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Sample records for quality improvement plan

  1. 42 CFR 441.474 - Quality assurance and improvement plan.

    Science.gov (United States)

    2010-10-01

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

  2. 45 CFR 1304.60 - Deficiencies and quality improvement plans.

    Science.gov (United States)

    2010-10-01

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

  3. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Science.gov (United States)

    2010-07-01

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

  4. Quality improvement initiatives: the missed opportunity for health plans.

    Science.gov (United States)

    Fernandez-Lopez, Sara; Lennert, Barbara

    2009-11-01

    The increase in healthcare cost without direct improvements in health outcomes, coupled with a desire to expand access to the large uninsured population, has underscored the importance of quality initiatives and organizations that provide more affordable healthcare by maximizing value. To determine the knowledge of managed care organizations about quality organizations and initiatives and to identify potential opportunities in which pharmaceutical companies could collaborate with health plans in the development and implementation of quality initiatives. We conducted a survey of 36 pharmacy directors and 15 medical directors of different plans during a Managed Care Network meeting in 2008. The represented plans cover almost 74 million lives in commercial, Medicare, and Medicaid programs, or a combination of them. The responses show limited knowledge among pharmacy and medical directors about current quality organizations and initiatives, except for quality organizations that provide health plan quality accreditation. The results also reveal an opportunity for pharmaceutical companies to collaborate with private health plans in the development of quality initiatives, especially those related to drug utilization, such as patient adherence and education and correct drug utilization. Our survey shows clearly that today's focus for managed care organizations is mostly limited to the organizations that provide health plan quality accreditation, with less focus on other organizations.

  5. Market and plan characteristics related to HMO quality and improvement.

    Science.gov (United States)

    Scanlon, Dennis P; Swaminathan, Shailender; Chernew, Michael; Lee, Woolton

    2006-12-01

    Existing research on health plan performance examines whether variation in plans' scores is related to enrollee and health plan traits, primarily using cross-sectional research designs. This study extends that literature by incorporating data on market characteristics using a longitudinal framework. We estimate multivariate growth models that relate plan performance on standard measures to market and HMO characteristics using an unbalanced panel of data for 1998 to 2002. We find that HMO competition is not associated with better performance or greater rates of improvement in performance on the HEDIS chronic care measures. HMO penetration, on the other hand, is positively associated with HEDIS performance in several of the chronic care process-and-outcomes measures but not with a greater rate of improvement through time. Our analysis indicates that a significant percentage of the unexplained variation in quality improvement is because of permanent, unobserved plan-level characteristics that future research should strive to identify.

  6. Project Hanford management contract quality improvement project management plan; TOPICAL

    International Nuclear Information System (INIS)

    ADAMS, D.E.

    1999-01-01

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

  7. The Best Laid Plans: An Examination of School Plan Quality and Implementation in a School Improvement Initiative

    Science.gov (United States)

    Strunk, Katharine O.; Marsh, Julie A.; Bush-Mecenas, Susan C.; Duque, Matthew R.

    2016-01-01

    Purpose: A common strategy used in school improvement efforts is a mandated process of formal planning, yet little is known about the quality of plans or the relationship between plan quality and implementation. This mixed-methods article investigates plan quality, factors associated with plan quality, and the relationship between plan quality and…

  8. Improved Planning Time and Plan Quality Through Multicriteria Optimization for Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Craft, David L.; Hong, Theodore S.; Shih, Helen A.; Bortfeld, Thomas R.

    2012-01-01

    Purpose: To test whether multicriteria optimization (MCO) can reduce treatment planning time and improve plan quality in intensity-modulated radiotherapy (IMRT). Methods and Materials: Ten IMRT patients (5 with glioblastoma and 5 with locally advanced pancreatic cancers) were logged during the standard treatment planning procedure currently in use at Massachusetts General Hospital (MGH). Planning durations and other relevant planning information were recorded. In parallel, the patients were planned using an MCO planning system, and similar planning time data were collected. The patients were treated with the standard plan, but each MCO plan was also approved by the physicians. Plans were then blindly reviewed 3 weeks after planning by the treating physician. Results: In all cases, the treatment planning time was vastly shorter for the MCO planning (average MCO treatment planning time was 12 min; average standard planning time was 135 min). The physician involvement time in the planning process increased from an average of 4.8 min for the standard process to 8.6 min for the MCO process. In all cases, the MCO plan was blindly identified as the superior plan. Conclusions: This provides the first concrete evidence that MCO-based planning is superior in terms of both planning efficiency and dose distribution quality compared with the current trial and error–based IMRT planning approach.

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

    Science.gov (United States)

    Jardim, Kevin P.

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

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

    Science.gov (United States)

    Day, G; Gardner, S; Herba, C

    1995-01-01

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

  11. 42 CFR 460.132 - Quality assessment and performance improvement plan.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assessment and performance improvement plan... assessment and performance improvement plan. (a) Basic rule. A PACE organization must have a written quality assessment and performance improvement plan. (b) Annual review. The PACE governing body must review the plan...

  12. Improving IMRT-plan quality with MLC leaf position refinement post plan optimization

    International Nuclear Information System (INIS)

    Niu Ying; Zhang Guowei; Berman, Barry L.; Parke, William C.; Yi Byongyong; Yu, Cedric X.

    2012-01-01

    Purpose: In intensity-modulated radiation therapy (IMRT) planning, reducing the pencil-beam size may lead to a significant improvement in dose conformity, but also increase the time needed for the dose calculation and plan optimization. The authors develop and evaluate a postoptimization refinement (POpR) method, which makes fine adjustments to the multileaf collimator (MLC) leaf positions after plan optimization, enhancing the spatial precision and improving the plan quality without a significant impact on the computational burden. Methods: The authors’ POpR method is implemented using a commercial treatment planning system based on direct aperture optimization. After an IMRT plan is optimized using pencil beams with regular pencil-beam step size, a greedy search is conducted by looping through all of the involved MLC leaves to see if moving the MLC leaf in or out by half of a pencil-beam step size will improve the objective function value. The half-sized pencil beams, which are used for updating dose distribution in the greedy search, are derived from the existing full-sized pencil beams without need for further pencil-beam dose calculations. A benchmark phantom case and a head-and-neck (HN) case are studied for testing the authors’ POpR method. Results: Using a benchmark phantom and a HN case, the authors have verified that their POpR method can be an efficient technique in the IMRT planning process. Effectiveness of POpR is confirmed by noting significant improvements in objective function values. Dosimetric benefits of POpR are comparable to those of using a finer pencil-beam size from the optimization start, but with far less computation and time. Conclusions: The POpR is a feasible and practical method to significantly improve IMRT-plan quality without compromising the planning efficiency.

  13. Compression planning for continuous improvement in quality programs

    International Nuclear Information System (INIS)

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

    1992-01-01

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

  14. SU-D-BRD-03: Improving Plan Quality with Automation of Treatment Plan Checks

    International Nuclear Information System (INIS)

    Covington, E; Younge, K; Chen, X; Lee, C; Matuszak, M; Kessler, M; Acosta, E; Orow, A; Filpansick, S; Moran, J; Keranen, W

    2015-01-01

    Purpose: To evaluate the effectiveness of an automated plan check tool to improve first-time plan quality as well as standardize and document performance of physics plan checks. Methods: The Plan Checker Tool (PCT) uses the Eclipse Scripting API to check and compare data from the treatment planning system (TPS) and treatment management system (TMS). PCT was created to improve first-time plan quality, reduce patient delays, increase efficiency of our electronic workflow, and to standardize and partially automate plan checks in the TPS. A framework was developed which can be configured with different reference values and types of checks. One example is the prescribed dose check where PCT flags the user when the planned dose and the prescribed dose disagree. PCT includes a comprehensive checklist of automated and manual checks that are documented when performed by the user. A PDF report is created and automatically uploaded into the TMS. Prior to and during PCT development, errors caught during plan checks and also patient delays were tracked in order to prioritize which checks should be automated. The most common and significant errors were determined. Results: Nineteen of 33 checklist items were automated with data extracted with the PCT. These include checks for prescription, reference point and machine scheduling errors which are three of the top six causes of patient delays related to physics and dosimetry. Since the clinical roll-out, no delays have been due to errors that are automatically flagged by the PCT. Development continues to automate the remaining checks. Conclusion: With PCT, 57% of the physics plan checklist has been partially or fully automated. Treatment delays have declined since release of the PCT for clinical use. By tracking delays and errors, we have been able to measure the effectiveness of automating checks and are using this information to prioritize future development. This project was supported in part by P01CA059827

  15. SU-D-BRD-03: Improving Plan Quality with Automation of Treatment Plan Checks

    Energy Technology Data Exchange (ETDEWEB)

    Covington, E; Younge, K; Chen, X; Lee, C; Matuszak, M; Kessler, M; Acosta, E; Orow, A; Filpansick, S; Moran, J [University of Michigan Hospital and Health System, Ann Arbor, MI (United States); Keranen, W [Varian Medical Systems, Palo Alto, CA (United States)

    2015-06-15

    Purpose: To evaluate the effectiveness of an automated plan check tool to improve first-time plan quality as well as standardize and document performance of physics plan checks. Methods: The Plan Checker Tool (PCT) uses the Eclipse Scripting API to check and compare data from the treatment planning system (TPS) and treatment management system (TMS). PCT was created to improve first-time plan quality, reduce patient delays, increase efficiency of our electronic workflow, and to standardize and partially automate plan checks in the TPS. A framework was developed which can be configured with different reference values and types of checks. One example is the prescribed dose check where PCT flags the user when the planned dose and the prescribed dose disagree. PCT includes a comprehensive checklist of automated and manual checks that are documented when performed by the user. A PDF report is created and automatically uploaded into the TMS. Prior to and during PCT development, errors caught during plan checks and also patient delays were tracked in order to prioritize which checks should be automated. The most common and significant errors were determined. Results: Nineteen of 33 checklist items were automated with data extracted with the PCT. These include checks for prescription, reference point and machine scheduling errors which are three of the top six causes of patient delays related to physics and dosimetry. Since the clinical roll-out, no delays have been due to errors that are automatically flagged by the PCT. Development continues to automate the remaining checks. Conclusion: With PCT, 57% of the physics plan checklist has been partially or fully automated. Treatment delays have declined since release of the PCT for clinical use. By tracking delays and errors, we have been able to measure the effectiveness of automating checks and are using this information to prioritize future development. This project was supported in part by P01CA059827.

  16. Improving the quality of manually acquired data: Applying the theory of planned behaviour to data quality

    International Nuclear Information System (INIS)

    Murphy, Glen D.

    2009-01-01

    The continued reliance of manual data capture in engineering asset intensive organisations highlights the critical role played by those responsible for recording raw data. The potential for data quality variance across individual operators also exposes the need to better manage this particular group. This paper evaluates the relative importance of the human factors associated with data quality. Using the theory of planned behaviour this paper considers the impact of attitudes, perceptions and behavioural intentions on the data collection process in an engineering asset context. Two additional variables are included, those of time pressure and operator feedback. Time pressure is argued to act as a moderator between intention and data collection behaviour, while perceived behavioural control will moderate the relationship between feedback and data collection behaviour. Overall the paper argues that the presence of best practice procedures or threats of disciplinary sanction are insufficient controls to determine data quality. Instead those concerned with improving the data collection performance of operators should consider the operator's perceptions of group attitude towards data quality, the level of feedback provided to data collectors and the impact of time pressures on procedure compliance. A range of practical recommendations are provided to those wishing to improve the quality of their manually acquired data.

  17. Summary of strategies for planning Productivity Improvement and Quality Enhancement (PIQE)

    Science.gov (United States)

    1986-01-01

    The Summary of NASA Strategies for Productivity Improvement and Quality Enhancement respond to NASA's eighth top goal: Establish NASA as a leader in the development and application of advanced technology and management practices which contribute to significant increases in both Agency and national productivity. The Strategies provide the framework for development of the agency-wide Productivity Improvement and Quality Enhancement (PIQE) Plans.

  18. [A plan for the improvement in the quality of life of people suffering from chronic diseases].

    Science.gov (United States)

    Portal, Stéphanie

    2011-10-01

    In 2007, the French Ministry of Health launched a plan devoted to the improvement of the quality of life of patients suffering from chronic diseases. Over the last four years this plan has resulted in a number of concrete actions: events and seminars have been organised, patients' education has obtained legislative recognition and several partnerships have been created. Time for a progress report.

  19. A summary of deliberations on strategic planning for continuous quality improvement in laboratory medicine.

    Science.gov (United States)

    Grzybicki, Dana Marie; Shahangian, Shahram; Pollock, Anne M; Raab, Stephen S

    2009-03-01

    On September 24-26, 2007, the Centers for Disease Control and Prevention convened the 2007 Institute on Critical Issues in Health Laboratory Practice: Managing for Better Health to develop an action plan for change for the immediate and long-term future. A wide variety of stakeholders, including pathologists, pathologist extenders, clinicians, and researchers, examined means to improve laboratory service communication, quality parameters, and potential future laboratory contributions to health care. In this summary document, we present the identified gaps, barriers, and proposed action plans for improvement for laboratory medicine in the 6 quality domains identified by the Institute of Medicine: safety, effectiveness, patient centeredness, timeliness, efficiency, and equity. Five major recommendations emerged from concluding discussions and included focusing on preanalytic and postanalytic processes as areas of potential quality improvement and recruiting a multidisciplinary group of nonlaboratory stakeholders to work with laboratory personnel to achieve improvement goals.

  20. Reducing DNACPR complaints to zero: designing and implementing a treatment escalation plan using quality improvement methodology.

    Science.gov (United States)

    Shermon, Elizabeth; Munglani, Laura; Oram, Sarah; William, Linda; Abel, Julian

    2017-01-01

    Do Not Attempt Resuscitation (DNAR)decisions have traditionally formed the basis of ceiling of care discussions. However, poor quality discussions can lead to high patient and relative dissatisfaction, generating hospital complaints. Treatment escalation plans (TEPs) aim to highlight the wider remit of treatment options with a focus on effective communication. We aimed to improve TEP discussions and documentation at Weston General Hospital by introducing a standardised form. We aimed to develop a TEP document to reduce resuscitation-related complaints by improving communication and documentation. Qualitative and quantitative data were collected over 2 years and used to develop plan-do-study-act (PDSA) cycles using quality improvement methodology. Main barriers to improvement included time constraints and clinician's resistance. Analysis of patient liaison services data showed a progressive reduction in complaints regarding resuscitation, with no complaints having been received for the final six months of the project. Through use of a standardised form including treatment prompts, the quality of discussions and plans improved. Qualitative feedback demonstrated increased patient and relative satisfaction. In addition, junior doctors report the plans are helpful when making out-of-hours decisions. Development of a user-friendly form to document patient-guided TEPs helped junior doctors to lead advanced care planning discussions. The use of PDSA cycles demonstrated improvement in the quality of forms, which in turn improved communication, documentation and satisfaction. Future developments could include involvement of specialist teams to ensure TEP forms remain relevant to all clinical areas. In addition, with widespread use of the TEP forms, the traditional tick-box DNAR could be replaced to focus on patient-led care planning.

  1. Developing Quality Strategic Plan in Secondary Schools for Successful School Improvement

    Science.gov (United States)

    Chukwumah, Fides Okwukweka

    2015-01-01

    The study examined the extent to which development of quality strategic plans for Anambra State secondary schools' improvement had been done by schools. The research design used was a descriptive survey. Respondents comprised 217 principals. There was no sampling since all the principals were used. Data were collected using "Schools'…

  2. Improving CT quality with optimized image parameters for radiation treatment planning and delivery guidance

    Directory of Open Access Journals (Sweden)

    Guang-Pei Chen

    2017-10-01

    Conclusion: CT image quality can be improved with the IQE protocols created in this study, to provide better soft tissue contrast, which would be beneficial for use in radiation therapy, e.g., for planning data acquisition or for IGRT for hypo-fractionated treatments.

  3. Ways of improving the quality of planning radiotherapy with modulated intensity

    International Nuclear Information System (INIS)

    Khvorostenko, M.I.; Kikhtenko, I.N.; Khvorostenko, Yu.M.; Volokitin, S.V.; Sklyar, N.V.

    2017-01-01

    3D planning standards do not exclude the presence of sections of the tumor with absorbed dose less than planned, which is considered as a prerequisite for relapse. To improve radiation therapy outcomes in cancer patients through the enhancing (intensity-modulated radiation therapy (IMRT) radiation planning quality, identifying areas of the tumor with minimal optical density exposed to lower absorbed dose in comparison with the planned one and assessment of the ways to eliminate it. Due to identified locations with a minimum optical density and the absorbed dose lower than the planned one, the ''resale'' was carried out. It was aimed to achieve the values recorded in the plan. The percentage of coverage isodose GTV and PTV was increased; on the area, where the total focal dose was lower than the planned, the dose absorbed was increased in comparison with the recorded one. Assessment of the tumor areas with minimal optical density makes it possible to detect areas with likely lower value of the total focal dose in comparison with the target on; correction of the total focal dose in these areas will improve the quality of radiation therapy.

  4. Plan of action for quality improvement of ventilation systems; Actieplan Kwaliteitsverbetering Ventilatievoorzieningen

    Energy Technology Data Exchange (ETDEWEB)

    Atsma, J. [Ministerie van Infrastructuur en Milieu IenM, Den Haag (Netherlands); Calon, M. [Aedes vereniging van woningcorporaties, Den Haag (Netherlands); Schoorl, F.J. [Bond Nederlandse Architecten BNA, Amsterdam (Netherlands); Van Tuinen, J.L. [Bouwend Nederland, Zoetermeer (Netherlands); Bodewes, W.J. [Vereniging van Nederlandse projectontwikkeling Maatschappijen Neprom, Voorburg (Netherlands); Goossens, J.H. [Vereniging voor ontwikkelaars en bouwondernemers NVB, Voorburg (Netherlands); Polman, E.J.M. [Stichting Waarborgfonds Koopwoningen SWK, Rotterdam (Netherlands); Engels, M. [Uneto-VNI, Zoetermeer (Netherlands); Werner-van Beek, H. J. [VACpunt Wonen, Utrecht (Netherlands); Mulder, R.J. [Vereniging Eigen Huis VEH, Amersfoort (Netherlands); Rook, G. [Vereniging Leveranciers van Luchttechnische Apparaten VLA, Zoetermeer (Netherlands); Van Noord, P. [Woningborg, Gouda (Netherlands); Paping, R.H.M. [De Nederlandse Woonbond, Amsterdam (Netherlands)

    2012-06-15

    The action plan comprises the agreements made by the Ministry of Infrastructure and Environment and the Ministry of Internal Affairs in the Netherlands with representatives of building organizations to improve the quality of ventilation systems in newly built houses [Dutch] Het actieplan bevat de afspraken die het ministerie van Infrastructuur en Milieu en het ministerie van Binnenlandse Zaken met de bouwpartijen hebben gemaakt om de kwaliteit van de ventilatievoorzieningen van nieuwbouwwoningen te verbeteren.

  5. State landscape in public health planning and quality improvement: results of the ASTHO survey.

    Science.gov (United States)

    Madamala, Kusuma; Sellers, Katie; Pearsol, Jim; Dickey, Michael; Jarris, Paul E

    2010-01-01

    Limited data exist on state public health agencies and their use of planning and quality improvement (QI) initiatives. Using the 2007 Association of State and Territorial Health Officials (ASTHO) State Public Health Survey, this article describes how state public health agencies perform tasks related to planning, performance management (PM), and QI. While 82 percent of respondents report having a QI process in place, only 9.8 percent have it fully implemented departmentwide. Seventy-six percent reported having a PM process in place, with 16 percent (n = 8) having it fully implemented departmentwide. A state health improvement plan was used by 80.4 percent of respondents, with 56.9 percent of respondents completing the plan more than 3 years ago. More than two-thirds (68.2%) of the respondents developed the plan by using results of their state health assessment. Analysis of state health department level planning, PM, and QI initiatives can inform states' efforts to ready themselves to meet the proposed national voluntary accreditation standards of the Public Health Accreditation Board.

  6. Improved plan quality with automated radiotherapy planning for whole brain with hippocampus sparing: a comparison to the RTOG 0933 trial.

    Science.gov (United States)

    Krayenbuehl, J; Di Martino, M; Guckenberger, M; Andratschke, N

    2017-10-02

    Whole-brain radiation therapy (WBRT) with hippocampus sparing (HS) has been investigated by the radiation oncology working group (RTOG) 0933 trial for patients with multiple brain metastases. They showed a decrease of adverse neurocognitive effects with HS WBRT compared to WBRT alone. With the development of automated treatment planning system (aTPS) in the last years, a standardization of the plan quality at a high level was achieved. The goal of this study was to evaluate the feasibility of using an aTPS for the treatment of HS WBRT and see if the RTOG 0933 dose constraints could be achieved and improved. Ten consecutive patients treated with HS WBRT were enrolled in this study. 10 × 3 Gy was prescribed according to the RTOG 0933 protocol to 92% of the target volume (whole-brain excluding the hippocampus expanded by 5 mm in 3-dimensions). In contrast to RTOG 0933, the maximum allowed point dose to normal brain was significantly lowered and restricted to 36.5 Gy. All patients were planned with volumetric modulated arc therapy (VMAT) technique using four arcs. Plans were optimized using Auto-Planning (AP) (Philips Radiation Oncology Systems) with one single AP template and optimization. All the constraints from the RTOG 0933 trial were achieved. A significant improvement for the maximal dose to 2% of the brain with a reduction of 4 Gy was achieved (33.5 Gy vs. RTOG 37.5 Gy) and the minimum hippocampus dose was reduced by 10% (8.1 Gy vs. RTOG 9 Gy). A steep dose gradient around the hippocampus was achieved with a mean dose of 27.3 Gy at a distance between 0.5 cm and 1 cm from the hippocampus. The effective working time to optimize a plan was kept below 6'. Automated treatment planning for HS WBRT was able to fulfil all the recommendations from the RTOG 0933 study while significantly improving dose homogeneity and decreasing unnecessary hot spot in the normal brain. With this approach, a standardization of plan quality was achieved and the effective

  7. Accelerate Water Quality Improvement

    Science.gov (United States)

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

  8. Integrating family planning into postpartum care through modern quality improvement: experience from Afghanistan.

    Science.gov (United States)

    Tawfik, Youssef; Rahimzai, Mirwais; Ahmadzai, Malalah; Clark, Phyllis Annie; Kamgang, Evelyn

    2014-05-01

    To address low contraceptive use in Afghanistan, we supported 2 large public maternity hospitals and 3 private hospitals in Kabul to use modern quality improvement (QI) methods to integrate family planning into postpartum care. In 2012, QI teams comprising hospital staff applied root cause analysis to identify barriers to integrated postpartum family planning (PPFP) services and to develop solutions for how to integrate services. Changes made to service provision to address identified barriers included creating a private counseling space near the postpartum ward, providing PPFP counseling training and job aids to staff, and involving husbands and mothers-in-law in counseling in person or via mobile phones. After 10 months, the proportion of postpartum women who received family planning counseling before discharge in the 5 hospitals increased from 36% to 55%, and the proportion of women who received family planning counseling with their husbands rose from 18% to 90%. In addition, the proportion of postpartum women who agreed to use family planning and left the hospital with their preferred method increased from 12% to 95%. Follow-up telephone surveys with a random sample of women who had received PPFP services in the 2 public hospitals and a control group of postpartum women who had received routine hospital services found significant differences in the proportion of women with self-reported pregnancies: 3% vs. 15%, respectively, 6 months after discharge; 6% vs. 22% at 12 months; and 14% vs. 35% at 18 months (P family planning and postpartum services by testing changes they deemed feasible.

  9. Improving Access to Quality Care in Family Planning: WHO's Four Cornerstones of Evidence-based Guidance

    Institute of Scientific and Technical Information of China (English)

    Shang-chun WU; Yan ZOU; K Church; O Meirik

    2007-01-01

    The four cornerstones of guidance in technique service of family planning are established by WHO based on high quality evidences. They have been updated according to the appearing new evidences, and the consensuses were reached by the international experts in this field. The four documents include Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use, Decision-making Tool for Family Planning Clients and Providers and The Global Handbook for Family Planning Providers. The first two documents mainlyface to the policy-makers and programme managers and were treated as the important references for creating the local guideline. The other two documents were developed for the front-line health-care and family planning providers at different levels, which include plenty of essential technical information to help providers improve their ability in service delivery and counselling. China paid great attention to the introduction and application of WHO guidelines. As soon as the newer editions of these documents were available, the Chinese version would be followed. WHO guidelines have been primarily adapted with the newly issued national guideline, The Clinical Practical Skill Guidelines- Family Planning Part, which was established by China Medical Association. At the same time, the WHO guidelines have been introduced to some of the linicians and family planning providers at different levels. In the future, more special training courses will be introduced to the township level based on the needs of grassroot providers.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-08-01

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

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

    International Nuclear Information System (INIS)

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

    2012-01-01

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

  12. How to plan workflow changes: a practical quality improvement tool used in an outpatient hospital pharmacy.

    Science.gov (United States)

    Aguilar, Christine; Chau, Connie; Giridharan, Neha; Huh, Youchin; Cooley, Janet; Warholak, Terri L

    2013-06-01

    A quality improvement tool is provided to improve pharmacy workflow with the goal of minimizing errors caused by workflow issues. This study involved workflow evaluation and reorganization, and staff opinions of these proposed changes. The study pharmacy was an outpatient pharmacy in the Tucson area. However, the quality improvement tool may be applied in all pharmacy settings, including but not limited to community, hospital, and independent pharmacies. This tool can help the user to identify potential workflow problem spots, such as high-traffic areas through the creation of current and proposed workflow diagrams. Creating a visual representation can help the user to identify problem spots and to propose changes to optimize workflow. It may also be helpful to assess employees' opinions of these changes. The workflow improvement tool can be used to assess where improvements are needed in a pharmacy's floor plan and workflow. Suggestions for improvements in the study pharmacy included increasing the number of verification points and decreasing high traffic areas in the workflow. The employees of the study pharmacy felt that the proposed changes displayed greater continuity, sufficiency, accessibility, and space within the pharmacy.

  13. STRATEGIC MARKETING PLANNING IN SPORTS – A PERSPECTIVE OF QUALITY OF LIFE IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Caescu Stefan Claudiu

    2012-12-01

    Full Text Available Strategic marketing planning requires that the marketing objectives strategies for a specific product-market configuration be in full correlation with the directions and the resources allocated at the corporate level or at the strategic business unit one. Such a correlation is more than necessary under the current market conditions, when the economic crisis affects both consumer behavior and corporate decisions. This article focuses on the particularities of strategic marketing planning in sport, given the fact that the vast majority of sports organizations in Romania, although very active on the reference market, do not have a marketing activity correlated with the medium and long term market needs. One of these needs refers to quality of life improvement, knowing that sport activities have positive influence on many dimensions of quality of life, such as health, education, social inclusion, relaxation and leisure. The improvement within the population participation in sport (both as an active participant and as a spectator, the increased duration of leisure and the development of private financing have led to the creation of a large market, where marketing plays a central role. Therefore the marketing management process must also be implemented within the sports organization, in order to make it easier in building and maintaining a relationship with the customer, especially if the organization wants a customer orientation strategy. Such an orientation includes identifying the current needs as well as the future ones in terms of target audience, to offer a series of sports products and services that bring their significant contribution to improving the quality of life. In this paper are highlighted the influences that consumer requirements concerning quality of life have on all components of marketing management process, starting with sports organization mission statement, up to establish strategies for the marketing mix (product, price

  14. Achieving Outcomes With Innovative Smart Pump Technology: Partnership, Planning, and Quality Improvement.

    Science.gov (United States)

    Lehr, Jennifer; Vitoux, Rachel R; Zavotsky, Kathleen Evanovich; Pontieri-Lewis, Vicky; Colineri, Lori

    2018-04-09

    A 5-time designated Magnet academic medical center partnered with its infusion systems supplier to successfully integrate 1327 smart pumps across 45 departments with an aggressive 3-month timeline. The team also achieved quality improvement (QI) outcomes through increased drug library compliance and decreased alerts with their new technology. This large academic medical center needed to implement innovative wireless infusion pump technology in a short time frame. The approach involved a strong partnership from the medical center and the supplier, with extensive planning and collaboration among the clinical nurse specialists and consultants from both organizations to accomplish QI goals. Lean principles were also followed to enhance efficiency and accountability. Quality improvement outcomes included 100% drug library compliance across all 6 intensive care units, a decrease in pump alert rates from 4.18% to 0.79%, and a decrease in pump programming correction rate from 0.36% to 0.06%. A partnership led to a large implementation being completed efficiently across an academic medical center. Through these joint efforts, quality of care was improved within a short period of time.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  15. A Plan-Do-Study-Act Approach to Improving Bowel Preparation Quality.

    Science.gov (United States)

    Calderwood, Audrey H; Mahoney, Elaine M; Jacobson, Brian C

    Up to 20% of patients presenting for colonoscopy have inadequate bowel cleanliness. In this study, the Plan-Do-Study-Act quality improvement process was used to improve bowel cleanliness among outpatients undergoing screening colonoscopy at Boston Medical Center. Rates of inadequate bowel cleanliness were assessed at baseline (April 2010 to September 2012), during several rapid-cycle experiments (October 2012 to September 2013), and through an observation phase (October 2013 to September 2015). The baseline rate of inadequate cleanliness was 9% with a target of 5%. Gap analysis identified 3 areas amenable to specific interventions: contacting patients, commitment to the procedure, and complexity and variation in instructions. Rates of inadequate cleanliness decreased to 4% at the end of the last intervention, but began rising for new reasons. Standardizing instructions and the use of navigators improved preparation quality. Bowel cleanliness is the end result of a multistep process with areas for improvement at many levels. Long-term monitoring is required to ensure ongoing success.

  16. Using SQUIRE 2.0 as a Guide for Planning Your Quality Improvement Project.

    Science.gov (United States)

    Stausmire, Julie M; Ulrich, Charla

    2017-12-01

    This article is the third of a 4-part quality improvement resource series for critical care nurses interested in implementing system process or performance improvement projects. Part 1 defined the differences between research and quality improvement. Part 2 discussed how nurses and managers could identify meaningful quality improvement projects that will make a real difference in their critical care unit while fitting within their time constraints and resources. Part 3 uses the recently revised Standards for Quality Improvement Reporting Excellence guidelines as a basis for designing, implementing, documenting, and publishing quality improvement projects. © 2017 American Association of Critical-Care Nurses.

  17. Continual improvement plan

    Science.gov (United States)

    1994-01-01

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

  18. SU-D-BRB-02: Combining a Commercial Autoplanning Engine with Database Dose Predictions to Further Improve Plan Quality

    Energy Technology Data Exchange (ETDEWEB)

    Robertson, SP; Moore, JA; Hui, X; Cheng, Z; McNutt, TR [Johns Hopkins University, Baltimore, MD (United States); DeWeese, TL; Tran, P; Quon, H [John Hopkins Hospital, Baltimore, MD (United States); Bzdusek, K [Philips, Fitchburg, WI (United States); Kumar, P [Philips India Limited, Bangalore, Karnataka (India)

    2016-06-15

    Purpose: Database dose predictions and a commercial autoplanning engine both improve treatment plan quality in different but complimentary ways. The combination of these planning techniques is hypothesized to further improve plan quality. Methods: Four treatment plans were generated for each of 10 head and neck (HN) and 10 prostate cancer patients, including Plan-A: traditional IMRT optimization using clinically relevant default objectives; Plan-B: traditional IMRT optimization using database dose predictions; Plan-C: autoplanning using default objectives; and Plan-D: autoplanning using database dose predictions. One optimization was used for each planning method. Dose distributions were normalized to 95% of the planning target volume (prostate: 8000 cGy; HN: 7000 cGy). Objectives used in plan optimization and analysis were the larynx (25%, 50%, 90%), left and right parotid glands (50%, 85%), spinal cord (0%, 50%), rectum and bladder (0%, 20%, 50%, 80%), and left and right femoral heads (0%, 70%). Results: All objectives except larynx 25% and 50% resulted in statistically significant differences between plans (Friedman’s χ{sup 2} ≥ 11.2; p ≤ 0.011). Maximum dose to the rectum (Plans A-D: 8328, 8395, 8489, 8537 cGy) and bladder (Plans A-D: 8403, 8448, 8527, 8569 cGy) were significantly increased. All other significant differences reflected a decrease in dose. Plans B-D were significantly different from Plan-A for 3, 17, and 19 objectives, respectively. Plans C-D were also significantly different from Plan-B for 8 and 13 objectives, respectively. In one case (cord 50%), Plan-D provided significantly lower dose than plan C (p = 0.003). Conclusion: Combining database dose predictions with a commercial autoplanning engine resulted in significant plan quality differences for the greatest number of objectives. This translated to plan quality improvements in most cases, although special care may be needed for maximum dose constraints. Further evaluation is warranted

  19. School Improvement Plans and Student Achievement: Preliminary Evidence from the Quality and Merit Project in Italy

    Science.gov (United States)

    Caputo, Andrea; Rastelli, Valentina

    2014-01-01

    This study provides preliminary evidence from an Italian in-service training program addressed to lower secondary school teachers which supports school improvement plans (SIPs). It aims at exploring the association between characteristics/contents of SIPs and student improvement in math achievement. Pre-post standardized tests and text analysis of…

  20. Improvement of VMAT plan quality for head and neck cancer with high resolution fluences generated by couch shift between arcs.

    Science.gov (United States)

    Park, Jong Min; Park, So-Yeon; Wu, Hong-Gyun; Kim, Jung-In

    2018-02-01

    To investigate the changes in quality of the volumetric modulated arc therapy (VMAT) plans with couch-shift between arcs by half of a multi-leaf collimator (MLC) leaf width. A total of 22 patients with head-and-neck cancer were retrospectively selected. Since the smallest MLC leaf width was 5 mm in this study, the couch was shifted by 2.5 mm in the longitudinal-direction between arcs to increase the resolution of fluence map. A total of three types of VMAT plans were generated for each patient; the three types of plans were a two-full-arc plan without couch-shift (NS plan), a two-half-arc-pair plan with couch-shift (HAS plan), and a two-full-arc pair plan with couch-shift (FAS plan). Changes in the dose-volumetric parameters were investigated. The FAS plan showed the best plan quality for the target volumes and organs at risk compared to the NS and HAS plans. However, the magnitudes of differences among the three types of plans were minimal, and every plan was clinically acceptable. The average integral doses of the NS, HAS, and FAS plans were 160,549 ± 37,600 Gy-cc, 147,828 ± 33,343 Gy-cc, and 156,030 ± 36,263 Gy-cc, respectively. The average monitor unit of the NS, HAS, and FAS plans were 717 ± 120 MU, 648 ± 100 MU, and 763 ± 158 MU, respectively. The HAS plan was better than the others in terms of normal tissue sparing and plan efficiency. By shifting the couch by half of the MLC leaf width in the longitudinal direction between arcs, the VMAT plan quality could be improved. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  1. A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia).

    Science.gov (United States)

    Vallès-Fernandez, Roser; Rosell-Murphy, Magdalena; Correcher-Aventin, Olga; Mengual-Martínez, Lucas; Aznar-Martínez, Núria; Prieto-De Lamo, Gemma; Franzi-Sisó, Alícia; Puig-Manresa, Jordi; Ma Bonet-Simó, Josep

    2009-03-25

    Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. multicentric study quasi-experimental before - after with control group. The non-randomised allocation of the intervention will be done at PHCT level. 18 PHCT in the Barcelona province (Spain). all patients with a diagnosis of hypertension (population based study). patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables. Significance level (alpha) will be set at improvement plan might benefit the coordination of different professionals of

  2. Is it possible for knowledge-based planning to improve intensity modulated radiation therapy plan quality for planners with different planning experiences in left-sided breast cancer patients?

    Science.gov (United States)

    Wang, Juanqi; Hu, Weigang; Yang, Zhaozhi; Chen, Xiaohui; Wu, Zhiqiang; Yu, Xiaoli; Guo, Xiaomao; Lu, Saiquan; Li, Kaixuan; Yu, Gongyi

    2017-05-22

    Knowledge-based planning (KBP) is a promising technique that can improve plan quality and increase planning efficiency. However, no attempts have been made to extend the domain of KBP for planners with different planning experiences so far. The purpose of this study was to quantify the potential gains for planners with different planning experiences after implementing KBP in intensity modulated radiation therapy (IMRT) plans for left-sided breast cancer patients. The model libraries were populated with 80 expert clinical plans from treated patients who previously received left-sided breast-conserving surgery and IMRT with simultaneously integrated boost. The libraries were created on the RapidPlan TM . 6 planners with different planning experiences (2 beginner planners, 2 junior planners and 2 senior planners) generated manual and KBP optimized plans for additional 10 patients, similar to those included in the model libraries. The plan qualities were compared between manual and KBP plans. All plans were capable of achieving the prescription requirement. There were almost no statistically significant differences in terms of the planning target volume (PTV) coverage and dose conformality. It was demonstrated that the doses for most of organs-at-risk (OARs) were on average lower or equal in KBP plans compared to manual plans except for the senior planners, where the very small differences were not statistically significant. KBP data showed a systematic trend to have superior dose sparing at most parameters for the heart and ipsilateral lung. The observed decrease in the doses to these OARs could be achieved, particularly for the beginner and junior planners. Many differences were statistically significant. It is feasible to generate acceptable IMRT plans after implementing KBP for left-sided breast cancer. KBP helps to effectively improve the quality of IMRT plans against the benchmark of manual plans for less experienced planners without any manual intervention. KBP

  3. Planning for design quality

    International Nuclear Information System (INIS)

    Marguglio, B.W.

    1977-01-01

    In the nuclear industry and in other high technology industries in which the Government serves as either a customer or a regulator, it is almost always required that the contractor prepare a Quality Program Plan sometimes also referred to as a Quality Program Index. Often, the Quality Program Plan is included as part of the contractor's proposal in response to the Government's or a prime contractor's Request for Proposal. At this stage, the Quality Program Plan serves to demonstrate to the prospective customer the availability of the various quality systems. It provides the customer with a commitment as to the use of these quality systems, thus giving greater assurance that the customer's overall quality and design requirements can be met. The Quality Program Plan is contributing to the salability of the proposal. 1 ref

  4. Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement.

    Science.gov (United States)

    Mpunga, Dieudonné; Lumbayi, J P; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

    2017-06-27

    contraceptive pills, and progestin-only injectable contraceptives. Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives. © Mpunga et al.

  5. Quality planning in Construction Project

    Science.gov (United States)

    Othman, I.; Shafiq, Nasir; Nuruddin, M. F.

    2017-12-01

    The purpose of this paper is to investigate deeper on the factors that contribute to the effectiveness of quality planning, identifying the common problems encountered in quality planning, practices and ways for improvements in quality planning for construction projects. This paper involves data collected from construction company representatives across Malaysia that are obtained through semi-structured interviews as well as questionnaire distributions. Results shows that design of experiments (average index: 4.61), inspection (average index: 4.45) and quality audit as well as other methods (average index: 4.26) rank first, second and third most important factors respectively.

  6. Quality initiatives: planning, setting up, and carrying out radiology process improvement projects.

    Science.gov (United States)

    Tamm, Eric P; Szklaruk, Janio; Puthooran, Leejo; Stone, Danna; Stevens, Brian L; Modaro, Cathy

    2012-01-01

    In the coming decades, those who provide radiologic imaging services will be increasingly challenged by the economic, demographic, and political forces affecting healthcare to improve their efficiency, enhance the value of their services, and achieve greater customer satisfaction. It is essential that radiologists master and consistently apply basic process improvement skills that have allowed professionals in many other fields to thrive in a competitive environment. The authors provide a step-by-step overview of process improvement from the perspective of a radiologic imaging practice by describing their experience in conducting a process improvement project: to increase the daily volume of body magnetic resonance imaging examinations performed at their institution. The first step in any process improvement project is to identify and prioritize opportunities for improvement in the work process. Next, an effective project team must be formed that includes representatives of all participants in the process. An achievable aim must be formulated, appropriate measures selected, and baseline data collected to determine the effects of subsequent efforts to achieve the aim. Each aspect of the process in question is then analyzed by using appropriate tools (eg, flowcharts, fishbone diagrams, Pareto diagrams) to identify opportunities for beneficial change. Plans for change are then established and implemented with regular measurements and review followed by necessary adjustments in course. These so-called PDSA (planning, doing, studying, and acting) cycles are repeated until the aim is achieved or modified and the project closed.

  7. Using IT to improve quality at NewYork-Presybterian Hospital: a requirements-driven strategic planning process.

    Science.gov (United States)

    Kuperman, Gilad J; Boyer, Aurelia; Cole, Curt; Forman, Bruce; Stetson, Peter D; Cooper, Mary

    2006-01-01

    At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goals that would enable demonstrably high quality care: 1) excellence at data warehousing, and 2) optimal use of automated clinical documentation to capture encounter-related quality and safety data. For each high priority goal, a working group was created to develop specific recommendations. The Data Warehousing subgroup has recommended the implementation of an architecture management process and an improved ability for users to get access to aggregate data. The Structured Documentation subgroup is establishing recommendations for a documentation template creation process. The strategic planning process at times is slow, but assures that the organization is focusing on the information technology activities most likely to lead to improved quality.

  8. A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia

    Directory of Open Access Journals (Sweden)

    Vallès-Fernandez Roser

    2009-03-01

    Full Text Available Abstract Background Different studies have shown insufficient blood pressure (BP control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. Methods and design Design: multicentric study quasi-experimental before – after with control group. The non-randomised allocation of the intervention will be done at PHCT level. Setting: 18 PHCT in the Barcelona province (Spain. Sample: all patients with a diagnosis of hypertension (population based study. Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. Intervention: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. Measurements: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure. The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Analysis: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non

  9. Instituting organizational learning for quality improvement through strategic planning nominal group processes.

    Science.gov (United States)

    White, D B

    2000-01-01

    Healthcare managers are faced with unprecedented challenges as characterized by managed care constraints, downsizing, increased client needs, and a society demanding more responsive services. Managers must initiate change for quality, efficiency, and survival. This article provides information and strategies for (a) assessing the change readiness of an organization, (b) conducting an organizational diagnosis, (c) instituting a team culture, (d) developing a change strategy, (e) integrating the strategy with a quality improvement process, and (f) identifying the leadership skills to implement organization renewal. Nominal group processes, namely, SWOT and the Search Conference, are described, and case examples are provided. The implementation strategies have been used successfully in a variety of milieus; practical advice for success is described in detail.

