety of KRS in every possible aspect. For this, reference scenarios, alternative scenarios covering engineered barrier failure and natural events are developed and assessed respectively for around 100 cases. The stylized template to assess the Korean reference biosphere is developed using the AMBER. Three critical groups, agricultural, freshwater and marine water fishing groups are identified to assess the DCF following the guidelines of ICRP. Based on the QA principles of T2R3, the web based QA system is developed using the procedures in the USNRC 10CFR50 Appendix B. The QA system is combined with the PAID and FEAS to create the comprehensive

  4. Total System Performance Assessment

    International Nuclear Information System (INIS)

    Hwang, Yong Soo; Kang, Chul Hyung; Lee, Youn Myoung; Han, Ji Woong; Choi, Jong Won; Hahn, Pil Soo; Park, Jeong Hwa; Jeong, Mi Seon

    2007-06-01

    Based on the KAERI FEP list developed through the previous studies, the KAERI FEP Encyclopedia has been developed. Current version is 1.0 which includes all relevant FEPs to compose of two references and all alternative scenarios. Many interaction FEPs between scenario defining FEP(SDF) are created throughout the study. FEPs are classified into many Integrated FEP(IFEP) which eventually become the elements of the RES matrix. The FEAS program one of the component of the KAERI's CYPRUS information system is added to develop the FEP, RES, AC, AMF and finally scenarios. It assists to create transparent way to deal with assessment from the stage of the planning of the R and D to the final stage of the external audit and regulatory body review. Even though MASCOT-K and compartment analysis codes such as AMBER, GoldSim and Ecolego are excellent for TSPA they by in heritage possess a certain limitation especially to identify a proper migration cross sectional area when a relatively big component intersects with a tiny one such as a fracture. It is truly 3D phenomena in nature. MDPSA code is developed which is expected to overcome limitations in compartment models while successfully deals with natural disruptive events. The R and D target for the TSPA is to develop the sufficient scenarios and their variation cases to understand the safety of KRS in every possible aspect. For this, reference scenarios, alternative scenarios covering engineered barrier failure and natural events are developed and assessed respectively for around 100 cases. The stylized template to assess the Korean reference biosphere is developed using the AMBER. Three critical groups, agricultural, freshwater and marine water fishing groups are identified to assess the DCF following the guidelines of ICRP. Based on the QA principles of T2R3, the web based QA system is developed using the procedures in the USNRC 10CFR50 Appendix B. The QA system is combined with the PAID and FEAS to create the comprehensive

  5. Total System Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Yong Soo; Kang, Chul Hyung; Lee, Youn Myoung; Han, Ji Woong; Choi, Jong Won; Hahn, Pil Soo; Park, Jeong Hwa; Jeong, Mi Seon

    2007-06-15

    Based on the KAERI FEP list developed through the previous studies, the KAERI FEP Encyclopedia has been developed. Current version is 1.0 which includes all relevant FEPs to compose of two references and all alternative scenarios. Many interaction FEPs between scenario defining FEP(SDF) are created throughout the study. FEPs are classified into many Integrated FEP(IFEP) which eventually become the elements of the RES matrix. The FEAS program one of the component of the KAERI's CYPRUS information system is added to develop the FEP, RES, AC, AMF and finally scenarios. It assists to create transparent way to deal with assessment from the stage of the planning of the R and D to the final stage of the external audit and regulatory body review. Even though MASCOT-K and compartment analysis codes such as AMBER, GoldSim and Ecolego are excellent for TSPA they by in heritage possess a certain limitation especially to identify a proper migration cross sectional area when a relatively big component intersects with a tiny one such as a fracture. It is truly 3D phenomena in nature. MDPSA code is developed which is expected to overcome limitations in compartment models while successfully deals with natural disruptive events. The R and D target for the TSPA is to develop the sufficient scenarios and their variation cases to understand the safety of KRS in every possible aspect. For this, reference scenarios, alternative scenarios covering engineered barrier failure and natural events are developed and assessed respectively for around 100 cases. The stylized template to assess the Korean reference biosphere is developed using the AMBER. Three critical groups, agricultural, freshwater and marine water fishing groups are identified to assess the DCF following the guidelines of ICRP. Based on the QA principles of T2R3, the web based QA system is developed using the procedures in the USNRC 10CFR50 Appendix B. The QA system is combined with the PAID and FEAS to create the

  6. Fatigue Performance of Ti-6Al-4V Additively Manufactured Specimens with Integrated Capillaries of an Embedded Structural Health Monitoring System.

    Science.gov (United States)

    Hinderdael, Michaël; Strantza, Maria; De Baere, Dieter; Devesse, Wim; De Graeve, Iris; Terryn, Herman; Guillaume, Patrick

    2017-08-25

    Additive manufacturing (AM) of metals offers new possibilities for the production of complex structures. Up to now, investigations on the mechanical response of AM metallic parts show a significant spread and unexpected failures cannot be excluded. In this work, we focus on the detection of fatigue cracks through the integration of a Structural Health Monitoring (SHM) system in Ti-6Al-4V specimens. The working principle of the presented system is based on the integration of small capillaries that are capable of detecting fatigue cracks. Four-point bending fatigue tests have been performed on Ti-6Al-4V specimens with integrated capillaries and compared to the reference specimenswithout capillaries. Specimens were produced by conventional subtractive manufacturing of wrought material and AM, using the laser based Directed Energy Deposition (DED) process. In this study, we investigated the effect of the presence of the capillary on the fatigue strength and fatigue initiation location. Finite element (FEM) simulations were performed to validate the experimental test results. The presence of a drilled capillary in the specimens did not alter the fatigue initiation location. However, the laser based DED production process introduced roughness on the capillary surface that altered the fatigue initiation location to the capillary surface. The fatigue performance was greatly reduced when considering a printed capillary. It is concluded that the surface quality of the integrated capillary is of primary importance in order not to influence the structural integrity of the component to be monitored.

  7. Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems.

    Science.gov (United States)

    Bertone, Maria Paola; Falisse, Jean-Benoît; Russo, Giuliano; Witter, Sophie

    2018-01-01

    Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. This article lays out initial hypotheses about how FCAS contexts may influence the adoption, adaption, implementation and health system effects of PBF. These are then interrogated through a review of available grey and published literature (140 documents in total, covering 23 PBF schemes). We find that PBF has been more common in FCAS contexts, which were also more commonly early adopters. Very little explanation of the rationale for its adoption, in particular in relation with the contextual features, is given in programme documents. However, there are a number of factors which could explain this, including the greater role of external actors and donors, a greater openness to institutional reform, and lower levels of trust within the public system and between government and donors, all of which favour more contractual approaches. These suggest that rather than emerging despite fragility, conditions of fragility may favour the rapid emergence of PBF. We also document few emerging adaptations of PBF to humanitarian settings and limited evidence of health system effects which may be contextually driven, but these require more in-depth analysis. Another area meriting more study is the political economy of PBF and its diffusion across contexts.

  8. Contractor Performance Assessment Reporting System

    Data.gov (United States)

    US Agency for International Development — CPARS is a web-based system used to input data on contractor performance. Reports from the system are used as an aid in awarding contracts to contractors that...

  9. Moving Medicine, Moving Minds: Helping Developing Countries Overcome Barriers to Outsourcing Health Commodity Distribution to Boost Supply Chain Performance and Strengthen Health Systems

    OpenAIRE

    Agrawal, Priya; Barton, Iain; Bianco, Roberto Dal; Hovig, Dana; Sarley, David; Yadav, Prashant

    2016-01-01

    Senegal and other developing countries are improving access to health commodities by outsourcing supply chain logistics to private providers. To achieve broader, lasting reform, we must support further adoption of the outsourced model; assist country-led cost-benefit analyses; and help governments build capacity to manage contracts and overcome other barriers.

  10. Data Performativity, Performing Health Work: Malaria and Labor in Senegal.

    Science.gov (United States)

    Tichenor, Marlee

    2017-07-01

    In this article, I investigate the ramifications of health data production in the health fight against malaria in and around Dakar, Senegal. Malaria health development funding at the community level is contingent on performativity; the Global Fund's "performance-based funding," for example, requires that local actors produce certain forms of evidence and that intermediaries synthesize this evidence into citable data. Analyzing the practices of diagnosis and approximation in health clinics and in global malaria documents, I argue that data production in Senegal is conditioned by and reifies preconceived notions of malaria as a problem addressable by the enumeration of technological fixes.

  11. Health and School Performance among Danish adolescents

    DEFF Research Database (Denmark)

    Hansen, Claus D.; Andersen, Johan Hviid

    adult educational achievement. Data are taken from a birth cohort study of all adolescents born in 1989 (n=3,058) living in a rural county in Denmark. Information was obtained from questionnaires (sent to the adolescents and their parents) and from different national registers (e.g. hospitalization......This study examines the impact of a wide range of health measures on school performance at the end of compulsory school (9 years of school). The key questions raised are whether different health problems lowers school performance contributing to a health selection process that could lead to lower...... health and school performance....

  12. Cultures for performance in health care

    National Research Council Canada - National Science Library

    Mannion, Russell; Davies, Huw T.O; Marshall, Martin N

    2005-01-01

    ... in performance are intrinsically linked to cultural changes within health care settings. Using theories from a wide range of disciplines including economics, management and organization studies, policy studies and the health sciences, this book sets out definitions of cultures and performance, in particular the specific characteristics that help...

  13. A composite indicator to measure universal health care coverage in India: way forward for post-2015 health system performance monitoring framework.

    Science.gov (United States)

    Prinja, Shankar; Gupta, Rakesh; Bahuguna, Pankaj; Sharma, Atul; Kumar Aggarwal, Arun; Phogat, Amit; Kumar, Rajesh

    2017-02-01

    There is limited work done on developing methods for measurement of universal health coverage. We undertook a study to develop a methodology and demonstrate the practical application of empirically measuring the extent of universal health coverage at district level. Additionally, we also develop a composite indicator to measure UHC. A cross-sectional survey was undertaken among 51 656 households across 21 districts of Haryana state in India. Using the WHO framework for UHC, we identified indicators of service coverage, financial risk protection, equity and quality based on the Government of India and the Haryana Government's proposed UHC benefit package. Geometric mean approach was used to compute a composite UHC index (CUHCI). Various statistical approaches to aggregate input indicators with or without weighting, along with various incremental combinations of input indicators were tested in a comprehensive sensitivity analysis. The population coverage for preventive and curative services is presented. Adjusting for inequality, the coverage for all the indicators were less than the unadjusted coverage by 0.1-6.7% in absolute term and 0.1-27% in relative term. There was low unmet need for curative care. However, about 11% outpatient consultations were from unqualified providers. About 30% households incurred catastrophic health expenditures, which rose to 38% among the poorest 20% population. Summary index (CUHCI) for UHC varied from 12% in Mewat district to 71% in Kurukshetra district. The inequality unadjusted coverage for UHC correlates highly with adjusted coverage. Our paper is an attempt to develop a methodology to measure UHC. However, careful inclusion of others indicators of service coverage is recommended for a comprehensive measurement which captures the spirit of universality. Further, more work needs to be done to incorporate quality in the measurement framework. © The Author 2016. Published by Oxford University Press in association with The London

  14. Toward a high-performance management system in health care, part 4: Using high-performance work practices to prevent central line-associated blood stream infections-a comparative case study.

    Science.gov (United States)

    McAlearney, Ann Scheck; Hefner, Jennifer; Robbins, Julie; Garman, Andrew N

    2016-01-01

    Central line-associated bloodstream infections (CLABSIs) are among the most harmful health care-associated infections and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Prior research on high-performance work practices (HPWPs) suggests that these practices may explain some of the differences health systems experience in the success of their quality improvement efforts; however, these relationships have not yet been systematically investigated. In this study, we sought to explore the potential role HPWPs may play in explaining differences in the success of CLABSI reduction efforts involving otherwise similar organizations and approaches. To form our sample, we identified eight hospitals participating in the federally funded "On the CUSP: Stop BSI" initiative. This sample included four hospital "pairs" matched on organizational characteristics (e.g., state, size, teaching status) but having reported contrasting CLABSI reduction outcomes. We collected data through site visits as well as 194 key informant interviews, which were framed using an evidence-informed model of health care HPWPs. We found evidence that, at higher performing sites, HPWPs facilitated the adoption and consistent application of practices known to prevent CLABSIs; these HPWPs were virtually absent at lower performing sites. We present examples of management practices and illustrative quotes categorized into four HPWP subsystems: (a) staff engagement, (b) staff acquisition/development, (c) frontline empowerment, and (d) leadership alignment/development. We present the HPWP model as an organizing framework that can be applied to facilitate quality and patient safety efforts in health care. Managers and senior leaders can use these four HPWP subsystems to select, prioritize, and communicate about management

  15. A National Initiative to Advance School Mental Health Performance Measurement in the US

    Science.gov (United States)

    Connors, Elizabeth Halsted; Stephan, Sharon Hoover; Lever, Nancy; Ereshefsky, Sabrina; Mosby, Amanda; Bohnenkamp, Jill

    2016-01-01

    Standardized health performance measurement has increasingly become an imperative for assuring quality standards in national health care systems. As compared to somatic health performance measures, behavioral health performance measures are less developed. There currently is no national standardized performance measurement system for monitoring…

  16. Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: implications for TB programmes.

    Directory of Open Access Journals (Sweden)

    Marian Loveday

    Full Text Available To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites.In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC complemented our quantitative findings.We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01. Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01, with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01, qualitative data indicated that the 'context' domain influenced the other domains.We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.

  17. Health systems around the world - a comparison of existing health system rankings.

    Science.gov (United States)

    Schütte, Stefanie; Acevedo, Paula N Marin; Flahault, Antoine

    2018-06-01

    Existing health systems all over the world are different due to the different combinations of components that can be considered for their establishment. The ranking of health systems has been a focal points for many years especially the issue of performance. In 2000 the World Health Organization (WHO) performed a ranking to compare the Performance of the health system of the member countries. Since then other health system rankings have been performed and it became an issue of public discussion. A point of contention regarding these rankings is the methodology employed by each of them, since no gold standard exists. Therefore, this review focuses on evaluating the methodologies of each existing health system performance ranking to assess their reproducibility and transparency. A search was conducted to identify existing health system rankings, and a questionnaire was developed for the comparison of the methodologies based on the following indicators: (1) General information, (2) Statistical methods, (3) Data (4) Indicators. Overall nine rankings were identified whereas six of them focused rather on the measurement of population health without any financial component and were therefore excluded. Finally, three health system rankings were selected for this review: "Health Systems: Improving Performance" by the WHO, "Mirror, Mirror on the wall: How the Performance of the US Health Care System Compares Internationally" by the Commonwealth Fund and "the Most efficient Health Care" by Bloomberg. After the completion of the comparison of the rankings by giving them scores according to the indicators, the ranking performed the WHO was considered the most complete regarding the ability of reproducibility and transparency of the methodology. This review and comparison could help in establishing consensus in the field of health system research. This may also help giving recommendations for future health rankings and evaluating the current gap in the literature.

  18. Facilities projects performance measurement system

    International Nuclear Information System (INIS)

    Erben, J.F.

    1979-01-01

    The two DOE-owned facilities at Hanford, the Fuels and Materials Examination Facility (FMEF), and the Fusion Materials Irradiation Test Facility (FMIT), are described. The performance measurement systems used at these two facilities are next described

  19. Joint Performance and Planning System

    Data.gov (United States)

    US Agency for International Development — A joint State/USAID system hosted by State that integrates resource and performance information at the program level and enables more flexible and frequent entry of...

  20. NASA Human Health and Performance Center (NHHPC)

    Science.gov (United States)

    Davis, Jeffery R.

    2010-01-01

    This slide presentation reviews the purpose, potential members and participants of the NASA Human Health and Performance Center (NHHPC). Included in the overview is a brief description of the administration and current activities of the NHHPC.

  1. [The national health system in Peru].

    Science.gov (United States)

    Sánchez-Moreno, Francisco

    2014-01-01

    In 1975, a group of professionals in Peru who were experts on national health systems began a process that led the country to be the first in South America to initiate a modern organization of the health system. This pioneering development meant that the creation of the National Health Services System [in Peru] in 1978 occurred before the health system reforms in Chile (1980), Brazil (1990), Colombia (1993), and Ecuador (2008). This encouraging start has had permanent reformist fluctuations since then, with negative development because of the lack of a State policy. Current features of the Peruvian system are inefficient performance, discontinuity, and lack of assessment, which creates a major setback in comparison with other health systems in America. In the 21st century, significant technical efforts have been missed to modernize the system and its functions. The future is worrying and the role of new generations will be decisive.

  2. The Netherlands: health system review

    NARCIS (Netherlands)

    Schäfer, W.; Kroneman, M.; Boerma, W.; van den Berg, M.; Westert, G.; Devillé, W.; van Ginneken, E.

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of

  3. TRICARE, Military Health System

    Science.gov (United States)

    ... Claim Get Proof of TRICARE Coverage View My Military Health Record Less TRICARE Enrollment Freeze Starting Dec. ... Disaster Information Download a Form Go Paperless My Military Health Records Multimedia Center Plan Information Kits Recoupment ...

  4. Trends in performance of the National Measles Case-Based Surveillance System, Ministry of Health and Child Welfare, Zimbabwe (1999 - 2008)

    Science.gov (United States)

    Choto, Regis; Chadambuka, Addmore; Shambira, Gerald; Gombe, Notion; Tshimanga, Mufuta; Midzi, Stanley; Mberikunashe, Joseph

    2012-01-01

    Introduction Since adoption of the measles case-based surveillance system in Zimbabwe in 1998, data has been routinely collected at all levels of the health delivery system and sent to national level with little or no documented evidence of use to identify risky populations, monitor impact of interventions and measure progress towards achieving measles elimination. We analysed this data to determine trends in the national measles case-based surveillance system (NMCBSS). Methods A retrospective record review of the NMCBSS dataset for period 1999 –2008 was conducted, assessing trends in proportions of investigated cases; timeliness and nature of specimens received at laboratory; timeliness of feedback of serology results, proportion of cases confirmed as measles and national annualized rates of investigation. Comparisons with WHO performance indicators were done. The secondary data analysis was done in Excel and Epi-Info statistical software. Results Cumulatively 4994 suspected cases were reported and investigated between 1999 and 2008. Reported suspected and confirmed measles cases declined from 24, 5% and 5.9% respectively in 2000 to 3.9% and 1.0% respectively in 2008. Proportion of cases with blood specimens collected and proportion reaching laboratory timely increased from 83% and 65% respectively in 1999, to 100% and 82% respectively in 2008. Proportion of specimens arriving at laboratory in good condition improved from 65% in 2004 to 94% in 2008 while timeliness of feedback of serology results improved from 4% in 2004 to 65% in 2008. Sensitivity of the NMCBSS however has been weakening, declining from 9.04 cases investigated per 100 000 population per year in 2000 to 1.58 cases/100 000/year in 2008. Conclusion The NMCBSS improved in quality, timeliness and feedback of laboratory results of specimens sent for investigation, but its sensitivity declined mainly due to reduced capacity to detect and confirm measles cases. We recommend training staff on active

  5. [The health system of Ecuador].

    Science.gov (United States)

    Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo

    2011-01-01

    This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.

  6. Benchmarking and performance management in health care

    OpenAIRE

    Buttigieg, Sandra; ; EHMA Annual Conference : Public Health Care : Who Pays, Who Provides?

    2012-01-01

    Current economic conditions challenge health care providers globally. Healthcare organizations need to deliver optimal financial, operational, and clinical performance to sustain quality of service delivery. Benchmarking is one of the most potent and under-utilized management tools available and an analytic tool to understand organizational performance. Additionally, it is required for financial survival and organizational excellence.

  7. Health Plan Performance Measurement within Medicare Subvention.

    Science.gov (United States)

    1998-06-01

    the causes of poor performance (Siren & Laffel, 1996). Although outcomes measures such as nosocomial infection rates, admission rates for select...defined. Traditional outcomes measures include infection rates, morbidity, and mortality. The problem with these traditional measures is... Maternal /Child Care Indicators Nursing Staffing Indicators Outcome Indicators Technical Outcomes Plan Performance Stability of Health Plan

  8. Data management system performance modeling

    Science.gov (United States)

    Kiser, Larry M.

    1993-01-01

    This paper discusses analytical techniques that have been used to gain a better understanding of the Space Station Freedom's (SSF's) Data Management System (DMS). The DMS is a complex, distributed, real-time computer system that has been redesigned numerous times. The implications of these redesigns have not been fully analyzed. This paper discusses the advantages and disadvantages for static analytical techniques such as Rate Monotonic Analysis (RMA) and also provides a rationale for dynamic modeling. Factors such as system architecture, processor utilization, bus architecture, queuing, etc. are well suited for analysis with a dynamic model. The significance of performance measures for a real-time system are discussed.

  9. Evaluation of EIT system performance.

    Science.gov (United States)

    Yasin, Mamatjan; Böhm, Stephan; Gaggero, Pascal O; Adler, Andy

    2011-07-01

    An electrical impedance tomography (EIT) system images internal conductivity from surface electrical stimulation and measurement. Such systems necessarily comprise multiple design choices from cables and hardware design to calibration and image reconstruction. In order to compare EIT systems and study the consequences of changes in system performance, this paper describes a systematic approach to evaluate the performance of the EIT systems. The system to be tested is connected to a saline phantom in which calibrated contrasting test objects are systematically positioned using a position controller. A set of evaluation parameters are proposed which characterize (i) data and image noise, (ii) data accuracy, (iii) detectability of single contrasts and distinguishability of multiple contrasts, and (iv) accuracy of reconstructed image (amplitude, resolution, position and ringing). Using this approach, we evaluate three different EIT systems and illustrate the use of these tools to evaluate and compare performance. In order to facilitate the use of this approach, all details of the phantom, test objects and position controller design are made publicly available including the source code of the evaluation and reporting software.

  10. Associations between shift schedule characteristics with sleep, need for recovery, health and performance measures for regular (semi-) continuous 3-shift systems

    NARCIS (Netherlands)

    van de Ven, Hardy A.; Brouwer, Sandra; Koolhaas, Wendy; Goudswaard, Anneke; de Looze, Michiel P.; Kecklund, Goran; Almansa, Josue; Bultmann, Ute; van der Klink, Jac J. L.

    In this cross-sectional study associations were examined between eight shift schedule characteristics with shift-specific sleep complaints and need for recovery and generic health and performance measures. It was hypothesized that shift schedule characteristics meeting ergonomic recommendations are

  11. Associations between shift schedule characteristics with sleep, need for recovery, health and performance measures for regular (semi-)continuous 3-shift systems

    NARCIS (Netherlands)

    van de Ven, Hardy A.; Brouwer, Sandra; Koolhaas, Wendy; Goudswaard, Anneke; de Looze, Michiel P.; Kecklund, Göran; Almansa, Josue; Bültmann, Ute; van der Klink, Jac J L

    2016-01-01

    In this cross-sectional study associations were examined between eight shift schedule characteristics with shift-specific sleep complaints and need for recovery and generic health and performance measures. It was hypothesized that shift schedule characteristics meeting ergonomic recommendations are

  12. The effects of ozonation on performance, health and welfare of rainbow trout Oncorhynchus mykiss in low-exchange water recirculation aquaculture systems

    Science.gov (United States)

    A controlled four-month trial was conducted to compare the effects of ozonation (oxidation-reduction potential setpoint = 250 mV) versus no ozonation on rainbow trout Oncorhynchus mykiss performance, health, and welfare in replicated WRAS operated at low exchange rates (0.26% of the total recirculat...

  13. Comparative Assessment of Health Workers Performance and The ...

    African Journals Online (AJOL)

    Comparative Assessment of Health Workers Performance and The Performance ... had very high significant effect on performance of health workers which was independent of ... Keywords: Health Worker Performance Factors Hospitals Nigeria ...

  14. Comparing the effects of high vs. low nitrate on the health, performance, and welfare of juvenile rainbow trout Oncorhynchus mykiss within water recirculating aquaculture systems

    Science.gov (United States)

    Previous research indicates that rainbow trout (Oncorhynchus mykiss) begin to exhibit health and welfare problems when cultured within water recirculating aquaculture systems (WRAS) operated at low exchange (6.7 days hydraulic retention time) and a mean feed loading rate of 4.1 kg feed/m3 daily make...

