Sample records for rapidly improved quality

  1. Rapid core measure improvement through a "business case for quality". (United States)

    Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M


    Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

  2. A rapid interview protocol supporting patient-centered quality improvement: hearing the parent's voice in a pediatric cancer unit. (United States)

    Sobo, Elisa J; Billman, Glenn; Lim, Lillian; Murdock, J Wilken; Romero, Elvia; Donoghue, Donna; Roberts, William; Kurtin, Paul S


    The Institute of Medicine's 2001 report on quality delimits six dimensions of optimal care: safety, effectiveness, efficiency, timeliness, patient centeredness, and equity. In fall 2001 parents of pediatric cancer patients were interviewed to determine how well they thought these dimensions were addressed with respect to medication administration. Immediate goals were to identify system weaknesses and devise strategies to prevent future errors. A higher-order goal was to develop and demonstrate a model protocol for rapid-cycle interview assessments. Hematology/oncology directors worked with a research expert to develop a semistructured interview protocol. After training, which included directed reading, oral instruction, and role-playing, a convenience sample of 20 English- and Spanish-speaking parents of inpatients was recruited. Parents were asked to characterize current medication administration practices and to describe problems that they had experienced or witnessed. Rapid content analysis techniques were used to identify issues of importance to the parents. Parents' medication concerns centered on their children's comfort. Parents called for communication improvements, standardization of all nursing procedures and techniques, and a guide or an outline providing a clear understanding of what to expect when and from whom. Viewing these concerns in relation to the Institute of Medicine's quality domains allowed the department to frame an improvement action plan aligned with organizational and national priorities. With good supervision and limited focused training, inexperienced staff can successfully administer semistructured qualitative interviews and help analyze findings for rapid cycle improvement purposes. The protocol can be adapted for use in organizations interested in rapid qualitative assessments of patient and parent preferences.

  3. Using rapid-cycle quality improvement methodology to reduce feeding tubes in patients with advanced dementia: before and after study. (United States)

    Monteleoni, Carol; Clark, Elizabeth


    Despite lack of evidence that enteral feeding tubes benefit patients with dementia, and often contrary to the wishes of patient and family, patients with dementia who have difficulty swallowing or reduced food intake often receive feeding tubes when hospitalised for an acute illness. We conducted a retrospective chart review of all patients receiving percutaneous endoscopic gastrostomy or jejunostomy tubes between March and September 2002. QI interventions including a palliative care consulting service and educational programmes were instituted. We conducted a second chart review for all patients receiving feeding tubes between March and September 2003. 652 bed urban acute care hospital. We measured the number of feeding tubes placed in patients with dementia, the number of feeding tubes placed in patients with dementia capable of taking food by mouth, and the number of feeding tubes placed in patients with dementia with an advance directive stating the wish to forgo artificial nutrition and hydration. Medical and allied health staff received educational programmes on end of life care and on feeding management of patients with dementia. A palliative care consulting team was established. After the interventions, the number of feeding tubes placed in all patients and in patients with dementia was greatly reduced. Multidisciplinary involvement, including participation by the administration, was essential to effect change in practice. The intensive focus on a particular issue and rapid change led to "culture shift" within the hospital community. The need to establish unified goals of care for each patient was highlighted. A growing body of research over the past decade has questioned the utility of placing feeding tubes (percutaneous endoscopic gastrostomy (PEG) or jejunostomy) in patients with advanced dementia. Studies have found no evidence that feeding tubes in this population prevent aspiration, prolong life, improve overall function, or reduce pressure sores

  4. Surgical assessment clinic - One stop emergency out-patient clinic for rapid assessment, reduced admissions and improved acute surgical service: A quality improvement study

    Directory of Open Access Journals (Sweden)

    Christina A.W. Macano


    Conclusion: By providing suitable guidance for referring practitioners we have optimised our clinic use significantly and improved our acute ambulatory surgical care. We have reduced admissions, provided rapid treatment and have established a service that helps address the ever increasing demand on acute services within the NHS.

  5. Measuring and Improving Value of Care in Oncology Practices: ASCO Programs from Quality Oncology Practice Initiative to the Rapid Learning System. (United States)

    Jacobson, Joseph O; Neuss, Michael N; Hauser, Robert


    Rising cancer care costs are no longer sustainable. Medical oncologists must focus on providing the maximum value to their patients; improving short-term, intermediate and long-term outcomes; and managing overall costs. Accurate measurement of outcomes and overall cost is essential to informing providers and institutions and in the quest for continuous improvement in value. The ASCO Quality Oncology Practice Initiative (QOPI) is an excellent tool for sampling processes of care in medical oncology practices. To achieve the larger goal of improving the value of cancer care, ASCO is investing in the development of a Rapid Learning System, which will leverage emerging information technologies to more accurately measure outcomes (including those reported by the patient) and costs, resulting in highly efficient, effective, and safe cancer care.



    Cevallos A., Juan; Universidad Nacional Mayor de San Marcos


    This article deals about the need of better highly-powered tools for quality improvement. A creative combination of Continuous Improvement Philosophy, Systems General Theory and Network General Theory is used, with the purpose of developing a Quality Improvement Network allowing an optimization of systems and processes within organizations. El artículo trata sobre la necesidad de herramientas con mayor potencia para la mejora de la calidad. Se utiliza la combinación, de manera creativa, de...

  7. Quality Improvement Poster (United States)


    FROM: 59 MDW/SGYU SUBJECT: Professional Presentation Approval 9 MAR 2017 1. Your paper, entitled Quality Improvement Poster presented at/published...information so that we can provide quality support for you, your department, and the Medical Center commander. This information is used to document the...MOW CRD Graduate Health Sciences Education (GHSE) (SGS O&M); SGS R&D; Tri- Service Nursing Research Program (TSNRP): Defense Medical Research

  8. Effectiveness of an alluvial wetland on improving ground-water quality in a municipal well field, Cedar Rapids, Iowa, 1998-2006 (United States)

    Schnoebelen, Douglas J.


    Nutrients and pesticides are water-quality topics of concern in Iowa. Nitrate concentrations in the Cedar River and other streams in Iowa are among the highest in the Nation. A 12-mile reach of the Cedar River upstream from Cedar Rapids, Iowa, is identified on the Total Maximum Daily Load list for nitrate impairment by the U.S. Environmental Protection Agency. In addition, pesticide concentrations in water samples from alluvial aquifers in Iowa have been ranked as some of the largest in the Nation. The Cedar River, like many rivers with alluvium, affects the alluvial aquifer that is used as a municipal water supply for Cedar Rapids, Iowa. A continuing challenge for the Cedar Rapids Water Department is to provide drinking water that meets all drinking-water regulations; this is made more of a challenge because of the high (often over 10 milligrams per liter) nitrate concentrations in the Cedar River and the presence of other potential chemicals of concern, such as pesticides.

  9. Determine quality of rice seed using rapid techniques (United States)

    Cheng, Fang; Zheng, Siyuan; Ying, Yibin


    This paper is aimed at investigating the possibility of sorting rice seeds by rapid techniques. Machine vision and dielectric separation were involved to determine external and internal quality of rice seeds. A conceptual rapid seed sorter is proposed. Two varieties of rice seeds planted and harvested in different years were involved in the experiments. Using morphological and color features gave a highly acceptable classification of normal and defective seeds. Dielectric parameters can be used to classify rice seeds into high vigor and low vigor. Combination of appearance characteristics and dielectric properties provide comprehensive response of seed quality. A highly acceptable defects classification and vigor improvement were achieved when the principle prototype was implemented for all the samples to test the adaptability. The good adaptability of machine vision and dielectric separation indicate the potential to determine quality of rice seeds rapidly. This paper presents the significant elements of the conceptual prototype and emphasizes the important aspects of the image processing and dielectric separation techniques.


    DEFF Research Database (Denmark)

    Bush, Stuart; Robotham, Antony John


    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...... developers, and the successes achieved using each have been widely reported. Here, though, we will share our experiences of using these tools with novice designers, i.e. student engineers.The use of both QFD and DFMA has proven to be a valuable approach for ensuring that a balanced consideration of design...

  11. MDSplus quality improvement project

    Energy Technology Data Exchange (ETDEWEB)

    Fredian, Thomas W., E-mail: [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)


    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 ( 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. Statistical methods for quality improvement

    National Research Council Canada - National Science Library

    Ryan, Thomas P


    ...."-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...

  13. Preanalytical quality improvement : in quality we trust


    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


    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...


    Directory of Open Access Journals (Sweden)

    Miodrag Hadžistević


    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.

  15. RAndomised controlled trial to imProve depressIon and the quality of life of people with Dementia using cognitive bias modification: RAPID study protocol. (United States)

    Almeida, Osvaldo P; MacLeod, Colin; Flicker, Leon; Ford, Andrew; Grafton, Ben; Etherton-Beer, Christopher


    Depressive symptoms are common and undermine the quality of life of people with Alzheimer's disease (AD). Cholinesterase inhibitors and antidepressants have all but no effect on the mood of patients, and their use increases adverse events. Cognitive bias modification (CBM) targets attentional and interpretative biases associated with anxiety, dysphoria and depression and may be useful to treat depression in AD (DAD). This trial aims to determine the effect of CBM on depression scores and the quality of life of people with DAD. Randomised, double-blind, parallel, controlled trial of CBM (1:1 allocation ratio). Participants will be 80 adults with probable AD living in the Western Australian community who score 8 or more on the Cornell Scale for Depression in Dementia (CSDD). They will have mild to moderate dementia (Mini-Mental State Examination-MMSE score ≥15) and will be free of severe sensory impairment or suicidal intent. The intervention will consist of 10 40 min sessions of CBM delivered over 2 weeks using a high-resolution monitor using a local computer station at the Western Australian Centre for Health and Ageing. The primary outcomes of interest are the 2-week change, from baseline, in the severity of CSDD scores and the Quality of Life AD (QoL-AD) scores. Secondary outcomes include changes in the CSDD, QoL-AD after 12 weeks, and changes in MMSE scores, negative attentional and interpretative bias and the proportion of participants with CSDD informed consent. The Ethics Committee of the Royal Perth Hospital will approve and oversee the study (REG14-036). The results of this trial will provide level 2 evidence of efficacy for CBM as a treatment of DAD. Australian and New Zealand Clinical Trials Registry number ACTRN12614000420640, date registered 06/04/2014. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  16. Quality of Care Is Improved by Rapid Short Incubation MALDI-ToF Identification from Blood Cultures as Measured by Reduced Length of Stay and Patient Outcomes as Part of a Multi-Disciplinary Approach to Bacteremia in Pediatric Patients.

    Directory of Open Access Journals (Sweden)

    Johannes A Delport

    Full Text Available Sepsis has seen an incremental increase in cases of about 13% annually in the USA and accounts for approximately 4400 deaths among pediatric patients. Early identification of the specific pathogen allows the clinician to ensure that the antibiotic coverage is optimal, an intervention that has been shown to improve patient outcomes in sepsis. Our study's objective was to assess the impact of a rapid Bruker MALDI-Tof identification protocol on pediatric sepsis cases by assessing various indicators. We assessed the quality of care by measuring the following indicators; time to identification of the pathogen, initiation of the most appropriate antibiotic, length of stay (LOS in hospital and patient outcomes, using a retrospective review over three consecutive years. In total 92 pediatric patients, similar in age and gender distributions were assessed; 37 in 2012, 33 in 2013 and 22 in 2014. The introduction of MALDI-TOF identification in 2013 led to a significant decrease in time to identify a pathogen by 21.03 hours (p = 1.95E-05. A short incubation MALDI-TOF identification protocol in 2014 further reduced time to identification by 17.75 hours (p = 2.48E-3. Overall in 2014 this led to a trend to earlier optimization of antibiotics by 20.2 hours (p = 0.14 and a reduction in length of stay after the implementation of MALDI-ToF identification in 2013 of 3.07 days and a further reduction of 8.92 days after the introduction of the rapid short incubation identification protocol using MALDI-Tof in 2014 (P = 0.12. By evaluating the subgroup of patients where antibiotics were changed, our study confirmed that patients received appropriate therapy 48.8% (20.2 hours earlier compared to conventional methods leading to a decrease in length of stay of 23.65 days after the implementation of MALDI-ToF identification and a further reduction of 9.82 days in 2014 compared to 2012 (p = 0.02. In 2014 outcomes between the patients needing a change in their antibiotic

  17. Applying Lean principles and Kaizen rapid improvement events in public health practice. (United States)

    Smith, Gene; Poteat-Godwin, Annah; Harrison, Lisa Macon; Randolph, Greg D


    This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.


    Directory of Open Access Journals (Sweden)

    Cornelia Petroman


    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.

  19. Global quality imaging: improvement actions. (United States)

    Lau, Lawrence S; Pérez, Maria R; Applegate, Kimberly E; Rehani, Madan M; Ringertz, Hans G; George, Robert


    Workforce shortage, workload increase, workplace changes, and budget challenges are emerging issues around the world, which could place quality imaging at risk. It is important for imaging stakeholders to collaborate, ensure patient safety, improve the quality of care, and address these issues. There is no single panacea. A range of improvement measures, strategies, and actions are required. Examples of improvement actions supporting the 3 quality measures are described under 5 strategies: conducting research, promoting awareness, providing education and training, strengthening infrastructure, and implementing policies. The challenge is to develop long-term, cost-effective, system-based improvement actions that will bring better outcomes and underpin a sustainable future for quality imaging. In an imaging practice, these actions will result in selecting the right procedure (justification), using the right dose (optimization), and preventing errors along the patient journey. To realize this vision and implement these improvement actions, a range of expertise and adequate resources are required. Stakeholders should collaborate and work together. In today's globalized environment, collaboration is strength and provides synergy to achieve better outcomes and greater success. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. [Financial incentives for quality improvement]. (United States)

    Belicza, Eva; Evetovits, Tamás


    Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

  1. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

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


    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...

  2. Culture shock: Improving software quality

    Energy Technology Data Exchange (ETDEWEB)

    de Jong, K.; Trauth, S.L.


    The concept of software quality can represent a significant shock to an individual who has been developing software for many years and who believes he or she has been doing a high quality job. The very idea that software includes lines of code and associated documentation is foreign and difficult to grasp, at best. Implementation of a software quality program hinges on the concept that software is a product whose quality needs improving. When this idea is introduced into a technical community that is largely ''self-taught'' and has been producing ''good'' software for some time, a fundamental understanding of the concepts associated with software is often weak. Software developers can react as if to say, ''What are you talking about. What do you mean I'm not doing a good job. I haven't gotten any complaints about my code yetexclamation'' Coupling such surprise and resentment with the shock that software really is a product and software quality concepts do exist, can fuel the volatility of these emotions. In this paper, we demonstrate that the concept of software quality can indeed pose a culture shock to developers. We also show that a ''typical'' quality assurance approach, that of imposing a standard and providing inspectors and auditors to assure its adherence, contributes to this shock and detracts from the very goal the approach should achieve. We offer an alternative, adopted through experience, to implement a software quality program: cooperative assistance. We show how cooperation, education, consultation and friendly assistance can overcome this culture shock. 3 refs.

  3. Improving quality through multidisciplinary education. (United States)

    Kveraga, Rikante; Jones, Stephanie B


    Multidisciplinary education (MDE) is perceived as the next means of implementing major improvements in the quality and cost-effectiveness of patient care. In this article, the authors discuss various definitions of MDE, evaluate how MDE might be implemented in clinical arenas relevant to the anesthesiologist, and describe several implementations of MDE within their hospital and the anesthesiology department. Copyright © 2011 Elsevier Inc. All rights reserved.

  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)


    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. Using Quality Function Deployment to Improve Reference Services Quality

    Directory of Open Access Journals (Sweden)

    Pao-Long Chang


    Full Text Available Much research has been conducted regarding how reference librarians can evaluate and improve the quality of the answers they provide to users' inquiries. There has been considerably less discussion, however, concerning how to improve the quality of the delivery of those answers, and to upgrade the overall quality of reference services as a whole. Suggestions for improving the quality of service contained within the business literature may be applied to improve library services as well. In this paper the use of Quality Function Deployment (QFD as a tool for improving reference services quality is explored and an adapted framework referred to as service quality function deployment is proposed.

  6. Creating quality improvement culture in public health agencies

    National Research Council Canada - National Science Library

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


    ...), 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...

  7. Rapid-fire improvement with short-cycle kaizen. (United States)

    Heard, E


    Continuous improvement is an attractive idea, but it is typically more myth than reality. SCK is no myth. It delivers dramatic improvements in traditional measures quickly. SCK accomplishes this via kaizens: rapid, repeated, time-compressed changes for the better in bite-sized chunks of the business.

  8. Contract management techniques for improving construction quality (United States)


    Efforts to improve quality in highway construction embrace many aspects of the construction process. Quality goals include enhanced efficiency and productivity, optimal cost and delivery time, improved performance, and changes in attitude-promoting a...

  9. Improving Education Through Quality Circles. (United States)

    Hunnicutt, David


    This article provides an overview of quality circles and suggests the integration through quality circles of administration, faculty, and staff in the decision-making process to enhance educational productivity and quality. (MT)

  10. Improving the Acute Myocardial Infarction Rapid Rule Out process. (United States)

    Hyden, Rachel; Fields, Willa


    Bedside staff nurses are in a unique position to identify implementation problems and ways to improve compliance with evidence-based practice guidelines. The goal of this performance improvement project was to improve compliance with an evidence-based Acute Myocardial Infarction Rapid Rule Out pathway. The purpose of the article is to demonstrate how a bedside staff nurse was able to decrease wait times and length of stay for patients with low-risk chest pain while applying evidence-based practice.

  11. Quality Circles Improve School Operations. (United States)

    Ladwig, Dennis J.


    Quality Circles are a participative management technique allowing employees opportunities to participate in decisionmaking and problem-solving processes at work. A Wisconsin vocational school successfully implemented Quality Circles with management and nonmanagement staff participating. (MD)

  12. Rapid economic analysis of northern hardwood stand improvement options (United States)

    William B. Leak


    Data and methodology are provided for projecting basal area, diameter, volumes, and values by product for northern hardwood stands, and for determining the rate of return on stand improvement investments. The method is rapid, requires a minimum amount of information, and should prove useful for on-the-ground economic analyses.

  13. Improving Your School through Quality Circles. (United States)

    Dunne, Thomas O'Neill; Maurer, Rick


    Asserts that the quality circle management technique is an exciting and challenging way to improve staff satisfaction and the quality of service. Defines the quality circle concept, outlines steps school administrators should take to establish quality circles, and warns of possible pitfalls. (Author/PGD)

  14. Voltage Quality Improvement Using Solar Photovoltaic Systems

    Directory of Open Access Journals (Sweden)

    Denisa Galzina


    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.

  15. How to Begin a Quality Improvement Project (United States)

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


    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. PMID:27016497

  16. Earthworm dispersal assay for rapidly evaluating soil quality. (United States)

    Kim, Shin Woong; Kim, Dokyung; Moon, Jongmin; Chae, Yooeun; Kwak, Jin Il; Park, Younsu; Jeong, Seung-Woo; An, Youn-Joo


    Earthworms enhance soil functioning and are therefore key species in the soil. Their presence is generally a positive sign for a terrestrial ecosystem, because these species serve as important biomarkers in soil quality evaluations. We describe a novel bioassay, the "dispersal assay," that is a simple and rapid technique for field-based soil quality evaluations. It is based on the premise that earthworms prefer optimal soils if given the choice. Thus, assay tubes containing a reference soil were inserted in target sites, and earthworms were placed into these tubes. According to their soil preference, the earthworms dispersed into the surrounding soil, remained in the initial soil within the tubes, avoided both by crawling up the tube, or died. Furthermore, sensitivity responses to metal concentrations, electrical conductivity, and soil pH were observed in field tests. Although the dispersal assay did not completely match traditional toxicity endpoints such as earthworm survival, we found that it can serve as an in situ screening test for assessing soil quality. Overall, our dispersal assay was relatively rapid (within 24 h), had low levels of variation, and showed high correlations between earthworm behavior and soil physicochemical properties. Environ Toxicol Chem 2017;36:2766-2772. © 2017 SETAC. © 2017 SETAC.

  17. Machine accuracy for rapid prototyping of quality components (United States)

    Gu, Peihua; Yan, May; Huang, X.; Zhang, Xiaochen


    Ever-growing global competition forces manufacturers to deliver more competitive products with better quality, lower price and in short time. One of the most important and challenging tasks faced by value-added product manufacturing industry is substantial reduction of product development time. Rapid prototyping technologies have received significant interests from both research and industrial communities. Due to the model accuracy, integrity and strength problems, their applications are limited. The most common sources of errors in the rapid prototyping and manufacturing systems including Cubital machines can be categorized as mathematical, process-related or material- related errors. In this paper, we present an analysis of accuracy of a Cubital Solider 4600 machine and an application on pattern and mould design and manufacturing. The experimental study determines the relationships between the machine accuracy and dimensions and parameter setting, which can be used to control the accuracy of parts to be built.