  10. Dwell time modulation restrictions do not necessarily improve treatment plan quality for prostate HDR brachytherapy

    International Nuclear Information System (INIS)

    Balvert, Marleen; Gorissen, Bram L; Den Hertog, Dick; Hoffmann, Aswin L

    2015-01-01

    Inverse planning algorithms for dwell time optimisation in interstitial high-dose-rate (HDR) brachytherapy may produce solutions with large dwell time variations within catheters, which may result in undesirable selective high-dose subvolumes. Extending the dwell time optimisation model with a dwell time modulation restriction (DTMR) that limits dwell time differences between neighboring dwell positions has been suggested to eliminate this problem. DTMRs may additionally reduce the sensitivity for uncertainties in dwell positions that inevitably result from catheter reconstruction errors and afterloader source positioning inaccuracies. This study quantifies the reduction of high-dose subvolumes and the robustness against these uncertainties by applying a DTMR to template-based prostate HDR brachytherapy implants. Three different DTMRs were consecutively applied to a linear dose-based penalty model (LD) and a dose-volume based model (LDV), both obtained from literature. The models were solved with DTMR levels ranging from no restriction to uniform dwell times within catheters in discrete steps. Uncertainties were simulated on clinical cases using in-house developed software, and dose-volume metrics were calculated in each simulation. For the assessment of high-dose subvolumes, the dose homogeneity index (DHI) and the contiguous dose volume histogram were analysed. Robustness was measured by the improvement of the lowest D 90% of the planning target volume (PTV) observed in the simulations. For (LD), a DTMR yields an increase in DHI of approximately 30% and reduces the size of the largest high-dose volume by 2–5 cc. However, this comes at a cost of a reduction in D 90% of the PTV of 10%, which often implies that it drops below the desired minimum of 100%. For (LDV), none of the DTMRs were able to improve high-dose volume measures. DTMRs were not capable of improving robustness of PTV D 90% against uncertainty in dwell positions for both models. (paper)

  11. A social marketing approach to quality improvement in family planning services: a case study from Rawalpindi, Pakistan.

    Science.gov (United States)

    Gulzar, Jamshaid; Ali, Moazzam; Kuroiwa, Chushi

    2008-02-01

    In the 1990s, social marketing approach was introduced in Pakistan to improve the quality and accessibility of family planning methods involving private practitioners. This study measured six quality elements using a Bruce-Jain framework. Cross-sectional survey data were collected from 29 randomly selected Green Star clinics. The study's four components were 1) an inventory of each outlet (infrastructure, equipment, and supplies); 2) an observation guide for interaction between family planning clients and service providers; 3) exit interviews with clients attending the outlet; and 4) interviews with providers at the outlet. Of the 29 clients participating in the exit interviews, 72% were new users of family planning. The clients' mean age was 32 years; all clients were married; 93% had received formal education. Housework was the principal activity of 93% of clients. The mean number of children reported was three. Both hormonal and intrauterine contraceptives (IUCDs) were available in all facilities; 86% of the clients reported being able to obtain their contraceptive of choice. Most facilities had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service outlets emphasized mechanisms to ensure continuity of use. Notable shortcomings included a shortage of information on alternative methods, contraindications, and side-effect management, as well as a dearth of registration records. In conclusion, this is a good example of public-private partnership involving private practitioners using a social marketing approach. The quality components of a Bruce-Jain framework were achieved, resulting in a satisfied clientele. Involvement of private service outlets increased the accessibility and enhanced the use of services. Social marketing may be expanded to improve quality and access by involving further components of health care.

  12. Improved robotic stereotactic body radiation therapy plan quality and planning efficacy for organ-confined prostate cancer utilizing overlap-volume histogram-driven planning methodology

    International Nuclear Information System (INIS)

    Wu, Binbin; Pang, Dalong; Lei, Siyuan; Gatti, John; Tong, Michael; McNutt, Todd; Kole, Thomas; Dritschilo, Anatoly; Collins, Sean

    2014-01-01

    Background and purpose: This study is to determine if the overlap-volume histogram (OVH)-driven planning methodology can be adapted to robotic SBRT (CyberKnife Robotic Radiosurgery System) to further minimize the bladder and rectal doses achieved in plans manually-created by clinical planners. Methods and materials: A database containing clinically-delivered, robotic SBRT plans (7.25 Gy/fraction in 36.25 Gy) of 425 patients with localized prostate cancer was used as a cohort to establish an organ’s distance-to-dose model. The OVH-driven planning methodology was refined by adding the PTV volume factor to counter the target’s dose fall-off effect and incorporated into Multiplan to automate SBRT planning. For validation, automated plans (APs) for 12 new patients were generated, and their achieved dose/volume values were compared to the corresponding manually-created, clinically-delivered plans (CPs). A two-sided, Wilcoxon rank-sum test was used for statistical comparison with a significance level of p < 0.05. Results: PTV’s V(36.25 Gy) was comparable: 95.6% in CPs comparing to 95.1% in APs (p = 0.2). On average, the refined approach lowered V(18.12 Gy) to the bladder and rectum by 8.2% (p < 0.05) and 6.4% (p = 0.14). A physician confirmed APs were clinically acceptable. Conclusions: The improvements in APs could further reduce toxicities observed in SBRT for organ-confined prostate cancer

  13. STRATEGIC MARKETING PLANNING IN SPORTS- A PERSPECTIVE OF QUALITY OF LIFE IMPROVEMENT

    OpenAIRE

    Constantinescu Mihaela; Caescu Stefan Claudiu; Ploesteanu Mara Gabriela

    2012-01-01

    Strategic marketing planning requires that the marketing objectives strategies for a specific product-market configuration be in full correlation with the directions and the resources allocated at the corporate level or at the strategic business unit one. Such a correlation is more than necessary under the current market conditions, when the economic crisis affects both consumer behavior and corporate decisions. This article focuses on the particularities of strategic marketing planning in sp...

  14. STRATEGIC MARKETING PLANNING IN SPORTS – A PERSPECTIVE OF QUALITY OF LIFE IMPROVEMENT

    OpenAIRE

    Caescu Stefan Claudiu; Ploesteanu Mara Gabriela; Constantinescu Mihaela

    2012-01-01

    Strategic marketing planning requires that the marketing objectives strategies for a specific product-market configuration be in full correlation with the directions and the resources allocated at the corporate level or at the strategic business unit one. Such a correlation is more than necessary under the current market conditions, when the economic crisis affects both consumer behavior and corporate decisions. This article focuses on the particularities of strategic marketing planning in sp...

  15. Design of Cycle 3 of the National Water-Quality Assessment Program, 2013-23: Part 2: Science plan for improved water-quality information and management

    Science.gov (United States)

    Rowe, Gary L.; Belitz, Kenneth; Demas, Charlie R.; Essaid, Hedeff I.; Gilliom, Robert J.; Hamilton, Pixie A.; Hoos, Anne B.; Lee, Casey J.; Munn, Mark D.; Wolock, David W.

    2013-01-01

    This report presents a science strategy for the third decade of the National Water-Quality Assessment (NAWQA) Program, which since 1991, has been responsible for providing nationally consistent information on the quality of the Nation's streams and groundwater; how water quality is changing over time; and the major natural and human factors that affect current water quality conditions and trends. The strategy is based on an extensive evaluation of the accomplishments of NAWQA over its first two decades, the current status of water-quality monitoring activities by USGS and its partners, and an updated analysis of stakeholder priorities. The plan is designed to address priority issues and national needs identified by NAWQA stakeholders and the National Research Council (2012) irrespective of budget constraints. This plan describes four major goals for the third decade (Cycle 3), the approaches for monitoring, modeling, and scientific studies, key partnerships required to achieve these goals, and products and outcomes that will result from planned assessment activities. The science plan for 2013–2023 is a comprehensive approach to meet stakeholder priorities for: (1) rebuilding NAWQA monitoring networks for streams, rivers, and groundwater, and (2) upgrading models used to extrapolate and forecast changes in water-quality and stream ecosystem condition in response to changing climate and land use. The Cycle 3 plan continues approaches that have been central to the Program’s long-term success, but adjusts monitoring intensities and study designs to address critical information needs and identified data gaps. Restoration of diminished monitoring networks and new directions in modeling and interpretative studies address growing and evolving public and stakeholder needs for water-quality information and improved management, particularly in the face of increasing challenges related to population growth, increasing demands for water, and changing land use and climate

  16. Mixed integer programming improves comprehensibility and plan quality in inverse optimization of prostate HDR Brachytherapy

    NARCIS (Netherlands)

    Gorissen, B.L.; den Hertog, D.; Hoffmann, A.L.

    2013-01-01

    Current inverse treatment planning methods that optimize both catheter positions and dwell times in prostate HDR brachytherapy use surrogate linear or quadratic objective functions that have no direct interpretation in terms of dose-volume histogram (DVH) criteria, do not result in an optimum or

  17. A knowledge-based approach to improving and homogenizing intensity modulated radiation therapy planning quality among treatment centers: an example application to prostate cancer planning.

    Science.gov (United States)

    Good, David; Lo, Joseph; Lee, W Robert; Wu, Q Jackie; Yin, Fang-Fang; Das, Shiva K

    2013-09-01

    Intensity modulated radiation therapy (IMRT) treatment planning can have wide variation among different treatment centers. We propose a system to leverage the IMRT planning experience of larger institutions to automatically create high-quality plans for outside clinics. We explore feasibility by generating plans for patient datasets from an outside institution by adapting plans from our institution. A knowledge database was created from 132 IMRT treatment plans for prostate cancer at our institution. The outside institution, a community hospital, provided the datasets for 55 prostate cancer cases, including their original treatment plans. For each "query" case from the outside institution, a similar "match" case was identified in the knowledge database, and the match case's plan parameters were then adapted and optimized to the query case by use of a semiautomated approach that required no expert planning knowledge. The plans generated with this knowledge-based approach were compared with the original treatment plans at several dose cutpoints. Compared with the original plan, the knowledge-based plan had a significantly more homogeneous dose to the planning target volume and a significantly lower maximum dose. The volumes of the rectum, bladder, and femoral heads above all cutpoints were nominally lower for the knowledge-based plan; the reductions were significantly lower for the rectum. In 40% of cases, the knowledge-based plan had overall superior (lower) dose-volume histograms for rectum and bladder; in 54% of cases, the comparison was equivocal; in 6% of cases, the knowledge-based plan was inferior for both bladder and rectum. Knowledge-based planning was superior or equivalent to the original plan in 95% of cases. The knowledge-based approach shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced institutions. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. A quality improvement plan to reduce 30-day readmissions of heart failure patients.

    Science.gov (United States)

    Simpson, Monica

    2014-01-01

    An evidence-based quality initiative to decrease heart failure 30-day readmissions was implemented at a hospital in Florida. Heart failure education and postdischarge telephone contact were provided to patients determined to be at high risk of readmission using risk stratification tools. The rate during the project decreased 13% as compared to the same time period in the previous year and 8.5% from the 2012 year to date rate.

  19. Simulation in Quality Management – An Approach to Improve Inspection Planning

    Directory of Open Access Journals (Sweden)

    H.-A. Crostack

    2005-01-01

    Full Text Available Production is a multi-step process involving many different articles produced in different jobs by various machining stations. Quality inspection has to be integrated in the production sequence in order to ensure the conformance of the products. The interactions between manufacturing processes and inspections are very complex since three aspects (quality, cost, and time should all be considered at the same time while determining the suitable inspection strategy. Therefore, a simulation approach was introduced to solve this problem.The simulator called QUINTE [the QUINTE simulator has been developed at the University of Dortmund in the course of two research projects funded by the German Federal Ministry of Economics and Labour (BMWA: Bundesministerium für Wirtschaft und Arbeit, the Arbeitsgemeinschaft industrieller Forschungsvereinigungen (AiF, Cologne/Germany and the Forschungsgemeinschaft Qualität, Frankfurt a.M./Germany] was developed to simulate the machining as well as the inspection. It can be used to investigate and evaluate the inspection strategies in manufacturing processes. The investigation into the application of QUINTE simulator in industry was carried out at two pilot companies. The results show the validity of this simulator. An attempt to run QUINTE in a user-friendly environment, i.e., the commercial simulation software – Arena® is also described in this paper.NOTATION: QUINTE Qualität in der Teilefertigung  (Quality in  the manufacturing process  

  20. Planning to improve the mechanical quality factor in the transducer impedance matchers for Mario Schenberg detector

    International Nuclear Information System (INIS)

    Frajuca, Carlos; Silva Bortoli, Fabio da

    2006-01-01

    Mario Schenberg is a spherical resonant-mass gravitational wave (GW) detector that will be part of a GW detection array of two detectors. Another one is been built in The Netherlands. Their resonant frequencies will be around 3.2 kHz with a bandwidth of about 200 Hz. This range of frequencies is new in a field where the typical frequencies lay below 1 kHz, making the transducer development much more complex. Some studies indicated that using low mass mechanical resonators (used for impedance matching to the parametric transducer, in a cold damping regime) allow the detector to reach the standard quantum limit. In this work we describe the procedures that are being developed to quickly test the mechanical quality factor of a very small resonator in the quest to find the best machining method and thermal annealing for the impedance matching resonator, one key part that makes a good coupling between the sphere and the transducer. The main goal is to optimize the mechanical quality factor in a reasonable time

  1. Simulation model for improved production planning and control through quality, cycle time and batch size management

    Directory of Open Access Journals (Sweden)

    Kotevski Živko

    2015-01-01

    Full Text Available Production planning and control (PPC systems are the base of all production facilities. In today's surroundings, having a good PPC system generates lots of benefits for the companies. But, having an excellent PPC system provides great competitive advantage and serious reduction of cost in many fields. In order to get to a point of having excellent PPC, the companies turn more and more to the newest software tools, for simulations as an example. Considering today's advanced computer technology, by using the simulations in this area, companies will have strong asset when dealing with different kinds of wastes, delays, overstock, bottlenecks and generally loss of time. This model is applicable in almost all production facilities. Taking into account the different scrap percentages for the pieces that form the end product, a detailed model and analysis were made in order to determine the optimal starting parameters. At first all the conditions of the company were determined, conceptual model was created along with all assumptions. Then the model was verified and validated and at the end a cost benefit analysis was conducted in order to have clear results.

  2. Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services

    Science.gov (United States)

    Daff, Bocar Mamadou; Seck, Cheikh; Belkhayat, Hassan; Sutton, Perri

    2014-01-01

    Contraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current “pull-based” distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015. PMID:25276582

  3. Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services.

    Science.gov (United States)

    Daff, Bocar Mamadou; Seck, Cheikh; Belkhayat, Hassan; Sutton, Perri

    2014-05-01

    Contraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current "pull-based" distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015.

  4. Region 7 Quality Management Plan

    Science.gov (United States)

    To document adherence to EPA Order 5360.1 A2, EPA requires each organizational unitto develop a quality management plan per the specifications in EPA Requirements for QualityManagement Plans, EPA QA R-2.

  5. Integrated surgical emergency training plan in the internship: A step toward improving the quality of training and emergency center management.

    Science.gov (United States)

    Akhlaghi, Mohammad Reza; Vafamehr, Vajiheh; Dadgostarnia, Mohammad; Dehghani, Alireza

    2013-01-01

    , facing a variety of patients, practicing the role of general practitioners, role-playing on a real patient's bedside, having a multilateral approach to the patient, reducing the wasting time on minor wards, balancing the work and rest schedules of the interns, and better learning and satisfaction of the interns. Over 60% of the participants believed the program has the following benefits: More attention on the training plan, improving the learning of patient management, being more responsive for the training of interns, increasing operational approach to emergency patients, being more aware of the performed actions, and increasing the quality and speed of services provided to patients. The mean score assigned to the whole questionnaire of investigating the viewpoints was 37.5 out of 50. The mean score of the interns' questionnaire was significantly more than the mean score of the assistants. The results obtained indicated that the greatest existing consensus about this plan was the positive impact on the learning of interns in the emergency setting. Thus, it will not only increase the number of patients who the interns are managing during the internship course, but also increases the balance of their workload and they can learn and manage the emergency patients with more leisure.

  6. Node-positive left-sided breast cancer. Does VMAT improve treatment plan quality with respect to IMRT?

    Energy Technology Data Exchange (ETDEWEB)

    Pasler, M.; Bartelt, S.; Lutterbach, J. [Lake Constance Radiation Oncology Center Singen, Friedrichshafen (Germany); Georg, D. [Medical University Vienna/AKH Wien, Vienna (Austria). Dept. of Radiooncology; Medical University Vienna (Austria). Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology

    2013-05-15

    Purpose: The aim of the present work was to explore plan quality and dosimetric accuracy of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for lymph node-positive left-sided breast cancer. Methods: VMAT and IMRT plans were generated with the Pinnacle{sup 3} V9.0 treatment planning system for 10 lymph node-positive left-sided breast cancer patients. VMAT plans were created using a single arc and IMRT was performed with 4 beams using 6, 10, and 15 MV photon energy, respectively. Plans were evaluated both manually and automatically using ArtiView trademark. Dosimetric plan verification was performed with a 2D ionization chamber array placed in a full scatter phantom. Results: Photon energy had no significant influence on plan quality for both VMAT and IMRT. Large variability in low doses to the heart was found due to patient anatomy (range V{sub 5} {sub Gy} 26.5-95 %). Slightly more normal tissue dose was found for VMAT (e.g., V{sub Tissue30%} = 22 %) than in IMRT (V{sub Tissue30%} = 18 %). The manual and ArtiView trademark plan evaluation coincided very accurately for most dose metrics (difference < 1 %). In VMAT, 96.7 % of detector points passed the 3 %/3 mm gamma criterion; marginally better accuracy was found in IMRT (98.3 %). Conclusion: VMAT for node-positive left-sided breast cancer retains target homogeneity and coverage when compared to IMRT and allows maximum doses to organs at risk to be reduced. ArtiView trademark enables fast and accurate plan evaluation. (orig.)

  7. A Preliminary Study on the Effects of Training Using Behavior Support Plan Quality Evaluation Guide (BSP-QE) to Improve Positive Behavioral Support Plans

    Science.gov (United States)

    Wright, Diana Browning; Mayer, G. Roy; Cook, Clayton R.; Crews, S. Dean; Kraemer, Bonnie Rawlings; Gale, Bruce

    2007-01-01

    The purpose of this research was to evaluate the effects of two trainings designed to increase the competencies of professionals to develop high quality positive behavior support plans for students that engage in problem behaviors that interfere with theirs and/or others' ability to learn. Training one consisted of training attendees on six key…

  8. Teaching quality improvement.

    Science.gov (United States)

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

    2010-08-01

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

  9. Continuous quality improvement

    International Nuclear Information System (INIS)

    Bourne, P.B.

    1985-01-01

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

  10. MDSplus quality improvement project

    Energy Technology Data Exchange (ETDEWEB)

    Fredian, Thomas W., E-mail: twf@psfc.mit.edu [Massachusetts Institute of Technology, 175 Albany Street, Cambridge, MA 02139 (United States); Stillerman, Joshua [Massachusetts Institute of Technology, 175 Albany Street, Cambridge, MA 02139 (United States); Manduchi, Gabriele; Rigoni, Andrea [Consorzio RFX, Euratom-ENEA Association, Corso Stati Uniti 4, Padova 35127 (Italy); Erickson, Keith [Princeton Plasma Physics Laboratory, Princeton, NJ 08543 (United States)

    2016-11-15

    Highlights: • Project to improve the quality of the MDSplus software package. • Use of modern software technology, compiler options, automake. • Refactoring of older code. • Use of testing tools. - Abstract: MDSplus is a data acquisition and analysis system used worldwide predominantly in the fusion research community. Development began 29 years ago on the OpenVMS operating system. Since that time there have been many new features added and the code has been ported to many different operating systems. There have been contributions to the MDSplus development from the fusion community in the way of feature suggestions, feature implementations, documentation and porting to different operating systems. The bulk of the development and support of MDSplus, however, has been provided by a relatively small core developer group of three or four members. Given the size of the development team and the large number of users much more effort was focused on providing new features for the community than on keeping the underlying code and documentation up to date with the evolving software development standards. To ensure that MDSplus will continue to provide the needs of the community in the future, the MDSplus development team along with other members of the MDSplus user community has commenced on a major quality improvement project. The planned improvements include changes to software build scripts to better use GNU Autoconf and Automake tools, refactoring many of the source code modules using new language features available in modern compilers, using GNU MinGW-w64 to create MS Windows distributions, migrating to a more modern source code management system, improvement of source documentation as well as improvements to the (www.mdsplus.org) web site documentation and layout, and the addition of more comprehensive test suites to apply to MDSplus code builds prior to releasing installation kits to the community. This work should lead to a much more robust product and

  11. MDSplus quality improvement project

    International Nuclear Information System (INIS)

    Fredian, Thomas W.; Stillerman, Joshua; Manduchi, Gabriele; Rigoni, Andrea; Erickson, Keith

    2016-01-01

    Highlights: • Project to improve the quality of the MDSplus software package. • Use of modern software technology, compiler options, automake. • Refactoring of older code. • Use of testing tools. - Abstract: MDSplus is a data acquisition and analysis system used worldwide predominantly in the fusion research community. Development began 29 years ago on the OpenVMS operating system. Since that time there have been many new features added and the code has been ported to many different operating systems. There have been contributions to the MDSplus development from the fusion community in the way of feature suggestions, feature implementations, documentation and porting to different operating systems. The bulk of the development and support of MDSplus, however, has been provided by a relatively small core developer group of three or four members. Given the size of the development team and the large number of users much more effort was focused on providing new features for the community than on keeping the underlying code and documentation up to date with the evolving software development standards. To ensure that MDSplus will continue to provide the needs of the community in the future, the MDSplus development team along with other members of the MDSplus user community has commenced on a major quality improvement project. The planned improvements include changes to software build scripts to better use GNU Autoconf and Automake tools, refactoring many of the source code modules using new language features available in modern compilers, using GNU MinGW-w64 to create MS Windows distributions, migrating to a more modern source code management system, improvement of source documentation as well as improvements to the (www.mdsplus.org) web site documentation and layout, and the addition of more comprehensive test suites to apply to MDSplus code builds prior to releasing installation kits to the community. This work should lead to a much more robust product and

  12. Does human resource management improve family planning service quality? Analysis from the Kenya Service Provision Assessment 2010.

    Science.gov (United States)

    Thatte, Nandita; Choi, Yoonjoung

    2015-04-01

    Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be

  13. Project Specific Quality Assurance Plan

    International Nuclear Information System (INIS)

    Pedersen, K.S.

    1995-01-01

    This Quality Assurance Project Plan (QAPP) identifies the Westinghouse Hanford Co. (WHC) Quality Assurance (QA) program requirements for all contractors involved in the planning and execution of the design, construction, testing and inspection of the 200 Area Effluent BAT/AKART Implementation, Project W-291

  14. Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: qualitative assessment of short term program outcomes.

    Science.gov (United States)

    Vachon, Brigitte; Désorcy, Bruno; Gaboury, Isabelle; Camirand, Michel; Rodrigue, Jean; Quesnel, Louise; Guimond, Claude; Labelle, Martin; Huynh, Ai-Thuy; Grimshaw, Jeremy

    2015-09-18

    Improving primary care for chronic disease management requires a coherent, integrated approach to quality improvement. Evidence in the continuing professional development (CPD) field suggests the importance of using strategies such as feedback delivery, reflective practice and action planning to facilitate recognition of gaps and service improvement needs. Our study explored the outcomes of a CPD intervention, named the COMPAS Project, which consists of a three-hour workshop composed of three main activities: feedback, critical reflection and action planning. The feedback intervention is delivered face-to-face and presents performance indicators extracted from clinical-administrative databases. This aim of this study was to assess the short term outcomes of this intervention to engage primary care professional in continuous quality improvement (QI). In order to develop an understanding of our intervention and of its short term outcomes, a program evaluation approach was used. Ten COMPAS workshops on diabetes management were directly observed and qualitative data was collected to assess the intervention short term outcomes. Data from both sources were combined to describe the characteristics of action plans developed by professionals. Two independent coders analysed the content of these plans to assess if they promoted engagement in QI and interprofessional collaboration. During the ten workshops held, 26 interprofessional work teams were formed. Twenty-two of them developed a QI project they could implement themselves and that targeted aspects of their own practice they perceived in need of change. Most frequently prioritized strategies for change were improvement of systematic clientele follow-up, medication compliance, care pathway and support to improve adoption of healthier life habits. Twenty-one out of 22 action plans were found to target some level of improvement of interprofessional collaboration in primary care. Our study results demonstrate that the

  15. Collaborative quality improvement.

    Science.gov (United States)

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

    2017-07-01

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

  16. Quality Improvement with Trustee Commitment.

    Science.gov (United States)

    Chaffee, Ellen Earle; Seymour, Daniel

    1991-01-01

    Total Quality Management is a comprehensive system for developing organizationwide participation in planning for and implementing continuous improvement in critical processes. In colleges, trustees can be central to the success of the method through their commitment and the development of supportive policy and procedures. (MSE)

  17. Diabetes Health Information Technology Innovation to Improve Quality of Life for Health Plan Members in Urban Safety Net

    Science.gov (United States)

    Ratanawongsa, Neda; Handley, Margaret A.; Sarkar, Urmimala; Quan, Judy; Pfeifer, Kelly; Soria, Catalina; Schillinger, Dean

    2014-01-01

    Safety net systems need innovative diabetes self-management programs for linguistically diverse patients. A low-income government-sponsored managed care plan implemented a 27-week automated telephone self-management support (ATSM) / health coaching intervention for English, Spanish-, and Cantonese-speaking members from four publicly-funded clinics in a practice-based research network. Compared to waitlist, immediate intervention participants had greater 6-month improvements in overall diabetes self-care behaviors (standardized effect size [ES] 0.29, pimproving patient-reported self-management and may also improve some outcomes. PMID:24594561

  18. Air Pollution Monitoring | Air Quality Planning & Standards ...

    Science.gov (United States)

    2016-06-08

    The basic mission of the Office of Air Quality Planning and Standards is to preserve and improve the quality of our nation's air. To accomplish this, OAQPS must be able to evaluate the status of the atmosphere as compared to clean air standards and historical information.

  19. FAILURE MODE EFFECTS AND CRITICALITY ANALYSIS (FMECA AS A QUALITY TOOL TO PLAN IMPROVEMENTS IN ULTRASONIC MOULD CLEANING SYSTEMS

    Directory of Open Access Journals (Sweden)

    Cristiano Fragassa

    2016-12-01

    Full Text Available Inside the complex process used for tire production, ultrasonic cleaning treatment probably represents the best solution to preserve the functionality of tire moulds, by removing residuals from moulds and keeping an unaltered quality for their surfaces. Ultrasonic Mould Cleaning Systems (UMCS is, however, a complicated technology that combines ultrasonic waves, high temperature and a succession of acid and basic attacks. At the same time, an UMCS plant, as part of a long productive chain, has to guarantee the highest productivity reducing failures and maintenances. This article describes the use of Failure Mode Effects and Criticality Analysis (FMECA as a methodology for improving quality in cleaning process. In particular, FMECA was utilized to identify potential defects in the original plant design, to recognize the inner causes of some failures actually occurred during operations and, finally, to suggest definitive re-design actions. Changes were implemented and the new UMCS offers a better quality in term of higher availability and productivity.

  20. A Comprehensive plan of improving water quality considering water system - concentrated on a basin of the Han River

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jee Yong; Moon, Hyun Joo; Yum, Kyu Jin; Kim, Eun Jung; Lee, Young Soon; Kim, Kang Suk; Lee, Chang Hee; Shin, Eun Sung; Kim, Jee Hoon [Korea Environment Institute, Seoul (Korea)

    1998-12-01

    The contents of this study are following: reviewing the present policy on land use in basin to improve the water quality of water supply source in Paldang and so on; improvement policy on land use in basin; management scheme of pollutant into Paldang; the variety and quantity of toxic substances, a control of particular pollutant; management of polluted deposit in Paldang; the control of efficient environment investment in upper stream of Paldang; financial assistance for damaged region; and purchasing land of sensitivity region for protecting water supply. 32 refs., 13 figs., 124 tabs.

  1. Project Quality Plan

    DEFF Research Database (Denmark)

    Sandborg-Petersen, Ulrik; Øhrstrøm, Peter

    This document defines the procedures, standards, and strategies which will be used to ensure high standards of quality of the work produced within the HANDS project. It contains the following sections...

  2. Total quality management program planning

    Energy Technology Data Exchange (ETDEWEB)

    Thornton, P.T.; Spence, K.

    1994-05-01

    As government funding grows scarce, competition between the national laboratories is increasing dramatically. In this era of tougher competition, there is no for resistance to change. There must instead be a uniform commitment to improving the overall quality of our products (research and technology) and an increased focus on our customers` needs. There has been an ongoing effort to bring the principles of total quality management (TQM) to all Energy Systems employees to help them better prepare for future changes while responding to the pressures on federal budgets. The need exists for instituting a vigorous program of education and training to an understanding of the techniques needed to improve and initiate a change in organizational culture. The TQM facilitator is responsible for educating the work force on the benefits of self-managed work teams, designing a program of instruction for implementation, and thus getting TQM off the ground at the worker and first-line supervisory levels so that the benefits can flow back up. This program plan presents a conceptual model for TQM in the form of a hot air balloon. In this model, there are numerous factors which can individually and collectively impede the progress of TQM within the division and the Laboratory. When these factors are addressed and corrected, the benefits of TQM become more visible. As this occurs, it is hoped that workers and management alike will grasp the ``total quality`` concept as an acceptable agent for change and continual improvement. TQM can then rise to the occasion and take its rightful place as an integral and valid step in the Laboratory`s formula for survival.

  3. Improving Indoor Air Quality

    Science.gov (United States)

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

  4. Linking customer satisfaction, quality, and strategic planning

    OpenAIRE

    Reis, Dayr; Peña, Leticia

    2000-01-01

    By acknowledging and dissecting the interconnected roles of customer satisfaction, quality, and strategic planning, this paper provides an analytical framework for creating a customer-driven organization and culture. It shows how quality starts and ends with the customer. Companies that are achieving long-term continuous improvement in quality tailored to customer satisfaction possess lasting characteristics such as customer orientation, customer consciousness, and customer responsiveness. In...

  5. Quality improvement - the future begins

    International Nuclear Information System (INIS)

    Boissy, G.J.

    1987-01-01

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

  6. Integrating Quality Improvement and Continuing Professional Development at an Academic Medical Center: A Partnership Between Practice Plan, Hospital, and Medical School.

    Science.gov (United States)

    Gold, Barbara; England, Dawn; Riley, William; Jacobs-Halsey, Ginny; Webb, Corinne; Daniels, Bobbi

    2016-01-01

    While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts. This article provides a case example describing our organizational context, what was done, and with what effect and makes our example and lessons learned available to others. We developed a new educational QI program that was jointly planned and implemented by a group comprising major QI stakeholders. This project was intended to create horizontal organizational linkages between continuing professional development, clinicians, the hospital, and QI department and produce QI activities that aligned with the strategic objectives of senior management. The group developed and implemented a curriculum based on Lean methodology and concepts from the Institute for Health Care Improvement Model for Improvement. Two cohorts (27 teams) completed the training and planned and implemented QI projects. All projects were aligned with organizational quality, safety, and patient experience goals. The majority of projects met their aim statements. This case description provides an example of successful horizontal integration of an AMCs' QI functions to disseminate knowledge and implement meaningful QI aligned with strategic objectives (vertical integration).

  7. Using Quality Improvement Methods to Implement an Electronic Medical Record (EMR) Supported Individualized Home Pain Management Plan for Children with Sickle Cell Disease.

    Science.gov (United States)

    Crosby, Lori E; Simmons, Kenya; Kaiser, Peggy; Davis, Blair; Boyd, Patricia; Eichhorn, Tiffany; Mahaney, Tracy; Joffe, Naomi; Morgan, Darice; Schibler, Kathy; Anderson, Viia; Quinn, Charles T; Kalinyak, Karen A

    2014-05-01

    Using quality improvement methodology, our goal was to develop and implement individualized home pain management plans (HPMP) that included pharmacologic as well as non-pharmacologic strategies for children with sickle cell disease (SCD). We hypothesized that successfully implemented HPMPs would have an impact on Emergency Department (ED) use, decreasing ED visits for uncomplicated SCD pain episodes. A multidisciplinary quality improvement team developed a questionnaire to assess the frequency, location and severity of a patient's pain during a routine, comprehensive visit in order to help the patient and family develop an effective pain management strategy using both pharmacologic and non-pharmacologic actions. Using plan do study act cycles (PDSAs), this team was able to build this process into the daily workflow for all SCD patients age 5 years to 21 years of age. Patients with comprehensive visits scheduled from January 2012 to May 2013 were included (N=188) in the intervention. By May of 2013, 88% of eligible patients had an individualized HPMP in place. There was a concomitant reduction in the percentage of SCD patients seen in the ED for uncomplicated SCD pain (6.9% vs. 1.1%). Using quality improvement methods, an individualized HPMP intervention was incorporated successfully into the daily workflow of a busy outpatient SCD clinic. This intervention has the potential to improve patient outcomes by decreasing avoidable ED visits as well as reducing overall healthcare costs.

  8. Waste Management Quality Assurance Plan

    International Nuclear Information System (INIS)

    1993-01-01

    Lawrence Berkeley Laboratory's Environment Department addresses its responsibilities through activities in a variety of areas. The need for a comprehensive management control system for these activities has been identified by the Department of Energy (DOE). The WM QA (Waste Management Quality Assurance) Plan is an integral part of a management system that provides controls necessary to ensure that the department's activities are planned, performed, documented, and verified. This WM QA Plan defines the requirements of the WM QA program. These requirements are derived from DOE Order 5700.6C, Quality Assurance, the LBL Operating and Assurance Program Plan (OAP, LBL PUB-3111), and other environmental compliance documents applicable to WM activities. The requirements presented herein, as well as the procedures and methodologies that direct the implementation of these requirements, will undergo review and revisions as necessary. The provisions of this QA Plan and its implementing documents apply to quality-affecting activities performed by and for WM. It is also applicable to WM contractors, vendors, and other LBL organizations associated with WM activities, except where such contractors, vendors, or organizations are governed by their own WM-approved QA programs. References used in the preparation of this document are (1) ASME NQA-1-1989, (2) ANSI/ASQC E4 (Draft), (3) Waste Management Quality Assurance Implementing Management Plan (LBL PUB-5352, Rev. 1), (4) LBL Operating and Assurance Program Plan (OAP), LBL PUB-3111, 2/3/93. A list of terms and definitions used throughout this document is included as Appendix A

  9. Quality-Assurance Program Plan

    International Nuclear Information System (INIS)

    Kettell, R.A.

    1981-05-01

    This Quality Assurance Program Plan (QAPP) is provided to describe the Quality Assurance Program which is applied to the waste management activities conducted by AESD-Nevada Operations at the E-MAD Facility located in Area 25 of the Nevada Test Site. The AESD-Nevada Operations QAPP provides the necessary systematic and administrative controls to assure activities that affect quality, safety, reliability, and maintainability during design, procurement, fabrication, inspection, shipments, tests, and storage are conducted in accordance with established requirements

  10. Continuous quality improvement

    NARCIS (Netherlands)

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

    2002-01-01

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

  11. Quality improvement tools and processes.

    Science.gov (United States)

    Lau, Catherine Y

    2015-04-01

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

  12. Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya.

    Science.gov (United States)

    Mutemwa, Richard; Mayhew, Susannah H; Warren, Charlotte E; Abuya, Timothy; Ndwiga, Charity; Kivunaga, Jackline

    2017-11-01

    The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client-provider consultation sessions. The cross-sectional study observed 366 client-provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63-0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07-14.21), adequate infrastructure (5.29; 95% CI: 2.89-7.69) and reagents (1.48; 95% CI: 1.02-1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92-4.36), job satisfaction (2.02; 95% CI: 1.21-2.83) and supervision (1.01; 95% CI: 0.35-1.68), while workload (-0.88; 95% CI: -1.75 to - 0.01) was negatively associated. Technical quality of the client-provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client-provider consultation sessions as measured by both health facility

  13. IMPROVING CONCEPTUAL DESIGN QUALITY

    DEFF Research Database (Denmark)

    Bush, Stuart; Robotham, Antony John

    1999-01-01

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

  14. "I sleep better at night:" How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs.

    Science.gov (United States)

    Brundage, Michael D; Hart, Margaret; O'Donnell, Jennifer; Reddeman, Lindsay; Gutierrez, Eric; Foxcroft, Sophie; Warde, Padraig

    Peer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans and can also have indirect effects on radiation treatment programs. We undertook a systematic, qualitative approach to describing the indirect benefits of peer review, factors that were seen to facilitate or act as barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs). Semistructured qualitative interviews were held with radiation oncology department heads and radiation therapy managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by 2 independent reviewers, and any discordance was resolved by consensus. A total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n = 3), process (n = 9), or outcome (n = 10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs. Although challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans. Copyright © 2016. Published by Elsevier Inc.

  15. Introspection into institutional database allows for focused quality improvement plan in cardiac surgery: example for a new global healthcare system.

    Science.gov (United States)

    Lancaster, Elizabeth; Postel, Mackenzie; Satou, Nancy; Shemin, Richard; Benharash, Peyman

    2013-10-01

    Reducing readmission rates is vital to improving quality of care and reducing healthcare costs. In accordance with the Patient Protection and Affordable Care Act, Medicare will cut payments to hospitals with high 30-day readmission rates. We retrospectively reviewed an institutional database to identify risk factors predisposing adult cardiac surgery patients to rehospitalization within 30 days of discharge. Of 2302 adult cardiac surgery patients within the study period from 2008 to 2011, a total of 218 patients (9.5%) were readmitted within 30 days. Factors found to be significant predictors of readmission were nonwhite race (P = 0.003), government health insurance (P = 0.02), ejection fraction less than 40 per cent (P = 0.001), chronic lung disease (P improving patient care. Our data suggest that optimizing cardiopulmonary status in patients with comorbidities such as heart failure and chronic obstructive pulmonary disease, increasing directed pneumonia prophylaxis, patient education tailored to specific patient social needs, earlier patient follow-up, and better communication between inpatient and outpatient physicians may reduce readmission rates.

  16. The Thames Science Plan: Suggested Hydrologic Investigations to Support Nutrient-Related Water-Quality Improvements in the Thames River Basin, Connecticut

    National Research Council Canada - National Science Library

    Todd Trench, Elaine C

    2005-01-01

    ... (CTDEP). The Science Plan outlines water-quality investigations that could provide information necessary for the CTDEP to develop water-quality management and restoration strategies for nutrient-related...

  17. Software Engineering Improvement Plan

    Science.gov (United States)

    2006-01-01

    In performance of this task order, bd Systems personnel provided support to the Flight Software Branch and the Software Working Group through multiple tasks related to software engineering improvement and to activities of the independent Technical Authority (iTA) Discipline Technical Warrant Holder (DTWH) for software engineering. To ensure that the products, comments, and recommendations complied with customer requirements and the statement of work, bd Systems personnel maintained close coordination with the customer. These personnel performed work in areas such as update of agency requirements and directives database, software effort estimation, software problem reports, a web-based process asset library, miscellaneous documentation review, software system requirements, issue tracking software survey, systems engineering NPR, and project-related reviews. This report contains a summary of the work performed and the accomplishments in each of these areas.

  18. Nuclear Station Facilities Improvement Planning

    International Nuclear Information System (INIS)

    Hooks, R. W.; Lunardini, A. L.; Zaben, O.

    1991-01-01

    An effective facilities improvement program will include a plan for the temporary relocation of personnel during the construction of an adjoining service building addition. Since the smooth continuation of plant operation is of paramount importance, the phasing plan is established to minimize the disruptions in day-to-day station operation and administration. This plan should consider the final occupancy arrangements and the transition to the new structure; for example, computer hookup and phase-in should be considered. The nuclear industry is placing more emphasis on safety and reliability of nuclear power plants. In order to do this, more emphasis is placed on operations and maintenance. This results in increased size of managerial, technical and maintenance staffs. This in turn requires improved office and service facilities. The facilities that require improvement may include training areas, rad waste processing and storage facilities, and maintenance facilities. This paper discusses an approach for developing an effective program to plan and implement these projects. These improvement projects can range in magnitude from modifying a simple system to building a new structure to allocating space for a future project. This paper addresses the planning required for the new structures with emphasis on site location, space allocation, and internal layout. Since facility planning has recently been completed by Sargent and Leyden at six U. S. nuclear stations, specific examples from some of those plants are presented. Site planning and the establishment of long-range goals are of the utmost importance when undertaking a facilities improvement program for a nuclear station. A plan that considers the total site usage will enhance the value of both the new and existing facilities. Proper planning at the beginning of the program can minimize costs and maximize the benefits of the program

  19. Waste Management Quality Assurance Plan

    International Nuclear Information System (INIS)

    2006-01-01

    The WMG QAP is an integral part of a management system designed to ensure that WMG activities are planned, performed, documented, and verified in a manner that assures a quality product. A quality product is one that meets all waste acceptance criteria, conforms to all permit and regulatory requirements, and is accepted at the offsite treatment, storage, and disposal facility. In addition to internal processes, this QA Plan identifies WMG processes providing oversight and assurance to line management that waste is managed according to all federal, state, and local requirements for waste generator areas. A variety of quality assurance activities are integral to managing waste. These QA functions have been identified in the relevant procedures and in subsequent sections of this plan. The WMG QAP defines the requirements of the WMG quality assurance program. These requirements are derived from Department of Energy (DOE) Order 414.1C, Quality Assurance, Contractor Requirements Document, the LBNL Operating and Assurance Program Plan (OAP), and other applicable environmental compliance documents. The QAP and all associated WMG policies and procedures are periodically reviewed and revised, as necessary, to implement corrective actions, and to reflect changes that have occurred in regulations, requirements, or practices as a result of feedback on work performed or lessons learned from other organizations. The provisions of this QAP and its implementing documents apply to quality-affecting activities performed by the WMG; WMG personnel, contractors, and vendors; and personnel from other associated LBNL organizations, except where such contractors, vendors, or organizations are governed by their own WMG-approved QA programs

  20. Air quality management planning (AQMP

    Directory of Open Access Journals (Sweden)

    Sivertsen Bjarne

    2012-01-01

    Full Text Available In most urban areas of the world, particulate matter (PM levels pose severe problems, addressed in several policy areas (air quality, climate change, and human health. PM presents multiple challenges due to the multitude of its sources, spanning many sectors of economic activity as well as nature, and due to the complexity of atmospheric processes involved in its transport and secondary formation. For the authorities, the goal is to assure minimal impacts of atmospheric PM levels, in practice represented by compliance with existing regulations and standards. This may be achieved through an air quality management plan (AQMP. In Northern America and in parts of Europe, comprehensive research programs have guided development of AQMP over the last forty years. This cumulated experience can be utilized by others who face the same problems, but have yet to develop their own substantial research base. The main purpose of the AQMP development process is to establish an effective and sound basis for planning and management of air quality in a selected area. This type of planning will ensure that significant sources of impacts are identified and controlled in a most cost-effective manner. The choice of tools, methods and input information is often dictated by their availability, and should be evaluated against current best practices. Important elements of the AQMP are the identification of sources and development of a complete emission inventory, the development and operation of an air quality monitoring programme, and the development and application of atmospheric dispersion models. Major task is to collect the necessary input data. The development of the AQMP will take into account: - Air Quality Management System (AQMS requirements; - Operational and functional structure requirements; - Source identification through emission inventories; - Source reduction alternatives, which may be implemented; - Mechanisms for facilitating interdepartmental

  1. Total Quality Management Master Plan

    Science.gov (United States)

    1989-01-01

    Enhanced competitiveness in the private . public and international sectors - Increased cash flow, influenced by contractor’s contributions to quality I...the project applies novel public- sector compensation concepts gleaned from the best in the private sector . Major employee development opportunities...management must strive to upgrade the quality of worklife which will also contribute to an environment which fosters continuous improvement. Individuals

  2. Improving planning, design, reporting and scientific quality of animal experiments by using the Gold Standard Publication Checklist, in addition to the ARRIVE guidelines.