  15. Performance Confirmation Data Acquisition System

    International Nuclear Information System (INIS)

    D.W. Markman

    2000-01-01

    The purpose of this analysis is to identify and analyze concepts for the acquisition of data in support of the Performance Confirmation (PC) program at the potential subsurface nuclear waste repository at Yucca Mountain. The scope and primary objectives of this analysis are to: (1) Review the criteria for design as presented in the Performance Confirmation Data Acquisition/Monitoring System Description Document, by way of the Input Transmittal, Performance Confirmation Input Criteria (CRWMS M and O 1999c). (2) Identify and describe existing and potential new trends in data acquisition system software and hardware that would support the PC plan. The data acquisition software and hardware will support the field instruments and equipment that will be installed for the observation and perimeter drift borehole monitoring, and in-situ monitoring within the emplacement drifts. The exhaust air monitoring requirements will be supported by a data communication network interface with the ventilation monitoring system database. (3) Identify the concepts and features that a data acquisition system should have in order to support the PC process and its activities. (4) Based on PC monitoring needs and available technologies, further develop concepts of a potential data acquisition system network in support of the PC program and the Site Recommendation and License Application

  16. Computed radiography systems performance evaluation

    International Nuclear Information System (INIS)

    Xavier, Clarice C.; Nersissian, Denise Y.; Furquim, Tania A.C.

    2009-01-01

    The performance of a computed radiography system was evaluated, according to the AAPM Report No. 93. Evaluation tests proposed by the publication were performed, and the following nonconformities were found: imaging p/ate (lP) dark noise, which compromises the clinical image acquired using the IP; exposure indicator uncalibrated, which can cause underexposure to the IP; nonlinearity of the system response, which causes overexposure; resolution limit under the declared by the manufacturer and erasure thoroughness uncalibrated, impairing structures visualization; Moire pattern visualized at the grid response, and IP Throughput over the specified by the manufacturer. These non-conformities indicate that digital imaging systems' lack of calibration can cause an increase in dose in order that image prob/ems can be so/ved. (author)

  17. Fixing Health Systems

    International Development Research Centre (IDRC) Digital Library (Canada)

    In Africa, health care has been in a state of crisis for several decades. ..... Instead, think about them as representations of real people — people with families that ...... blood screening; patient care, counseling, and social support; palliative care.

  18. Clinical quality performance in U.S. health centers.

    Science.gov (United States)

    Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen

    2012-12-01

    To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. National data from the 2009 Uniform Data System. Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. © Health Research and Educational Trust.

  19. Relations between mental health team characteristics and work role performance.

    Science.gov (United States)

    Fleury, Marie-Josée; Grenier, Guy; Bamvita, Jean-Marie; Farand, Lambert

    2017-01-01

    Effective mental health care requires a high performing, interprofessional team. Among 79 mental health teams in Quebec (Canada), this exploratory study aims to 1) determine the association between work role performance and a wide range of variables related to team effectiveness according to the literature, and to 2) using structural equation modelling, assess the covariance between each of these variables as well as the correlation with other exogenous variables. Work role performance was measured with an adapted version of a work role questionnaire. Various independent variables including team manager characteristics, user characteristics, team profiles, clinical activities, organizational culture, network integration strategies and frequency/satisfaction of interactions with other teams or services were analyzed under the structural equation model. The later provided a good fit with the data. Frequent use of standardized procedures and evaluation tools (e.g. screening and assessment tools for mental health disorders) and team manager seniority exerted the most direct effect on work role performance. While network integration strategies had little effect on work role performance, there was a high covariance between this variable and those directly affecting work role performance among mental health teams. The results suggest that the mental healthcare system should apply standardized procedures and evaluation tools and, to a lesser extent, clinical approaches to improve work role performance in mental health teams. Overall, a more systematic implementation of network integration strategies may contribute to improved work role performance in mental health care.

  20. Associations between shift schedule characteristics with sleep, need for recovery, health and performance measures for regular (semi-)continuous 3-shift systems.

    Science.gov (United States)

    van de Ven, Hardy A; Brouwer, Sandra; Koolhaas, Wendy; Goudswaard, Anneke; de Looze, Michiel P; Kecklund, Göran; Almansa, Josue; Bültmann, Ute; van der Klink, Jac J L

    2016-09-01

    In this cross-sectional study associations were examined between eight shift schedule characteristics with shift-specific sleep complaints and need for recovery and generic health and performance measures. It was hypothesized that shift schedule characteristics meeting ergonomic recommendations are associated with better sleep, need for recovery, health and performance. Questionnaire data were collected from 491 shift workers of 18 companies with 9 regular (semi)-continuous shift schedules. The shift schedule characteristics were analyzed separately and combined using multilevel linear regression models. The hypothesis was largely not confirmed. Relatively few associations were found, of which the majority was in the direction as expected. In particular early starts of morning shifts and many consecutive shifts seem to be avoided. The healthy worker effect, limited variation between included schedules and the cross-sectional design might explain the paucity of significant results. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Power system health analysis

    International Nuclear Information System (INIS)

    Billinton, Roy; Fotuhi-Firuzabad, Mahmud; Aboreshaid, Saleh

    1997-01-01

    This paper presents a technique which combines both probabilistic indices and deterministic criteria to reflect the well-being of a power system. This technique permits power system planners, engineers and operators to maximize the probability of healthy operation as well as minimizing the probability of risky operation. The concept of system well-being is illustrated in this paper by application to the areas of operating reserve assessment and composite power system security evaluation

  2. Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness.

    Science.gov (United States)

    Bramesfeld, A; Stegbauer, C

    2016-10-01

    The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users' legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services' performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.

  3. Oral health and elite sport performance

    Science.gov (United States)

    Needleman, Ian; Ashley, Paul; Fine, Peter; Haddad, Fares; Loosemore, Mike; de Medici, Akbar; Donos, Nikos; Newton, Tim; van Someren, Ken; Moazzez, Rebecca; Jaques, Rod; Hunter, Glenn; Khan, Karim; Shimmin, Mark; Brewer, John; Meehan, Lyndon; Mills, Steve; Porter, Stephen

    2015-01-01

    While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies. PMID:25263651

  4. Subsonic Performance of Ejector Systems

    Science.gov (United States)

    Weil, Samuel

    Combined cycle engines combining scramjets with turbo jets or rockets can provide efficient hypersonic flight. Ejectors have the potential to increase the thrust and efficiency of combined cycle engines near static conditions. A computer code was developed to support the design of a small-scale, turbine-based combined cycle demonstrator with an ejector, built around a commercially available turbojet engine. This code was used to analyze the performance of an ejector system built around a micro-turbojet. With the use of a simple ejector, net thrust increases as large as 20% over the base engine were predicted. Additionally the specific fuel consumption was lowered by 10%. Increasing the secondary to primary area ratio of the ejector lead to significant improvements in static thrust, specific fuel consumption (SFC), and propulsive efficiency. Further ejector performance improvements can be achieved by using a diffuser. Ejector performance drops off rapidly with increasing Mach number. The ejector has lower thrust and higher SFC than the turbojet core at Mach numbers above 0.2. When the nozzle chokes a significant drop in ejector performance is seen. When a diffuser is used, higher Mach numbers lead to choking in the mixer and a shock in the nozzle causing a significant decrease in ejector performance. Evaluation of different turbo jets shows that ejector performance depends significantly on the properties of the turbojet. Static thrust and SFC improvements can be achieved with increasing ejector area for all engines, but size of increase and change in performance at higher Mach numbers depend heavily on the turbojet. The use of an ejector in a turbine based combined cycle configuration also increases performance at static conditions with a thrust increase of 5% and SFC decrease of 5% for the tested configuration.

  5. Hawaii's public mental health system.

    Science.gov (United States)

    VanderVoort, Debra J

    2005-03-01

    The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.

  6. Performance comparison between the mycobacteria growth indicator tube system and Löwenstein-Jensen medium in the routine detection of Mycobacterium tuberculosis at public health care facilities in Rio de Janeiro, Brazil: preliminary results of a pragmatic clinical trial.

    Science.gov (United States)

    Moreira, Adriana da Silva Rezende; Huf, Gisele; Vieira, Maria Armanda; Fonseca, Leila; Ricks, Monica; Kritski, Afrânio Lineu

    2013-01-01

    In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. (ISRCTN.org Identifier: ISRCTN79888843 [http://isrctn.org/]) In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. (ISRCTN.org Identifier: ISRCTN79888843 [http://isrctn.org/]).

  7. Integrated Systems Health Management for Intelligent Systems

    Science.gov (United States)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  8. Indicator-based systems of performance management in the National Health Service: a comparison of the perceptions of local- and national-level managers.

    Science.gov (United States)

    Jones, G T

    2000-02-01

    Historically, the UK Government has policed the use of National Health Service (NHS) resources through the centralization of control. With the majority of resource-draining decisions being taken by clinicians, however, professional financial accountability is becoming more important within the NHS management structure. Variations in clinical performance can be monitored through the use of performance indicators, although these are not without their problems. The use of league tables of such indicators in the national press is now infamous and there is much anecdotal evidence about the intraorganizational conflict arising from the use of such tables. A questionnaire survey and interview study of clinical directors, clinical service directors and business managers in several Scottish NHS Trusts was undertaken to ascertain the perceptions of local-level managers on the issue of performance indicators. Interviews were also carried out with a number of personnel in the Scottish Office Department of Economics and Information, the Division of Health Gain and the Finance Directorate. This paper explores the differences between the perceptions of the managers at these two levels of the NHS with regards to issues of performance measurement, intraorganizational conflict and corporate vision.

  9. The effects of long-term 20 mg/L carbon dioxide exposure on the health and performance of Atlantic salmon Salmo salar post-smolts in water recirculation aquaculture systems

    Science.gov (United States)

    Previous research and experience has linked elevated dissolved carbon dioxide (CO2) to reduced growth performance, poor feed conversion, and a variety of health issues in farm-raised fish, including Atlantic salmon Salmo salar. Supplemental control measures in water recirculation aquaculture systems...

  10. United States of America: health system review.

    Science.gov (United States)

    Rice, Thomas; Rosenau, Pauline; Unruh, Lynn Y; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

    2013-01-01

    This analysis of the United States health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The US health system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor measures on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It is difficult to determine the extent to which deficiencies are health-system related, though it seems that at least some of the problems are a result of poor access to care. Because of the adoption of the Affordable Care Act in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central aim, envisaged through subsidies for the uninsured to purchase private insurance, expanded eligibility for Medicaid (in some states) and greater protection for insured persons. Furthermore, primary care and public health receive increased funding, and quality and expenditures are addressed through a range of measures. Whether the ACA will indeed be effective in addressing the challenges identified above can only be determined over time. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

  11. Suomi NPP Ground System Performance

    Science.gov (United States)

    Grant, K. D.; Bergeron, C.

    2013-12-01

    The National Oceanic and Atmospheric Administration (NOAA) and National Aeronautics and Space Administration (NASA) are jointly acquiring the next-generation civilian weather and environmental satellite system: the Joint Polar Satellite System (JPSS). JPSS will replace the afternoon orbit component and ground processing system of the current Polar-orbiting Operational Environmental Satellites (POES) managed by NOAA. The JPSS satellites will carry a suite of sensors designed to collect meteorological, oceanographic, climatological and geophysical observations of the Earth. The first satellite in the JPSS constellation, known as the Suomi National Polar-orbiting Partnership (Suomi NPP) satellite, was launched on 28 October 2011, and is currently undergoing product calibration and validation activities. As products reach a beta level of maturity, they are made available to the community through NOAA's Comprehensive Large Array-data Stewardship System (CLASS). CGS's data processing capability processes the satellite data from the Joint Polar Satellite System satellites to provide environmental data products (including Sensor Data Records (SDRs) and Environmental Data Records (EDRs)) to NOAA and Department of Defense (DoD) processing centers operated by the United States government. CGS is currently processing and delivering SDRs and EDRs for Suomi NPP and will continue through the lifetime of the Joint Polar Satellite System programs. Following the launch and sensor activation phase of the Suomi NPP mission, full volume data traffic is now flowing from the satellite through CGS's C3, data processing, and data delivery systems. Ground system performance is critical for this operational system. As part of early system checkout, Raytheon measured all aspects of data acquisition, routing, processing, and delivery to ensure operational performance requirements are met, and will continue to be met throughout the mission. Raytheon developed a tool to measure, categorize, and

  12. Diabetes Outcomes in the Indian Health System During the Era of the Special Diabetes Program for Indians and the Government Performance and Results Act

    Science.gov (United States)

    Wilson, Charlton; Gilliland, Susan; Cullen, Theresa; Moore, Kelly; Roubideaux, Yvette; Valdez, Lorraine; Vanderwagen, William; Acton, Kelly

    2005-01-01

    Objectives. We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (IHS) health care delivery system. Methods. We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit. Results. Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively. Conclusions. We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals. PMID:16051933

  13. Health record systems that meet clinical needs

    Directory of Open Access Journals (Sweden)

    Gabriella Negrini

    2012-10-01

    Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

  14. Mobile health systems and emergence

    NARCIS (Netherlands)

    Jones, Valerie M.; Graziosi, Barbara

    2015-01-01

    Changes in the age distribution of the population and increased prevalence of chronic illnesses, together with a shortage of health professionals and other resources, will increasingly challenge the ability of national healthcare systems to meet rising demand for services. Large-scale use of eHealth

  15. STILT: System design and performance

    Science.gov (United States)

    Mawson, N. R.; Steele, I. A.; Smith, R. J.

    2013-08-01

    The Small Telescopes Installed at the Liverpool Telescope (STILT) have been in operation since March 2009, collecting wide field data from their position, mounted to the Liverpool Telescope. The two instruments; SkycamT and SkycamZ have been used to create a variability search of the skies visible at La Palma with the limits of 12th and 18th R-band magnitude with fields of view of 21°× 21o and 1°× 1o. We provide here a description of the hardware and software setup and the performance of the system to date.

  16. Health and School Performance amongst Danish adolescents

    DEFF Research Database (Denmark)

    Hansen, Claus D.; Andersen, Johan Hviid

    2009-01-01

    in Ringkoebing County, Denmark in 2004 was collected from questionnaires. Participants’ childhood health was obtained from questionnaires to their parents at the same time. Information on grades in Danish spelling, oral Danish and written math was collected at the end of compulsory school (1 year after baseline...... years has between 0.27 [95% confidence interval (CI) 0.13 to 0.40] and 0.34 (95% CI 0.21 to 0.48) lower grades, adjusted for a range of other factors influencing school performance. Specific symptoms leading to poorer school performance includes frequent headaches, high levels of perceived stress...

  17. Breast Health Belief Systems Study

    National Research Council Canada - National Science Library

    Williams, Mary

    1999-01-01

    .... The hypothesis underlying this research is that a breast health promotion approach that is based in specific belief systems among three disparate African American rural populations of low socioeconomic status (SES...

  18. [Corruption and health care system].

    Science.gov (United States)

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.

  19. Health Systems Strengthening

    DEFF Research Database (Denmark)

    Hanlin, Rebecca; Andersen, Margrethe Holm

    The Global Network for the Economics of Learning, Innovation, and Competence Building Systems (Globelics) is an open and diverse community of scholars working on innovation and competence building in the context of economic development. The major purpose of the network is to contribute to buildin...

  20. Plant operator performance evaluation system

    International Nuclear Information System (INIS)

    Ujita, Hiroshi; Fukuda, Mitsuko; Kubota, Ryuji.

    1989-01-01

    A plant operator performance evaluation system to analyze plant operation records during accident training and to identify and classify operator errors has been developed for the purpose of supporting realization of a training and education system for plant operators. A knowledge engineering technique was applied to evaluation of operator behavior by both even-based and symptom-based procedures, in various situations including event transition due to multiple failures or operational errors. The system classifies the identified errors as to their single and double types based on Swain's error classification and the error levels reflecting Rasmussen's cognitive level, and it also evaluates the effect of errors on plant state and then classifies error influence, using 'knowledge for phenomena and operations', as represented by frames. It has additional functions for analysis of error statistics and knowledge acquisition support of 'knowledge for operations'. The system was applied to a training analysis for a scram event in a BWR plant, and its error analysis function was confirmed to be effective by operational experts. (author)

  1. Intelligent Integrated System Health Management

    Science.gov (United States)

    Figueroa, Fernando

    2012-01-01

    Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems

  2. Does front-of-pack nutrition information improve consumer ability to make healthful choices? Performance of warnings and the traffic light system in a simulated shopping experiment.

    Science.gov (United States)

    Machín, Leandro; Aschemann-Witzel, Jessica; Curutchet, María Rosa; Giménez, Ana; Ares, Gastón

    2018-02-01

    The inclusion of more attention-grabbing and easily interpretable front-of-pack (FOP) nutrition information is one of the public policies that can be implemented to empower consumers to identify unhealthful food products and to make more informed food choices. The aim of the present work was to evaluate the influence of two FOP nutrition labelling schemes - the traffic light labelling and the warning scheme - on consumer food purchases when facing a health goal. The study was conducted with 1182 people from Montevideo (Uruguay), recruited using a Facebook advertisement. Participants were randomly allocated to one of three between-subjects experimental conditions: (i) a control condition with no FOP nutrition information, (ii) FOP nutrition information using a modified version of the traffic light system including information about calorie, saturated fat, sugars and sodium content per portion, and (iii) FOP nutrition information using the Chilean warning system including separate signs for high calorie, saturated fat, sugars and sodium content. Respondents were asked to imagine that they had to purchase food in order to prepare a healthy dinner for themselves and their family, using the website of an online grocery store. Results showed that FOP nutrition information effectively improved the average healthfulness of participants' choices compared to the control condition, both in terms of the average nutritional composition of the purchased products and expenditure in specific product categories. No relevant differences between the effect of the traffic light and the warning system were found. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Health-educator performance evaluation for quality teaching ...

    African Journals Online (AJOL)

    The aim of this study was to investigate the efficacy of health educator performance evaluation procedures using the Integrated Quality Management System. This quantitative study used questionnaires to collect data from three hundred and thirty eight respondents selected through a convenient sampling procedure.

  4. Electricity system performance in Brazil

    International Nuclear Information System (INIS)

    Pires Rodrigues, A.; Souza Dias, D. De

    1992-01-01

    Nowadays, there is great uncertainty and concern about the capacity of the electric sector to go ahead with the programme of investments which was planned to keep pace with the growth in electricity demand. The sector is in an important financial crisis caused by the progressive reduction in its ability to generate resources either through self-financing or through external sources. The Brazilian electric sector is mostly public. Moreover, it is marked by a high degree of integration, which makes the whole system vulnerable to problem in each of its parts. First, the financial health of the Electrobras system which is at the top of the pyramidal sectoral structure depends on the capacity of the state-level utilities (operating mainly on the distribution side) to pay for the bulk supplies which they buy from Electrobras-controlled utilities. Second, tariffs are equal in the country as a whole regardless of differences in costs. Differences must be covered by the transfers between state utilities. Thus, there is also a significant horizontal financial inter-dependence in the sector. These institutional characteristics have been very important in the context of the present financial crisis

  5. [The health system of Guatemala].

    Science.gov (United States)

    Becerril-Montekio, Víctor; López-Dávila, Luis

    2011-01-01

    This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.

  6. Strengthening Governance in Health Systems for Reproductive ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Home · What we do ... As a result, Pakistan's health system has suffered and health service delivery has worsened. ... This four-year project aims to strengthen health systems governance for reproductive health and rights in Pakistan.

  7. Mobile health information system: a mobile app. to aid health ...

    African Journals Online (AJOL)

    Mobile health information system: a mobile app. to aid health workers relate health information. ... Global Journal of Mathematical Sciences ... phones in delivering vital health information and effective fieldwork reporting is of significance.

  8. Prognostics and health management of photovoltaic systems

    Science.gov (United States)

    Johnson, Jay; Riley, Daniel

    2018-04-10

    The various technologies presented herein relate to providing prognosis and health management (PHM) of a photovoltaic (PV) system. A PV PHM system can eliminate long-standing issues associated with detecting performance reduction in PV systems. The PV PHM system can utilize an ANN model with meteorological and power input data to facilitate alert generation in the event of a performance reduction without the need for information about the PV PHM system components and design. Comparisons between system data and the PHM model can provide scheduling of maintenance on an as-needed basis. The PHM can also provide an approach for monitoring system/component degradation over the lifetime of the PV system.

  9. Introduction on health recommender systems.

    Science.gov (United States)

    Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

    2015-01-01

    People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.

  10. AMiBA: SYSTEM PERFORMANCE

    International Nuclear Information System (INIS)

    Lin, K.-Y.; Li, C.-T.; Ho, Paul T.P.; Liu, G.-C.; Koch, Patrick M.; Molnar, Sandor M.; Nishioka, Hiroaki; Umetsu, Keiichi; Altamirano, Pablo; Chang, C.-H.; Chang, S.-H.; Chang, S.-W.; Chen, M.-T.; Martin-Cocher, Pierre; Huang, C.-W.L.; Liao, Y.-W.; Wang, F.-C.; Wu, J.-H.P.; Kestevan, Michael; Birkinshaw, Mark

    2009-01-01

    The Y.T. Lee Array for Microwave Background Anisotropy started scientific operation in early 2007. This work describes the optimization of the system performance for the measurements of the Sunyaev-Zel'dovich effect for six massive galaxy clusters at redshifts 0.09-0.32. We achieved a point-source sensitivity of 63 ± 7 mJy with the seven 0.6 m dishes in 1 hr of on-source integration in two-patch differencing observations. We measured and compensated for the delays between the antennas of our platform-mounted interferometer. Beam switching was used to cancel instrumental instabilities and ground pick up. Total power and phase stability were good on timescales of hours, and the system was shown to integrate down on equivalent timescales of 300 hr per baseline/correlation, or about 10 hr for the entire array. While the broadband correlator leads to good sensitivity, the small number of lags in the correlator resulted in poorly measured bandpass response. We corrected for this by using external calibrators (Jupiter and Saturn). Using Jupiter as the flux standard, we measured the disk brightness temperature of Saturn to be 149 +5 -12 K.

  11. AMiBA: System Performance

    Science.gov (United States)

    Lin, Kai-Yang; Li, Chao-Te; Ho, Paul T. P.; Huang, Chih-Wei Locutus; Liao, Yu-Wei; Liu, Guo-Chin; Koch, Patrick M.; Molnar, Sandor M.; Nishioka, Hiroaki; Umetsu, Keiichi; Wang, Fu-Cheng; Wu, Jiun-Huei Proty; Kestevan, Michael; Birkinshaw, Mark; Altamirano, Pablo; Chang, Chia-Hao; Chang, Shu-Hao; Chang, Su-Wei; Chen, Ming-Tang; Martin-Cocher, Pierre; Han, Chih-Chiang; Huang, Yau-De; Hwang, Yuh-Jing; Ibañez-Roman, Fabiola; Jiang, Homin; Kubo, Derek Y.; Oshiro, Peter; Raffin, Philippe; Wei, Tashun; Wilson, Warwick; Chen, Ke-Jung; Chiueh, Tzihong

    2009-04-01

    The Y.T. Lee Array for Microwave Background Anisotropy started scientific operation in early 2007. This work describes the optimization of the system performance for the measurements of the Sunyaev-Zel'dovich effect for six massive galaxy clusters at redshifts 0.09-0.32. We achieved a point-source sensitivity of 63 ± 7 mJy with the seven 0.6 m dishes in 1 hr of on-source integration in two-patch differencing observations. We measured and compensated for the delays between the antennas of our platform-mounted interferometer. Beam switching was used to cancel instrumental instabilities and ground pick up. Total power and phase stability were good on timescales of hours, and the system was shown to integrate down on equivalent timescales of 300 hr per baseline/correlation, or about 10 hr for the entire array. While the broadband correlator leads to good sensitivity, the small number of lags in the correlator resulted in poorly measured bandpass response. We corrected for this by using external calibrators (Jupiter and Saturn). Using Jupiter as the flux standard, we measured the disk brightness temperature of Saturn to be 149+5 -12 K.

  12. The right to health, health systems development and public health policy challenges in Chad.

    Science.gov (United States)

    Azétsop, Jacquineau; Ochieng, Michael

    2015-02-15

    There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded

  13. Managing interoperability and complexity in health systems.

    Science.gov (United States)

    Bouamrane, M-M; Tao, C; Sarkar, I N

    2015-01-01

    In recent years, we have witnessed substantial progress in the use of clinical informatics systems to support clinicians during episodes of care, manage specialised domain knowledge, perform complex clinical data analysis and improve the management of health organisations' resources. However, the vision of fully integrated health information eco-systems, which provide relevant information and useful knowledge at the point-of-care, remains elusive. This journal Focus Theme reviews some of the enduring challenges of interoperability and complexity in clinical informatics systems. Furthermore, a range of approaches are proposed in order to address, harness and resolve some of the many remaining issues towards a greater integration of health information systems and extraction of useful or new knowledge from heterogeneous electronic data repositories.