  18. Examining Changes to Michigan's Early Childhood Quality Rating and Improvement System (QRIS). REL 2015-029 (United States)

    Faria, Ann-Marie; Hawkinson, Laura E.; Greenberg, Ariela C.; Howard, Eboni C.; Brown, Leah


    Documenting and improving early childhood program quality is a national priority, leading to a rapid expansion of Quality Rating and Improvement Systems (QRISs). QRISs document and improve the quality of early childhood education programs and provide clear information to families about their child care choices. The current study described how…

  19. Quality Improvement Pearls for the Palliative Care and Hospice Professional. (United States)

    Kamal, Arif H; Nicolla, Jonathan M; Power, Steve


    Rapid changes in how palliative care clinicians are evaluated and paid present an imperative for clinicians to adeptly and routinely perform quality improvement in usual practice. Like empathic communication and facilitating goals of care discussions, quality improvement skills must be learned, honed, and practiced, so identifying problems and brainstorming solutions becomes a natural component of delivering serious illness care. Using our experience in both failures and successes in performing quality improvement, here we provide a prioritized list of 10 pearls specifically aimed to palliative care and hospice professionals. We aim to demystify quality improvement, highlight areas where rigor and a systematic approach are needed for success, and offer our own lessons learned and mistakes made to promote success for our colleagues and our field. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  20. The Quality of Education Can Be Improved. (United States)

    Hoffman, Michael S.


    Instead of being defensive about criticism of public education, educators must work to improve the quality of education. Two areas needing improvement are teacher and administrator apathy and student discipline. (MD)

  1. Physical Activity Improves Quality of Life (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 ...

  2. Metrics for rapid quality control in RNA structure probing experiments. (United States)

    Choudhary, Krishna; Shih, Nathan P; Deng, Fei; Ledda, Mirko; Li, Bo; Aviran, Sharon


    The diverse functionalities of RNA can be attributed to its capacity to form complex and varied structures. The recent proliferation of new structure probing techniques coupled with high-throughput sequencing has helped RNA studies expand in both scope and depth. Despite differences in techniques, most experiments face similar challenges in reproducibility due to the stochastic nature of chemical probing and sequencing. As these protocols expand to transcriptome-wide studies, quality control becomes a more daunting task. General and efficient methodologies are needed to quantify variability and quality in the wide range of current and emerging structure probing experiments. We develop metrics to rapidly and quantitatively evaluate data quality from structure probing experiments, demonstrating their efficacy on both small synthetic libraries and transcriptome-wide datasets. We use a signal-to-noise ratio concept to evaluate replicate agreement, which has the capacity to identify high-quality data. We also consider and compare two methods to assess variability inherent in probing experiments, which we then utilize to evaluate the coverage adjustments needed to meet desired quality. The developed metrics and tools will be useful in summarizing large-scale datasets and will help standardize quality control in the field. The data and methods used in this article are freely available at: CONTACT: saviran@ucdavis.eduSupplementary information: Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail:

  3. The unintended consequences of quality improvement. (United States)

    Bardach, Naomi S; Cabana, Michael D


    The focus on quality improvement has led to several types of initiatives in pediatric care; however, these programs may lead to potential unintended consequences. Unintended consequences of quality improvement programs that have been described are reviewed. Unintended effects on resource utilization include effects on costs, as well as the inability to apply programs across different populations and affect disparities in care. Unintended effects on provider behavior include measurement fixation behavior, as well as 'crowding out' behavior, in which gains in quality in one area may simply occur at the expense of quality of care in another. Patient preferences may not always match specific quality improvement measures. Unintended effects for patients may include decreased patient satisfaction, trust, or confidence in their provider. Recognition and anticipation of the possible unintended consequences of guideline implementation is a critical step to harnessing all the benefits of quality improvement in practice.

  4. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

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


    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....

  5. How to Sustain Change and Support Continuous Quality Improvement. (United States)

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


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

  6. Sustaining Health Care Interventions to Achieve Quality Care: What We Can Learn From Rapid Response Teams. (United States)

    Stolldorf, Deonni P

    Rapid response team (RRT) adoption and implementation are associated with improved quality of care of patients who experience an unanticipated medical emergency. The sustainability of RRTs is vital to achieve long-term benefits of these teams for patients, staff, and hospitals. Factors required to achieve RRT sustainability remain unclear. This study examined the relationship between sustainability elements and RRT sustainability in hospitals that have previously implemented RRTs.

  7. Project Management for Quality Improvement in Radiology. (United States)

    Larson, David B; Mickelsen, L Jake


    This article outlines a structured approach for applying project management principles to quality improvement in radiology. We highlight the framework we use for managing improvement projects in our department and review basic project management principles. Project management involves techniques for executing projects effectively and efficiently. We recognize the following phases for managing improvement projects: idea, project evaluation and selection, role assignment, planning, improvement, and sustaining improvement.

  8. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Radoslaw Wolniak


    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.

  9. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Ph. D. Radoslaw Wolniak


    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.

  10. Improving prescribing practices with rapid diagnostic tests (RDTs)

    DEFF Research Database (Denmark)

    Burchett, Helen E D; Leurent, Baptiste; Baiden, Frank


    OBJECTIVES: The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts...... packages, supervision, supplies and community sensitisation. OUTCOME MEASURES: Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider...

  11. Rapid Health Care Improvement Science Curriculum Integration Across Programs in a School of Nursing. (United States)

    Oliver, Brant J; Potter, Mertie; Pomerleau, Mimi; Phillips, Andrew; O'Donnell, Mimi; Cowley, Connie; Sipe, Margie

    This article describes the systematic efforts undertaken by a school of nursing in the Northeastern United States to foster innovation in health professions education. We present an application of modified team coaching and plan-do-study-act improvement methods in an educational context to rapidly integrate a quality and safety curriculum across programs. We discuss applications in generalist, advanced practice, doctoral, residency, and advanced fellowship programs and provide examples of each.

  12. Urban Quality vs single travel: the Personal Rapid Transit

    Directory of Open Access Journals (Sweden)

    Carmela Gargiulo


    Full Text Available The great increase in the demand for private mobility with the con­sequent macroscopic growth of channels to meet it, together with short-sighted policies of transport and urban development spread above all in Italy, has produced pollution, congestion and unlivability in the last fifty years.The hope of assuring the maximum individual freedom of travel to people living in consolidated urban centres, in addition to those living in the outskirts arisen and developed without any reasonable urban logic, still goes on producing congestion of vehicular traffic, conside­red, by the majority of citizens, the main cause of the deterioration of the quality of life in our cities.Indeed, also the most recent reports on environment in Italian cities show that the pollution levels are increasing in the big cities, although the news are full of very expensive projects, innovative solutions and unexpected goals continuously shown by public administrations. One of the main environmental detractors is car traffic, which has recently gained on public transport. unlike the previous period. Most of mobility policies implemented in our cities aims at reaching the modal balance by means of measures for controlling and managing the demand for mobility, for mitigating traffic and limiting circulation., such as the road pricing and the parking strategies; for developing and increasing public transport and not polluting means of transport, car sharing and car pooling.All of them have showed modest results both in terms of pollution reduction and vehicular traffic reduction. For over fifty years, mostly in the United States, the Personal Rapid Transit has been tested, a system of public transport trying to join two apparently incompatible factors: the possibility of assuring individual travels and the need for decreasing the levels of acoustic and air pol­lution as well as the congestion caused by private vehicular traffic. In Italy this system is still not well known

  13. Urban Quality vs Single Travel: the Personal Rapid Transit

    Directory of Open Access Journals (Sweden)

    Carmela Gargiulo


    Full Text Available The great increase in the demand for private mobility with theconsequent macroscopic growth of channels to meet it, togetherwith short-sighted policies of transport and urban developmentspread above all in Italy, has produced pollution, congestion andunlivability in the last fifty years.The hope of assuring the maximum individual freedom of travel topeople living in consolidated urban centres, in addition to thoseliving in the outskirts arisen and developed without any reasonableurban logic, still goes on producing congestion of vehicular traffic,considered, by the majority of citizens, the main cause of thedeterioration of the quality of life in our cities.Indeed, also the most recent reports on environment in Italiancities show that the pollution levels are increasing in the big cities,although the news are full of very expensive projects, innovativesolutions and unexpected goals continuously shown by publicadministrations. One of the main environmental detractors is cartraffic, which has recently gained on public transport. unlike theprevious period.Most of mobility policies implemented in our cities aims at reachingthe modal balance by means of measures for controlling and managingthe demand for mobility, for mitigating traffic and limiting circulation.,such as the road pricing and the parking strategies; for developingand increasing public transport and not polluting means of transport,car sharing and car pooling.All of them have showed modest results both in terms of pollutionreduction and vehicular traffic reduction.For over fifty years, mostly in the United States, the Personal RapidTransit has been tested, a system of public transport trying to jointwo apparently incompatible factors: the possibility of assuringindividual travels and the need for decreasing the levels of acousticand air pollution as well as the congestion caused by privatevehicular traffic.In Italy this system is still not well known despite the versatility ofits fields

  14. Healthcare quality improvement programme improves monitoring of people with diabetes

    NARCIS (Netherlands)

    Denig, Petra


    Question. Does a healthcare quality improvement programme, incorporating education and claims-based feedback about practice-specific models of monitoring diabetes care, increase the regularity with which primary care physicians assess people with diabetes mellitus receiving Medicare benefits? Study

  15. Power theories for improved power quality

    CERN Document Server

    Pasko, Marian


    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...

  16. Shared Decision Making in Neonatal Quality Improvement. (United States)

    Warren, Jamie B; Wiggins, Nikki


    Since the Institute of Medicine published Crossing the Quality Chasm in 2001, healthcare systems have become more focused on improving the quality of healthcare delivery. At Oregon Health & Science University and Doernbecher Children's Hospital, we recognize the need to take an interprofessional, team-based approach to improving the care we provide to our current and future patients. We describe here an ongoing quality improvement project in the Doernbecher Neonatal Intensive Care Unit (NICU), with specific attention to the factors we believe have contributed to the implementation and early success of the project. These factors include the history of quality improvement work in our NICU and in the field of neonatology, the "dyad leadership" structure under which we operate in our NICU, and our developing understanding of the concept of "team intelligence." These elements have led to the formation of a team that can practice shared decision making and work as one to realize a shared goal.

  17. Distributed Power Quality Improvement in Residential Microgrids

    DEFF Research Database (Denmark)

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


    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 harmo...

  18. Improving the quality of cancer registration data.


    Brewster, D


    Cancer registration is an essential element of any cancer control strategy. Data quality is, however, of paramount importance. This paper sets out some of the ways in which the quality of cancer registration data might be improved. In particular, the potential contribution of clinicians and pathologists is highlighted.

  19. Formalising medical quality indicators to improve guidelines

    NARCIS (Netherlands)

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


    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

  20. [Adverse event sheets, a quality improvement tool]. (United States)

    Didry, Pascale; Lapp, Aymeric


    The declaration of adverse events comprises a written nurse report which helps to improve the quality and safety of care. Submitted to professionals from the quality department, this report will be used to perform an analysis of the causes and must therefore be descriptive and objective. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. A Total Quality Leadership Process Improvement Model (United States)


    APPENDIX A DEMING’S 14 MANAGEMENT PRINCIPLES Department of the Navy TQL Office A-0 TQLO No. 93-02 A Total Quality Leadership Process Improvement Model 1... Leadership Process Improvement Model by Archester Houston, Ph.D. and Steven L. Dockstader, Ph.D. DTICS ELECTE tleaese oand sale itsFeat ben proe 94-12058...tTl ’AND SIATE COVERID0 Z lits Z40 uerI’Ll12/93 IFinalS.FNR IM F A Total Quality Leadership Process Improvement Model M ARRhOW~ Archester Houston, Ph.D

  2. Nursing informatics, outcomes, and quality improvement. (United States)

    Charters, Kathleen G


    Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.

  3. Improving resident education in quality improvement: role for a resident quality improvement director. (United States)

    Sarwar, Ammar; Eisenberg, Ronald L; Boiselle, Phillip M; Siewert, Bettina; Kruskal, Jonathan B


    As a component of the practice-based core competency of the Accreditation Council for Graduate Medical Education, all residents must receive training to be able to evaluate and improve their patient care practices. To further enhance our overall resident quality improvement (QI) educational experience, and to ensure resident involvement in the many aspects of a quality assurance program, we have established a resident educational leadership role and have appointed a resident as resident QI director. We have designed and implemented a resident leadership position in QI in our department. A senior resident (postgraduate year 4 and above) is provided with dedicated training in QI methods, mentored opportunities to develop professional skills in QI, and didactic teaching in applications of QI to other residents. A leadership position in QI for trainees introduces this important concept early in their career. The resident QI director is provided dedicated training, receives a broader perspective of QI and is optimally positioned to introduce the concept to junior residents leading to greater acceptance of QI at a resident level. The introduction of a resident QI director enhances the importance of QI for trainees, prepares the individual for a strong academic and QI career, and improves acceptance of QI methods among trainees. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

  4. Improved sensitivity over time with rapid prescreening in gynecologic cytology. (United States)

    Dudding, Nick; Renshaw, Andrew A; Ellis, Kay


    Rapid prescreening (RPS) is a powerful tool to measure and improve performance in the cytology laboratory. Long-term use of RPS has been shown to result in improved sensitivity and precision in routine screening. The effect of long-term RPS on RPS itself is not known. We compared the sensitivity of 100% RPS of Surepath™ liquid-based cytology over a 4-year period in a laboratory of 11 cytotechnologists (CTs). In comparison with the first 2 years, RPS for the laboratory showed a significant increase in sensitivity for all abnormalities (72.2% vs. 67.3%, P < 0.001) and ASCUS + LSIL (68.5% vs. 62.1%, P < 0.001). For individual CTs s, the lowest sensitivity for all abnormalities increased from 59.0 to 63.2%, whereas, for HSIL, it increased from 71.4% to 75.0%. We conclude that long-term use of RPS leads to significant increase in the sensitivity of RPS. Copyright © 2010 Wiley-Liss, Inc.

  5. Quality circles: Organizational adaptations, improvements and results (United States)

    Tortorich, R.


    The effective application in industry and government of quality circles work was demonstrated. The results achieved in quality and productivity improvements and cost savings are impressive. The circle process should be institutionalized within industry and government. The stages of circle program growth, innovations that help achieve circle process institutionalization, and the result achieved at Martin Marietta's Michoud Division and within the National Aeronautics and Space Administration (NASA) are addressed.

  6. Improving service quality in primary care. (United States)

    Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L


    A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models. © 2014 by the American College of Medical Quality.

  7. Assessing Public Metabolomics Metadata, Towards Improving Quality. (United States)

    Ferreira, João D; Inácio, Bruno; Salek, Reza M; Couto, Francisco M


    Public resources need to be appropriately annotated with metadata in order to make them discoverable, reproducible and traceable, further enabling them to be interoperable or integrated with other datasets. While data-sharing policies exist to promote the annotation process by data owners, these guidelines are still largely ignored. In this manuscript, we analyse automatic measures of metadata quality, and suggest their application as a mean to encourage data owners to increase the metadata quality of their resources and submissions, thereby contributing to higher quality data, improved data sharing, and the overall accountability of scientific publications. We analyse these metadata quality measures in the context of a real-world repository of metabolomics data (i.e. MetaboLights), including a manual validation of the measures, and an analysis of their evolution over time. Our findings suggest that the proposed measures can be used to mimic a manual assessment of metadata quality.

  8. Basic quality tools in continuous improvement process


    Soković, Mirko; Jovanović, Jelena; Krivokapić, Zdravko; Vujović, Aleksandar


    If organizations wish to achieve continuous quality improvement they need to use appropriate selection of quality tools and techniques. In this paper a review of possibilities of the systematic use of seven basic quality tools (7QC tools) is presented. It is shown that 7QC tools can be used in all process phases, from the beginning of a product development up to management of a production process and delivery. It is further shown how to involve 7QC tools in some phases of continuous improveme...

  9. There is need for improvement of Quality Improvement

    DEFF Research Database (Denmark)

    Knudsen, Søren Valgreen; Laursen, Henrik Vitus Bering; Mainz, Jan

    published QI studies are conducted according to key principles of the PDSA method. Method A systematic literature search was performed in the PubMed, Embase and CINAHL databases for PDSA-based studies, published in English in peer-reviewed journals in 2015-2016. Empirical studies using PDSA to improve......Introduction Quality Improvement (QI) and PDSA cycles is regarded as a tool to maximise effectiveness and efficiency in health care and is prioritised in most healthcare systems. It is important to document whether the PDSA method provide an effect in terms of better clinical practices and outcomes...... method and further emphasise the need to use and document in accordance with the key principles. There still seems to be a need for improvement in quality improvement....

  10. Rapidly improving stroke symptoms: a pilot, prospective study. (United States)

    Balucani, Clotilde; Bianchi, Riccardo; Ramkishun, Charles; Weedon, Jeremy; Law, Susan; Szarek, Michael; Rojas-Soto, Diana; Tariq, Sara; Levine, Steven R


    Rapidly improving stroke symptoms (RISSs) are a controversial exclusion for intravenous recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke (AIS). We estimated the frequency of 4 prespecified RISS definitions and explored their relationship to clinical outcome. Pilot, prospective study of AIS patients admitted within 4.5 hours of symptom onset. Serial assessments using National Institute of Health Stroke Scale (NIHSS) were performed every 20 ± 5 minutes until a rt-PA treatment decision was made, independent of the study. Improvement was calculated as the difference between baseline NIHSS and treatment decision NIHSS. RISS was defined as a 4-point or greater improvement, 25% or greater, 50% or greater, and according to the previously reported TREAT (The Re-examining Acute Eligibility for Thrombolysis) criteria. Unfavorable outcome was defined as modified Rankin Scale score more than 1 at 90 days after stroke. Logistic regression determined if RISS definition(s) related to the outcome. Fifty patients with AIS were enrolled: mean age 65 years; median baseline NIHSS score 5 (interquartile range, 2-11). RISS frequencies were 10%-22% based on definition. Median treatment decision NIHSS score is 5 (interquartile range, 2-9). Twenty-three (46%) patients received rt-PA. None of the 3 non-TREAT RISS definitions was independently associated with the outcome. Five of fifty (10%) were RISS according to the TREAT criteria, all 5 had good outcome without rt-PA. A Serial NIHSS assessment before treatment decision is feasible and may help determine the frequency and magnitude of RISS. This is the first prospective estimate of RISS frequency and outcome according to various prespecified definitions. The TREAT RISS frequency as a more restrictive definition may better predict good outcome of RISS in future, larger studies. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Strategies to improve quality of childbirth care

    Directory of Open Access Journals (Sweden)

    farahnaz Changaee


    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.

  12. Improved rapid prototyping methodology for MPEG-4 IC development (United States)

    Tang, Clive K. K.; Moseler, Kathy; Levi, Sami


    One important factor in deciding the success of a new consumer product or integrated circuit is minimized time-to- market. A rapid prototyping methodology that encompasses algorithm development in the hardware design phase will have great impact on reducing time-to-market. In this paper, a proven hardware design methodology and a novel top-down design methodology based on Frontier Design's DSP Station tool are described. The proven methodology was used during development of the MC149570 H.261/H.263 video codec manufactured by Motorola. This paper discusses an improvement to this method to create an integrated environment for both system and hardware development, thereby further reducing the time-to-market. The software tool chosen is DSP Station tool by Frontier Design. The rich features of DSP Station tool will be described and then it will be shown how these features may be useful in designing from algorithm to silicon. How this methodology may be used in the development of a new MPEG4 Video Communication ASIC will be outlined. A brief comparison with a popular tool, Signal Processing WorkSystem tool by Cadence, will also be given.

  13. Quality Improvement in University Counseling Centers (United States)

    Maffini, Cara S.; Toth, Paul L.


    University Counseling Centers (UCCs) experience high clinical demands and severe client presentations leaving counselors with limited time and resources to evaluate delivery of services. In this article, we present clinician-friendly quality improvement (QI) strategies used at a large Midwestern university and provide recommendations for…

  14. Semen quality improves marginally during young adulthood

    DEFF Research Database (Denmark)

    Perheentupa, Antti; Sadov, Sergey; Rönkä, Riitta


    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...

  15. Engaging Clinical Nurses in Quality Improvement Projects. (United States)

    Moore, Susan; Stichler, Jaynelle F


    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.

  16. Improving wind power quality with energy storage

    DEFF Research Database (Denmark)

    Rasmussen, Claus Nygaard


    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...... 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....

  17. A rapid, small-scale sedimentation method to predict breadmaking quality of hard winter wheat (United States)

    Breeders and processors are always looking for rapid and accurate methods to evaluate wheat quality. A rapid small-scale hybrid sedimentation method was developed for predicting breadmaking quality of breeders samples by combining the sodium dodecyl-sulfate (SDS) sedimentation method (AACC 56-70) an...

  18. Improving quality of care through improved audit and feedback

    Directory of Open Access Journals (Sweden)

    Hysong Sylvia J


    Full Text Available Abstract Background The Department of Veterans Affairs (VA has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F, an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed. This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care. Methods We will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness

  19. Improving the ignition quality of fuels

    KAUST Repository

    Sarathy, Mani


    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.