    Science.gov (United States)

    Hooijmans, Carlijn R; de Vries, Rob; Leenaars, Marlies; Curfs, Jo; Ritskes-Hoitinga, Merel

    2011-03-01

    Several studies have demonstrated serious omissions in the way research that use animals is reported. In order to improve the quality of reporting of animal experiments, the Animals in research: reporting in vivo experiments (ARRIVE) Guidelines were published in the British Journal of Pharmacology in August 2010. However, not only the quality of reporting of completed animal studies needs to be improved, but also the design and execution of new experiments. With both these goals in mind, we published the Gold Standard Publication Checklist (GSPC) in May 2010, a few months before the ARRIVE guidelines appeared. In this letter, we compare the GSPC checklist with the ARRIVE Guidelines. The GSPC describes certain items in more detail, which makes it both easier to use when designing and conducting an experiment and particularly suitable for making systematic reviews of animal studies more feasible. In order to improve not only the reporting but also the planning, design, execution and thereby, the scientific quality of animal experiments, we strongly recommend to all scientists involved in animal experimentation and to editors of journals publishing animal studies to take a closer look at the contents of both the ARRIVE guidelines and GSPC, and select the set of guidelines which is most appropriate for their particular situation. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  3. Clean Water Act (CWA) Action Plan Implementation Priorities: Changes to Improve Water Quality, Increase Compliance and Expand Transparency

    Science.gov (United States)

    The Clean Water Act (CWA) Action Plan Implementation Priorities describes the new approaches to revamp the National Pollutant Discharge Elimination System (NPDES) permitting, compliance and enforcement program.Issued May 11, 2011

  4. Quality of Family Planning Services in Primary Health Centers of ...

    African Journals Online (AJOL)

    Background: Good quality of care in family planning (FP) services help individuals and couples to meet their reproductive health needs safely and effectively. Therefore, assessment and improvement of the quality of family planning services could enhance family planning services utilization. This study was thus conducted ...

  5. Quality Assurance Project Plan for Facility Effluent Monitoring Plan activities

    International Nuclear Information System (INIS)

    Frazier, T.P.

    1994-01-01

    This Quality Assurance Project Plan addresses the quality assurance requirements for the activities associated with the Facility Effluent Monitoring Plans, which are part of the overall Hanford Site Environmental Protection Plan. This plan specifically applies to the sampling and analysis activities and continuous monitoring performed for all Facility Effluent Monitoring Plan activities conducted by Westinghouse Hanford Company. It is generic in approach and will be implemented in conjunction with the specific requirements of the individual Facility Effluent Monitoring Plans

  6. Planning product quality: An example - ornamental plants

    Directory of Open Access Journals (Sweden)

    Kovačević Miodrag

    2003-01-01

    Full Text Available The industry of ornamental plants is a subject of quality planning. The quality plan is a document setting out the specific quality practices in ornamental plants production. That plan introduce organizational structure procedures, processes and resources needed to implement quality in life cycle of product chain. For engineers it represents a new tool.

  7. SU-F-T-444: Quality Improvement Review of Radiation Therapy Treatment Planning in the Presence of Dental Implants

    Energy Technology Data Exchange (ETDEWEB)

    Parenica, H; Ford, J [Texas A& M University, College Station, TX (United States); Mavroidis, P [University of North Carolina, Chapel Hill, NC, (United States); Li, Y; Stathakis, S [Cancer Therapy and Research Center, San Antonio, TX (United States); Papanikolaou, N [University of Texas Health Science Center at San Antonio, San Antonio, TX (United States)

    2016-06-15

    Purpose: To quantify and compare the effect of metallic dental implants (MDI) on dose distributions calculated using Collapsed Cone Convolution Superposition (CCCS) algorithm or a Monte Carlo algorithm (with and without correcting for the density of the MDI). Methods: Seven previously treated patients to the head and neck region were included in this study. The MDI and the streaking artifacts on the CT images were carefully contoured. For each patient a plan was optimized and calculated using the Pinnacle3 treatment planning system (TPS). For each patient two dose calculations were performed, a) with the densities of the MDI and CT artifacts overridden (12 g/cc and 1 g/cc respectively) and b) without density overrides. The plans were then exported to the Monaco TPS and recalculated using Monte Carlo dose calculation algorithm. The changes in dose to PTVs and surrounding Regions of Interest (ROIs) were examined between all plans. Results: The Monte Carlo dose calculation indicated that PTVs received 6% lower dose than the CCCS algorithm predicted. In some cases, the Monte Carlo algorithm indicated that surrounding ROIs received higher dose (up to a factor of 2). Conclusion: Not properly accounting for dental implants can impact both the high dose regions (PTV) and the low dose regions (OAR). This study implies that if MDI and the artifacts are not appropriately contoured and given the correct density, there is potential significant impact on PTV coverage and OAR maximum doses.

  8. SU-F-T-444: Quality Improvement Review of Radiation Therapy Treatment Planning in the Presence of Dental Implants

    International Nuclear Information System (INIS)

    Parenica, H; Ford, J; Mavroidis, P; Li, Y; Stathakis, S; Papanikolaou, N

    2016-01-01

    Purpose: To quantify and compare the effect of metallic dental implants (MDI) on dose distributions calculated using Collapsed Cone Convolution Superposition (CCCS) algorithm or a Monte Carlo algorithm (with and without correcting for the density of the MDI). Methods: Seven previously treated patients to the head and neck region were included in this study. The MDI and the streaking artifacts on the CT images were carefully contoured. For each patient a plan was optimized and calculated using the Pinnacle3 treatment planning system (TPS). For each patient two dose calculations were performed, a) with the densities of the MDI and CT artifacts overridden (12 g/cc and 1 g/cc respectively) and b) without density overrides. The plans were then exported to the Monaco TPS and recalculated using Monte Carlo dose calculation algorithm. The changes in dose to PTVs and surrounding Regions of Interest (ROIs) were examined between all plans. Results: The Monte Carlo dose calculation indicated that PTVs received 6% lower dose than the CCCS algorithm predicted. In some cases, the Monte Carlo algorithm indicated that surrounding ROIs received higher dose (up to a factor of 2). Conclusion: Not properly accounting for dental implants can impact both the high dose regions (PTV) and the low dose regions (OAR). This study implies that if MDI and the artifacts are not appropriately contoured and given the correct density, there is potential significant impact on PTV coverage and OAR maximum doses.

  9. Does competition improve health care quality?

    Science.gov (United States)

    Scanlon, Dennis P; Swaminathan, Shailender; Lee, Woolton; Chernew, Michael

    2008-12-01

    To identify the effect of competition on health maintenance organizations' (HMOs) quality measures. Longitudinal analysis of a 5-year panel of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey(R) (CAHPS) data (calendar years 1998-2002). All plans submitting data to the National Committee for Quality Assurance (NCQA) were included regardless of their decision to allow NCQA to disclose their results publicly. NCQA, Interstudy, the Area Resource File, and the Bureau of Labor Statistics. Fixed-effects models were estimated that relate HMO competition to HMO quality controlling for an unmeasured, time-invariant plan, and market traits. Results are compared with estimates from models reliant on cross-sectional variation. Estimates suggest that plan quality does not improve with increased levels of HMO competition (as measured by either the Herfindahl index or the number of HMOs). Similarly, increased HMO penetration is generally not associated with improved quality. Cross-sectional models tend to suggest an inverse relationship between competition and quality. The strategies that promote competition among HMOs in the current market setting may not lead to improved HMO quality. It is possible that price competition dominates, with purchasers and consumers preferring lower premiums at the expense of improved quality, as measured by HEDIS and CAHPS. It is also possible that the fragmentation associated with competition hinders quality improvement.

  10. Plan to Have No Unplanned: A Collaborative, Hospital-Based Quality-Improvement Project to Reduce the Rate of Unplanned Extubations in the Pediatric ICU.

    Science.gov (United States)

    Tripathi, Sandeep; Nunez, Denise J; Katyal, Chaavi; Ushay, H Michael

    2015-08-01

    Although under-reported and understudied, unplanned extubations carry a significant risk of patient harm and even death. They are an important yardstick of quality control of care of intubated patients in the ICU. A unit-based risk assessment and multidisciplinary approach is required to decrease the incidence of unplanned extubations. As part of a quality-improvement initiative of Children's Hospital at Montefiore, all planned and unplanned extubations in a multidisciplinary 20-bed pediatric ICU were evaluated over a 12-month period (January to December 2010). At the end of 6 months, an interim analysis was performed, and high-risk patient groups and patient care factors were identified. These factors were targeted in the second phase of the project. Over this period, there were a total of 267 extubations, of which 231 (87%) were planned extubations and 36 (13%) were unplanned. A patient care policy targeting the risk factors was instituted, along with extensive nursing and other personnel education in the second phase. As a result of this intervention, the unplanned extubation rate in the pediatric ICU decreased from 3.55 to 2.59/100 intubation days. All subjects who had an unplanned extubation during nursing procedures or transport required re-intubation, whereas none of the unplanned extubations during ventilator weaning required re-intubation. A targeted approach based on unit-specific risk factors is most effective in quality-improvement projects. A specific policy for sedation and weaning can be very helpful in managing intubated patients and preventing unintended harm. Copyright © 2015 by Daedalus Enterprises.

  11. Sandia software guidelines: Software quality planning

    Energy Technology Data Exchange (ETDEWEB)

    1987-08-01

    This volume is one in a series of Sandia Software Guidelines intended for use in producing quality software within Sandia National Laboratories. In consonance with the IEEE Standard for Software Quality Assurance Plans, this volume identifies procedures to follow in producing a Software Quality Assurance Plan for an organization or a project, and provides an example project SQA plan. 2 figs., 4 tabs.

  12. On intra-supply chain system with an improved distribution plan, multiple sales locations and quality assurance.

    Science.gov (United States)

    Chiu, Singa Wang; Huang, Chao-Chih; Chiang, Kuo-Wei; Wu, Mei-Fang

    2015-01-01

    Transnational companies, operating in extremely competitive global markets, always seek to lower different operating costs, such as inventory holding costs in their intra- supply chain system. This paper incorporates a cost reducing product distribution policy into an intra-supply chain system with multiple sales locations and quality assurance studied by [Chiu et al., Expert Syst Appl, 40:2669-2676, (2013)]. Under the proposed cost reducing distribution policy, an added initial delivery of end items is distributed to multiple sales locations to meet their demand during the production unit's uptime and rework time. After rework when the remaining production lot goes through quality assurance, n fixed quantity installments of finished items are then transported to sales locations at a fixed time interval. Mathematical modeling and optimization techniques are used to derive closed-form optimal operating policies for the proposed system. Furthermore, the study demonstrates significant savings in stock holding costs for both the production unit and sales locations. Alternative of outsourcing product delivery task to an external distributor is analyzed to assist managerial decision making in potential outsourcing issues in order to facilitate further reduction in operating costs.

  13. Long-term mortality benefits of air quality improvement during the twelfth five-year-plan period in 31 provincial capital cities of China

    Science.gov (United States)

    Liu, Tao; Cai, Yuanyuan; Feng, Baixiang; Cao, Ganxiang; Lin, Hualiang; Xiao, Jianpeng; Li, Xing; Liu, Sha; Pei, Lei; Fu, Li; Yang, Xinyi; Zhang, Bo; Ma, Wenjun

    2018-01-01

    The severe air pollution across China in the past several years has made the Chinese government recognize its significant impacts on public health and society, and take enormous efforts to improve the air quality all over the country, especially during the Twelfth Five-Year Plan (12th FYP). However, the overall effectiveness of these air pollution control policies remains unclear. In this study, we selected the 31 municipalities and provincial capital cities in mainland China as study settings. We collected the annual average population size, mortality rates (total mortality and mortality due to cardiovascular diseases, respiratory diseases, total cancer, lung cancer and breast cancer) and concentrations of air pollutants (PM10, PM2.5, SO2 and NO2) in each capital city from 2010 to 2015 from national or local Statistical Yearbooks. The effect sizes of air pollutants on mortality were obtained from previously published meta analyses or cohort studies. We first estimated the annual mortality rates attributed to the changes in air pollutant concentrations for every city in each year. Then, we further estimated the mortality benefits in the scenarios where the air quality had reached the grade II levels of Chinese Ambient Air Quality Standards (CAAQS) and World Health Organization (WHO) guidelines. In most capital cities, we observed dominant decreases in air pollutant concentrations during the 12th FYP, particularly from 2013 to 2015, which has led to significant mortality benefits for the public. A total of 121,658 deaths (0.441‰) have been prevented due to the decrease of PM2.5concentrations from 2013 to 2015 in all included cities. The morality benefits were larger in capital cities located in the key regions (the three main regions and ten city groups) than the other cities. In addition, more mortality benefits could be obtained in the future if the air quality reaches the grade II levels of Chinese Ambient Air Quality Standards (CAAQS) or WHO guidelines. We

  14. PLANNING THE QUALITY OF LIFE FOR TIMISOARA GROWTH POLE

    Directory of Open Access Journals (Sweden)

    Cătălina-Livia POPA

    2014-06-01

    Full Text Available This paper aims to show that planning the quality of life at local level through economic development can be a new approach for policy makers and community in improving quality of life. In this purpose, the Quality Function Deployment (QFD model will be use to planning the quality of life and to identify the main directions of economic development to support improving the quality of life at the level of Timisoara Growth Pole from Romania. The dimensions of quality of life are analyzed starting from the point of view of inhabitants. The results include a new approach in which the dimensions of quality of life are the key element that orients economic development in order to improve the quality of life of human being. The case study results refer to the main elements of quality of life at Timisoara Growth Pole and the relevant directions of economic development to improve the quality of life for Timisoara Growth Pole.

  15. Directing a Quality Enhancement Plan

    Directory of Open Access Journals (Sweden)

    Ronald A. Styron, Jr.

    2015-08-01

    Full Text Available This paper is drawn from a project aimed at enhancing the quality of instructional practice and improving studentlearning outcomes in classes across an urban university located in the southern region of the United States. The strategies, employed by the project leader, are discussed in detail as framed by a new problem-solving leadership design called the Alloy Improvement Model (AIM. Data collected at the end of the second full year and reported in this paper indicated all project goals were met and that the utilization of the AIM was central to project success.

  16. Revision of Krsko NPP Quality Assurance Plan

    International Nuclear Information System (INIS)

    Biscan, R.; Fifnja, I.; Kavsek, D.

    2012-01-01

    International standards from nuclear power plant operation area are being frequently upgraded and revised in accordance with the continuous improvement philosophy. This philosophy applies also to the area of Quality Assurance, which has also undergone significant improvement since the early 1950s. Besides just nuclear industry, there are also other international quality standards that are being continuously developed and revised, bringing needs for upgrades also in the nuclear application. Since the beginning of Krsko NPP construction, the overall Quality Assurance program and its applicable procedures were in place to assure that all planned and systematic actions necessary to provide adequate confidence that an item or service will satisfy given requirements to quality, are in place. The overall requirements for quality as one of the major objectives for Krsko NPP operation are also set forth in the Updated Safety Analyses Report, the document that serves as a base for operating license. During more than 30 years of Krsko NPP operation, the quality requirements and related documents were revised and upgraded in several attempts. The latest revision 6 of QD-1, Quality Assurance Plan was issued during the year 2011. The bases for the revision were: Changes of the Slovenian regulatory requirements (ZVISJV, JV5, JV9?), Changes of Krsko NPP licensing documents (USAR section 13?), SNSA inspection requirements, Changes of international standards (IAEA, ISO?), Conclusions of first PSR, Implementation of ISO standards in Krsko NPP (ISO14001, ISO17025), Changes of plant procedures, etc. One of the most obvious changes was the enlargement of the QA Plan scope to cover interdisciplinary areas defined in the plant management program MD-1, such as Safety culture, Self-assessment, Human performance, Industrial Safety etc. The attachment of the QA Plan defining relationships between certain standards was also updated to provide matrix for better correlation of requirements of

  17. Improvement of energy efficiency and quality of street lighting in South Italy as an action of Sustainable Energy Action Plans. The case study of Comiso (RG)

    International Nuclear Information System (INIS)

    Beccali, Marco; Bonomolo, Marina; Ciulla, Giuseppina; Galatioto, Alessandra; Lo Brano, Valerio

    2015-01-01

    Existing street lighting systems, in most of South Italy cities, are often inefficient due to the obsolescence of lamps and luminaires and of ineffective light control systems unable to implement efficient on-off and dimming strategies. Energy efficiency improvement, in street lighting systems, is often one of the key actions to be adopted by Public Administration in their Sustainable Energy Action Plan in the framework of the “Covenant of Majors” activities. As a task of FACTOR 20 project, a set of planning options has been analysed and proposed. Particularly, street lighting efficiency projects have been studied for representative case studies. A detailed survey of the public lighting systems, in Comiso, allowed represent current performance figures such us installed power, luminance and illuminance levels in roads categories, electricity consumption, switching and dimming schedules. A project of system upgrade has been elaborated. To do this, many lighting simulations, energy and economic assessments in three scenarios have been performed. The obtained results show that high improvements of the lighting quality are foreseeable together with large energy and economic saving. An economic sensitivity analysis, has shown how the performance can change. The proposed methodology can be applied in many similar South Italy cities. - Highlights: • Retrofit actions in urban lighting systems of typical South Italy cities are studied. • A methodology for the comparison of baseline and design scenarios is presented. • An analysis of energy and economic savings of different scenarios is performed. • A sensitivity analysis of payback times is presented for different costs of LED and kWhe.

  18. Quality of family planning services in Northwest Ethiopia | Fantahun ...

    African Journals Online (AJOL)

    Background: The unmet need for family planning services in Ethiopia is believed to be high (36%) while the already available services do not appear to be optimally used by potential clients. It is thus expected that an assessment and improvement of the quality of family planning services could enhance family planning ...

  19. 23 CFR 1200.25 - Improvement plan.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Improvement plan. 1200.25 Section 1200.25 Highways... Implementation and Management of the Highway Safety Program § 1200.25 Improvement plan. If a review of the Annual... improvement plan. This plan will detail strategies, program activities, and funding targets to meet the...

  20. Quality Assurance Project Plan for Facility Effluent Monitoring Plan activities

    International Nuclear Information System (INIS)

    Nickels, J.M.

    1991-06-01

    This Quality Assurance Project Plan addresses the quality assurance requirements for the Facility Monitoring Plans of the overall site-wide environmental monitoring plan. This plan specifically applies to the sampling and analysis activities and continuous monitoring performed for all Facility Effluent Monitoring Plan activities conducted by Westinghouse Hanford Company. It is generic in approach and will be implemented in conjunction with the specific requirements of individual Facility Effluent Monitoring Plans. This document is intended to be a basic road map to the Facility Effluent Monitoring Plan documents (i.e., the guidance document for preparing Facility Effluent Monitoring Plans, Facility Effluent Monitoring Plan determinations, management plan, and Facility Effluent Monitoring Plans). The implementing procedures, plans, and instructions are appropriate for the control of effluent monitoring plans requiring compliance with US Department of Energy, US Environmental Protection Agency, state, and local requirements. This Quality Assurance Project Plan contains a matrix of organizational responsibilities, procedural resources from facility or site manuals used in the Facility Effluent Monitoring Plans, and a list of the analytes of interest and analytical methods for each facility preparing a Facility Effluent Monitoring Plan. 44 refs., 1 figs., 2 tabs

  1. Trading emissions improve air quality

    International Nuclear Information System (INIS)

    Lents, J.M.

    1993-01-01

    While admitting sharply contrasting views exist, James M. Lents of the South Coast Air Quality Management District in southern California sees emissions trading open-quotes as a lifesaver for our troubled planet.close quotes He explains: open-quotes If political support for the environment is to be maintained, we must seek the most economical and flexible means of pursuing cleanup. At present, market incentives and emissions trading represent our best hope.close quotes Lents is putting his money where his pen is. The air quality management district he heads plans to use market incentives, including emissions trading, to reduce air pollution in the notoriously dirty southern California area. When the system goes into operation in 1994, he estimates it will save southern California businesses more than $400 million a year in compliance costs, while also making major improvements in the region's air quality. If the idea works there, why won't it work elsewhere, even on a global scale, Lents asks? He believes it will. But open-quotes the ultimate success of emissions-trading programs, whether regional, national, or international in scope, lies in the proof that they're actually achieving reductions in harmful emissions,close quotes he emphasizes. open-quotes These reductions must be real and verifiable to satisfy the Clean Air Act and a skeptical public.close quotes

  2. Workers' Objectives in Quality Improvement.

    Science.gov (United States)

    Brossard, Michel

    1990-01-01

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

  3. How to Begin a Quality Improvement Project.

    Science.gov (United States)

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

    2016-05-06

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

  4. Quality planning for major plant design modifications

    International Nuclear Information System (INIS)

    Dulee, R.J.

    1988-01-01

    This paper reviews the approach and activities undertaken by Public Service Electric and Gas Company's (PSE and G's) nuclear quality assurance (QA) department to support major plant design modifications conducted during refueling outages at Salem Generating Station. It includes the planning and implementation of quality plans developed to provide both QA and quality control (QC) coverage of modification performed by contracted service organizations

  5. Statistical methods for quality improvement

    National Research Council Canada - National Science Library

    Ryan, Thomas P

    2011-01-01

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

  6. Renewing focus on family planning service quality globally.

    Science.gov (United States)

    Hancock, Nancy L; Stuart, Gretchen S; Tang, Jennifer H; Chibwesha, Carla J; Stringer, Jeffrey S A; Chi, Benjamin H

    2016-01-01

    Reducing the global unmet need for contraception is currently a priority for many governments, multi-lateral initiatives, non-governmental organizations, and donors. Evidence strongly suggests that the provision of quality family planning services can increase uptake, prevalence, and continuation of contraception. While an accepted framework to define the components of family planning service quality exists, translating this framework into assessment tools that are accessible, easily utilized, and valid for service providers has remained a challenge. We propose new approaches to improve the standardization and accessibility of family planning service quality assessment tools to simplify family planning service quality evaluation. With easier approaches to program evaluation, quality improvements can be performed more swiftly to help increase uptake and continuation of contraception to improve the health of women and their families.

  7. Integrating Planning, Assessment, and Improvement in Higher Education

    Science.gov (United States)

    Sherlock, Barbara J.

    2009-01-01

    Based on Penn State's popular "Innovation Insights" series, this book brings together in one handy reference nearly a decade of tried and true insights into continuous quality improvements in higher education. Their five-step model for integrating planning, assessment, and improvement moves plans off the shelf and into the weekly and daily…

  8. Visions, Strategic Planning, and Quality--More than Hype.

    Science.gov (United States)

    Kaufman, Roger

    1996-01-01

    Discusses the need to shift from the old models for organizational development to the new methods of quality management and continuous improvement, visions and visioning, and strategic planning, despite inappropriate criticisms they receive. (AEF)

  9. Internal quality control: planning and implementation strategies.

    Science.gov (United States)

    Westgard, James O

    2003-11-01

    The first essential in setting up internal quality control (IQC) of a test procedure in the clinical laboratory is to select the proper IQC procedure to implement, i.e. choosing the statistical criteria or control rules, and the number of control measurements, according to the quality required for the test and the observed performance of the method. Then the right IQC procedure must be properly implemented. This review focuses on strategies for planning and implementing IQC procedures in order to improve the quality of the IQC. A quantitative planning process is described that can be implemented with graphical tools such as power function or critical-error graphs and charts of operating specifications. Finally, a total QC strategy is formulated to minimize cost and maximize quality. A general strategy for IQC implementation is recommended that employs a three-stage design in which the first stage provides high error detection, the second stage low false rejection and the third stage prescribes the length of the analytical run, making use of an algorithm involving the average of normal patients' data.

  10. Checklist for Reviewing EPA Quality Management Plans

    Science.gov (United States)

    This checklist will be used to review the Quality Management Plans (QMPs) that are submitted to the Quality Staff of the Office of Environmental Information (OEI) for Agency review under EPA Order 5360.1 A2.

  11. Quality Assurance Planning for Region 9

    Science.gov (United States)

    The ultimate success of an environmental program or project depends on the quality of the environmental data collected and used in decision-making. EPA has developed guidances to help state and tribal governments develop Quality Assurance Program Plans.

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

    Science.gov (United States)

    Vogelsang, J

    1999-04-01

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

  13. Improving the quality of life.

    Science.gov (United States)

    Suyono, H

    1993-12-01

    It is encouraging that most developing countries now have population policies, but it is discouraging that some countries have been unable to implement their policies. Therefore, Indonesia believes technical cooperation should be strengthened among developing countries. International cooperation is working in 108 developing countries, but the desired impact has yet to be reached, and the quality of life in many countries is still unacceptable. For example, life expectancy at birth in developing countries is 14-17 years shorter for females and 10-13 years shorter for males as compared to developed countries which have superior health and welfare systems. The speed of population growth is also hindering efforts to help improve living conditions, and the biggest increase in growth will occur in Asia and Africa. This will increase the numbers of poor, hungry, and illiterate in developing countries and will lead to a lack of arable land, deterioration in education, and increase in unsafe sanitation. In order to slow population growth, quality family planning (FP) services must be provided to those who want them. By the year 2000, developed countries and donors should be ready to provide half of the required US$10.5 billion to FP services in developing countries. In Indonesia, population programs and policies have been governed by the National FP Coordinating Board as well as by the State Ministry for Population and the Environment, which was divided into two ministries in 1993 in order to deal with the enormity and seriousness of the two issues.

  14. Una clave para la calidad de la institución educativa: Los planes de mejora The plans of improvement: a key for the quality of educational institutions

    Directory of Open Access Journals (Sweden)

    José Antonio Pareja Fernández de la Reguera

    2006-12-01

    Full Text Available En el artículo se plantea la relación existente entre los "planes de mejora y las organizaciones educativas que aprenden", además de cómo la calidad educativa no tiene sentido, actualmente, sin su simbiosis. Por otra parte, la paradójica situación generada por el acercamiento de los modelos empresariales de gestión de la calidad, al ámbito educativo, se ve resuelta cuando los planes de mejora se basan en la institución educativa, en la escuela como unidad, pero también en el docente como eje del proceso de cambio. Las innovaciones que se desarrollen deben empezar en el aula, pero deben influir en todos los niveles de la organización. No existirá mejora de la escuela sin decisiones claras sobre el desarrollo y el mantenimiento del proceso. Ha de intentarse equilibrar "el cambio y la estabilidad", o dicho de otro modo, tomar decisiones sobre qué cambios llevar a cabo y cómo relacionarlos entre sí, manteniendo lo bueno y positivo que hay en la escuela sin dejar de responder a la innovación. El éxito de la mejora de la escuela implica adaptar cambios externos a propósitos internos. Así, está demostrado cómo las escuelas que reconocen la consonancia entre prioridades internas propias del centro y las exigencias externas (más propias del contexto sociocultural responden mejor a la reforma educativa.The article talks about the relationship between "plans of improvement and educational organizations that learn", and about how the quality in education does not make sense, at the moment, without their symbiosis. On the other hand, the paradoxical situation generated by the approach of Education to business and quality management models, is solved when the plans of improvement are based on the educational institution, at school as a unit, but also on the teacher as the axis of the process of change. The innovations to be developed should begin at the classroom, but they should affect every level of the organization. No school

  15. Noncoplanar VMAT for nasopharyngeal tumors: Plan quality versus treatment time

    International Nuclear Information System (INIS)

    Wild, Esther; Bangert, Mark; Nill, Simeon; Oelfke, Uwe

    2015-01-01

    treatment plan quality. Conclusions: The authors’ study reconfirms the dosimetric benefits of noncoplanar irradiation of nasopharyngeal tumors. Both SnS using optimized noncoplanar beam ensembles and VMAT using an optimized, arbitrary, noncoplanar trajectory enabled dose reductions in organs at risk compared to coplanar SnS and VMAT. Using great circles or simple couch rotations to implement noncoplanar VMAT, however, was not sufficient to yield meaningful improvements in treatment plan quality. The authors estimate that noncoplanar VMAT using arbitrary optimized irradiation trajectories comes at an increased delivery time compared to coplanar VMAT yet at a decreased delivery time compared to noncoplanar SnS IMRT

  16. Noncoplanar VMAT for nasopharyngeal tumors: Plan quality versus treatment time

    Energy Technology Data Exchange (ETDEWEB)

    Wild, Esther, E-mail: e.wild@dkfz.de; Bangert, Mark [Department of Medical Physics in Radiation Oncology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg (Germany); Nill, Simeon [Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG (United Kingdom); Oelfke, Uwe [Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, United Kingdom and Department of Medical Physics in Radiation Oncology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg (Germany)

    2015-05-15

    treatment plan quality. Conclusions: The authors’ study reconfirms the dosimetric benefits of noncoplanar irradiation of nasopharyngeal tumors. Both SnS using optimized noncoplanar beam ensembles and VMAT using an optimized, arbitrary, noncoplanar trajectory enabled dose reductions in organs at risk compared to coplanar SnS and VMAT. Using great circles or simple couch rotations to implement noncoplanar VMAT, however, was not sufficient to yield meaningful improvements in treatment plan quality. The authors estimate that noncoplanar VMAT using arbitrary optimized irradiation trajectories comes at an increased delivery time compared to coplanar VMAT yet at a decreased delivery time compared to noncoplanar SnS IMRT.

  17. 24 CFR 901.145 - Improvement Plan.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Improvement Plan. 901.145 Section... PUBLIC HOUSING MANAGEMENT ASSESSMENT PROGRAM § 901.145 Improvement Plan. (a) After receipt of the State... a PHA, or a RMC through the PHA, to prepare and submit to the State/Area Office an Improvement Plan...

  18. Improving treatment plan evaluation with automation

    Science.gov (United States)

    Covington, Elizabeth L.; Chen, Xiaoping; Younge, Kelly C.; Lee, Choonik; Matuszak, Martha M.; Kessler, Marc L.; Keranen, Wayne; Acosta, Eduardo; Dougherty, Ashley M.; Filpansick, Stephanie E.

    2016-01-01

    The goal of this work is to evaluate the effectiveness of Plan‐Checker Tool (PCT) which was created to improve first‐time plan quality, reduce patient delays, increase the efficiency of our electronic workflow, and standardize and automate the physics plan review in the treatment planning system (TPS). PCT uses an application programming interface to check and compare data from the TPS and treatment management system (TMS). PCT includes a comprehensive checklist of automated and manual checks that are documented when performed by the user as part of a plan readiness check for treatment. Prior to and during PCT development, errors identified during the physics review and causes of patient treatment start delays were tracked to prioritize which checks should be automated. Nineteen of 33 checklist items were automated, with data extracted with PCT. There was a 60% reduction in the number of patient delays in the six months after PCT release. PCT was successfully implemented for use on all external beam treatment plans in our clinic. While the number of errors found during the physics check did not decrease, automation of checks increased visibility of errors during the physics check, which led to decreased patient delays. The methods used here can be applied to any TMS and TPS that allows queries of the database. PACS number(s): 87.55.‐x, 87.55.N‐, 87.55.Qr, 87.55.tm, 89.20.Bb PMID:27929478

  19. Improving the Quality of Think-Alouds

    Science.gov (United States)

    Ness, Molly; Kenny, MaryBeth

    2016-01-01

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

  20. Preoperative teaching and stoma marking in an inpatient population: a quality improvement process using a FOCUS-Plan-Do-Check-Act model.

    Science.gov (United States)

    Zimnicki, Katherine M

    2015-01-01

    Preoperative teaching and stoma marking are supported by research and included in clinical practice guidelines from the WOCN Society and others. Using a FOCUS-Plan-Do-Check-Act model of Total Quality Management, a multidisciplinary team was formed that developed a flow chart outlining the process of care for patients undergoing planned ostomy surgery that included an educational intervention that enabled staff nurses to perform preoperative stoma site marking and education. After 3 months, we found a statistically significant increase in the number of surgical patients who received these evidence-based interventions (14% vs 64%; χ = 9.32; P = .002).

  1. Identifying Contractors’ Planned Quality Costs in Indonesian Construction Projects

    Directory of Open Access Journals (Sweden)

    Puti F. Marzuki

    2014-12-01

    Full Text Available In a very competitive construction industry, quality costs have to be measured to be able to identify potential quality problem areas and to focus attention on work output improvement opportunities. The awareness of contractors on the importance of quality costs could be reflected in the extent of their quality costs planning. This paper presents an identification of planned quality costs in three construction projects executed by two large Indonesian contractors, a state-owned company and a private company in Jakarta. The objective is to enable the contractors to elaborate their quality costs planning and thereby improve their work output based on the findi ngs. Quality costs are first grouped into three categories: prevention, appraisal, and failure costs. Based on the works of previous researchers, a list of quality management activities that should be covered in each quality costs category is then created. The contractors’ planned quality costs data for each category are identified and collected through interviews and questionnaire surveys that refer to the list. Quality costs are expressed as a percentage of contract value. It is revealed that although large contractors already have certain knowledge on quality costs in construction projects, these costs are not planned in a structured way through an analysis of systematic quality costs records. Through cost categorization it is also shown that higher prevention and appraisal costs lead to lower failure costs. It is then concluded that a lot of work is still to be done by the contractors to set up a quality costs recording system which can serve as a basis for their quality improvement planning.

  2. Preanalytical quality improvement : in quality we trust

    OpenAIRE

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

    2013-01-01

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

  3. Quality improvement: the nurse's role.

    Science.gov (United States)

    Moran, M J; Johnson, J E

    1992-06-01

    Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers

  4. [Quality planning of Family Health Units using Quality Function Deployment (QFD)].

    Science.gov (United States)

    Volpato, Luciana Fernandes; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos; Ambrosano, Gláucia Maria Bovi

    2010-08-01

    Quality is an indispensible requirement in the health field, and its pursuit is necessary in order to meet demands by a population that is aware of its rights, as part of the essence of good work relations, and to decrease technological costs. Quality thus involves all parties to the process (users and professionals), and is no longer merely an attribute of the health service. This study aimed to verify the possibility of quality planning in the Family Health Units, using Quality Function Deployment (QFD). QFD plans quality according to user satisfaction, involving staff professionals and identifying new approaches to improve work processes. Development of the array, called the House of Quality, is this method's most important characteristics. The results show a similarity between the quality demanded by users and the quality planned by professionals. The current study showed that QFD is an efficient tool for quality planning in public health services.

  5. SU-F-J-71: Improving CT Quality for Radiation Therapy Planning and Delivery Guidance Using a Non-Linear Contrast Enhancement Technique

    Energy Technology Data Exchange (ETDEWEB)

    Noid, G; Tai, A; Li, X [Medical College of Wisconsin, Milwaukee, WI (United States)

    2016-06-15

    Purpose: Advanced image post-processing techniques which enhance soft-tissue contrast in CT have not been widely employed for RT planning or delivery guidance. The purpose of this work is to assess the soft-tissue contrast enhancement from non-linear contrast enhancing filters and its impact in RT. The contrast enhancement reduces patient alignment uncertainties. Methods: Non-linear contrast enhancing methods, such as Best Contrast (Siemens), amplify small differences in X-ray attenuation between two adjacent structure without significantly increasing noise. Best Contrast (BC) separates a CT into two frequency bands. The low frequency band is modified by a non-linear scaling function before recombination with the high frequency band. CT data collected using a CT-on-rails (Definition AS Open, Siemens) during daily CT-guided RT for 6 prostate cancer patients and an image quality phantom (The Phantom Laboratory) were analyzed. Images acquired with a standard protocol (120 kVp, 0.6 pitch, 18 mGy CTDIvol) were processed before comparison to the unaltered images. Contrast and noise were measured in the the phantom. Inter-observer variation was assessed by placing prostate contours on the 12 CT study sets, 6 enhanced and 6 unaltered, in a blinded study involving 8 observers. Results: The phantom data demonstrate that BC increased the contrast between the 1.0% supra-slice element and the background substrate by 46.5 HU while noise increased by only 2.3 HU. Thus the contrast to noise ratio increased from 1.28 to 6.71. Furthermore, the variation in centroid position of the prostate contours was decreased from 1.3±0.4 mm to 0.8±0.3 mm. Thus the CTV-to-PTV margin was reduced by 1.1 mm. The uncertainty in delineation of the prostate/rectum edge decreased by 0.5 mm. Conclusion: As demonstrated in phantom and patient scans the BC filter accentuates soft-tissue contrast. This enhancement leads to reduced inter-observer variation, which should improve RT planning and delivery

  6. NETWORKS AND QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Miodrag Hadžistević

    2009-12-01

    Full Text Available Tools used in the past to analyze business value creation, such as value chain and process models, are simply too slow, inadequate, or inappropriate to address this new level of business complexity. In stead of that, company has to find way to create quality management system in a multi-layered supply chain. The problem can be solved by networking in the cluster. Cluster can be known as a competitive cooperation in the purpose to gain higher level of competitiveness and success. Bat there is another problem: Organization of the production process in a company is extremely complex process itself, and when we transfer it to the cluster level, we get a complex task which is difficult to solve. For that purpose, this paper analyses the conditions and possibilities that would enable those structures to adapt to changes in the surroundings - flexibility and management adequacy of production and organizational structures - by creating network value system.

  7. Quality planning and executive force of program files in quality management

    International Nuclear Information System (INIS)

    Sun Danyu

    2008-01-01

    This paper discussed the quality planning in quality management. In the quality planning, the quality objectives, the quality liabilities and the procedures shall be developed, grading supervise shall be exercised, quality assurance program shall be established, and requirements on resource and documents shall be defined. At the same time, we shall also intensify and enhance the execute force of program documentation, supervise and inspect the implementation result, establish detailed check indicators, and bring up the requirement on how to improve the quality of products. (author)

  8. Transuranic Waste Characterization Quality Assurance Program Plan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-04-30

    This quality assurance plan identifies the data necessary, and techniques designed to attain the required quality, to meet the specific data quality objectives associated with the DOE Waste Isolation Pilot Plant (WIPP). This report specifies sampling, waste testing, and analytical methods for transuranic wastes.

  9. Transuranic Waste Characterization Quality Assurance Program Plan

    International Nuclear Information System (INIS)

    1995-01-01

    This quality assurance plan identifies the data necessary, and techniques designed to attain the required quality, to meet the specific data quality objectives associated with the DOE Waste Isolation Pilot Plant (WIPP). This report specifies sampling, waste testing, and analytical methods for transuranic wastes

  10. The 2000 DOD Financial Management Improvement Plan

    National Research Council Canada - National Science Library

    2001-01-01

    .... As a result, DoD has prepared the Financial Management Improvement Plan (the Plan), which is a strategic framework that includes the Departments financial management concept of operations for the future...

  11. Quality Customer Service Action Plan

    International Nuclear Information System (INIS)

    2008-12-01

    Since its establishment in 1992 the RPII has been committed to the provision of high quality services to its customers. This report outlines how the RPII will work towards providing a high quality service to our customers and the standards we aim for in the provision of our services

  12. Preanalytical quality improvement: in quality we trust.

    Science.gov (United States)

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

    2013-01-01

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

  13. The two (quality) faces of HCHP (Harvard Community Health Plan).

    Science.gov (United States)

    Burda, D

    1991-03-18

    When it comes to total quality management, Harvard Community Health Plan has two personalities. It's using the principles espoused by such TQM gurus as Joseph Juran to reduce costs and improve quality in its clinics and offices. But HCHP also is enhancing its image in the healthcare industry by teaching TQM principles to others for big bucks.

  14. Quality assurance program plan for Building 324

    International Nuclear Information System (INIS)

    Tanke, J.M.

    1997-01-01

    This Quality Assurance Program Plan (QAPP) provides an overview of the quality assurance program for Building 324. This plan supersedes the PNNL Nuclear Facilities Quality Management System Description, PNL-NF-QMSD, Revision 2, dated March 1996. The program applies to the facility safety structures, systems, and components and to activities that could affect safety structures, systems, and components. Adherence to the quality assurance program ensures the following: US Department of Energy missions and objectives are effectively accomplished; Products and services are safe, reliable, and meet or exceed the requirements and expectations of the user; Hazards to the public, to Hanford Site and facility workers, and to the environment are minimized. The format of this Quality Assurance Program Plan is structured to parallel that of 10 CFR 83 0.120, Quality Assurance Requirements

  15. Improving planning, design, reporting and scientific quality of animal experiments by using the Gold Standard Publication Checklist, in addition to the ARRIVE guidelines

    NARCIS (Netherlands)

    Hooijmans, C.R.; Vries, R.B.M. de; Leenaars, M.; Curfs, J.H.A.J.; Ritskes-Hoitinga, M.