  14. Enhancing health leadership performance using neurotherapy.

    Science.gov (United States)

    Swingle, Paul G; Hartney, Elizabeth

    2018-05-01

    The discovery of neuroplasticity means the brain can change, functionally, in response to the environment and to learning. While individuals can develop harmful patterns of brain activity in response to stressors, they can also learn to modify or control neurological conditions associated with specific behaviors. Neurotherapy is one way of changing brain functioning to modify troubling conditions which can impair leadership performance, through responding to feedback on their own brain activity, and enhancing optimal leadership functioning through learning to maximize such cognitive strengths as mental efficiency, focus, creativity, perseverance, and executive functioning. The present article outlines the application of the concept of optimal performance training to organizational leadership in a healthcare context, by describing approaches to neurotherapy and illustrating their application through a case study of a health leader learning to overcome the neurological and emotional sequelae of workplace stress and trauma.

  15. Systemic Approach to Architectural Performance

    Directory of Open Access Journals (Sweden)

    Marie Davidova

    2017-04-01

    Full Text Available First-hand experiences in several design projects that were based on media richness and collaboration are described in this article. Although complex design processes are merely considered as socio-technical systems, they are deeply involved with natural systems. My collaborative research in the field of performance-oriented design combines digital and physical conceptual sketches, simulations and prototyping. GIGA-mapping - is applied to organise the data. The design process uses the most suitable tools, for the subtasks at hand, and the use of media is mixed according to particular requirements. These tools include digital and physical GIGA-mapping, parametric computer aided design (CAD, digital simulation of analyses, as well as sampling and 1:1 prototyping. Also discussed in this article are the methodologies used in several design projects to strategize these tools and the developments and trends in the tools employed.  The paper argues that the digital tools tend to produce similar results through given pre-sets that often do not correspond to real needs. Thus, there is a significant need for mixed methods including prototyping in the creative design process. Media mixing and cooperation across disciplines is unavoidable in the holistic approach to contemporary design. This includes the consideration of diverse biotic and abiotic agents. I argue that physical and digital GIGA-mapping is a crucial tool to use in coping with this complexity. Furthermore, I propose the integration of physical and digital outputs in one GIGA-map and the participation and co-design of biotic and abiotic agents into one rich design research space, which is resulting in an ever-evolving research-design process-result time-based design.

  16. Can action research strengthen district health management and improve health workforce performance? A research protocol.

    Science.gov (United States)

    Mshelia, C; Huss, R; Mirzoev, T; Elsey, H; Baine, S O; Aikins, M; Kamuzora, P; Bosch-Capblanch, X; Raven, J; Wyss, K; Green, A; Martineau, T

    2013-08-30

    The single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnel and by improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome. The overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, 'bundles' of HR/HS strategies that are feasible within the context and affordable within the districts' budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions. Different challenges were faced during the development of

  17. ACCESS Sub-system Performance

    Science.gov (United States)

    Kaiser, Mary Elizabeth; Morris, Matthew J.; Aldoroty, Lauren Nicole; Godon, David; Pelton, Russell; McCandliss, Stephan R.; Kurucz, Robert L.; Kruk, Jeffrey W.; Rauscher, Bernard J.; Kimble, Randy A.; Wright, Edward L.; Benford, Dominic J.; Gardner, Jonathan P.; Feldman, Paul D.; Moos, H. Warren; Riess, Adam G.; Bohlin, Ralph; Deustua, Susana E.; Dixon, William Van Dyke; Sahnow, David J.; Lampton, Michael; Perlmutter, Saul

    2016-01-01

    ACCESS: Absolute Color Calibration Experiment for Standard Stars is a series of rocket-borne sub-orbital missions and ground-based experiments designed to leverage significant technological advances in detectors, instruments, and the precision of the fundamental laboratory standards used to calibrate these instruments to enable improvements in the precision of the astrophysical flux scale through the transfer of laboratory absolute detector standards from the National Institute of Standards and Technology (NIST) to a network of stellar standards with a calibration accuracy of 1% and a spectral resolving power of 500 across the 0.35 to 1.7 micron bandpass.A cross wavelength calibration of the astrophysical flux scale to this level of precision over this broad a bandpass is relevant for the data used to probe fundamental astrophysical problems such as the SNeIa photometry based measurements used to constrain dark energy theories.We will describe the strategy for achieving this level of precision, the payload and calibration configuration, present sub-system test data, and the status and preliminary performance of the integration and test of the spectrograph and telescope. NASA APRA sounding rocket grant NNX14AH48G supports this work.

  18. Performance confirmation data acquisition system

    International Nuclear Information System (INIS)

    McAffee, D.A.; Raczka, N.T.

    1997-01-01

    As part of the Viability Assessment (VA) work, this QAP-3-9 document presents and evaluates a comprehensive set of viable concepts for collecting Performance Confirmation (PC) related data. The concepts include: monitoring subsurface repository air temperatures, humidity levels and gaseous emissions via the subsurface ventilation systems, and monitoring the repository geo-technical parameters and rock mass from bore-holes located along the perimeter main drifts and throughout a series of human-rated Observation Drifts to be located in a plane 25 meters above the plane of the emplacement drifts. A key element of this document is the development and analysis of a purposed multi-purpose Remote Inspection Gantry that would provide direct, real-time visual, thermal, and radiological monitoring of conditions inside operational emplacement drifts and close-up observations of in-situ Waste Packages. Preliminary finite-element analyses are presented that indicate the technological feasibility of operating an inspection gantry inside the operational emplacement drifts for short inspection missions lasting 2--3 hours. Overall reliability, availability, and maintainability of the PC data collection concepts are discussed. Preliminary concepts for PC data collection network are also provided

  19. Performance confirmation data acquisition system

    Energy Technology Data Exchange (ETDEWEB)

    McAffee, D.A.; Raczka, N.T. [Yucca Mountain Project, Las Vegas, NV (United States)

    1997-12-31

    As part of the Viability Assessment (VA) work, this QAP-3-9 document presents and evaluates a comprehensive set of viable concepts for collecting Performance Confirmation (PC) related data. The concepts include: monitoring subsurface repository air temperatures, humidity levels and gaseous emissions via the subsurface ventilation systems, and monitoring the repository geo-technical parameters and rock mass from bore-holes located along the perimeter main drifts and throughout a series of human-rated Observation Drifts to be located in a plane 25 meters above the plane of the emplacement drifts. A key element of this document is the development and analysis of a purposed multi-purpose Remote Inspection Gantry that would provide direct, real-time visual, thermal, and radiological monitoring of conditions inside operational emplacement drifts and close-up observations of in-situ Waste Packages. Preliminary finite-element analyses are presented that indicate the technological feasibility of operating an inspection gantry inside the operational emplacement drifts for short inspection missions lasting 2--3 hours. Overall reliability, availability, and maintainability of the PC data collection concepts are discussed. Preliminary concepts for PC data collection network are also provided.

  20. Optimal Sensor Selection for Health Monitoring Systems

    Science.gov (United States)

    Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.

    2005-01-01

    Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.

  1. United Kingdom (England): Health system review.

    Science.gov (United States)

    Boyle, Seán

    2011-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Various indicators show that the health of the population has improved over the last few decades. However, inequalities in health across socioeconomic groups have been increasing since the 1970s. The main diseases affecting the population are circulatory diseases, cancer, diseases of the respiratory system and diseases of the digestive system. Risk factors such as the steadily rising levels of alcohol consumption, the sharp increases in adult and child obesity and prevailing smoking levels are among the most pressing public health concerns, particularly as they reflect the growing health inequalities among different socioeconomic groups. Health services in England are largely free at the point of use. The NHS provides preventive medicine, primary care and hospital services to all those ordinarily resident. Over 12% of the population is covered by voluntary health insurance schemes, known in the United Kingdom as private medical insurance (PMI), which mainly provides access to acute elective care in the private sector. Responsibility for publicly funded health care rests with the Secretary of State for Health, supported by the Department of Health. The Department operates at a regional level through 10 strategic health authorities (SHAs), which are responsible for ensuring the quality and performance of local health services within their geographic area. Responsibility for commissioning health services at the local level lies with 151 primary care

  2. IT Performance Dashboard: Systems Dashboard

    Data.gov (United States)

    Department of Veterans Affairs — The IT Performance Dashboard a trusted source for IT performance information across VA. This is available only on the VA intranet. The dashboard is a collection of...

  3. [The health system of Brazil].

    Science.gov (United States)

    Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana

    2011-01-01

    This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.

  4. The Chinese Health Care System

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi

    In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...

  5. Comparisons of weed community, soil health and economic performance between wheat-maize and garlic-soybean rotation systems under different weed managements

    Directory of Open Access Journals (Sweden)

    Mahmud A. Muminov

    2018-05-01

    Full Text Available This study compared the impacts of different weed managements on weed community, soil health and economic performance between the wheat–maize (WM and garlic–soybean (GS rotations. A total of four treatments (H0T, tillage without herbicide; H0T0, without both herbicide and tillage; HT, both herbicide and tillage; HT0, herbicide without tillage were designed for both rotations. A total of 16 weed species were recorded in the WM rotation, with life forms of 62% for annuals, 12% for annual + perennial and 20% for perennials. While in the GS rotation, there were 17 weed species, with 71% being annuals. When crop rotation changed from WM to GS, the topsoil layer seed bank (0–5 cm decreased by 137%. GS rotation always had higher earthworm densities than that of WM under the same condition. Organic weed control (H0T, H0T0 from both WM and GS added more soil organic matters than the chemical methods (HT and HT0. Economically, up to 69% higher net profit had been achieved in the GS than WM for their organic products. This study provides an ecological basis to guide organic farming practices, especially for weed management in the future.

  6. Strengthening Health Systems Research Capacity in Mozambique ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Mozambique's health sector is dealing with system-wide challenges. ... the Ministry's work on national health accounts, resource allocation, and national health ... a combined INS-FIOCRUS program, and the master's in public health and field ...

  7. Paying health workers for performance in Battagram district, Pakistan

    Directory of Open Access Journals (Sweden)

    Javeed Sarah

    2011-10-01

    Full Text Available Abstract Background There is a growing interest in using pay-for-performance mechanisms in low and middle-income countries in order to improve the performance of health care providers. However, at present there is a dearth of independent evaluations of such approaches which can guide understanding of their potential and risks in differing contexts. This article presents the results of an evaluation of a project managed by an international non-governmental organisation in one district of Pakistan. It aims to contribute to learning about the design and implementation of pay-for-performance systems and their impact on health worker motivation. Methods Quantitative analysis was conducted of health management information system (HMIS data, financial records, and project documents covering the period 2007-2010. Key informant interviews were carried out with stakeholders at all levels. At facility level, in-depth interviews were held, as were focus group discussions with staff and community members. Results The wider project in Battagram had contributed to rebuilding district health services at a cost of less than US$4.5 per capita and achieved growth in outputs. Staff, managers and clients were appreciative of the gains in availability and quality of services. However, the role that the performance-based incentive (PBI component played was less clear--PBI formed a relatively small component of pay, and did not increase in line with outputs. There was little evidence from interviews and data that the conditional element of the PBIs influenced behaviour. They were appreciated as a top-up to pay, but remained low in relative terms, and only slightly and indirectly related to individual performance. Moreover, they were implemented independently of the wider health system and presented a clear challenge for longer term integration and sustainability. Conclusions Challenges for performance-based pay approaches include the balance of rewarding individual

  8. African Health Systems Initiative (AHSI) | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The African Health Systems Initiative (AHSI) is a 10-year Canadian International ... for strengthening African-led health systems and human resources for health. ... IDRC congratulates first cohort of Women in Climate Change Science Fellows.

  9. Improving File System Performance by Striping

    Science.gov (United States)

    Lam, Terance L.; Kutler, Paul (Technical Monitor)

    1998-01-01

    This document discusses the performance and advantages of striped file systems on the SGI AD workstations. Performance of several striped file system configurations are compared and guidelines for optimal striping are recommended.

  10. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

    This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

  11. Annual health, safety and environmental performance report for 1993

    Energy Technology Data Exchange (ETDEWEB)

    Gallapher, J D; Wright, M G

    1994-05-01

    This report summarizes the occupational health and safety and the environmental protection record of the operations of Atomic Energy of Canada Limited (AECL) during 1993. An introduction highlights the results and describes the facilities and organizational systems. Subsequent sections indicate the performance of the company with respect to personnel radiation exposures, occupational injuries, the handling of wastes, and the release of materials into the environment. Programs in health, safety and environmental protection are presented, along with site remediation and emergency preparedness practices. (author). 14 figs.

  12. Annual health, safety and environmental performance report for 1993

    International Nuclear Information System (INIS)

    Gallapher, J.D.; Wright, M.G.

    1994-05-01

    This report summarizes the occupational health and safety and the environmental protection record of the operations of Atomic Energy of Canada Limited (AECL) during 1993. An introduction highlights the results and describes the facilities and organizational systems. Subsequent sections indicate the performance of the company with respect to personnel radiation exposures, occupational injuries, the handling of wastes, and the release of materials into the environment. Programs in health, safety and environmental protection are presented, along with site remediation and emergency preparedness practices. (author). 14 figs

  13. Annual health, safety and environmental performance report for 1992

    International Nuclear Information System (INIS)

    Orman, R.F.; Richards, S.

    1993-12-01

    This report summarizes the safety and environmental record of the operations of Atomic Energy of Canada Limited (AECL) during 1992. An introduction highlights the results and describes the facilities and organizational systems. Subsequent sections indicate the performance of the company with respect to personnel radiation exposures, occupational injuries, the handling of wastes and the release of materials into the environment. Programs in health, safety and environmental protection are presented, along with site remediation and emergency preparedness practices

  14. Annual health, safety and environmental performance report for 1992

    International Nuclear Information System (INIS)

    Orman, R.F.; Richards, S.

    1993-12-01

    This report summarizes the safety and environmental record of the operations of Atomic Energy of Canada Limited (AECL) during 1992. an introduction highlights the results and describes the facilities and organizational systems. Subsequent sections indicate the performance of the company with respect to personnel radiation exposures, occupational injuries, the handling of wastes and the release of materials into the environment. Programs in health, safety and environmental protection are presented, along with site remediation and emergency preparedness practices

  15. Dynamism in Electronic Performance Support Systems.

    Science.gov (United States)

    Laffey, James

    1995-01-01

    Describes a model for dynamic electronic performance support systems based on NNAble, a system developed by the training group at Apple Computer. Principles for designing dynamic performance support are discussed, including a systems approach, performer-centered design, awareness of situated cognition, organizational memory, and technology use.…

  16. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    Science.gov (United States)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  17. Distributed Rocket Engine Testing Health Monitoring System, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The on-ground and Distributed Rocket Engine Testing Health Monitoring System (DiRETHMS) provides a system architecture and software tools for performing diagnostics...

  18. Principles and core functions of integrated child health information systems.

    Science.gov (United States)

    Hinman, Alan R; Atkinson, Delton; Diehn, Tonya Norvell; Eichwald, John; Heberer, Jennifer; Hoyle, Therese; King, Pam; Kossack, Robert E; Williams, Donna C; Zimmerman, Amy

    2004-11-01

    Infants undergo a series of preventive and therapeutic health interventions and activities. Typically, each activity includes collection and submission of data to a dedicated information system. Subsequently, health care providers, families, and health programs must query each information system to determine the child's status in a given area. Efforts are underway to integrate information in these separate information systems. This requires specifying the core functions that integrated information systems must perform.

  19. Performance analysis of nuclear materials accounting systems

    International Nuclear Information System (INIS)

    Cobb, D.D.; Shipley, J.P.

    1979-01-01

    Techniques for analyzing the level of performance of nuclear materials accounting systems in terms of the four performance measures, total amount of loss, loss-detection time, loss-detection probability, and false-alarm probability, are presented. These techniques are especially useful for analyzing the expected performance of near-real-time (dynamic) accounting systems. A conservative estimate of system performance is provided by the CUSUM (cumulative summation of materials balances) test. Graphical displays, called performance surfaces, are developed as convenient tools for representing systems performance, and examples from a recent safeguards study of a nuclear fuels reprocessing plant are given. 6 refs

  20. School infrastructure performance indicator system (SIPIS)

    CSIR Research Space (South Africa)

    Gibberd, Jeremy T

    2007-05-01

    Full Text Available This paper describes the School Infrastructure Performance Indicator System (SIPIS) project which explores how an indicator system could be developed for school infrastructure in South Africa. It outlines the key challenges faced by the system...

  1. Cognitive performance modeling based on general systems performance theory.

    Science.gov (United States)

    Kondraske, George V

    2010-01-01

    General Systems Performance Theory (GSPT) was initially motivated by problems associated with quantifying different aspects of human performance. It has proved to be invaluable for measurement development and understanding quantitative relationships between human subsystem capacities and performance in complex tasks. It is now desired to bring focus to the application of GSPT to modeling of cognitive system performance. Previous studies involving two complex tasks (i.e., driving and performing laparoscopic surgery) and incorporating measures that are clearly related to cognitive performance (information processing speed and short-term memory capacity) were revisited. A GSPT-derived method of task analysis and performance prediction termed Nonlinear Causal Resource Analysis (NCRA) was employed to determine the demand on basic cognitive performance resources required to support different levels of complex task performance. This approach is presented as a means to determine a cognitive workload profile and the subsequent computation of a single number measure of cognitive workload (CW). Computation of CW may be a viable alternative to measuring it. Various possible "more basic" performance resources that contribute to cognitive system performance are discussed. It is concluded from this preliminary exploration that a GSPT-based approach can contribute to defining cognitive performance models that are useful for both individual subjects and specific groups (e.g., military pilots).

  2. Improving Process Heating System Performance v3

    Energy Technology Data Exchange (ETDEWEB)

    None

    2016-04-11

    Improving Process Heating System Performance: A Sourcebook for Industry is a development of the U.S. Department of Energy (DOE) Advanced Manufacturing Office (AMO) and the Industrial Heating Equipment Association (IHEA). The AMO and IHEA undertook this project as part of an series of sourcebook publications developed by AMO on energy-consuming industrial systems, and opportunities to improve performance. Other topics in this series include compressed air systems, pumping systems, fan systems, steam systems, and motors and drives

  3. Performance management excellence among the Malcolm Baldrige National Quality Award Winners in Health Care.

    Science.gov (United States)

    Duarte, Neville T; Goodson, Jane R; Arnold, Edwin W

    2013-01-01

    When carefully constructed, performance management systems can help health care organizations direct their efforts toward strategic goals, high performance, and continuous improvement needed to ensure high-quality patient care and cost control. The effective management of performance is an integral component in hospital and health care systems that are recognized for excellence by the Malcolm Baldrige National Quality Award in Health Care. Using the framework in the 2011-2012 Health Care Criteria for Performance Excellence, this article identifies the best practices in performance management demonstrated by 15 Baldrige recipients. The results show that all of the recipients base their performance management systems on strategic goals, outcomes, or competencies that cascade from the organizational to the individual level. At the individual level, each hospital or health system reinforces the strategic direction with performance evaluations of leaders and employees, including the governing board, based on key outcomes and competencies. Leader evaluations consistently include feedback from internal and external stakeholders, creating a culture of information sharing and performance improvement. The hospitals or health care systems also align their reward systems to promote high performance by emphasizing merit and recognition for contributions. Best practices can provide a guide for leaders in other health systems in developing high-performance work systems.

  4. Managing the health of the elite athlete: a new integrated performance health management and coaching model.

    Science.gov (United States)

    Dijkstra, H Paul; Pollock, N; Chakraverty, R; Alonso, J M

    2014-04-01

    Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.

  5. Performance assurance for IT systems

    CERN Document Server

    King, Brian

    2004-01-01

    INDIVIDUAL AREAS OF INTERESTPreparing for the ChallengeAbstractIntroductionIn the BeginningThe Need to Address New ApplicationsDefinition of PerformanceThe Required SkillsPerformance Assurance Within a Project LifecycleSummaryCaveat Emptor (Let the Buyer Beware)AbstractSoftware Product LifecycleHardware Product LifecycleMarketingTechnical Reviews of ProductsLies, Damned Lies and BenchmarksAbstractIntroductionIndustry BenchmarksVendor BenchmarksIndependent BenchmarkingIn-House Benchmarking""Tricks of the Trade""Using Benchmarks Non-Functional Requirements and SolutionsAbstractIntroductionThe Pr

  6. Energy Systems and Population Health

    Energy Technology Data Exchange (ETDEWEB)

    Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.

    2004-04-12

    It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy

  7. Behavioral Health and Performance (BHP) Work-Rest Cycles

    Science.gov (United States)

    Leveton, Lauren B.; Whitmire, Alexandra

    2011-01-01

    BHP Program Element Goal: Identify, characterize, and prevent or reduce behavioral health and performance risks associated with space travel, exploration and return to terrestrial life. BHP Requirements: a) Characterize and assess risks (e.g., likelihood and consequences). b) Develop tools and technologies to prevent, monitor, and treat adverse outcomes. c) Inform standards. d) Develop technologies to: 1) reduce risks and human systems resource requirements (e.g., crew time, mass, volume, power) and 2) ensure effective human-system integration across exploration mission.

  8. Rocket Testing and Integrated System Health Management

    Science.gov (United States)

    Figueroa, Fernando; Schmalzel, John

    2005-01-01

    Integrated System Health Management (ISHM) describes a set of system capabilities that in aggregate perform: determination of condition for each system element, detection of anomalies, diagnosis of causes for anomalies, and prognostics for future anomalies and system behavior. The ISHM should also provide operators with situational awareness of the system by integrating contextual and timely data, information, and knowledge (DIaK) as needed. ISHM capabilities can be implemented using a variety of technologies and tools. This chapter provides an overview of ISHM contributing technologies and describes in further detail a novel implementation architecture along with associated taxonomy, ontology, and standards. The operational ISHM testbed is based on a subsystem of a rocket engine test stand. Such test stands contain many elements that are common to manufacturing systems, and thereby serve to illustrate the potential benefits and methodologies of the ISHM approach for intelligent manufacturing.

  9. System Reliability Analysis Considering Correlation of Performances

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Saekyeol; Lee, Tae Hee [Hanyang Univ., Seoul (Korea, Republic of); Lim, Woochul [Mando Corporation, Seongnam (Korea, Republic of)

    2017-04-15

    Reliability analysis of a mechanical system has been developed in order to consider the uncertainties in the product design that may occur from the tolerance of design variables, uncertainties of noise, environmental factors, and material properties. In most of the previous studies, the reliability was calculated independently for each performance of the system. However, the conventional methods cannot consider the correlation between the performances of the system that may lead to a difference between the reliability of the entire system and the reliability of the individual performance. In this paper, the joint probability density function (PDF) of the performances is modeled using a copula which takes into account the correlation between performances of the system. The system reliability is proposed as the integral of joint PDF of performances and is compared with the individual reliability of each performance by mathematical examples and two-bar truss example.

  10. Telerobotic system performance measurement - Motivation and methods

    Science.gov (United States)

    Kondraske, George V.; Khoury, George J.

    1992-01-01

    A systems performance-based strategy for modeling and conducting experiments relevant to the design and performance characterization of telerobotic systems is described. A developmental testbed consisting of a distributed telerobotics network and initial efforts to implement the strategy described is presented. Consideration is given to the general systems performance theory (GSPT) to tackle human performance problems as a basis for: measurement of overall telerobotic system (TRS) performance; task decomposition; development of a generic TRS model; and the characterization of performance of subsystems comprising the generic model. GSPT employs a resource construct to model performance and resource economic principles to govern the interface of systems to tasks. It provides a comprehensive modeling/measurement strategy applicable to complex systems including both human and artificial components. Application is presented within the framework of a distributed telerobotics network as a testbed. Insight into the design of test protocols which elicit application-independent data is described.

  11. System Reliability Analysis Considering Correlation of Performances

    International Nuclear Information System (INIS)

    Kim, Saekyeol; Lee, Tae Hee; Lim, Woochul

    2017-01-01

    Reliability analysis of a mechanical system has been developed in order to consider the uncertainties in the product design that may occur from the tolerance of design variables, uncertainties of noise, environmental factors, and material properties. In most of the previous studies, the reliability was calculated independently for each performance of the system. However, the conventional methods cannot consider the correlation between the performances of the system that may lead to a difference between the reliability of the entire system and the reliability of the individual performance. In this paper, the joint probability density function (PDF) of the performances is modeled using a copula which takes into account the correlation between performances of the system. The system reliability is proposed as the integral of joint PDF of performances and is compared with the individual reliability of each performance by mathematical examples and two-bar truss example.