  20. A Model to Improve the Quality Products

    Directory of Open Access Journals (Sweden)

    Hasan GOKKAYA


    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.

  1. Improvement of organic apple quality and storability


    Tahir, Ibrahim


    Improvements in yield and quality by increasing the light distribution and carbohydrate uptake (summer pruning and ground covering), optimizing the physiological state of harvested fruit (cultivar-specific harvesting indices), postharvest fruit protection (treatment with hot water and ethanol, respectively) and optimizing storage conditions (cultivar-specific CA and ULO storage procedures) were investigated in a set of eight organically grown apple cultivars. A combination of summer pruning a...

  2. Improvement of catheter quality inspection process

    Directory of Open Access Journals (Sweden)

    Bożek Mariusz


    Full Text Available Quality inspection is very often one of the most important stages of the production process, although it does not create any added value. Therefore, optimization of the related number of activities is of crucial importance. However, reduction should not be made arbitrarily, but preceded and documented by appropriate research. The article describes a study aimed at reducing the high cost of quality inspection as part of the manufacturing process of a diagnostic catheter at a medical company. The product is used for blood pressure monitoring and blood sampling by the Seldinger technique. A critical quality feature for the catheter is air/water tightness. Following a thorough analysis, some control points were eliminated, and others were improved. The resulting conclusion is that detection of defective components is the most beneficial for this specific production process if carried out during the 100 percent final quality inspection. The finding is based on the fact that the cost of producing the final device with a defective component is lower than a quality inspection run directly after each operation. The authors also managed to decrease the sample size for control charts used to supervise the adhesive connection strength.

  3. Quality improvement in neurology: AAN Parkinson disease quality measures (United States)

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


    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

  4. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration (United States)

    Ogrinc, G; Mooney, S E; Estrada, C; Foster, T; Goldmann, D; Hall, L W; Huizinga, M M; Liu, S K; Mills, P; Neily, J; Nelson, W; Pronovost, P J; Provost, L; Rubenstein, L V; Speroff, T; Splaine, M; Thomson, R; Tomolo, A M; Watts, B


    As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work. This “Explanation and Elaboration” document (E & E) is a companion to the SQUIRE statement. For each item in the SQUIRE guidelines the E & E document provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item. As with the E & E documents created to accompany other biomedical publication guidelines, the purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication. The SQUIRE statement itself, this E & E document, and additional information about reporting improvement work can be found at PMID:18836062

  5. Improving tomato seed quality- challenges and possibilities

    DEFF Research Database (Denmark)

    Shrestha, Santosh

    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...... of NIR-HSI for varietal identification is very important. The work on MS III demonstrates the utilisation in various scenarios for classification of tomato seeds using MSI. The results displayed that MSI can be used in confirming the hybridity of the hybrid seeds. Manuscript III showed that accuracy......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...

  6. Rapid Analysis Model: Reducing Analysis Time without Sacrificing Quality. (United States)

    Lee, William W.; Owens, Diana


    Discusses the performance technology design process and the fact that the analysis phase is often being eliminated to speed up the process. Proposes a rapid analysis model that reduces time needed for analysis and still ensures more successful value-added solutions that focus on customer satisfaction. (LRW)

  7. Improving the quality by a competitive comparison

    Directory of Open Access Journals (Sweden)

    Bujaloboková Beáta


    Full Text Available The improvement of the competitiveness of a company assumes the use of efficient tools and methods of analysis and assessment of production and processes. There is no doubt that one of these tools is benchmarking. The paper discusses the scope of benchmarking and his classification. The Advance of benchmarking have four points: Planning, Analysis, Integration and Implementation, Upgrade. Benchmarking is a methods of development supports orientation on the inside and outside background. The category of benchmarking focuses on the comparison of processes and products. Benchmarking is not a simple comparison of certain information. It is the comparison which is evaluated and which emphasis es the necessity for the actions after the comparisons and necessity of the implementation of findings. In order to make benchmarking significant for the company, it is important, to direct it on the quality factors. Keywords of quality factors rank among marketing, human factors, finances, management. In case of benchmarking entrepreneur’s, processes are analysed and compared to entrepreneur’s processes. This processes do not depend on the production.This method significantly contributes to the identification of the quality improvement and also helps to solve specific problems in these processes or products and the effective entrepreneur’s strategy.

  8. Quality improvements of cell membrane chromatographic column. (United States)

    Ding, Xuan; Chen, Xiaofei; Cao, Yan; Jia, Dan; Wang, Dongyao; Zhu, Zhenyu; Zhang, Juping; Hong, Zhanying; Chai, Yifeng


    Cell Membrane Chromatography (CMC) is a biological affinity chromatographic method using a silica stationary phase covered with specific cell membrane. However, its short life span and poor quality control was highlighted in a lot of research articles. In this study, special attention has been paid to the disruption, cell load and packing procedure in order to improve the quality of the CMC columns. Hereto, two newly established CMC models, HSC-T6/CMC and SMMC-7721/CMC have been developed and used in this research project. The optimization of the abovementioned parameters resulted in a better reproducibility of the retention time of the compound GFT (RSDCMC columns. 3.5×10(7)cells were the optimal cell load for the preparation of the CMC columns, the disruption condition was optimized to 5 cycles (400W and 20s interval per cycle) by an ultrasonic processor reducing the total time of cell disruption to 1.5min and the packing flow rate was optimized by applying a linear gradient program. Additionally, 4% paraformaldehyde (PFA) was employed to improve the column quality and prolong the column life span. The results showed that the retention time was longer with PFA treated columns than the ones obtained with the control groups. Copyright © 2014 Elsevier B.V. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Jacek Karcz


    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.

  10. Improving wind power quality with energy storage

    DEFF Research Database (Denmark)

    Rasmussen, Claus Nygaard


    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....

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

    Directory of Open Access Journals (Sweden)

    Cathy Kande


    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.

  12. Operative blood transfusion quality improvement audit (United States)

    Al Sohaibani, Mazen; Al Malki, Assaf; Pogaku, Venumadhav; Al Dossary, Saad; Al Bernawi, Hanan


    Context: To determine how current anesthesia team handless the identification of surgical anaesthetized patient (right patient). And the check of blood unit before collecting and immediately before blood administration (right blood) in operating rooms where nurses have minimal duties and responsibility to handle blood for transfusion in anaesthetized patients. Aims: To elicit the degree of anesthesia staff compliance with new policies and procedures for anaesthetized surgical patient the blood transfusion administration. Settings and Design: Setting: A large tertiary care reference and teaching hospital. Design: A prospective quality improvement. Elaboration on steps for administration of transfusion from policies and procedures to anaesthetized patients; and analysis of the audit forms for conducted transfusions. Subjects and Methods: An audit form was used to get key performance indicators (KPIs) observed in all procedures involve blood transfusion and was ticked as item was met, partially met, not met or not applicable. Statistical Analysis Used: Descriptive statistics as number and percentage Microsoft excel 2003. Central quality improvement committee presented the results in number percentage and graphs. Results: The degree of compliance in performing the phases of blood transfusion by anesthesia staff reached high percentage which let us feel certain that the quality is assured that the internal policy and procedures (IPP) are followed in the great majority of all types of red cells and other blood products transfusion from the start of requesting the blood or blood product to the prescript of checking the patient in the immediate post-transfusion period. Conclusions: Specific problem area of giving blood transfusion to anaesthetized patient was checking KPI concerning the phases of blood transfusion was audited and assured the investigators of high quality performance in procedures of transfusion. PMID:25886107

  13. Quality Rating and Improvement System State Evaluations and Research (United States)

    Ferguson, Daniel


    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. Rapid evaluation and quality control of next generation sequencing data with FaQCs. (United States)

    Lo, Chien-Chi; Chain, Patrick S G


    Next generation sequencing (NGS) technologies that parallelize the sequencing process and produce thousands to millions, or even hundreds of millions of sequences in a single sequencing run, have revolutionized genomic and genetic research. Because of the vagaries of any platform's sequencing chemistry, the experimental processing, machine failure, and so on, the quality of sequencing reads is never perfect, and often declines as the read is extended. These errors invariably affect downstream analysis/application and should therefore be identified early on to mitigate any unforeseen effects. Here we present a novel FastQ Quality Control Software (FaQCs) that can rapidly process large volumes of data, and which improves upon previous solutions to monitor the quality and remove poor quality data from sequencing runs. Both the speed of processing and the memory footprint of storing all required information have been optimized via algorithmic and parallel processing solutions. The trimmed output compared side-by-side with the original data is part of the automated PDF output. We show how this tool can help data analysis by providing a few examples, including an increased percentage of reads recruited to references, improved single nucleotide polymorphism identification as well as de novo sequence assembly metrics. FaQCs combines several features of currently available applications into a single, user-friendly process, and includes additional unique capabilities such as filtering the PhiX control sequences, conversion of FASTQ formats, and multi-threading. The original data and trimmed summaries are reported within a variety of graphics and reports, providing a simple way to do data quality control and assurance.

  15. Using Q Methodology in Quality Improvement Projects. (United States)

    Tiernon, Paige; Hensel, Desiree; Roy-Ehri, Leah

    Q methodology consists of a philosophical framework and procedures to identify subjective viewpoints that may not be well understood, but its use in nursing is still quite limited. We describe how Q methodology can be used in quality improvement projects to better understand local viewpoints that act as facilitators or barriers to the implementation of evidence-based practice. We describe the use of Q methodology to identify nurses' attitudes about the provision of skin-to-skin care after cesarean birth. Copyright © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  16. 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


    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.

  17. 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


    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.

  18. 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


    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.

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

    National Research Council Canada - National Science Library

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


    ...) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria...

  20. Scaling up success to improve health: Towards a rapid assessment guide for decision makers

    Directory of Open Access Journals (Sweden)

    Jason Paltzer


    Full Text Available Introduction Evidence-based health interventions exist and are effectively implemented throughout resource-limited settings. The literature regarding scale-up strategies and frameworks is growing. The purpose of this paper is to identify and systematically document the variation in scale-up strategies to develop a rapid assessment tool for decision-makers looking to identify the most appropriate strategy for their organizational and environmental contexts. Methods A list of scale-up strategies and frameworks were identified through an in-depth literature review and conversations with scale-up and quality improvement leaders. The literature search included a broad range of terms that might be used interchangeably with scale-up of best practices. Terms included: implementation research, knowledge translation, translational research, quality improvement research, health systems improvement, scale-up, best practices, improvement collaborative, and community based research. Based on this research, 18 strategies and frameworks were identified, and nine met our inclusion criteria for scale-up of health-related strategies. We interviewed the key contact for four of the nine strategies to obtain additional information regarding the strategy’s scale-up components, targets, underlying theories, evaluation efforts, facilitating factors, and barriers. A comparative analysis of common elements and strategy characteristics was completed by two of the authors on the nine selected strategies. Key strategy characteristics and common factors that facilitate or hinder the strategy’s success in scaling up health-related interventions were identified. Results Common features of scale-up strategies include: 1 the development of context-specific evidence; 2 collaborative partnerships; 3 iterative processes; and 4 shared decision-making. Facilitating factors include strong leadership, community engagement, communication, government collaboration, and a focus on

  1. A Simulation-based Quality Improvement Approach to Improve Pediatric Resident Competency with Required Procedures. (United States)

    Starr, Michelle; Sawyer, Taylor; Jones, Maya; Batra, Maneesh; McPhillips, Heather


    Pediatric residents report a lack of confidence and competence with procedural skills at graduation. Training programs could benefit from improved approaches to target these needs. Using the Institute for Healthcare Improvement (IHI) Model for Improvement and three Plan-Do-Study-Act (PDSA) cycles, we examined the impact of a procedure simulation boot camp on self-reported procedural confidence and competence as well as the longitudinal impacts of these sequential interventions on Accreditation Council for Graduate Medical Education (ACGME) Graduating Resident Survey (GRS) results. Three rapid cycle interventions were performed in successive academic years. The interventions included 1) increased awareness of available procedural experiences, 2) institution of procedural educational conferences, and 3) implementation of a senior resident procedure boot camp. Senior resident self-reported procedural confidence was measured before and after the boot camp. Procedural competence was measured using the ACGME GRS.  Results: Thirty-two of 34 senior residents (94%) completed the 2016 ACGME GRS, similar to the response rates of 2014 (92%) and 2015 (94%), and 30 of 34 third-year residents participated in the procedure boot camp (88%). Resident confidence and competence with procedural skills improved after the institution of the quality improvement intervention. ACGME GRS-reported competency increased in bag and mask ventilation (77% to 94%), neonatal endotracheal intubation (39% to 69%), peripheral IV placement (10% to 50%), and umbilical catheter placement (35% to 53%). A quality improvement intervention with three rapid PDSA cycles was successful in improving senior pediatric resident confidence and competence with ACGME required procedural skills.

  2. Concurrent implementation of quality improvement programs. (United States)

    Nyström, Monica Elisabeth; Garvare, Rickard; Westerlund, Anna; Weinehall, Lars


    Competing activities and projects can interfere with implementing new knowledge and approaches. The purpose, therefore, was to investigate processes and impact related to implementing two concurrent quality initiatives in a Swedish hospital. These were a regionally initiated, system-wide organizational learning programme called the Dynamic and Viable Organization (DVO) and a national initiative on stopping healthcare-associated and hospital-acquired infections (SHAI). Both undertakings aspired to increase staff competence in systematic improvement approaches. Multiple methods were applied including surveys, observations, interviews, process diaries, documents and organizational measurements. Respondents were unit managers, change facilitators and improvement team members. Even though both initiatives shared the same improvement approach, there was no strong indication that they were strategically combined to benefit each other. The initiatives existed side by side with some coordination and some conflict. Despite absent management strategies to utilize the national SHAI initiative, positive developments in QI culture and communication were reported. The current study illustrates the inherent difficulties coordinating change initiatives, even in favourable circumstances. This article addresses the lesser studied but common situation of coinciding and competing projects in organizations.

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

    Greene, Laurence; Moreo, Kathleen


    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

  4. Quality improvement in neurology: dementia management quality measures. (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


    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 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

  5. Algal and water-quality data for Rapid Creek and Canyon Lake near Rapid City, South Dakota, 2007 (United States)

    Hoogestraat, Galen K.; Putnam, Larry D.; Graham, Jennifer L.


    This report summarizes the results of algae and water-quality sampling on Rapid Creek and Canyon Lake during May and September 2007. The overall purpose of the study was to determine the algal community composition of Rapid Creek and Canyon Lake in relation to organisms that are known producers of unwanted tastes and odors in drinking-water supplies. Algal assemblage structure (phytoplankton and periphyton) was examined at 16 sites on Rapid Creek and Canyon Lake during May and September 2007, and actinomycetes bacteria were sampled at the Rapid City water treatment plant intake in May 2007, to determine if taste-and-odor producing organisms were present. During the May 2007 sampling, 3 Rapid Creek sites and 4 Canyon Lake sites were quantitatively sampled for phytoplankton in the water column, 7 Rapid Creek sites were quantitatively sampled for attached periphyton, and 4 lake and retention pond sites were qualitatively sampled for periphyton. Five Rapid Creek sites were sampled for geosmin and 2-methylisoborneol, two common taste-and-odor causing compounds known to affect water supplies. During the September 2007 sampling, 4 Rapid Creek sites were quantitatively sampled for attached periphyton, and 3 Canyon Lake sites were qualitatively sampled for periphyton. Water temperature, dissolved oxygen, pH, and specific conductance were measured during each sampling event. Methods of collection and sample analysis are presented for the various types of biological and chemical constituent samples. Diatoms comprised 91-100 percent of the total algal biovolume in periphyton samples collected during May and September. Cyanobacteria (also called blue-green algae) were detected in 7 of the 11 quantitative periphyton samples and ranged from 0.01 to 2.0 percent of the total biovolume. Cyanobacteria were present in 3 of the 7 phytoplankton samples collected in May, but the relative biovolumes were small (0.01-0.2 percent). Six of seven qualitative samples collected from Canyon Lake

  6. How to Sustain Change and Support Continuous Quality Improvement

    National Research Council Canada - National Science Library

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


    .... However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement...

  7. SF Bay Water Quality Improvement Fund: Projects and Accomplishments (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.

  8. Easing Opioid Dose May Improve Pain and Quality of Life (United States)

    ... html Easing Opioid Dose May Improve Pain and Quality of Life Slowly lowering the drug amount also helps people ... improve pain and function, as well as boost quality of life. "As many as 10 million Americans use long- ...

  9. Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement collaboratives. (United States)

    Savant, Adrienne P; Britton, LaCrecia J; Petren, Kristofer; McColley, Susanna A; Gutierrez, Hector H


    To describe the characteristics of sustained improved nutritional outcomes through the use of quality improvement (QI) methodology. Retrospective analysis of a QI intervention in two institutions, implemented as part of larger national collaboratives. Paediatric cystic fibrosis (CF) programmes in academic centres in Alabama and Illinois. All paediatric patients enrolled in the CF Foundation (CFF) Patient Data Registry were included. Improved and sustained nutrition outcomes occurred through implementation of the CFF practice guidelines for CF nutrition management via care delivery processes, nutritional interventions, team engagement and data display. Mean body mass index (BMI) percentile, percentage of patients less than 50th percentile and percentage less than 10th percentile for all patients aged 2-20 years were tracked through run charts and statistical process control charts. Mann-Whitney U and χ(2) tests were used to determine significance between each centre and national outcomes. Each centre achieved rapid improvement in mean BMI percentile in patients, one centre rising from the 40th percentile in 2001 to the 49th percentile in 2003, the other rising from the 37th percentile in 2003 to the 45th percentile in 2004. These centres have also maintained improved nutritional outcomes, so that they were at the 60th and 55th percentiles, respectively, in 2011. Sustained improvement was accomplished through QI methodology, use of data as a driver for improvement and a change in culture. Participation in collaboratives led to improved nutrition outcomes while a strong culture of QI facilitated sustained improvement.

  10. Foliage Plants for Improving Indoor Air Quality (United States)

    Wolverton, B. C.


    NASA's research with foliage houseplants during the past 10 years has produced a new concept in indoor air quality improvement. This new and exciting technology is quite simple. Both plant leaves and roots are utilized in removing trace levels of toxic vapors from inside tightly sealed buildings. Low levels of chemicals such as carbon monoxide and formaldehyde can be removed from indoor environments by plant leaves alone, while higher concentrations of numerous toxic chemicals can be removed by filtering indoor air through the plant roots surrounded by activated carbon. The activated carbon absorbs large quantities of the toxic chemicals and retains them until the plant roots and associated microorganisms degrade and assimilate these chemicals.

  11. Improving quality of OE spun yarn (United States)

    Gafurov, J. K.; Vassiliadis, S.; Gofurov, K.


    During the formation of OE yarns on high frequency spinning rotors, dynamic shocks occur which lead to variations in the yarn tension. It is well known that by increasing the spinning speed the irregularity of yarn also increases. The variation of the yarn tension reduces the quality of the product (yarn). The aim of this research work is to find method to decrease the yarn irregularity without decreasing the spinning speed. In this paper also the way of improving of the quality of OE spun yarn is discussed. The OE yarn irregularity has been decreased by changing the construction of existed OE rotor’s separator (OERS). The yarn passes through the yarn lead-funnel to the yarn lead-out tube. The variation of the yarn tension results in the change of the yarn friction on the yarn lead-out wall of the funnel. Then concentric protrusion formed at the centre on the surface of the base lead-out funnel lets the yarn contact the separator and it presses a spring disposed in a recess formed in the separator. As a result, the spring is deformed (axially) and allows the reciprocation the yarn lead-out funnel and yarn lead-out tube, whereby the vibration leading to changes in the yarn tension are absorbed.

  12. Improving the quality of drug error reporting. (United States)

    Armitage, Gerry; Newell, Robert; Wright, John


    Drug errors are a common and persistent problem in health care and are also associated with serious adverse events. Reporting has become the cornerstone of learning from errors, but is not without its imperfections. The aim of this study is to improve reporting and learning from drug errors through investigating the contributory factors in drug errors and quality of reporting in an acute hospital. A retrospective, random sample of 991 drug error reports from 1999 to 2003 were subjected to quantitative and qualitative analysis. This was followed by 40 qualitative interviews with a volunteer, multi-disciplinary sample of health professionals. The combined analysis has been used to develop a knowledge base for improved drug error reporting. The quality of reports varied considerably, and 27% of reports lacked any contributory factors. Documentary analysis revealed a focus on individuals, sometimes culminating in blame without obvious justification. Doctors submitted few reports, and there were notable differences in reporting according to clinical location. Communication difficulties commonly featured in causation, and high workload and interruptions were predominant contributory factors in the interview data. Interviewees viewed causation as multifactorial, including cognitive and psychosocial factors. Organizational orientation to error was predominantly perceived by interviewees as individual rather than systems-based. Staff felt obliged to report but rarely received feedback. IMPLICATIONS AND CONCLUSION: Drug errors are multifactorial in causation. Current reporting schemes lack a theoretical basis, and are unlikely to capture the information required to ensure learning about causation. Health professionals have reporting fatigue and some remain concerned that reporting promotes individual blame rather than an examination of systems factors. Reporting can be strengthened by human error theory, redesigned to capture a range of contributory factors, facilitate

  13. Toyota production system quality improvement initiative improves perioperative antibiotic therapy. (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


    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.