    2011-01-01

    Several studies have demonstrated serious omissions in the way research that use animals is reported. In order to improve the quality of reporting of animal experiments, the Animals in research: reporting in vivo experiments (ARRIVE) Guidelines were published in the British Journal of Pharmacology

  16. Improvement of quality service in Uruguay - plans developed and its results in the period 93-95. Fault statistic as a parameter of measurement

    Energy Technology Data Exchange (ETDEWEB)

    Carrasco, J.; Rodriguez, R.; Rondoni, A.; Pardo, A. [U.T.E. (Uruguay)

    1997-12-31

    The present paper aims to describe the improvement process of the quality of the product and the technical service that has been undertaken in UTE since 1990 and to show the results obtained so far as well as the actions foreseen in the future. In addition the system for the quality control is developed. It is structured based on global and individual indexes supported by the corporate centralised and distributed informatic tools that the company possess. This control system has allowed us to carry out a pursuit of the relative evolution of the quality year to year and to establish absolute comparisons with companies from the region and from Europe. The current situation and the improvements for Montevideo, are described. (author)

  17. 40 CFR 130.6 - Water quality management plans.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... and certified and approved updates to those plans. Continuing water quality planning shall be based...

  18. SWiFT Software Quality Assurance Plan.

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Jonathan Charles [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-01-01

    This document describes the software development practice areas and processes which contribute to the ability of SWiFT software developers to provide quality software. These processes are designed to satisfy the requirements set forth by the Sandia Software Quality Assurance Program (SSQAP). APPROVALS SWiFT Software Quality Assurance Plan (SAND2016-0765) approved by: Department Manager SWiFT Site Lead Dave Minster (6121) Date Jonathan White (6121) Date SWiFT Controls Engineer Jonathan Berg (6121) Date CHANGE HISTORY Issue Date Originator(s) Description A 2016/01/27 Jon Berg (06121) Initial release of the SWiFT Software Quality Assurance Plan

  19. KCBX Quality Assurance Project Plan - October 2014

    Science.gov (United States)

    This revised plan's standards for data quality, sampling and testing methods, and task management guide the implementation of Ambient Air Monitoring by URS Corporation at the KCBX Terminals Company North and South Terminals in Chicago, Ill.

  20. KCBX Quality Assurance Project Plan - February 2014

    Science.gov (United States)

    This plan's standards for data quality, sampling and testing methods, and task management guide the implementation of Ambient Air Monitoring, by URS Corporation, at the KCBX Terminals Company North and South Terminals in Chicago, IL.

  1. Quality Assurance Project Plan Development Tool

    Science.gov (United States)

    This tool contains information designed to assist in developing a Quality Assurance (QA) Project Plan that meets EPA requirements for projects that involve surface or groundwater monitoring and/or the collection and analysis of water samples.

  2. Improving and monitoring air quality.

    Science.gov (United States)

    DuPont, André

    2018-05-01

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

  3. Performance improvement plan in customer technical services

    International Nuclear Information System (INIS)

    Lachambre, L.

    1995-01-01

    This presentation centred around the philosophy, goals, and initiatives associated with Gaz Metropolitain's performance improvement plan. Various aspects of the plan including customer surveys, new customer service policies, the creation of small working units, the decentralization of the Montreal service department, and customer-harmonized shift schedules were explored. Implementation of new service plans and contracts, the formation of improvement groups related to human resources, human resource and productivity management, leadership training, and the use of performance indicators were also explained

  4. IMPROVING QUALITY MANAGEMENT IN PANIFICATION

    Directory of Open Access Journals (Sweden)

    Cornelia Petroman

    2010-12-01

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

  5. 75 FR 61367 - Revisions to the California State Implementation Plan, South Coast Air Quality Management District

    Science.gov (United States)

    2010-10-05

    ... the California State Implementation Plan, South Coast Air Quality Management District AGENCY... the South Coast Air Quality Management District (SCAQMD) portion of the California State... Measure for Architectural Coatings,'' CARB, October 2007. 4. ``Improving Air Quality with Economic...

  6. 77 FR 66780 - Revisions to the California State Implementation Plan, South Coast Air Quality Management District

    Science.gov (United States)

    2012-11-07

    ... the California State Implementation Plan, South Coast Air Quality Management District AGENCY... the South Coast Air Quality Management District (SCAQMD) portion of the California State... Control Measure for Architectural Coatings,'' CARB, October 2007. 4. ``Improving Air Quality with Economic...

  7. Organisational travel plans for improving health.

    Science.gov (United States)

    Hosking, Jamie; Macmillan, Alexandra; Connor, Jennie; Bullen, Chris; Ameratunga, Shanthi

    2010-03-17

    quality and extracted data. Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre-selected group who were already contemplating or preparing for active travel, found improved health-related quality of life on some sub scales, and increased walking. Two controlled before-after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No included studies were conducted in low- or middle-income countries, and no studies measured the social distribution of effects or adverse effects, such as injury. There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly-designed research studies, such as well-designed cluster randomised trials.

  8. Improving 4D plan quality for PBS-based liver tumour treatments by combining online image guided beam gating with rescanning

    Science.gov (United States)

    Zhang, Ye; Knopf, Antje-Christin; Weber, Damien Charles; Lomax, Antony John

    2015-10-01

    Pencil beam scanned (PBS) proton therapy has many advantages over conventional radiotherapy, but its effectiveness for treating mobile tumours remains questionable. Gating dose delivery to the breathing pattern is a well-developed method in conventional radiotherapy for mitigating tumour-motion, but its clinical efficiency for PBS proton therapy is not yet well documented. In this study, the dosimetric benefits and the treatment efficiency of beam gating for PBS proton therapy has been comprehensively evaluated. A series of dedicated 4D dose calculations (4DDC) have been performed on 9 different 4DCT(MRI) liver data sets, which give realistic 4DCT extracting motion information from 4DMRI. The value of 4DCT(MRI) is its capability of providing not only patient geometries and deformable breathing characteristics, but also includes variations in the breathing patterns between breathing cycles. In order to monitor target motion and derive a gating signal, we simulate time-resolved beams’ eye view (BEV) x-ray images as an online motion surrogate. 4DDCs have been performed using three amplitude-based gating window sizes (10/5/3 mm) with motion surrogates derived from either pre-implanted fiducial markers or the diaphragm. In addition, gating has also been simulated in combination with up to 19 times rescanning using either volumetric or layered approaches. The quality of the resulting 4DDC plans has been quantified in terms of the plan homogeneity index (HI), total treatment time and duty cycle. Results show that neither beam gating nor rescanning alone can fully retrieve the plan homogeneity of the static reference plan. Especially for variable breathing patterns, reductions of the effective duty cycle to as low as 10% have been observed with the smallest gating rescanning window (3 mm), implying that gating on its own for such cases would result in much longer treatment times. In addition, when rescanning is applied on its own, large differences between volumetric

  9. Laboratory quality improvement in Thailand's northernmost provinces.

    Science.gov (United States)

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

    2010-01-01

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

  10. Approved Air Quality Implementation Plans in Region 10

    Science.gov (United States)

    Landing page for information about EPA-approved air quality State Implementation Plans (SIPs), Tribal Implementation Plans (TIPs), and Federal Implementation Plans (FIPs) in Alaska, Idaho, Oregon, Washington.

  11. Planned activities to improve safety

    International Nuclear Information System (INIS)

    1998-01-01

    This document presents the fulfilling of the Brazilian obligations under the Convention on Nuclear Safety. The Chapter 6 of the document contains some details about the planed activities to safety improvements

  12. Methodology of quality improvement projects for the Texas Medicare population.

    Science.gov (United States)

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

    1998-07-01

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

  13. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

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

    1998-01-01

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

  14. Continuous improvement of software quality

    International Nuclear Information System (INIS)

    Sivertsen, Terje

    1999-04-01

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

  15. Research and development quality assurance planning

    Energy Technology Data Exchange (ETDEWEB)

    Hoke, P.B.

    1990-05-14

    Planning for quality assurance (QA) in research and development (R D) is like stealing eggs without waking up the chickens. The QA program should be as unobtrusive as possible. Researchers require a QA program that affords them an environment capable of supporting repeatable experiments with accurate data without unduly stifling their creative abilities. Careful advance planning ensures that the intensity of control provided by quality-related systems is commensurate with the importance and scope of the activities being performed. Good scientific practices applied to small bench-scale projects may require minimal additional controls. As projects increase in size and complexity the controls imposed through planning must, by necessity, be increased. Research and development QA planning, just like any other planning, involves all affected individuals. The application of control systems is determined by factors such as customer or sponsor requirements, the importance of an item or activity to the experiment's success, and the organizational complexity of the project. Many larger experiments are highly dependent on quality-related support activities such as calibration, engineering design, and inspection provided by organizations outside the R D group. Since, in most cases, the expense of support activities is taken directly from funds available for research, it is important for the researchers to be involved in the planning efforts to help determine and agree with the level of QA effort required. A single plan will often suffice for organizations engaged in large numbers of similar experiments. Complex experiments may require unique QA plans or additions to existing plans. Once implemented, the R D QA plans, like any others, require audits or surveillances and may require revisions if the scope of the experiment changes. 1 ref., 1 fig.

  16. Research and development quality assurance planning

    International Nuclear Information System (INIS)

    Hoke, P.B.

    1990-01-01

    Planning for quality assurance (QA) in research and development (R ampersand D) is like stealing eggs without waking up the chickens. The QA program should be as unobtrusive as possible. Researchers require a QA program that affords them an environment capable of supporting repeatable experiments with accurate data without unduly stifling their creative abilities. Careful advance planning ensures that the intensity of control provided by quality-related systems is commensurate with the importance and scope of the activities being performed. Good scientific practices applied to small bench-scale projects may require minimal additional controls. As projects increase in size and complexity the controls imposed through planning must, by necessity, be increased. Research and development QA planning, just like any other planning, involves all affected individuals. The application of control systems is determined by factors such as customer or sponsor requirements, the importance of an item or activity to the experiment's success, and the organizational complexity of the project. Many larger experiments are highly dependent on quality-related support activities such as calibration, engineering design, and inspection provided by organizations outside the R ampersand D group. Since, in most cases, the expense of support activities is taken directly from funds available for research, it is important for the researchers to be involved in the planning efforts to help determine and agree with the level of QA effort required. A single plan will often suffice for organizations engaged in large numbers of similar experiments. Complex experiments may require unique QA plans or additions to existing plans. Once implemented, the R ampersand D QA plans, like any others, require audits or surveillances and may require revisions if the scope of the experiment changes. 1 ref., 1 fig

  17. The Genesis of a Trauma Performance Improvement Plan.

    Science.gov (United States)

    Pidgeon, Kristopher

    2015-01-01

    The purpose of this article is to assist the trauma medical and program director with developing a performance improvement and patients safety plan (PIPS), which is a required component of a successful trauma verification process by the American College of Surgeons. This article will review trauma quality standards and will describe in detail the required elements of a successful trauma center's performance improvement plan including a written comprehensive plan that outlines the mission and vision of the PIPS Program, authority of the PIPS Program, PIPS Program Committee reporting structure to the other hospital committees, list of required PIPS multidisciplinary team members, the operational components of the utilized data management system (trauma registry), list of indicators/audit filters, levels of review, peer determinations, corrective action plan with implementation, event resolution, and reevaluation. Strategies to develop a successful trauma performance improvement plan are presented.

  18. The Individualized Teacher Improvement Plan

    Science.gov (United States)

    Hamlin, Erica

    2013-01-01

    This author states her belief that there must be an answer to devising an effective and credible way to link compensation to professional development and improved teaching. Such a model would need to be transparent, equitable, and financially manageable for the school. It would need to marry objectivity with the art of teaching, and have buy-in…

  19. Holistic needs assessment and care plans for women with gynaecological cancer: do they improve cancer-specific health-related quality of life? A randomised controlled trial using mixed methods.

    Science.gov (United States)

    Sandsund, Catherine; Towers, Richard; Thomas, Karen; Tigue, Ruth; Lalji, Amyn; Fernandes, Andreia; Doyle, Natalie; Jordan, Jake; Gage, Heather; Shaw, Clare

    2017-08-28

    Holistic needs assessment (HNA) and care planning are proposed to address unmet needs of people treated for cancer. We tested whether HNA and care planning by an allied health professional improved cancer-specific quality of life for women following curative treatment for stage I-III gynaecological cancer. Consecutive women were invited to participate in a randomised controlled study (HNA and care planning vs usual care) at a UK cancer centre. Data were collected by questionnaire at baseline, 3 and 6 months. The outcomes were 6-month change in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 (version 3), global score (primary) and, in EORTC subscales, generic quality of life and self-efficacy (secondary). The study was blinded for data management and analysis. Differences in outcomes were compared between groups. Health service utilisation and quality-adjusted life years (QALY) (from Short Form-6) were gathered for a cost-effectiveness analysis. Thematic analysis was used to interpret data from an exit interview. 150 women consented (75 per group); 10 undertook interviews. For 124 participants (61 intervention, 63 controls) with complete data, no statistically significant differences were seen between groups in the primary endpoint. The majority of those interviewed reported important personal gains they attributed to the intervention, which reflected trends to improvement seen in EORTC functional and symptom scales. Economic analysis suggests a 62% probability of cost-effectiveness at a £30 000/QALY threshold. Care plan development with an allied health professional is cost-effective, acceptable and useful for some women treated for stage I-III gynaecological cancer. We recommend its introduction early in the pathway to support person-centred care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless

  20. Quality assurance in dosimetry and treatment planning

    International Nuclear Information System (INIS)

    Cunningham, J.R.

    1984-01-01

    The considerations of tissue response to radiation absorbed dose suggest a need for an accuracy of +/-5% in its delivery. This is very demanding and its regular achievement requires careful quality control. There are three distinct phases to the delivery of the planned treatment: calibration of the radiation beam in a reference situation, calculation of the dose distribution for a patient relative to the reference dose and the delivery of the radiation to the patient as planned. Each has distinctly different quality assurance requirements and must be diligently observed if the desired accuracy is to be achieved

  1. Modalities of hemodialysis: Quality improvement

    Directory of Open Access Journals (Sweden)

    Ayman Karkar

    2012-01-01

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

  2. SNF project engineering process improvement plan

    International Nuclear Information System (INIS)

    DESAI, S.P.

    1999-01-01

    This Engineering Process Improvement Plan documents the activities and plans to be taken by the SNF Project to support its engineering process and to produce a consolidated set of engineering procedures that are fully compliant with the requirements of HNF-PRO-1819. All new procedures will be issued and implemented by September 30, 1999

  3. Improving water services through inclusive planning | IDRC ...

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

    2013-05-21

    May 21, 2013 ... ... with the municipality on a large-scale solid waste storage and recycling plant. ... As a result, not only were infrastructure and planning processes improved, but ... Clean water initiative in Peru led by former IDRC awardee.

  4. Improving Flood Management Planning in Thailand | IDRC ...

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

    According to World Bank estimates, this disaster caused US$46.5 billion in ... This project seeks to improve the Flood Management Master Plan, proposing ... New Dutch-Canadian funding for the Climate and Development Knowledge Network.

  5. Using Optimization to Improve Test Planning

    Science.gov (United States)

    2017-09-01

    OPTIMIZATION TO IMPROVE TEST PLANNING by Arlene M. Payne September 2017 Thesis Advisor: Jeffrey E. Kline Second Reader: Oleg A. Yakimenko THIS... Project (0704-0188) Washington, DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE September 2017 3. REPORT TYPE AND DATES COVERED Master’s...thesis 4. TITLE AND SUBTITLE USING OPTIMIZATION TO IMPROVE TEST PLANNING 5. FUNDING NUMBERS 6. AUTHOR(S) Arlene M. Payne 7. PERFORMING ORGANIZATION

  6. Using Lean to Advance Quality Improvement Research.

    Science.gov (United States)

    Blackmore, Christopher Craig; Williams, Barbara L; Ching, Joan M; Chafetz, Lynne A; Kaplan, Gary S

    2016-01-01

    Quality improvement research skills are not commonplace among quality improvement practitioners, and research on the effectiveness of quality improvement has not always kept pace with improvement innovation. However, the Lean tools applied to quality improvement should be equally relevant to the advancement of quality improvement research. We applied the Lean methods to develop a simplified quality improvement publication pathway enabling a small research methodology group to increase quality improvement research throughout the institution. The key innovations of the pathway are horizontal integration of the quality improvement research methods group across the institution, implementation of a Lean quality improvement research pathway, and application of a just-in-time quality improvement research toolkit. This work provides a road map and tools for the acceleration of quality improvement research. At our institution, the Lean quality improvement research approach was associated with statistically significant increases in the number (annual mean increase from 3.0 to 8.5, p = .03) and breadth of published quality improvement research articles, and in the number of quality improvement research projects currently in process. Application of Lean methods to the quality improvement research process can aid in increasing publication of quality improvement articles from across the institution.

  7. Improving coal quality and service

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-06-01

    Russia's new coal export industry has quickly produced a generation of extremely experienced operators. While improvements are happening, can buyers also expect the service, flexibility and quality control that they get from other export sources? In the light of the first-ever Coaltrans Russia conference held in April the article reports on developments in Russia's coal industry, quoting from many of the papers presented. 5 photos.

  8. 24 Command Fire Improvement Action Program Plan

    International Nuclear Information System (INIS)

    GRIFFIN, G.B.

    2000-01-01

    Fluor Hanford (FH) is responsible for providing support to the Department of Energy Richland Operations Office (RL) in the implementation of the Hanford Emergency Preparedness (EP) program. During fiscal year 2000, a number of program improvements were identified from various sources including a major range fire (24 Command Fire). Evaluations of the emergency preparedness program have confirmed that it currently meets all requirements and that performance of personnel involved is good, however the desire to effect continuous improvement resulted in the development of this improvement program plan. This program plan defines the activities that will be performed in order to achieve the desired performance improvements

  9. Quality Management Plan for the Environmental Assessment and Innovation Division

    Science.gov (United States)

    Quality management plan (QMP) which identifies the mission, roles, responsibilities of personnel with regard to quality assurance and quality management for the environmental assessment and innovation division.

  10. Quantity and quality of written feedback, action plans, and student ...

    African Journals Online (AJOL)

    Background. Mini-clinical-evaluation exercise (mini-CEX) assessment forms that have been modified with the addition of specific spaces on separate sheets are expected to improve the quantity and quality of written feedback and the action plan for further learning which is agreed upon, and to encourage written reflection.

  11. Process quality planning of quality function deployment for carrot syrup

    Science.gov (United States)

    Ekawati, Yurida; Noya, Sunday; Widjaja, Filemon

    2017-06-01

    Carrot products are rarely available in the market. Based on previous research that had been done using QFD to generate product design of carrots products, the research to produce the process quality planning had been carried out. The carrot product studied was carrot syrup. The research resulted in a process planning matrix for carrot syrup. The matrix gives information about critical process plan and the priority of the critical process plan. The critical process plan on the production process of carrot syrup consists of carrots sorting, carrots peeling, carrots washing, blanching process, carrots cutting, the making of pureed carrots, filtering carrot juice, the addition of sugar in carrot juice, the addition of food additives in carrot juice, syrup boiling, syrup filtering, syrup filling into the bottle, the bottle closure and cooling. The information will help the design of the production process of carrot syrup.

  12. MCNP trademark Software Quality Assurance plan

    International Nuclear Information System (INIS)

    Abhold, H.M.; Hendricks, J.S.

    1996-04-01

    MCNP is a computer code that models the interaction of radiation with matter. MCNP is developed and maintained by the Transport Methods Group (XTM) of the Los Alamos National Laboratory (LANL). This plan describes the Software Quality Assurance (SQA) program applied to the code. The SQA program is consistent with the requirements of IEEE-730.1 and the guiding principles of ISO 900

  13. Software quality assurance plan for GCS

    Science.gov (United States)

    Duncan, Stephen E.; Bailey, Elizabeth K.

    1990-01-01

    The software quality assurance (SQA) function for the Guidance and Control Software (GCS) project which is part of a software error studies research program is described. The SQA plan outlines all of the procedures, controls, and audits to be carried out by the SQA organization to ensure adherence to the policies, procedures, and standards for the GCS project.

  14. The Effect of School Improvement Planning on Student Achievement

    Science.gov (United States)

    Huber, David J.; Conway, James M.

    2015-01-01

    This study evaluated the hypothesis that schools in Connecticut's Alliance Districts (lowest-performing districts) with higher-quality school improvement plans (SIPs) would have higher levels of student achievement. An exploratory research question evaluated whether SIPs predicted achievement of particular subgroups. SIPs were obtained and scored…

  15. Standard Review Plan for Environmental Restoration Program Quality Management Plans

    International Nuclear Information System (INIS)

    1993-12-01

    The Department of Energy, Richland Operations Office (RL) Manual Environmental Restoration Program Quality System Requirements (QSR) for the Hanford Site, defines all quality requirements governing Hanford Environmental Restoration (ER) Program activities. The QSR requires that ER Program participants develop Quality Management Plans (QMPs) that describe how the QSR requirements will be implemented for their assigned scopes of work. This standard review plan (SRP) describes the ER program participant responsibilities for submittal of QMPs to the RL Environmental Restoration Division for review and the RL methodology for performing the reviews of participant QMPS. The SRP serves the following functions: acts as a guide in the development or revision of QMPs to assure that the content is complete and adequate; acts as a checklist to be used by the RL staff in their review of participant QMPs; acts as an index or matrix between the requirements of the QSR and implementing methodologies described in the QMPs; decreases the time and subjectivity of document reviews; and provides a formal, documented method for describing exceptions, modifications, or waivers to established ER Program quality requirements

  16. SQIMSO: Quality Improvement for Small Software Organizations

    OpenAIRE

    Rabih Zeineddine; Nashat Mansour

    2005-01-01

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

  17. A plan quality classifier derived with overlap-wall-histogram of hollow organs for automatic IMRT plan quality control of prostate cancer cases

    Directory of Open Access Journals (Sweden)

    Ting Song

    2014-03-01

    Full Text Available Purpose: We developed a plan quality classification model to assess IMRT plan quality of prostate cancer patients for automatic plan quality control. Methods: For hollow organs such as rectum and bladder, dose-wall-histogram (DWH was used to evaluate OAR dose sparing in our institution. Correspondingly, we proposed a new descriptor called overlap-wall-histogram (OWH to describe the complex spatial relationship between PTV and a hollow organ. Two metrics calculated from the OWH and DWH are introduced to quantitatively evaluate the difficulty of patient geometry for planning and plan quality in terms of OAR sparing, respectively. A linear correlation between these two metrics was observed after plotting plan quality metric as a function of geometry difficulty metric studied from a database of prostate cases treated in our institution with acceptable plan quality. Thus, a fitting line was built acting as the boundary of high quality and poor quality plans. A query plan falling above the boundary is assessed as high quality, vice versa poor quality. Results: 15 prostate IMRT plans were used to test our model. One was identified as poor quality and the others were common-level. After re-planning all plans, the dose constraints for bladder wall W75 (percentage of wall receiving more than 75Gy, W70, W65 and W60 can be reduced by 3.34%, 3%, 6.99%, 6.54% for that poor quality plan and 1.11%, 0.95%, 1.45% and 1.81% averagely for the common-level quality group, without sacrificing PTV coverage and rectum dose sparing. Conclusion: An effective model was built to provide automatic IMRT plan quality control by evaluating hollow OAR dose sparing for prostate cancer patients. Furthermore, for the query plan with poor quality, potential improvement of plan quality can be estimated and a good reference plan with similar or harder geometry can be automatically chosen from our database to help guide the re-planning if necessary.---------------------------Cite this

  18. Achieving Improvement Through Nursing Home Quality Measurement

    OpenAIRE

    Harris, Yael; Clauser, Steven B.

    2002-01-01

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

  19. Planning ahead: Improving escalation plans before the weekend.

    Science.gov (United States)

    Zarkali, Angeliki; Black, Duncan; Smee, Elizabeth; Deshraj, Anshul; Smallwood, Nicholas

    2014-01-01

    Handover is the system by which responsibility for patient care is transferred between healthcare professionals. A significant aspect of handover is the existence of an escalation plan for each patient in case of deterioration over the weekend. According to the Royal College of Physicians, all patients should have a clear escalation plan documented in the notes before a weekend, since parent medical teams (Consultant team in charge of care) are best placed to make these decisions. If left to on-call teams, at a time of deterioration over a weekend, they might not have all available information, the patient might be unable to be involved in the decisions, and the family might not be consulted. With this is mind, we decided to analyse the existing handover process in a medium sized district general hospital, with the aim of improving the process and the documentation of escalation plans. The results from our retrospective analysis of the system in place revealed a significant lack of documentation of escalation plans in the medical notes. Three sample wards were selected to analyse the current handover system and test proposed measures before hospital-wide implementation. After trialling of a physical handover meeting in addition to the existing intranet system and a proforma for the Friday ward round, the documentation of escalation plans in the patients' notes improved from 9.1% to 41.1%. Based on these results, as well as formal feedback from junior doctors and informal feedback from other staff, the physical handover meeting and Friday ward round proforma will be implemented throughout the Trust. Our interventions led to an improvement in the documentation of escalation plans in our hospital, thus saving precious time in the event of a patient's deterioration. This also ensures that families and patients are involved in the decision making process and kept informed, and reduces the burden for the weekend on-call teams.

  20. 78 FR 63929 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Revisions to Rules and...

    Science.gov (United States)

    2013-10-25

    ... requirements for grandfathered facilities. The revisions will contribute to improvement in overall air quality... to contribute to improvement of air quality and attainment or maintenance of the federal air quality...] Approval and Promulgation of Air Quality Implementation Plans; Texas; Revisions to Rules and Regulations...

  1. 222-S laboratory quality assurance plan

    International Nuclear Information System (INIS)

    Meznarich, H.K.

    1995-01-01

    This document provides quality assurance guidelines and quality control requirements for analytical services. This document is designed on the basis of Hanford Analytical Services Quality Assurance Plan (HASQAP) technical guidelines and is used for governing 222-S and 222-SA analytical and quality control activities. The 222-S Laboratory provides analytical services to various clients including, but not limited to, waste characterization for the Tank Waste Remediation Systems (TWRS), waste characterization for regulatory waste treatment, storage, and disposal (TSD), regulatory compliance samples, radiation screening, process samples, and TPA samples. A graded approach is applied on the level of sample custody, QC, data verification, and data reporting to meet the specific needs of the client

  2. Hanford Tanks Initiative quality assurance implementation plan

    International Nuclear Information System (INIS)

    Huston, J.J.

    1998-01-01

    Hanford Tanks Initiative (HTI) Quality Assurance Implementation Plan for Nuclear Facilities defines the controls for the products and activities developed by HTI. Project Hanford Management Contract (PHMC) Quality Assurance Program Description (QAPD)(HNF-PRO599) is the document that defines the quality requirements for Nuclear Facilities. The QAPD provides direction for compliance to 10 CFR 830.120 Nuclear Safety Management, Quality Assurance Requirements. Hanford Tanks Initiative (HTI) is a five-year activity resulting from the technical and financial partnership of the US Department of Energy's Office of Waste Management (EM-30), and Office of Science and Technology Development (EM-50). HTI will develop and demonstrate technologies and processes for characterization and retrieval of single shell tank waste. Activities and products associated with HTI consist of engineering, construction, procurement, closure, retrieval, characterization, and safety and licensing

  3. Quality Improvement and Learning in Productive Systems

    OpenAIRE

    Charles H. Fine

    1986-01-01

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

  4. Software quality assurance plan for viscometer

    International Nuclear Information System (INIS)

    Gimera, M.

    1994-01-01

    The in situ viscometer is a portable instrument designed to raise and lower a sphere (rheometer ball) through layers of tank waste material while recording ball position, velocity, and cable tension. In the field, the viscometer attaches to a decontamination spool piece which in turn is designed to attach to any 4-inch, 150-pound flange (typical of many available tank risers). The motion of the ball and collection of data is controlled by instrumentation and control equipment housed in a separate remote control console. This document covers the product, Viscometer Data Acquisition Software. This document provides the software quality assurance plan, verification and validation plan, and configuration management plan for developing the software for the instrumentation that will be used to obtain rheology data from Tank SY-101

  5. 42 CFR 84.40 - Quality control plans; filing requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Quality control plans; filing requirements. 84.40... Control § 84.40 Quality control plans; filing requirements. As a part of each application for approval or... proposed quality control plan which shall be designed to assure the quality of respiratory protection...

  6. 30 CFR 28.30 - Quality control plans; filing requirements.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Quality control plans; filing requirements. 28... PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.30 Quality control plans; filing... part, each applicant shall file with MSHA a proposed quality control plan which shall be designed to...

  7. Software Engineering Improvement Activities/Plan

    Science.gov (United States)

    2003-01-01

    bd Systems personnel accomplished the technical responsibilities for this reporting period, as planned. A close working relationship was maintained with personnel of the MSFC Avionics Department Software Group (ED14). Work accomplishments included development, evaluation, and enhancement of a software cost model, performing literature search and evaluation of software tools available for code analysis and requirements analysis, and participating in other relevant software engineering activities. Monthly reports were submitted. This support was provided to the Flight Software Group/ED 1 4 in accomplishing the software engineering improvement engineering activities of the Marshall Space Flight Center (MSFC) Software Engineering Improvement Plan.

  8. 45 CFR 1355.35 - Program improvement plans.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Program improvement plans. 1355.35 Section 1355.35... plans. (a) Mandatory program improvement plan. (1) States found not to be operating in substantial conformity shall develop a program improvement plan. The program improvement plan must: (i) Be developed...

  9. Solutions to Improve Educational Management Quality

    OpenAIRE

    Ramezan Jahanian; Masoomeh Motahari

    2013-01-01

    Nowadays, enhancing the quality in educational systems of different countries has gained especial importance and stand. Improving utilizing and increasing the quality in our country’s educational system is felt too. One of the utilizing factors in education system is to improve the educational management quality.In this article, effective factors in educational management quality and one of its improving solutions, thorough management quality, is analyzed.

  10. Improving Tanzanian childbirth service quality.

    Science.gov (United States)

    Jaribu, Jennie; Penfold, Suzanne; Green, Cathy; Manzi, Fatuma; Schellenberg, Joanna

    2018-04-16

    Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

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

    Science.gov (United States)

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

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

  12. A Total Quality-Control Plan with Right-Sized Statistical Quality-Control.

    Science.gov (United States)

    Westgard, James O

    2017-03-01

    A new Clinical Laboratory Improvement Amendments option for risk-based quality-control (QC) plans became effective in January, 2016. Called an Individualized QC Plan, this option requires the laboratory to perform a risk assessment, develop a QC plan, and implement a QC program to monitor ongoing performance of the QC plan. Difficulties in performing a risk assessment may limit validity of an Individualized QC Plan. A better alternative is to develop a Total QC Plan including a right-sized statistical QC procedure to detect medically important errors. Westgard Sigma Rules provides a simple way to select the right control rules and the right number of control measurements. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Quality assurance for IAEA inspection planning

    International Nuclear Information System (INIS)

    Markin, J.T.

    1986-01-01

    Under the provisions of the Treaty on Nonproliferation of Nuclear Weapons and other agreements with states, the International Atomic Energy Agency (IAEA) conducts inspections at nuclear facilities to confirm that their operation is consistent with the peaceful use of nuclear material. The Department of Safeguards at the IAEA is considering a quality assurance program for activities related to the planning of these facility inspections. In this report, we summarize recent work in writing standards for planning inspections at the types of facilities inspected by the IAEA. The standards specify the sequence of steps in planning inspections, which are: (1) administrative functions, such as arrangements for visas and travel, and communications with the state to confirm facility operating schedules and the state's acceptance of the assigned inspectors; (2) technical functions including a specification of the required inspection activities, determination of personnel and equipment resources, and a schedule for implementing the inspection activities at the facility; and (3) management functions, such as pre- and post-inspection briefings, where the planned and implemented inspection activities are reviewed

  14. Quality improvement and emerging global health priorities

    Science.gov (United States)

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

    2018-01-01

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

  15. Quality of life after planned neck dissection

    International Nuclear Information System (INIS)

    Iwae, Shigemichi; Hirayama, Yuji; Komatsu, Hirokazu

    2009-01-01

    We evaluated the effect of planned neck dissection (PND) after concurrent chemoradiotherapy (CCRT) on quality of life (QOL) by using a self-administered neck dissection questionnaire and an arm abduction test. Subjects are fourteen patients who had undergone CCRT followed by planned selective neck dissection for the treatment of mesopharyngeal and hypopharyngeal cancer. The findings of the survey were compared with thirty-two patients who had undergone CCRT alone. Patients without PND had better scores on measures of pain, constriction, numbness and appearance of the neck, but had no advantage about arm abduction. After PND, the patients who had dissected dominant hand side had lower satisfaction compared with those who had dissected non-dominant hand side. (author)

  16. Improvement of the financial planning on a railway transport

    OpenAIRE

    Bogomolova, N.; Kravchenko, O.

    2011-01-01

    In the article are considered approaches to the determination of financial planning, are chose defects of ukrainian financial planning system, is conducted analysis of financial planning and budgeting, are offered directions to improvement of financial planning in railroad transport.

  17. 40 CFR 35.2102 - Water quality management planning.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Water quality management planning. 35... Administrator shall first determine that the project is: (a) Included in any water quality management plan being implemented for the area under section 208 of the Act or will be included in any water quality management plan...

  18. 7 CFR 634.23 - Water quality plan.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Water quality plan. 634.23 Section 634.23 Agriculture... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.23 Water quality plan. (a) The participant's water quality plan, developed with technical assistance by the NRCS or its...

  19. Improving treatment planning accuracy through multimodality imaging

    International Nuclear Information System (INIS)

    Sailer, Scott L.; Rosenman, Julian G.; Soltys, Mitchel; Cullip, Tim J.; Chen, Jun

    1996-01-01

    the patient's initial fields and boost, respectively. Case illustrations are shown. Conclusions: We have successfully integrated multimodality imaging into our treatment-planning system, and its routine use is increasing. Multimodality imaging holds out the promise of improving treatment planning accuracy and, thus, takes maximum advantage of three dimensional treatment planning systems.

  20. Surfscholar business plan: quality reigns supreme

    OpenAIRE

    Einstein, Samuel

    2016-01-01

    The following master’s thesis entails a business plan for a free service-based company aimed at helping American students to enroll in fulltime master’s programs in Lisbon, Portugal for a fraction of the price of what they would be paying at home. Combining a high-quality and internationally accredited education with world-class surf, exploration and cultural enrichment is the mission. The company, SurfScholar, will function on a per student commission basis which will allow it...

  1. SNF project engineering process improvement plan

    International Nuclear Information System (INIS)

    KELMENSON, R.L.

    1999-01-01

    This Engineering Process Improvement Plan documents the activities and plans to be taken by the SNF Project (the Project) to support its engineering process and to produce a consolidated set of engineering procedures that are fully compliant with the requirements of HNF-PRO-1819 (1819). These requirements are imposed on all engineering activities performed for the Project and apply to all life-cycle stages of the Project's systems, structures and components (SSCs). This Plan describes the steps that will be taken by the Project during the transition period to ensure that new procedures are effectively integrated into the Project's work process as these procedures are issued. The consolidated procedures will be issued and implemented by September 30, 1999

  2. Metro Vancouver air quality management plan : progress report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-10-15

    The Greater Vancouver Regional District (GVRD) developed an air quality management plan (AQMP) in 2005 as a means of addressing air quality issues in the region. The plan required progress reports every 2 years as well as a comprehensive review every 5 years. The AQMP established goals to minimize risk to public health from air pollution, improve visibility, and minimize the region's contributions to global climatic change by reducing emissions; implementing local air quality management programs; and enhancing air quality information and public awareness. The AQMP also included a sustainability framework for GVRD's policies and regulations related to regional growth, service delivery and political leadership. Regional strategies for solid waste and liquid waste management were developed in 2008. The sustainability framework has developed 3 priority goals: (1) to reduce diesel particulates by 75 per cent from Metro Vancouver corporate sources by 2012, (2) to be carbon neutral by 2012 excluding solid waste operations, and (3) to reduce regional GHGs by 15 per cent by 2015, and 33 per cent by 2020. Progress updates on regional planning efforts for the AQMP were presented. The report also outlined trends and performance measures used by the GVRD, and discussed changes in air quality issues and priorities that have occurred since the AQMP was adopted in 2005. 1 tab., 8 figs.

  3. The Groundwater Performance Assessment Project Quality Assurance Plan

    International Nuclear Information System (INIS)

    Luttrell, Stuart P.

    2006-01-01

    U.S. Department of Energy (DOE) has monitored groundwater on the Hanford Site since the 1940s to help determine what chemical and radiological contaminants have made their way into the groundwater. As regulatory requirements for monitoring increased in the 1980s, there began to be some overlap between various programs. DOE established the Groundwater Performance Assessment Project (groundwater project) in 1996 to ensure protection of the public and the environment while improving the efficiency of monitoring activities. The groundwater project is designed to support all groundwater monitoring needs at the site, eliminate redundant sampling and analysis, and establish a cost-effective hierarchy for groundwater monitoring activities. This document provides the quality assurance guidelines that will be followed by the groundwater project. This QA Plan is based on the QA requirements of DOE Order 414.1C, Quality Assurance, and 10 CFR 830, Subpart A--General Provisions/Quality Assurance Requirements as delineated in Pacific Northwest National Laboratory's Standards-Based Management System. In addition, the groundwater project is subject to the Environmental Protection Agency (EPA) Requirements for Quality Assurance Project Plans (EPA/240/B-01/003, QA/R-5). The groundwater project has determined that the Hanford Analytical Services Quality Assurance Requirements Documents (HASQARD, DOE/RL-96-68) apply to portions of this project and to the subcontractors. HASQARD requirements are discussed within applicable sections of this plan

  4. Metro Vancouver air quality management plan : progress report

    International Nuclear Information System (INIS)

    2008-10-01

    The Greater Vancouver Regional District (GVRD) developed an air quality management plan (AQMP) in 2005 as a means of addressing air quality issues in the region. The plan required progress reports every 2 years as well as a comprehensive review every 5 years. The AQMP established goals to minimize risk to public health from air pollution, improve visibility, and minimize the region's contributions to global climatic change by reducing emissions; implementing local air quality management programs; and enhancing air quality information and public awareness. The AQMP also included a sustainability framework for GVRD's policies and regulations related to regional growth, service delivery and political leadership. Regional strategies for solid waste and liquid waste management were developed in 2008. The sustainability framework has developed 3 priority goals: (1) to reduce diesel particulates by 75 per cent from Metro Vancouver corporate sources by 2012, (2) to be carbon neutral by 2012 excluding solid waste operations, and (3) to reduce regional GHGs by 15 per cent by 2015, and 33 per cent by 2020. Progress updates on regional planning efforts for the AQMP were presented. The report also outlined trends and performance measures used by the GVRD, and discussed changes in air quality issues and priorities that have occurred since the AQMP was adopted in 2005. 1 tab., 8 figs

  5. Towards improvement in quality assurance

    International Nuclear Information System (INIS)

    1987-03-01

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

  6. Quality improvement in neurology: dementia management quality measures.

    Science.gov (United States)

    Odenheimer, Germaine; Borson, Soo; Sanders, Amy E; Swain-Eng, Rebecca J; Kyomen, Helen H; Tierney, Samantha; Gitlin, Laura; Forciea, Mary Ann; Absher, John; Shega, Joseph; Johnson, Jerry

    2014-03-01

    Professional and advocacy organizations have long urged that dementia should be recognized and properly diagnosed. With the passage of the National Alzheimer's Project Act in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer's disease, and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings. Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE), practitioners, healthcare systems, and insurers have not widely embraced implementation. This executive summary (full manuscript available at www.neurology.org) reports on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of individuals with dementia. The American Academy of Neurology (AAN), the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement led this effort. The ACOVE measures and the measurement set described here apply to individuals whose dementia has already been identified and properly diagnosed. Although similar in concept to ACOVE, the DWG measurement set differs in several important ways; it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care before the advanced stages of illness, and provides evidence-based support

  7. Learning to improve path planning performance

    International Nuclear Information System (INIS)

    Chen, Pang C.

    1995-04-01

    In robotics, path planning refers to finding a short. collision-free path from an initial robot configuration to a desired configuratioin. It has to be fast to support real-time task-level robot programming. Unfortunately, current planning techniques are still too slow to be effective, as they often require several minutes, if not hours of computation. To remedy this situation, we present and analyze a learning algorithm that uses past experience to increase future performance. The algorithm relies on an existing path planner to provide solutions to difficult tasks. From these solutions, an evolving sparse network of useful robot configurations is learned to support faster planning. More generally, the algorithm provides a speedup-learning framework in which a slow but capable planner may be improved both cost-wise and capability-wise by a faster but less capable planner coupled with experience. The basic algorithm is suitable for stationary environments, and can be extended to accommodate changing environments with on-demand experience repair and object-attached experience abstraction. To analyze the algorithm, we characterize the situations in which the adaptive planner is useful, provide quantitative bounds to predict its behavior, and confirm our theoretical results with experiments in path planning of manipulators. Our algorithm and analysis are sufficiently, general that they may also be applied to other planning domains in which experience is useful

  8. Air quality and future energy system planning

    Science.gov (United States)

    Sobral Mourao, Zenaida; Konadu, Dennis; Lupton, Rick

    2016-04-01

    energy system planning. Some example applications of this work are: (1) to discover conflicts and synergies between air quality regulations and future developments in the energy system and land use change; (2) to show the drivers of air quality in a given spatial context; (3) to explore effective ways to visualize impacts of different energy, land use and emissions control policies on air quality. An initial test case for the Bay Area in California will be presented, extending the scope of the existing California ForeseerTM tool to identify impacts of different policies within the water-energy-land nexus on local air quality.

  9. Care Plan Improvement in Nursing Homes: An Integrative Review.

    Science.gov (United States)

    Mariani, Elena; Chattat, Rabih; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne

    2017-01-01

    Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents' needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents' conditions occur. The aim of this review was to identify the core elements of the implementation of changes in nursing homes' care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed. An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore. Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents' care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs. Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.