  12. NASA Human Research Program Behavioral Health and Performance Element (BHP)

    Science.gov (United States)

    Whitmire, Sandra; Faulk, Jeremy; Leveton, Lauren

    2010-01-01

    The goal of NASA BHP is to identify, characterize, and prevent or reduce behavioral health and performance risks associated with space travel, exploration, and return to terrestrial life. The NASA Behavioral Health and Performance Operations Group (BHP Ops) supports astronauts and their families before, during, and after a long-duration mission (LDM) on the ISS. BHP Ops provides ISS crews with services such as preflight training (e.g., psychological factors of LDM, psychological support, cross-cultural); preflight, in-flight, and postflight support services, including counseling for astronauts and their families; and psychological support such as regular care packages and a voice-over IP phone system between crew members and their families to facilitate real-time one-on-one communication.

  13. Enhancing health worker performance in Ethiopia with mHealth ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2018-01-29

    Jan 29, 2018 ... ... in maternal and child health and tuberculosis (TB) control, priority health areas. ... Carried out in collaboration with the Liverpool School of Tropical ... HEWs to visit expectant mothers during the weeks leading up to the birth.

  14. Measured performance of the GTA rf systems

    International Nuclear Information System (INIS)

    Denney, P.M.; Jachim, S.P.

    1993-01-01

    This paper describes the performance of the RF systems on the Ground Test Accelerator (GTA). The RF system architecture is briefly described. Among the RF performance results presented are RF field flatness and stability, amplitude and phase control resolution, and control system bandwidth and stability. The rejection by the RF systems of beam-induced disturbances, such as transients and noise, are analyzed. The observed responses are also compared to computer-based simulations of the RF systems for validation

  15. Performance Enhancements for Advanced Database Management Systems

    OpenAIRE

    Helmer, Sven

    2000-01-01

    New applications have emerged, demanding database management systems with enhanced functionality. However, high performance is a necessary precondition for the acceptance of such systems by end users. In this context we developed, implemented, and tested algorithms and index structures for improving the performance of advanced database management systems. We focused on index structures and join algorithms for set-valued attributes.

  16. Do Danes enjoy a high performing chronic care system?

    DEFF Research Database (Denmark)

    Hernández-Quevedo, Christina; Olejaz, Maria; Juul, Annegrete

    2012-01-01

    The trends in population health in Denmark are similar to those in most Western European countries. Major health issues include, among others, the high prevalence of chronic illnesses and lifestyle related risk factors such as obesity, tobacco, physical inactivity and alcohol. This has pressed...... the health system towards a model of provision of care based on the management of chronic care conditions. While the Chronic Care Model was introduced in 2005, the Danish health system does not fulfil the ten key preconditions that would characterise a high-performing chronic care system. As revealed...... in a recent report, the fragmented structure of the Danish health system poses challenges in providing effectively coordinated care to patients with chronic diseases....

  17. Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System.

    Science.gov (United States)

    Kajiwara, Naohiro; Kato, Yasufumi; Hagiwara, Masaru; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2018-04-20

    To discuss the cost-benefit performance (CBP) and establish a medical fee system for robotic-assisted thoracic surgery (RATS) under the Japanese National Health Insurance System (JNHIS), which is a system not yet firmly established. All management steps for RATS are identical, such as preoperative and postoperative management. This study examines the CBP based on medical fees of RATS under the JNHIS introduced in 2016. Robotic-assisted laparoscopic prostatectomy (RALP) and robotic-assisted partial nephrectomy (RAPN) now receive insurance reimbursement under the category of use of support devices for endoscopic surgery ($5420 and $3485, respectively). If the same standard amount were to be applied to RATS, institutions would need to perform at least 150 or 300 procedures thoracic operation per year to show a positive CBP ($317 per procedure as same of RALP and $130 per procedure as same of RAPN, respectively). Robotic surgery in some areas receives insurance reimbursement for its "supportive" use for endoscopic surgery as for RALP and RAPN. However, at present, it is necessary to perform da Vinci Surgical System Si (dVSi) surgery at least 150-300 times in a year in a given institution to prevent a deficit in income.

  18. Point systems in Games for Health: A bibliometric scoping study

    OpenAIRE

    Kokol, Peter

    2018-01-01

    Very few details about point systems used in games for health are reported in scientific literature. To shed some light on this topic a bibliometric study, analyzing the papers containing terms related to games for health and point systems was performed and a mini taxonomy was derived. The search string game* AND health AND (point* OR score) AND system* in a Scopus bibliographic database was used to produce the corpus. We limited the search to articles, reviews and conference papers written i...

  19. Readiness to adopt a performance measurement system for ...

    African Journals Online (AJOL)

    Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative. ... system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation.

  20. Health Care Information System (HCIS) Data File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...

  1. Traffic Management Systems Performance Measurement: Final Report

    OpenAIRE

    Banks, James H.; Kelly, Gregory

    1997-01-01

    This report documents a study of performance measurement for Transportation Management Centers (TMCs). Performance measurement requirements were analyzed, data collection and management techniques were investigated, and case study traffic data system improvement plans were prepared for two Caltrans districts.

  2. Health systems research in the time of health system reform in India: a review.

    Science.gov (United States)

    Rao, Krishna D; Arora, Radhika; Ghaffar, Abdul

    2014-08-09

    Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in

  3. Infrastructures and Necessary Actions Parallel to Reforms of Medical Service Tariffs to Improve Health System Performance in Iran: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Alireza Jabbari

    2017-09-01

    Conclusion: First, it seems that various issues and aspects related to tariff determination should be considered. Furthermore, some preliminaries should be provided before tariffs' reformation or some actions should be taken in line with that for the success of tariff reformation process. These measures and reformations  are related to the Ministry of Health, insurances, and the government.

  4. Spacecraft Multiple Array Communication System Performance Analysis

    Science.gov (United States)

    Hwu, Shian U.; Desilva, Kanishka; Sham, Catherine C.

    2010-01-01

    The Communication Systems Simulation Laboratory (CSSL) at the NASA Johnson Space Center is tasked to perform spacecraft and ground network communication system simulations, design validation, and performance verification. The CSSL has developed simulation tools that model spacecraft communication systems and the space and ground environment in which the tools operate. In this paper, a spacecraft communication system with multiple arrays is simulated. Multiple array combined technique is used to increase the radio frequency coverage and data rate performance. The technique is to achieve phase coherence among the phased arrays to combine the signals at the targeting receiver constructively. There are many technical challenges in spacecraft integration with a high transmit power communication system. The array combining technique can improve the communication system data rate and coverage performances without increasing the system transmit power requirements. Example simulation results indicate significant performance improvement can be achieved with phase coherence implementation.

  5. Health performance of housing. Indicators and tools

    NARCIS (Netherlands)

    Hasselaar, E.

    2009-01-01

    Occupants and housing managers deal with several environmental problems in dwellings. To support the diagnosis of cause and effect and to promote good communication about health hazards, indicators of the relationship between physical properties, occupancy patterns and health risks are needed. The

  6. Information systems for materials performance

    International Nuclear Information System (INIS)

    Roberge, P.

    1999-01-01

    The rapid development of accessible computing power in the 1980s has led to the use of machine intelligence in every sphere of engineering. The incredible progress in computing power and availability has also created a tremendous wealth of information available at the touch of few buttons. However, such wealth can easily provoke what is commonly described as 'information overload'. The massive number of connections produced by a single search of the web, for example, can greatly overwhelm users of this new technology. The rapidity of Web searches is due to the synergy between progress made in network connectivity protocols, intelligent search strategies and supporting hardware. This paper will attempt to define the basic elements of machine intelligence in the context of corrosion engineering and examine what has been done or could be done to introduce artificial thinking into daily operations. This paper will also review some modem software systems commonly used for information processing and internet searches. (author)

  7. Strategic performance management: development of a performance measurement system at the Mayo Clinic.

    Science.gov (United States)

    Curtright, J W; Stolp-Smith, S C; Edell, E S

    2000-01-01

    Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.

  8. Health policy, health systems research and analysis capacity ...

    African Journals Online (AJOL)

    Introduction: Health Policy and Systems Research and Analysis (HPSR&A) is an applied science that deals with complexity as it tries to provide lessons, tools and methods to understand and improve health systems and health policy. It is defined by the kinds of questions asked rather than a particular methodology.

  9. Influence of Design Variations on Systems Performance

    Science.gov (United States)

    Tumer, Irem Y.; Stone, Robert B.; Huff, Edward M.; Norvig, Peter (Technical Monitor)

    2000-01-01

    High-risk aerospace components have to meet very stringent quality, performance, and safety requirements. Any source of variation is a concern, as it may result in scrap or rework. poor performance, and potentially unsafe flying conditions. The sources of variation during product development, including design, manufacturing, and assembly, and during operation are shown. Sources of static and dynamic variation during development need to be detected accurately in order to prevent failure when the components are placed in operation. The Systems' Health and Safety (SHAS) research at the NASA Ames Research Center addresses the problem of detecting and evaluating the statistical variation in helicopter transmissions. In this work, we focus on the variations caused by design, manufacturing, and assembly of these components, prior to being placed in operation (DMV). In particular, we aim to understand and represent the failure and variation information, and their correlation to performance and safety and feed this information back into the development cycle at an early stage. The feedback of such critical information will assure the development of more reliable components with less rework and scrap. Variations during design and manufacturing are a common source of concern in the development and production of such components. Accounting for these variations, especially those that have the potential to affect performance, is accomplished in a variety ways, including Taguchi methods, FMEA, quality control, statistical process control, and variation risk management. In this work, we start with the assumption that any of these variations can be represented mathematically, and accounted for by using analytical tools incorporating these mathematical representations. In this paper, we concentrate on variations that are introduced during design. Variations introduced during manufacturing are investigated in parallel work.

  10. [Teaching performance assessment in Public Health employing three different strategies].

    Science.gov (United States)

    Martínez-González, Adrián; Moreno-Altamirano, Laura; Ponce-Rosas, Efrén Raúl; Martínez-Franco, Adrián Israel; Urrutia-Aguilar, María Esther

    2011-01-01

    The educational system depends upon the quality and performance of their faculty and should therefore be process of continuous improvement. To assess the teaching performance of the Public Health professors, at the Faculty of Medicine, UNAM through three strategies. Justification study. The evaluation was conducted under a mediational model through three strategies: students' opinion assessment, self-assessment and students' academic achievement. We applied descriptive statistics, Student t test, ANOVA and Pearson correlation. Twenty professors were evaluated from the Public Health department, representing 57% of all them who teach the subject. The professor's performance was highly valued self-assessment compared with assessment of student opinion, was confirmed by statistical analysis the difference was significant. The difference amongst the three evaluation strategies became more evident between self-assessment and the scores obtained by students in their academic achievement. The integration of these three strategies offers a more complete view of the teacher's performance quality. Academic achievement appears to be a more objective strategy for teaching performance assessment than students' opinion and self-assessment.

  11. Integrated Systems Health Management for Space Exploration

    Science.gov (United States)

    Uckun, Serdar

    2005-01-01

    Integrated Systems Health Management (ISHM) is a system engineering discipline that addresses the design, development, operation, and lifecycle management of components, subsystems, vehicles, and other operational systems with the purpose of maintaining nominal system behavior and function and assuring mission safety and effectiveness under off-nominal conditions. NASA missions are often conducted in extreme, unfamiliar environments of space, using unique experimental spacecraft. In these environments, off-nominal conditions can develop with the potential to rapidly escalate into mission- or life-threatening situations. Further, the high visibility of NASA missions means they are always characterized by extraordinary attention to safety. ISHM is a critical element of risk mitigation, mission safety, and mission assurance for exploration. ISHM enables: In-space maintenance and repair; a) Autonomous (and automated) launch abort and crew escape capability; b) Efficient testing and checkout of ground and flight systems; c) Monitoring and trending of ground and flight system operations and performance; d) Enhanced situational awareness and control for ground personnel and crew; e) Vehicle autonomy (self-sufficiency) in responding to off-nominal conditions during long-duration and distant exploration missions; f) In-space maintenance and repair; and g) Efficient ground processing of reusable systems. ISHM concepts and technologies may be applied to any complex engineered system such as transportation systems, orbital or planetary habitats, observatories, command and control systems, life support systems, safety-critical software, and even the health of flight crews. As an overarching design and operational principle implemented at the system-of-systems level, ISHM holds substantial promise in terms of affordability, safety, reliability, and effectiveness of space exploration missions.

  12. Performance improvement integration: a whole systems approach.

    Science.gov (United States)

    Page, C K

    1999-02-01

    Performance improvement integration in health care organizations is a challenge for health care leaders. Required for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), performance improvement (PI) can be designed as a sustainable model for performance to survive in a turbulent period. Central Baptist Hospital developed a model for PI that focused on strategy established by the leadership team, delineated responsibility through the organizational structure of shared governance, and accountability for outcomes evidenced through the organization's profitability. Such an approach integrated into the culture of the organization can produce positive financial margins, positive customer satisfaction, and commendations from the Joint Commission.

  13. Software for Intelligent System Health Management

    Science.gov (United States)

    Trevino, Luis C.

    2004-01-01

    This viewgraph presentation describes the characteristics and advantages of autonomy and artificial intelligence in systems health monitoring. The presentation lists technologies relevant to Intelligent System Health Management (ISHM), and some potential applications.

  14. The public health system in England

    National Research Council Canada - National Science Library

    Hunter, David J; Marks, Linda; Smith, Katherine E

    2010-01-01

    .... The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time...

  15. Towards a digitized and integrated health information system in ...

    African Journals Online (AJOL)

    Background: A strong health information system able to generate timely and accurate information is essential to ensure effective and efficient performance. Sudan's health information system is still paper-based and characterized by fragmentation and verticality. Efforts to overcome this have led to development of an ...

  16. Capital investment strategies in health care systems.

    Science.gov (United States)

    Reiter, K L; Smith, D G; Wheeler, J R; Rivenson, H L

    2000-01-01

    Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

  17. A Blueprint for Innovation to Achieve Health System Transformation.

    Science.gov (United States)

    Snowdon, Anne W

    2017-01-01

    Global health systems are challenged by escalating costs and growing demands for care created by the demands of aging populations and rising rates of chronic illness which place unsustainable pressure on health systems to meet population health needs. To overcome these challenges, transformational change is needed to strengthen health system performance and sustainability. Innovation is widely viewed as the strategy to drive transformational change in health systems; yet to date, innovation has lacked a clearly defined focus or agenda to achieve transformation. An actionable innovation agenda is needed to achieve transformational change for health systems. The key conditions for success as an innovation strategy are examined, including clearly defined innovation objectives, key milestones, and actionable steps every system stakeholder must pursue in order to guide the innovation agenda and ultimately accelerate the transformational changes needed for a sustainable healthcare system that delivers value to populations.

  18. Financial Performance of Health Plans in Medicaid Mana...

    Data.gov (United States)

    U.S. Department of Health & Human Services — This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly...

  19. Performance of Active Wave Absorption Systems

    DEFF Research Database (Denmark)

    Hald, Tue; Frigaard, Peter

    on a horisontal and vertical velocity are treated. All three systems are based on digital FIR-filters. For numerical comparison a performance function combining the frequency response of the set of filters for each system is derived enabling discussion on optimal filter design and system setup. Irregular wave......A comparison of wave gauge based on velocity meter based active absorption systems is presented discussing advantages and disadvantages of the systems. In detail one system based on two surface elevations, one system based on a surface elevation and a horisontal velocity and one system based...... tests with a highly reflective structure with the purely wave gauge based system and the wave gauge velocity meter based system are performed. The wave test depict the differences between the systems....

  20. Cascade Distiller System Performance Testing Interim Results

    Science.gov (United States)

    Callahan, Michael R.; Pensinger, Stuart; Sargusingh, Miriam J.

    2014-01-01

    The Cascade Distillation System (CDS) is a rotary distillation system with potential for greater reliability and lower energy costs than existing distillation systems. Based upon the results of the 2009 distillation comparison test (DCT) and recommendations of the expert panel, the Advanced Exploration Systems (AES) Water Recovery Project (WRP) project advanced the technology by increasing reliability of the system through redesign of bearing assemblies and improved rotor dynamics. In addition, the project improved the CDS power efficiency by optimizing the thermoelectric heat pump (TeHP) and heat exchanger design. Testing at the NASA-JSC Advanced Exploration System Water Laboratory (AES Water Lab) using a prototype Cascade Distillation Subsystem (CDS) wastewater processor (Honeywell d International, Torrance, Calif.) with test support equipment and control system developed by Johnson Space Center was performed to evaluate performance of the system with the upgrades as compared to previous system performance. The system was challenged with Solution 1 from the NASA Exploration Life Support (ELS) distillation comparison testing performed in 2009. Solution 1 consisted of a mixed stream containing human-generated urine and humidity condensate. A secondary objective of this testing is to evaluate the performance of the CDS as compared to the state of the art Distillation Assembly (DA) used in the ISS Urine Processor Assembly (UPA). This was done by challenging the system with ISS analog waste streams. This paper details the results of the AES WRP CDS performance testing.

  1. Verification and Performance Analysis for Embedded Systems

    DEFF Research Database (Denmark)

    Larsen, Kim Guldstrand

    2009-01-01

    This talk provides a thorough tutorial of the UPPAAL tool suite for, modeling, simulation, verification, optimal scheduling, synthesis, testing and performance analysis of embedded and real-time systems.......This talk provides a thorough tutorial of the UPPAAL tool suite for, modeling, simulation, verification, optimal scheduling, synthesis, testing and performance analysis of embedded and real-time systems....

  2. Cost and Performance Model for Photovoltaic Systems

    Science.gov (United States)

    Borden, C. S.; Smith, J. H.; Davisson, M. C.; Reiter, L. J.

    1986-01-01

    Lifetime cost and performance (LCP) model assists in assessment of design options for photovoltaic systems. LCP is simulation of performance, cost, and revenue streams associated with photovoltaic power systems connected to electric-utility grid. LCP provides user with substantial flexibility in specifying technical and economic environment of application.

  3. RHIC sextant test: Accelerator systems and performance

    Energy Technology Data Exchange (ETDEWEB)

    Pilat, F.; Trbojevic, D.; Ahrens, L. [and others

    1997-08-01

    One sextant of the RHIC Collider was commissioned in early 1997 with beam. We describe here the performance of the accelerator systems, instrumentation subsystems and application software. We also describe a ramping test without beam that took place after the commissioning with beam. Finally, we analyze the implications of accelerator systems performance and their impact on the planning for RHIC installation and commissioning.

  4. RHIC sextant test: Accelerator systems and performance

    International Nuclear Information System (INIS)

    Pilat, F.; Trbojevic, D.; Ahrens, L.

    1997-01-01

    One sextant of the RHIC Collider was commissioned in early 1997 with beam. We describe here the performance of the accelerator systems, instrumentation subsystems and application software. We also describe a ramping test without beam that took place after the commissioning with beam. Finally, we analyze the implications of accelerator systems performance and their impact on the planning for RHIC installation and commissioning

  5. Performances of the HL (Hyperloop) transport system

    NARCIS (Netherlands)

    van Goeverden, C.D.; Milakis, D.; Janic, M.; Konings, J.W.; Cools, M.; Limbourg, S.

    2017-01-01

    This paper deals with an analysis of performances of the HL (Hyperloop) transport system considered as an advanced transport alternative to the existing APT (Air Passenger Transport) and HSR (High Speed Rail) systems. The considered performances are operational, financial, social and environmental.

  6. High-performance OPCPA laser system

    International Nuclear Information System (INIS)

    Zuegel, J.D.; Bagnoud, V.; Bromage, J.; Begishev, I.A.; Puth, J.

    2006-01-01

    Optical parametric chirped-pulse amplification (OPCPA) is ideally suited for amplifying ultra-fast laser pulses since it provides broadband gain across a wide range of wavelengths without many of the disadvantages of regenerative amplification. A high-performance OPCPA system has been demonstrated as a prototype for the front end of the OMEGA Extended Performance (EP) Laser System. (authors)

  7. High-performance OPCPA laser system

    Energy Technology Data Exchange (ETDEWEB)

    Zuegel, J.D.; Bagnoud, V.; Bromage, J.; Begishev, I.A.; Puth, J. [Rochester Univ., Lab. for Laser Energetics, NY (United States)

    2006-06-15

    Optical parametric chirped-pulse amplification (OPCPA) is ideally suited for amplifying ultra-fast laser pulses since it provides broadband gain across a wide range of wavelengths without many of the disadvantages of regenerative amplification. A high-performance OPCPA system has been demonstrated as a prototype for the front end of the OMEGA Extended Performance (EP) Laser System. (authors)

  8. Consultants' Corner: System Performance. A Forum.

    Science.gov (United States)

    Drabenstott, John, Ed.

    1986-01-01

    Five library consultants address issues that affect online system performance: options in system design that relate to diverse library requirements; criteria that most affect performance; benchmark tests and sizing criteria; minimalizing the risks of miscalculation; and the roles and responsibilities of vendors, libraries, and consultants.…

  9. Performance Aspects of Synthesizable Computing Systems

    DEFF Research Database (Denmark)

    Schleuniger, Pascal

    Embedded systems are used in a broad range of applications that demand high performance within severely constrained mechanical, power, and cost requirements. Embedded systems implemented in ASIC technology tend to provide the highest performance, lowest power consumption and lowest unit cost. How...

  10. Technology integration performance assessment using lean principles in health care.

    Science.gov (United States)

    Rico, Florentino; Yalcin, Ali; Eikman, Edward A

    2015-01-01

    This study assesses the impact of an automated infusion system (AIS) integration at a positron emission tomography (PET) center based on "lean thinking" principles. The authors propose a systematic measurement system that evaluates improvement in terms of the "8 wastes." This adaptation to the health care context consisted of performance measurement before and after integration of AIS in terms of time, utilization of resources, amount of materials wasted/saved, system variability, distances traveled, and worker strain. The authors' observations indicate that AIS stands to be very effective in a busy PET department, such as the one in Moffitt Cancer Center, owing to its accuracy, pace, and reliability, especially after the necessary adjustments are made to reduce or eliminate the source of errors. This integration must be accompanied by a process reengineering exercise to realize the full potential of AIS in reducing waste and improving patient care and worker satisfaction. © The Author(s) 2014.

  11. Performance estimates for personnel access control systems

    International Nuclear Information System (INIS)

    Bradley, R.G.

    1980-10-01

    Current performance estimates for personnel access control systems use estimates of Type I and Type II verification errors. A system performance equation which addresses normal operation, the insider, and outside adversary attack is developed. Examination of this equation reveals the inadequacy of classical Type I and II error evaluations which require detailed knowledge of the adversary threat scenario for each specific installation. Consequently, new performance measures which are consistent with the performance equation and independent of the threat are developed as an aid in selecting personnel access control systems

  12. Evaluating Library Staff: A Performance Appraisal System.

    Science.gov (United States)

    Belcastro, Patricia

    This manual provides librarians and library managers with a performance appraisal system that measures staff fairly and objectively and links performance to the goals of the library. The following topics are addressed: (1) identifying expectations for quality service or standards of performance; (2) the importance of a library's code of service,…

  13. Business School's Performance Management System Standards Design

    Science.gov (United States)

    Azis, Anton Mulyono; Simatupang, Togar M.; Wibisono, Dermawan; Basri, Mursyid Hasan

    2014-01-01

    This paper aims to compare various Performance Management Systems (PMS) for business school in order to find the strengths of each standard as inputs to design new model of PMS. There are many critical aspects and gaps notified for new model to improve performance and even recognized that self evaluation performance management is not well…

  14. Analytical performance modeling for computer systems

    CERN Document Server

    Tay, Y C

    2013-01-01

    This book is an introduction to analytical performance modeling for computer systems, i.e., writing equations to describe their performance behavior. It is accessible to readers who have taken college-level courses in calculus and probability, networking and operating systems. This is not a training manual for becoming an expert performance analyst. Rather, the objective is to help the reader construct simple models for analyzing and understanding the systems that they are interested in.Describing a complicated system abstractly with mathematical equations requires a careful choice of assumpti

  15. Performances of the HL (Hyperloop) transport system

    OpenAIRE

    van Goeverden, C.D.; Milakis, D.; Janic, M.; Konings, J.W.; Cools, M.; Limbourg, S.

    2017-01-01

    This paper deals with an analysis of performances of the HL (Hyperloop) transport system considered as an advanced transport alternative to the existing APT (Air Passenger Transport) and HSR (High Speed Rail) systems. The considered performances are operational, financial, social and environmental. The operational performance include capacity and quality of service provided to the system’s users-passengers with attributes such as door-to-door travel time consisting of the access and egress ti...