  14. Criteria for the Evaluation of Quality Improvement Programs and the Use of Quality Improvement Data (United States)

    American Psychologist, 2009


    This document provides a set of criteria to be used by psychologists in evaluating quality improvement programs (QIPs) that have been promulgated by health care organizations, government agencies, professional associations, or other entities. These criteria also address the privacy and confidentiality issues evoked by the intended use of patient…

  15. Improving quality of care in substance abuse treatment using five key process improvement principles. (United States)

    Hoffman, Kim A; Green, Carla A; Ford, James H; Wisdom, Jennifer P; Gustafson, David H; McCarty, Dennis


    Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.

  16. Rapid start-up and improvement of granulation in SBR. (United States)

    Jalali, Sajjad; Shayegan, Jalal; Rezasoltani, Samira


    The aim of this study is to accelerate and improve aerobic granulation within a Sequencing Batch Reactor (SBR) by cationic polymer addition. To identify whether the polymer additive is capable of enhancing granule formation, two SBRs (R1 and R2, each 0.15 m in diameter and 2 m in height) are used by feeding synthetic wastewater. The cationic polymer with concentration of 30 to 2 ppm is added to R2, while no cationic polymer is added to R1. Results show that the cationic polymer addition causes faster granule formation and consequently shorter reactor start-up period. The polymer-amended reactor contains higher concentration of biomass with better settling ability (23% reduction in SVI15) and larger and denser granules (112% increase of granular diameter). In addition, the results demonstrate that the cationic polymer improve the sludge granulation process by 31% increase in Extracellular Polymer Substance(EPS) concentration, 7% increase in Specific Oxygen Uptake Rate(SOUR), 18% increase in hydrophobicity, and 17% reduction in effluent Mixed Liquor Suspended Solid(MLSS) concentration. Concludingly, it is found that using the cationic polymer to an aerobic granular system has the potential to enhance the sludge granulation process.

  17. Ethical oversight in quality improvement and quality improvement research: new approaches to promote a learning health care system. (United States)

    Fiscella, Kevin; Tobin, Jonathan N; Carroll, Jennifer K; He, Hua; Ogedegbe, Gbenga


    Institutional review boards (IRBs) distinguish health care quality improvement (QI) and health care quality improvement research (QIR) based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR. Minimal risk projects should entail minimal oversight including waivers for informed consent for both QI and QIR projects. Minimizing the burdens of conducting QIR, while ensuring minimal safeguards for QI projects, is needed to restore this imbalance in oversight. Potentially, such ethical oversight could be provided by the integration of Institutional Review Boards and Clinical Ethical Committees, using a more integrated and streamlined approach such as a two-step process involving a screening review, followed by a review by committee trained in QIR. Standards for such ethical review and training in these standards, coupled with rapid review cycles, could facilitate an appropriate level of oversight within the context of creating and sustaining learning health care systems. We argue that QI and QIR are not reliably distinguishable. We advocate for approaches that improve protections for QI participants while minimizing over-protection for participants in QIR through reasonable ethical oversight that aligns risk to participants in both QI and QIR with the needs of a learning health care system.

  18. First do no harm: integrating patient safety and quality improvement. (United States)

    Mawji, Zubina; Stillman, Paula; Laskowski, Robert; Lawrence, Susan; Karoly, Elizabeth; Capuano, Terry Ann; Sussman, Elliot


    Lehigh Valley Hospital's (LVH's; Allentown, Penn) interdisciplinary quality improvement program Primum Non Nocere (PNN), or First Do No Harm, is composed of 12 quality improvement (QI) projects that are a combination of ongoing operations improvement projects and new projects in patient safety. The projects stress delivery of cost-effective medical care while reducing preventable adverse events through improved communication, process redesign, and evidence-based protocol use. WRONG-SITE SURGERY: In response to an initial alert warning in 1998, LVH developed a policy of marking "yes" on the surgical site and "no" on the other side. However, several near misses occurred, and a root cause analysis indicated that the policy was not always followed for some very specific reasons. For example, the operative record included no prompt to address laterality, and the procedures in which laterality should be addressed were never specified. Interventions to address these issues were quickly developed that were in keeping with the recommendations outlined in a second alert warning on the issue in December 2001. A year after these stepwise changes, compliance with the policy is almost 100%, and there have been no further near misses. Specific project barriers included the initial challenge of changing the mindset in the institution from gradual change on a grand scale to smaller, more rapid changes, analyses, and actions. Another issue identified early in the initiative was the tendency of project groups to outline elaborate process improvements without determining how to measure and monitor success. A project sustainability is inherently linked to its initial strengths and the successful solutions to barriers that are encountered.

  19. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD


    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology


    Directory of Open Access Journals (Sweden)

    B.P. Mahesh


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

  1. Improving Water Quality With Conservation Buffers (United States)

    Lowrance, R.; Dabney, S.; Schultz, R.


    Conservation buffer technologies are new approaches that need wider application. In-field buffer practices work best when used in combination with other buffer types and other conservation practices. Vegetative barriers may be used in combination with edge-of-field buffers to protect and improve their function and longevity by dispersing runoff and encouraging sediment deposition upslope of the buffer. It's important to understand how buffers can be managed to help reduce nutrient transport potential for high loading of nutrients from manure land application sites, A restored riparian wetland buffer retained or removed at least 59 percent of the nitrogen and 66 percent of the phosphorus that entered from an adjacent manure land application site. The Bear Creek National Restoration Demonstration Watershed project in Iowa has been the site of riparian forest buffers and filter strips creation; constructed wetlands to capture tile flow; stream-bank bioengineering; in-stream structures; and controlling livestock grazing. We need field studies that test various widths of buffers of different plant community compositions for their efficacy in trapping surface runoff, reducing nonpoint source pollutants in subsurface waters, and enhancing the aquatic ecosystem. Research is needed to evaluate the impact of different riparian grazing strategies on channel morphology, water quality, and the fate of livestock-associated pathogens and antibiotics. Integrating riparian buffers and other conservation buffers into these models is a key objective in future model development.

  2. Balur and Improving Quality of Life

    Directory of Open Access Journals (Sweden)

    Gatra Ervi Jayanti


    Full Text Available Balur treatment aimed to leach free radicals overwhelmingly produced in unhealthy body with rubbed over the human body. In Balur used some amino acid, bawang sabrang (Eleutherine palmifolia (L. Merr, kopi balur (Mixed Coffea arabica L. with Acetosal, coconut Water (Cocos nucifera L., secang (Caesalpinia sappan L. and “Divine” smoke from cloves (Syzygium aromaticum (L. Merr. & L. M. Perry and tobacco (Nicotiana tabacum L. This is an observation research of balur application in volunteers during four years at Rumah Sehat, Malang, Indonesia. The result suggested that balur can improve quality of life in male volunteers i.e. 61.54% cancer (39 volunteers; 80% tumor (20 volunteers; 86.36% diabetes mellitus (22 volunteers; 93.33% heart (15 volunteers; 92.86% autism (28 volunteers; 72.73% hepatitis (11 volunteers; 100% neuron disease (2 volunteers; 93.62% various of disease (94 volunteers. in female volunteers: 72.31% cancer (65 volunteers; 88.57% tumor (35 volunteers;75% diabetes mellitus (16 volunteers; 100% hemorrhoid (3 volunteers; 100% stroke (3 volunteers; 40% cardiomegaly (5 volunteers; 66.67% autism (3 volunteers; 88% various of disease (50 volunteers and 100% healthy (3 volunteers.

  3. Applying Triz for Production Quality Improvement

    Directory of Open Access Journals (Sweden)

    Swee Nikalus Shu Luing


    Full Text Available This paper aims to provide a thorough analysis on the application of TRIZ in improving the quality of canned food production. TRIZ tools such as engineering systems analysis, function analysis, cause and effect chain analysis, By-separation model and 40 Inventive Principles are applied in order to discover some feasible and elegant solutions to alleviate the problem. Findings revealed that the rejected canned products on the conveyor belt will be isolated or picked up with other good condition canned products which are lined up very closely to the rejected cans; though the visioning system is able detect the fault printing on the canned product. The main root cause is that the rejected canned product is picked up with other canned products in good condition because all cans are lined up on the belt and are very close to each other or having no gaps between the cans. Conversely, all cans on the conveyor belts are required to be very close to each other to avoid collisions that may damage the cans. The root cause is solved by applying function analysis, By-separation tool and Inventive Principles. Therefore, it can be concluded that TRIZ is a powerful tool in inventive problem solving.

  4. Air Quality in Mexico City: Policies Implemented for its Improvement (United States)

    Paramo, V.


    stringent emission levels of the gasoline fleet; update the detention of pollutant vehicles program; partial exemption of the inspection and maintenance program for cleaner and or highly efficient vehicles; substitution of 3,000 microbuses, 40,000 taxis and 1,200 buses; commissioning of the first Bus Rapid Transit system; implementation of a program for the emissions reduction for the 300 most polluted industrial facilities; and continuous update of the air quality environmental management programs. To continue improving the air quality in the MCMA, the environmental authorities will continue the implementation of the 2002-2010 Air Quality Improvement Program. In 2007 the Green Program was started, this includes those actions that have proven to be effective reduction of pollutant emissions and incorporates new actions for the reduction of local and global pollutant emissions. The most important of these new actions are: substitution of 9,500 microbuses; renewal of all the taxis fleet; commissioning of 10 Bus Rapid Transit lines; commissioning of Line 12 of the underground system; schedules and routes limitations to the cargo fleet; increase 5 percent the number of non-motorized trips (bicycling and walking); regulation of the private public transport passenger stops; requirement of private schools to provide school transport; regulation of non-occupied taxis in circulation; modifications to the circulation of 350 critical crossing points in the city; adoption of intelligent traffic lights systems; complete substitution of the local government vehicle's fleet; implement the inspection and maintenance of the cargo fleet; introduction of low- sulfur diesel, among other measures.

  5. Changes in Sensory Evoked Responses Coincide with Rapid Improvement in Speech Identification Performance (United States)

    Alain, Claude; Campeanu, Sandra; Tremblay, Kelly


    Perceptual learning is sometimes characterized by rapid improvements in performance within the first hour of training (fast perceptual learning), which may be accompanied by changes in sensory and/or response pathways. Here, we report rapid physiological changes in the human auditory system that coincide with learning during a 1-hour test session…

  6. Groundwater Quality Assessment Based on Improved Water Quality Index in Pengyang County, Ningxia, Northwest China

    Directory of Open Access Journals (Sweden)

    Li Pei-Yue


    Full Text Available The aim of this work is to assess the groundwater quality in Pengyang County based on an improved water quality index. An information entropy method was introduced to assign weight to each parameter. For calculating WQI and assess the groundwater quality, total 74 groundwater samples were collected and all these samples subjected to comprehensive physicochemical analysis. Each of the groundwater samples was analyzed for 26 parameters and for computing WQI 14 parameters were chosen including chloride, sulphate, pH, chemical oxygen demand (COD, total dissolved solid (TDS, total hardness (TH, nitrate, ammonia nitrogen, fluoride, total iron (Tfe, arsenic, iodine, aluminum, nitrite, metasilicic acid and free carbon dioxide. At last a zoning map of different water quality was drawn. Information entropy weight makes WQI perfect and makes the assessment results more reasonable. The WQI for 74 samples ranges from 12.40 to 205.24 and over 90% of the samples are below 100. The excellent quality water area covers nearly 90% of the whole region. The high value of WQI has been found to be closely related with the high values of TDS, fluoride, sulphate, nitrite and TH. In the medium quality water area and poor quality water area, groundwater needs some degree of pretreated before consumption. From the groundwater conservation view of point, the groundwater still need protection and long term monitoring in case of future rapid industrial development. At the same time, preventive actions on the agricultural non point pollution sources in the plain area are also need to be in consideration.

  7. Vegetation improvement and soil biological quality in the Sahel of ...

    African Journals Online (AJOL)

    ... processes have not significantly improved soil biological quality. It is concluded that vegetation improvement might be at the beginning stage in the Sahel, especially in croplands, and clear change of soil biological quality is not perceptible but may be tangible in the future. Keywords: Macro-fauna, ecosystem, soil quality, ...

  8. Institutionalizing urban forestry as a "biotechnology" to improve environmental quality (United States)

    David J. Nowak


    Urban forests can provide multiple environmental benefits. As urban areas expand, the role of urban vegetation in improving environmental quality will increase in importance. Quantification of these benefits has revealed that urban forests can significantly improve air quality. As a result, national air quality regulations are now willing to potentially credit tree...

  9. How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement

    NARCIS (Netherlands)

    Akdemir, Nesibe; Lombarts, Kiki M. J. M. H.; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde


    Background: Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training.

  10. Quality of life in patients with an idiopathic rapid eye movement sleep behaviour disorder in Korea. (United States)

    Kim, Keun Tae; Motamedi, Gholam K; Cho, Yong Won


    There have been few quality of life studies in patients with idiopathic rapid eye movement sleep behaviour disorder. We compared the quality of life in idiopathic rapid eye movement sleep behaviour disorder patients to healthy controls, patients with hypertension, type 2 diabetes mellitus without complication and idiopathic restless legs syndrome. Sixty patients with idiopathic rapid eye movement sleep behaviour disorder (24 female; mean age: 61.43 ± 8.99) were enrolled retrospectively. The diagnosis was established based on sleep history, overnight polysomnography, neurological examination and Mini-Mental State Examination to exclude secondary rapid eye movement sleep behavior disorder. All subjects completed questionnaires, including the Short Form 36-item Health Survey for quality of life. The total quality of life score in idiopathic rapid eye movement sleep behaviour disorder (70.63 ± 20.83) was lower than in the healthy control group (83.38 ± 7.96) but higher than in the hypertension (60.55 ± 24.82), diabetes mellitus (62.42 ± 19.37) and restless legs syndrome (61.77 ± 19.25) groups. The total score of idiopathic rapid eye movement sleep behaviour disorder patients had a negative correlation with the Pittsburg Sleep Quality Index (r = -0.498, P Health Survey score and the Insomnia Severity Index (β = -1.100, P = 0.001) and Beck Depression Inventory-2 (β = -1.038, P sleep behaviour disorder had a significant negative impact on quality of life, although this effect was less than that of other chronic disorders. This negative effect might be related to a depressive mood associated with the disease. © 2016 European Sleep Research Society.

  11. Good air quality in offices improves productivity

    DEFF Research Database (Denmark)

    Fanger, Povl Ole


    Three recent independent studies have documented that the quality of indoor air has a significant and positive influence on the productivity of office workers. A combined analysis of the results of the three studies shows a significant relationship between productivity and perceived indoor air...... quality. The impact on productivity justifies a much higher indoor air quality than the minimum levels prescribed in present standards and guidelines. One way of providing air of high quality for people to breathe, without involving excessive ventilation rates and energy use, is to provide "personalized...

  12. Good air quality in offices improves productivity

    DEFF Research Database (Denmark)

    Fanger, Povl Ole


    Three recent independent studies have documented that the quality of indoor air has a significant and positive influence or? the productivity of office workers. A combined analysis of the results of the three studies shows a significant relationship between productivity and perceived indoor air...... quality. The impact on productivity justifies a much higher indoor air quality than the minimum levels prescribed in present standards and guidelines. One way of providing air of high quality for people to breathe, without involving excessive ventilation rates and energy use, is to provide "personalized...

  13. A history of industrial statistics and quality and efficiency improvement

    NARCIS (Netherlands)

    de Mast, J.; Coleman, S.; Greenfield, T.; Stewardson, D.; Montgomery, D.C.


    The twentieth century witnessed incredible increases in product quality, while in the same period product priced dropped dramatically. These important improvements in quality and efficiency in industry were the result of innovations in management and engineering. But these developments were

  14. Improving patient safety and healthcare quality: examples of good practice. (United States)

    Tingle, John


    John Tingle, Reader in Health Law at Nottingham Trent University, discusses a recent report by the Care Quality Commission that showcases eight NHS trusts that have improved their patient safety and healthcare quality.

  15. The improvement of movement and speech during rapid eye movement sleep behaviour disorder in multiple system atrophy. (United States)

    De Cock, Valérie Cochen; Debs, Rachel; Oudiette, Delphine; Leu, Smaranda; Radji, Fatai; Tiberge, Michel; Yu, Huan; Bayard, Sophie; Roze, Emmanuel; Vidailhet, Marie; Dauvilliers, Yves; Rascol, Olivier; Arnulf, Isabelle


    Multiple system atrophy is an atypical parkinsonism characterized by severe motor disabilities that are poorly levodopa responsive. Most patients develop rapid eye movement sleep behaviour disorder. Because parkinsonism is absent during rapid eye movement sleep behaviour disorder in patients with Parkinson's disease, we studied the movements of patients with multiple system atrophy during rapid eye movement sleep. Forty-nine non-demented patients with multiple system atrophy and 49 patients with idiopathic Parkinson's disease were interviewed along with their 98 bed partners using a structured questionnaire. They rated the quality of movements, vocal and facial expressions during rapid eye movement sleep behaviour disorder as better than, equal to or worse than the same activities in an awake state. Sleep and movements were monitored using video-polysomnography in 22/49 patients with multiple system atrophy and in 19/49 patients with Parkinson's disease. These recordings were analysed for the presence of parkinsonism and cerebellar syndrome during rapid eye movement sleep movements. Clinical rapid eye movement sleep behaviour disorder was observed in 43/49 (88%) patients with multiple system atrophy. Reports from the 31/43 bed partners who were able to evaluate movements during sleep indicate that 81% of the patients showed some form of improvement during rapid eye movement sleep behaviour disorder. These included improved movement (73% of patients: faster, 67%; stronger, 52%; and smoother, 26%), improved speech (59% of patients: louder, 55%; more intelligible, 17%; and better articulated, 36%) and normalized facial expression (50% of patients). The rate of improvement was higher in Parkinson's disease than in multiple system atrophy, but no further difference was observed between the two forms of multiple system atrophy (predominant parkinsonism versus cerebellar syndrome). Video-monitored movements during rapid eye movement sleep in patients with multiple system

  16. Improving Quality Higher Education in Nigeria: The Roles of Stakeholders (United States)

    Asiyai, Romina Ifeoma


    This paper discusses the roles of stakeholders in improving quality of university education in Nigeria. Internal and external stakeholders are identified and the various roles they could play in improving the quality of university education are discussed. The paper contends that continuous and holistic improvement in university education system…

  17. Quality improvement teaching at medical school: a student perspective

    Directory of Open Access Journals (Sweden)

    Nair P


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

  18. Relief of BPO or improvement in quality of life? (United States)

    Teillac, P


    Benign prostatic hyperplasia (BPH) can cause benign prostatic enlargement with subsequent benign prostatic obstruction (BPO) and lower urinary tract symptoms (LUTS). A reduction in the size of the prostate has long been considered one of the most important treatment goals. However, there is a poor correlation between prostate size and both LUTS and BPO, and between BPO and symptoms. Today, the urologist's primary objectives are to minimize symptoms, relieve BPO and decrease the morbidity associated with BPO. From the patient's point of view, rapid relief of LUTS and immediate improvement in associated quality of life (QOL) are the most important factors. Although there is a good correlation between relief of symptoms (as measured by the International Prostate Symptom Score [I-PSS], for example) and associated improvement in bothersomeness and QOL, particularly that associated with filling ('irritative') symptoms, it is still important to quantify LUTS-related bothersomeness and QOL. Various questionnaires have been developed to measure bothersomeness (e.g. Symptom Problem Index [SPI], Danish PSS [DAN-PSS], International Continence Society BPH Study Group [ICSmale] questionnaire) and QOL (e.g. I-PSS-QOL, BPH Impact Index [BII] and QOL9 BPH-specific questionnaire). In addition, the impact of treatment on sexual function should also be taken into account when judging the overall well being or QOL of the patient. A grading system to evaluate the global improvement in patients following treatment has been established. Patients are either graded as showing 'slight', 'moderate' or 'marked' improvement, with the reduction in I-PSS or BII scores required for each classification dependent on baseline symptom severity. Medical treatment strategies designed to alleviate the symptoms of BPH and consequently improve the patient's QOL are now becoming increasingly important.