  10. Quality plan and configuration management in complex systems

    International Nuclear Information System (INIS)

    Gonzalez Junto, J.; Merchan Teyssiere

    1993-01-01

    Since the Second World War, the philosophy behind the quality systems of industries and service companies has evolved to embrace the whole life cycle of the product, system or service. In this evolution process, quality has become a strategic factor in the survival of entreprises. The first steps in trying to establish quality systems were taken for the armed forces, followed by space, aeronautical and nuclear projects, whose products were more and more complex and sophisticated. These systems were established by means of quality plans or programmes, and their basic objective was to guarantee a high safety level for the user and/or the general population. In later years, the main concern was to reach a determined quality level not only in one phase of the product life, but in the complete life cycle of the final product. Today a new goal is established and pursued: better quality of the product, service or system life cycle at a lower cost. Methods of improving the quality of systems and processes are the subject of numerous initiatives and studies, to better availability and maintainability of complex equipment or installations, with an extended useful life and greater requirements. Experience in the performance of complex projects shows that a higher quality may be obtained through designing a comprehensive quality plan which pays special attention to information management and modifications of the original design. Obtaining a high reliability level for an installation (equipment, systems, etc), increasing its availability and rationalizing its maintenance may be little less than fanciful without a deep knowledge of the installation, of its activities and its current status in day-to-day operation, which shows the importance of truthful information available to operators and corresponding exactly to their needs. In this frame of mind, a quality plan comprising a configuration management system of information and documents constitutes the basic support tool for

  11. Hanford Sampling Quality Management Plan (HSQMP)

    International Nuclear Information System (INIS)

    Hyatt, J.E.

    1995-01-01

    This document provides a management tool for evaluating and designing the appropriate elements of a field sampling program. This document provides discussion of the elements of a program and is to be used as a guidance document during the preparation of project and/or function specific documentation. This document does not specify how a sampling program shall be organized. The HSQMP is to be used as a companion document to the Hanford Analytical Services Quality Assurance Plan (HASQAP) DOE/RL-94-55. The generation of this document was enhanced by conducting baseline evaluations of current sampling organizations. Valuable input was received from members of field and Quality Assurance organizations. The HSQMP is expected to be a living document. Revisions will be made as regulations and or Hanford Site conditions warrant changes in the best management practices. Appendices included are: summary of the sampling and analysis work flow process, a user's guide to the Data Quality Objective process, and a self-assessment checklist

  12. Voltage Quality Improvement Using Solar Photovoltaic Systems

    Directory of Open Access Journals (Sweden)

    Denisa Galzina

    2015-06-01

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

  13. San Francisco Bay Water Quality Improvement Fund

    Science.gov (United States)

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

  14. Does quality improvement work in neonatology improve clinical outcomes?

    Science.gov (United States)

    Ellsbury, Dan L; Clark, Reese H

    2017-04-01

    Quality improvement initiatives in neonatology have been promoted as an important way of improving outcomes of newborns. The purpose of this review is to examine the effectiveness of recent quality improvement work in improving the outcomes of infants requiring neonatal intensive care. Quality improvement collaboratives and single-center projects demonstrate improvement of clinical processes and outcomes in neonatology that impact both preterm and term infants. Declines in morbidities, resource use, and length of stay have been associated with reductions in healthcare costs. Recent quality improvement work has shown evidence of improvement in clinical outcomes in neonatal intensive care patients. These improvements have important implications for the reduction of healthcare costs in this population.

  15. A cluster-randomised trial of a multifaceted quality improvement intervention in Brazilian intensive care units (Checklist-ICU trial): statistical analysis plan.

    Science.gov (United States)

    Damiani, Lucas P; Cavalcanti, Alexandre B; Moreira, Frederico R; Machado, Flavia; Bozza, Fernando A; Salluh, Jorge I F; Campagnucci, Valquiria P; Normilio-Silva, Karina; Chiattone, Viviane C; Angus, Derek C; Berwanger, Otavio; Chou H Chang, Chung-

    2015-06-01

    The Checklist During Multidisciplinary Visits for Reduction of Mortality in Intensive Care Units (Checklist- ICU) trial is a pragmatic, two-arm, cluster-randomised trial involving 118 intensive care units in Brazil, with the primary objective of determining if a multifaceted qualityimprovement intervention with a daily checklist, definition of daily care goals during multidisciplinary daily rounds and clinician prompts can reduce inhospital mortality. To describe our trial statistical analysis plan (SAP). This is an ongoing trial conducted in two phases. In the preparatory observational phase, we collect three sets of baseline data: ICU characteristics; patient characteristics, processes of care and outcomes; and completed safety attitudes questionnaires (SAQs). In the randomised phase, ICUs are assigned to the experimental or control arms and we collect patient data and repeat the SAQ. Our SAP includes the prespecified model for the primary and secondary outcome analyses, which account for the cluster-randomised design and availability of baseline data. We also detail the multiple mediation models that we will use to assess our secondary hypothesis (that the effect of the intervention on inhospital mortality is mediated not only through care processes targeted by the checklist, but also through changes in safety culture). We describe our approach to sensitivity and subgroup analyses and missing data. We report our SAP before closing our study database and starting analysis. We anticipate that this should prevent analysis bias and enhance the utility of results.

  16. QUALITY FUNCTION DEPLOYMENT AS A STRATEGIC PLANNING TOOL

    OpenAIRE

    DEVRİM İÇTENBAŞ, Burcu; ERYILMAZ, Hande

    2011-01-01

    Quality Function Deployment (QFD) uses a house of quality to translate customer requirements into engineering specifications. QFD has been widely used as a tool to develop new products. It has been adopted in the fields of education quality, service quality, software development and marketing planning. The tool has recently been applied in strategic planning .In this study authors reviewed current research which uses QFD as a strategic planning tool and described how QFD methods can be ...

  17. Who plans for health improvement? SEA, HIA and the separation of spatial planning and health planning

    International Nuclear Information System (INIS)

    Bond, Alan; Cave, Ben; Ballantyne, Rob

    2013-01-01

    This study examines whether there is active planning for health improvement in the English spatial planning system and how this varies across two regions using a combination of telephone surveys and focus group interviews in 2005 and 2010. The spatial planning profession was found to be ill-equipped to consider the health and well-being implications of its actions, whilst health professionals are rarely engaged and have limited understanding and aspirations when it comes to influencing spatial planning. Strategic Environmental Assessment was not considered to be successful in integrating health into spatial plans, given it was the responsibility of planners lacking the capacity to do so. For their part, health professionals have insufficient knowledge and understanding of planning and how to engage with it to be able to plan for health gains rather than simply respond to health impacts. HIA practice is patchy and generally undertaken by health professionals outside the statutory planning framework. Thus, whilst appropriate assessment tools exist, they currently lack a coherent context within which they can function effectively and the implementation of the Kiev protocol requiring the engagement of health professionals in SEA is not to likely improve the consideration of health in planning while there continues to be separation of functions between professions and lack of understanding of the other profession. -- Highlights: ► Health professionals have limited aspirations for health improvement through the planning system. ► Spatial planners are ill-equipped to understand the health and well-being implications of their activities. ► SEA and HIA currently do not embed health consideration in planning decisions. ► The separation of health and planning functions is problematic for the effective conduct of SEA and/or HIA

  18. Who plans for health improvement? SEA, HIA and the separation of spatial planning and health planning

    Energy Technology Data Exchange (ETDEWEB)

    Bond, Alan, E-mail: alan.bond@uea.ac.uk [InteREAM (Interdisciplinary Research in Environmental Assessment and Management), School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ (United Kingdom); Cave, Ben, E-mail: ben.cave@bcahealth.co.uk [Ben Cave Associates Ltd., Leeds (United Kingdom); Ballantyne, Rob, E-mail: robdballantyne@gmail.com [Planning and Health Consultant, Oxfordshire (United Kingdom)

    2013-09-15

    This study examines whether there is active planning for health improvement in the English spatial planning system and how this varies across two regions using a combination of telephone surveys and focus group interviews in 2005 and 2010. The spatial planning profession was found to be ill-equipped to consider the health and well-being implications of its actions, whilst health professionals are rarely engaged and have limited understanding and aspirations when it comes to influencing spatial planning. Strategic Environmental Assessment was not considered to be successful in integrating health into spatial plans, given it was the responsibility of planners lacking the capacity to do so. For their part, health professionals have insufficient knowledge and understanding of planning and how to engage with it to be able to plan for health gains rather than simply respond to health impacts. HIA practice is patchy and generally undertaken by health professionals outside the statutory planning framework. Thus, whilst appropriate assessment tools exist, they currently lack a coherent context within which they can function effectively and the implementation of the Kiev protocol requiring the engagement of health professionals in SEA is not to likely improve the consideration of health in planning while there continues to be separation of functions between professions and lack of understanding of the other profession. -- Highlights: ► Health professionals have limited aspirations for health improvement through the planning system. ► Spatial planners are ill-equipped to understand the health and well-being implications of their activities. ► SEA and HIA currently do not embed health consideration in planning decisions. ► The separation of health and planning functions is problematic for the effective conduct of SEA and/or HIA.

  19. A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

    Science.gov (United States)

    Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Lee, Andrew J.; Xiao, Ying

    2013-07-01

    The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.

  20. A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

    International Nuclear Information System (INIS)

    Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Xiao, Ying; Lee, Andrew J

    2013-01-01

    The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10–20 min to 2 min by applying the semi-automated plan-quality evaluation program. (note)

  1. A new plan quality index for nasopharyngeal cancer SIB IMRT.

    Science.gov (United States)

    Jin, X; Yi, J; Zhou, Y; Yan, H; Han, C; Xie, C

    2014-02-01

    A new plan quality index integrating dosimetric and radiobiological indices was proposed to facilitate the evaluation and comparison of simultaneous integrated boost (SIB) intensity modulated radiotherapy (IMRT) plans for nasopharyngeal cancer (NPC) patients. Ten NPC patients treated by SIB-IMRT were enrolled in the study. Custom software was developed to read dose-volume histogram (DVH) curves from the treatment planning system (TPS). A plan filtering matrix was introduced to filter plans that fail to satisfy treatment protocol. Target plan quality indices and organ at risk (OAR) plan quality indices were calculated for qualified plans. A unique composite plan quality index (CPQI) was proposed based on the relative weight of these indices to evaluate and compare competing plans. Plan ranking results were compared with detailed statistical analysis, radiation oncology quality system (ROQS) scoring results and physician's evaluation results to verify the accuracy of this new plan quality index. The average CPQI values for plans with OAR priority of low, normal, high, and PTV only were 0.22 ± 0.08, 0.49 ± 0.077, 0.71 ± 0.062, and -0.21 ± 0.16, respectively. There were significant differences among these plan quality indices (One-way ANOVA test, p plans were selected. Plan filtering matrix was able to speed up the plan evaluation process. The new matrix plan quality index CPQI showed good consistence with physician ranking results. It is a promising index for NPC SIB-IMRT plan evaluation. Copyright © 2013 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  2. SAPHIRE 8 Software Quality Assurance Plan

    Energy Technology Data Exchange (ETDEWEB)

    Curtis Smith

    2010-02-01

    This Quality Assurance (QA) Plan documents the QA activities that will be managed by the INL related to JCN N6423. The NRC developed the SAPHIRE computer code for performing probabilistic risk assessments (PRAs) using a personal computer (PC) at the Idaho National Laboratory (INL) under Job Code Number (JCN) L1429. SAPHIRE started out as a feasibility study for a PRA code to be run on a desktop personal PC and evolved through several phases into a state-of-the-art PRA code. The developmental activity of SAPHIRE was the result of two concurrent important events: The tremendous expansion of PC software and hardware capability of the 90s and the onset of a risk-informed regulation era.

  3. Strategy to Support Improvement of Healthcare Quality.

    Directory of Open Access Journals (Sweden)

    Ing. Andrea Zejdlova

    2013-01-01

    Full Text Available One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. It is an emerging movement in health insurance (initially in Britain and United States. Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.Also known as "P4P" or “value-based purchasing,” this payment model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care (medical errors or increased costs, have also been proposed. In the developed nations, the rapidly aging population and rising health care costs have recently brought P4P to the forefront of health policy discussions. Pilot studies underway in several large healthcare systems have shown modest improvements in specific outcomes and increased efficiency, but no cost savings due to added administrative requirements. Statements by professional medical societies generally support incentive programs to increase the quality of health care, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. This article serves as an introduction to pay for performance. We discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care area.

  4. Improved product planning by problem-oriented use of preventive quality management methods; Verbesserte Produktplanung durch den problemorientierten Einsatz praeventiver Qualitaetsmanagementmethoden

    Energy Technology Data Exchange (ETDEWEB)

    Lesmeister, F.

    2001-07-01

    The development of innovative products meeting the customer's needs is getting increasingly complex. The production cost and the time to market must be reduced constantly. Modern methods of preventive quality management like QFD, FMEA and Target Costing offer help but they tend to be complex and costly. The author attempted a modularisation of the methods, with the possibility of linking modules as desired using a commercially available software. [German] Die Entwicklung innovativer, den Kundenbeduerfnissen entsprechender Produkte wird zunehmend komplexer. Die Unternehmen sind gezwungen, die Kosten der Produkterstellung stetig zu reduzieren und den Time-to-Market zu verkuerzen. Moderne Methoden des praeventiven Qualitaetsmanagements wie das QFD, die FMEA und das Target Costing bieten Unterstuetzungsmoeglichkeiten zur Loesung der damit zusammenhaengenden Probleme. Doch ist der Einsatz der oft komplizierten Methoden sehr aufwendig. Gruende hierfuer sind die oft starren Anwendungsschemata, die einem situationsspezifischen Einsatz der Methoden entgegenstehen, und die fehlende Verknuepfung der Methoden. Ergebnis der Arbeit ist eine Modularisierung der Methoden und eine Verknuepfung der einzelnen Methodenmodule. Hierdurch koennen die Methoden an die jeweilige Problemsituation angepasst eingesetzt und dadurch der gesamte Produktentwicklungsprozess durchgaengig unterstuetzt werden. Die Anwendung der Methoden wird mittels einer auf dem Markt erhaeltlichen Software unterstuetzt. (orig.)

  5. Do Clinical Practice Guidelines Improve Quality?

    Science.gov (United States)

    Baldassari, Cristina M

    2017-07-01

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

  6. Transportation Planning and Quality of Life: Where Do They Intersect?

    Science.gov (United States)

    Lee, Richard J.

    2016-01-01

    Policy makers and researchers are increasingly recognizing the connections between public health and transportation, but health improvements are typically framed from a physical health perspective rather than considering broader quality of life (QOL) impacts. Currently, there is a limited understanding of the ways in which transportation and QOL intersect, and little is known about how metropolitan planning organizations (MPOs) in the United States are addressing QOL outcomes. This study addressed these gaps by developing a conceptual framework holistically linking transportation to QOL. The proposed framework identified four transportation-related QOL dimensions—physical, mental, social, and economic well-being—which are predominantly influenced by three components of the transportation system: mobility/accessibility, the built environment, and vehicle traffic. This framework then formed the basis for a content analysis of 148 long-range transportation plans in the United States to evaluate the extent to which QOL is being considered in the planning process. The results of the analysis and a follow-up examination of 13 plans revealed that MPOs are inconsistently addressing QOL. Plans primarily targeted QOL enhancement from the perspective of physical well-being, while mental and social well-being were rarely considered. Policy recommendations were provided to more comprehensively integrate QOL into the transportation planning process. PMID:27546998

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

    Science.gov (United States)

    Aluri, Rao

    1993-01-01

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

  8. 78 FR 53270 - Revision of Air Quality Implementation Plan; California; Sacramento Metropolitan Air Quality...

    Science.gov (United States)

    2013-08-29

    ... Quality Implementation Plan; California; Sacramento Metropolitan Air Quality Management District... to the Sacramento Metropolitan Air Quality Management District (SMAQMD or District) portion of the..., Sacramento Metropolitan Air Quality Management District, Rule 214 (Federal New Source Review), Rule 203...

  9. Effect of beamlet step-size on IMRT plan quality

    International Nuclear Information System (INIS)

    Zhang Guowei; Jiang Ziping; Shepard, David; Earl, Matt; Yu, Cedric

    2005-01-01

    We have studied the degree to which beamlet step-size impacts the quality of intensity modulated radiation therapy (IMRT) treatment plans. Treatment planning for IMRT begins with the application of a grid that divides each beam's-eye-view of the target into a number of smaller beamlets (pencil beams) of radiation. The total dose is computed as a weighted sum of the dose delivered by the individual beamlets. The width of each beamlet is set to match the width of the corresponding leaf of the multileaf collimator (MLC). The length of each beamlet (beamlet step-size) is parallel to the direction of leaf travel. The beamlet step-size represents the minimum stepping distance of the leaves of the MLC and is typically predetermined by the treatment planning system. This selection imposes an artificial constraint because the leaves of the MLC and the jaws can both move continuously. Removing the constraint can potentially improve the IMRT plan quality. In this study, the optimized results were achieved using an aperture-based inverse planning technique called direct aperture optimization (DAO). We have tested the relationship between pencil beam step-size and plan quality using the American College of Radiology's IMRT test case. For this case, a series of IMRT treatment plans were produced using beamlet step-sizes of 1, 2, 5, and 10 mm. Continuous improvements were seen with each reduction in beamlet step size. The maximum dose to the planning target volume (PTV) was reduced from 134.7% to 121.5% and the mean dose to the organ at risk (OAR) was reduced from 38.5% to 28.2% as the beamlet step-size was reduced from 10 to 1 mm. The smaller pencil beam sizes also led to steeper dose gradients at the junction between the target and the critical structure with gradients of 6.0, 7.6, 8.7, and 9.1 dose%/mm achieved for beamlet step sizes of 10, 5, 2, and 1 mm, respectively

  10. Software process improvement, quality assurance and measurement

    NARCIS (Netherlands)

    Trienekens, J.J.M.; Kusters, R.J.; Balla, K.; Kontogiannis, K.; Zou, Y.; Di Penta, M.

    2006-01-01

    The aim of this workshop was to present and discuss emergent software quality improvement approaches, with an emphasis on practical applications. Different views on the improvement of software processes, software products, and their interrelations, have been addressed during the workshop.

  11. Physical Activity Improves Quality of Life

    Science.gov (United States)

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

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

    Science.gov (United States)

    Laverentz, Delois Meyer; Kumm, Sharon

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

  13. Quality assurance program plan for radionuclide airborne emissions monitoring

    International Nuclear Information System (INIS)

    Boom, R.J.

    1995-12-01

    This Quality Assurance Program Plan identifies quality assurance program requirements and addresses the various Westinghouse Hanford Company organizations and their particular responsibilities in regards to sample and data handling of radiological airborne emissions. This Quality Assurance Program Plan is prepared in accordance with and to written requirements

  14. 40 CFR 35.2023 - Water quality management planning.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Water quality management planning. 35... to the States to carry out water quality management planning including but not limited to: (1... ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2023 Water quality...

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

    Science.gov (United States)

    Roche, B G; Sommer, C

    1995-01-01

    In may 1994 we were selected by the surgical Swiss association to make a study about quality in USA. During our travel we visited 3 types of institutions: Hospitals, National Institute of standard and Technology, Industry, Johnson & Johnson. We appreciate to compare 2 types of quality programs: Quality Assurance (QA) and Continuous Quality Improvement (CQI). In traditional healthcare circles, QA is the process established to meet external regulatory requirements and to assure that patient care is consistent with established standards. In a modern quality terms, QA outside of healthcare means designing a product or service, as well as controlling its production, so well that quality is inevitable. The ideas of W. Edward Deming is that there is never improvement just by inspection. He developed a theory based on 14 principles. A productive work is accomplished through processes. Understanding the variability of processes is a key to improve quality. Quality management sees each person in an organisation as part of one or more processes. The job of every worker is to receive the work of others, add value to that work, and supply it to the next person in the process. This is called the triple role the workers as customer, processor, and supplier. The main source of quality defects is problems in the process. The old assumption is that quality fails when people do the right thing wrong; the new assumption is that, more often, quality failures arise when people do the wrong think right. Exhortation, incentives and discipline of workers are unlikely to improve quality. If quality is failing when people do their jobs as designed, then exhorting them to do better is managerial nonsense. Modern quality theory is customer focused. Customers are identified internally and externally. The modern approach to quality is thoroughly grounded in scientific and statistical thinking. Like in medicine, the symptom is a defect in quality. The therapist of process must perform diagnostic

  16. Developing a Quality Improvement Process to Optimize Faculty Success

    Science.gov (United States)

    Merillat, Linda; Scheibmeir, Monica

    2016-01-01

    As part of a major shift to embed quality improvement processes within a School of Nursing at a medium-sized Midwestern university, a faculty enrichment program using a Plan-Do-Act-Study design was implemented. A central focus for the program was the development and maintenance of an online faculty resource center identified as "My Faculty…

  17. Quality Assurance Project Plan for Citizen Science Projects

    Science.gov (United States)

    The Quality Assurance Project Plan is necessary for every project that collects or uses environmental data. It documents the project planning process and serves as a blueprint for how your project will run.

  18. Quality assessment for VMAT prostate radiotherapy planning based on data envelopment analysis

    International Nuclear Information System (INIS)

    Lin, Kuan-Min; Simpson, John; Raith, Andrea; Ehrgott, Matthias; Sasso, Giuseppe

    2013-01-01

    The majority of commercial radiotherapy treatment planning systems requires planners to iteratively adjust the plan parameters in order to find a satisfactory plan. This iterative trial-and-error nature of radiotherapy treatment planning results in an inefficient planning process and in order to reduce such inefficiency, plans can be accepted without achieving the best attainable quality. We propose a quality assessment method based on data envelopment analysis (DEA) to address this inefficiency. This method compares a plan of interest to a set of past delivered plans and searches for evidence of potential further improvement. With the assistance of DEA, planners will be able to make informed decisions on whether further planning is required and ensure that a plan is only accepted when the plan quality is close to the best attainable one. We apply the DEA method to 37 prostate plans using two assessment parameters: rectal generalized equivalent uniform dose (gEUD) as the input and D95 (the minimum dose that is received by 95% volume of a structure) of the planning target volume (PTV) as the output. The percentage volume of rectum overlapping PTV is used to account for anatomical variations between patients and is included in the model as a non-discretionary output variable. Five plans that are considered of lesser quality by DEA are re-optimized with the goal to further improve rectal sparing. After re-optimization, all five plans improve in rectal gEUD without clinically considerable deterioration of the PTV D95 value. For the five re-optimized plans, the rectal gEUD is reduced by an average of 1.84 Gray (Gy) with only an average reduction of 0.07 Gy in PTV D95. The results demonstrate that DEA can correctly identify plans with potential improvements in terms of the chosen input and outputs. (paper)

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

    Science.gov (United States)

    Chow, Shirley L; Shojania, Kaveh G

    2017-09-01

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

  20. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  2. Practical Approaches to Quality Improvement for Radiologists.

    Science.gov (United States)

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

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

  3. Airport Capital Improvement Planning: Stewardship for Airport Development

    Science.gov (United States)

    1997-09-01

    "Airport Capital Improvement Planning: Stewardship for Airport Development", was : originally written in October, 1995. It documented an effort to implement the : concept of capital improvement planning with the airport development industry. : Airpor...

  4. Quality Assurance Program Plan for FFTF effluent controls. Revision 1

    International Nuclear Information System (INIS)

    Seamans, J.A.

    1995-01-01

    This Quality Assurance Program Plan is specific to environmental related activities within the FFTF Property Protected Area. The activities include effluent monitoring and Low Level Waste Certification

  5. Individualized Quality Control Plan (IQCP): Is It Value-Added for Clinical Microbiology?

    OpenAIRE

    Sharp, Susan E.; Miller, Melissa B.; Hindler, Janet

    2015-01-01

    The Center for Medicaid and Medicare Services (CMS) recently published their Individualized Quality Control Plan (IQCP [https://www.cms.gov/regulations-and-guidance/legislation/CLIA/Individualized_Quality_Control_Plan_IQCP.html]), which will be the only option for quality control (QC) starting in January 2016 if laboratories choose not to perform Clinical Laboratory Improvement Act (CLIA) [U.S. Statutes at Large 81(1967):533] default QC. Laboratories will no longer be able to use “equivalent ...

  6. Achieving performance breakthroughs in an HMO business process through quality planning.

    Science.gov (United States)

    Hanan, K B

    1993-01-01

    Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.

  7. Structured data quality reports to improve EHR data quality.

    Science.gov (United States)

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

    2015-12-01

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

  8. Improving Quality in Colorectal Surgery

    NARCIS (Netherlands)

    J.C. Slieker (Juliette)

    2014-01-01

    markdownabstract__Abstract__ Colorectal surgery is an important aspect of our current health system, due to the high incidence of colorectal cancer combined with an ageing population, improved long-term outcomes after colorectal surgery, and the perfectioning of the operative and postoperative

  9. Technological measures to improve automotive product quality

    OpenAIRE

    Gladkov, V.; Kruglov, S.

    2010-01-01

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

  10. China's women leaders promote quality and equity in family planning.

    Science.gov (United States)

    He, S

    1995-08-01

    In China, key policy-makers at the highest levels of government recognize that the success of the family planning (FP) program depends upon improving the status of Chinese women. The highest ranking female government official, Peng Peiyun, a State Councilor and the Minister of the State Family Planning (FP) Commission, has initiated a new policy of improving the quality of service in the FP program. She recognizes that women who are gainfully employed and control their income are less likely to desire large families. One aspect of the effort to improve quality involves training FP personnel in interpersonal communication and counseling skills. The results of a pilot training program show that clients are pleased with the new approach and that use of FP services has increased. The FP Commission is also experimenting with programs which integrate all the needs of women and their families (FP, credit availability, old age support) in rural areas. Traditionally, sons provided for their elderly parents, so families with only one daughter are concerned about old age provision. Thus, national efforts are underway to develop social security systems. In the meantime, women at all levels, from grassroots FP acceptors to FP staff members and researchers are the major contributors to the innovations which will allow China to control its population growth.

  11. UMTRA technical assistance contractor Quality Assurance Program Plan

    International Nuclear Information System (INIS)

    Pehrson, P.

    1993-01-01

    This Quality Assurance Program Plan (QAPP) provides the primary requirements for the integration of quality functions into all Technical Assistance Contractor (TAC) Project organization activities. The QAPP is the written directive authorized by the TAC Program Manager to accomplish this task and to implement procedures that provide the controls and sound management practices needed to ensure TAC contractual obligations are met. The QA program is designed to use monitoring, audit, and surveillance functions as management tools to ensure that all Project organization functions are executed in a manner that will protect public health and safety, promote the success of the Project, and meet or exceed contract requirements. The key to ensuring compliance with this directive is a two-step professional approach: utilize the quality system in all areas of activity, and generate a personal commitment from all personnel to provide quality service. The quality staff will be experienced, trained professionals capable of providing maximum flexibility to Project goal attainment. Such flexibility will enable the staff to be more cost effective and to further improve communication and coordination. To provide control details, this QAPP will be supplemented by approved standard operating procedures that provide requirements for performing the various TAC quality-related activities. These procedures shall describe applicable design input and document control activities and documentation

  12. Outage preparation milestones - A tool to improve planned outage performance

    International Nuclear Information System (INIS)

    Laplatney, Jere; Hwang, Euiyoub

    2006-01-01

    Sustainable development of Nuclear Energy depends heavily on excellent performance of the existing fleet which in turn depend heavily on the performance of planned outages. Nuclear Power Plants who have successfully undertaken outage optimization projects have demonstrated than an effective Outage Preparation Milestone program is a key component of their improvement programs. This paper will provide background into the field of 'Outage Optimization' including the philosophy, general approach, and results obtained in the U. S. industry. The significant safety improvements afforded by properly implementing outage improvement programs will be explained. Some specific examples of outage improvements will be given including the adoption of a strong Outage Preparation Milestone Program. The paper will then describe the attributes of an effective Outage Preparation Milestone Program and list a set of specific key milestones. The key milestones are defined and the reasons for each are explained. Suggested due dates for each key milestone relative to the outage start date are provided. Successful implementation of an Outage Preparation Milestone program depends heavily upon the management tools and methods used to assure that the organization meets the milestones on time and in a quality fashion. These include methods to handle cases where milestones are not met - either partially or fully. KHNP is investigating implementing an improved Outage Preparation Milestone program for its fleet of reactors as part of its overall program to improve its performance of planned outages

  13. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

    Energy Technology Data Exchange (ETDEWEB)

    Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia; Pilch, Martin M.

    2009-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and the software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.

  14. References on EPA Quality Assurance Project Plans

    Science.gov (United States)

    Provides requirements for the conduct of quality management practices, including quality assurance (QA) and quality control (QC) activities, for all environmental data collection and environmental technology programs performed by or for this Agency.

  15. Quality improvement through multiple response optimization

    International Nuclear Information System (INIS)

    Noorossana, R.; Alemzad, H.

    2003-01-01

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

  16. EPA Region 3 Quality Management Plans

    Science.gov (United States)

    Has links to resources that describe the Region's Quality Assurance Program, which is a collection of the Region's ongoing quality assurance (QA) policies, procedures, responsibilities and management systems.

  17. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Ph. D. Radoslaw Wolniak

    2011-05-01

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

  18. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Radoslaw Wolniak

    2011-12-01

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

  19. 78 FR 10589 - Revision of Air Quality Implementation Plan; California; Sacramento Metropolitan Air Quality...

    Science.gov (United States)

    2013-02-14

    ... Quality Implementation Plan; California; Sacramento Metropolitan Air Quality Management District... Sacramento Metropolitan Air Quality Management District (SMAQMD or District) portion of the California State... sources within the areas covered by the plan as necessary to assure that the National Ambient Air Quality...

  20. 77 FR 73320 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

    Science.gov (United States)

    2012-12-10

    ... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... Implementation Plan (SIP) revision for the South Coast Air Quality Management District (SCAQMD or District... in a August 15, 2012 letter from the South Coast Air Quality Management District regarding specific...

  1. Air quality management: challenges and solutions in delivering air quality action plans

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, C.I.; Longhurst, J.W.S.; Woodfield, N.K.

    2000-07-01

    The Air Quality Strategy for England, Scotland, Wales and Northern Ireland (DETR, 2001) has the aim of showing how improved local air quality in the UK may be delivered. Through a process of reviewing and assessing local air quality in both urban and rural localities, a clear picture is emerging of areas of the UK where air quality objectives are not likely to be met. The next challenge will be the identification of the required actions and new ways of working to achieve specific air quality objectives. The declaration of air quality management areas, where objectives are not predicted to be met by their target years, involves co-ordinated local action and collaborative working, which can only be effective with support across local authority departments and external stake holders. This paper provides a background to the relevant legislation underpinning, local air quality management and summarises the review and assessment process. It then comments on future directions in relation to the designation of Air Quality Management Areas and considers the requirements of action plans to deliver the goal of cleaner air in the UK. It is concluded that the UK has developed a highly sophisticated system of air quality management over a relatively short period of time, and with it has brought a new way of local authority working. The challenge of the next stage of the process is likely to be in implementing cost effective and proportional solutions to identified problems at the local level. (Author)

  2. Process safety improvement--quality and target zero.

    Science.gov (United States)

    Van Scyoc, Karl

    2008-11-15

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

  3. Process safety improvement-Quality and target zero

    International Nuclear Information System (INIS)

    Van Scyoc, Karl

    2008-01-01

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

  4. Process safety improvement-Quality and target zero

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-11-15

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

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

    Science.gov (United States)

    Godény, Sándor

    2012-02-05

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

  6. Power theories for improved power quality

    CERN Document Server

    Pasko, Marian

    2012-01-01

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

  7. SNF Project Engineering Process Improvement Plan

    International Nuclear Information System (INIS)

    DESAI, S.P.

    2000-01-01

    This plan documents the SNF Project activities and plans to support its engineering process. It describes five SNF Project Engineering initiatives: new engineering procedures, qualification cards process; configuration management, engineering self assessments, and integrated schedule for engineering activities

  8. NIF Projects Controls and Information Systems Software Quality Assurance Plan

    Energy Technology Data Exchange (ETDEWEB)

    Fishler, B

    2011-03-18

    Quality achievement for the National Ignition Facility (NIF) and the National Ignition Campaign (NIC) is the responsibility of the NIF Projects line organization as described in the NIF and Photon Science Directorate Quality Assurance Plan (NIF QA Plan). This Software Quality Assurance Plan (SQAP) is subordinate to the NIF QA Plan and establishes quality assurance (QA) activities for the software subsystems within Controls and Information Systems (CIS). This SQAP implements an activity level software quality assurance plan for NIF Projects as required by the LLNL Institutional Software Quality Assurance Program (ISQAP). Planned QA activities help achieve, assess, and maintain appropriate quality of software developed and/or acquired for control systems, shot data systems, laser performance modeling systems, business applications, industrial control and safety systems, and information technology systems. The objective of this SQAP is to ensure that appropriate controls are developed and implemented for management planning, work execution, and quality assessment of the CIS organization's software activities. The CIS line organization places special QA emphasis on rigorous configuration control, change management, testing, and issue tracking to help achieve its quality goals.

  9. NIF Projects Controls and Information Systems Software Quality Assurance Plan

    International Nuclear Information System (INIS)

    Fishler, B.

    2011-01-01

    Quality achievement for the National Ignition Facility (NIF) and the National Ignition Campaign (NIC) is the responsibility of the NIF Projects line organization as described in the NIF and Photon Science Directorate Quality Assurance Plan (NIF QA Plan). This Software Quality Assurance Plan (SQAP) is subordinate to the NIF QA Plan and establishes quality assurance (QA) activities for the software subsystems within Controls and Information Systems (CIS). This SQAP implements an activity level software quality assurance plan for NIF Projects as required by the LLNL Institutional Software Quality Assurance Program (ISQAP). Planned QA activities help achieve, assess, and maintain appropriate quality of software developed and/or acquired for control systems, shot data systems, laser performance modeling systems, business applications, industrial control and safety systems, and information technology systems. The objective of this SQAP is to ensure that appropriate controls are developed and implemented for management planning, work execution, and quality assessment of the CIS organization's software activities. The CIS line organization places special QA emphasis on rigorous configuration control, change management, testing, and issue tracking to help achieve its quality goals.

  10. Reaching Rural Mammographers for Quality Improvement

    National Research Council Canada - National Science Library

    Urban, Nicole

    1997-01-01

    The Fred Hutchinson Cancer Research Center, the University of Washington, and the Washington State Department of Health are collaborating to develop and implement a mammography quality improvement program (MQIP...

  11. Reaching Rural Mammographers for Quality Improvement

    National Research Council Canada - National Science Library

    Urban, Nicole

    1998-01-01

    The Fred Hutchinson Cancer Research Center, the University of Washington, and the Washington State Department of Health are collaborating to develop and implement a mammography quality improvement. program (MQIP...

  12. Reaching Rural Mammographers for Quality Improvement

    National Research Council Canada - National Science Library

    Urban, Nicole

    1999-01-01

    The Fred Hutchinson Cancer Research Center, the University of Washington, and the Washington State Department of Health are collaborating to develop and implement a mammography quality improvement program (MQIP...

  13. Improve the teaching quality by two-way education mode

    Directory of Open Access Journals (Sweden)

    Hongyan Shi

    2017-02-01

    Full Text Available Teaching activities contain teaching and learning, and both teachers and students have to work hard to improve the quality of teaching. This essay introduced the basic conception of “two-way and five-ring” mode first, and expatiated on the structure of this mode. The author used her own experiences to combine the teaching mode with the real situation of military school, emphasized teaching itself and talked about some spe-cific plans. This will give a certain extend help in improving the quality of teaching in military school.

  14. Plan-provider integration, premiums, and quality in the Medicare Advantage market.

    Science.gov (United States)

    Frakt, Austin B; Pizer, Steven D; Feldman, Roger

    2013-12-01

    To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration. With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents. We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). © Health Research and Educational Trust.

  15. Quality Improvement Initiatives in Inflammatory Bowel Disease.

    Science.gov (United States)

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

    2017-08-01

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

  16. Formalising medical quality indicators to improve guidelines

    NARCIS (Netherlands)

    Van Gendt, Marjolein; Ten Teije, Annette; Serban, Radu; Van Harmelen, Frank

    2005-01-01

    Medical guidelines can significantly improve quality of medical care and reduce costs. But how do we get sound and well-structured guidelines? This paper investigates the use of quality indicators that are formulated by medical institutions to evaluate medical care. The main research questions are

  17. Assessing local resources and culture before instituting quality improvement projects.

    Science.gov (United States)

    Hawkins, C Matthew

    2014-12-01

    The planning phases of quality improvement projects are commonly overlooked. Disorganized planning and implementation can escalate chaos, intensify resistance to change, and increase the likelihood of failure. Two important steps in the planning phase are (1) assessing local resources available to aid in the quality improvement project and (2) evaluating the culture in which the desired change is to be implemented. Assessing local resources includes identifying and engaging key stakeholders and evaluating if appropriate expertise is available for the scope of the project. This process also involves engaging informaticists and gathering available IT tools to plan and automate (to the extent possible) the data-gathering, analysis, and feedback steps. Culture in a department is influenced by the ability and willingness to manage resistance to change, build consensus, span boundaries between stakeholders, and become a learning organization. Allotting appropriate time to perform these preparatory steps will increase the odds of successfully performing a quality improvement project and implementing change. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  18. Quality Management Plan for EPA Region 1

    Science.gov (United States)

    The QMP describes policies, procedures & management systems within EPA NE that govern quality assurance & quality control activities supporting the transparency & scientific defensibility of environmental data collected, used & disseminated by the Region.

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

    Science.gov (United States)

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

    2018-01-01

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

  20. Transfer from planned home birth to hospital: improving interprofessional collaboration.

    Science.gov (United States)

    Vedam, Saraswathi; Leeman, Lawrence; Cheyney, Melissa; Fisher, Timothy J; Myers, Susan; Low, Lisa Kane; Ruhl, Catherine

    2014-01-01

    Women's heightened interest in choice of birthplace and increased rates of planned home birth in the United States have been well documented, yet there remains significant public and professional debate about the ethics of planned home birth in jurisdictions where care is not clearly integrated across birth settings. Simultaneously, the quality of interprofessional interactions is recognized as a predictor of health outcomes during obstetric events. When care is transferred across birth settings, confusion and conflict among providers with respect to roles and responsibilities can adversely affect both outcomes and the experience of care for women and newborns. This article reviews findings of recent North American studies that examine provider attitudes toward planned home birth, differing concepts of safety of birthplace as reported by women and providers, and sources of conflict among maternity care providers during transfer from home to hospital. Emerging evidence and clinical exemplars can inform the development of systems for seamless transfer of women and newborns from planned home births to hospital and improve experience and perceptions of safety among families and providers. Three successful models in the United States that have enhanced multidisciplinary cooperation and coordination of care across birth settings are described. Finally, best practice guidelines for roles, communication, and mutual accommodation among all participating providers when transfer occurs are introduced. Research, health professional education, and policy recommendations for incorporation of key components into existing health care systems in the United States are included. © 2014 by the American College of Nurse-Midwives.

  1. Software quality assurance plan for PORFLOW-3D

    International Nuclear Information System (INIS)

    Maheras, S.J.

    1993-03-01

    This plan describes the steps taken by the Idaho National Engineering Laboratory Subsurface and Environmental Modeling Unit personnel to implement software quality assurance procedures for the PORFLOW-3D computer code. PORFLOW-3D was used to conduct radiological performance assessments at the Savannah River Site. software quality assurance procedures for PORFLOW-3D include software acquisition, installation, testing, operation, maintenance, and retirement. Configuration control and quality assurance procedures are also included or referenced in this plan

  2. Use of plan quality degradation to evaluate tradeoffs in delivery efficiency and clinical plan metrics arising from IMRT optimizer and sequencer compromises

    Science.gov (United States)

    Wilkie, Joel R.; Matuszak, Martha M.; Feng, Mary; Moran, Jean M.; Fraass, Benedick A.

    2013-01-01

    site and on the stage in the process at which the levels are limited. The cost of improved delivery efficiency, in terms of plan quality degradation, increased as the number of intensity levels in the sequencer or optimizer decreased. The degradation was more substantial for the head and neck cases relative to the prostate cases, particularly when fewer than 20 intensity levels were used. Plan quality degradation was less severe when the number of intensity levels was limited in the optimizer rather than the sequencer. Conclusions: Analysis of plan quality degradation allows for a quantitative assessment of the compromises in clinical plan quality as delivery efficiency is improved, in order to determine the optimal delivery settings. The technique is based on physician-determined quality degradation factors and can be extended to other clinical situations where investigation of various tradeoffs is warranted. PMID:23822412

  3. Improving Family Meetings in Intensive Care Units: A Quality Improvement Curriculum.

    Science.gov (United States)

    Gruenewald, David A; Gabriel, Michelle; Rizzo, Dorothy; Luhrs, Carol A

    2017-07-01

    Family meetings in the intensive care unit are associated with beneficial outcomes for patients, their families, and health care systems, yet these meetings often do not occur in a timely, effective, reliable way. The Department of Veterans Affairs Comprehensive End-of-Life Care Implementation Center sponsored a national initiative to improve family meetings in Veterans Affairs intensive care units across the United States. Process measures of success for the initiative were identified, including development of a curriculum to support facility-based quality improvement projects to implement high-quality family meetings. Identified curriculum requirements included suitability for distance learning and applicability to many clinical intensive care units. Curriculum modules were cross-mapped to the "Plan-Do-Study-Act" model to aid in planning quality improvement projects. A questionnaire was e-mailed to users to evaluate the curriculum's effectiveness. Users rated the curriculum's effectiveness in supporting and achieving aims of the initiative as 3.6 on a scale of 0 (not effective) to 4 (very effective). Users adapted the curriculum to meet local needs. The number of users increased from 6 to 17 quality improvement teams in 2 years. All but 3 teams progressed to implementation of an action plan. Users were satisfied with the effectiveness and adaptability of a family-meeting quality improvement curriculum to support implementation of a quality improvement project in Veterans Affairs intensive care units. This tool may be useful in facilitating projects to improve the quality of family meetings in other intensive care units. ©2017 American Association of Critical-Care Nurses.