  16. [Health services research for the public health service (PHS) and the public health system].

    Science.gov (United States)

    Hollederer, A; Wildner, M

    2015-03-01

    There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

  17. Health system resilience: Lebanon and the Syrian refugee crisis

    Science.gov (United States)

    Ammar, Walid; Kdouh, Ola; Hammoud, Rawan; Hamadeh, Randa; Harb, Hilda; Ammar, Zeina; Atun, Rifat; Christiani, David; Zalloua, Pierre A

    2016-01-01

    Background Between 2011 and 2013, the Lebanese population increased by 30% due to the influx of Syrian refugees. While a sudden increase of such magnitude represents a shock to the health system, threatening the continuity of service delivery and destabilizing governance, it also offers a unique opportunity to study resilience of a health system amidst ongoing crisis. Methods We conceptualized resilience as the capacity of a health system to absorb internal or external shocks (for example prevent or contain disease outbreaks and maintain functional health institutions) while sustaining achievements. We explored factors contributing to the resilience of the Lebanese health system, including networking with stakeholders, diversification of the health system, adequate infrastructure and health human resources, a comprehensive communicable disease response and the integration of the refugees within the health system. Results In studying the case of Lebanon we used input–process–output–outcome approach to assess the resilience of the Lebanese health system. This approach provided us with a holistic view of the health system, as it captured not only the sustained and improved outcomes, but also the inputs and processes leading to them. Conclusion Our study indicates that the Lebanese health system was resilient as its institutions sustained their performance during the crisis and even improved. PMID:28154758

  18. Evaluating the chronic effects of nitrate on the health and performance of post-smolt Atlantic salmon Salmo salar in freshwater recirculation aquaculture systems

    Science.gov (United States)

    Commercial production of Atlantic salmon smolts, post-smolts, and market-size fish using land-based recirculation aquaculture systems (RAS) is expanding. RAS generally provide a nutrient-rich environment in which nitrate accumulates as an end-product of nitrification. An 8-month study was conducted ...

  19. Strengthening of oral health systems

    DEFF Research Database (Denmark)

    Petersen, Poul Erik

    2014-01-01

    is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral...... diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work......Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care...

  20. Approaching Sentient Building Performance Simulation Systems

    DEFF Research Database (Denmark)

    Negendahl, Kristoffer; Perkov, Thomas; Heller, Alfred

    2014-01-01

    Sentient BPS systems can combine one or more high precision BPS and provide near instantaneous performance feedback directly in the design tool, thus providing speed and precision of building performance in the early design stages. Sentient BPS systems are essentially combining: 1) design tools, 2......) parametric tools, 3) BPS tools, 4) dynamic databases 5) interpolation techniques and 6) prediction techniques as a fast and valid simulation system, in the early design stage....

  1. Management system, organizational climate and performance relationships

    Science.gov (United States)

    Davis, B. D.

    1979-01-01

    Seven aerospace firms were investigated to determine if a relationship existed among management systems, organizational climate, and organization performance. Positive relationships were found between each of these variables, but a statistically significant relationship existed only between the management system and organizational climate. The direction and amount of communication and the degree of decentralized decision-making, elements of the management system, also had a statistically significant realtionship with organization performance.

  2. Structured Performance Analysis for Component Based Systems

    OpenAIRE

    Salmi , N.; Moreaux , Patrice; Ioualalen , M.

    2012-01-01

    International audience; The Component Based System (CBS) paradigm is now largely used to design software systems. In addition, performance and behavioural analysis remains a required step for the design and the construction of efficient systems. This is especially the case of CBS, which involve interconnected components running concurrent processes. % This paper proposes a compositional method for modeling and structured performance analysis of CBS. Modeling is based on Stochastic Well-formed...

  3. Performance measurement for information systems: Industry perspectives

    Science.gov (United States)

    Bishop, Peter C.; Yoes, Cissy; Hamilton, Kay

    1992-01-01

    Performance measurement has become a focal topic for information systems (IS) organizations. Historically, IS performance measures have dealt with the efficiency of the data processing function. Today, the function of most IS organizations goes beyond simple data processing. To understand how IS organizations have developed meaningful performance measures that reflect their objectives and activities, industry perspectives on IS performance measurement was studied. The objectives of the study were to understand the state of the practice in IS performance techniques for IS performance measurement; to gather approaches and measures of actual performance measures used in industry; and to report patterns, trends, and lessons learned about performance measurement to NASA/JSC. Examples of how some of the most forward looking companies are shaping their IS processes through measurement is provided. Thoughts on the presence of a life-cycle to performance measures development and a suggested taxonomy for performance measurements are included in the appendices.

  4. Long term performance of radon mitigation systems

    International Nuclear Information System (INIS)

    Prill, R.; Fisk, W.J.

    2002-01-01

    Researchers installed radon mitigation systems in 12 houses in Spokane, Washington and Coeur d'Alene, Idaho during the heating season 1985--1986 and continued to monitor indoor radon quarterly and annually for ten years. The mitigation systems included active sub-slab ventilation, basement over-pressurization, and crawlspace isolation and ventilation. The occupants reported various operational problems with these early mitigation systems. The long-term radon measurements were essential to track the effectiveness of the mitigation systems over time. All 12 homes were visited during the second year of the study, while a second set 5 homes was visited during the fifth year to determine the cause(s) of increased radon in the homes. During these visits, the mitigation systems were inspected and measurements of system performance were made. Maintenance and modifications were performed to improve system performance in these homes

  5. SIMS Prototype System 4: performance test report

    Energy Technology Data Exchange (ETDEWEB)

    1978-10-09

    The results obtained during testing of a self-contained, preassembled air type solar system, designed for installation remote from the dwelling, to provide space heating and hot water are presented. Data analysis is included which documents the system performance and verifies the suitability of SIMS Prototype System 4 for field installation.

  6. Physicians' professional performance: an occupational health psychology perspective

    NARCIS (Netherlands)

    Scheepers, Renée A.

    2017-01-01

    Physician work engagement is considered to benefit physicians' professional performance in clinical teaching practice. Following an occupational health psychology perspective, this PhD report presents research on how physicians' professional performance in both doctor and teacher roles can be

  7. Integrated System Health Management Development Toolkit

    Science.gov (United States)

    Figueroa, Jorge; Smith, Harvey; Morris, Jon

    2009-01-01

    This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

  8. The role of health system governance in strengthening the rural health insurance system in China.

    Science.gov (United States)

    Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

    2017-05-23

    Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding

  9. Security for decentralized health information systems.

    Science.gov (United States)

    Bleumer, G

    1994-02-01

    Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit).

  10. Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization

    Science.gov (United States)

    Markgraf, Rainer; Deutschinoff, Gerd; Pientka, Ludger; Scholten, Theo; Lorenz, Cristoph

    2001-01-01

    Background: Mortality predictions calculated using scoring scales are often not accurate in populations other than those in which the scales were developed because of differences in case-mix. The present study investigates the effect of first-level customization, using a logistic regression technique, on discrimination and calibration of the Acute Physiology and Chronic Health Evaluation (APACHE) II and III scales. Method: Probabilities of hospital death for patients were estimated by applying APACHE II and III and comparing these with observed outcomes. Using the split sample technique, a customized model to predict outcome was developed by logistic regression. The overall goodness-of-fit of the original and the customized models was assessed. Results: Of 3383 consecutive intensive care unit (ICU) admissions over 3 years, 2795 patients could be analyzed, and were split randomly into development and validation samples. The discriminative powers of APACHE II and III were unchanged by customization (areas under the receiver operating characteristic [ROC] curve 0.82 and 0.85, respectively). Hosmer-Lemeshow goodness-of-fit tests showed good calibration for APACHE II, but insufficient calibration for APACHE III. Customization improved calibration for both models, with a good fit for APACHE III as well. However, fit was different for various subgroups. Conclusions: The overall goodness-of-fit of APACHE III mortality prediction was improved significantly by customization, but uniformity of fit in different subgroups was not achieved. Therefore, application of the customized model provides no advantage, because differences in case-mix still limit comparisons of quality of care. PMID:11178223

  11. Biosecurity through Public Health System Design.

    Energy Technology Data Exchange (ETDEWEB)

    Beyeler, Walter E. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Finley, Patrick D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Arndt, William [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Walser, Alex Christian [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Mitchell, Michael David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-11-01

    We applied modeling and simulation to examine the real-world tradeoffs between developingcountry public-health improvement and the need to improve the identification, tracking, and security of agents with bio-weapons potential. Traditionally, the international community has applied facility-focused strategies for improving biosecurity and biosafety. This work examines how system-level assessments and improvements can foster biosecurity and biosafety. We modeled medical laboratory resources and capabilities to identify scenarios where biosurveillance goals are transparently aligned with public health needs, and resource are distributed in a way that maximizes their ability to serve patients while minimizing security a nd safety risks. Our modeling platform simulates key processes involved in healthcare system operation, such as sample collection, transport, and analysis at medical laboratories. The research reported here extends the prior art by provided two key compone nts for comparative performance assessment: a model of patient interaction dynamics, and the capability to perform uncertainty quantification. In addition, we have outlined a process for incorporating quantitative biosecurity and biosafety risk measures. Two test problems were used to exercise these research products examine (a) Systemic effects of technological innovation and (b) Right -sizing of laboratory networks.

  12. Corruption in the health care system: the circumstantial evidence.

    Science.gov (United States)

    Ibrahim, Joseph; Majoor, Jennifer

    2002-01-01

    Health care systems are under intense scrutiny, and there is an increasing emphasis on patient safety and quality of care in general. Evidence continues to emerge demonstrating that health systems are performing at sub-optimal levels. The evidence includes the under-use, over-use and mis-use of health care services; new standards asking for respect, dignity, honesty and transparency; the corporatization of health; and the existing inequalities in power and health outcomes. Recommendations for improving health care often refer to increasing the level of collaboration and consultation. These strategies are unlikely to remedy the root causes of our ailing health systems if we accept the circumstantial evidence that suggests the system is rotten.

  13. Mobile technology in health information systems - a review.

    Science.gov (United States)

    Zhang, X-Y; Zhang, P-Y

    2016-05-01

    Mobile technology is getting involved in every sphere of life including medical health care. There has been an immense upsurge in mobile phone-based health innovations these days. The expansion of mobile phone networks and the proliferation of inexpensive mobile handsets have made the digital information and communication technology capabilities very handy for the people to exploit if for any utility including health care. The mobile phone based innovations are able to transform weak and under performing health information system into more modern and efficient information system. The present review article will enlighten all these aspects of mobile technology in health care.

  14. Managing Health Information System | Campbell | Nigerian ...

    African Journals Online (AJOL)

    The effective planning, management monitoring and evaluation of health services, health resources and indeed the health system requires a wealth of health information, with its simultaneous effective and efficient management. It is an instrument used to help policy-making, decision making and day to day actions in the ...

  15. Synergy between indigenous knowledge systems, modern health ...

    African Journals Online (AJOL)

    ... the people of this country should harness a synergy between indigenous health care systems, scientific research and modern health care methods. This article attempts to address the historical evolution of health care methods in South Africa, its effect on the community as well as challenges facing the health professions.

  16. Military Health System Transformation Implications on Health Information Technology Modernization.

    Science.gov (United States)

    Khan, Saad

    2018-03-01

    With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system. In this perspective, we discuss the implications of the intersection of two large-scope and large-scale initiatives, health system transformation, and information technology modernization, being rolled out in the largest and most complex federal agency and potential risk mitigating steps. The Military Health System will require an expanded unified clinical leadership to spearhead short-term transformation; furthermore, developing, organizing, and growing a cadre of informatics expertise to expand the use and diffusion of novel solutions such as health information exchanges, data analytics, and others to transcend organizational barriers are still needed to achieve the long-term aim of health system reform as envisioned by the National Defense Authorization Act for Fiscal Year 2017.

  17. Integrating ICTs within health systems | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-06-10

    Jun 10, 2016 ... But for too long, ICT and health system researchers have worked in isolation ... be used to enable the governance and functioning of health systems in ... most African countries adopted direct payment for health services as the ...

  18. Operating health analysis of electric power systems

    Science.gov (United States)

    Fotuhi-Firuzabad, Mahmud

    The required level of operating reserve to be maintained by an electric power system can be determined using both deterministic and probabilistic techniques. Despite the obvious disadvantages of deterministic approaches there is still considerable reluctance to apply probabilistic techniques due to the difficulty of interpreting a single numerical risk index and the lack of sufficient information provided by a single index. A practical way to overcome difficulties is to embed deterministic considerations in the probabilistic indices in order to monitor the system well-being. The system well-being can be designated as healthy, marginal and at risk. The concept of system well-being is examined and extended in this thesis to cover the overall area of operating reserve assessment. Operating reserve evaluation involves the two distinctly different aspects of unit commitment and the dispatch of the committed units. Unit commitment health analysis involves the determination of which unit should be committed to satisfy the operating criteria. The concepts developed for unit commitment health, margin and risk are extended in this thesis to evaluate the response well-being of a generating system. A procedure is presented to determine the optimum dispatch of the committed units to satisfy the response criteria. The impact on the response wellbeing being of variations in the margin time, required regulating margin and load forecast uncertainty are illustrated. The effects on the response well-being of rapid start units, interruptible loads and postponable outages are also illustrated. System well-being is, in general, greatly improved by interconnection with other power systems. The well-being concepts are extended to evaluate the spinning reserve requirements in interconnected systems. The interconnected system unit commitment problem is decomposed into two subproblems in which unit scheduling is performed in each isolated system followed by interconnected system evaluation

  19. Occupational Health Record-keeping System (OHRS)

    Data.gov (United States)

    Department of Veterans Affairs — Occupational Health Record-keeping System (OHRS) is part of the Clinical Information Support System (CISS) portal framework and the initial CISS partner system. OHRS...

  20. Performance Monitoring Applied to System Supervision

    Directory of Open Access Journals (Sweden)

    Bertille Somon

    2017-07-01

    Full Text Available Nowadays, automation is present in every aspect of our daily life and has some benefits. Nonetheless, empirical data suggest that traditional automation has many negative performance and safety consequences as it changed task performers into task supervisors. In this context, we propose to use recent insights into the anatomical and neurophysiological substrates of action monitoring in humans, to help further characterize performance monitoring during system supervision. Error monitoring is critical for humans to learn from the consequences of their actions. A wide variety of studies have shown that the error monitoring system is involved not only in our own errors, but also in the errors of others. We hypothesize that the neurobiological correlates of the self-performance monitoring activity can be applied to system supervision. At a larger scale, a better understanding of system supervision may allow its negative effects to be anticipated or even countered. This review is divided into three main parts. First, we assess the neurophysiological correlates of self-performance monitoring and their characteristics during error execution. Then, we extend these results to include performance monitoring and error observation of others or of systems. Finally, we provide further directions in the study of system supervision and assess the limits preventing us from studying a well-known phenomenon: the Out-Of-the-Loop (OOL performance problem.

  1. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

  2. A decision technology system for health care electronic commerce.

    Science.gov (United States)

    Forgionne, G A; Gangopadhyay, A; Klein, J A; Eckhardt, R

    1999-08-01

    Mounting costs have escalated the pressure on health care providers and payers to improve decision making and control expenses. Transactions to form the needed decision data will routinely flow, often electronically, between the affected parties. Conventional health care information systems facilitate flow, process transactions, and generate useful decision information. Typically, such support is offered through a series of stand-alone systems that lose much useful decision knowledge and wisdom during health care electronic commerce (e-commerce). Integrating the stand-alone functions can enhance the quality and efficiency of the segmented support, create synergistic effects, and augment decision-making performance and value for both providers and payers. This article presents an information system that can provide complete and integrated support for e-commerce-based health care decision making. The article describes health care e-commerce, presents the system, examines the system's potential use and benefits, and draws implications for health care management and practice.

  3. Mobile health monitoring system for community health workers

    CSIR Research Space (South Africa)

    Sibiya, G

    2014-09-01

    Full Text Available of hypertension as it provides real time information and eliminates the need to visit a healthcare facility to take blood pressure readings. Our proposed mobile health monitoring system enables faster computerization of data that has been recorded... pressure, heart rate and glucose readings. These reading closely related to most common NCDs. D. Feedback to health worker and the subject of care Community health workers are often not professionally trained on health. As a result they are not expected...

  4. Health-Sector Performance in Post-Independent Nigeria: A ...

    African Journals Online (AJOL)

    A lot of studies had been carried out to ascertain the reasons for this poor performance, the findings from these studies are contradictory. Most of the studies in this area have treated health output or performance and health expenditure in Nigeria, without considering its link with governance. Therefore, this study examined ...

  5. The future of health/fitness/sports performance

    NARCIS (Netherlands)

    Foster, Carl; Cortis, Cristina; Fusco, Andrea; Bok, Daniel; Boullosa, Daniel A.; Capranica, Laura; de Koning, Jos J.; Haugen, Thomas; Olivera-Silva, Iranse; Periara, Julien; Porcari, John P.; Pyne, David Bruce; Sandbakk, Oyvind

    2017-01-01

    Exercise relative to health/fitness and sports performance has displayed an evolutionary role over time. Large scale, overriding, factors are present which are likely to help us understand the likely future evolutionary path of health/fitness and sports performance. These factors include: 1) the

  6. Performance Needs Assessment of Maternal and Newborn Health ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    African Journal of Reproductive Health June 2014; 18(2): 105 ... The study aimed to determine performance and compare gaps in maternal and newborn health ... in MNH service performance and this was worse in the rural areas. ... particularly disadvantaged in terms of social .... significance was determined at p < 0.05.

  7. Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

    Directory of Open Access Journals (Sweden)

    Elizabeth H. Bradley

    2015-07-01

    Full Text Available Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management – defined here as the process of achieving predetermined objectives through human, financial, and technical resources – is a cross-cutting function necessary for success in all World Health Organization (WHO building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved

  8. Multipurpose Health Care Telemedicine System

    National Research Council Canada - National Science Library

    Kyriacou, E

    2001-01-01

    .... Ambulances, Rural Health Centers (RHC) or other remote health location, Ships navigating in wide seas and Airplanes in flight are common examples of possible emergency sites, while critical care telemetry, and telemedicine home follow-ups...

  9. Forecasting the Performance of Agroforestry Systems

    Science.gov (United States)

    Luedeling, E.; Shepherd, K.

    2014-12-01

    Agroforestry has received considerable attention from scientists and development practitioners in recent years. It is recognized as a cornerstone of many traditional agricultural systems, as well as a new option for sustainable land management in currently treeless agricultural landscapes. Agroforestry systems are diverse, but most manifestations supply substantial ecosystem services, including marketable tree products, soil fertility, water cycle regulation, wildlife habitat and carbon sequestration. While these benefits have been well documented for many existing systems, projecting the outcomes of introducing new agroforestry systems, or forecasting system performance under changing environmental or climatic conditions, remains a substantial challenge. Due to the various interactions between system components, the multiple benefits produced by trees and crops, and the host of environmental, socioeconomic and cultural factors that shape agroforestry systems, mechanistic models of such systems quickly become very complex. They then require a lot of data for site-specific calibration, which presents a challenge for their use in new environmental and climatic domains, especially in data-scarce environments. For supporting decisions on the scaling up of agroforestry technologies, new projection methods are needed that can capture system complexity to an adequate degree, while taking full account of the fact that data on many system variables will virtually always be highly uncertain. This paper explores what projection methods are needed for supplying decision-makers with useful information on the performance of agroforestry in new places or new climates. Existing methods are discussed in light of these methodological needs. Finally, a participatory approach to performance projection is proposed that captures system dynamics in a holistic manner and makes probabilistic projections about expected system performance. This approach avoids the temptation to take

  10. Thermal performance advisor expert system development

    International Nuclear Information System (INIS)

    McClintock, M.; Hirota, N.; Metzinger, R.

    1991-01-01

    In recent years the electric industry has developed an increased interest in improving efficiency of nuclear power plants. EPRI has embarked upon a research project RP2407, Nuclear Plant Performance Improvements which is designed to address needs in this area. One product of this project has been the Thermal Performance Diagnostic Manual for Nuclear Power Plants (NP-4990P). The purpose of this manual is to provide engineering personnel at nuclear power plants with a consistent way in which to identify thermal performance problems. General Physics is also involved in the development of another computer system called Fossil Thermal Performance Advisor (FTPA) which helps operators improve performance for fossil power plants. FTPA is a joint venture between General Physics and New York State Electric and Gas Company. This paper describes both of these computer systems and uses the FTPA as an interesting comparison that illustrates the considerations required for the development of a computer system that effectively addresses the needs of the users

  11. Stakeholder driven indicators for eHealth performance management.

    Science.gov (United States)

    Vedlūga, Tomas; Mikulskienė, Birutė

    2017-08-01

    The goal of the present article is to compile a corpus of indicators of eHealth development evaluation that would essentially reflect stakeholder approaches and complement technical indicators of assessment of an eHealth system. Consequently, the assessment of the development of an eHealth system would reflect stakeholder approaches and become an innovative solution in attempting to improve productivity of IT projects in the field of health care. The compiled minimum set of indicators will be designed to monitor implementation of the national eHealth information system. To ensure reliability of the quality research, the respondents were grouped in accordance to the geographical distribution and diversity of the levels and types of the represented jobs and institutions. The applied analysis implies several managerial insights on the hierarchy of eHealth indicators. These insights may be helpful in recommending priority activities in implementation of an eHealth data system on the national or international level. The research is practically useful as it is the first to deal with the topic in Lithuania and its theoretical and practical aspect are particularly relevant in implementation of an eHealth data system in Lithuania. The eHealth assessment indicators presented in the article may be practically useful in two aspects: (1) as key implementation guidelines facilitating the general course of eHealth system development and (2) as a means to evaluate eHealth outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Amtrak performance tracking (APT) system : methodology summary

    Science.gov (United States)

    2017-09-15

    The Volpe Center collaborated with Amtrak and the Federal Railroad Administration (FRA) to develop a cost accounting system named Amtrak Performance Tracking (APT) used by Amtrak to manage, allocate, and report its costs. APTs initial development ...

  13. Embedded High Performance Scalable Computing Systems

    National Research Council Canada - National Science Library

    Ngo, David

    2003-01-01

    The Embedded High Performance Scalable Computing Systems (EHPSCS) program is a cooperative agreement between Sanders, A Lockheed Martin Company and DARPA that ran for three years, from Apr 1995 - Apr 1998...

  14. Effects of different housing systems on growth performance and ...

    African Journals Online (AJOL)

    Effects of different housing systems on growth performance and carcass yield of two breeds of turkey. ... Bulletin of Animal Health and Production in Africa ... The results on carcass yield showed a significantly (p<0.05) higher plucked weight ...

  15. The New Jersey Performance Management System: A State System and Uses of Simple Measures.

    Science.gov (United States)

    Kamis-Gould, Edna

    1987-01-01

    The New Jersey Performance Management System (PMS) is a major mechanism used by the leadership of the New Jersey Division of Mental Health and Hospitals to contract for, monitor, and manage community mental health services. This paper describes PMS, its components, implementation, and limitations. (Author/LMO)

  16. Health Behaviors and Academic Performance Among Korean Adolescents.

    Science.gov (United States)

    So, Eun Sun; Park, Byoung Mo

    2016-06-01

    This study aimed to examine the most prominent health-related behaviors impacting the academic performance of Korean adolescents. The 2012 Korea Youth Risk Behavior Web-Based Survey data were analyzed using an ordinal regression analysis after adjusting for general and other health behaviors. Before adjustment, all health behaviors were significantly associated with academic performance. After adjustment for other health behaviors and confounding factors, only smoking [odds ratio (OR) = 2.07, 95% confidence interval (CI) (1.98, 2.16), p academic performance, and engaging in a regular diet [OR = 0.65, 95% CI (0.65, 0.62), p academic performance. Regular diet, reducing smoking and alcohol drinking, and physical activity should be the target when designing health interventions for improving academic performance in Korean adolescents. Copyright © 2016. Published by Elsevier B.V.