  19. Culture change and mandating quality improvement. (United States)

    Bartlett, Thomas; Hewertson, Edward; Vassallo, Michael


    A mandatory programme of quality improvement (QI) education was developed for newly qualified Foundation Year 1 (FY1) doctors to complete their curriculum requirements. Their perceptions were evaluated to refine the programme. The programme delivered theoretical and experiential learning. Participants were asked to form groups and to come up with their own projects addressing the areas of need that they had identified. The 9-month group project included formal teaching and a formal presentation to the hospital. There was access to facilitation and teaching throughout. Self-rating questionnaires were used to measure the effects of the programme on knowledge and motivation. In a quasi-experimental design, data were compared before and after the programme, and comparison data were collected from the FY1 of the previous year. Across the domains of knowledge, attitudes and motivations, there were no significant differences between the pre-intervention group and the comparison group. Pre- and post-intervention [mean (SD) median] there was a significant increase in overall QI knowledge [2.1 (0.76) 2.0 versus 3.2 (0.62) 3.0; p = 0.000]; however, by the end the FY1s were less motivated to complete the projects [3.9 (0.54) 4.0 versus 3.4 (0.91) 4.0; p = 0.02] and were less positive about them [2.3 (0.69) 2.0 versus 3.0 (0.77) 3.0; p = 0.005]. They felt that the projects were less important for their professional development [3.89 (0.66) 4.0 versus 3.1 (0.73) 3.0; p = 0.000] and were less likely to generate positive change in the long term [2.72 (0.61) 3.0 versus 3.4 (0.92) 3.5; p = 0.007]. Doctors perceptions [of QI] were evaluated to refine a mandatory programme DISCUSSION: Despite delivering a successful theoretical and experiential QI teaching programme with more trainee involvement, the results suggest that mandatory participation for the completion of training risks losing the innovative and creative force of junior doctors and, for some

  20. Context in Quality of Care: Improving Teamwork and Resilience. (United States)

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


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

  1. The quality of rapid HIV testing in South Africa: an assessment of ...

    African Journals Online (AJOL)

    Abstract. Background: The aim of this study was to assess the quality of rapid HIV testing in South Africa. Method: A two-stage sampling procedure was used to select HCT sites in eight provinces of South Africa. The study employed both semi-structured interviews with HIV testers and observation of testing sessions as a ...

  2. The quality of rapid HIV testing in South Africa: an assessment of ...

    African Journals Online (AJOL)

    Background: The aim of this study was to assess the quality of rapid HIV testing in South Africa. Method: A two-stage sampling procedure was used to select HCT sites in eight provinces of South Africa. The study employed both semi-structured interviews with HIV testers and observation of testing sessions as a means of ...

  3. The quality improvement attitude survey: Development and preliminary psychometric characteristics. (United States)

    Dunagan, Pamela B


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

  4. Improving Quality in Education: Dynamic Approaches to School Improvement (United States)

    Creemers, Bert P. M.; Kyriakides, Leonidas


    This book explores an approach to school improvement that merges the traditions of educational effectiveness research and school improvement efforts. It displays how the dynamic model, which is theoretical and empirically validated, can be used in both traditions. Each chapter integrates evidence from international and national studies, showing…

  5. 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)


    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.

  6. Afforestation for improving valley urban air quality


    Chu, Peter C.; Chen, Y.C.; Lu, S.H.


    Air Quality Management at Urban, Regional, and Global Scales, Third International Symposium on Air Quality Management Lanzhou is one of the major cities in northwest China and the capital of Gansu Province and located at a narrow (2-8 km width), long (40-km), NW-SE oriented valley basin (elevation: 1,500- 1,600-m) with the Tibetan plateau in the west, Baita mountain (above 1,700-m elevation) in the north, and the Gaolan mountain in the south. Due to topographic and meteorol...

  7. New Casting Method for Improving Billet Quality (United States)

    Faunce, John P.; Wagstaff, Frank E.; Shaw, Howard

    Extrusion billet cast by the direct chill (DC) casting process frequently has inconsistent quality. This can adversely affect extrudability of the billet, for example, by causing a poor as-extruded surface. A recent development, the Wagstaff AIR-SLIP™ casting mold, incorporating several proprietary features, overcomes the problem of inconsistent quality and produces billet to exceptional metallurgical standards. Samples of 6xxx alloy aluminum billet cast by the AIR-SLIP™ process have had 0.005" peripheral segregation and an extremely smooth as-cast surface.

  8. Using Quality Tools and Methodologies to Improve a Hospital's Quality Position. (United States)

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


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

  9. Factorial experiments for product quality improvement in a Ghanaian ...

    African Journals Online (AJOL)

    It is important that the quality of manufactured products meets the expectations of those who use them. There are many tools available to the quality engineer seeking to achieve this goal. This paper discusses improvements in product quality in a Ghanaian edible oil processing firm achievable through factorial experiments.

  10. Quality Improvement in Virtual Higher Education: A Grounded Theory Approach (United States)

    Mahdiuon, Rouhollah; Masoumi, Davoud; Farasatkhah, Maghsoud


    The article aims to explore the attributes of quality and quality improvement including the process and specific actions associated with these attributes--that contribute enhancing quality in Iranian Virtual Higher Education (VHE) institutions. A total of 16 interviews were conducted with experts and key actors in Iranian virtual higher education.…


    Directory of Open Access Journals (Sweden)

    Alina-Andreea Dragoescu


    Full Text Available The latest political positioning of Serbia has caused many changes in the society with the most dramatic economic shift on the market. The market requires young educated employees with special additional "soft skills". This has resulted in the need to change the Serbian educational system with the Bologna process implemented. Therefore, the syllabus of ESP in Mechanical Engineering must be adjusted to the demands as regards needs analysis so that it can meet the requirements of the rapidly growing market. This paper offers an outline of ESP syllabus which can be regularly updated with respect to technological and other changes on the market.

  12. [Improving the quality of glass ocular prostheses]. (United States)

    Nadareĭshvili, T B; Pakhomova, T S; Labutina, L V; Kachko, A L


    A critical analysis has been attempted of the current state-of-the-art in studying seleno-cadmium ruby glasses applicable for glass ocular prosthesis production. Better quality of these prostheses can be achieved by both the refinement of the ruby glass composition and by its strengthening (hardening) through proper methods.

  13. Barley Breeding for Quality Improvement in Tunisia

    African Journals Online (AJOL)



    Nov 6, 2012 ... This study was initiated to assess the effectiveness of three selection procedures applied in the early segregating generations of barley crosses for quality traits. The selection procedures were pedigree selection (PS), bulk selection (BS) and single seed descent selection (SSD). Selection was operated in.

  14. Compost improves urban soil and water quality (United States)

    Construction in urban zones compacts the soil, which hinders root growth and infiltration and may increase erosion, which may degrade water quality. The purpose of our study was to determine the whether planting prairie grasses and adding compost to urban soils can mitigate these concerns. We simula...

  15. Data quality improvement in general practice

    NARCIS (Netherlands)

    Brouwer, H. J.; Bindels, P. J. E.; Weert, H. C.


    BACKGROUND: The importance of routine data generated by GPs has grown extensively in the last decade. These data have found many applications other than patient care. More attention has therefore been given to the issue of data quality. Several systematic reviews have detected ample space for

  16. From sensor output to improved product quality

    NARCIS (Netherlands)

    Hertog, M.L.A.T.M.; Vollebregt, Martijntje; Unzueta, I.; Hoofman, R.J.O.M.; Lammertyn, J.


    The research conducted in the European PASTEUR project focussed on perishables monitoring through smart tracking of lifetime and quality. The aim was to develop a wireless sensor platform to monitor the environmental conditions of perishable goods in the supply chain between producer and

  17. Improving organizational sustainability using a quality perspective

    NARCIS (Netherlands)

    Broekhuis, Manda; Vos, Janita F.J.


    This article derives lessons from the quality approach for further developing the organizational sustainability approach. Taking a responsibility perspective on organizational sustainability, four issues emerge that need to be resolved, i.e. what is the responsibility?, what is the responsibility

  18. The Benefits of Improving Indoor Environmental Quality (United States)

    Lamping, Jerry


    As school funding levels nationwide continue to plummet amid public demands for increased student performance, an expanding body of research in the field of indoor environmental quality (IEQ) is providing greater statistical validity about the relationship between environmental conditions in school facilities and student achievement. Since the…

  19. Households willingness to pay for improved water quality and ...

    African Journals Online (AJOL)

    This survey investigated the willingness to pay for an improved water quality and reliability in Chobe ward in Maun. On average, 54% of the households are willing to pay for improved water quality. It is therefore apparent that Chobe Ward, Maun residents in general regard water as an economic good as they are willing to ...

  20. International Accreditations as Drivers of Business School Quality Improvement (United States)

    Bryant, Michael


    Business schools are under pressure to implement continuous improvement and quality assurance processes to remain competitive in a globalized higher education market. Drivers for quality improvement include external, environmental pressures, regulatory bodies such as governments, and, increasingly, voluntary accreditation agencies such as AACSB…

  1. The Role of Staff in Quality Improvement in Early Childhood (United States)

    Sims, Margaret; Waniganayake, Manjula


    There is international recognition of the importance of high quality services for young children with a consensus that three pillars contribute to quality improvement: adult: child ratios, staff qualifications and group size. In Australia over the past 5 years, early childhood policy has attempted to drive improvements in early childhood service…

  2. Accelerating the spread of laboratory quality improvement efforts in Botswana

    Directory of Open Access Journals (Sweden)

    Kelebeletse O. Mokobela


    Conclusion: SLMTA facilitated improvements in laboratory quality management systems,yielding immediate and measurable results. This study suggests that pairing the SLMTA programme with additional training and mentorship activities may lead to further increases in laboratory performance; and that SLMTA is a practical approach to extending quality improvement to MOH laboratories.

  3. Quality Improvement for Maternal and Newborn Health in Mtwara ...

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

    Quality Improvement for Maternal and Newborn Health in Mtwara Region, Tanzania (IMCHA). This project will provide evidence for how systems-wide quality improvements can enhance maternal and newborn health outcomes at the district, health facility, and community levels in Tanzania. Healthy women, healthy babies

  4. Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders. (United States)

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


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

  5. Can quality circles improve hospital-acquired infection control? (United States)

    Forster, D H; Krause, G; Gastmeier, P; Ebner, W; Rath, A; Wischnewski, N; Lacour, M; Rüden, H; Daschner, F D


    It is a fundamental principle of continuous quality improvement (CQI) that processes should be the objects of quality improvement. The objective of this study was to improve process quality concerning the prevention of hospital-acquired infections in surgical departments and intensive care units by a continuous quality improvement (CQI) approach based mainly on quality circles. This approach was evaluated in a prospective controlled intervention study in medium-size acute care hospitals (four intervention and four control hospitals). During two intervention periods (each 10 months) four external physicians with training in hospital epidemiology and infection control introduced and supervised quality circles in the intervention hospitals. Process quality was assessed by interviewing senior staff members before the first and after the second intervention period using standardized questionnaires. The gold standard process quality was defined on the basis of the CDC/HICPAC-guidelines for the prevention of hospital-acquired infections. Most of the evaluated aspects of process quality belonged to the HICPAC-categories IA and IB respectively, the CDC category I. Fifty quality circle sessions were performed in the four intervention hospitals of which 28 were dealing directly with key subjects in infection control. In the intervention hospitals, 19.8% of evaluated aspects of process quality which concerned the prevention of hospital-acquired infections were improved compared to only 6.9% in the control hospitals (Pquality were initiated by the results of the quality circles. Our study demonstrates that a CQI approach based on infection control quality circles can lead to a substantial improvement of process quality regarding the prevention of hospital-acquired infections.

  6. Music improves sleep quality in students. (United States)

    Harmat, László; Takács, Johanna; Bódizs, Róbert


    This paper is a report of a study to investigate the effects of music on sleep quality in young participants with poor sleep. Sleep disorders may result in fatigue, tiredness, depression and problems in daytime functioning. Music can reduce sympathetic nervous system activity, decrease anxiety, blood pressure, heart and respiratory rate and may have positive effects on sleep via muscle relaxation and distraction from thoughts. Control groups have not been used in most previous studies. We used a three-group repeated measures design. Ninety-four students (aged between 19 and 28 years) with sleep complaints were studied in 2006. Participants listened for 45 minutes either to relaxing classical music (Group 1) or an audiobook (Group 2) at bedtime for 3 weeks. The control group (Group 3) received no intervention. Sleep quality was measured using the Pittsburg Sleep Quality Index before the study and weekly during the intervention. Depressive symptoms in experimental group participants were measured using the Beck Depression Inventory. Repeated measures anova revealed a main effect of TIME (P audiobook and the control group. Depressive symptoms decreased statistically significantly in the music group (P audiobooks. Relaxing classical music is an effective intervention in reducing sleeping problems. Nurses could use this safe, cheap and easy to learn method to treat insomnia.

  7. Simple changes within dietary subgroups can rapidly improve the nutrient adequacy of the diet of French adults. (United States)

    Verger, Eric O; Holmes, Bridget A; Huneau, Jean François; Mariotti, François


    Identifying the dietary changes with the greatest potential for improving diet quality is critical to designing efficient nutrition communication campaigns. Our objective was to simulate the effects of different types of dietary substitutions to improve diet quality at the individual level. Starting from the observed diets of 1330 adults participating in the national French Nutrition and Health Survey (Etude Nationale Nutrition Santé), we simulated the effects of 3 different types of food and beverage substitutions with graded implementation difficulty for the consumer in a stepwise dietary counseling model based on the improvement in the PANDiet index, which measures diet quality in terms of nutrient adequacy. In scenario 1, substitutions of a food or beverage for its "lighter" version resulted in a modest improvement in the PANDiet score (Δ = +3.3 ± 0.1) and a decrease in energy intake (Δ = -114 ± 2 kcal/d). In scenario 2, substitutions of a food or beverage within the same food subgroup resulted in a marked improvement in the PANDiet score (Δ = +26.4 ± 0.2) with no significant change in energy intake. In this second scenario, the improvement in nutrient adequacy was due to substitutions in many subgroups, with no single subgroup contributing >8% to the increase in the PANDiet score. In scenario 3, substitutions of a food or beverage within the same food group resulted in the greatest improvement in the PANDiet score (Δ = +31.8 ± 0.2) but with an increase in energy intake (Δ = +204 ± 9 kcal/d). In this third scenario, the improvement in nutrient adequacy was largely due to substitutions of fish for meat and processed meat (∼30% of the increase in the PANDiet score). This study shows that a strategy based on simple substitutions within food subgroups is effective in rapidly improving the nutritional adequacy of the diet of French adults and could be used in public health nutrition actions. © 2014 American Society for Nutrition.

  8. Is quality of healthcare improving in the US?

    Directory of Open Access Journals (Sweden)

    Robbins RA


    Full Text Available Politicians and healthcare administrators have touted that under their leadership enormous strides have been made in the quality of healthcare. However, the question of how to measure quality remains ambiguous. To demonstrate improved quality that is meaningful to patients, outcomes such as life expectancy, mortality, and patient satisfaction must be validly and reliably measured. Dramatic improvements made in many of these patient outcomes through the twentieth century have not been sustained through the twenty-first. Most studies have shown no, or only modest improvements in the past several years, and at a considerable increase in cost. These data suggest that the rate of healthcare improvement is slowing and that many of the quality improvements touted have not been associated with improved outcomes.

  9. Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients. (United States)

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


    Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the

  10. Quality improvement "201": context-relevant quality improvement leadership training for the busy clinician-educator. (United States)

    Stille, Christopher J; Savageau, Judith A; McBride, Jeanne; Alper, Eric J


    Development of quality improvement (QI) skills and leadership for busy clinician-educators in academic medical centers is increasingly necessary, although it is challenging given limited resources. In response, the authors developed the Quality Scholars program for primary care teaching faculty. They conducted a needs assessment, evaluated existing internal and national resources, and developed a 9-month, 20-session project-based curriculum that combines didactic and hands-on techniques with facilitated project discussion. They also conducted pre-post tests of knowledge and attitudes, and evaluations of each session, scholars' projects, and program sustainability and costs. In all, 10 scholars from all 3 generalist disciplines comprised the first class. A wide spectrum of previous experiences enhanced collaboration. QI knowledge increased slightly, and reported self-readiness to lead QI projects increased markedly. Protected time for project work and group discussion of QI topics was seen as essential. All 10 scholars completed projects and presented results. Institutional leadership agreed to sustain the program using institutional funds.

  11. Improving system quality through software evaluation. (United States)

    McDaniel, James G


    The role of evaluation is examined with respect to quality of software in healthcare. Of particular note is the failure of the Therac-25 radiation therapy machine. This example provides evidence of several types of defect which could have been detected and corrected using appropriate evaluation procedures. The field of software engineering has developed metrics and guidelines to assist in software evaluation but this example indicates that software evaluation must be extended beyond the formally defined interfaces of the software to its real-life operating context.

  12. Implementing Hebert’s Multimodal Approach to Improve Hand Hygiene Quality: A Position Statement

    Directory of Open Access Journals (Sweden)

    Emmanuel Mensah Nti


    Full Text Available The health care field is ever growing and changing at rapid speeds. One consistent and important issue in the field circles around infection prevention and control. The paper seeks to highlight issues and trends pertaining to hand hygiene quality improvement. Hand hygiene is key in ensuring the safety and health of both personnel and clients. In addition, it is a key in health promotion and cost saving. The paper advocates for Hebert’s Multimodal Approach to improve hand hygiene. This approach will promote good patient care outcomes and quality of work life of health care personnel.

  13. Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey. (United States)

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


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

  14. Improvement of power quality using distributed generation

    Energy Technology Data Exchange (ETDEWEB)

    Moreno-Munoz, A.; Lopez-Rodriguez, M.A.; Flores-Arias, J.M.; Bellido-Outerino, F.J. [Universidad de Cordoba, Departamento A.C., Electronica y T.E., Escuela Politecnica Superior, Campus de Rabanales, E-14071 Cordoba (Spain); de-la-Rosa, J.J.G. [Universidad de Cadiz, Area de Electronica, Dpto. ISA, TE y Electronica, Escuela Politecnica Superior Avda, Ramon Puyol, S/N, E-11202-Algeciras-Cadiz (Spain); Ruiz-de-Adana, M. [Universidad de Cordoba, Departamento de Quimica Fisica y Termodinamica Aplicada, Campus de Rabanales, E-14071 Cordoba (Spain)


    This paper addresses how Distributed Generation (DG), particularly when configured in Combined Heat and Power (CHP) mode, can become a powerful reliability solution in highlight automated factories, especially when integrated with complimentary Power Quality (PQ) measures. The paper presents results from the PQ audit conducted at a highly automated plant over last year. It was found that the main problems for the equipment installed were voltage sags. Among all categories of electrical disturbances, the voltage sag (dip) and momentary interruption are the nemeses of the automated industrial process. The paper analyzes the capabilities of modern electronic power supplies and the convenience of embedded solution. Finally it is addressed the role of the DG/CHP on the reliability of digital factories. (author)

  15. Approaching the Practice Quality Improvement Project in Interventional Radiology. (United States)

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


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

  16. Systematic Quality Improvement in Medicine: Everyone Can Do It

    Directory of Open Access Journals (Sweden)

    Mark L. Zeidel


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

  17. Nigerian electric power supply quality improvement | Ibe | Scientia ...

    African Journals Online (AJOL)

    Improving the quality of the Nigeria electric power supply means improving voltage, transient and frequency stabilities. Power system voltages are controlled by the reactive power component of the power supply; hence voltage and transient stabilities can be improved by using reactive power compensators to either supply ...

  18. Quality Improvement Policies in a Supply Chain with Stackelberg Games

    Directory of Open Access Journals (Sweden)

    Gang Xie


    Full Text Available We first analyze quality and price decisions in a supply chain with two Stackelberg games: Manufacturer’s Stackelberg (MS and Supplier’s Stackelberg (SS. Then, we investigate how equilibrium solutions are influenced by proposed quality improvement policies: coordination and manufacturer’s involvement. Also, we derive the conditions under which the policies can be implemented in both MS and SS strategies. Numerical experiments illustrate the problems and several related issues are discussed. The results suggest that proposed quality improvement policies can realize Pareto improvement for the supply chain performance.

  19. Improving organizational climate for quality and quality of care: does membership in a collaborative help? (United States)

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


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

  20. Software Quality Improvement in the OMC Team

    CERN Document Server

    Maier, Viktor

    Physicists use self-written software as a tool to fulfill their tasks and often the developed software is used for several years or even decades. If a software product lives for a long time, it has to be changed and adapted to external influences. This implies that the source code has to be read, understood and modified. The same applies to the software of the Optics Measurements and Corrections (OMC) team at CERN. Their task is to track, analyze and correct the beams in the LHC and other accelerators. To solve this task, they revert to a self-written software base with more than 150,000 physical lines of code. The base is subject to continuous changes as well. Their software does its job and is effective, but runs regrettably not efficient because some parts of the source code are in a bad shape and has a low quality. The implementation could be faster and more memory efficient. In addition it is difficult to read and understand the code. Source code files and functions are too big and identifiers do not rev...

  1. Continuous quality improvement and the education of the generalist physician. (United States)

    Headrick, L A; Neuhauser, D; Schwab, P; Stevens, D P


    The new health care environment--centered on patients, focused on health, and managed by generalists--requires new competencies for the generalist physician. Among these are knowledge and skills for the continuous improvement of health care. In many areas, generalist physicians already use quality improvement methods and principles to improve the health and health care of their communities. Efforts to teach medical students and residents to improve quality continuously in health care are beginning. Early lessons are: (1) quality improvement is most effectively learned in the context of real work; (2) initial emphasis must be on the basics; (3) the focus is on the needs of those we serve; (4) interdisciplinary skills are essential and best learned during clinical training; and (5) the best learning environment for future generalist physicians, one which results in optimism about the future and the ability to make things better, is an environment that is continuously improving.