  4. ANALYSIS OF QUALITY COSTS FOR STATISTICA QUALITY CONTROL PLANNING

    Directory of Open Access Journals (Sweden)

    N. Chiadamrong

    2017-12-01

    Full Text Available Quality has become one or the most important force leading to organizational success and company growth in national and international markets. The return-on-investment from strong and effective quality programs is providing excellent profitability results in firms with effective quality strategies. Due to the wide variation in quality results, the search for the genuine keys to success in quality has become a matter of deep concern to management of companies. This paper suggests a way to quantifying quality costs. As a result, the appropriate quality strategies can be adjusted and set to match with each company situation based on the categorization of the quality costs suggested. This outcome can, then, be used as a guideline for manufactures in setting their suitable quality program, which establishes the proper balance between the costs and customer services.

  5. Improving embryo quality in assisted reproduction

    NARCIS (Netherlands)

    Mantikou, E.

    2013-01-01

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

  6. Quality measurement and improvement in liver transplantation.

    Science.gov (United States)

    Mathur, Amit K; Talwalkar, Jayant

    2018-06-01

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

  7. Developing a revenue integrity improvement plan.

    Science.gov (United States)

    Banks, Kate

    2010-11-01

    A revenue integrity plan should address five key areas: Accuracy of patient information. Verification of payer information and policies. Accuracy of documentation. Processing of claims. Accuracy of payment.

  8. Louisiana Airport System Plan Five-Year Capital Improvement Program.

    Science.gov (United States)

    1992-07-01

    The Louisiana Airport System Plan (LASP) Five-Year-Capital Improvement Program (CIP) is a development plan for all commercial service, reliever, and general aviation airports in Louisiana. It is a detailed listing of potential projects based on the a...

  9. Frameworks for improvement: clinical audit, the plan-do-study-act cycle and significant event audit.

    Science.gov (United States)

    Gillam, Steve; Siriwardena, A Niroshan

    2013-01-01

    This is the first in a series of articles about quality improvement tools and techniques. We explore common frameworks for improvement, including the model for improvement and its application to clinical audit, plan-do-study-act (PDSA) cycles and significant event analysis (SEA), examining the similarities and differences between these and providing examples of each.

  10. Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans

    International Nuclear Information System (INIS)

    Purdie, Thomas G.; Dinniwell, Robert E.; Fyles, Anthony; Sharpe, Michael B.

    2014-01-01

    Purpose: To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to define and simplify the technical aspects of the treatment planning process. Results: Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Conclusions: Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented

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

    Science.gov (United States)

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

    2013-08-01

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

  12. 77 FR 52277 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

    Science.gov (United States)

    2012-08-29

    ... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... rule. SUMMARY: EPA is proposing approval of a permitting rule submitted for the South Coast Air Quality Management District (District) portion of the California State Implementation Plan (SIP). The State is...

  13. 77 FR 12524 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality...

    Science.gov (United States)

    2012-03-01

    ... Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality Standards AGENCY... Indiana State Implementation Plan (SIP) for lead (Pb) under the Clean Air Act (CAA). This submittal incorporates the National Ambient Air Quality Standards (NAAQS) for Pb promulgated by EPA in 2008. DATES...

  14. 75 FR 65594 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality...

    Science.gov (United States)

    2010-10-26

    ... Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality Standards AGENCY... the Ohio Administrative Code (OAC) relating to the consolidation of Ohio's Ambient Air Quality Standards (AAQS) into Ohio's State Implementation Plan (SIP) under the Clean Air Act. On April 8, 2009, and...

  15. Improving patient safety through quality assurance.

    Science.gov (United States)

    Raab, Stephen S

    2006-05-01

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

  16. Improving PSA quality of KSNP PSA model

    International Nuclear Information System (INIS)

    Yang, Joon Eon; Ha, Jae Joo

    2004-01-01

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

  17. [QUIPS: quality improvement in postoperative pain management].

    Science.gov (United States)

    Meissner, Winfried

    2011-01-01

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

  18. Electronic health records improve clinical note quality.

    Science.gov (United States)

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

    2015-01-01

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

  19. Processes for Quality Improvements in Radiation Oncology Clinical Trials

    International Nuclear Information System (INIS)

    FitzGerald, T.J.; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey C.; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Cicchetti, M. Giulia; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

    2008-01-01

    Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials

  20. 78 FR 54835 - Air Quality Implementation Plan; Alabama; Attainment Plan for the Troy Area 2008 Lead...

    Science.gov (United States)

    2013-09-06

    ... 4] Air Quality Implementation Plan; Alabama; Attainment Plan for the Troy Area 2008 Lead... Troy 2008 Lead nonattainment area (hereafter referred to as the ``Troy Area'' or ``Area''). The Troy... submittal regarding the attainment plan based on Alabama's attainment demonstration for the Troy Area. The...

  1. Research Quality Assessment and Planning Journals. The Italian Perspective.

    Directory of Open Access Journals (Sweden)

    Bruno Zanon

    2014-02-01

    Full Text Available Assessment of research products is a crucial issue for universities and research institutions faced with internationalization and competition. Disciplines are reacting differently to this challenge, and planning, in its various forms – from urban design to process­oriented sectors – is under strain because the increasingly common assessment procedures based on the number of articles published in ranked journals and on citation data are not generally accepted. The reputation of journals, the impact of publications, and the profiles of scholars are increasingly defined by means of indexes such as impact factor and citations counts, but these metrics are questioned because they do not take account of all journals and magazines – in particular those published in languages other than English – and they do not consider teaching and other activities typical of academics and which have a real impact on planning practices at the local level. In Italy the discussion is particularly heated because assessment procedures are recent, the disciplinary community is not used to publishing in ranked international journals, and the Italian literature is not attuned to the international quality criteria. The paper reviews the recent debate on planning journals and research assessment. It focuses on the Italian case from the perspective of improving current practices.

  2. Municipalities in action. Comment to the article 'Slow with air quality plans' of the SNM

    International Nuclear Information System (INIS)

    2006-01-01

    The Association of Dutch Municipalities (VNG) does not agree with the environmental organization SNM, which states in another article in this issue of the magazine that municipalities in the Netherlands are slow in setting up and implementing air quality plans. From a VNG study it appears that investments are made to improve the air quality [nl

  3. SU-G-TeP1-07: Investigation of RapidPlan Based Plan Quality for Breast IMRTSimultaneously Integrated Boost

    International Nuclear Information System (INIS)

    Wang, J; Hu, W; Chen, X; Wu, Z

    2016-01-01

    Purpose: The aim of this study is to investigate the feasibility of using RapidPlan for breast cancer radiotherapy and to evaluate its performance for planners with different planning experiences. Methods: A training database was collected with 80 expert plan datasets from patients previously received left breast conserving surgery and IMRT-simultaneously integrated boost radiotherapy. The models were created on the RapidPlan. Five patients from the training database and 5 external patients were used for internal and external validation, respectively. Three planners with different planning experiences (beginner, junior, senior) designed manual and RapidPlan based plans for additional ten patients. The plan qualities were compared with manual and RapidPlan based ones. Results: For the internal and external validations, there were no significant dose differences on target coverage for plans from RapidPlan and manual. Also, no difference was found in the mean doses to contralateral breast and lung. The RapidPlan improved the heart (V5, V10, V20, V30, and mead dose) and ipsilateral lung (V5, V10, V20, V30, and mean dose) sparing for the beginner and junior planners. Compare to the plans from senior planner, 6 out of 16 clinically checked parameters were improved in RapidPlan, and the left parameters were similar. Conclusion: It is feasible to generate clinical acceptable plans using RapidPlan for breast cancer radiotherapy. The RapidPlan helps to systematically improve the quality of IMRT plans against the benchmark of clinically accepted plans. The RapidPlan shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced planners.

  4. SU-G-TeP1-07: Investigation of RapidPlan Based Plan Quality for Breast IMRTSimultaneously Integrated Boost

    Energy Technology Data Exchange (ETDEWEB)

    Wang, J; Hu, W; Chen, X; Wu, Z [Fudan University Shanghai Cancer Center, Shanghai, Shanghai (China)

    2016-06-15

    Purpose: The aim of this study is to investigate the feasibility of using RapidPlan for breast cancer radiotherapy and to evaluate its performance for planners with different planning experiences. Methods: A training database was collected with 80 expert plan datasets from patients previously received left breast conserving surgery and IMRT-simultaneously integrated boost radiotherapy. The models were created on the RapidPlan. Five patients from the training database and 5 external patients were used for internal and external validation, respectively. Three planners with different planning experiences (beginner, junior, senior) designed manual and RapidPlan based plans for additional ten patients. The plan qualities were compared with manual and RapidPlan based ones. Results: For the internal and external validations, there were no significant dose differences on target coverage for plans from RapidPlan and manual. Also, no difference was found in the mean doses to contralateral breast and lung. The RapidPlan improved the heart (V5, V10, V20, V30, and mead dose) and ipsilateral lung (V5, V10, V20, V30, and mean dose) sparing for the beginner and junior planners. Compare to the plans from senior planner, 6 out of 16 clinically checked parameters were improved in RapidPlan, and the left parameters were similar. Conclusion: It is feasible to generate clinical acceptable plans using RapidPlan for breast cancer radiotherapy. The RapidPlan helps to systematically improve the quality of IMRT plans against the benchmark of clinically accepted plans. The RapidPlan shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced planners.

  5. Strategic planning applied to quality in asthma management for children.

    Science.gov (United States)

    Goonan, K J; Healy, J M; Jordan, H S; Zazzali, J L; Horowitz, M

    1993-01-01

    This strategic plan translates the HCHP vision statement into a working plan for one major clinical condition--asthma in children. It is a working plan for clinicians and managers across specialties and levels. The results of the projects will improve in a measurable way significant clinical practice and outcomes, in keeping with the FY 1993 strategic goals.

  6. Improving care at cystic fibrosis centers through quality improvement.

    Science.gov (United States)

    Kraynack, Nathan C; McBride, John T

    2009-10-01

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

  7. Learning to Improve Earth Observation Flight Planning

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper describes a method and system for integrating machine learning with planning and data visualization for the management of mobile sensors for Earth science...

  8. ISO certification pays off in quality improvement

    International Nuclear Information System (INIS)

    Vermeer, F.J.G.

    1992-01-01

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

  9. 222-S Laboratory Quality Assurance Plan. Revision 1

    International Nuclear Information System (INIS)

    Meznarich, H.K.

    1995-01-01

    This Quality Assurance Plan provides,quality assurance (QA) guidance, regulatory QA requirements (e.g., 10 CFR 830.120), and quality control (QC) specifications for analytical service. This document follows the U.S Department of Energy (DOE) issued Hanford Analytical Services Quality Assurance Plan (HASQAP). In addition, this document meets the objectives of the Quality Assurance Program provided in the WHC-CM-4-2, Section 2.1. Quality assurance elements required in the Guidelines and Specifications for Preparing Quality Assurance Program Plans (QAMS-004) and Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans (QAMS-005) from the US Environmental Protection Agency (EPA) are covered throughout this document. A quality assurance index is provided in the Appendix A. This document also provides and/or identifies the procedural information that governs laboratory operations. The personnel of the 222-S Laboratory and the Standards Laboratory including managers, analysts, QA/QC staff, auditors, and support staff shall use this document as guidance and instructions for their operational and quality assurance activities. Other organizations that conduct activities described in this document for the 222-S Laboratory shall follow this QA/QC document

  10. How to Measure and Interpret Quality Improvement Data.

    Science.gov (United States)

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

    2016-05-06

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

  11. Ninety to Nothing: a PDSA quality improvement project.

    Science.gov (United States)

    Prybutok, Gayle Linda

    2018-05-14

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

  12. Quality assurance program plan fuel supply shutdown project

    International Nuclear Information System (INIS)

    Metcalf, I.L.

    1998-01-01

    This Quality Assurance Program plan (QAPP) describes how the Fuel Supply Shutdown (FSS) project organization implements the quality assurance requirements of HNF-MP-599, Project Hanford Quality Assurance Program Description (QAPD) and the B and W Hanford Company Quality Assurance Program Plan (QAPP), FSP-MP-004. The QAPP applies to facility structures, systems, and components and to activities (e.g., design, procurement, testing, operations, maintenance, etc.) that could affect structures, systems, and components. This QAPP also provides a roadmap of applicable Project Hanford Policies and Procedures (PHPP) which may be utilized by the FSS project organization to implement the requirements of this QAPP

  13. Improvements in geomagnetic observatory data quality

    DEFF Research Database (Denmark)

    Reda, Jan; Fouassier, Danielle; Isac, Anca

    2011-01-01

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

  14. Hanford Sampling Quality Management Plan (HSQMP)

    International Nuclear Information System (INIS)

    Hyatt, J.E.

    1995-06-01

    HSQMP establishes quality requirements in response to DOE Order 5700. 6C and to 10 Code of Federal Regulations 830.120. HSQMP is designed to meet the needs of Richland Operations Office for controlling the quality of services provided by sampling operations. It is issued through the Analytical Services Program of the Waste Programs Division. This document describes the Environmental Sampling and Analysis Program activities considered to represent the best management activities necessary to achieve a sampling program with adequate control

  15. Quality assurance program plan for radionuclide airborne emissions monitoring

    International Nuclear Information System (INIS)

    Boom, R.J.

    1995-03-01

    This Quality Assurance Program Plan identifies quality assurance program requirements and addresses the various Westinghouse Hanford Company organizations and their particular responsibilities in regards to sample and data handling of airborne emissions. The Hanford Site radioactive airborne emissions requirements are defined in National Emissions Standards for Hazardous Air Pollutants (NESHAP), Code of Federal Regulations, Title 40, Part 61, Subpart H (EPA 1991a). Reporting of the emissions to the US Department of Energy is performed in compliance with requirements of US Department of Energy, Richland Operations Office Order 5400.1, General Environmental Protection Program (DOE-RL 1988). This Quality Assurance Program Plan is prepared in accordance with and to the requirements of QAMS-004/80, Guidelines and Specifications for Preparing Quality Assurance Program Plans (EPA 1983). Title 40 CFR Part 61, Appendix B, Method 114, Quality Assurance Methods (EPA 1991b) specifies the quality assurance requirements and that a program plan should be prepared to meet the requirements of this regulation. This Quality Assurance Program Plan identifies NESHAP responsibilities and how the Westinghouse Hanford Company Environmental, Safety, Health, and Quality Assurance Division will verify that the methods are properly implemented

  16. Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems.

    Science.gov (United States)

    Zimmerman, Lindsey; Lounsbury, David W; Rosen, Craig S; Kimerling, Rachel; Trafton, Jodie A; Lindley, Steven E

    2016-11-01

    Implementation planning typically incorporates stakeholder input. Quality improvement efforts provide data-based feedback regarding progress. Participatory system dynamics modeling (PSD) triangulates stakeholder expertise, data and simulation of implementation plans prior to attempting change. Frontline staff in one VA outpatient mental health system used PSD to examine policy and procedural "mechanisms" they believe underlie local capacity to implement evidence-based psychotherapies (EBPs) for PTSD and depression. We piloted the PSD process, simulating implementation plans to improve EBP reach. Findings indicate PSD is a feasible, useful strategy for building stakeholder consensus, and may save time and effort as compared to trial-and-error EBP implementation planning.

  17. Managing Air Quality - Multi-Pollutant Planning and Control

    Science.gov (United States)

    Describes how planning controls for multiple pollutants at the same time can save money and time and achieve significant benefits, and how control strategies can address both climate change and air quality.

  18. Explicit optimization of plan quality measures in intensity-modulated radiation therapy treatment planning.

    Science.gov (United States)

    Engberg, Lovisa; Forsgren, Anders; Eriksson, Kjell; Hårdemark, Björn

    2017-06-01

    To formulate convex planning objectives of treatment plan multicriteria optimization with explicit relationships to the dose-volume histogram (DVH) statistics used in plan quality evaluation. Conventional planning objectives are designed to minimize the violation of DVH statistics thresholds using penalty functions. Although successful in guiding the DVH curve towards these thresholds, conventional planning objectives offer limited control of the individual points on the DVH curve (doses-at-volume) used to evaluate plan quality. In this study, we abandon the usual penalty-function framework and propose planning objectives that more closely relate to DVH statistics. The proposed planning objectives are based on mean-tail-dose, resulting in convex optimization. We also demonstrate how to adapt a standard optimization method to the proposed formulation in order to obtain a substantial reduction in computational cost. We investigated the potential of the proposed planning objectives as tools for optimizing DVH statistics through juxtaposition with the conventional planning objectives on two patient cases. Sets of treatment plans with differently balanced planning objectives were generated using either the proposed or the conventional approach. Dominance in the sense of better distributed doses-at-volume was observed in plans optimized within the proposed framework. The initial computational study indicates that the DVH statistics are better optimized and more efficiently balanced using the proposed planning objectives than using the conventional approach. © 2017 American Association of Physicists in Medicine.

  19. Near-facility environmental monitoring quality assurance project plan

    International Nuclear Information System (INIS)

    McKinney, S.M.

    1997-01-01

    This Quality Assurance Project Plan addresses the quality assurance requirements for the activities associated with the preoperational and near facility environmental monitoring performed by Waste Management Federal Services, Inc., Northwest Operations and supersedes WHC-EP-0538-2. This plan applies to all sampling and monitoring activities performed by waste management Federal Services, Inc., Northwest Operations in implementing facility environmental monitoring at the Hanford Site

  20. Strategies to improve quality of childbirth care

    Directory of Open Access Journals (Sweden)

    farahnaz Changaee

    2015-01-01

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

  1. Evaluation of plan quality assurance models for prostate cancer patients based on fully automatically generated Pareto-optimal treatment plans.

    Science.gov (United States)

    Wang, Yibing; Breedveld, Sebastiaan; Heijmen, Ben; Petit, Steven F

    2016-06-07

    IMRT planning with commercial Treatment Planning Systems (TPSs) is a trial-and-error process. Consequently, the quality of treatment plans may not be consistent among patients, planners and institutions. Recently, different plan quality assurance (QA) models have been proposed, that could flag and guide improvement of suboptimal treatment plans. However, the performance of these models was validated using plans that were created using the conventional trail-and-error treatment planning process. Consequently, it is challenging to assess and compare quantitatively the accuracy of different treatment planning QA models. Therefore, we created a golden standard dataset of consistently planned Pareto-optimal IMRT plans for 115 prostate patients. Next, the dataset was used to assess the performance of a treatment planning QA model that uses the overlap volume histogram (OVH). 115 prostate IMRT plans were fully automatically planned using our in-house developed TPS Erasmus-iCycle. An existing OVH model was trained on the plans of 58 of the patients. Next it was applied to predict DVHs of the rectum, bladder and anus of the remaining 57 patients. The predictions were compared with the achieved values of the golden standard plans for the rectum D mean, V 65, and V 75, and D mean of the anus and the bladder. For the rectum, the prediction errors (predicted-achieved) were only  -0.2  ±  0.9 Gy (mean  ±  1 SD) for D mean,-1.0  ±  1.6% for V 65, and  -0.4  ±  1.1% for V 75. For D mean of the anus and the bladder, the prediction error was 0.1  ±  1.6 Gy and 4.8  ±  4.1 Gy, respectively. Increasing the training cohort to 114 patients only led to minor improvements. A dataset of consistently planned Pareto-optimal prostate IMRT plans was generated. This dataset can be used to train new, and validate and compare existing treatment planning QA models, and has been made publicly available. The OVH model was highly accurate

  2. Continuous quality improvement in the ambulatory endoscopy center.

    Science.gov (United States)

    Johanson, John F

    2002-04-01

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

  3. ITER safety studies: starting the quality plan code AINA

    International Nuclear Information System (INIS)

    Dies, J.; Rivas, J. C.; Bargallo, E.

    2010-01-01

    This contribution discusses the implementation of the Quality Plan AINA Code 2.0. The work has affected areas such as the life cycle model, the software reliability plan, the design of the equipment or software tools to use, and has finally produced a new code.

  4. Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014.

    Science.gov (United States)

    Ndumele, Chima D; Schpero, William L; Schlesinger, Mark J; Trivedi, Amal N

    2017-06-27

    .9%]). There was no significant difference between exiting and nonexiting plans for the quality of chronic disease care management (76.2% vs 77.1%; difference, 1.0% [95% CI, -2.1% to 4.0%]). There was also no significant change in overall market performance before and after the exit of a plan: 0.7-percentage point improvement in preventive care quality (95% CI, -4.9 to 6.3); 0.2-percentage point improvement in chronic disease care management quality (95% CI, -5.8 to 6.2); 0.7-percentage point decrease in maternity care quality (95% CI, -6.4 to 5.0]); and a 0.6-percentage point improvement in patient experience ratings (95% CI, -3.9 to 5.1). Medicaid beneficiaries enrolled in exiting plans had access to coverage for a higher-quality plan, with 78% of plans in the same county having higher quality for preventive care, 71.1% for chronic disease management, 65.5% for maternity care, and 80.8% for patient experience. Between 2006 and 2014, health plan exit from the US Medicaid program was frequent. Plans that exited generally had lower quality ratings than those that remained, and the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market.

  5. Improving environmental performance through mine closure planning

    International Nuclear Information System (INIS)

    McKee, W.; McKenna, G.

    1998-01-01

    Syncrude has been investigating landscape redevelopment concepts since 1995 after a two-year tailings technology selection study resulted in a major shift in their long-term tailings disposal strategy. The change from fluid disposal to solid disposal of tailings leads to a different landscape, incorporating a new water material type, new landforms and a new schedule of reclamation activity. A multidisciplinary approach was needed to assess, design and develop the final landscape. Planning approach in progress at Syncrude Canada was described, and the basic concepts and tools of closure planning discovered to date were outlined. The economic impacts of closure planning on mining and tailings operations in general, were discussed. 14 refs

  6. Strategic facility planning improves capital decision making.

    Science.gov (United States)

    Reeve, J R

    2001-03-01

    A large, Midwestern IDS undertook a strategic facility-planning process to evaluate its facility portfolio and determine how best to allocate future investments in facility development. The IDS assembled a facility-planning team, which initiated the planning process with a market analysis to determine future market demands and identify service areas that warranted facility expansion. The team then analyzed each of the IDS's facilities from the perspective of uniform capacity measurements, highest and best use compared with needs, building condition and investment-worthiness, and facility growth and site development opportunities. Based on results of the analysis, the strategy adopted entailed, in part, shifting some space from inpatient care to ambulatory care services and demolishing and replacing the 11 percent of facilities deemed to be in the worst condition.

  7. Greater utilization of wood residue fuels through improved financial planning

    International Nuclear Information System (INIS)

    Billings, C.D.; Ziemke, M.C.; Stanford, R.

    1991-01-01

    Recent events have focused attention on the promotion of greater utilization of biomass fuel. Considerations include the need to reduce increases in global warming and also to improve ground level air quality by limiting the use of fossil fuels. However, despite all these important environmentally related considerations, economics remains the most important factor in the decision process used to determine the feasibility of using available renewable fuels instead of more convenient fossil fuels. In many areas of the Southeast, this decision process involves choosing between wood residue fuels such as bark, sawdust and shavings and presently plentiful natural gas. The primary candidate users of wood residue fuels are industries that use large amounts of heat and electric power and are located near centers of activity in the forest products industry such as sawmills, veneer mills and furniture factories. Given that such facilities both produce wood residues and need large amounts of heat and electricity, it is understandable that these firms are often major users of wood-fired furnaces and boilers. The authors have observed that poor or incomplete financial planning by the subject firms is a major barrier to economic utilization of inexpensive and widely available renewable fuels. In this paper, the authors suggest that wider usage of improved financial planning could double the present modest annual incidence of new commercial wood-fueled installation

  8. Improving Power Quality in AC Supply Grids

    Directory of Open Access Journals (Sweden)

    Piotr Fabijański

    2015-12-01

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

  9. 78 FR 63934 - Approval of Air Quality Implementation Plans; California; El Dorado County Air Quality Management...

    Science.gov (United States)

    2013-10-25

    ...] Approval of Air Quality Implementation Plans; California; El Dorado County Air Quality Management District... California for the El Dorado County Air Quality Management District (EDAQMD) portion of the California SIP... 24, 1987 Federal Register, May 25, 1988, U.S. EPA, Air Quality Management Division, Office of Air...

  10. 78 FR 19990 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality...

    Science.gov (United States)

    2013-04-03

    ... Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality Standards; Correction AGENCY... approved revisions to Ohio regulations that consolidated air quality standards in a new chapter of rules... State's air quality standards into Ohio Administrative Code (OAC) 3745-25 and modifying an assortment of...

  11. 75 FR 65572 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality...

    Science.gov (United States)

    2010-10-26

    ... Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality Standards AGENCY... Ohio Administrative Code (OAC) relating to the consolidation of Ohio's Ambient Air Quality Standards... apply to Ohio's SIP. Incorporating the air quality standards into Ohio's SIP helps assure that...

  12. 77 FR 12482 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality...

    Science.gov (United States)

    2012-03-01

    ... Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality Standards AGENCY... incorporates the National Ambient Air Quality Standards (NAAQS) for Pb promulgated by EPA in 2008. DATES: This... FR 66964) and codified at 40 CFR 50.16, ``National primary and secondary ambient air quality...

  13. Planning urban settlements for quality of life

    DEFF Research Database (Denmark)

    Boje Groth, N.; Hansen, K.E.; Björnberg, U.

    Notatet er et indlæg på den Europæiske Økonomiske Kommissions (ECE) konference om by- og regionforskning, tema II: "Research on the Quality of Life in Urban Settlements, Warszawa, maj 1976. I notatet opstilles en begrebsramme for livskvalitetsbegrebet, og man diskuterer hvorledes livskvalitetsana......Notatet er et indlæg på den Europæiske Økonomiske Kommissions (ECE) konference om by- og regionforskning, tema II: "Research on the Quality of Life in Urban Settlements, Warszawa, maj 1976. I notatet opstilles en begrebsramme for livskvalitetsbegrebet, og man diskuterer hvorledes...

  14. Westinghouse Water Reactor Divisions quality assurance plan

    International Nuclear Information System (INIS)

    1977-09-01

    The Quality Assurance Program used by Westinghouse Water Reactor Divisions is described. The purpose of the program is to assure that the design, materials, and workmanship on Nuclear Steam Supply System (NSSS) equipment meet applicable safety requirements, fulfill the requirements of the contracts with the applicants, and satisfy the applicable codes, standards, and regulatory requirements. This program satisfies the NRC Quality Assurance Criteria, 10CFR50 Appendix B, to the extent that these criteria apply to safety related NSSS equipment. Also, it follows the regulatory position provided in NRC regulatory guides and the requirements of ANSI Standard N45.2.12 as identified in this Topical Report

  15. Improving the Quality of Constructive Peer Feedback

    Science.gov (United States)

    Waggoner Denton, Ashley

    2018-01-01

    This article presents some simple strategies that instructors can use to improve the quality of the feedback students provide each other during a peer review activity. Briefly, I recommend that emphasis be placed solely on the provision of constructive comments, and that in order to qualify as constructive, a comment must: (1) identify a specific…

  16. Teaching Quality Improvement Through a Book Club

    Directory of Open Access Journals (Sweden)

    Benjamin Doolittle

    2015-12-01

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

  17. Fostering Quality Improvement in EHDI Programs

    Science.gov (United States)

    Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd; Guignard, Gayla Hutsell

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the quality improvement area, a total of 218 items were listed by 47 EHDI coordinators, and themes were identified in each…

  18. National Quality Improvement Center on Early Childhood

    Science.gov (United States)

    Browne, Charlyn Harper

    2014-01-01

    The national Quality Improvement Center on early Childhood (QIC-eC) funded four research and demonstration projects that tested child maltreatment prevention approaches. The projects were guided by several key perspectives: the importance of increasing protective factors in addition to decreasing risk factors in child maltreatment prevention…

  19. Semen quality improves marginally during young adulthood

    DEFF Research Database (Denmark)

    Perheentupa, Antti; Sadov, Sergey; Rönkä, Riitta

    2016-01-01

    STUDY QUESTION: Does semen quality improve during early adulthood? SUMMARY ANSWER: Semen variables change little during the third decade of life, however some improvement in sperm morphology and motility may occur. WHAT IS KNOWN ALREADY: A suspicion of deteriorating semen quality has been raised...... in several studies. The longitudinal development of semen quality in early adulthood is insufficiently understood. STUDY DESIGN, SIZE, DURATION: A longitudinal follow-up of two cohorts of volunteer young adult Finnish men representing the general population was carried out. Cohorts A (discovery cohort, born...... 1979-1981, n = 336) and B (validation cohort, born 1983, n = 197) were followed up from the age of 19 years onward for 10 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Inclusion criteria included that both the men and their mothers were born in Finland. Semen analysis was performed in cohorts...

  20. Quality Assurance/Quality Control Issues for Intraoperative Planning and Adaptive Repeat Planning of Image-Guided Prostate Implants

    International Nuclear Information System (INIS)

    Zaider, Marco; Cohen, Gilad; Meli, Jerome; Rosenfeld, Anatoly B.

    2008-01-01

    The quality assurance/quality control purpose is this. We design a treatment plan, and we wish to be as certain as reasonably possible that the treatment is delivered as planned. In the case of conventionally planned prostate brachytherapy, implementing to the letter the implantation plan is rarely attainable and therefore can require adaptive replanning (a quality control issue). The reasons for this state of affairs include changes in the prostate shape and volume during implantation and treatment delivery (e.g., edema resolution) and unavoidable inaccuracy in the placement of the seeds in the prostate. As a result, quality-control activities (e.g., the need to monitor-ideally, on the fly-the target and urethral and rectal dosage) must be also addressed

  1. Quality assurance plan, Westinghouse Water Reactor Divisions

    Energy Technology Data Exchange (ETDEWEB)

    1976-03-01

    The Quality Assurance Program used by Westinghouse Nuclear Energy Systems Water Reactor Divisions is described. The purpose of the program is to assure that the design, materials, and workmanship on Nuclear Steam Supply System (NSSS) equipment meet applicable safety requirements, fulfill the requirements of the contracts with the applicants, and satisfy the applicable codes, standards, and regulatory requirements.

  2. Spatial quality, location theory and spatial planning

    NARCIS (Netherlands)

    Assink, Mathijs; Groenendijk, Nico

    2009-01-01

    This paper deals with spatial quality as a possible factor in location choices made by companies. Actual location decisions as well as location theory have changed over time. In the industrial era primary “hard” cost factors were dominant, to be supplemented by agglomeration factors ever since the

  3. D7.1 Quality Plan

    DEFF Research Database (Denmark)

    Ryberg, Thomas; Lee, Deirdre; Maglavera, Stavroula

    2009-01-01

    This deliverable includes a detailed description of the quality assurance process for the EATrain2 project, the initial results of the risk assessment and self-evaluation processes as well as a description of the peer-review process for ensuring qualitative deliverables....

  4. Impact of leaf motion constraints on IMAT plan quality, deliver accuracy, and efficiency

    International Nuclear Information System (INIS)

    Chen Fan; Rao Min; Ye Jinsong; Shepard, David M.; Cao Daliang

    2011-01-01

    Purpose: Intensity modulated arc therapy (IMAT) is a radiation therapy delivery technique that combines the efficiency of arc based delivery with the dose painting capabilities of intensity modulated radiation therapy (IMRT). A key challenge in developing robust inverse planning solutions for IMAT is the need to account for the connectivity of the beam shapes as the gantry rotates from one beam angle to the next. To overcome this challenge, inverse planning solutions typically impose a leaf motion constraint that defines the maximum distance a multileaf collimator (MLC) leaf can travel between adjacent control points. The leaf motion constraint ensures the deliverability of the optimized plan, but it also impacts the plan quality, the delivery accuracy, and the delivery efficiency. In this work, the authors have studied leaf motion constraints in detail and have developed recommendations for optimizing the balance between plan quality and delivery efficiency. Methods: Two steps were used to generate optimized IMAT treatment plans. The first was the direct machine parameter optimization (DMPO) inverse planning module in the Pinnacle 3 planning system. Then, a home-grown arc sequencer was applied to convert the optimized intensity maps into deliverable IMAT arcs. IMAT leaf motion constraints were imposed using limits of between 1 and 30 mm/deg. Dose distributions were calculated using the convolution/superposition algorithm in the Pinnacle 3 planning system. The IMAT plan dose calculation accuracy was examined using a finer sampling calculation and the quality assurance verification. All plans were delivered on an Elekta Synergy with an 80-leaf MLC and were verified using an IBA MatriXX 2D ion chamber array inserted in a MultiCube solid water phantom. Results: The use of a more restrictive leaf motion constraint (less than 1-2 mm/deg) results in inferior plan quality. A less restrictive leaf motion constraint (greater than 5 mm/deg) results in improved plan quality

  5. Improving Consumer Information for Higher Education Planning

    Science.gov (United States)

    Herndon, M. Craig

    2012-01-01

    It is a historically held principle of microeconomics that in the presence of better information, consumers make better decisions. This chapter focuses on information to guide consumers in making decisions about higher education. It examines the development and implementation of a one-stop career and college planning tool that leverages existing…

  6. Engaging clinical nurses in quality and performance improvement activities.

    Science.gov (United States)

    Albanese, Madeline P; Evans, Dietra A; Schantz, Cathy A; Bowen, Margaret; Disbot, Maureen; Moffa, Joseph S; Piesieski, Patricia; Polomano, Rosemary C

    2010-01-01

    Nursing performance measures are an integral part of quality initiatives in acute care; however, organizations face numerous challenges in developing infrastructures to support quality improvement processes and timely dissemination of outcomes data. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, extensive work has been conducted to incorporate nursing-related outcomes in the organization's quality plan and to integrate roles for clinical nurses into the Department of Nursing and organization's core performance-based programs. Content and strategies that promote active involvement of nurses and prepare them to be competent and confident stakeholders in quality initiatives are presented. Engaging clinical nurses in the work of quality and performance improvement is essential to achieving excellence in clinical care. It is important to have structures and processes in place to bring meaningful data to the bedside; however, it is equally important to incorporate outcomes into practice. When nurses are educated about performance and quality measures, are engaged in identifying outcomes and collecting meaningful data, are active participants in disseminating quality reports, and are able to recognize the value of these activities, data become one with practice.

  7. Planning, Conducting, and Documenting Data Analysis for Program Improvement

    Science.gov (United States)

    Winer, Abby; Taylor, Cornelia; Derrington, Taletha; Lucas, Anne

    2015-01-01

    This 2015 document was developed to help technical assistance (TA) providers and state staff define and limit the scope of data analysis for program improvement efforts, including the State Systemic Improvement Plan (SSIP); develop a plan for data analysis; document alternative hypotheses and additional analyses as they are generated; and…

  8. Linking the Teacher Appraisal Process to the School Improvement Plan

    Science.gov (United States)

    Reddekopp, Therese

    2007-01-01

    If a school improvement plan includes input from all stakeholders and focuses on data-driven processes that are linked to teacher appraisal, it can be powerful in leading the school toward the common mission of achieving student success. Linking the school improvement plan to the teacher appraisal process creates a system whereby all individuals…

  9. Improvements in patient treatment planning systems

    International Nuclear Information System (INIS)

    Wheeler, F.J.; Wessol, D.E.; Nigg, D.W.; Atkinson, C.A.; Babcock, R.; Evans, J.

    1995-01-01

    The Boron Neutron Capture Therapy, Radiation treatment planning environment (BNCT-Rtpe) software system is used to develop treatment planning information. In typical use BNCT-Rtpe consists of three main components: (1) Semi-automated geometric modeling of objects (brain, target, eyes, sinus) derived from MRI, CT, and other medical imaging modalities, (2) Dose computations for these geometric models with rtt-MC, the INEL Monte Carlo radiation transport computer code, and (3) Dose contouring overlaid on medical images as well as generation of other dose displays. We continue to develop a planning system based on three-dimensional image-based reconstructions using Bspline surfaces. Even though this software is in an experimental state, it has been applied for large animal research and for an isolated case of treatment for a human glioma. Radiation transport is based on Monte Carlo, however there will be implementations of faster methods (e.g. diffusion theory) in the future. The important thing for treatment planning is the output which must convey, to the radiologist, the deposition of dose to healthy and target tissue. Many edits are available such that one can obtain contours registered to medical image, dose/volume histograms and most information required for treatment planning and response assessment. Recent work has been to make the process more automatic and easier to use. The interface, now implemented for contouring and reconstruction, utilizes the Xwindowing system and the MOTIF graphical users interface for effective interaction with the planner. Much work still remains before the tool can be applied in a routine clinical setting

  10. TU-FG-201-10: Quality Management of Accelerated Partial Breast Irradiation (APBI) Plans

    International Nuclear Information System (INIS)

    Ji, H; Lorio, V; Cernica, G; Han, J; Nurhussien, M; Nasr, N; Hong, R

    2016-01-01

    Purpose: Since 2008, over 700 patients received high dose rate (HDR) APBI treatment at Virginia Hospital Center. The complexity involved in the planning process demonstrated a broad variation between patient geometry across all applicators, in relation to anatomical regions of interest. A quality management program instituting various metrics was implemented in March 2013 with the goal of ensuring an optimal plan is achieved for each patient. Methods: For each plan, an in-house complexity index, geometric conformity index, and plan quality index were defined. These indices were obtained for all patients treated. For patients treated after the implementation, the conformity index and quality index were maximized while other dosimetric limits, such as maximum skin and rib doses, were strictly kept. Subsequently, all evaluation parameters and applicator information were placed in a database for cross-evaluation with similar complexity. Results: Both the conformity and quality indices show good correlation with the complexity index. They decrease as complexity increases for all applicators. Multi lumen type balloon applicators demonstrate a minimal advantage over single lumen applicators in increasingly complex patient geometries, as compared to SAVI applicators which showed considerably greater advantage in these circumstances. After the implementation of the in-house planning protocol, there is a direct improvement of quality for SAVI plans. Conclusion: Due to their interstitial nature, SAVI devices show a better conformity in comparison to balloon-based devices regardless of the number of lumens, especially in complex cases. The quality management program focuses on optimizing indices by utilizing prior planning knowledge based on complexity levels. The database of indices assists in decision making and has subsequently aided in balancing the experience level among planners. This approach has made APBI planning more robust for patient care, with a measurable

  11. TU-FG-201-10: Quality Management of Accelerated Partial Breast Irradiation (APBI) Plans

    Energy Technology Data Exchange (ETDEWEB)

    Ji, H; Lorio, V; Cernica, G [Associates In Medical Physics, Lanham, MD (United States); Virginia Hospital Center, Arlington, VA (United States); Han, J; Nurhussien, M; Nasr, N; Hong, R [Virginia Hospital Center, Arlington, VA (United States)

    2016-06-15

    Purpose: Since 2008, over 700 patients received high dose rate (HDR) APBI treatment at Virginia Hospital Center. The complexity involved in the planning process demonstrated a broad variation between patient geometry across all applicators, in relation to anatomical regions of interest. A quality management program instituting various metrics was implemented in March 2013 with the goal of ensuring an optimal plan is achieved for each patient. Methods: For each plan, an in-house complexity index, geometric conformity index, and plan quality index were defined. These indices were obtained for all patients treated. For patients treated after the implementation, the conformity index and quality index were maximized while other dosimetric limits, such as maximum skin and rib doses, were strictly kept. Subsequently, all evaluation parameters and applicator information were placed in a database for cross-evaluation with similar complexity. Results: Both the conformity and quality indices show good correlation with the complexity index. They decrease as complexity increases for all applicators. Multi lumen type balloon applicators demonstrate a minimal advantage over single lumen applicators in increasingly complex patient geometries, as compared to SAVI applicators which showed considerably greater advantage in these circumstances. After the implementation of the in-house planning protocol, there is a direct improvement of quality for SAVI plans. Conclusion: Due to their interstitial nature, SAVI devices show a better conformity in comparison to balloon-based devices regardless of the number of lumens, especially in complex cases. The quality management program focuses on optimizing indices by utilizing prior planning knowledge based on complexity levels. The database of indices assists in decision making and has subsequently aided in balancing the experience level among planners. This approach has made APBI planning more robust for patient care, with a measurable

  12. Quality improvement in basic histotechnology: the lean approach.

    Science.gov (United States)

    Clark, David

    2016-01-01

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

  13. Prioritizing quality improvement in general surgery.

    Science.gov (United States)

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

    2008-11-01

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

  14. Engaging Clinical Nurses in Quality Improvement Projects.

    Science.gov (United States)

    Moore, Susan; Stichler, Jaynelle F

    2015-10-01

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

  15. Quality Assurance Program Plan for radionuclide airborne emissions monitoring

    International Nuclear Information System (INIS)

    Vance, L.M.

    1993-07-01

    This Quality Assurance Program Plan (QAPP) describes the quality assurance requirements and responsibilities for radioactive airborne emissions measurements activities from regulated stacks are controlled at the Hanford Site. Detailed monitoring requirements apply to stacks exceeding 1% of the standard of 10 mrem annual effective dose equivalent to the maximally exposed individual from operations of the Hanford Site

  16. Quality Assessment of Family Planning Services in Ife/Ijesa ...

    African Journals Online (AJOL)

    Context: Medical audit in healthcare has a goal to monitor and upgrade the standard of health care in a setting. Whether a client will accept, use effectively and continue to practice contraception depends on the quality of services rendered. Objective: To assess the quality of our family planning services as perceived by our ...

  17. Embedding soil quality in land-use planning

    NARCIS (Netherlands)

    Wezel AP van; Weijden AGG van der; Wijnen HJ van; Mulder Ch; Wijnen HJ van; MNP; LER; LDL

    2006-01-01

    Changes in land use in the Netherlands are anticipated on a large scale. Soil quality, however, hardly plays a role in spatial planning, which was reason enough to analyse the relationship between land use and soil quality on a national scale using ecological data. Despite major changes in land

  18. Quality Assurance Program Plan for radionuclide airborne emissions monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Vance, L.M.

    1993-07-01

    This Quality Assurance Program Plan (QAPP) describes the quality assurance requirements and responsibilities for radioactive airborne emissions measurements activities from regulated stacks are controlled at the Hanford Site. Detailed monitoring requirements apply to stacks exceeding 1% of the standard of 10 mrem annual effective dose equivalent to the maximally exposed individual from operations of the Hanford Site.