  17. Ambivalent implications of health care information systems: a study in the Brazilian public health care system

    Directory of Open Access Journals (Sweden)

    João Porto de Albuquerque

    2011-01-01

    Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

  18. Performance Analysis of Photovoltaic Water Heating System

    Directory of Open Access Journals (Sweden)

    Tomas Matuska

    2017-01-01

    Full Text Available Performance of solar photovoltaic water heating systems with direct coupling of PV array to DC resistive heating elements has been studied and compared with solar photothermal systems. An analysis of optimum fixed load resistance for different climate conditions has been performed for simple PV heating systems. The optimum value of the fixed load resistance depends on the climate, especially on annual solar irradiation level. Use of maximum power point tracking compared to fixed optimized load resistance increases the annual yield by 20 to 35%. While total annual efficiency of the PV water heating systems in Europe ranges from 10% for PV systems without MPP tracking up to 15% for system with advanced MPP trackers, the efficiency of solar photothermal system for identical hot water load and climate conditions is more than 3 times higher.

  19. Strengthening Health Systems Governance in Latin American ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This project seeks to improve the governance of health systems by designing and ... of the data (locally elected officials, health authorities, civil society groups), the ... In partnership with UNESCO's Organization for Women in Science for the ...

  20. Governance for Equity in Health Systems

    International Development Research Centre (IDRC) Digital Library (Canada)

    GEHS

    allocation, and power distribution in health systems are addressed to improve health ... development of a knowledge base on innovative and rigorous research ..... The Public Sector Anti-retroviral Treatment in Free State – Phase II; and Impact ...

  1. Participatory Action Research in Health Systems: Empowering ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2014-12-02

    Dec 2, 2014 ... Home · Resources · Publications ... A new publication, Participatory Action Research in Health Systems: a methods ... organizations, most African countries adopted direct payment for health services as the primary means.

  2. Fourth Global Health Systems Research Symposium features ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2017-01-13

    Jan 13, 2017 ... Home · Resources · Publications ... These solutions touch on diverse aspects of health systems, ... Read more on how IDRC is helping increase equitable access to health services for the poor in Mali and Burkina Faso.

  3. Vitrification Facility integrated system performance testing report

    International Nuclear Information System (INIS)

    Elliott, D.

    1997-01-01

    This report provides a summary of component and system performance testing associated with the Vitrification Facility (VF) following construction turnover. The VF at the West Valley Demonstration Project (WVDP) was designed to convert stored radioactive waste into a stable glass form for eventual disposal in a federal repository. Following an initial Functional and Checkout Testing of Systems (FACTS) Program and subsequent conversion of test stand equipment into the final VF, a testing program was executed to demonstrate successful performance of the components, subsystems, and systems that make up the vitrification process. Systems were started up and brought on line as construction was completed, until integrated system operation could be demonstrated to produce borosilicate glass using nonradioactive waste simulant. Integrated system testing and operation culminated with a successful Operational Readiness Review (ORR) and Department of Energy (DOE) approval to initiate vitrification of high-level waste (HLW) on June 19, 1996. Performance and integrated operational test runs conducted during the test program provided a means for critical examination, observation, and evaluation of the vitrification system. Test data taken for each Test Instruction Procedure (TIP) was used to evaluate component performance against system design and acceptance criteria, while test observations were used to correct, modify, or improve system operation. This process was critical in establishing operating conditions for the entire vitrification process

  4. Declining amenable mortality: a reflection of health care systems?

    Science.gov (United States)

    Gianino, Maria Michela; Lenzi, Jacopo; Fantini, Maria Pia; Ricciardi, Walter; Damiani, Gianfranco

    2017-11-15

    Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries. A time trend analysis was performed. Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0-74 years per 100,000 inhabitants. We classified health care systems according to a deductively generated classification by Böhm. This classification identifies three dimensions that are not entirely independent of each other but follow a clear order: the regulation dimension is first, followed by the financing dimension and finally service provision. We performed a hierarchical semi-log polynomial regression analysis on the annual SDRs to determine whether specific health care systems were associated with different SDR trajectories over time. The results showed a clear decline in SDRs in all 22 health care systems between 2000 and 2014 although at different annual changes (slopes). Regression analysis showed that there was a significant difference among the slopes according to provision dimension. Health care systems with a private provision exhibited a slowdown in the decline of amenable mortality over time. It therefore seems that ownership is the most relevant dimension in determining a different pattern of decline in mortality. All countries experienced decreases in amenable mortality between 2000 and 2014; this decline seems to be partially a reflection of health care systems, especially when affected by the provision dimension. If the private ownership is maintained or promoted by health systems, these findings might be

  5. Organizing Performance Requirements For Dynamical Systems

    Science.gov (United States)

    Malchow, Harvey L.; Croopnick, Steven R.

    1990-01-01

    Paper describes methodology for establishing performance requirements for complicated dynamical systems. Uses top-down approach. In series of steps, makes connections between high-level mission requirements and lower-level functional performance requirements. Provides systematic delineation of elements accommodating design compromises.

  6. ASUPT Automated Objective Performance Measurement System.

    Science.gov (United States)

    Waag, Wayne L.; And Others

    To realize its full research potential, a need exists for the development of an automated objective pilot performance evaluation system for use in the Advanced Simulation in Undergraduate Pilot Training (ASUPT) facility. The present report documents the approach taken for the development of performance measures and also presents data collected…

  7. Systems Biology and Health Systems Complexity in;

    NARCIS (Netherlands)

    Donald Combs, C.; Barham, S.R.; Sloot, P.M.A.

    2016-01-01

    Systems biology addresses interactions in biological systems at different scales of biological organization, from the molecular to the cellular, organ, organism, societal, and ecosystem levels. This chapter expands on the concept of systems biology, explores its implications for individual patients

  8. High-performance commercial building systems

    Energy Technology Data Exchange (ETDEWEB)

    Selkowitz, Stephen

    2003-10-01

    This report summarizes key technical accomplishments resulting from the three year PIER-funded R&D program, ''High Performance Commercial Building Systems'' (HPCBS). The program targets the commercial building sector in California, an end-use sector that accounts for about one-third of all California electricity consumption and an even larger fraction of peak demand, at a cost of over $10B/year. Commercial buildings also have a major impact on occupant health, comfort and productivity. Building design and operations practices that influence energy use are deeply engrained in a fragmented, risk-averse industry that is slow to change. Although California's aggressive standards efforts have resulted in new buildings designed to use less energy than those constructed 20 years ago, the actual savings realized are still well below technical and economic potentials. The broad goal of this program is to develop and deploy a set of energy-saving technologies, strategies, and techniques, and improve processes for designing, commissioning, and operating commercial buildings, while improving health, comfort, and performance of occupants, all in a manner consistent with sound economic investment practices. Results are to be broadly applicable to the commercial sector for different building sizes and types, e.g. offices and schools, for different classes of ownership, both public and private, and for owner-occupied as well as speculative buildings. The program aims to facilitate significant electricity use savings in the California commercial sector by 2015, while assuring that these savings are affordable and promote high quality indoor environments. The five linked technical program elements contain 14 projects with 41 distinct R&D tasks. Collectively they form a comprehensive Research, Development, and Demonstration (RD&D) program with the potential to capture large savings in the commercial building sector, providing significant economic benefits to

  9. Drivers of improved health sector performance in Rwanda: a qualitative view from within.

    Science.gov (United States)

    Sayinzoga, Felix; Bijlmakers, Leon

    2016-04-08

    Rwanda has achieved great improvements in several key health indicators, including maternal mortality and other health outcomes. This raises the question: what has made this possible, and what makes Rwanda so unique? We describe the results of a web-based survey among district health managers in Rwanda who gave their personal opinions on the factors that drive performance in the health sector, in particular those that determine maternal health service coverage and outcomes. The questionnaire covered the six health systems building blocks that make up the WHO framework for health systems analysis, and two additional clusters of factors that are not directly covered by the framework: community health and determinants beyond the health sector. Community health workers and health insurance come out as factors that are considered to have contributed most to Rwanda's remarkable achievements in the past decade. The results also indicate the importance of other health system features, such as managerial skills and the culture of continuous monitoring of key indicators. In addition, there are factors beyond the health sector per se, such as the widespread determination of people to increase performance and achieve targets. This determination appears multi-levelled and influenced by both intrinsic and extrinsic motivation. It is the comprehensiveness and combination of interventions that drive performance in Rwanda, rather than a single health systems strengthening intervention or a set of interventions that target a specific disease. There is need for policy makers and scholars to acknowledge the complexity of health systems, and the fact that they are dynamic and influenced by society's fabric, including the overall culture of performance management in the public sector. Rwanda's robust model is difficult to replicate and fast-tracking elsewhere in the world of some of the interventions that form part of its success will require a holistic approach.

  10. Mapping Health Needs to Support Health System Management in Poland

    Science.gov (United States)

    Holecki, Tomasz; Romaniuk, Piotr; Woźniak-Holecka, Joanna; Szromek, Adam R.; Syrkiewicz-Świtała, Magdalena

    2018-01-01

    In Poland, following the example of other EU countries, the first maps of health needs prepared by the Ministry of Health were presented in 2016. The maps constitute a foundation for rational decision-making in the management of health care resources, being potentially useful for all actors in health system. This refers in particular to the institutions responsible for distribution of funds and contracting health service, but also for decision-makers, who determine the scope of funds to be utilized in the health system, or the structure of benefits provided to patients. Service providers are also addressees of the maps, to give them a basis for planning future activities. The article presents a structured assessment of the current state of affairs, based on recent experience and sets out likely directions for the development of health needs in mapping in Poland in the future. We discuss the criticism addressed toward maps by representatives of various groups acting in health care. It includes the lack of recognition of some of the key health needs, or wrong emphases, where much more attention is paid to the recognition of current resources in the health system, instead of making prognoses regarding the future developments of health needs. Nonetheless, we find that this instrument is potentially of high usability, in case of elimination of the existing weaknesses. PMID:29662876

  11. CITYkeys Smart city performance measurement system

    NARCIS (Netherlands)

    Huovila, A.; Airaksinen, M.; Pinto-Seppa, I.; Piira, K.; Bosch, P.R.; Penttinen, T.; Neumann, H.M.; Kontinakis, N.

    2017-01-01

    Cities are tackling their economic, social and environmental challenges through smart city solutions. To demonstrate that these solutions achieve the desired impact, an indicator-based assessment system is needed. This paper presents the process of developing CITYkeys performance measurement system

  12. Diversity in School Performance Feedback Systems

    Science.gov (United States)

    Verhaeghe, Goedele; Schildkamp, Kim; Luyten, Hans; Valcke, Martin

    2015-01-01

    As data-based decision making is receiving increased attention in education, more and more school performance feedback systems (SPFSs) are being developed and used worldwide. These systems provide schools with data on their functioning. However, little research is available on the characteristics of the different SPFSs. Therefore, this study…

  13. Toward High Performance in Industrial Refrigeration Systems

    DEFF Research Database (Denmark)

    Thybo, C.; Izadi-Zamanabadi, Roozbeh; Niemann, H.

    2002-01-01

    Achieving high performance in complex industrial systems requires information manipulation at different system levels. The paper shows how different models of same subsystems, but using different quality of information/data, are used for fault diagnosis as well as robust control design...

  14. Towards high performance in industrial refrigeration systems

    DEFF Research Database (Denmark)

    Thybo, C.; Izadi-Zamanabadi, R.; Niemann, Hans Henrik

    2002-01-01

    Achieving high performance in complex industrial systems requires information manipulation at different system levels. The paper shows how different models of same subsystems, but using different quality of information/data, are used for fault diagnosis as well as robust control design...

  15. SIMS prototype system 4 - performance test report

    Science.gov (United States)

    1978-01-01

    A self-contained, preassembled air type solar system, designed for installation remote from the dwelling, to provide space heating and hot water was evaluated. Data analysis is included which documents the system performance and verifies its suitability for field installation.

  16. Optimizing Hydronic System Performance in Residential Applications

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-10-01

    Even though new homes constructed with hydronic heat comprise only 3% of the market (US Census Bureau 2009), of the 115 million existing homes in the United States, almost 14 million of those homes (11%) are heated with steam or hot water systems according to 2009 US Census data. Therefore, improvements in hydronic system performance could result in significant energy savings in the US.

  17. Internal Performance Measurement Systems: Problems and Solutions

    DEFF Research Database (Denmark)

    Jakobsen, Morten; Mitchell, Falconer; Nørreklit, Hanne

    2010-01-01

    This article pursues two aims: to identify problems and dangers related to the operational use of internal performance measurement systems of the Balanced Scorecard (BSC) type and to provide some guidance on how performance measurement systems may be designed to overcome these problems....... The analysis uses and extends N rreklit's (2000) critique of the BSC by applying the concepts developed therein to contemporary research on the BSC and to the development of practice in performance measurement. The analysis is of relevance for many companies in the Asia-Pacific area as an increasing numbers...

  18. Performance diagnostic system for emergency diesel generators

    International Nuclear Information System (INIS)

    Logan, K.P.

    1991-01-01

    Diesel generators are commonly used for emergency backup power at nuclear stations. Emergency diesel generators (EDGs) are subject to both start-up and operating failures, due to infrequent and fast-start use. EDG reliability can be critical to plant safety, particularly when station blackout occurs. This paper describes an expert diagnostic system designed to consistently evaluate the operating performance of diesel generators. The prototype system is comprised of a suite of sensor monitoring, cylinder combustion analyzing, and diagnostic workstation computers. On-demand assessments of generator and auxiliary equipment performance are provided along with color trend displays comparing measured performance to reference-normal conditions

  19. Influence of Information Systems on Business Performance

    Directory of Open Access Journals (Sweden)

    Dmitrij Lipaj

    2013-04-01

    Full Text Available Considering increased competition nowadays, businesses strive to gain competitive advantage, increase their economic indicators, work productivity and efficiency, reduce costs and get other benefits through implementation of integrated information systems. By improving internal processes and financial performance of the company, the general business performance could be influenced by the deployment of such information system (IS. In order to identify tangible and intangible benefits of IS implementation, influence on business performance, business processes and areas that are being affected, analysis of scientific literature, research synthesis and generalizations have been made.

  20. Computer performance optimization systems, applications, processes

    CERN Document Server

    Osterhage, Wolfgang W

    2013-01-01

    Computing power performance was important at times when hardware was still expensive, because hardware had to be put to the best use. Later on this criterion was no longer critical, since hardware had become inexpensive. Meanwhile, however, people have realized that performance again plays a significant role, because of the major drain on system resources involved in developing complex applications. This book distinguishes between three levels of performance optimization: the system level, application level and business processes level. On each, optimizations can be achieved and cost-cutting p

  1. High Performance Commercial Fenestration Framing Systems

    Energy Technology Data Exchange (ETDEWEB)

    Mike Manteghi; Sneh Kumar; Joshua Early; Bhaskar Adusumalli

    2010-01-31

    A major objective of the U.S. Department of Energy is to have a zero energy commercial building by the year 2025. Windows have a major influence on the energy performance of the building envelope as they control over 55% of building energy load, and represent one important area where technologies can be developed to save energy. Aluminum framing systems are used in over 80% of commercial fenestration products (i.e. windows, curtain walls, store fronts, etc.). Aluminum framing systems are often required in commercial buildings because of their inherent good structural properties and long service life, which is required from commercial and architectural frames. At the same time, they are lightweight and durable, requiring very little maintenance, and offer design flexibility. An additional benefit of aluminum framing systems is their relatively low cost and easy manufacturability. Aluminum, being an easily recyclable material, also offers sustainable features. However, from energy efficiency point of view, aluminum frames have lower thermal performance due to the very high thermal conductivity of aluminum. Fenestration systems constructed of aluminum alloys therefore have lower performance in terms of being effective barrier to energy transfer (heat loss or gain). Despite the lower energy performance, aluminum is the choice material for commercial framing systems and dominates the commercial/architectural fenestration market because of the reasons mentioned above. In addition, there is no other cost effective and energy efficient replacement material available to take place of aluminum in the commercial/architectural market. Hence it is imperative to improve the performance of aluminum framing system to improve the energy performance of commercial fenestration system and in turn reduce the energy consumption of commercial building and achieve zero energy building by 2025. The objective of this project was to develop high performance, energy efficient commercial

  2. Assessing the Performance of Natural Resource Systems

    Directory of Open Access Journals (Sweden)

    Bruce Campbell

    2002-01-01

    Full Text Available Assessing the performance of management is central to natural resource management, in terms of improving the efficiency of interventions in an adaptive-learning cycle. This is not simple, given that such systems generally have multiple scales of interaction and response; high frequency of nonlinearity, uncertainty, and time lags; multiple stakeholders with contrasting objectives; and a high degree of context specificity. The importance of bounding the problem and preparing a conceptual model of the system is highlighted. We suggest that the capital assets approach to livelihoods may be an appropriate organizing principle for the selection of indicators of system performance. In this approach, five capital assets are recognized: physical, financial, social, natural, and human. A number of principles can be derived for each capital asset; indicators for assessing system performance should cover all of the principles. To cater for multiple stakeholders, participatory selection of indicators is appropriate, although when cross-site comparability is required, some generic indicators are suitable. Because of the high degree of context specificity of natural resource management systems, a typology of landscapes or resource management domains may be useful to allow extrapolation to broader systems. The problems of nonlinearities, uncertainty, and time lags in natural resource management systems suggest that systems modeling is crucial for performance assessment, in terms of deriving "what would have happened anyway" scenarios for comparison to the measured trajectory of systems. Given that a number of indicators are necessary for assessing performance, the question becomes whether these can be combined to give an integrative assessment. We explore five possible approaches: (1 simple additive index, as used for the Human Development Index; (2 derived variables (e.g., principal components as the indices of performance; (3 two-dimensional plots of

  3. Monitoring SLAC High Performance UNIX Computing Systems

    International Nuclear Information System (INIS)

    Lettsome, Annette K.

    2005-01-01

    Knowledge of the effectiveness and efficiency of computers is important when working with high performance systems. The monitoring of such systems is advantageous in order to foresee possible misfortunes or system failures. Ganglia is a software system designed for high performance computing systems to retrieve specific monitoring information. An alternative storage facility for Ganglia's collected data is needed since its default storage system, the round-robin database (RRD), struggles with data integrity. The creation of a script-driven MySQL database solves this dilemma. This paper describes the process took in the creation and implementation of the MySQL database for use by Ganglia. Comparisons between data storage by both databases are made using gnuplot and Ganglia's real-time graphical user interface

  4. Health, Health Care, and Systems Science: Emerging Paradigm.

    Science.gov (United States)

    Janecka, Ivo

    2017-02-15

    Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of

  5. ARIES nondestructive assay system operation and performance

    International Nuclear Information System (INIS)

    Cremers, Teresa L.; Hansen, Walter J.; Herrera, Gary D.; Nelson, David C.; Sampson, Thomas E.; Scheer, Nancy L.

    2000-01-01

    The ARIES (Advanced Recovery and Integrated Extraction System) Project is an integrated system at the Los Alamos Plutonium Facility for the dismantlement of nuclear weapons. The plutonium produced by the ARIES process was measured by an integrated nondestructive assay (NDA) system. The performance of the NDA systems was monitored by a measurement control program which is a part of a nuclear material control and accountability system. In this paper we will report the results of the measurements of the measurement control standards as well as an overview of the measurement of the ARIES process materials

  6. Prognostic Performance and Reproducibility of the 1973 and 2004/2016 World Health Organization Grading Classification Systems in Non-muscle-invasive Bladder Cancer: A European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review.

    Science.gov (United States)

    Soukup, Viktor; Čapoun, Otakar; Cohen, Daniel; Hernández, Virginia; Babjuk, Marek; Burger, Max; Compérat, Eva; Gontero, Paolo; Lam, Thomas; MacLennan, Steven; Mostafid, A Hugh; Palou, Joan; van Rhijn, Bas W G; Rouprêt, Morgan; Shariat, Shahrokh F; Sylvester, Richard; Yuan, Yuhong; Zigeuner, Richard

    2017-11-01

    Tumour grade is an important prognostic indicator in non-muscle-invasive bladder cancer (NMIBC). Histopathological classifications are limited by interobserver variability (reproducibility), which may have prognostic implications. European Association of Urology NMIBC guidelines suggest concurrent use of both 1973 and 2004/2016 World Health Organization (WHO) classifications. To compare the prognostic performance and reproducibility of the 1973 and 2004/2016 WHO grading systems for NMIBC. A systematic literature search was undertaken incorporating Medline, Embase, and the Cochrane Library. Studies were critically appraised for risk of bias (QUIPS). For prognosis, the primary outcome was progression to muscle-invasive or metastatic disease. Secondary outcomes were disease recurrence, and overall and cancer-specific survival. For reproducibility, the primary outcome was interobserver variability between pathologists. Secondary outcome was intraobserver variability (repeatability) by the same pathologist. Of 3593 articles identified, 20 were included in the prognostic review; three were eligible for the reproducibility review. Increasing tumour grade in both classifications was associated with higher disease progression and recurrence rates. Progression rates in grade 1 patients were similar to those in low-grade patients; progression rates in grade 3 patients were higher than those in high-grade patients. Survival data were limited. Reproducibility of the 2004/2016 system was marginally better than that of the 1973 system. Two studies on repeatability showed conflicting results. Most studies had a moderate to high risk of bias. Current grading classifications in NMIBC are suboptimal. The 1973 system identifies more aggressive tumours. Intra- and interobserver variability was slightly less in the 2004/2016 classification. We could not confirm that the 2004/2016 classification outperforms the 1973 classification in prediction of recurrence and progression. This article

  7. Shared performance monitor in a multiprocessor system

    Science.gov (United States)

    Chiu, George; Gara, Alan G.; Salapura, Valentina

    2012-07-24

    A performance monitoring unit (PMU) and method for monitoring performance of events occurring in a multiprocessor system. The multiprocessor system comprises a plurality of processor devices units, each processor device for generating signals representing occurrences of events in the processor device, and, a single shared counter resource for performance monitoring. The performance monitor unit is shared by all processor cores in the multiprocessor system. The PMU comprises: a plurality of performance counters each for counting signals representing occurrences of events from one or more the plurality of processor units in the multiprocessor system; and, a plurality of input devices for receiving the event signals from one or more processor devices of the plurality of processor units, the plurality of input devices programmable to select event signals for receipt by one or more of the plurality of performance counters for counting, wherein the PMU is shared between multiple processing units, or within a group of processors in the multiprocessing system. The PMU is further programmed to monitor event signals issued from non-processor devices.

  8. Performance management models for public health: Public Health Accreditation Board/Baldrige connections, alignment, and distinctions.

    Science.gov (United States)

    Gorenflo, Grace G; Klater, David M; Mason, Marlene; Russo, Pamela; Rivera, Lillian

    2014-01-01

    The nationally known Malcolm Baldrige Award for Excellence ("Baldrige program") recognizes outstanding performance management and is specifically cited by the Public Health Accreditation Board (PHAB) as a potential framework for PHAB's requisite performance management system. The authors developed a crosswalk that identifies alignments between the 2 programs and is a highlight of the Quest for Exceptional Performance tool that is intended to help health departments capitalize on the connections between the 2 programs. To provide deeper insight into the most robust connections between the 2 programs. The authors developed a crosswalk by listing the PHAB measures, identifying corresponding Baldrige areas to address, and assigning a rating regarding the strength of the alignment. Subsequently, they generated a matrix with numerical scores reflecting the strength of the PHAB-Baldrige alignments that were then analyzed for frequency and strength of alignment by PHAB domain and by Baldrige category. The tool developers and 3 public health leaders with experience in the Baldrige program contributed to both the design and the analyses. The measures used reflected both the frequency and strength of alignments. Of the 123 alignments identified in the crosswalk, 39 were rated as high, 40 as medium, and 44 as low. The strongest connections were in the areas of performance management, quality improvement, strategic planning, workforce development, assessment and analysis, and customer service. While the areas with the most frequent and strongest connections provide the most useful basis for health departments pursuing Baldrige recognition or using Baldrige criteria as a framework for performance management, all alignments could be considered for both purposes.

  9. Introduction to control system performance measurements

    CERN Document Server

    Garner, K C

    1968-01-01

    Introduction to Control System Performance Measurements presents the methods of dynamic measurements, specifically as they apply to control system and component testing. This book provides an introduction to the concepts of statistical measurement methods.Organized into nine chapters, this book begins with an overview of the applications of automatic control systems that pervade almost every area of activity ranging from servomechanisms to electrical power distribution networks. This text then discusses the common measurement transducer functions. Other chapters consider the basic wave

  10. Performance Evaluation Of Behavioral Biometric Systems

    OpenAIRE

    Cherifi , Fouad; Hemery , Baptiste; Giot , Romain; Pasquet , Marc; Rosenberger , Christophe

    2009-01-01

    We present in this chapter an overview of techniques for the performance evaluation of behavioral biometric systems. The BioAPI standard that defines the architecture of a biometric system is presented in the first part of the chapter... The general methodology for the evaluation of biometric systems is given including statistical metrics, definition of benchmark databases and subjective evaluation. These considerations rely with the ISO/IEC19795-1 standard describing the biometric performanc...