  2. Water Quality Changes during Rapid Urbanization in the Shenzhen River Catchment: An Integrated View of Socio-Economic and Infrastructure Development

    Directory of Open Access Journals (Sweden)

    Hua-peng Qin


    Full Text Available Surface water quality deterioration is a serious problem in many rapidly urbanizing catchments in developing countries. There is currently a lack of studies that quantify water quality variation (deterioration or otherwise due to both socio-economic and infrastructure development in a catchment. This paper investigates the causes of water quality changes over the rapid urbanization period of 1985–2009 in the Shenzhen River catchment, China and examines the changes in relation to infrastructure development and socio-economic policies. The results indicate that the water quality deteriorated rapidly during the earlier urbanization stages before gradually improving over recent years, and that rapid increases in domestic discharge were the major causes of water quality deterioration. Although construction of additional wastewater infrastructure can significantly improve water quality, it was unable to dispose all of the wastewater in the catchment. However, it was found that socio-economic measures can significantly improve water quality by decreasing pollutant load per gross regional production (GRP or increasing labor productivity. Our findings suggest that sustainable development during urbanization is possible, provided that: (1 the wastewater infrastructure should be constructed timely and revitalized regularly in line with urbanization, and wastewater treatment facilities should be upgraded to improve their nitrogen and phosphorus removal efficiencies; (2 administrative regulation policies, economic incentives and financial policies should be implemented to encourage industries to prevent or reduce the pollution at the source; (3 the environmental awareness and education level of local population should be increased; (4 planners from various sectors should consult each other and adapt an integrated planning approach for socio-economic and wastewater infrastructure development.

  3. Hyperspectral Imaging as a Rapid Quality Control Method for Herbal Tea Blends

    Directory of Open Access Journals (Sweden)

    Majolie Djokam


    Full Text Available In South Africa, indigenous herbal teas are enjoyed due to their distinct taste and aroma. The acclaimed health benefits of herbal teas include the management of chronic diseases such as hypertension and diabetes. Quality control of herbal teas has become important due to the availability of different brands of varying quality and the production of tea blends. The potential of hyperspectral imaging as a rapid quality control method for herbal tea blends from rooibos (Aspalathus linearis, honeybush (Cyclopia intermedia, buchu (Agathosma Betulina and cancerbush (Sutherlandia frutescens was investigated. Hyperspectral images of raw materials and intact tea bags were acquired using a sisuChema shortwave infrared (SWIR hyperspectral pushbroom imaging system (920–2514 nm. Principal component analysis (PCA plots showed clear discrimination between raw materials. Partial least squares discriminant analysis (PLS-DA models correctly predicted the raw material constituents of each blend and accurately determined the relative proportions. The results were corroborated independently using ultra-high performance liquid chromatography coupled to mass spectrometry (UHPLC-MS. This study demonstrated the application of hyperspectral imaging coupled with chemometric modelling as a reliable, rapid and non-destructive quality control method for authenticating herbal tea blends and to determine relative proportions in a tea bag.

  4. Rapid in situ assessment for predicting soil quality using an algae-soaked disc seeding assay. (United States)

    Nam, Sun-Hwa; Moon, Jongmin; Kim, Shin Woong; Kim, Hakyeong; Jeong, Seung-Woo; An, Youn-Joo


    The soil quality of remediated land is altered and this land consequently exerts unexpected biological effects on terrestrial organisms. Therefore, field evaluation of such land should be conducted using biological indicators. Algae are a promising new biological indicator since they are a food source for organisms in higher soil trophic levels and easily sampled from the soil. Field evaluation of soil characteristics is preferred to be testing in laboratory conditions because many biological effects cannot be duplicated during laboratory evaluations. Herein, we describe a convenient and rapid algae-soaked disc seeding assay for assessing soil quality in the field based on soil algae. The collection of algae is easy and rapid and the method predicts the short-term quality of contaminated, remediated, and amended farm and paddy soils. The algae-soaked disc seeding assay is yet to be extensively evaluated, and the method cannot be applied to loamy sand soil in in situ evaluations. The algae-soaked disc seeding assay is recommended for prediction of soil quality in in situ evaluations because it reflects all variations in the environment. The algae-soaked disc seeding assay will help to develop management strategies for in situ evaluation.

  5. Use of refractometry and colorimetry as field methods to rapidly assess antimalarial drug quality. (United States)

    Green, Michael D; Nettey, Henry; Villalva Rojas, Ofelia; Pamanivong, Chansapha; Khounsaknalath, Lamphet; Grande Ortiz, Miguel; Newton, Paul N; Fernández, Facundo M; Vongsack, Latsamy; Manolin, Ot


    The proliferation of counterfeit and poor-quality drugs is a major public health problem; especially in developing countries lacking adequate resources to effectively monitor their prevalence. Simple and affordable field methods provide a practical means of rapidly monitoring drug quality in circumstances where more advanced techniques are not available. Therefore, we have evaluated refractometry, colorimetry and a technique combining both processes as simple and accurate field assays to rapidly test the quality of the commonly available antimalarial drugs; artesunate, chloroquine, quinine, and sulfadoxine. Method bias, sensitivity, specificity and accuracy relative to high-performance liquid chromatographic (HPLC) analysis of drugs collected in the Lao PDR were assessed for each technique. The HPLC method for each drug was evaluated in terms of assay variability and accuracy. The accuracy of the combined method ranged from 0.96 to 1.00 for artesunate tablets, chloroquine injectables, quinine capsules, and sulfadoxine tablets while the accuracy was 0.78 for enterically coated chloroquine tablets. These techniques provide a generally accurate, yet simple and affordable means to assess drug quality in resource-poor settings.

  6. 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:


    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.

  7. Process safety improvement--quality and target zero. (United States)

    Van Scyoc, Karl


    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.

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

  9. Improving Quality of Life and Depression After Stroke Through Telerehabilitation


    Linder, Susan M.; Rosenfeldt, Anson B.; Bay, R. Curtis; Sahu, Komal; Wolf, Steven L.; Alberts, Jay L.


    Robot-assisted interventions and home exercise programs administered using a telerehabilitation model may be valuable components of programs to improve quality of life and depression in people after stroke.

  10. Open Schools for improving Equity and Quality Education

    NARCIS (Netherlands)

    Stracke, Christian M.


    Invited Speech at International Lensky Education Forum 2016, Yakutsk, Republic of Sakha, Russian Federation, by Stracke, C. M. (2016, 16 August): "Open Schools for improving Equity and Quality Education"

  11. Nonformal Education in Improving Quality of Life of Underprivileged Children

    National Research Council Canada - National Science Library

    Mamun, Abdullah Al; Rahman, Kh. Atikur


    This study explores the role of Non-formal Primary Education (NFPE) in improving the quality of the life of underprivileged children in Bangladesh considering their economic, health, environmental issues and life skills...

  12. Creating the evidence base for quality improvement collaboratives. (United States)

    Mittman, Brian S


    Intensive efforts are under way to improve health care quality and safety throughout the United States and abroad. Many of these efforts use the quality improvement collaborative method, an approach emphasizing collaborative learning and exchange of insights and support among a set of health care organizations. Unfortunately, the widespread acceptance and reliance on this approach are based not on solid evidence but on shared beliefs and anecdotal affirmations that may overstate the actual effectiveness of the method. More effective use of the collaborative method will require a commitment by users, researchers, and other stakeholders to rigorous, objective evaluation and the creation of a valid, useful knowledge and evidence base. Development of this evidence base will require improved conceptions of the nature of quality problems, quality improvement processes, and the types of research needed to elucidate these processes. Researchers, journal editors, and funding agencies must also cooperate to ensure that published evaluations are relevant, comprehensive, and cumulative.

  13. The quality infrastructure measuring, analyzing, and improving library services

    CERN Document Server

    Murphy, Sarah Anne


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

  14. Training and support to improve ICD coding quality: A controlled ...

    African Journals Online (AJOL)

    patient records would therefore result in under-costing DRGs and .... more than one “main condition treated”, then the most clinically severe or life-threatening condition ..... evaluation forms part of a province-wide quality improvement cycle.

  15. Do quality improvement systems improve health library services? A systematic review. (United States)

    Gray, Hannah; Sutton, Gary; Treadway, Victoria


    A turbulent financial and political climate requires health libraries to be more accountable than ever. Quality improvement systems are widely considered a 'good thing to do', but do they produce useful outcomes that can demonstrate value? To undertake a systematic review to identify which aspects of health libraries are being measured for quality, what tools are being used and what outcomes are reported following utilisation of quality improvement systems. Many health libraries utilise quality improvement systems without translating the data into service improvements. Included studies demonstrate that quality improvement systems produce valuable outcomes including a positive impact on strategic planning, promotion, new and improved services and staff development. No impact of quality improvement systems on library users or patients is reported in the literature. The literature in this area is sparse and requires updating. We recommend further primary research is conducted in health libraries focusing upon the outcomes of utilising quality improvement systems. An exploration of quality improvement systems in other library sectors may also provide valuable insight for health libraries. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

  16. Improving quality and safety education: The QSEN Learning Collaborative. (United States)

    Cronenwett, Linda; Sherwood, Gwen; Gelmon, Sherril B


    As part of a national initiative to improve quality and safety education in prelicensure nursing programs, 15 schools participated in a 15-month learning collaborative sponsored by Quality and Safety Education for Nurses, funded by the Robert Wood Johnson Foundation. This article presents the rationale, design, activities, and outcomes of the collaborative. Collaborative members revised curricula, developed new teaching strategies, and established the foundation for future faculty development efforts to advance teaching of quality and safety concepts in nursing education.

  17. Progress in applying patient experience in nursing quality improvement

    Directory of Open Access Journals (Sweden)

    Cheng-Shuang Wang


    Conclusions: Professional indexes are important to maintain the care quality, but it cannot fully reflect quality of nursing care, which needs patient experience as the supplement. Nursing staffs need to make more efforts to enhance patient's nursing care experience, and apply the research results to clinical practice, and finally make patient-centered care come true. For future study, the evaluation system and management strategies about patient experience need to be developed to guide nursing quality improvement.

  18. Leadership – The Key Element in Improving Quality Management

    Directory of Open Access Journals (Sweden)

    Iveta Paulová


    Full Text Available The present contribution is processed partial results of the survey application of leadership as one of the fundamental principles of quality management in organizations in the Slovak Republic. This survey was conducted in the research project VEGA No. 1/0229/08 Perspectives of quality management development in coherence with requirements of Slovak republic market. Results from the survey were the basis for proposals to improve the quality management in Slovak industrial organizations

  19. The business case for health-care quality improvement. (United States)

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M


    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

  20. Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition

    Directory of Open Access Journals (Sweden)

    Alberto Caprioglio


    Full Text Available Abstract Background The aim of this study is to identify cephalometric pretreatment parameters for prediction of Class II improvement induced by rapid maxillary expansion. Methods Lateral cephalograms of 30 patients (mean age 8.3 ± 1.6 years old showing Class II molar relationship and undergone to rapid maxillary expansion on the upper deciduous molars were traced before treatment, and molar relation changes were evaluated on dental casts before and after treatment. Overall treatment time lasted 10.2 ± 2 months. Good responders (18 subjects, 10 females and 8 males showed improvement of at least 2.50 mm, and bad responders (12 subjects, 7 females and 5 males showed no improvement, improvement less than 2.50 mm, or worsening of molar relationship after treatment. Student’s t test was used to assess significance of differences between groups, and discriminant analysis allowed identification of predictive pretreatment variables. Results Articular angle, superior gonial angle, and mandibular dimensions (Co-Gn, S-Ar, Ar-Go, Go-Me showed significant differences in the comparison between groups. Mandibular length Co-Gn and superior gonial angle were selected as significant predictive variable for discrimination. Conclusions Patients with smaller mandibular length and more acute superior gonial angle are expected to have more chances to improve molar Class II after rapid maxillary expansion.

  1. Effects of Quality Improvement System for Child Care Centers (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace


    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…


    Directory of Open Access Journals (Sweden)

    Milan Radenkovic


    Full Text Available In this paper, Kaikaku method is presented. The essence of this method is introduction, principles and ways of implementation in the real systems. The main point how Kaikaku method influences on quality. It is presented on the practical example (furniture industry, one way how to implement Kaikaku method and how influence on quality improvement of production process.

  3. Diagnosing and reporting of occupational diseases: a quality improvement study

    NARCIS (Netherlands)

    Spreeuwers, D.; de Boer, A. G. E. M.; Verbeek, J. H. A. M.; van Beurden, M. M.; van Dijk, F. J. H.


    AIM: To assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder. METHODS: Performance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were

  4. Towards Improving the Quality of Work Life in Education. (United States)

    Wood, J. M.

    Addressing the need to consider ways in which the quality of educator work life can be improved, the author uses J. Walton's eight-point definition of the quality of work life as a framework for discussion. The eight points include (1) adequate and fair compensation, in which financial incentives are provided for advanced coursework; (2) safe and…

  5. Combining traditional breeding and genomics to improve pork quality

    NARCIS (Netherlands)

    Heuven, H.C.M.; Wijk, van H.J.; Arendonk, van J.A.M.


    Breeding or improved pork quality has been the focus of much research in recent years and some of the results have already been put into practice. The realized genetic response in pork quality to selection within lines has generally been limited, however, compared with the responses obtained for

  6. Piloting the NPF data-driven quality improvement initiative.

    NARCIS (Netherlands)

    Okun, M.S.; Siderowf, A.; Nutt, J.G.; O'Conner, G.T.; Bloem, B.R.; Olmstead, E.M.; Guttman, M.; Simuni, T.; Cheng, E.; Cohen, E.V.; Parashos, S.; Marsh, L.; Malaty, I.A.; Giladi, N.; Schmidt, P.; Oberdorf, J.


    OBJECTIVE: To pilot a data-driven quality care program in National Parkinson Foundation (NPF) Centers of Excellence. BACKGROUND: Evidence from comparative effectiveness research (CER) can be used to guide decisions regarding health care and to improve quality and efficiency of care. We propose to

  7. Quality Rating and Improvement Systems and Children's Cognitive Development (United States)

    Jeon, Lieny; Buettner, Cynthia K.


    Background: Providing enriched learning environments is important to stimulating children's development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children's school readiness. Objective: The purpose of…

  8. Total Quality Improvement Guide for Institutions of Higher Education. (United States)

    Cornesky, Robert A.; McCool, Samuel A.

    This book describes the steps and tools of Total Quality Management (TQM) and their use in the academic units of colleges and universities for Total Quality Improvement (TQI), illustrated by a case study from the School of Arts & Sciences at a state university. Section 1 explains how to: (1) identify problems contributing to non-value-added…

  9. Effective interventions on service quality improvement in a physiotherapy clinic. (United States)

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


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

  10. Hyperthyroidism in molar pregnancy: rapid preoperative preparation by plasmapheresis and complete improvement after evacuation. (United States)

    Azezli, Adil; Bayraktaroglu, Taner; Topuz, Samet; Kalayoglu-Besisik, Sevgi


    Human chorionic gonadotropin bears structural homology to pituitary thyrotropin. The extremely elevated levels of human chorionic gonadotropin in patients with molar pregnancy or other trophoblastic diseases can lead to hyperthyroidism. We describe a patient with molar pregnancy who had secondary hyperthyroidism prepared rapidly by plasmapheresis for surgery. The clinical picture improved dramatically after the first plasmapheresis. Three subsequent plasmapheresis provided a 75.1% decrease in serum free T3 concentrations and 63.9% free T4 concentrations and recovery after evacuation. This is the first use of plasmapheresis in rapid preparation of a patient who had secondary hyperthyroidism due to molar pregnancy.

  11. Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System (United States)

    Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye


    Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…



    Vrdoljak, Marija; Konjaĉić, Miljenko; Kegalj, Andrijana; Madir, Ante; Pamuković, Anita


    Recent biotechnology advances have entered into all segments of animal production, including the process of milk production. The breeders are interested into improving the genetic base and technology in order to produce quality milk more effectively and make a suitable profit. Applying biotechnology opens the opportunities with which it is possible to move forward in the selection process, to improve the genetic basis, and produce milk which will, due to its content and quality, match the spe...

  13. Quality Function Deployment Application for Improving Quality of Education in Business Schools (United States)

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


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

  14. Application of kaizen methodology to foster departmental engagement in quality improvement. (United States)

    Knechtges, Paul; Decker, Michael Christopher


    The Toyota Production System, also known as Lean, is a structured approach to continuous quality improvement that has been developed over the past 50 years to transform the automotive manufacturing process. In recent years, these techniques have been successfully applied to quality and safety improvement in the medical field. One of these techniques is kaizen, which is the Japanese word for "good change." The central tenant of kaizen is the quick analysis of the small, manageable components of a problem and the rapid implementation of a solution with ongoing, real-time reassessment. Kaizen adds an additional "human element" that all stakeholders, not just management, must be involved in such change. Because of the small size of the changes involved in a kaizen event and the inherent focus on human factors and change management, a kaizen event can serve as good introduction to continuous quality improvement for a radiology department. Copyright © 2014. Published by Elsevier Inc.

  15. Improving primary percutaneous coronary intervention performance in an urban minority population using a quality improvement approach. (United States)

    Bhalla, Rohit; Yongue, Brandon G; Currie, Brian P; Greenberg, Mark A; Myrie-Weir, Jacqueline; Defino, Maryrose; Esses, David; Menegus, Mark A; McAllen, Susan J; Monrad, E Scott; Galhotra, Sanjay; Kalkut, Gary


    It has been well established that there are racial and ethnic disparities in cardiovascular care. Quality improvement initiatives have been recommended to proactively address these disparities. An initiative was implemented to improve timeliness of and access to primary percutaneous coronary intervention (PCI) procedures among myocardial infarction patients at an academic medical center serving a predominantly minority population. The effort was part of a national quality improvement collaborative focused on improving cardiovascular care for Hispanic/Latino and African American/ black populations. The proportion of primary PCI procedures performed within 90 minutes improved significantly from 17% in the first quarter of 2006 to 93% in the fourth quarter of 2008 (P < .001). There were no significant differences in the frequency with which Hispanic/Latino or African American/black patients received primary PCI therapy in comparison to nonmembers of these groups. Quality improvement techniques can improve the quality of and access to acute cardiovascular care for minority populations.

  16. Provider-Payer Partnerships as an Engine for Continuous Quality Improvement. (United States)

    Balfour, Margaret E; Zinn, Tylar E; Cason, Karena; Fox, Jerimya; Morales, Myra; Berdeja, Cesar; Gray, Jay


    The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers.

  17. Maternal and neonatal services in Ethiopia: measuring and improving quality. (United States)

    Canavan, Maureen E; Brault, Marie A; Tatek, Dawit; Burssa, Daniel; Teshome, Ayele; Linnander, Erika; Bradley, Elizabeth H


    Maternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress. We developed and tested a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative. The tool used direct observations and medical record reviews to score quality in nine domains of intrapartum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services. Ethiopia has invested in hospital quality improvement for more than a decade and this tool was integrated into existing quality improvement mechanisms within lead hospitals, with the potential for scale-up to all government hospitals. Significant improvements in quality of intrapartum care were detected from baseline (June-July 2015) to follow-up (February-March 2016) in targeted hospitals. The overall mean quality score rose from 65.6 (standard deviation, SD: 10.5) to 91.2 (SD: 12.4) out of 110 items (P < 0.001). The method was feasible, requiring a total of 3 days and two to three trained data collectors per hospital visit. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. With additional replication studies, this tool may be useful in other low- and middle-income countries.

  18. Can Quality Improvement System Improve Childcare Site Performance in School Readiness? (United States)

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


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

  19. Home Health Aides' Perceptions of Quality Care: Goals, Challenges, and Implications for a Rapidly Changing Industry. (United States)

    Franzosa, Emily; Tsui, Emma K; Baron, Sherry


    Home care payment models, quality measures, and care plans are based on physical tasks workers perform, ignoring relational care that supports clients' cognitive, emotional, and social well-being. As states seek to rein in costs and improve the efficiency and quality of care, they will need to consider how to measure and support relational care. In four focus groups ( n = 27) of unionized, agency-based New York City home health aides, workers reported aide-client relationships were a cornerstone of high-quality care, and building them required communication, respect, and going the extra mile. Since much of this care was invisible outside the worker-client relationship, aides received little supervisory support and felt excluded from the formal care team. Aligning payment models with quality requires understanding the full scope of services aides provide and a quality work environment that offers support and supervision, engages aides in patient care, and gives them a voice in policy decisions.