  19. Considerations for using data envelopment analysis for the assessment of radiotherapy treatment plan quality.

    Science.gov (United States)

    Simpson, John; Raith, Andrea; Rouse, Paul; Ehrgott, Matthias

    2017-10-09

    Purpose The operations research method of data envelopment analysis (DEA) shows promise for assessing radiotherapy treatment plan quality. The purpose of this paper is to consider the technical requirements for using DEA for plan assessment. Design/methodology/approach In total, 41 prostate treatment plans were retrospectively analysed using the DEA method. The authors investigate the impact of DEA weight restrictions with reference to the ability to differentiate plan performance at a level of clinical significance. Patient geometry influences plan quality and the authors compare differing approaches for managing patient geometry within the DEA method. Findings The input-oriented DEA method is the method of choice when performing plan analysis using the key undesirable plan metrics as the DEA inputs. When considering multiple inputs, it is necessary to constrain the DEA input weights in order to identify potential plan improvements at a level of clinical significance. All tested approaches for the consideration of patient geometry yielded consistent results. Research limitations/implications This work is based on prostate plans and individual recommendations would therefore need to be validated for other treatment sites. Notwithstanding, the method that requires both optimised DEA weights according to clinical significance and appropriate accounting for patient geometric factors is universally applicable. Practical implications DEA can potentially be used during treatment plan development to guide the planning process or alternatively used retrospectively for treatment plan quality audit. Social implications DEA is independent of the planning system platform and therefore has the potential to be used for multi-institutional quality audit. Originality/value To the authors' knowledge, this is the first published examination of the optimal approach in the use of DEA for radiotherapy treatment plan assessment.

  20. 77 FR 19280 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical...

    Science.gov (United States)

    2012-03-30

    ... concerns that current system data quality might not allow for an AC optimal power flow model to be properly... Market and Planning Efficiency Through Improved Software; Notice of Technical Conference: Increasing Real-Time and Day- Ahead Market Efficiency Through Improved Software Take notice that Commission staff will...

  1. MANAGEMENT PLANS AND THEIR IMPACT ON SCHOOL IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Ignacio Polo Martínez

    2016-06-01

    Full Text Available OECD (2015 states that management's leadership is a critical factor for implementing reforms and improving schools. Candidates are required to submit a management plan outlining the framework of a plan to be followed during their 4 year term. Despite the plan outlined in the proposal, the implicit "non aggression pact" between the participants (the teachers and the directors, who are teachers themselves, makes change difficult. As a result, management plans have little impact on improving methods of teaching and academic results achieved by the students. In this article we have tried to achieve three objectives: 1 analyze the relationship between the renewal, selection and appointment of a director with the management plan around our country, 2 analyze which aspects are those that, according to major international studies, should determine the content, development and evaluation of a management plan, and 3 to suggest how one could implement a management plan for an education center or school.

  2. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

  3. Distributed power quality improvement in residential microgrids

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  4. Pediatric CT quality management and improvement program

    Energy Technology Data Exchange (ETDEWEB)

    Larson, David B.; Chan, Frandics P.; Newman, Beverley; Fleischmann, Dominik [Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States); Molvin, Lior Z. [Stanford Hospital and Clinics, Stanford, CA (United States); Wang, Jia [Stanford University, Environmental Health and Safety, Stanford, CA (United States)

    2014-10-15

    Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve. (orig.)

  5. Pediatric CT quality management and improvement program

    International Nuclear Information System (INIS)

    Larson, David B.; Chan, Frandics P.; Newman, Beverley; Fleischmann, Dominik; Molvin, Lior Z.; Wang, Jia

    2014-01-01

    Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve. (orig.)

  6. Targeting Environmental Quality to Improve Population Health ...

    Science.gov (United States)

    Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Yet, the stakeholders are typically all within the healthcare system, e.g. the Accountable Care Organization or Patient-Centered Medical Home, leaving important contributors to the health of the population such as the public health and environmental health systems absent. And rarely is the quality of the environment regarded as a modifiable factor capable of imparting a health benefit. Underscoring this point, a PubMed search of the search terms “environmental quality” with “value-based payment”, “value-based healthcare” or “value-based reimbursement” returned no relevant articles, providing further evidence that the healthcare industry largely disregards the quality of the environment as a significant determinant of wellbeing and an actionable risk factor for clinical disease management and population health intervention. Yet, the quality of the environment is unequivocally related to indicators of population health including all-cause mortality. The EPA’s Environmental Quality Index (EQI) composed of five different domains (air, land use, water, built environment and social) has provided new estimates of the associations between environmental quality and health stat

  7. Linking Quality Assurance to Performance Improvement to Produce a High Reliability Organization

    International Nuclear Information System (INIS)

    Silvey, Andrea B.; Warrick, Louise H.

    2008-01-01

    Three basic change management models are currently used in healthcare to produce and sustain quality improvement. We have presented the context to determine where any particular organization stands within these paradigms. We also have introduced a change-management tool used to assess, plan, and monitor leadership effort and commitment to quality improvement and culture change activities, tracked as 'momentum for change.' This 'momentum' is measured at eight discrete levels, from recognizing a performance gap to officially implementing changes intended to improve quality

  8. Family planning services quality as a determinant of use of IUD in Egypt

    Directory of Open Access Journals (Sweden)

    Montana Livia

    2006-06-01

    . Improving quality of family planning services may help further increase use of clinical contraceptive methods and reduce fertility.

  9. Creating quality improvement culture in public health agencies.

    Science.gov (United States)

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

    2014-01-01

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

  10. Creating Quality Improvement Culture in Public Health Agencies

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

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

    International Nuclear Information System (INIS)

    Wang Xiaoling

    2004-01-01

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

  13. Improving the quality of orthopaedic elective and trauma operative notes: A completed audit loop study

    Directory of Open Access Journals (Sweden)

    Parth Arvind Shah

    2016-01-01

    Discussion: This study showed that the quality of elective operative notes was improved through surgeon education and the circulation of a guideline based electronic operative note. We have further plans to implement procedure specific notes for the most common types of trauma cases to help improve the quality of trauma operative notes.

  14. 78 FR 18936 - Revision to the California State Implementation Plan, South Coast Air Quality Management Plan

    Science.gov (United States)

    2013-03-28

    ... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA-R09-OAR-2012-0920; FRL-9779-1] Revision to the California State Implementation Plan, South Coast Air Quality Management Plan AGENCY: Environmental Protection Agency (EPA). ACTION: Proposed rule. SUMMARY: EPA is proposing to approve a revision to the South...

  15. The 2000 DOD Financial Management Improvement Plan

    National Research Council Canada - National Science Library

    2001-01-01

    The Federal Financial Management Improvement Act of 1996 requires DoD financial management systems to comply substantially with Federal financial management system requirements, Federal accounting standards, and the U.S...

  16. Improving of Business Planning Using the Method of Fuzzy Numbers

    Directory of Open Access Journals (Sweden)

    Iryna Kosteteska

    2016-03-01

    Full Text Available Purpose: Summarize the experience of using modern methods in the business plan with the application of economic and mathematical modeling. Methodology: Theoretical and methodological basis of the study is the basic principles of economic theory, agricultural economics and scientific research of leading home and foreign scholars on the theory of planning. Originality: This further justifies business planning processes in agriculture from the standpoint of raising economic protection of farmers. The methodology for assessing farm income for planned indicators through the application of fuzzy numbers method in business planning is improved.

  17. Goal hierarchy: Improving asset data quality by improving motivation

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-11-15

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

  18. Goal hierarchy: Improving asset data quality by improving motivation

    International Nuclear Information System (INIS)

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

    2011-01-01

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

  19. Progress in improving provincial plans for nutrition through targeted technical assistance and local advocacy in Vietnam.

    Science.gov (United States)

    Harris, Jody; Nguyen, Phuong H; To, Quyen; Frongillo, Edward A; Menon, Purnima

    2016-12-01

    Vietnam has been decentralizing nutrition planning to provinces, which could help with local relevance and accountability. Assessment in 2009 found a continuing top-down approach, limited human capacity, and difficulty in integrating multiple sectors. Alive and Thrive (A&T) provided targeted assistance and capacity-building for 15 provincial plans for nutrition (PPNs). We aimed to (i) assess PPN content and quality improvements 2009-2014, and (ii) explain processes through which change occurred. Data consisted of interview-based assessments of provincial planning processes, annual PPN assessments, and tracking of A&T involvement. At endline, some provinces produced higher quality plans. Local planning skills improved, but capacity remained insufficient. Awareness of and support for nutrition improved, but some policy and legal environments were contradictory. Objectives were clearer, but use of data for planning remained inconsistent. Provinces became more proactive and creative, but remained constrained by slow approval processes and insufficient funding. Targeted assistance and local advocacy can improve decentralized planning, with success dependent on policy and programming contexts and ability to overcome constraints around capacity, investment, data use and remnants of centralized planning. We recommend strong engagement with planners at the national level to understand how to unblock major constraints; solutions must take into consideration the particular political, financial and administrative context. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  20. Improving the ignition quality of fuels

    KAUST Repository

    Sarathy, Mani

    2017-06-08

    Provided herein are compounds and methods of producing compounds for improving ignition quality and combustion efficiency of fuels, for example fossil fuels. In various aspects we generate highly oxygenated compounds from hydrocarbon feedstocks. The feedstock can be a branched alkane or n-alkane having a chain length greater than or equal to 6, a cycloalkane with a 5 or 6 membered ring structure, or a alkylated cycloalkane with 5 or more carbon atoms. The reactant can be fed in the gas- phase to a partial oxidation reactor (with or without a catalyst), and at a fixed temperature, mixture composition, and residence time. The reactant can be converted to a mixture of products including keto hydroperoxides, diketo hydroperoxides, keto dihydroperoxides, hydroperoxyl cyclic ethers, and alkenyl hydroperoxides. The compounds are inherently unstable and can quickly decompose to highly reactive radical species that can be used to improve the ignition quality of a fuel and advance ignition in an engine.

  1. A Model to Improve the Quality Products

    Directory of Open Access Journals (Sweden)

    Hasan GOKKAYA

    2010-08-01

    Full Text Available The topic of this paper is to present a solution who can improve product qualityfollowing the idea: “Unlike people who have verbal skills, machines use "sign language"to communicate what hurts or what has invaded their system’. Recognizing the "signs"or symptoms that the machine conveys is a required skill for those who work withmachines and are responsible for their care and feeding. The acoustic behavior of technical products is predominantly defined in the design stage, although the acoustic characteristics of machine structures can be analyze and give a solution for the actual products and create a new generation of products. The paper describes the steps intechnological process for a product and the solution who will reduce the costs with the non-quality of product and improve the management quality.

  2. Improving the ignition quality of fuels

    KAUST Repository

    Sarathy, Mani; Wang, Zhandong; Shankar, Vijai Shankar Bhavani

    2017-01-01

    Provided herein are compounds and methods of producing compounds for improving ignition quality and combustion efficiency of fuels, for example fossil fuels. In various aspects we generate highly oxygenated compounds from hydrocarbon feedstocks. The feedstock can be a branched alkane or n-alkane having a chain length greater than or equal to 6, a cycloalkane with a 5 or 6 membered ring structure, or a alkylated cycloalkane with 5 or more carbon atoms. The reactant can be fed in the gas- phase to a partial oxidation reactor (with or without a catalyst), and at a fixed temperature, mixture composition, and residence time. The reactant can be converted to a mixture of products including keto hydroperoxides, diketo hydroperoxides, keto dihydroperoxides, hydroperoxyl cyclic ethers, and alkenyl hydroperoxides. The compounds are inherently unstable and can quickly decompose to highly reactive radical species that can be used to improve the ignition quality of a fuel and advance ignition in an engine.

  3. A planning quality evaluation tool for prostate adaptive IMRT based on machine learning

    International Nuclear Information System (INIS)

    Zhu Xiaofeng; Ge Yaorong; Li Taoran; Thongphiew, Danthai; Yin Fangfang; Wu, Q Jackie

    2011-01-01

    Purpose: To ensure plan quality for adaptive IMRT of the prostate, we developed a quantitative evaluation tool using a machine learning approach. This tool generates dose volume histograms (DVHs) of organs-at-risk (OARs) based on prior plans as a reference, to be compared with the adaptive plan derived from fluence map deformation. Methods: Under the same configuration using seven-field 15 MV photon beams, DVHs of OARs (bladder and rectum) were estimated based on anatomical information of the patient and a model learned from a database of high quality prior plans. In this study, the anatomical information was characterized by the organ volumes and distance-to-target histogram (DTH). The database consists of 198 high quality prostate plans and was validated with 14 cases outside the training pool. Principal component analysis (PCA) was applied to DVHs and DTHs to quantify their salient features. Then, support vector regression (SVR) was implemented to establish the correlation between the features of the DVH and the anatomical information. Results: DVH/DTH curves could be characterized sufficiently just using only two or three truncated principal components, thus, patient anatomical information was quantified with reduced numbers of variables. The evaluation of the model using the test data set demonstrated its accuracy ∼80% in prediction and effectiveness in improving ART planning quality. Conclusions: An adaptive IMRT plan quality evaluation tool based on machine learning has been developed, which estimates OAR sparing and provides reference in evaluating ART.

  4. Quality Improvement in Athletic Health Care.

    Science.gov (United States)

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

    2017-11-01

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

  5. In Brief: Improving Mississippi River water quality

    Science.gov (United States)

    Showstack, Randy

    2007-10-01

    If water quality in the Mississippi River and the northern Gulf of Mexico is to improve, the U.S. Environmental Protection Agency (EPA) needs to take a stronger leadership role in implementing the federal Clean Water Act, according to a 16 October report from the U.S. National Research Council. The report notes that EPA has failed to use its authority to coordinate and oversee activities along the river. In addition, river states need to be more proactive and cooperative in efforts to monitor and improve water quality, and the river should be monitored and evaluated as a single system, the report indicates. Currently, the 10 states along the river conduct separate and widely varying water quality monitoring programs. ``The limited attention being given to monitoring and managing the Mississippi's water quality does not match the river's significant economic, ecological, and cultural importance,'' said committee chair David A. Dzombak, director of the Steinbrenner Institute for Environmental Education and Research at Carnegie Mellon University, Pittsburgh, Pa. The report notes that while measures taken under the Clean Water Act have successfully reduced much point source pollution, nutrient and sediment loads from nonpoint sources continue to be significant problems. For more information, visit the Web site: http://books.nap.edu/catalog.php?record_id=12051.

  6. Improving quality of service in the internet

    OpenAIRE

    Flückiger, François

    2000-01-01

    The Internet transport technology was designed to be robust, resilient to link or node outages, and with no single point of failure. The resulting connectionless system supports what is called a "best effort datagram delivery service", the perfo rmance of which is often greatly unpredictable. To improve the predictability of IP-based networks, several Quality of Service technologies have been designed over the past decade. The first one, RSVP, based on reservation of resources, is operational...

  7. Dosimetric improvements following 3D planning of tangential breast irradiation

    International Nuclear Information System (INIS)

    Aref, Amr; Thornton, Dale; Youssef, Emad; He, Tony; Tekyi-Mensah, Samuel; Denton, Lori; Ezzell, Gary

    2000-01-01

    Purpose: To evaluate the dosimetric difference between a simple radiation therapy plan utilizing a single contour and a more complex three-dimensional (3D) plan utilizing multiple contours, lung inhomogeneity correction, and dose-based compensators. Methods and Materials: This is a study of the radiation therapy (RT) plans of 85 patients with early breast cancer. All patients were considered for breast-conserving management and treated by conventional tangential fields technique. Two plans were generated for each patient. The first RT plan was based on a single contour taken at the central axis and utilized two wedges. The second RT plan was generated by using the 3D planning system to design dose-based compensators after lung inhomogeneity correction had been made. The endpoints of the study were the comparison between the volumes receiving greater than 105% and greater than 110% of the reference dose, as well as the magnitude of the treated volume maximum dose. Dosimetric improvement was defined to be of significant value if the volume receiving > 105% of one plan was reduced by at least 50% with the absolute difference between the volumes being 5% or greater. The dosimetric improvements in 49 3D plans (58%) were considered of significant value. Patients' field separation and breast size did not predict the magnitude of improvement in dosimetry. Conclusion: Dose-based compensator plans significantly reduced the volumes receiving > 105%, >110%, and volume maximum dose.

  8. Bioethanol Quality Improvement of Coffee Fruit Leather

    Directory of Open Access Journals (Sweden)

    Edahwati Luluk

    2016-01-01

    Full Text Available Recently, Indonesia’s dependence on petroleum is to be reduced and even eliminated. To overcome the problem of finding the needed alternative materials that can produce ethanol, in this case as a substitute material or a transport fuel mix, boosting the octane number, and gasoline ethanol (gasohol can be conducted. In the red coffee processing (cooking that will produce 65% and 35% of coffee beans, coffee leather waste is a source of organic material with fairly high cellulose content of 46.82%, 3.01% of pectin and 7.68% of lignin. In this case, its existence is abundant in Indonesia and optimally utilized. During the coffee fruit peeling, the peel waste is only used as a mixture of animal feed or simply left to rot. The purpose of this study was to produce and improve the quality of the fruit skin of bioethanol from coffee cellulose. However, to improve the quality of bioethanol, the production of the lignin content in the skin of the coffee fruit should be eliminated or reduced. Hydrolysis process using organosolve method is expected to improve the quality of bioethanol produced. In particular, the use of enzyme Saccharomyces and Zymmomonas will change the resulting sugar into bioethanol. On one hand, by using batch distillation process for 8 hours with Saccharomyces, bioethanol obtains high purity which is 39.79%; on the other hand, by using the same batch distillation process with Zymmomonas, the bioethanol obtains 38.78%.

  9. Improving energy audit process and report outcomes through planning initiatives

    Science.gov (United States)

    Sprau Coulter, Tabitha L.

    Energy audits and energy models are an important aspect of the retrofit design process, as they provide project teams with an opportunity to evaluate a facilities current building systems' and energy performance. The information collected during an energy audit is typically used to develop an energy model and an energy audit report that are both used to assist in making decisions about the design and implementation of energy conservation measures in a facility. The current lack of energy auditing standards results in a high degree of variability in energy audit outcomes depending on the individual performing the audit. The research presented is based on the conviction that performing an energy audit and producing a value adding energy model for retrofit buildings can benefit from a revised approach. The research was divided into four phases, with the initial three phases consisting of: 1.) process mapping activity - aimed at reducing variability in the energy auditing and energy modeling process. 2.) survey analysis -- To examine the misalignment between how industry members use the top energy modeling tools compared to their intended use as defined by software representatives. 3.) sensitivity analysis -- analysis of the affect key energy modeling inputs are having on energy modeling analysis results. The initial three phases helped define the need for an improved energy audit approach that better aligns data collection with facility owners' needs and priorities. The initial three phases also assisted in the development of a multi-criteria decision support tool that incorporates a House of Quality approach to guide a pre-audit planning activity. For the fourth and final research phase explored the impacts and evaluation methods of a pre-audit planning activity using two comparative energy audits as case studies. In each case, an energy audit professionals was asked to complete an audit using their traditional methods along with an audit which involved them first

  10. Quality improvement in neurology: AAN Parkinson disease quality measures

    Science.gov (United States)

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

    2010-01-01

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

  11. MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases

    International Nuclear Information System (INIS)

    Chang, J.

    2015-01-01

    The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi

  12. MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases

    Energy Technology Data Exchange (ETDEWEB)

    Chang, J. [New York Weill Cornell Medical Ctr (United States)

    2015-06-15

    The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi

  13. Improving acceptance in wind power planning

    Energy Technology Data Exchange (ETDEWEB)

    Hammarlund, K. [Lund Univ. (Sweden). Dept. of Social and Economic Geography

    1996-12-01

    This paper presents important factors and planning procedures for public acceptance of wind power. Opinion surveys in Sweden show that acceptance is connected to the concept of utility rather than the aesthetic values. If wind turbines are confined by the authorities to marginal areas, they will not earn their rightful place in the landscape by being of use. A positive attitude in general promotes a positive experience of the effects of wind turbines. It is therefore essential to establish a sense of cooperation between the project management and the public. An open dialogue and continuous information will increase the possibilities for acceptance of future development. We must establish new codes of practice in permit processing because policies today contains ideological and practical contradictions between development and preservation of landscapes. 16 refs, 2 tabs

  14. Improving acceptance in wind power planning

    International Nuclear Information System (INIS)

    Hammarlund, K.

    1996-01-01

    This paper presents important factors and planning procedures for public acceptance of wind power. Opinion surveys in Sweden show that acceptance is connected to the concept of utility rather than the aesthetic values. If wind turbines are confined by the authorities to marginal areas they will not earn their rightful place in the landscape by being of use. A positive attitude in general promotes positive experience of the effects of wind turbines. It is therefore essential to establish a sense of cooperation between the project management and the public. An open dialogue and continuous information will increase the possibilities for acceptance of future development. We must establish new codes of practice in permit processing because policies today contains idealogical and practical contradictions between the development and preservation of landscapes. (author)

  15. How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

    Science.gov (United States)

    Cho, Yu Kyung

    2016-07-01

    In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

  16. A method of quality audit for treatment planning system for intracavitary HDR brachytherapy

    International Nuclear Information System (INIS)

    Sharma, S.D.; Vandana, S.; Philomina, A.; Kannan, S.; Rituraj, U.

    2007-01-01

    High dose rate brachytherapy is a multipurpose modality. Quality audit (QAu) is an independent examination and evaluation of quality assurance activities and results of an institution. Both clinical and physical aspects of patient treatments must be subjected to careful control and planning to achieve a high degree of accuracy in radiation therapy treatments. Comprehensive quality assurance (QA) programmes should be established to cover all steps from dose prescription to dose delivery. These programmes should include detailed internal checks performed by the radiotherapy centres and external audits made by independent bodies. A systematic and independent examination and evaluation to determine whether quality activities and results comply with planned arrangements and whether the arrangements are implemented effectively and are suitable to achieve objectives is called quality audit. One purpose of a quality audit (QAu) is to evaluate the need for improvement or corrective action

  17. Are hospital quality improvement and public accountability compatible?

    Science.gov (United States)

    Panzer, R J

    1994-07-01

    The goals of public accountability and quality improvement are compatible in theory but not necessarily in practice. Both concepts emphasize the customer. However, those working toward these two goals design systems with quite different roles and relationships between the providers and consumers of health care. Superficial interactions obstruct meaningful dialogue about how to build a better system meeting both sets of goals. Current practices of public accountability and quality improvement have fundamentally different paradigms concerning the roles and responsibilities of those who provide and those who consume health care. There are at least three ways to improve the current relationship between public accountability and quality improvement. First, optimizing the design and performance of each effort would be an improvement since the goals are highly compatible. Neither ideal currently meets its own expectations, creating distrust among the proponents of each when reality falls short. Second, the two efforts could be coordinated through joint community-level planning and sharing. Finally and optimally, the two concepts could be made part of the same community-level cooperative system, an approach that offers the greatest opportunity for achieving shared goals.

  18. 242-A Evaporator quality assurance plan. Revision 2

    International Nuclear Information System (INIS)

    Basra, T.S.

    1995-01-01

    The purpose of this quality assurance project plan (Plan) is to provide requirements for activities pertaining to sampling, shipping, and analyses associated with candidate feed tank samples for the 242-A Evaporator project. The purpose of the 242-A Evaporator project is to reduce the volume of aqueous waste in the Double Shell Tank (DST) System and will result in considerable savings to the disposal of mixed waste. The 242-A Evaporator feed stream originates from DSTs identified as candidate feed tanks. The 242-A Evaporator reduces the volume of aqueous waste contained in DSTs by boiling off water and sending the condensate (called process condensate) to the Liquid Effluent Retention Facility (LEPF) storage basin where it is stored prior to treatment in the Effluent Treatment Facility (ETF). The objective of this quality assurance project plan is to provide the planning, implementation, and assessment of sample collection and analysis, data issuance, and validation activities for the candidate feed tanks

  19. Evaluation of service quality in family planning clinics in Lusaka, Zambia.

    Science.gov (United States)

    Hancock, Nancy L; Vwalika, Bellington; Sitali, Elizabeth Siyama; Mbwili-Muleya, Clara; Chi, Benjamin H; Stuart, Gretchen S

    2015-10-01

    To determine the quality of contraceptive services in family planning clinics in Lusaka, Zambia, using a standardized approach. We utilized the Quick Investigation of Quality, a cross-sectional survey tool consisting of a facility assessment, client-provider observation and client exit interview, in public-sector family planning clinics. Data were collected on availability of seven contraceptive methods, information given to clients, interpersonal relations between providers and clients, providers' technical competence and mechanisms for continuity and follow-up. Data were collected from five client-provider observations and client exit interviews in each of six public-sector family planning clinics. All clinics had at least two contraceptive methods continuously available for the preceding 6 months. Most providers asked clients about concerns with their contraceptive method (80%) and told clients when to return to the clinic (87%). Most clients reported that the provider advised what to do if a problem develops (93%), described possible side effects (89%), explained how to use the method effectively (85%) and told them when to come for follow-up (83%). Clients were satisfied with services received (93%). This application of the Quick Investigation of Quality showed that the participating family planning clinics in Lusaka, Zambia, were prepared to offer high-quality services with the available commodities and that clients were satisfied with the received services. Despite the subjective client satisfaction, quality improvement efforts are needed to increase contraceptive availability. Although clients perceived the quality of care received to be high, family planning service quality could be improved to continuously offer the full spectrum of contraceptive options. The Quick Investigation of Quality was easily implemented in Lusaka, Zambia, and this simple approach could be utilized in a variety of settings as a modality for quality improvement. Copyright © 2015

  20. Strategic Planning to Improve EHDI Programs

    Science.gov (United States)

    White, Karl R.; Blaiser, Kristina M.

    2011-01-01

    Because newborn hearing screening has become the standard of care in the United States, every state has established an early hearing detection and intervention (EHDI) program responsible for establishing, maintaining, and improving the system of services needed to serve children with hearing loss and their families. While significant developments…

  1. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

    Energy Technology Data Exchange (ETDEWEB)

    Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise; Boucheron, Edward A.; Drake, Richard Roy; Minana, Molly A.; Hackney, Patricia; Forsythe, Christi A.; Schofield, Joseph Richard, Jr. (,; .); Pavlakos, Constantine James; Williamson, Charles Michael; Edwards, Harold Carter

    2006-09-01

    The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

  2. SU-F-T-617: Remotely Pre-Planned Stereotactic Ablative Radiation Therapy: Validation of Treatment Plan Quality

    International Nuclear Information System (INIS)

    Juang, T; Bush, K; Loo, B; Gensheimer, M

    2016-01-01

    Purpose: We propose a workflow to improve access to stereotactic ablative radiation therapy (SABR) for rural patients. When implemented, a separate trip to the central facility for simulation can be eliminated. Two elements are required: (1) Fabrication of custom immobilization devices to match positioning on prior diagnostic CT (dxCT). (2) Remote radiation pre-planning on dxCT, with transfer of contours/plan to simulation CT (simCT) and initiation of treatment same-day or next day. In this retrospective study, we validated part 2 of the workflow using patients already treated with SABR for upper lobe lung tumors. Methods: Target/normal structures were contoured on dxCT; a plan was created and approved by the physician. Structures were transferred to simCT using deformable image registration and the plan was re-optimized on simCT. Plan quality was evaluated through comparison to gold-standard structures contoured on simCT and a gold-standard plan based on these structures. Workflow-generated plan quality in this study represents a worst-case scenario as these patients were not treated using custom immobilization to match dxCT position as would be done when the workflow is implemented clinically. Results: 5/6 plans created through the pre-planning workflow were clinically acceptable. For all six plans, the gold-standard GTV received full prescription dose, along with median PTV V95%=95.2% and median PTV D95%=95.4%. Median GTV DSC=0.80, indicating high degree of similarity between the deformed and gold-standard GTV contours despite small GTV sizes (mean=3.0cc). One outlier (DSC=0.49) resulted in inadequate PTV coverage (V95%=62.9%) in the workflow plan; in clinical practice, this mismatch between deformed/gold-standard GTV would be revised by the physician after deformable registration. For all patients, normal tissue doses were comparable to the gold-standard plan and well within constraints. Conclusion: Pre-planning SABR cases on diagnostic imaging generated

  3. Increased Mercury Bioaccumulation Follows Water Quality Improvement

    Energy Technology Data Exchange (ETDEWEB)

    Bogle, M.A.; Peterson, M.J.; Smith, J.G.; Southworth, G.R.

    1999-09-15

    Changes in physical and chemical characteristics of aquatic habitats made to reduce or eliminate ecological risks can sometimes have unforeseen consequences. Environmental management activities on the U.S. Dept. of Energy reservation in Oak Ridge, Tennessee,have succeeded in improving water quality in streams impacted by discharges fi-om industrial facilities and waste disposal sites. The diversity and abundance of pollution-sensitive components of the benthic macroinvertebrate communities of three streams improved after new waste treatment systems or remedial actions reduced inputs of various toxic chemicals. Two of the streams were known to be mercury-contaminated from historical spills and waste disposal practices. Waterborne mercury concentrations in the third were typical of uncontaminated systems. In each case, concentrations of mercury in fish, or the apparent biological availability of mercury increased over the period during which ecological metrics indicated improved water quality. In the system where waterborne mercury concentrations were at background levels, increased mercury bioaccumulation was probably a result of reduced aqueous selenium concentrations; however, the mechanisms for increased mercury accumulation in the other two streams remain under investigation. In each of the three systems, reduced inputs of metals and inorganic anions was followed by improvements in the health of aquatic invertebrate communities. However, this reduction in risk to aquatic invertebrates was accompanied by increased risk to humans and piscivorous wildlife related to increased mercury concentrations in fish.

  4. Increased Mercury Bioaccumulation Follows Water Quality Improvement

    International Nuclear Information System (INIS)

    Bogle, M.A.; Peterson, M.J.; Smith, J.G.; Southworth, G.R.

    1999-01-01

    Changes in physical and chemical characteristics of aquatic habitats made to reduce or eliminate ecological risks can sometimes have unforeseen consequences. Environmental management activities on the U.S. Dept. of Energy reservation in Oak Ridge, Tennessee,have succeeded in improving water quality in streams impacted by discharges fi-om industrial facilities and waste disposal sites. The diversity and abundance of pollution-sensitive components of the benthic macroinvertebrate communities of three streams improved after new waste treatment systems or remedial actions reduced inputs of various toxic chemicals. Two of the streams were known to be mercury-contaminated from historical spills and waste disposal practices. Waterborne mercury concentrations in the third were typical of uncontaminated systems. In each case, concentrations of mercury in fish, or the apparent biological availability of mercury increased over the period during which ecological metrics indicated improved water quality. In the system where waterborne mercury concentrations were at background levels, increased mercury bioaccumulation was probably a result of reduced aqueous selenium concentrations; however, the mechanisms for increased mercury accumulation in the other two streams remain under investigation. In each of the three systems, reduced inputs of metals and inorganic anions was followed by improvements in the health of aquatic invertebrate communities. However, this reduction in risk to aquatic invertebrates was accompanied by increased risk to humans and piscivorous wildlife related to increased mercury concentrations in fish

  5. The Columbia River Protection Supplemental Technologies Quality Assurance Project Plan

    International Nuclear Information System (INIS)

    Fix, Anne

    2007-01-01

    The U.S. Department of Energy (DOE) has conducted interim groundwater remedial activities on the Hanford Site since the mid-1990s for several groundwater contamination plumes. DOE established the Columbia River Protection Supplemental Technologies Project (Technologies Project) in 2006 to evaluate alternative treatment technologies. The objectives for the technology project are as follows: develop a 300 Area polyphosphate treatability test to immobilize uranium, design and test infiltration of a phosphate/apatite technology for Sr-90 at 100-N, perform carbon tetrachloride and chloroform attenuation parameter studies, perform vadose zone chromium characterization and geochemistry studies, perform in situ biostimulation of chromium studies for a reducing barrier at 100-D, and perform a treatability test for phytoremediation for Sr-90 at 100-N. This document provides the quality assurance guidelines that will be followed by the Technologies Project. This Quality Assurance Project Plan is based on the quality assurance requirements of DOE Order 414.1C, Quality Assurance, and 10 CFR 830, Subpart A--Quality Assurance Requirements as delineated in Pacific Northwest National Laboratory?s Standards-Based Management System. In addition, the technology project is subject to the Environmental Protection Agency (EPA) Requirements for Quality Assurance Project Plans (EPA/240/B-01/003, QA/R-5). The Hanford Analytical Services Quality Assurance Requirements Documents (HASQARD, DOE/RL-96-68) apply to portions of this project and to the subcontractors. HASQARD requirements are discussed within applicable sections of this plan.

  6. Implementation guide for Hanford Analytical Services Quality Assurance Plan

    International Nuclear Information System (INIS)

    1994-09-01

    This implementation guide for the Hanford Analytical Services Quality Assurance Plan (HASQAP) was developed by the US Department of Energy, Richland Operations Office (RL) Waste Management Division, Analytical Services Branch. This plan formally presents RL's direction for Hanford Sitewide implementation of the HASQAP. The HASQAP establishes a uniform standard for quality requirements to meet US Department of Energy Order 5700.6C, Quality Assurance (10 CFR 830.120, ''Quality Assurance Requirements''), and is intended to satisfy the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) requirements for ''Guidance on Preparation of Laboratory Quality Assurance Plans''. The quality assurance criteria specified in the HASQAP shall serve as a baseline for implementing quality management systems for the laboratories that provide analytical services, for data requesters and users, and for oversight organizations that monitor the data-generation process. Affected organizations shall implement the HASQAP requirements that are applicable to their work scope. Full implementation of the HASQAP is scheduled to occur by August 1995. RL will work with the US Environmental Protection Agency (EPA) and Washington State Department of Ecology (Ecology) to have the HASQAP document incorporated into Appendix F of the Tri-Party Agreement by early Fiscal Year 1996

  7. Integration of air quality-related planning processes : report

    International Nuclear Information System (INIS)

    2004-05-01

    Several communities in British Columbia have conducted air quality, greenhouse gas, or community energy management plans. This report explored the possibility of integrating 3 community-based air quality-related planning processes into a single process and evaluated the use of these 3 processes by local governments and First Nations in identifying and addressing air quality-related objectives, and determined to what extent they could be integrated to achieve planning objectives for air quality, greenhouse gas emissions, and energy supply and conservation. The lessons learned from 9 case studies in British Columbia were presented. The purpose of the case studies was to examine how communities handled emissions and energy related inventory and planning work, as well as their experiences with, or considerations for, an integrated process. The lessons were grouped under several key themes including organization and stakeholder involvement; messaging and focus; leadership/champions; and resources and capacity. The report also outlined a framework for an integrated planning process and provided recommendations regarding how an integrated or complementary process could be performed. A number of next steps were also offered for the provincial government to move the concept of an integrated process forward with the assistance of other partners. These included identifying the resources required to support communities engaging in an integrated process as well as discussing the series of options for provincial support with key stakeholders. refs., tabs., figs

  8. The Individualized Quality Control Plan - Coming Soon to Clinical Microbiology Laboratories Everywhere!

    Science.gov (United States)

    Anderson, Nancy

    2015-11-15

    As of January 1, 2016, microbiology laboratories can choose to adopt a new quality control option, the Individualized Quality Control Plan (IQCP), under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). This voluntary approach increases flexibility for meeting regulatory requirements and provides laboratories the opportunity to customize QC for their testing in their unique environments and by their testing personnel. IQCP is an all-inclusive approach to quality based on risk management to address potential errors in the total testing process. It includes three main steps, (1) performing a risk assessment, (2) developing a QC plan, and (3) monitoring the plan through quality assessment. Resources are available from the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, American Society for Microbiology, Clinical and Laboratory Standards Institute, and accrediting organizations, such as the College of American Pathologists and Joint Commission, to assist microbiology laboratories implementing IQCP.

  9. MODERN CONCEPTS OF THE SIX SIGMA METHODOLOGY FOR IMPROVING THE QUALITY

    Directory of Open Access Journals (Sweden)

    MARGARITA JANESKA

    2018-02-01

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

  10. Plutonium stabilization and handling quality assurance program plan

    International Nuclear Information System (INIS)

    Weiss, E.V.

    1998-01-01

    This Quality Assurance Program Plan (QAPP) identifies project quality assurance requirements for all contractors involved in the planning and execution of Hanford Site activities for design, procurement, construction, testing and inspection for Project W-460, Plutonium Stabilization and Handling. The project encompasses procurement and installation of a Stabilization and Packaging System (SPS) to oxidize and package for long term storage remaining plutonium-bearing special nuclear materials currently in inventory at the Plutonium Finishing Plant (PFP), and modification of vault equipment to allow storage of resulting packages of stabilized SNM

  11. Gas generation matrix depletion quality assurance project plan

    International Nuclear Information System (INIS)

    1998-01-01

    The Los Alamos National Laboratory (LANL) is to provide the necessary expertise, experience, equipment and instrumentation, and management structure to: Conduct the matrix depletion experiments using simulated waste for quantifying matrix depletion effects; and Conduct experiments on 60 cylinders containing simulated TRU waste to determine the effects of matrix depletion on gas generation for transportation. All work for the Gas Generation Matrix Depletion (GGMD) experiment is performed according to the quality objectives established in the test plan and under this Quality Assurance Project Plan (QAPjP)

  12. ERD UMTRA Project quality assurance program plan, Revision 7

    International Nuclear Information System (INIS)

    1995-09-01

    This document is the revised Quality Assurance Program Plan (QAPP) dated September, 1995 for the Environmental Restoration Division (ERD) Uranium Mill Tailings Remedial Action Project (UMTRA). Quality Assurance requirements for the ERD UMTRA Project are based on the criteria outlined in DOE Order 5700.6C or applicable sections of 10 CFR 830.120. QA requirements contained in this QAPP shall apply to all personnel, processes, and activities, including planning, scheduling, and cost control, performed by the ERD UMTRA Project and its contractors

  13. Evaluating School Improvement Plans and Their Affect on Academic Performance

    Science.gov (United States)

    Fernandez, Kenneth E.

    2011-01-01

    The development of a school improvement plan (SIP) has become an integral part of many school reform efforts. However, there are almost no studies that empirically examine the effectiveness of SIPs. The few studies examining the planning activities of organizations have generally focused on the private sector and have not provided clear or…

  14. Columbia River Channel Improvement Project Rock Removal Blasting: Monitoring Plan

    Energy Technology Data Exchange (ETDEWEB)

    Carlson, Thomas J.; Johnson, Gary E.

    2010-01-29

    This document provides a monitoring plan to evaluate take as outlined in the National Marine Fisheries Service 2002 Biological Opinion for underwater blasting to remove rock from the navigation channel for the Columbia River Channel Improvement Project. The plan was prepared by the Pacific Northwest National Laboratory (PNNL) for the U.S. Army Corps of Engineers (USACE), Portland District.

  15. Total quality drives nuclear plant improvements

    International Nuclear Information System (INIS)

    Richey, R.B.

    1991-01-01

    Total quality (TQ) at Carolina Power and Light (CP and L) is fulfilling a 1985 vision of Sherwood H. Smith, Jr., CP and L's chairman, president, and chief executive officer. The TQ concept has provided a way for employees to align their creative energies toward meeting the business needs of the company. Throughout CP and L, TQ has been recognized as the vehicle for reducing operating costs and improving customer satisfaction. Within the nuclear organization, application of the TQ process has helped to improve communications, resolve challenges, and provide more consistent work practices among CP and L's three nuclear plants. Total quality was introduced from the top down, with initial benefits coming from team interactions. Senior management at CP and L defined the corporate expectations and outlined the training requirements for implementing TQ. Management staffs at each organizational level became steering committees for TQ team activities within their departments. Teams of employees most knowledgeable about a given work area were empowered to solve problems or overcome obstacles related to that work area. Employees learned to become better team players and to appreciate the quality of decisions reached through group consensus. Now, formalized methods that started TQ are becoming part of the day-to-day work ethic

  16. Quality plan for criticality safety calculations at Rocky Flats

    International Nuclear Information System (INIS)

    Pecora, D.

    1978-01-01

    The text of the plan is given, and some of the guidelines followed in writing it are discussed to aid others who may be faced with the same task. The plan is divided into four sections. The Introduction describes the general functions and purpose of the calculational program. The second section, Activities and Responsibilities, lists specific tasks and their purposes and assigns responsibility for performance. The third section references relevant documentation (e.g., ANSI standards), and the final section describes quality plans for specific functions

  17. Airport Capital Improvement Plan : stewardship for airport development

    Science.gov (United States)

    1997-09-01

    This document summarizes efforts of the Federal Aviation Administration (FAA) Office : of the Associate Administrator for Airports to implement the concept of Airport Capital : Improvement Planning (ACIP). It is based on the experiences of the FAA's ...

  18. AVLIS Production Plant Preliminary Quality Assurance Plan and Assessment

    International Nuclear Information System (INIS)

    1984-01-01

    This preliminary Quality Assurance Plan and Assessment establishes the Quality Assurance requirements for the AVLIS Production Plant Project. The Quality Assurance Plan defines the management approach, organization, interfaces, and controls that will be used in order to provide adequate confidence that the AVLIS Production Plant design, procurement, construction, fabrication, installation, start-up, and operation are accomplished within established goals and objectives. The Quality Assurance Program defined in this document includes a system for assessing those elements of the project whose failure would have a significant impact on safety, environment, schedule, cost, or overall plant objectives. As elements of the project are assessed, classifications are provided to establish and assure that special actions are defined which will eliminate or reduce the probability of occurrence or control the consequences of failure. 8 figures, 18 tables

  19. Improved Beam Angle Arrangement in Intensity Modulated Proton Therapy Treatment Planning for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Cao, Wenhua; Lim, Gino J.; Li, Yupeng; Zhu, X. Ronald; Zhang, Xiaodong

    2015-01-01

    Purpose: This study investigates potential gains of an improved beam angle arrangement compared to a conventional fixed gantry setup in intensity modulated proton therapy (IMPT) treatment for localized prostate cancer patients based on a proof of principle study. Materials and Methods: Three patients with localized prostate cancer retrospectively selected from our institution were studied. For each patient, IMPT plans were designed using two, three and four beam angles, respectively, obtained from a beam angle optimization algorithm. Those plans were then compared with ones using two lateral parallel-opposed beams according to the conventional planning protocol for localized prostate cancer adopted at our institution. Results: IMPT plans with two optimized angles achieved significant improvements in rectum sparing and moderate improvements in bladder sparing against those with two lateral angles. Plans with three optimized angles further improved rectum sparing significantly over those two-angle plans, whereas four-angle plans found no advantage over three-angle plans. A possible three-beam class solution for localized prostate patients was suggested and demonstrated with preserved dosimetric benefits because individually optimized three-angle solutions were found sharing a very similar pattern. Conclusions: This study has demonstrated the potential of using an improved beam angle arrangement to better exploit the theoretical dosimetric benefits of proton therapy and provided insights of selecting quality beam angles for localized prostate cancer treatment

  20. The Columbia River Protection Supplemental Technologies Quality Assurance Project Plan

    Energy Technology Data Exchange (ETDEWEB)

    Fix, N. J.