  11. Interrogating resilience in health systems development.

    Science.gov (United States)

    van de Pas, Remco; Ashour, Majdi; Kapilashrami, Anuj; Fustukian, Suzanne

    2017-11-01

    The Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Performance Assessment and Active System Monitoring for Refrigeration Systems

    DEFF Research Database (Denmark)

    Green, Torben

    to the refrigeration system, is to optimise the total cost of ownership, (TCO). However, directly measuring TCO provides some challenges. It can therefore be beneficial to divide TCO into performance criteria, which can be quantied and measured. For supermarket refrigeration systems the performance criteria can...... is measure by the switch frequency of the compressors in the refrigeration system. The reason is that excessive compressor switching will wear down the compressors too fast and thereby decrease the reliability of the system due to a higher demand for maintenance. The proposed performance function provides...

  13. A system of health accounts 2011

    National Research Council Canada - National Science Library

    2011-01-01

    .... As demands for information increase and more countries implement and institutionalize health accounts according to the system, the data produced are expected to be more comparable, more detailed...

  14. WFIRST: Coronagraph Systems Engineering and Performance Budgets

    Science.gov (United States)

    Poberezhskiy, Ilya; cady, eric; Frerking, Margaret A.; Kern, Brian; Nemati, Bijan; Noecker, Martin; Seo, Byoung-Joon; Zhao, Feng; Zhou, Hanying

    2018-01-01

    The WFIRST coronagraph instrument (CGI) will be the first in-space coronagraph using active wavefront control to directly image and characterize mature exoplanets and zodiacal disks in reflected starlight. For CGI systems engineering, including requirements development, CGI performance is predicted using a hierarchy of performance budgets to estimate various noise components — spatial and temporal flux variations — that obscure exoplanet signals in direct imaging and spectroscopy configurations. These performance budgets are validated through a robust integrated modeling and testbed model validation efforts.We present the performance budgeting framework used by WFIRST for the flow-down of coronagraph science requirements, mission constraints, and observatory interfaces to measurable instrument engineering parameters.

  15. Health system vision of iran in 2025.

    Science.gov (United States)

    Rostamigooran, N; Esmailzadeh, H; Rajabi, F; Majdzadeh, R; Larijani, B; Dastgerdi, M Vahid

    2013-01-01

    Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Vision statement in evolutionary plan of health system is considered to be :"a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region(1) and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision. Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system.

  16. Embedded Sensor Systems for Health - A Step Towards Personalized Health.

    Science.gov (United States)

    Lindén, Maria; Björkman, Mats

    2018-01-01

    The demography is changing towards older people, and the challenge to provide an appropriate care is well known. Sensor systems, combined with IT solutions are recognized as one of the major tools to handle this situation. Embedded Sensor Systems for Health (ESS-H) is a research profile at Mälardalen University in Sweden, focusing on embedded sensor systems for health technology applications. The research addresses several important issues: to provide sensor systems for health monitoring at home, to provide sensor systems for health monitoring at work, to provide safe and secure infrastructure and software testing methods for physiological data management. The user perspective is important in order to solve real problems and to develop systems that are easy and intuitive to use. One of the overall aims is to enable health trend monitoring in home environments, thus being able to detect early deterioration of a patient. Sensor systems, signal processing algorithms, and decision support algorithms have been developed. Work on development of safe and secure infrastructure and software testing methods are important for an embedded sensor system aimed for health monitoring, both in home and in work applications. Patient data must be sent and received in a safe and secure manner, also fulfilling the integrity criteria.

  17. Costs and Performance of English Mental Health Providers.

    Science.gov (United States)

    Moran, Valerie; Jacobs, Rowena

    2017-06-01

    Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period. The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime. The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multi-level log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers. There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level. The results suggest that some providers may have to increase

  18. Health System Transformation through a Scalable, Actionable Innovation Strategy.

    Science.gov (United States)

    Snowdon, Anne

    2017-01-01

    The authors who contributed to this issue of Healthcare Papers have provided rich insights into a promising innovation agenda to support transformational change aimed at achieving high-performing, person-centric health systems that are sustainable and deliver value. First and foremost, the commentaries make clear that a focused innovation agenda with defined goals, objectives and milestones is needed, if innovation is to be a viable and successful strategy to achieve health system transformation. To date, innovation has been a catch-all term for solving the many challenges health systems are experiencing. Yet, innovation on its own cannot fix all the ills of a health system; strategic goals and objectives are needed to define the way forward if innovation is to achieve value for Canadians. To this end, the authors identify goals and objectives that are worthy of serious consideration by all health system stakeholders.

  19. Performance regression manager for large scale systems

    Science.gov (United States)

    Faraj, Daniel A.

    2017-08-01

    System and computer program product to perform an operation comprising generating, based on a first output generated by a first execution instance of a command, a first output file specifying a value of at least one performance metric, wherein the first output file is formatted according to a predefined format, comparing the value of the at least one performance metric in the first output file to a value of the performance metric in a second output file, the second output file having been generated based on a second output generated by a second execution instance of the command, and outputting for display an indication of a result of the comparison of the value of the at least one performance metric of the first output file to the value of the at least one performance metric of the second output file.

  20. Smart health monitoring systems: an overview of design and modeling.

    Science.gov (United States)

    Baig, Mirza Mansoor; Gholamhosseini, Hamid

    2013-04-01

    Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way health care is currently delivered. Although smart health monitoring systems automate patient monitoring tasks and, thereby improve the patient workflow management, their efficiency in clinical settings is still debatable. This paper presents a review of smart health monitoring systems and an overview of their design and modeling. Furthermore, a critical analysis of the efficiency, clinical acceptability, strategies and recommendations on improving current health monitoring systems will be presented. The main aim is to review current state of the art monitoring systems and to perform extensive and an in-depth analysis of the findings in the area of smart health monitoring systems. In order to achieve this, over fifty different monitoring systems have been selected, categorized, classified and compared. Finally, major advances in the system design level have been discussed, current issues facing health care providers, as well as the potential challenges to health monitoring field will be identified and compared to other similar systems.

  1. Human health and performance considerations for near earth asteroids (NEA)

    Science.gov (United States)

    Steinberg, Susan; Kundrot, Craig; Charles, John

    2013-11-01

    Humans are considered as a system in the design of any deep space exploration mission. The addition of many potential near asteroid (NEA) destinations to the existing multiple mission architecture for Lunar and Mars missions increases the complexity of human health and performance issues that are anticipated for exploration of space. We suggest that risks to human health and performance be analyzed in terms of the 4 major parameters related to multiple mission architecture: destination, duration, distance and vehicle design. Geological properties of the NEA will influence design of exploration tasks related to sample handling and containment, and extravehicular activity (EVA) capabilities including suit ports and tools. A robotic precursor mission that collects basic information on NEA surface properties would reduce uncertainty about these aspects of the mission as well as aid in mission architecture and exploration task design. Key mission parameters are strongly impacted by duration and distance. The most critical of these is deep-space radiation exposure without even the temporary shielding of a nearby large planetary body. The current space radiation permissible exposure limits (PEL) limits mission duration to 3-10 months depending on age, gender and stage of the solar cycle. Duration also impacts mission architectures including countermeasures for bone, muscle, and cardiovascular atrophy during continuous weightlessness; and behavioral and psychological issues resulting from isolation and confinement. Distance affects communications and limits abort and return options for a NEA mission. These factors are anticipated to have important effects on crew function and autonomous operations, as well as influence medical capability, supplies and training requirements of the crew. The design of a habitat volume that can maintain the physical and psychological health of the crew and support mission operations with limited intervention from earth will require an

  2. Building health research systems to achieve better health

    Directory of Open Access Journals (Sweden)

    González Block Miguel

    2006-11-01

    Full Text Available Abstract Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics

  3. Building National Health Research Information Systems (COHRED ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Building National Health Research Information Systems (COHRED). This grant will allow the Council on Health Research for Development (COHRED) to create, host and maintain a web-based resource on national health research in low- and middle-income countries in partnership with institutions in the South. Called ...

  4. Self-rated job performance and absenteeism according to employee engagement, health behaviors, and physical health.

    Science.gov (United States)

    Merrill, Ray M; Aldana, Steven G; Pope, James E; Anderson, David R; Coberley, Carter R; Grossmeier, Jessica J; Whitmer, R William

    2013-01-01

    To better understand the combined influence of employee engagement, health behavior, and physical health on job performance and absenteeism. Analyses were based on 20,114 employees who completed the Healthways Well-Being Assessment from 2008 to 2010. Employees represented three geographically dispersed companies in the United States. Employee engagement, health behavior, and physical health indices were simultaneously significantly associated with job performance and also with absenteeism. Employee engagement had a greater association with job performance than did the health behavior or physical health indices, whereas the physical health index was more strongly associated with absenteeism. Specific elements of the indices were evaluated for association with self-rated job performance and absenteeism. Efforts to improve worker productivity should take a holistic approach encompassing employee health improvement and engagement strategies.

  5. Performance Based Supplementary Payment System at University Hospitals in Turkey

    Directory of Open Access Journals (Sweden)

    Vahit YÝÐÝT

    2017-06-01

    Results: The result of the analysis has revealed that PBSP system encourage physicians who would like to receive financial incentives. PBSP system supports the individual performance, reduces waiting times in patients, increases revenues and decreases expenditures and increases in efficiency of department. However, this payment system increases work load, number of examinations and provokes the conflict among personals. Conclusions: University hospitals are academic institutions that perform important missions such as research, medical education and health services provision. Therefore, PBSP system should be revised so as to encourage performing these missions at university hospitals. There is also shortage of financial resources at the university hospitals. This situation leads to less additional payments to physicians. [J Contemp Med 2017; 7(2.000: 126-131

  6. Integration of community health workers into health systems in developing countries: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Collins Otieno Asweto

    2016-02-01

    Full Text Available Background: Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health workers (CHWs. It is imperative that health care systems focus on improving access to quality continuous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness. Objective: To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries. Methods: Six databases were examined for quantitative, qualitative, and mixed-methods studies that included the integration of CHWs, their motivation and supervision, and CHW policy making and implementation in developing countries. Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs. Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized. Results: CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health. Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings. Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work, as well as financial and nonfinancial incentives, motivation, collaborative and supportive supervision, and a manageable workload. Conclusions: For sustainable integration of CHWs into health care systems, high-performing health systems with sound governance, adequate financing, well-organized service delivery, and adequate supplies and equipment are essential. Similarly, competent communities could contribute to better CHW performance through sound

  7. Performance management system enhancement and maintenance

    Science.gov (United States)

    Cleaver, T. G.; Ahour, R.; Johnson, B. R.

    1984-01-01

    The research described in this report concludes a two-year effort to develop a Performance Management System (PMS) for the NCC computers. PMS provides semi-automated monthly reports to NASA and contractor management on the status and performance of the NCC computers in the TDRSS program. Throughout 1984, PMS was tested, debugged, extended, and enhanced. Regular PMS monthly reports were produced and distributed. PMS continues to operate at the NCC under control of Bendix Corp. personnel.

  8. A Proposed RTN Officer Performance Evaluation System

    Science.gov (United States)

    1989-12-01

    Taa& No. WokI Unlit Acca ~def 11¶. TITLE (biclde Securiy ClassifiCation) A PROPOSED ROYAL THAI NAVY OFIICER PERFORM NCE EVALUATION SYSTEM 12. PERSONAL...all aspects of performance into account , the commanding officer uses his opinion to decide who is "the best." There are no standard guidelines for...ftequently used in orgunsadozn as a bais for adminiardstive decisions such as employee promotion., tuufer, and allocation of financial reward; employee

  9. The French Health Care System: What Can We Learn?

    Directory of Open Access Journals (Sweden)

    El Taguri A

    2008-01-01

    Full Text Available All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. (Specific, Measurable, Achievable, Realistic, Time specific objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services.The French Health Care System (FHCS ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System.

  10. The better model to predict and improve pediatric health care quality: performance or importance-performance?

    Science.gov (United States)

    Olsen, Rebecca M; Bryant, Carol A; McDermott, Robert J; Ortinau, David

    2013-01-01

    The perpetual search for ways to improve pediatric health care quality has resulted in a multitude of assessments and strategies; however, there is little research evidence as to their conditions for maximum effectiveness. A major reason for the lack of evaluation research and successful quality improvement initiatives is the methodological challenge of measuring quality from the parent perspective. Comparison of performance-only and importance-performance models was done to determine the better predictor of pediatric health care quality and more successful method for improving the quality of care provided to children. Fourteen pediatric health care centers serving approximately 250,000 patients in 70,000 households in three West Central Florida counties were studied. A cross-sectional design was used to determine the importance and performance of 50 pediatric health care attributes and four global assessments of pediatric health care quality. Exploratory factor analysis revealed five dimensions of care (physician care, access, customer service, timeliness of services, and health care facility). Hierarchical multiple regression compared the performance-only and the importance-performance models. In-depth interviews, participant observations, and a direct cognitive structural analysis identified 50 health care attributes included in a mailed survey to parents(n = 1,030). The tailored design method guided survey development and data collection. The importance-performance multiplicative additive model was a better predictor of pediatric health care quality. Attribute importance moderates performance and quality, making the importance-performance model superior for measuring and providing a deeper understanding of pediatric health care quality and a better method for improving the quality of care provided to children. Regardless of attribute performance, if the level of attribute importance is not taken into consideration, health care organizations may spend valuable

  11. Governance of Health Systems Comment on “A Network Based Theory of Health Systems and Cycles of Well-Being”

    OpenAIRE

    Blanchet, Karl

    2013-01-01

    Health systems research aims to understand the governance of health systems (i.e. how health systems function and perform and how their actors interact with each other). This can be achieved by applying innovative methodologies and concepts that are going to capture the complexity and dynamics of health systems when they are affected by shocks. The capacity of health systems to adapt to shocks (i.e. the resilience of health systems) is a new area of investigation. Social network analysis is a...

  12. Traditional formwork system sustainability performance: experts’ opinion

    Science.gov (United States)

    Taher Al-ashwal, Mohammed; Abdullah, Redzuan; Zakaria, Rozana

    2017-11-01

    The traditional formwork system is one of the commonly used systems in concrete construction. It is considered as one of the least observed activities in term of sustainability performance. In this paper, the sustainability performance of the traditional formwork has been assessed by using a multi-criteria assessment tool to facilitate the decision on the sustainability performance measurement. A quantitative five Likert scale survey study using judgemental sampling is employed in this study. A sample of 93 of engineering construction experts, with different fields including contractors, developers, and consultants in the Malaysian context has made the body of the collected primary data. The results show variety in the distribution of the respondents’ working experience. The sustainability performance is considered moderately sustainable by the experts with only given 40.24 % of the overall total score for the three sustainable categories namely environmental, social and economic. Despite the finding that shows that the economic pillar was rated as the most sustainable aspect in comparison to the environmental and social pillars the traditional formwork system sustainability still needs enhancement. Further incorporation of the social and environmental pillars into the concrete construction the sustainability performance of traditional formwork system could be improved.

  13. The State Public Health Laboratory System.

    Science.gov (United States)

    Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

    2010-01-01

    This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

  14. LISA Mission and System architectures and performances

    International Nuclear Information System (INIS)

    Gath, Peter F; Weise, Dennis; Schulte, Hans-Reiner; Johann, Ulrich

    2009-01-01

    In the context of the LISA Mission Formulation Study, the LISA System was studied in detail and a new baseline architecture for the whole mission was established. This new baseline is the result of trade-offs on both, mission and system level. The paper gives an overview of the different mission scenarios and configurations that were studied in connection with their corresponding advantages and disadvantages as well as performance estimates. Differences in the required technologies and their influence on the overall performance budgets are highlighted for all configurations. For the selected baseline concept, a more detailed description of the configuration is given and open issues in the technologies involved are discussed.

  15. LISA Mission and System architectures and performances

    Energy Technology Data Exchange (ETDEWEB)

    Gath, Peter F; Weise, Dennis; Schulte, Hans-Reiner; Johann, Ulrich, E-mail: peter.gath@astrium.eads.ne [Astrium GmbH Satellites, 88039 Friedrichshafen (Germany)

    2009-03-01

    In the context of the LISA Mission Formulation Study, the LISA System was studied in detail and a new baseline architecture for the whole mission was established. This new baseline is the result of trade-offs on both, mission and system level. The paper gives an overview of the different mission scenarios and configurations that were studied in connection with their corresponding advantages and disadvantages as well as performance estimates. Differences in the required technologies and their influence on the overall performance budgets are highlighted for all configurations. For the selected baseline concept, a more detailed description of the configuration is given and open issues in the technologies involved are discussed.

  16. Research of Performance Linux Kernel File Systems

    Directory of Open Access Journals (Sweden)

    Andrey Vladimirovich Ostroukh

    2015-10-01

    Full Text Available The article describes the most common Linux Kernel File Systems. The research was carried out on a personal computer, the characteristics of which are written in the article. The study was performed on a typical workstation running GNU/Linux with below characteristics. On a personal computer for measuring the file performance, has been installed the necessary software. Based on the results, conclusions and proposed recommendations for use of file systems. Identified and recommended by the best ways to store data.

  17. APPROXIMATIONS TO PERFORMANCE MEASURES IN QUEUING SYSTEMS

    Directory of Open Access Journals (Sweden)

    Kambo, N. S.

    2012-11-01

    Full Text Available Approximations to various performance measures in queuing systems have received considerable attention because these measures have wide applicability. In this paper we propose two methods to approximate the queuing characteristics of a GI/M/1 system. The first method is non-parametric in nature, using only the first three moments of the arrival distribution. The second method treads the known path of approximating the arrival distribution by a mixture of two exponential distributions by matching the first three moments. Numerical examples and optimal analysis of performance measures of GI/M/1 queues are provided to illustrate the efficacy of the methods, and are compared with benchmark approximations.

  18. Mental health service delivery following health system reform in Colombia.

    Science.gov (United States)

    Romero-González, Mauricio; González, Gerardo; Rosenheck, Robert A

    2003-12-01

    In 1993, Colombia underwent an ambitious and comprehensive process of health system reform based on managed competition and structured pluralism, but did not include coverage for mental health services. In this study, we sought to evaluate the impact of the reform on access to mental health services and whether there were changes in the pattern of mental health service delivery during the period after the reform. Changes in national economic indicators and in measures of mental health and non-mental health service delivery for the years 1987 and 1997 were compared. Data were obtained from the National Administrative Department of Statistics of Colombia (DANE), the Department of National Planning and Ministry of the Treasury of Colombia, and from national official reports of mental health and non-mental health service delivery from the Ministry of Health of Colombia for the same years. While population-adjusted access to mental health outpatient services declined by -2.7% (-11.2% among women and +5.8% among men), access to general medical outpatient services increased dramatically by 46%. In-patient admissions showed smaller differences, with a 7% increase in mental health admissions, as compared to 22.5% increase in general medical admissions. The health reform in Colombia imposed competition across all health institutions with the intention of encouraging efficiency and financial autonomy. However, the challenge of institutional survival appears to have fallen heavily on mental health care institutions that were also expected to participate in managed competition, but that were at a serious disadvantage because their services were excluded from the compulsory standardized package of health benefits. While the Colombian health care reform intended to close the gap between those who had and those who did not have access to health services, it appears to have failed to address access to specialized mental health services, although it does seem to have promoted a

  19. The performance of mHealth in cancer supportive care: a research agenda.

    Science.gov (United States)

    Nasi, Greta; Cucciniello, Maria; Guerrazzi, Claudia

    2015-02-13

    Since the advent of smartphones, mHealth has risen to the attention of the health care system as something that could radically change the way health care has been viewed, managed, and delivered to date. This is particularly relevant for cancer, as one of the leading causes of death worldwide, and for cancer supportive care, since patients and caregivers have key roles in managing side effects. Given adequate knowledge, they are able to expect appropriate assessments and interventions. In this scenario, mHealth has great potential for linking patients, caregivers, and health care professionals; for enabling early detection and intervention; for lowering costs; and achieving better quality of life. Given its great potential, it is important to evaluate the performance of mHealth. This can be considered from several perspectives, of which organizational performance is particularly relevant, since mHealth may increase the productivity of health care providers and as a result even the productivity of health care systems. This paper aims to review studies on the evaluation of the performance of mHealth, with particular focus on cancer care and cancer supportive care processes, concentrating on its contribution to organizational performance, as well as identifying some indications for a further research agenda. We carried out a review of literature, aimed at identifying studies related to the performance of mHealth in general or focusing on cancer care and cancer supportive care. Our analysis revealed that studies are almost always based on a single dimension of performance. Any evaluations of the performance of mHealth are based on very different methods and measures, with a prevailing focus on issues linked to efficiency. This fails to consider the real contribution that mHealth can offer for improving the performance of health care providers, health care systems, and the quality of life in general. Further research should start by stating and explaining what is meant

  20. Performance evaluation of real time radiographic systems

    International Nuclear Information System (INIS)

    Venkatraman, B.; Saravanan, S.; Jayakumar, T.; Kalyanasundaram, P.; Baldev Raj

    1996-01-01

    The Real Time Radiography (RTR) system can be studied completely by knowing the modulation transfer function (MTF) of the whole system. The MTF curve is a special form of contrast/detail-size diagram in which the image contrast is plotted against the spatial frequency of a test object measured in line-pairs per millimetre (lp/mm). MTF curves are widely used to measure the characteristics of optical equipment, particularly for assessing the contribution of individual items in a complex imaging transfer system. Codes of practice indicate that the image intensifier systems should be checked periodically to assess its performance through the use of MTF curves and step wedges for contrast ratio. Authors, instead, suggest the use of performance curves which are simple to obtain and can be easily interpreted by radiographers. (author)

  1. A guide to performance management for the Health Information Manager.

    Science.gov (United States)

    Leggat, Sandra G

    This paper provides a summary of human resource management practices that have been identified as being associated with better outcomes in performance management. In general, essential practices include transformational leadership and a coherent program of goal setting, performance monitoring and feedback. Some Health Information Managers may feel they require training assistance to develop the necessary skills in the establishment of meaningful work performance goals for staff and the provision of useful and timely feedback. This paper provides useful information to assist Health Information Managers enhance the performance of their staff.

  2. Health Systems Sustainability and Rare Diseases.

    Science.gov (United States)

    Ferrelli, Rita Maria; De Santis, Marta; Egle Gentile, Amalia; Taruscio, Domenica

    2017-01-01

    The paper is addressing aspects of health system sustainability for rare diseases in relation to the current economic crisis and equity concerns. It takes into account the results of the narrative review carried out in the framework of the Joint Action for Rare Diseases (Joint RD-Action) "Promoting Implementation of Recommendations on Policy, Information and Data for Rare Diseases", that identified networks as key factors for health systems sustainability for rare diseases. The legal framework of European Reference Networks and their added value is also presented. Networks play a relevant role for health systems sustainability, since they are based upon, pay special attention to and can intervene on health systems knowledge development, partnership, organizational structure, resources, leadership and governance. Moreover, sustainability of health systems can not be separated from the analysis of the context and the action on it, including fiscal equity. As a result of the financial crisis of 2008, cuts of public health-care budgets jeopardized health equity, since the least wealthy suffered from the greatest health effects. Moreover, austerity policies affected economic growth much more adversely than previously believed. Therefore, reducing public health expenditure not only is going to jeopardise citizens' health, but also to hamper fair and sustainable development.

  3. Management issues for high performance storage systems

    Energy Technology Data Exchange (ETDEWEB)

    Louis, S. [Lawrence Livermore National Lab., CA (United States); Burris, R. [Oak Ridge National Lab., TN (United States)

    1995-03-01

    Managing distributed high-performance storage systems is complex and, although sharing common ground with traditional network and systems management, presents unique storage-related issues. Integration technologies and frameworks exist to help manage distributed network and system environments. Industry-driven consortia provide open forums where vendors and users cooperate to leverage solutions. But these new approaches to open management fall short addressing the needs of scalable, distributed storage. We discuss the motivation and requirements for storage system management (SSM) capabilities and describe how SSM manages distributed servers and storage resource objects in the High Performance Storage System (HPSS), a new storage facility for data-intensive applications and large-scale computing. Modem storage systems, such as HPSS, require many SSM capabilities, including server and resource configuration control, performance monitoring, quality of service, flexible policies, file migration, file repacking, accounting, and quotas. We present results of initial HPSS SSM development including design decisions and implementation trade-offs. We conclude with plans for follow-on work and provide storage-related recommendations for vendors and standards groups seeking enterprise-wide management solutions.