  20. Improving health system quality in low- and middle-income countries that are expanding health coverage: a framework for insurance. (United States)

    Mate, Kedar S; Sifrim, Zoe K; Chalkidou, Kalipso; Cluzeau, Francoise; Cutler, Derek; Kimball, Meredith; Morente, Tricia; Smits, Helen; Barker, Pierre


    Low- and middle-income countries are increasingly pursuing health financing reforms aimed at achieving universal health coverage. As these countries rapidly expand access to care, overburdened health systems may fail to deliver high-quality care, resulting in poor health outcomes. Public insurers responsible for financing coverage expansions have the financial leverage to influence the quality of care and can benefit from guidance to execute a cohesive health-care quality strategy. and selection Following a literature review, we used a cascading expert consultation and validation process to develop a conceptual framework for insurance-driven quality improvements in health care. The framework presents the strategies available to insurers to influence the quality of care within three domains: ensuring a basic standard of quality, motivating providers and professionals to improve, and activating patient and public demand for quality. By being sensitive to the local context, building will among key stakeholders and selecting context-appropriate ideas for improvement, insurers can influence the quality through four possible mechanisms: selective contracting; provider payment systems; benefit package design and investments in systems, patients and providers. This framework is a resource for public insurers that are responsible for rapidly expanding access to care, as it places the mechanisms that insurers directly control within the context of broader strategies of improving health-care quality. The framework bridges the existing gap in the literature between broad frameworks for strategy design for system improvement and narrower discussions of the technical methods by which payers directly influence the quality.

  1. A residency clinic chronic condition management quality improvement project. (United States)

    Halverson, Larry W; Sontheimer, Dan; Duvall, Sharon


    Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics. Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress. Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators. Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.

  2. An opinion paper: emphasis on white muscle development and growth to improve farmed fish flesh quality


    Videler, J.J.


    Due to rapid depletion of wild stocks, the necessity to cultivate fish is eminent. Current fish farming practices seek to improve flesh quality. The notion that white muscles are the main target of the fishing industry is emphasized. A novel approach is suggested based on the development of white muscles in wild fish from eggs to adults. A compilation of facts about white muscle structure, function and ontogeny is followed by an account of the changes in swimming behaviour and performance rel...

  3. Improving the Quality of Electric Energy to Electric Arc Furnace

    Directory of Open Access Journals (Sweden)

    Adrian-Ioan Toma


    Full Text Available This paper presents a study of power quality problems created by an electric arc furnace (EAF with eccentric bottom tap (EBT at power system. The analysis have been done to EAF of 100 t capacity used for steel melting. Experimental results show this EAF is substantial source of electric disturbances, such as voltage fluctuations, flicker, harmonics, and unbalance between phases. Improvement of the quality of electric energy at EAF imposes a careful technical and economical analysis. Of all possible solutions for improvement of the power quality for an EAF (passive filter, STATCOM or SVC, SVC is the ideal solution.


    Directory of Open Access Journals (Sweden)



    Full Text Available Today, changing of competition conditions and customer preferences caused to happen many differences in the viewpoint of firms' quality studies. At the same time, improvements in computer technologies accelerated use of artificial intelligence. Artificial intelligence technologies are being used to solve many industry problems. In this paper, we investigated the use of artificial intelligence techniques to solve quality problems. The artificial intelligence techniques, which are used in quality improving process in the recent years, are artificial neural networks, expert systems, genetic algorithms and fuzzy logic.

  5. Quality of care: measuring a neglected driver of improved health. (United States)

    Akachi, Yoko; Kruk, Margaret E


    The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.

  6. Rapid non-destructive assessment of pork edible quality by using VIS/NIR spectroscopic technique (United States)

    Zhang, Leilei; Peng, Yankun; Dhakal, Sagar; Song, Yulin; Zhao, Juan; Zhao, Songwei


    The objectives of this research were to develop a rapid non-destructive method to evaluate the edible quality of chilled pork. A total of 42 samples were packed in seal plastic bags and stored at 4°C for 1 to 21 days. Reflectance spectra were collected from visible/near-infrared spectroscopy system in the range of 400nm to 1100nm. Microbiological, physicochemical and organoleptic characteristics such as the total viable counts (TVC), total volatile basic-nitrogen (TVB-N), pH value and color parameters L* were determined to appraise pork edible quality. Savitzky-Golay (SG) based on five and eleven smoothing points, Multiple Scattering Correlation (MSC) and first derivative pre-processing methods were employed to eliminate the spectra noise. The support vector machines (SVM) and partial least square regression (PLSR) were applied to establish prediction models using the de-noised spectra. A linear correlation was developed between the VIS/NIR spectroscopy and parameters such as TVC, TVB-N, pH and color parameter L* indexes, which could gain prediction results with Rv of 0.931, 0.844, 0.805 and 0.852, respectively. The results demonstrated that VIS/NIR spectroscopy technique combined with SVM possesses a powerful assessment capability. It can provide a potential tool for detecting pork edible quality rapidly and non-destructively.

  7. Pulmonary rehabilitation improves subjective sleep quality in COPD. (United States)

    Lan, Chou-Chin; Huang, Hui-Chuan; Yang, Mei-Chen; Lee, Chih-Hsin; Huang, Chun-Yao; Wu, Yao-Kuang


    Poor sleep quality is often reported among patients with COPD. Pulmonary rehabilitation (PR) is beneficial in improving exercise capacity and health-related quality of life (HRQOL). However, its benefit in terms of sleep quality in patients with COPD remains unclear. This study aimed to investigate the effects of PR on sleep quality of patients with COPD. Thirty-four subjects with COPD were studied. All subjects participated in a 12-week (2 sessions/week) hospital-based out-patient PR study. Baseline and post-PR status were evaluated by spirometry, a sleep questionnaire (Pittsburgh Sleep Quality Index [PSQI]), a disease-specific questionnaire of HRQOL (St George Respiratory Questionnaire [SGRQ]), cardiopulmonary exercise testing, respiratory muscle strength, and the Borg dyspnea scale. Mean FEV1/FVC in the subjects was 0.49 ± 0.13, and the mean FEV1 was 1.06 ± 0.49 L/min (49.7 ± 18.0% of predicted). After PR, the PSQI score decreased from 9.41 ± 4.33 to 7.82 ± 3.90 (P 5 also decreased (85.3-64.7%, P = .006). There were significant improvements in HRQOL (SGRQ, P = .003), exercise capacity (peak oxygen uptake, P rate, P sleep quality, along with concurrent improvements in HRQOL and exercise capacity. PR is an effective nonpharmacologic treatment to improve sleep quality in patients with COPD and should be part of their clinical management. Copyright © 2014 by Daedalus Enterprises.

  8. Galantamine improves sleep quality in patients with dementia. (United States)

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin


    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality.

  9. Model for improvement - Part Two: Measurement and feedback for quality improvement efforts. (United States)

    Randolph, Greg; Esporas, Megan; Provost, Lloyd; Massie, Sara; Bundy, David G


    Measurement and feedback are fundamental to quality improvement. There is a knowledge gap among health care professionals in knowing how to measure the impact of their quality improvement projects and how to use these data to improve care. This article presents a pragmatic approach to measurement and feedback for quality improvement efforts in local health care settings, such as hospitals or clinical practices. The authors include evidence-based strategies from health care and other industries, augmented with practical examples from the authors' collective years of experience designing measurement and feedback strategies.

  10. Ethical oversight in quality improvement and quality improvement research: new approaches to promote a learning health care system


    Fiscella, Kevin; Tobin, Jonathan N.; Carroll, Jennifer K.; He, Hua; Ogedegbe, Gbenga


    Background Institutional review boards (IRBs) distinguish health care quality improvement (QI) and health care quality improvement research (QIR) based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR. Discussion Minimal risk projects should entai...

  11. Controlled dehydration improves the diffraction quality of two RNA crystals. (United States)

    Park, HaJeung; Tran, Tuan; Lee, Jun Hyuck; Park, Hyun; Disney, Matthew D


    Post-crystallization dehydration methods, applying either vapor diffusion or humidity control devices, have been widely used to improve the diffraction quality of protein crystals. Despite the fact that RNA crystals tend to diffract poorly, there is a dearth of reports on the application of dehydration methods to improve the diffraction quality of RNA crystals. We use dehydration techniques with a Free Mounting System (FMS, a humidity control device) to recover the poor diffraction quality of RNA crystals. These approaches were applied to RNA constructs that model various RNA-mediated repeat expansion disorders. The method we describe herein could serve as a general tool to improve diffraction quality of RNA crystals to facilitate structure determinations.

  12. (ART) in primary care: a quality improvement project

    African Journals Online (AJOL)

    Claire van Deventer

    With the added complexity of managing children, there was a concern in the research district that children were not being optimally managed at PHC level. Method: A quality improvement project was initiated to assess HIV-positive children's management at PHC clinics and to implement an intervention to improve this care.

  13. Applying GRA and QFD to Improve Library Service Quality (United States)

    Chen, Yen-Ting; Chou, Tsung-Yu


    This paper applied Grey Relational Analysis (GRA) to Quality Function Deployment (QFD) to identify service improvement techniques for an academic library. First, reader needs and their importance, and satisfaction degrees were examined via questionnaires. Second, the service improvement techniques for satisfying the reader needs were developed by…

  14. A roadmap to improve the quality of atrial fibrillation management

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Bax, Jeroen


    in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v...

  15. Investigation of the sequential validity of quality improvement team ...

    African Journals Online (AJOL)

    Background: Self-assessment is widely used in the health care improvement collaboratives quality improvement (QI) teams' to assess their own performance. There is mixed evidence on the validity of this approach. This study investigated sequential validity of self-assessments in a QI HIV collaborative in Tanzania.

  16. Lean management systems: creating a culture of continuous quality improvement. (United States)

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


    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.

  17. Quality improvement cycles that reduced waiting times at Tshwane ...

    African Journals Online (AJOL)

    system, improvement of the process of up- and down-referrals to and from the tertiary hospital, easy access to stock, reorganisation of doctors' duty roster, ... a recognised tool for analysing and improving the efficiency and quality of healthcare .... Standardised management textbooks were made available at the doctors' desk ...

  18. Improving Milk Quality for Dairy Goat Farm Development

    Directory of Open Access Journals (Sweden)

    L. Cyrilla


    Full Text Available The present study was designed to evaluate factors affecting goat’s milk quality, consumer’s satisfaction to goat’s milk, and technical responses associated with goat’s milk quality. Three farms having more than 100 dairy goats were purposively selected for the study. Thirty consumers were determined by using judgement sampling techniques to assess the satisfaction of consumer to goat’s milk quality. Data were analyzed by using fishbone diagram and House of Quality matrix. The study revealed that milk quality produced by dairy goat farms met the standard quality of milk composition namely; specific gravity, total solid, fat, protein, and total solid non-fat. The main factors affecting goat milk quantity and quality were the quality of does, pregnancy status, number of kids per birth, shape and size of the udder, lactation length, and the health status of the goat. The attributes of goat’s milk that were able to achieve customer’s satisfaction targets were nutritional content, packaging size, and goat milk color. Technical responses that were major concern in ensuring goat’s milk quality included goat breed quality and health conditions, skills and performances of farmers and employees, feed quality, farm equipment hygiene and completeness, cleanliness, and hygiene of livestock housing and environment. Technical response on livestock health condition was the first priority to be improved.

  19. Improvement of Selected Logistics Processes Using Quality Engineering Tools (United States)

    Zasadzień, Michał; Žarnovský, Jozef


    Increase in the number of orders, the increasing quality requirements and the speed of order preparation require implementation of new solutions and improvement of logistics processes. Any disruption that occurs during execution of an order often leads to customer dissatisfaction, as well as loss of his/her confidence. The article presents a case study of the use of quality engineering methods and tools to improve the e-commerce logistic process. This made it possible to identify and prioritize key issues, identify their causes, and formulate improvement and prevention measures.

  20. Quality improvement in the healthcare industry: some evidence from Singapore. (United States)

    Clare, C C; Goh, M


    Presents an exploratory field research on all hospitals in Singapore, highlighting the different routes hospitals have adopted in pursuing their corporate quality journey for the new millennium. In general, both continuous improvement and innovation-based approaches have generated cost and time savings and helped to streamline work processes. However, the initial survey results show that innovation-based programs require a longer time frame for implementation, are more prone to resistance to change and suffer from program failure. Also, large hospitals and public hospitals are more inclined to implement innovation based approaches while medium-sized hospitals tend to use continuous improvement as a medium for quality improvement.

  1. Quality improvement in clinical documentation: does clinical governance work?

    Directory of Open Access Journals (Sweden)

    Dehghan M


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

  2. Quality Improvement Efforts among Early Childhood Education Programs Participating in Iowa's Quality Rating System. REL 2017-244 (United States)

    Hawkinson, Laura E.; Faria, Ann-Marie; Bouacha, Nora; Lee, Dong Hoon; Metzger, Ivan


    This report describes the quality improvement efforts of early childhood education programs participating in Iowa's Quality Rating System (QRS). It identifies supports and barriers to quality improvement and examines how quality improvement supports and activities relate to changes in program quality ratings across time. The study team developed…

  3. Efficiency Improvement and Quality Initiatives Application in Financial Institutions

    Directory of Open Access Journals (Sweden)

    MSc. Ajtene Avdullahi


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

  4. On Improving Higher Vocational College Education Quality Assessment (United States)

    Wu, Xiang; Chen, Yan; Zhang, Jie; Wang, Yi

    Teaching quality assessment is a judgment process by using the theory and technology of education evaluation system to test whether the process and result of teaching have got to a certain quality level. Many vocational schools have established teaching quality assessment systems of their own characteristics as the basic means to do self-examination and teaching behavior adjustment. Combined with the characteristics and requirements of the vocational education and by analyzing the problems exist in contemporary vocational school, form the perspective of the content, assessment criteria and feedback system of the teaching quality assessment to optimize the system, to complete the teaching quality information net and offer suggestions for feedback channels, to make the institutionalization, standardization of the vocational schools and indeed to make contribution for the overall improvement of the quality of vocational schools.

  5. Novel methods for improving rapid paper-based protein assays with gold nanoparticle detection


    Lama, Lara


    This thesis describes methods for improving sensitivity in rapid singleplex and multiplex microarray assays. The assays utilize the optical characteristics of colloidal gold nanoparticles for the colorimetric detection of proteins. Multiplexed detection in sandwich immunoassays is limited by cross-reactivity between different detection antibodies. The cross-reactivity between antibodies can contribute to increased background noise - decreasing the Limit-of-Detection of the assay - or generate...

  6. Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer's disease


    Gross Hyman; Tobinick Edward L


    Abstract Background Recent clinical studies point to rapid and sustained clinical, cognitive, and behavioral improvement in both Alzheimer's disease and primary progressive aphasia following weekly perispinal administration of etanercept, a TNF-alpha inhibitor that acts by blocking the binding of this cytokine to its receptors. This outcome is concordant with recent basic science studies suggesting that TNF-alpha functions in vivo as a gliotransmitter that regulates synaptic function in the b...

  7. A course assessment process for curricular quality improvement. (United States)

    Peterson, Steven L; Wittstrom, Kristina M; Smith, Mark J


    To describe a systematic assessment process that provides continuous improvement in the curriculum, supports faculty development, and enhances student learning outcomes. Teams of faculty members, students, and course instructors conducted course assessments, which consisted of monitoring the delivered instruction for agreement with planned content and course integration within the curriculum, and providing ongoing feedback for improving course content, course management, faculty teaching, and student learning experiences. Areas needing improvement were identified and appropriate changes were made. Improvements were achieved in course policy standardization, course integration within the curriculum, faculty teaching behaviors, and student experiences. The curriculum assessment plan provides a structured method of monitoring and delivering continuous quality improvement.

  8. Decreasing pressure ulcer risk during hospital procedures: a rapid process improvement workshop. (United States)

    Haugen, Vicki; Pechacek, Judy; Maher, Travis; Wilde, Joy; Kula, Larry; Powell, Julie


    A 300-bed acute care community hospital used a 2-day "Rapid Process Improvement Workshop" to identify factors contributing to facility-acquired pressure ulcers (PU). The Rapid Process Improvement Workshop included key stakeholders from all procedural areas providing inpatient services and used standard components of rapid process improvement: data analysis, process flow charting, factor identification, and action plan development.On day 1, the discovery process revealed increased PU risk related to prolonged immobility when transporting patients for procedures, during imaging studies, and during the perioperative period. On day 2, action plans were developed that included communication of PU risk or presence of an ulcer,measures to shorten procedure times when clinically appropriate, implementation of prevention techniques during procedures, and recommendations for mattress upgrades. In addition, educational programs about PU prevention were developed, schedules for presentations were established, and an online power point presentation was completed and placed in a learning management system module. Finally, our nursing department amended a hospital wide handoff communication tool to include skin status and PU risk level. This tool is used in all patient handoff situations, including nonnursing departments such as radiology. Patients deemed at risk for ulcers were provided "Braden Risk" armbands to enhance interdepartmental awareness.

  9. Rapid chilling cannot prevent inferior pork quality caused by high preslaughter stress

    NARCIS (Netherlands)

    Hambrecht, E.; Eissen, J.J.; Klein, W.J.H.; Ducro, B.J.; Smits, C.H.M.; Verstegen, M.W.A.; Hartog, den L.A.


    The present experiment investigated whether increasing chilling rate could improve meat quality in pigs exposed to either minimal or high stress immediately preslaughter. Pigs (n = 192) were offspring of halothane-free lines. On various days, four groups of 48 pigs were processed at a commercial

  10. Improving maternal health quality: reviewing the context and consequences

    Directory of Open Access Journals (Sweden)

    Anshul Chauhan


    Full Text Available Background: Approximately 99% of pregnancy-related deaths in developing countries are due to preventable causes related to pregnancy and childbirth which signifies that around 800 women die every day due to such causes. Major causes that lead to maternal deaths are post-partum hemorrhage, infections, high blood pressure and unsafe abortion. There are several facilities being provided for pregnant mothers yet the quality of care needs to be analyzed. Objectives: To understand the quality perspective of maternal health services and to review available evidence for strengthening maternal health services. Material & Methods: Research studies published between 2006 and 2016 were selected by specific inclusion criteria. Pub Med and Google Scholar were used to search studies on the topic, and few articles were identified through references and citations. Results: The result of the review highlighted the evidence of pitfalls, gaps in quality care, and need for interventions and approaches to improve the quality of maternal health care. Conclusion: Quality care encompasses various elements which stride towards improving the health of women and the interventions are to be scaled up to improve the quality of care. Generation of public health evidence and uniformity in quality assessments can help interventions to achieve desirable standards.

  11. Improving MRT image quality in patients with movement disorders. (United States)

    Schültke, Elisabeth; Nanko, Norbert; Pinsker, Marcus; Katzev, Michael; Sebastian, Alexandra; Feige, Bernd; Nikkhah, Guido


    In order to improve image quality in a simultaneous fMRI-EEG study with patients suffering from the involuntary movements typical for Huntington's disease, the aim was to develop a technique for immobilizing the heads of our patients inside an MRI head coil. We modified a mask technique previously used for reliable repositioning in temporally fractionated radiotherapy. The mask was tested in three patients with Huntington's disease, acquiring structural and functional MR images with simultaneous EEG with and without the mask. Image as well as EEG signal quality were significantly improved in patients wearing the mask. However, the image quality with mask was comparable to acquisitions from patients without movement disorders only in patients with light to moderate dyskinesia. Although image quality was also significantly improved in a patient suffering from severe dyskinesia with quasi-continuous involuntary movements, the quality of both the MR images as well as the EEG signal was lower than what would be expected in a healthy control person. We have succeeded in developing a mask that fits into the MRI head coil, does not disturb the MRI signal, and significantly improves both fMRI and EEG signal quality.