    2008-03-12

    Pacific Northwest National Laboratory researchers are working on the Columbia River Protection Supplemental Technologies Project. This project is a U. S. Department of Energy, Office of Environmental Management-funded initiative designed to develop new methods, strategies, and technologies for characterizing, modeling, remediating, and monitoring soils and groundwater contaminated with metals, radionuclides, and chlorinated organics. This Quality Assurance Project Plan provides the quality assurance requirements and processes that will be followed by the Technologies Project staff.

  1. Improving tomato seed quality- challenges and possibilities

    DEFF Research Database (Denmark)

    Shrestha, Santosh

    The thesis investigates the possibility of using single seed near-infrared (NIR) spectroscopy, multispectral imaging (MSI) and NIR hyperspectral imaging (NIR-HSI) in combination with chemometrics for rapid determination of the tomato seed quality. The results of the PhD study are compiled in four...... manuscripts (MS). These non-destructive methods show the potential of sorting tomato seeds as per their viability and varietal identity. The results are discussed in the context of possible contribution from these methods in the improvement of the seed quality in Nepal. In MS I, potential application of NIR...... spectroscopy in combination with chemometrics for prediction of tomato seed viability is demonstrated. The work in MS I also emphasises on identifying the important NIR spectral regions for the chemometric model that are relevant to the separation of viable and non-viable seeds. The NIR-HIS method was also...

  2. IMPROVEMENTS IN THE QUALITY OF COURIER DELIVERY

    Directory of Open Access Journals (Sweden)

    Jacek Karcz

    2016-06-01

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

  3. Improving wind power quality with energy storage

    DEFF Research Database (Denmark)

    Rasmussen, Claus Nygaard

    2009-01-01

    The results of simulation of the influence of energy storage on wind power quality are presented. Simulations are done using a mathematical model of energy storage. Results show the relation between storage power and energy, and the obtained increase in minimum available power from the combination...... of wind and storage. The introduction of storage enables smoothening of wind power on a timescale proportional to the storage energy. Storage does not provide availability of wind power at all times, but allows for a certain fraction of average power in a given timeframe to be available with high...... probability. The amount of storage capacity necessary for significant wind power quality improvement in a given period is found to be 20 to 40% of the energy produced in that period. The necessary power is found to be 80 to 100% of the average power of the period....

  4. Performance indicators: A tool for continuous quality improvement

    Directory of Open Access Journals (Sweden)

    Nidhi M Bhatnagar

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

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

  7. Improving quality of reproductive health care in Senegal through formative supervision: results from four districts.

    Science.gov (United States)

    Suh, Siri; Moreira, Philippe; Ly, Moussa

    2007-11-29

    In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. The most notable improvement across regions was in infection prevention.Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

  8. Improving quality of reproductive health care in Senegal through formative supervision: results from four districts

    Directory of Open Access Journals (Sweden)

    Moreira Philippe

    2007-11-01

    Full Text Available Abstract Background In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. Methods This study evaluated changes in service quality and community involvement after two rounds of supervision in 45 health facilities in four districts of Senegal. We used checklists to assess quality in four areas of service delivery: infrastructure, staff and services management, record-keeping, and technical competence. We also measured community involvement in improving service quality using the completion rates of action plans. Results The most notable improvement across regions was in infection prevention. Management of staff, services, and logistics also consistently improved across the four districts. Record-keeping skills showed variable but lower improvement by region. The completion rates of action plans suggest that communities are engaged in improving service quality in all four districts. Conclusion Formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality.

  9. Review of quality assessment tools for family planning programmes in low- and middle-income countries.

    Science.gov (United States)

    Sprockett, Andrea

    2017-03-01

    Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this literature review was to identify widely used public domain quality assessment tools with existing or potential application in clinic-based family planning programmes. Using PubMed, PopLine, Google Scholar and Google, key terms such as ‘quality assessment tool’, ‘quality assessment method’, ‘quality measurement’, ‘LMIC’, ‘developing country’, ‘family planning’ and ‘reproductive health’ were searched for articles, identifying 20 relevant tools. Tools were assessed to determine the type of quality components assessed, divided into structure and process components, level of application (national or facility), health service domain that can be assessed by the tool, cost and current use of the tool. Tools were also assessed for shortcomings based on application in a low- and middle-income clinic-based family planning programme, including personnel required, re-assessment frequency, assessment of structure, process and outcome quality, comparability of data over time and across facilities and ability to benchmark clinic results to a national benchmark. No tools met all criteria, indicating a critical gap in quality assessment for low- and middle-income family planning programmes. To achieve Universal Health Coverage, agreed on in the Sustainable Development Goals and to improve system-wide healthcare quality, we must develop and widely adopt a standardized quality assessment tool.

  10. 75 FR 19923 - Revisions to the California State Implementation Plan, Yolo-Solano Air Quality Management District

    Science.gov (United States)

    2010-04-16

    ... the California State Implementation Plan, Yolo- Solano Air Quality Management District AGENCY... the Yolo-Solano Air Quality Management District (YSAQMD) portion of the California State.... ``Improving Air Quality with Economic Incentive Programs,'' EPA- 452/R-01-001, January 2001. B. Does the rule...

  11. Using genomics to improve fruit quality.

    Science.gov (United States)

    Meneses, Claudio; Orellana, Ariel

    2013-01-01

    New fruit varieties are needed to satisfy consumers, and the industry is facing new challenges in order to respond to these demands. The emergence of genomic tools is releasing information on polymorphisms that can be utilized to expedite breeding processes in species that are difficult to breed, given the long periods of time required to get new varieties. The present review describes the current stages of the ongoing efforts that are being taken to apply these technologies to obtain varieties with improved fruit quality in species of the family Rosaceae.

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

    Science.gov (United States)

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

    2017-10-09

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

  13. Quality Rating and Improvement System State Evaluations and Research

    Science.gov (United States)

    Ferguson, Daniel

    2016-01-01

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

  14. Waste Management Project Quality Assurance Program Plan (QAPP)

    International Nuclear Information System (INIS)

    HORHOTA, M.J.

    2000-01-01

    The Waste Management Project (WMP) is committed to excellence in our work and to delivering quality products and services to our customers, protecting our employees and the public and to being good stewards of the environment. We will continually strive to understand customer requirements, perform services, and activities that meet or exceed customer expectations, and be cost-effective in our performance. The WMP maintains an environment that fosters continuous improvement in our processes, performance, safety and quality. The achievement of quality will require the total commitment of all WMP employees to our ethic that Quality, Health and Safety, and Regulatory Compliance must come before profits. The successful implementation of this policy and ethic requires a formal, documented management quality system to ensure quality standards are established and achieved in all activities. The following principles are the foundation of our quality system. Senior management will take full ownership of the quality system and will create an environment that ensures quality objectives are met, standards are clearly established, and performance is measured and evaluated. Line management will be responsible for quality system implementation. Each organization will adhere to all quality system requirements that apply to their function. Every employee will be responsible for their work quality, to work safely and for complying with the policies, procedures and instructions applicable to their activities. Quality will be addressed and verified during all phases of our work scope from proposal development through closeout including contracts or projects. Continuous quality improvement will be an ongoing process. Our quality ethic and these quality principles constantly guide our actions. We will meet our own quality expectations and exceed those of our customers with vigilance, commitment, teamwork, and persistence

  15. Quality Assurance Program Plan (QAPP) Waste Management Project

    Energy Technology Data Exchange (ETDEWEB)

    HORHOTA, M.J.

    2000-12-21

    The Waste Management Project (WMP) is committed to excellence in our work and to delivering quality products and services to our customers, protecting our employees and the public and to being good stewards of the environment. We will continually strive to understand customer requirements, perform services, and activities that meet or exceed customer expectations, and be cost-effective in our performance. The WMP maintains an environment that fosters continuous improvement in our processes, performance, safety and quality. The achievement of quality will require the total commitment of all WMP employees to our ethic that Quality, Health and Safety, and Regulatory Compliance must come before profits. The successful implementation of this policy and ethic requires a formal, documented management quality system to ensure quality standards are established and achieved in all activities. The following principles are the foundation of our quality system. Senior management will take full ownership of the quality system and will create an environment that ensures quality objectives are met, standards are clearly established, and performance is measured and evaluated. Line management will be responsible for quality system implementation. Each organization will adhere to all quality system requirements that apply to their function. Every employee will be responsible for their work quality, to work safely and for complying with the policies, procedures and instructions applicable to their activities. Quality will be addressed and verified during all phases of our work scope from proposal development through closeout including contracts or projects. Continuous quality improvement will be an ongoing process. Our quality ethic and these quality principles constantly guide our actions. We will meet our own quality expectations and exceed those of our customers with vigilance, commitment, teamwork, and persistence.

  16. Impact of Dynamics of Planned Change on Employees Quality of ...

    African Journals Online (AJOL)

    In this study, we determined the impact of organizational planned change programmes on the quality of worklife (QWL) of employees. The study involved four organizations selected from both the private and public sector establishments in Port Harcourt. Two organizations were randomly selected from each sector.

  17. A deterministic aggregate production planning model considering quality of products

    International Nuclear Information System (INIS)

    Madadi, Najmeh; Wong, Kuan Yew

    2013-01-01

    Aggregate Production Planning (APP) is a medium-term planning which is concerned with the lowest-cost method of production planning to meet customers' requirements and to satisfy fluctuating demand over a planning time horizon. APP problem has been studied widely since it was introduced and formulated in 1950s. However, in several conducted studies in the APP area, most of the researchers have concentrated on some common objectives such as minimization of cost, fluctuation in the number of workers, and inventory level. Specifically, maintaining quality at the desirable level as an objective while minimizing cost has not been considered in previous studies. In this study, an attempt has been made to develop a multi-objective mixed integer linear programming model that serves those companies aiming to incur the minimum level of operational cost while maintaining quality at an acceptable level. In order to obtain the solution to the multi-objective model, the Fuzzy Goal Programming approach and max-min operator of Bellman-Zadeh were applied to the model. At the final step, IBM ILOG CPLEX Optimization Studio software was used to obtain the experimental results based on the data collected from an automotive parts manufacturing company. The results show that incorporating quality in the model imposes some costs, however a trade-off should be done between the cost resulting from producing products with higher quality and the cost that the firm may incur due to customer dissatisfaction and sale losses.

  18. Sequence Coding and Search System Backfit Quality Assurance Program Plan

    International Nuclear Information System (INIS)

    Lovell, C.J.; Stepina, P.L.

    1985-03-01

    The Sequence Coding and Search System is a computer-based encoding system for events described in Licensee Event Reports. This data system contains LERs from 1981 to present. Backfit of the data system to include LERs prior to 1981 is required. This report documents the Quality Assurance Program Plan that EG and G Idaho, Inc. will follow while encoding 1980 LERs

  19. Quality Assurance Plans under the Renewable Fuel Standard Program

    Science.gov (United States)

    Quality Assurance Plan or (QAP) is a voluntary program where independent third-parties may audit and verify that RINs have been properly generated and are valid for compliance purposes. RINs verified under a QAP may be purchased by regulated parties.

  20. POSTER FOR NRMRL QUALITY MANAGEMENT PLAN (QMP) TRAINING COURSE

    Science.gov (United States)

    NRMRL QMP Training CourseContact: Lauren Drees, NRMRL/STD (drees.lauren@epa.gov) NRMRL has developed a computer-based course to train personnel in the requirements of the NRMRL Quality Management Plan (QMP). This training course was developed using Trainersoft s...

  1. Near-Facility Environmental Monitoring Quality Assurance Project Plan

    International Nuclear Information System (INIS)

    MCKINNEY, S.M.

    2000-01-01

    This Quality Assurance Project Plan addresses the quality assurance requirements for the activities associated with the preoperational and near-facility environmental monitoring directed by Waste Management Technical Services and supersedes HNF-EP-0538-4. This plan applies to all sampling and monitoring activities performed by Waste Management Technical Services in implementing near-facility environmental monitoring at the Hanford Site. This Quality Assurance Project Plan is required by U.S. Department of Energy Order 5400.1 (DOE 1990) as a part of the Environmental Monitoring Plan (DOE-RL 1997) and is used to define: Environmental measurement and sampling locations used to monitor environmental contaminants near active and inactive facilities and waste storage and disposal sites; Procedures and equipment needed to perform the measurement and sampling; Frequency and analyses required for each measurement and sampling location; Minimum detection level and accuracy; Quality assurance components; and Investigation levels. Near-facility environmental monitoring for the Hanford Site is conducted in accordance with the requirements of U.S. Department of Energy Orders 5400.1 (DOE 1990), 5400.5 (DOE 1993), 5484.1 (DOE 1990), and 435.1 (DOE 1999), and DOE/EH-O173T (DOE 1991). It is Waste Management Technical Services' objective to manage and conduct near-facility environmental monitoring activities at the Hanford Site in a cost-effective and environmentally responsible manner that is in compliance with the letter and spirit of these regulations and other environmental regulations, statutes, and standards

  2. Assessment report for Hanford analytical services quality assurance plan

    International Nuclear Information System (INIS)

    Taylor, L.H.

    1994-11-01

    This report documents the assessment results of DOE/RL-94-55, Hanford Analytical Services Quality Assurance Plan. The assessment was conducted using the Requirement and Self-Assessment Database (RSAD), which contains mandatory and nonmandatory DOE Order statements for the relevant DOE orders

  3. Quality Assurance Plan, N springs expedited response action

    International Nuclear Information System (INIS)

    Jackson, G.J.

    1994-01-01

    This document is the Quality Assurance Plan (QAP) to be followed during the definitive design, construction, and operational phases for activities associated with the N Springs Expedited Response Action (ERA) for the 100-NR-2 Operable Unit (OU). Westinghouse Hanford Company (WHC) will comply with the US Department of Energy (DOE) Order 5700.6C, Quality Assurance (DOE 1989), and the US Environmental Protection Agency (EPA), EPA/530-SW-86-031, Technical Guidance Document: Construction Quality Assurance for Hazardous Waste Land Disposal Facilities (EPA 1986)

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

    Science.gov (United States)

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

    2016-01-01

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

  5. Tiered on-the-ground implementation projects for Gulf of Mexico water quality improvements

    Science.gov (United States)

    Both the Gulf Hypoxia Action Plan for Reducing, Mitigating, and Controlling Hypoxia in the Northern Gulf of Mexico and Improving Water Quality in the Mississippi River Basin (USEPA 2008) and the GOMA Governors’ Action Plan II for Healthy and Resilient Coasts (GOMA 2009) call for the development and ...

  6. Nevada Nuclear Waste Storage Investigations: Quality Assurance Plan

    International Nuclear Information System (INIS)

    1980-08-01

    The Nevada Nuclear Waste Storage Investigations (NNWSI) were established by DOE/NV to evaluate the geohydrologic setting and underground rock masses of the Nevada Test Site (NTS) and contiguous areas to determine whether a suitable site exists for constructing a repository for isolating highly radioactive solid wastes. Since the results of these evaluations will impact possible risks to public health and safety, a quality assurance program which conforms to the criteria given in the Code of Federal Regulations is needed to control the quality aspects of the work. This Quality Assurance Plan (QAP) describes the general quality assurance program for the overall NNWSI project under which the quality assurance programs of the individual participating organizations and support contractors are to operate. The details of how each of these groups will meet the criteria will differ among participating organizations and support contractors, and those details are given in the QAPP's listed in Appendix A. It is the purpose of this plan to show the commonality of quality assurance programs in effect within the project and to define how each element fits into the entire picture to give total quality assurance coverage for the NNWSI Project

  7. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

    National Cancer Institute; Jewell, Ph.D., Scott D.; Seijo, M.S., Edward; Kelly, Ph.D., Andrea; Somiari, Ph.D., Stella; B.Chir., M.B.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., M.S., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Moore, Ph.D., Helen M.; Vaught, Ph.D., Jim; Watson, Peter

    2010-09-02

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  8. Biospecimen Reporting for Improved Study Quality

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Ph.D., Helen M.; Kelly, Ph.D., Andrea B.; Jewell, Ph.D., Scott D.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas P.; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth A.; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Seijo, M.S., Edward; Somiari, Ph.D., Stella; Chir., B; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Vaught, Ph.D., Jim; Watson,M.B., Peter

    2010-12-27

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  9. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Ph.D., Helen M.; Kelly Ph.D., Andrea; Jewell Ph.D., Scott D.; McShane Ph.D., Lisa M.; Clark M.D., Douglas P.; Greenspan M.D., Renata; Hayes M.D., Daniel F.; Hainaut Ph.D.,, Pierre; Kim, Paula; Mansfield Ph.D., Elizabeth; Potapova Ph.D., Olga; Riegman Ph.D., Peter; Rubinstein Ph.D., Yaffa; Seijo M.S., Edward; Somiari Ph.D., Stella; Watson M.B., Peter; Weier Ph.D., Heinz-Ulrich; Zhu Ph.D., Claire; Vaught Ph.D., Jim

    2011-04-26

    Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.

  10. Mixed Waste Integrated Program Quality Assurance requirements plan

    International Nuclear Information System (INIS)

    1994-01-01

    Mixed Waste Integrated Program (MWIP) is sponsored by the US Department of Energy (DOE), Office of Technology Development, Waste Management Division. The strategic objectives of MWIP are defined in the Mixed Waste Integrated Program Strategic Plan, and expanded upon in the MWIP Program Management Plan. This MWIP Quality Assurance Requirement Plan (QARP) applies to mixed waste treatment technologies involving both hazardous and radioactive constituents. As a DOE organization, MWIP is required to develop, implement, and maintain a written Quality Assurance Program in accordance with DOE Order 4700.1 Project Management System, DOE Order 5700.6C, Quality Assurance, DOE Order 5820.2A Radioactive Waste Management, ASME NQA-1 Quality Assurance Program Requirements for Nuclear Facilities and ANSI/ASQC E4-19xx Specifications and Guidelines for Quality Systems for Environmental Data Collection and Environmental Technology Programs. The purpose of the MWIP QA program is to establish controls which address the requirements in 5700.6C, with the intent to minimize risks and potential environmental impacts; and to maximize environmental protection, health, safety, reliability, and performance in all program activities. QA program controls are established to assure that each participating organization conducts its activities in a manner consistent with risks posed by those activities

  11. Mixed Waste Integrated Program Quality Assurance requirements plan

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-15

    Mixed Waste Integrated Program (MWIP) is sponsored by the US Department of Energy (DOE), Office of Technology Development, Waste Management Division. The strategic objectives of MWIP are defined in the Mixed Waste Integrated Program Strategic Plan, and expanded upon in the MWIP Program Management Plan. This MWIP Quality Assurance Requirement Plan (QARP) applies to mixed waste treatment technologies involving both hazardous and radioactive constituents. As a DOE organization, MWIP is required to develop, implement, and maintain a written Quality Assurance Program in accordance with DOE Order 4700.1 Project Management System, DOE Order 5700.6C, Quality Assurance, DOE Order 5820.2A Radioactive Waste Management, ASME NQA-1 Quality Assurance Program Requirements for Nuclear Facilities and ANSI/ASQC E4-19xx Specifications and Guidelines for Quality Systems for Environmental Data Collection and Environmental Technology Programs. The purpose of the MWIP QA program is to establish controls which address the requirements in 5700.6C, with the intent to minimize risks and potential environmental impacts; and to maximize environmental protection, health, safety, reliability, and performance in all program activities. QA program controls are established to assure that each participating organization conducts its activities in a manner consistent with risks posed by those activities.

  12. Problems of Implementation of Strategic Plans for Secondary Schools' Improvement in Anambra State

    Science.gov (United States)

    Chukwumah, Fides Okwukweka; Ezeugbor, Carol Obiageli

    2015-01-01

    This study investigated the extent of problems of strategic plans implementation for secondary schools' improvement in Anambra State, Nigeria for quality education provision. The study used a descriptive survey design paradigm. Respondents comprised 217 principals. There was no sampling. All the principals were used. Data were collected using…

  13. UMTRA Project Office quality assurance program plan. Revision 6

    International Nuclear Information System (INIS)

    1994-09-01

    The Uranium Mill Tailings Remedial Action (UMTRA) Project was established to accomplish remedial actions at inactive uranium mill tailings sites. The UMTRA Project's mission is to stabilize and control the residual radioactive materials at designated sites in a safe and environmentally sound manner so as to minimize or eliminate radiation health hazards to the public. Because these efforts may involve possible risks to public health and safety, a quality assurance (QA) program that conforms to the applicable criteria has been established to control the quality of the work. This document, the Quality Assurance Program Plan (QAPP), brings into one document the essential criteria to be applied on a selective basis, depending upon the nature of the activity being conducted, and describes how those criteria shall be applied to the UMTRA Project. QA requirements contained in this QAPP shall apply to all personnel, processes, and activities, including planning, scheduling, and cost control, performed by the UMTRA Project Office and its contractors

  14. 78 FR 59840 - Revisions to the California State Implementation Plan, Antelope Valley Air Quality Management...

    Science.gov (United States)

    2013-09-30

    ...] Revisions to the California State Implementation Plan, Antelope Valley Air Quality Management District... of plan. * * * * * (c) * * * (428) * * * (i) * * * (B) Antelope Valley Air Quality Management...) * * * (i) * * * (B) Antelope Valley Air Quality Management District. (1) Rule 431.1, ``Sulfur Content of...

  15. 76 FR 44535 - Revisions to the California State Implementation Plan, Northern Sierra Air Quality Management...

    Science.gov (United States)

    2011-07-26

    ... the California State Implementation Plan, Northern Sierra Air Quality Management District, Sacramento Metropolitan Air Quality Management District, and South Coast Air Quality Management District AGENCY... the Northern Sierra Air Quality Management District (NSAQMD), Sacramento Metropolitan Air Quality...

  16. Strategic plans for the Hardwood Tree Improvement and Regeneration Center

    Science.gov (United States)

    Charles H. Michler; Keith E. Woeste

    2002-01-01

    The mission of the Hardwood Tree Improvement and Regeneration Center (HTIRC) at Purdue University is to advance the science of hardwood tree improvement and genomics in the central hardwood region of the United States by: developing and disseminating knowledge on improving the genetic quality of hardwood tree species; conserving fine hardwood germplasm; developing...

  17. School Improvement Plans and Student Learning in Jamaica

    Science.gov (United States)

    Lockheed, Marlaine; Harris, Abigail; Jayasundera, Tamara

    2010-01-01

    A school improvement program that provided support to poor-performing schools on the basis of needs identified in a school improvement plan was implemented in 72 government schools in Jamaica, from 1998 to 2005. In this independent evaluation of the program, we use propensity score matching to create, post hoc, a control group of schools that were…

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

    Science.gov (United States)

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

    2015-01-01

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

  19. How can we recognize continuous quality improvement?

    Science.gov (United States)

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

    2014-02-01

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

  20. SU-G-TeP4-14: Quality Control of Treatment Planning Using Knowledge-Based Planning Across a System of Radiation Oncology Practices

    Energy Technology Data Exchange (ETDEWEB)

    Masi, K; Ditman, M; Marsh, R; Archer, P; Matuszak, M [University of Michigan, Ann Arbor, MI (United States); Dai, J [Alpena Cancer Center, Alpena, MI (United States); Huberts, M [McLaren Greater Lansing, Lansing, MI (United States); Khadija, M [Metro Health, Wyoming, MI (United States); Tatro, D [Allegiance Health, Jackson, MI (United States)

    2016-06-15

    Purpose: There is potentially a wide variation in plan quality for a certain disease site, even for clinics located in the same system of hospitals. We have used a prostate-specific knowledge-based planning (KBP) model as a quality control tool to investigate the variation in prostate treatment planning across a network of affiliated radiation oncology departments. Methods: A previously created KBP model was applied to 10 patients each from 4 community-based clinics (Clinics A, B, C, and D). The KBP model was developed using RapidPlan (Eclipse v13.5, Varian Medical Systems) from 60 prostate/prostate bed IMRT plans that were originally planned using an in-house treatment planning system at the central institution of the community-based clinics. The dosimetric plan quality (target coverage and normal-tissue sparing) of each model-generated plan was compared to the respective clinically-used plan. Each community-based clinic utilized the same planning goals to develop the clinically-used plans that were used at the main institution. Results: Across all 4 clinics, the model-generated plans decreased the mean dose to the rectum by varying amounts (on average, 12.5, 2.6, 4.5, and 2.7 Gy for Clinics A, B, C, and D, respectively). The mean dose to the bladder also decreased with the model-generated plans (5.4, 2.3, 3.0, and 4.1 Gy, respectively). The KBP model also identified that target coverage (D95%) improvements were possible for for Clinics A, B, and D (0.12, 1.65, and 2.75%) while target coverage decreased by 0.72% for Clinic C, demonstrating potentially different trade-offs made in clinical plans at different institutions. Conclusion: Quality control of dosimetric plan quality across a system of radiation oncology practices is possible with knowledge-based planning. By using a quality KBP model, smaller community-based clinics can potentially identify the areas of their treatment plans that may be improved, whether it be in normal-tissue sparing or improved target

  1. SU-G-TeP4-14: Quality Control of Treatment Planning Using Knowledge-Based Planning Across a System of Radiation Oncology Practices

    International Nuclear Information System (INIS)

    Masi, K; Ditman, M; Marsh, R; Archer, P; Matuszak, M; Dai, J; Huberts, M; Khadija, M; Tatro, D

    2016-01-01

    Purpose: There is potentially a wide variation in plan quality for a certain disease site, even for clinics located in the same system of hospitals. We have used a prostate-specific knowledge-based planning (KBP) model as a quality control tool to investigate the variation in prostate treatment planning across a network of affiliated radiation oncology departments. Methods: A previously created KBP model was applied to 10 patients each from 4 community-based clinics (Clinics A, B, C, and D). The KBP model was developed using RapidPlan (Eclipse v13.5, Varian Medical Systems) from 60 prostate/prostate bed IMRT plans that were originally planned using an in-house treatment planning system at the central institution of the community-based clinics. The dosimetric plan quality (target coverage and normal-tissue sparing) of each model-generated plan was compared to the respective clinically-used plan. Each community-based clinic utilized the same planning goals to develop the clinically-used plans that were used at the main institution. Results: Across all 4 clinics, the model-generated plans decreased the mean dose to the rectum by varying amounts (on average, 12.5, 2.6, 4.5, and 2.7 Gy for Clinics A, B, C, and D, respectively). The mean dose to the bladder also decreased with the model-generated plans (5.4, 2.3, 3.0, and 4.1 Gy, respectively). The KBP model also identified that target coverage (D95%) improvements were possible for for Clinics A, B, and D (0.12, 1.65, and 2.75%) while target coverage decreased by 0.72% for Clinic C, demonstrating potentially different trade-offs made in clinical plans at different institutions. Conclusion: Quality control of dosimetric plan quality across a system of radiation oncology practices is possible with knowledge-based planning. By using a quality KBP model, smaller community-based clinics can potentially identify the areas of their treatment plans that may be improved, whether it be in normal-tissue sparing or improved target

  2. Measuring the quality of Patients’ goals and action plans: development and validation of a novel tool

    Directory of Open Access Journals (Sweden)

    Teal Cayla R

    2012-12-01

    Full Text Available Abstract Background The purpose of this study is to develop and test reliability, validity, and utility of the Goal-Setting Evaluation Tool for Diabetes (GET-D. The effectiveness of diabetes self-management is predicated on goal-setting and action planning strategies. Evaluation of self-management interventions is hampered by the absence of tools to assess quality of goals and action plans. To address this gap, we developed the GET-D, a criteria-based, observer rating scale that measures the quality of patients’ diabetes goals and action plans. Methods We conducted 3-stage development of GET-D, including identification of criteria for observer ratings of goals and action plans, rater training and pilot testing; and then performed psychometric testing of the GET-D. Results Trained raters could effectively rate the quality of patient-generated goals and action plans using the GET-D. Ratings performed by trained evaluators demonstrated good raw agreement (94.4% and inter-rater reliability (Kappa = 0.66. Scores on the GET-D correlated well with measures theoretically associated with goal-setting, including patient activation (r=.252, P Conclusions The GET-D can reliably and validly rate the quality of goals and action plans. It holds promise as a measure of intervention fidelity for clinical interventions that promote diabetes self-management behaviors to improve clinical outcomes. Trial registration Clinicaltrials.gov Identifier: NCT00481286

  3. Improving reproductive health in rural China through participatory planning.

    Science.gov (United States)

    Kaufman, Joan; Liu, Yunguo; Fang, Jing

    2012-01-01

    China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.

  4. WE-DE-201-02: A Statistical Analysis Tool for Plan Quality Verification in HDR Brachytherapy Forward Planning for Cervix Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ma, R; Zhu, X; Li, S; Zheng, D; Lei, Y; Wang, S; Verma, V; Bennion, N; Wahl, A; Zhou, S [University of Nebraska Medical Center, Omaha, NE (United States)

    2016-06-15

    Purpose: High Dose Rate (HDR) brachytherapy forward planning is principally an iterative process; hence, plan quality is affected by planners’ experiences and limited planning time. Thus, this may lead to sporadic errors and inconsistencies in planning. A statistical tool based on previous approved clinical treatment plans would help to maintain the consistency of planning quality and improve the efficiency of second checking. Methods: An independent dose calculation tool was developed from commercial software. Thirty-three previously approved cervical HDR plans with the same prescription dose (550cGy), applicator type, and treatment protocol were examined, and ICRU defined reference point doses (bladder, vaginal mucosa, rectum, and points A/B) along with dwell times were collected. Dose calculation tool then calculated appropriate range with a 95% confidence interval for each parameter obtained, which would be used as the benchmark for evaluation of those parameters in future HDR treatment plans. Model quality was verified using five randomly selected approved plans from the same dataset. Results: Dose variations appears to be larger at the reference point of bladder and mucosa as compared with rectum. Most reference point doses from verification plans fell between the predicted range, except the doses of two points of rectum and two points of reference position A (owing to rectal anatomical variations & clinical adjustment in prescription points, respectively). Similar results were obtained for tandem and ring dwell times despite relatively larger uncertainties. Conclusion: This statistical tool provides an insight into clinically acceptable range of cervical HDR plans, which could be useful in plan checking and identifying potential planning errors, thus improving the consistency of plan quality.

  5. Technical Note: Improving the VMERGE treatment planning algorithm for rotational radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Gaddy, Melissa R., E-mail: mrgaddy@ncsu.edu; Papp, Dávid, E-mail: dpapp@ncsu.edu [Department of Mathematics, North Carolina State University, Raleigh, North Carolina 27695-8205 (United States)

    2016-07-15

    Purpose: The authors revisit the VMERGE treatment planning algorithm by Craft et al. [“Multicriteria VMAT optimization,” Med. Phys. 39, 686–696 (2012)] for arc therapy planning and propose two changes to the method that are aimed at improving the achieved trade-off between treatment time and plan quality at little additional planning time cost, while retaining other desirable properties of the original algorithm. Methods: The original VMERGE algorithm first computes an “ideal,” high quality but also highly time consuming treatment plan that irradiates the patient from all possible angles in a fine angular grid with a highly modulated beam and then makes this plan deliverable within practical treatment time by an iterative fluence map merging and sequencing algorithm. We propose two changes to this method. First, we regularize the ideal plan obtained in the first step by adding an explicit constraint on treatment time. Second, we propose a different merging criterion that comprises of identifying and merging adjacent maps whose merging results in the least degradation of radiation dose. Results: The effect of both suggested modifications is evaluated individually and jointly on clinical prostate and paraspinal cases. Details of the two cases are reported. Conclusions: In the authors’ computational study they found that both proposed modifications, especially the regularization, yield noticeably improved treatment plans for the same treatment times than what can be obtained using the original VMERGE method. The resulting plans match the quality of 20-beam step-and-shoot IMRT plans with a delivery time of approximately 2 min.

  6. 242-A evaporator quality assurance project plan: Revision 1

    International Nuclear Information System (INIS)

    Tucker, B.J.

    1994-01-01

    The scope of this quality assurance project plan (Plan) is sampling and analytical services including, but not limited to, sample receipt, handling and storage, analytical measurements, submittal of data deliverables, archiving selected portions of samples, returning unneeded sample material to Westinghouse Hanford Company (WHC), and/or sample disposal associated with candidate feed samples and process condensate compliance samples. Sampling and shipping activities are also included within the scope. The purpose of this project is to provide planning, implementation, and assessment guidance for achieving established data quality objectives measurement parameters. This Plan requires onsite and offsite laboratories to conform to that guidance. Laboratory conformance will help ensure that quality data are being generated and therefore, that the 242-A evaporator is operating in a safe and compliant manner. The 242-A evaporator feed stream originates from double-shell tanks (DSTs) identified as candidate feed tanks. The 242-A evaporator reduces the volume of aqueous waste contained in DSTs by boiling off water and sending it to the Liquid Effluent Retention Facility (LERF) storage basin before further treatment. The slurry product is returned to DSTs. Evaporation results in considerable savings by reducing the volume of mixed waste for disposal

  7. Making quality improvement programs more effective.

    Science.gov (United States)

    Shaw-Taylor, Yoku

    2014-01-01

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

  8. Improved operational performance through the use of business planning tools

    International Nuclear Information System (INIS)

    Hoelscher, H.L.

    1996-01-01

    Improved operational performance at Point Beach Nuclear Plant is based on a focused business plan. Quantitative goals that compare past performance with the performance of potential competitors are the basis of the business plan. This establishes goals for the nuclear power business unit which support corporate goals. Strategies and objectives are then developed to meet the established goals. To continue support for these strategies and objectives, individual performance plans are developed for all management personnel. These performance management plans identify individual contributor actions to support the goals, and also provide periodic feedback for changes to better prioritize individual actions. Performance criteria are also established to measure progress toward achieving the goals. The author also has a program to provide incentives for improved performance based upon success of the organization in achieving established goals

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

    Science.gov (United States)

    Cain, Katherine L; Collins, Ragan P

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

  10. Financing Secondary Education in Kenya: Exploring Strategic Management Approach for Improving Quality of Education

    Science.gov (United States)

    Itegi, Florence M.

    2016-01-01

    The aim of this paper is to explore the influence of strategic planning in improving the quality of education. The quality of education is directly linked to the effort expended in making arrangements or preparations of educational objectives and determining the requisite resources to facilitate the training, instruction or study that leads to the…

  11. SU-F-P-64: The Impact of Plan Complexity Parameters On the Plan Quality and Deliverability of Volumetric Modulated Arc Therapy with Canonical Correlation Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jin, X; Yi, J; Xie, C [The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang (China)

    2016-06-15

    Purpose: To evaluate the impact of complexity indices on the plan quality and deliverability of volumetric modulated arc therapy (VMAT), and to determine the most significant parameters in the generation of an ideal VMAT plan. Methods: A multi-dimensional exploratory statistical method, canonical correlation analysis (CCA) was adopted to study the correlations between VMAT parameters of complexity, quality and deliverability, as well as their contribution weights with 32 two-arc VMAT nasopharyngeal cancer (NPC) patients and 31 one-arc VMAT prostate cancer patients. Results: The MU per arc (MU/Arc) and MU per control point (MU/CP) of NPC were 337.8±25.2 and 3.7±0.3, respectively, which were significantly lower than those of prostate cancer patients (MU/Arc : 506.9±95.4, MU/CP : 5.6±1.1). The plan complexity indices indicated that two-arc VMAT plans were more complex than one-arc VMAT plans. Plan quality comparison confirmed that one-arc VMAT plans had a high quality than two-arc VMAT plans. CCA results implied that plan complexity parameters were highly correlated with plan quality with the first two canonical correlations of 0.96, 0.88 (both p<0.001) and significantly correlated with deliverability with the first canonical correlation of 0.79 (p<0.001), plan quality and deliverability was also correlated with the first canonical correlation of 0.71 (p=0.02). Complexity parameters of MU/CP, segment area (SA) per CP, percent of MU/CP less 3 and planning target volume (PTV) were weighted heavily in correlation with plan quality and deliveability . Similar results obtained from individual NPC and prostate CCA analysis. Conclusion: Relationship between complexity, quality, and deliverability parameters were investigated with CCA. MU, SA related parameters and PTV volume were found to have strong effect on the plan quality and deliverability. The presented correlation among different quantified parameters could be used to improve the plan quality and the efficiency

  12. SU-E-T-616: Plan Quality Assessment of Both Treatment Planning System Dose and Measurement-Based 3D Reconstructed Dose in the Patient

    International Nuclear Information System (INIS)

    Olch, A

    2015-01-01

    Purpose: Systematic radiotherapy plan quality assessment promotes quality improvement. Software tools can perform this analysis by applying site-specific structure dose metrics. The next step is to similarly evaluate the quality of the dose delivery. This study defines metrics for acceptable doses to targets and normal organs for a particular treatment site and scores each plan accordingly. The input can be the TPS or the measurement-based 3D patient dose. From this analysis, one can determine whether the delivered dose distribution to the patient receives a score which is comparable to the TPS plan score, otherwise replanning may be indicated. Methods: Eleven neuroblastoma patient plans were exported from Eclipse to the Quality Reports program. A scoring algorithm defined a score for each normal and target structure based on dose-volume parameters. Each plan was scored by this algorithm and the percentage of total possible points was obtained. Each plan also underwent IMRT QA measurements with a Mapcheck2 or ArcCheck. These measurements were input into the 3DVH program to compute the patient 3D dose distribution which was analyzed using the same scoring algorithm as the TPS plan. Results: The mean quality score for the TPS plans was 75.37% (std dev=14.15%) compared to 71.95% (std dev=13.45%) for the 3DVH dose distribution. For 3/11 plans, the 3DVH-based quality score was higher than the TPS score, by between 0.5 to 8.4 percentage points. Eight/11 plans scores decreased based on IMRT QA measurements by 1.2 to 18.6 points. Conclusion: Software was used to determine the degree to which the plan quality score differed between the TPS and measurement-based dose. Although the delivery score was generally in good agreement with the planned dose score, there were some that improved while there was one plan whose delivered dose quality was significantly less than planned. This methodology helps evaluate both planned and delivered dose quality. Sun Nuclear Corporation has

  13. SU-E-T-616: Plan Quality Assessment of Both Treatment Planning System Dose and Measurement-Based 3D Reconstructed Dose in the Patient

    Energy Technology Data Exchange (ETDEWEB)

    Olch, A [University of Southern California, Los Angeles, CA (United States)

    2015-06-15

    Purpose: Systematic radiotherapy plan quality assessment promotes quality improvement. Software tools can perform this analysis by applying site-specific structure dose metrics. The next step is to similarly evaluate the quality of the dose delivery. This study defines metrics for acceptable doses to targets and normal organs for a particular treatment site and scores each plan accordingly. The input can be the TPS or the measurement-based 3D patient dose. From this analysis, one can determine whether the delivered dose distribution to the patient receives a score which is comparable to the TPS plan score, otherwise replanning may be indicated. Methods: Eleven neuroblastoma patient plans were exported from Eclipse to the Quality Reports program. A scoring algorithm defined a score for each normal and target structure based on dose-volume parameters. Each plan was scored by this algorithm and the percentage of total possible points was obtained. Each plan also underwent IMRT QA measurements with a Mapcheck2 or ArcCheck. These measurements were input into the 3DVH program to compute the patient 3D dose distribution which was analyzed using the same scoring algorithm as the TPS plan. Results: The mean quality score for the TPS plans was 75.37% (std dev=14.15%) compared to 71.95% (std dev=13.45%) for the 3DVH dose distribution. For 3/11 plans, the 3DVH-based quality score was higher than the TPS score, by between 0.5 to 8.4 percentage points. Eight/11 plans scores decreased based on IMRT QA measurements by 1.2 to 18.6 points. Conclusion: Software was used to determine the degree to which the plan quality score differed between the TPS and measurement-based dose. Although the delivery score was generally in good agreement with the planned dose score, there were some that improved while there was one plan whose delivered dose quality was significantly less than planned. This methodology helps evaluate both planned and delivered dose quality. Sun Nuclear Corporation has

  14. Involving vendors in continuous quality improvement efforts.

    Science.gov (United States)

    McDevitt, M C

    1995-03-01

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

  15. A Report Card on Continuous Quality Improvement

    Science.gov (United States)

    Blumenthal, David; Kilo, Charles M.

    1998-01-01

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

  16. Quality improvement in neurological surgery graduate medical education.

    Science.gov (United States)

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

    2015-04-01

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

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

    Science.gov (United States)

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

  18. Improving smoked herring quality by gamma irradiation

    International Nuclear Information System (INIS)

    Zahran, D.A.; Abd El-Wahab, S.A.; Hendy, B.A.

    2009-01-01

    Smoked herring which is a highly purchasable product in Egypt, was exposed to different gamma irradiation doses (1.5,3.0 and 5.0 kGy) and stored at environmental temperature (12± 2 deg C) until spoilage of the control. Microbiological, chemical and sensory analyses were performed throughout storage to monitor the quality attributes. It is worthy to mention that irradiation reduced the population of bacteria and the effect was more pronounced at the highest dose used (5.0 kGy). At the same time 1.5 kGy completely eliminated staphylococcus aureus (coagulase + ve) and coliforms. By chemical analysis, there was significant decrease in average moisture content by different gamma irradiation doses and storage. Although the average thiobarbituric acid reactive substances (TBARS) increased slightly by γ-irradiation, this increase was highly significant by storage . At the same time there was a significant (p< 0.05)decrease in the average trimethylamine (TMA) value of all irradiated samples compared with unirradiated control, this value increased significantly by storage. interestingly, the average histamine value decreased significantly in all irradiated samples. The sensory analysis revealed a highly significant difference in the average acceptability scores between different irradiation doses used and also by storage. Therefore it could be concluded that the quality of smoked herring during storage at environmental temperature (12 ± 2 deg C) could be improved by using 5.0 kGy γ -irradiation

  19. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  20. Transferring skills in quality collaboratives focused on improving patient logistics

    NARCIS (Netherlands)

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

    2018-01-01

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