  4. E-health, health systems and social innovation

    DEFF Research Database (Denmark)

    Brem, Alexander; Sliwa, Sophie Isabel; Agarwal, Nivedita

    2017-01-01

    This paper explores telecare as one of the practical applications in the field of e-health. Using 11 expert interviews the study evaluates development of cross-national analogies between the different institutional contexts of health systems in Germany, Austria, and Denmark. Telecare is treated a...... to be driving socially innovative solutions. Implications for research and practice, as well as future research directions, are elaborated....... as a set of ideas regarding future processes in health and home care services, involving technological solutions, starting to change stakeholders' behaviour, work practices, and social roles. A system-centric framework is proposed to evaluate the interdependencies between telecare, the changing...

  5. Primary health care and public health: foundations of universal health systems.

    Science.gov (United States)

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

  6. Problem reporting management system performance simulation

    Science.gov (United States)

    Vannatta, David S.

    1993-01-01

    This paper proposes the Problem Reporting Management System (PRMS) model as an effective discrete simulation tool that determines the risks involved during the development phase of a Trouble Tracking Reporting Data Base replacement system. The model considers the type of equipment and networks which will be used in the replacement system as well as varying user loads, size of the database, and expected operational availability. The paper discusses the dynamics, stability, and application of the PRMS and addresses suggested concepts to enhance the service performance and enrich them.

  7. High performance VLSI telemetry data systems

    Science.gov (United States)

    Chesney, J.; Speciale, N.; Horner, W.; Sabia, S.

    1990-01-01

    NASA's deployment of major space complexes such as Space Station Freedom (SSF) and the Earth Observing System (EOS) will demand increased functionality and performance from ground based telemetry acquisition systems well above current system capabilities. Adaptation of space telemetry data transport and processing standards such as those specified by the Consultative Committee for Space Data Systems (CCSDS) standards and those required for commercial ground distribution of telemetry data, will drive these functional and performance requirements. In addition, budget limitations will force the requirement for higher modularity, flexibility, and interchangeability at lower cost in new ground telemetry data system elements. At NASA's Goddard Space Flight Center (GSFC), the design and development of generic ground telemetry data system elements, over the last five years, has resulted in significant solutions to these problems. This solution, referred to as the functional components approach includes both hardware and software components ready for end user application. The hardware functional components consist of modern data flow architectures utilizing Application Specific Integrated Circuits (ASIC's) developed specifically to support NASA's telemetry data systems needs and designed to meet a range of data rate requirements up to 300 Mbps. Real-time operating system software components support both embedded local software intelligence, and overall system control, status, processing, and interface requirements. These components, hardware and software, form the superstructure upon which project specific elements are added to complete a telemetry ground data system installation. This paper describes the functional components approach, some specific component examples, and a project example of the evolution from VLSI component, to basic board level functional component, to integrated telemetry data system.

  8. A Study of Vicon System Positioning Performance

    Directory of Open Access Journals (Sweden)

    Pierre Merriaux

    2017-07-01

    Full Text Available Motion capture setups are used in numerous fields. Studies based on motion capture data can be found in biomechanical, sport or animal science. Clinical science studies include gait analysis as well as balance, posture and motor control. Robotic applications encompass object tracking. Today’s life applications includes entertainment or augmented reality. Still, few studies investigate the positioning performance of motion capture setups. In this paper, we study the positioning performance of one player in the optoelectronic motion capture based on markers: Vicon system. Our protocol includes evaluations of static and dynamic performances. Mean error as well as positioning variabilities are studied with calibrated ground truth setups that are not based on other motion capture modalities. We introduce a new setup that enables directly estimating the absolute positioning accuracy for dynamic experiments contrary to state-of-the art works that rely on inter-marker distances. The system performs well on static experiments with a mean absolute error of 0.15 mm and a variability lower than 0.025 mm. Our dynamic experiments were carried out at speeds found in real applications. Our work suggests that the system error is less than 2 mm. We also found that marker size and Vicon sampling rate must be carefully chosen with respect to the speed encountered in the application in order to reach optimal positioning performance that can go to 0.3 mm for our dynamic study.

  9. High performance computing on vector systems

    CERN Document Server

    Roller, Sabine

    2008-01-01

    Presents the developments in high-performance computing and simulation on modern supercomputer architectures. This book covers trends in hardware and software development in general and specifically the vector-based systems and heterogeneous architectures. It presents innovative fields like coupled multi-physics or multi-scale simulations.

  10. High Performance Work Systems for Online Education

    Science.gov (United States)

    Contacos-Sawyer, Jonna; Revels, Mark; Ciampa, Mark

    2010-01-01

    The purpose of this paper is to identify the key elements of a High Performance Work System (HPWS) and explore the possibility of implementation in an online institution of higher learning. With the projected rapid growth of the demand for online education and its importance in post-secondary education, providing high quality curriculum, excellent…

  11. Health systems financing: putting together the “back office”

    OpenAIRE

    Dare, Lola; Reeler, Anne

    2005-01-01

    Strengthening healthcare systems has been identified as central to Africa achieving global and regional development targets, including the millennium development goals. Lola Dare and Anne Reeler present case studies on issues that can contribute to improved integration and lead to better performance of health systems in Africa

  12. The former Yugoslav Republic of Macedonia: Health System Review.

    Science.gov (United States)

    Milevska Kostova, Neda; Chichevalieva, Snezhana; Ponce, Ninez A; van Ginneken, Ewout; Winkelmann, Juliane

    2017-05-01

    This analysis of the health system of the former Yugoslav Republic of Macedonia reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The country has made important progress during its transition from a socialist system to a market-based system, particularly in reforming the organization, financing and delivery of health care and establishing a mix of private and public providers. Though total health care expenditure has risen in absolute terms in recent decades, it has consistently fallen as share of GDP, and high levels of private health expenditure remain. Despite this, the health of the population has improved over the last decades, with life expectancy and mortality rates for both adults and children reaching similar levels to those in ex-communist EU countries, though death rates caused by unhealthy behaviour remain high. Inheriting a large health infrastructure, good public health services and well-distributed health service coverage after independence in 1991, the country re-built a social health insurance system with a broad benefit package. Primary care providers were privatized and new private hospitals were allowed to enter the market. In recent years, the country reformed the organization of care delivery to better incorporate both public and private providers in an integrated system. Significant efficiency gains were reached with a pioneering health information system that has reduced waiting times and led to a better coordination of care. This multi-modular e-health system has the potential to further reduce existing inefficiencies and to generate evidence for assessment and research. Despite this progress, satisfaction with health care delivery is very mixed with low satisfaction levels with public providers. The public hospital sector in particular is characterized by inefficient organization, financing and provision of health care; and many professionals

  13. Precast concrete pavement - systems and performance review

    Science.gov (United States)

    Novak, Josef; Kohoutková, Alena; Křístek, Vladimír; Vodička, Jan

    2017-09-01

    Long-term traffic restrictions belong to the key disadvantages of conventional cast-in-plane concrete pavements which have been used for technical structures such as roads, parking place and airfield pavements. As a consequence, the pressure is put on the development of such systems which have short construction time, low production costs, long-term durability, low maintenance requirements etc.. The paper presents the first step in the development of an entirely new precast concrete pavement (PCP) system applicable to airfield and highway pavements. The main objective of the review of PCP systems is to acquire a better understanding of the current systems and design methods used for transport infrastructure. There is lack of information on using PCP systems for the construction of entirely new pavements. To most extensive experience is dated back to the 20th century when hexagonal slab panels and system PAG were used in the Soviet Union for the military airfields. Since cast-in-situ pavements became more common, the systems based on precast concrete panels have been mainly utilized for the removal of damaged sections of existing structures including roads, highways etc.. Namely, it concerns Fort Miller Super Slab system, Michigan system, Uretek Stitch system and Kwik system. The presented review indicates several issues associated with the listed PCP systems and their applications to the repair and rehabilitation of existing structures. Among others, the type of manufacturing technology, particularly the position of slots for dowel bars, affects the durability and performance of the systems. Gathered information serve for the development of a new system for airfield and highway pavement construction.

  14. Virginia power's human performance evaluation system (HPES)

    International Nuclear Information System (INIS)

    Patterson, W.E.

    1991-01-01

    This paper reports on the Human Performance Evaluation System (HPES) which was initially developed by the Institute of Nuclear Power Operations (INPO) using the Aviation Safety Reporting System (ASRS) as a guide. After a pilot program involving three utilities ended in 1983, the present day program was instituted. A methodology was developed, for specific application to nuclear power plant employees, to aid trained coordinators/evaluators in determining those factors that exert a negative influence on human behavior in the nuclear power plant environment. HPES is for anyone and everyone on site, from contractors to plant staff to plant management. No one is excluded from participation. Virginia Power's HPES program goal is to identify and correct the root causes of human performance problems. Evaluations are performed on reported real or perceived conditions that may have an adverse influence on members of the nuclear team. A report is provided to management identifying root cause and contributing factors along with recommended corrective actions

  15. Integrating modular mechatronic systems for immersive performances

    DEFF Research Database (Denmark)

    Pagliarini, Luigi; Lund, Henrik Hautop

    2015-01-01

    and video output in a very easy manner, thanks to mechatronical wearable interfaces. In this light, we describe two of our systems that explore the concept of run-time composition of a variety of input and output modalities, e.g. both music and graphical expression. Indeed, we developed both hardware......As a branch of mechatronic research in interactivity, and in robot art, we describe the concept of implementing Playware based tools inspired by modern AI robotic systems for audio-video performances. We develop immersive and personalizable tools that can allow any user to manipulate both audio...... to create a run-time audio-video performance that is original and unique. This can further be combined with modular wearable – inspired by modular robotics – to interact and control the performance. This mechatronic wearable concept and its implementations exemplify how to convey a user-centered experience...

  16. NASA Human Health and Performance Information Architecture Panel

    Science.gov (United States)

    Johnson-Throop, Kathy; Kadwa, Binafer; VanBaalen, Mary

    2014-01-01

    The Human Health and Performance (HH&P) Directorate at NASA's Johnson Space Center has a mission to enable optimization of human health and performance throughout all phases of spaceflight. All HH&P functions are ultimately aimed at achieving this mission. Our activities enable mission success, optimizing human health and productivity in space before, during, and after the actual spaceflight experience of our crews, and include support for ground-based functions. Many of our spaceflight innovations also provide solutions for terrestrial challenges, thereby enhancing life on Earth.

  17. Reforming the health care system: implications for health care marketers.

    Science.gov (United States)

    Petrochuk, M A; Javalgi, R G

    1996-01-01

    Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

  18. Performance of deep geothermal energy systems

    Science.gov (United States)

    Manikonda, Nikhil

    Geothermal energy is an important source of clean and renewable energy. This project deals with the study of deep geothermal power plants for the generation of electricity. The design involves the extraction of heat from the Earth and its conversion into electricity. This is performed by allowing fluid deep into the Earth where it gets heated due to the surrounding rock. The fluid gets vaporized and returns to the surface in a heat pipe. Finally, the energy of the fluid is converted into electricity using turbine or organic rankine cycle (ORC). The main feature of the system is the employment of side channels to increase the amount of thermal energy extracted. A finite difference computer model is developed to solve the heat transport equation. The numerical model was employed to evaluate the performance of the design. The major goal was to optimize the output power as a function of parameters such as thermal diffusivity of the rock, depth of the main well, number and length of lateral channels. The sustainable lifetime of the system for a target output power of 2 MW has been calculated for deep geothermal systems with drilling depths of 8000 and 10000 meters, and a financial analysis has been performed to evaluate the economic feasibility of the system for a practical range of geothermal parameters. Results show promising an outlook for deep geothermal systems for practical applications.

  19. Performance evaluation of a computed radiography system

    Energy Technology Data Exchange (ETDEWEB)

    Roussilhe, J.; Fallet, E. [Carestream Health France, 71 - Chalon/Saone (France); Mango, St.A. [Carestream Health, Inc. Rochester, New York (United States)

    2007-07-01

    Computed radiography (CR) standards have been formalized and published in Europe and in the US. The CR system classification is defined in those standards by - minimum normalized signal-to-noise ratio (SNRN), and - maximum basic spatial resolution (SRb). Both the signal-to-noise ratio (SNR) and the contrast sensitivity of a CR system depend on the dose (exposure time and conditions) at the detector. Because of their wide dynamic range, the same storage phosphor imaging plate can qualify for all six CR system classes. The exposure characteristics from 30 to 450 kV, the contrast sensitivity, and the spatial resolution of the KODAK INDUSTREX CR Digital System have been thoroughly evaluated. This paper will present some of the factors that determine the system's spatial resolution performance. (authors)

  20. Generating units performances: power system requirements

    Energy Technology Data Exchange (ETDEWEB)

    Fourment, C; Girard, N; Lefebvre, H

    1994-08-01

    The part of generating units within the power system is more than providing power and energy. Their performance are not only measured by their energy efficiency and availability. Namely, there is a strong interaction between the generating units and the power system. The units are essential components of the system: for a given load profile the frequency variation follows directly from the behaviour of the units and their ability to adapt their power output. In the same way, the voltage at the units terminals are the key points to which the voltage profile at each node of the network is linked through the active and especially the reactive power flows. Therefore, the customer will experience the frequency and voltage variations induced by the units behaviour. Moreover, in case of adverse conditions, if the units do not operate as well as expected or trip, a portion of the system, may be the whole system, may collapse. The limitation of the performance of a unit has two kinds of consequences. Firstly, it may result in an increased amount of not supplied energy or loss of load probability: for example if the primary reserve is not sufficient, a generator tripping may lead to an abnormal frequency deviation, and load may have to be shed to restore the balance. Secondly, the limitation of a unit performance results in an economic over-cost for the system: for instance, if not enough `cheap` units are able to load-following, other units with higher operating costs have to be started up. We would like to stress the interest for the operators and design teams of the units on the one hand, and the operators and design teams of the system on the other hand, of dialog and information exchange, in operation but also at the conception stage, in order to find a satisfactory compromise between the system requirements and the consequences for the generating units. (authors). 11 refs., 4 figs.

  1. Network performance for graphical control systems

    International Nuclear Information System (INIS)

    Clout, P.; Geib, M.; Westervelt, R.

    1992-01-01

    Vsystem is a toolbox for building graphically-based control systems. The real-tiem database component, Vaccess, includes all the networking support necessary to build multi-computer control systems. Vaccess has two modes of database access, synchronous and asynchronous. Vdraw is another component of Vsystem that allows developers and users to develop control screens and windows by drawing rather than programming. Based on X-windows, Vsystem provides the possibility of running Vdraw either on the workstation with the graphics or on the computer with the database. We have made some measurements on the cpu loading, elapsed time and the network loading to give some guidance in system configuration performance. It will be seen that asynchronous network access gives large performance increases and that the network database change notification protocol can be either more or less efficient than the X-window network protocol, depending on the graphical representation of the data. (author)

  2. Thermal insulation performance of green roof systems

    Energy Technology Data Exchange (ETDEWEB)

    Celik, Serdar; Morgan, Susan; Retzlaff, William; Once, Orcun [southern Illinois University (United States)], e-mail: scelik@siue.edu, e-mail: smorgan@siue.edu, e-mail: wretzla@siue.edu, e-mail: oonce@siue.edu

    2011-07-01

    With the increasing costs of energy, good building insulation has become increasingly important. Among existing insulation techniques is the green roof system, which consists of covering the roof of a building envelop with plants. The aim of this paper is to assess the impact of vegetation type and growth media on the thermal performance of green roof systems. Twelve different green roof samples were made with 4 different growth media and 3 sedum types. Temperature at the sample base was recorded every 15 minutes for 3 years; the insulation behavior was then analysed. Results showed that the insulation characteristics were achieved with a combination of haydite and sedum sexangulare. This study demonstrated that the choice of growth media and vegetation is important to the green roof system's performance; further research is required to better understand the interactions between growth media and plant roots.

  3. Information Technology Adoption and Procedural Performance in Health Care

    Science.gov (United States)

    Shi, Yunfeng

    2010-01-01

    This dissertation studies two specific topics on information technologies in health care industry. (1) The status and change of integrated health care delivery system level IT spending and hospital level IT adoption between 1999 and 2006. (2) The potential link between hospital level IT adoptions and quality as quantified by procedural performance…

  4. Supplier Performance Evaluation and Rating System (SPEARS)

    International Nuclear Information System (INIS)

    Oged, M.; Warner, D.; Gurbuz, E.

    1993-03-01

    The SSCL Magnet Quality Assurance Department has implemented a Supplier Performance Evaluation and Rating System (SPEARS) to assess supplier performance throughout the development and production stages of the SSCL program. The main objectives of SPEARS are to promote teamwork and recognize performance. This paper examines the current implementation of SPEARS. MSD QA supports the development and production of SSCsuperconducting magnets while implementing the requirements of DOE Order 5700.6C. The MSD QA program is based on the concept of continuous improvement in quality and productivity. The QA program requires that procurement of items and services be controlled to assure conformance to specification. SPEARS has been implemented to meet DOE requirements and to enhance overall confidence in supplier performance. Key elements of SPEARS include supplier evaluation and selection as well as evaluation of furnished quality through source inspection, audit, and receipt inspection. These elements are described in this paper

  5. Supplier Performance Evaluation and Rating System (SPEARS)

    International Nuclear Information System (INIS)

    Oged, M.; Warner, D.G.; Gurbuz, E.

    1994-01-01

    The SSCL Magnet Quality Assurance Department has implemented a Supplier Performance Evaluation and Rating System (SPEARS) to assess supplier performance throughout the development and production stages of the SSCL program. The main objectives of SPEARS are to promote teamwork and recognize performance. This paper examines the current implementation of SPEARS. MSD QA supports the development and production of SSC superconducting magnets while implementing the requirements of DOE Order 5700.6C. The MSD QA program is based on the concept of continuous improvement in quality and productivity. The QA program requires that procurement of items and services be controlled to assure conformance to specification. SPEARS has been implemented to meet DOE requirements and to enhance overall confidence in supplier performance. Key elements of SPEARS include supplier evaluation and selection as well as evaluation of furnished quality through source inspection, audit, and receipt inspection. These elements are described in this paper

  6. Welcome to health information science and systems.

    Science.gov (United States)

    Zhang, Yanchun

    2013-01-01

    Health Information Science and Systems is an exciting, new, multidisciplinary journal that aims to use technologies in computer science to assist in disease diagnoses, treatment, prediction and monitoring through the modeling, design, development, visualization, integration and management of health related information. These computer-science technologies include such as information systems, web technologies, data mining, image processing, user interaction and interface, sensors and wireless networking and are applicable to a wide range of health related information including medical data, biomedical data, bioinformatics data, public health data.

  7. Environmental health risk assessment: Energy systems

    International Nuclear Information System (INIS)

    Krewski, D.; Somers, E.; Winthrop, S.O.

    1984-01-01

    Most industrialized nations have come to rely on a variety of systems for energy production, both of a conventional and non-conventional nature. In the paper, the spectrum of energy systems currently in use in Canada is outlined along with their potential health risks. Several examples of environmental health studies involving both outdoor and indoor air pollution related to energy production in Canada are reported. The limitations of current technologies for assessing health risks are discussed and possible approaches to managing energy related health risks are indicated. (author)

  8. Rating the Efficiency of Regional Health Systems and Compulsory Health Insurance

    Directory of Open Access Journals (Sweden)

    Tatyana Nikolayevna Russkikh

    2015-12-01

    Full Text Available In the face of increasing of the regional differentiation of the health systems and compulsory health insurance, the comparative analysis and efficiency assessment of their performance in the context of the subjects of the Russian Federation becomes particularly relevant. Therefore, the research is focused on the regional health systems and compulsory health insurance (CHI, and the subject matter of the study is the analysis of the system performance. In the article, the comparative analysis of the authors’ approaches to the formation of efficiency criteria of the performance of regional health systems and CHI, as well as to the development of a typology of the constituent entities of the Russian Federation based on these criteria is conducted. The authors propose a system of indicators to measure the economic, medical and social efficiency of the systems under consideration. Moreover, a set of indicators of economic efficiency forms two groups of indicators. The first group of indicators reflects the financial performance, and the second — the structural efficiency. A methodological approach to the formation of the rating for subjects of the Russian Federation according to the levels of efficiency, based on the procedures of cluster analysis and fuzzy mathematics are developed. A feature of the proposed approach to the construction of a typology of the subjects in terms of efficiency is the introduction of a reference subject with the national average performance indicators system that allows to qualitatively assess the effectiveness of regional health systems and CHI by comparing them with the «reference subject». The results of the empirical research have indicated a high differentiation of the subjects of the Russian Federation in terms of economic efficiency, have allowed to identify the subjects-outsiders. The theoretical and practical results can be used for the rational choice of priorities of the state policy in the field of the

  9. Health care financing and the sustainability of health systems.

    Science.gov (United States)

    Liaropoulos, Lycourgos; Goranitis, Ilias

    2015-09-15

    The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.

  10. Engineered Barrier System performance requirements systems study report. Revision 02

    Energy Technology Data Exchange (ETDEWEB)

    Balady, M.A.

    1997-01-14

    This study evaluates the current design concept for the Engineered Barrier System (EBS), in concert with the current understanding of the geologic setting to assess whether enhancements to the required performance of the EBS are necessary. The performance assessment calculations are performed by coupling the EBS with the geologic setting based on the models (some of which were updated for this study) and assumptions used for the 1995 Total System Performance Assessment (TSPA). The need for enhancements is determined by comparing the performance assessment results against the EBS related performance requirements. Subsystem quantitative performance requirements related to the EBS include the requirement to allow no more than 1% of the waste packages (WPs) to fail before 1,000 years after permanent closure of the repository, as well as a requirement to control the release rate of radionuclides from the EBS. The EBS performance enhancements considered included additional engineered components as well as evaluating additional performance available from existing design features but for which no performance credit is currently being taken.

  11. Engineered Barrier System performance requirements systems study report. Revision 02

    International Nuclear Information System (INIS)

    Balady, M.A.

    1997-01-01

    This study evaluates the current design concept for the Engineered Barrier System (EBS), in concert with the current understanding of the geologic setting to assess whether enhancements to the required performance of the EBS are necessary. The performance assessment calculations are performed by coupling the EBS with the geologic setting based on the models (some of which were updated for this study) and assumptions used for the 1995 Total System Performance Assessment (TSPA). The need for enhancements is determined by comparing the performance assessment results against the EBS related performance requirements. Subsystem quantitative performance requirements related to the EBS include the requirement to allow no more than 1% of the waste packages (WPs) to fail before 1,000 years after permanent closure of the repository, as well as a requirement to control the release rate of radionuclides from the EBS. The EBS performance enhancements considered included additional engineered components as well as evaluating additional performance available from existing design features but for which no performance credit is currently being taken

  12. Home Rx: The Health Benefits of Home Performance

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, Jonathan [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Jacobs, David [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Reddy, Amanda [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Tohn, Ellen [Tohn Environmental Strategies, Wayland, MA (United States); Cohen, Jonathan [Dept. of Energy (DOE), Washington DC (United States); Jacobsohn, Ely [Dept. of Energy (DOE), Washington DC (United States)

    2016-12-01

    Evidence in a new, groundbreaking U.S. Department of Energy report, Home Rx: The Health Benefits of Home Performance, shows that home performance upgrades can improve the quality of a home’s indoor environment by reducing the prevalence of harmful indoor air pollutants and contaminants. Until recently, no systematic review of this evidence had been conducted, limiting full understanding of the link between home performance and health. This new report summarizes current knowledge and identifies research gaps. The design characteristics and results of each of the 40 studies considered in the report are summarized in a searchable matrix.

  13. Theory of constraints for publicly funded health systems.

    Science.gov (United States)

    Sadat, Somayeh; Carter, Michael W; Golden, Brian

    2013-03-01

    Originally developed in the context of publicly traded for-profit companies, theory of constraints (TOC) improves system performance through leveraging the constraint(s). While the theory seems to be a natural fit for resource-constrained publicly funded health systems, there is a lack of literature addressing the modifications required to adopt TOC and define the goal and performance measures. This paper develops a system dynamics representation of the classical TOC's system-wide goal and performance measures for publicly traded for-profit companies, which forms the basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC's process of ongoing improvement in publicly funded health systems. Future research is required to more accurately define the factors affecting system performance and populate the model with evidence-based estimates for various parameters in order to use the model to guide TOC's process of ongoing improvement.

  14. Reducing maternal mortality in Nigeria: the need for urgent changes in financing for maternal health in the Nigerian health system.

    Science.gov (United States)

    Ebeigbe, P N

    2013-06-01

    Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mot