  12. Applying an improved rapid impact assessment matrix method to strategic environmental assessment of urban planning in China

    Energy Technology Data Exchange (ETDEWEB)

    Li, Wei, E-mail:; Xie, Yuanbo, E-mail:; Hao, Fanghua, E-mail:


    Strategic environmental assessment (SEA) has become an increasingly important decision-support tool for providing information on the environmental implications of a policy, plan, or program. The goal is to safeguard the environment and promote sustainable development at the strategic level. Despite major progress in implementing SEA practices internationally, developing countries, such as China, often lag behind in applying SEA methodology. Lack of available data and time constraints arising from tight schedules create problems. The rapid impact assessment matrix (RIAM) is a potential resource for breaking through such difficulties. Our analysis of RIAM applications suggested that it could become a tool for evaluating strategic alternatives because of its applicability in interdisciplinary settings, its transparency, and its short implementation timeframe. To make it more suitable for the SEA context, we have developed two major improvements to the conventional RIAM process: assignment of weights to assessment indicators and the development of an integrated environmental assessment score (IES). The improved RIAM process was employed in an SEA of the development plan for the Nansha District in Guangzhou, the capital city of Guangdong Province in China. It was used to assess five alternatives for development in Wanqingsha (WQS), a subunit of Nansha, where important ecological resources are located and where industrial development could impact the air quality in the neighboring Hong Kong Special Administrative Region (HKSAR). The evaluation identified WQS-A04 as the preferred alternative. This alternative involved a minimal amount of industrial development – 10% compared with the most intense development alternative – and included important wetland preservation plans. The assessment results have been incorporated into the officially approved development plan for Nansha. The improved RIAM methodology is well adapted to the technical aims of SEA and decision

  13. Parathyroidectomy for primary hyperparathyroidism improves sleep quality: A prospective study. (United States)

    La, Justin; Wang, Tracy S; Hammad, Abdulrahman Y; Burgardt, Laura; Doffek, Kara; Carr, Azadeh A; Shaker, Joseph L; Carroll, Ty B; Evans, Douglas B; Yen, Tina W F


    This prospective survey study assessed changes in sleep quality in patients with primary hyperparathyroidism after parathyroidectomy. Patients undergoing parathyroidectomy for primary hyperparathyroidism (n = 110) or thyroidectomy for benign euthyroid disease (control group; n = 45) were recruited between June 2013 and June 2015 and completed the Pittsburgh Sleep Quality Index preoperatively and at 1- and 6 months postoperatively. "Poor" sleep quality was defined as a score >5; a clinically important and relevant improvement was a ≥3-point decrease. Preoperatively, parathyroid patients had worse sleep quality than thyroid patients (mean 8.1 vs 5.3; P sleep quality (P = .03). Postoperatively, only parathyroid patients demonstrated improvement in sleep quality; mean scores did not differ between the parathyroid and thyroid groups at 1 month (6.3 vs 5.3; P = .12) or 6 months (5.8 vs 4.6; P = .11). The proportion of patients with a clinically important improvement in sleep quality was greater in the parathyroid group at 1 month (37% vs 10%; P sleep quality between the 2 groups at 1 month (50% vs 40%; P = .32) and 6 months (40% vs 29%; P = .22). More than two-thirds of patients with primary hyperparathyroidism report poor sleep quality. After parathyroidectomy, over one-third experienced improvement, typically within the first month postoperatively. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Value of Clean Water Resources: Estimating the Water Quality Improvement in Metro Manila, Philippines

    Directory of Open Access Journals (Sweden)

    Shokhrukh-Mirzo Jalilov


    Full Text Available While having many positive impacts, a tremendous economic performance and rapid industrial expansion over the last decades in the Philippines has had negative effects that have resulted in unfavorable hydrological and ecological changes in most urban river systems and has created environmental problems. Usually, these effects would not be part of a systematic assessment of urban water benefits. To address the issue, this study investigates the relationship between poor water quality and resident’s willingness to pay (WTP for improved water quality in Metro Manila. By employing a contingent valuation method (CVM, this paper estimates the benefits of the provision of clean water quality (swimmable and fishable in waterbodies of Metro Manila for its residents. Face-to-face interviews were completed with 240 randomly selected residents. Residents expressed a mean WTP of PHP102.44 (USD2.03 for a swimmable water quality (good quality and a mean WTP of PHP102.39 (USD2.03 for fishable water quality (moderate quality. The aggregation of this mean willingness-to-pay value amounted to annual economic benefits from PHP9443 billion to PHP9447 billion (approx. USD190 million per year for all taxpayers in Metro Manila. As expected, these estimates could inform local decision-makers about the benefits of future policy interventions aimed at improving the quality of waterbodies in Metro Manila.

  15. Rapid quality assessment of Radix Aconiti Preparata using direct analysis in real time mass spectrometry

    Energy Technology Data Exchange (ETDEWEB)

    Zhu Hongbin; Wang Chunyan; Qi Yao [Changchun Center of Mass Spectrometry and Chemical Biology Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022 (China); University of Chinese Academy of Sciences, Beijing 100039 (China); Song Fengrui, E-mail: [Changchun Center of Mass Spectrometry and Chemical Biology Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022 (China); Liu Zhiqiang; Liu Shuying [Changchun Center of Mass Spectrometry and Chemical Biology Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022 (China)


    Highlights: Black-Right-Pointing-Pointer DART MS combined with PCA and HCA was used to rapidly identify markers of Radix Aconiti. Black-Right-Pointing-Pointer The DART MS behavior of six aconitine-type alkaloids was investigated. Black-Right-Pointing-Pointer Chemical markers were recognized between the qualified and unqualified samples. Black-Right-Pointing-Pointer DART MS was shown to be an effective tool for quality control of Radix Aconiti Preparata. - Abstract: This study presents a novel and rapid method to identify chemical markers for the quality control of Radix Aconiti Preparata, a world widely used traditional herbal medicine. In the method, the samples with a fast extraction procedure were analyzed using direct analysis in real time mass spectrometry (DART MS) combined with multivariate data analysis. At present, the quality assessment approach of Radix Aconiti Preparata was based on the two processing methods recorded in Chinese Pharmacopoeia for the purpose of reducing the toxicity of Radix Aconiti and ensuring its clinical therapeutic efficacy. In order to ensure the safety and effectivity in clinical use, the processing degree of Radix Aconiti should be well controlled and assessed. In the paper, hierarchical cluster analysis and principal component analysis were performed to evaluate the DART MS data of Radix Aconiti Preparata samples in different processing times. The results showed that the well processed Radix Aconiti Preparata, unqualified processed and the raw Radix Aconiti could be clustered reasonably corresponding to their constituents. The loading plot shows that the main chemical markers having the most influence on the discrimination amongst the qualified and unqualified samples were mainly some monoester diterpenoid aconitines and diester diterpenoid aconitines, i.e. benzoylmesaconine, hypaconitine, mesaconitine, neoline, benzoylhypaconine, benzoylaconine, fuziline, aconitine and 10-OH-mesaconitine. The established DART MS approach in

  16. Studies on the Process Parameters of Rapid Prototyping Technique (Stereolithography for the Betterment of Part Quality

    Directory of Open Access Journals (Sweden)

    Raju Bangalore Singe Gowda


    Full Text Available Rapid prototyping (RP has evolved as frontier technology in the recent times, which allows direct transformation of CAD files into functional prototypes where it tremendously reduces the lead time to produce physical prototypes necessary for design verification, fit, and functional analysis by generating the prototypes directly from the CAD data. Part quality in the rapid prototyping process is a function of build parameters such as hatch cure depth, layer thickness, orientation, and hatch spacing. Thus an attempt was made to identify, study, and optimize the process parameters governing the system which are related to part characteristics using Taguchi experimental design techniques quality. The part characteristics can be divided into physical part and mechanical part characteristics. The physical characteristics are surface finish, dimensional accuracy, distortion, layer thickness, hatch cure, and hatch file, whereas mechanical characteristics are flexural strength, ultimate tensile strength, and impact strength. Thus, this paper proposes to characterize the influence of the physical build parameters over the part quality. An L9 orthogonal array was designed with the minimum number of experimental runs with desired parameter settings and also by analysis tools such as ANOVA (analysis of variance. Establishment of experimentally verified correlations between the physical part characteristics and mechanical part characteristics to obtain an optimal process parameter level for betterment of part quality is obtained. The process model obtained by the empirical relation can be used to determine the strength of the prototype for the given set of parameters that shows the dependency of strength, which are essential for designers and RP machine users.

  17. Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice. (United States)

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


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

  18. Internal Resources to Improve the Quality of Higher Education

    Directory of Open Access Journals (Sweden)

    Tatyana V. Zak


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

  19. Quality controls in cellular immunotherapies: rapid assessment of clinical grade dendritic cells by gene expression profiling. (United States)

    Castiello, Luciano; Sabatino, Marianna; Zhao, Yingdong; Tumaini, Barbara; Ren, Jiaqiang; Ping, Jin; Wang, Ena; Wood, Lauren V; Marincola, Francesco M; Puri, Raj K; Stroncek, David F


    Cell-based immunotherapies are among the most promising approaches for developing effective and targeted immune response. However, their clinical usefulness and the evaluation of their efficacy rely heavily on complex quality control assessment. Therefore, rapid systematic methods are urgently needed for the in-depth characterization of relevant factors affecting newly developed cell product consistency and the identification of reliable markers for quality control. Using dendritic cells (DCs) as a model, we present a strategy to comprehensively characterize manufactured cellular products in order to define factors affecting their variability, quality and function. After generating clinical grade human monocyte-derived mature DCs (mDCs), we tested by gene expression profiling the degrees of product consistency related to the manufacturing process and variability due to intra- and interdonor factors, and how each factor affects single gene variation. Then, by calculating for each gene an index of variation we selected candidate markers for identity testing, and defined a set of genes that may be useful comparability and potency markers. Subsequently, we confirmed the observed gene index of variation in a larger clinical data set. In conclusion, using high-throughput technology we developed a method for the characterization of cellular therapies and the discovery of novel candidate quality assurance markers.

  20. Improving quality of care in general practices by self-audit, benchmarking and quality circles. (United States)

    Mahlknecht, Angelika; Abuzahra, Muna E; Piccoliori, Giuliano; Enthaler, Nina; Engl, Adolf; Sönnichsen, Andreas


    Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study "Improvement of Quality by Benchmarking" was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0-5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.

  1. State public health laboratory system quality improvement activities. (United States)

    Su, Bertina; Vagnone, Paula Snippes


    The Association of Public Health Laboratories (APHL) and the APHL Laboratory Systems and Standards Committee manage the Laboratory System Improvement Program (L-SIP). One component of L-SIP is an assessment that allows the members and stakeholders of a laboratory system to have an open and honest discussion about the laboratory system's strengths and weaknesses. From these facilitated discussions, gaps and opportunities for improvement are identified. In some cases, ideas for how to best address these gaps emerge, and workgroups are formed. Depending on resources, both monetary and personnel, laboratory staff will then prioritize the next component of L-SIP: which quality improvement activities to undertake. This article describes a sample of quality improvement activities initiated by several public health laboratories after they conducted L-SIP assessments. These projects can result in more robust linkages between system entities, which can translate into improvements in the way the system addresses the needs of stakeholders.

  2. Interventions to improve water quality for preventing diarrhoea (United States)

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


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

  3. Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification. (United States)

    Lee, Cindy S; Wadhwa, Vibhor; Kruskal, Jonathan B; Larson, David B


    Practice quality improvement (PQI) is a required component of the American Board of Radiology (ABR) Maintenance of Certification (MOC) cycle, with the goal to "improve the quality of health care through diplomate-initiated learning and quality improvement." The essential requirements of PQI projects include relevance to one's practice, achievability in one's clinical setting, results suited for repeat measurements during an ABR MOC cycle, and reasonable expectation to result in quality improvement (QI). PQI projects can be performed by a group or an individual or as part of a participating institution. Given the interdisciplinary nature of radiology, teamwork is critical to ensure patient safety and the success of PQI projects. Additionally, successful QI requires considerable investment of time and resources, coordination, organizational support, and individual engagement. Group PQI projects offer many advantages, especially in larger practices and for processes that cross organizational boundaries, whereas individual projects may be preferred in small practices or for focused projects. In addition to the three-phase "plan, do, study, act" model advocated by the ABR, there are several other improvement models, which are based on continuous data collection and rapid simultaneous testing of multiple interventions. When properly planned, supported, and executed, group PQI projects can improve the value and viability of a radiology practice. © RSNA, 2015.

  4. Implementation of quality improvement strategies for better patient care


    Asinas-Tan, Marxengel; Leonardo, Josephine; Aldana, Eduardo; Reboton, William Christian; Libunao, Jose Antonio


    In the recent decade, Quality has become an important policy issue in the Philippine health care setting. Current data suggests thousands of people suffering from complications following medical errors and hospital inaccuracies each year despite having well-qualified medical professionals tending to their conditions. Its impact has become more apparent in hospitals, and the push for continuous quality improvement has become evident following amendments in hospital accreditation standards as w...

  5. Improving the quality of point-of-care testing. (United States)

    Price, Christopher P; Smith, Ian; Van den Bruel, Ann


    It is suggested that new models of primary care should have better access to test results through the use of point-of-care testing (POCT). To determine whether quality management of POCT leads to better results. A comprehensive search of the literature on quality management of POCT in primary care, where the impact of participation in quality management programmes had been investigated with relevant outcome measures. Three databases were systematically searched using key words relevant to POCT and quality management, covering from 1945 to January 2017. Titles and abstracts were reviewed for relevance and papers selected for review and data extraction. Five observational studies were found in which the performance of POCT for specific analytes in external quality assurance (EQA) programmes was used to assess improvement over a period of time, varying from 3.5 to 15 years. The tests monitored were HbA1c, urine albumin, C-reactive protein, glucose and haemoglobin. In each case, the performance of the test against defined analytical criteria was used to judge improvement in performance. Different summary performance criteria were used, including the imprecision of results over a period of time (two studies) and meeting defined target values for bias and imprecision of measurement (three studies). Performance improved with time and was associated with regular participation in EQA schemes and with the use of internal quality control (IQC) procedures. These findings indicate that adoption of quality management for POCT, including participation in IQC and EQA, with the support of laboratory medicine professionals, will improve the quality of the results 'produced'.

  6. Improving quality of care among patients hospitalised with schizophrenia

    DEFF Research Database (Denmark)

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


    BACKGROUND: The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS: To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD: In a nationwide population-...... AND USAGE: © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence....

  7. Increased office productivity through improved indoor air quality

    DEFF Research Database (Denmark)

    Fanger, Povl Ole


    Control of indoor pollution sources and ventilation are both means of improving indoor air quality. Three independent experiments have recently documented that removing a pollution source or increasing the ventilation rate will improve perceived air quality, reduce the intensity of several Sick...... twofold decrease of pollution load in the range 0.3-2 olf/m2floor, and with increasing outdoor air supply rate by a 1.8% increase in performance for each twofold increase in the outdoor air supply rate in the range 0.8-5.3 L/s per olf. As these results clearly justify increased initial and operating costs......, future developments in HVCAC technology may include "personalized air ", new ways of improving the quality of supply air (e.g., by filtration), more extensive use of heat recovery from exhaust air and systematic selection of low-polluting building and furnishing materials....

  8. Using internal marketing to improve organizational commitment and service quality. (United States)

    Tsai, Yafang; Wu, Shih-Wang


    The purpose of this article was to explore the structural relationships among internal marketing, organizational commitment and service quality and to practically apply the findings. Internal marketing is a way to assist hospitals in improving the quality of the services that they provide while executing highly labour-intensive tasks. Through internal marketing, a hospital can enhance the organizational commitment of its employees to attain higher service quality. This research uses a cross-sectional study to survey nursing staff perceptions about internal marketing, organizational commitment and service quality. The results of the survey are evaluated using equation models. The sample includes three regional hospitals in Taiwan. Three hundred and fifty questionnaires were distributed and 288 valid questionnaires were returned, yielding a response rate of 82.3%. The survey process lasted from 1 February to 9 March 2007. The data were analysed with SPSS 12.0, including descriptive statistics based on demographics. In addition, the influence of demographics on internal marketing, organizational commitment and service quality is examined using one-way anova. The findings reveal that internal marketing plays a critical role in explaining employee perceptions of organizational commitment and service quality. Organizational commitment is the mediator between internal marketing and service quality. The results indicate that internal marketing has an impact on both organizational commitment and service quality. Internal marketing should be emphasized to influence frontline nursing staff, thereby helping to create better organizational commitment and service quality. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

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

    NARCIS (Netherlands)

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


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

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

    NARCIS (Netherlands)

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


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

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

    Directory of Open Access Journals (Sweden)

    Hongyan Shi


    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.

  12. How grounded theory can improve nursing care quality. (United States)

    Nathaniel, Alvita K; Andrews, Tom


    This article presents an overview of the grounded theory research method and demonstrates how nurses can employ specific grounded theories to improve patient care quality. Because grounded theory is derived from real-world experience, it is a particularly appropriate method for nursing research. An overview of the method and language of grounded theory provides a background for nurses as they read grounded theories and apply newly acquired understandings to predictable processes and patterns of behavior. This article presents 2 exemplar grounded theories with suggestions as to how nurses can apply these and other grounded theories to improve the provision of quality nursing care.

  13. Chinese auriculotherapy to improve quality of life of nursing team. (United States)

    Kurebayashi, Leonice Fumiko Sato; da Silva, Maria Júlia Paes


    To evaluated the efficacy of auriculotherapy for improving quality of life and reducing stress in nursing staff. Single-blind radomizad clinical trail envolving 175 subjects randomized in: Control (G1), Protocol Group (G2) and without Protocol Group (G3). They were evaluated by the Stress Symptoms List and SF36v2 at baseline, after 12 sessions and follow up (30 days), between January and July 2012. Both intervention groups reduced stress (p auriculotherapy (G3) had greater effect compared to the protocol auriculotherapy (G2) for reducing stress and improving life quality.

  14. Improving quality and efficiency of postpartum hospital education. (United States)

    Buchko, Barbara L; Gutshall, Connie H; Jordan, Elizabeth T


    The purpose of this study was to investigate the implementation of an evidence-based, streamlined, education process (comprehensive education booklet, individualized education plan, and integration of education into the clinical pathway) and nurse education to improve the quality and efficiency of postpartum education during hospitalization. A one-group pretest-posttest design was used to measure the quality of discharge teaching for new mothers and efficiency of the education process for registered nurses before and after implementation of an intervention. Results indicated that a comprehensive educational booklet and enhanced documentation can improve efficiency in the patient education process for nurses.

  15. Pre-processing techniques to improve HEVC subjective quality (United States)

    Fernández, D. G.; Del Barrio, A. A.; Botella, Guillermo; Meyer-Baese, Uwe; Meyer-Baese, Anke; Grecos, Christos


    Nowadays, HEVC is the cutting edge encoding standard being the most efficient solution for transmission of video content. In this paper a subjective quality improvement based on pre-processing algorithms for homogeneous and chaotic regions detection is proposed and evaluated for low bit-rate applications at high resolutions. This goal is achieved by means of a texture classification applied to the input frames. Furthermore, these calculations help also reduce the complexity of the HEVC encoder. Therefore both the subjective quality and the HEVC performance are improved.

  16. Quality improvement research on late life depression in primary care. (United States)

    Callahan, C M


    Two million older Americans suffer from depression annually. Depression causes more functional impairment than many other common medical conditions and older adults have the highest rate of suicide in the United States. Although many of these patients fail to seek or fail to receive care for depression, the majority will be seen in primary care for the treatment of other conditions. To review the health services research on quality improvement for late life depression. Qualitative literature review. During the past 30 years, multiple educational and quality improvement interventions have been designed and tested to improve the recognition and treatment of depression in primary care settings. The findings from this large body of health services research suggest that: (1) the outcome of major depression in the usual care of primary care is typically poor; this is particularly true of late life depression; (2) informational support provided to primary care physicians is necessary but insufficient to improve the outcomes of late life depression in primary care; achieving guideline-level therapy requires the substantial participation of an informed and motivated patient working in concert with a health care team and health care system designed to care for chronic conditions; (3) up to 30% of older primary care patients will fail to respond to excellent guideline-level therapy provided in primary care; and (4) the latest quality improvement efforts focus not only on the clinical skills of primary care physicians, but also on patient's self-care and on innovative strategies to improve the system of care. Late life depression is often a chronic disease and outcomes research demonstrates that quality improvement efforts that focus resources on improving systems of care and the active participation of patients offer the best evidence of improved patient outcomes.

  17. Effect of Rapid Chilling on Beef Quality and Cytoskeletal Protein Degradation in M. longissimus of Chinese Yellow Crossbred Bulls. (United States)

    Mao, Yanwei; Zhang, Yimin; Liang, Rongrong; Ren, Lulu; Zhu, He; Li, Ke; Zhu, Lixian; Luo, Xin


    The objective of this study was to investigate the effect of rapid chilling (RC) on beef quality and the degradation of cytoskeletal proteins. Twenty Chinese Yellow crossbred bulls were selected and randomly divided into two groups. RC and conventional chilling (CC) were applied to left and right sides of the carcasses respectively after slaughtering. To determine whether electrical stimulation (ES) treatment can alleviate the potential hazard of RC on meat quality, ES was applied to one group. The effects of RC and ES were determined by meat color, shear force and cytoskeletal protein degradation postmortem (PM). The results showed that RC decreased beef tenderness at 1 d and 3 d postmortem, but had no detrimental effect on meat color. Western blotting showed that RC decreased the degradation rate of desmin and troponin-T, but the effects weakened gradually as postmortem aging extended. Degradation rates of both desmin and troponin-T were accelerated by ES. The combination of RC and ES could improve beef color, accelerate degradation rate of cytoskeletal protein and improve beef tenderness.

  18. Effect of Rapid Chilling on Beef Quality and Cytoskeletal Protein Degradation in of Chinese Yellow Crossbred Bulls

    Directory of Open Access Journals (Sweden)

    Yanwei Mao


    Full Text Available The objective of this study was to investigate the effect of rapid chilling (RC on beef quality and the degradation of cytoskeletal proteins. Twenty Chinese Yellow crossbred bulls were selected and randomly divided into two groups. RC and conventional chilling (CC were applied to left and right sides of the carcasses respectively after slaughtering. To determine whether electrical stimulation (ES treatment can alleviate the potential hazard of RC on meat quality, ES was applied to one group. The effects of RC and ES were determined by meat color, shear force and cytoskeletal protein degradation postmortem (PM. The results showed that RC decreased beef tenderness at 1 d and 3 d postmortem, but had no detrimental effect on meat color. Western blotting showed that RC decreased the degradation rate of desmin and troponin-T, but the effects weakened gradually as postmortem aging extended. Degradation rates of both desmin and troponin-T were accelerated by ES. The combination of RC and ES could improve beef color, accelerate degradation rate of cytoskeletal protein and improve beef tenderness.

  19. Accelerating quality improvement within your organization: Applying the Model for Improvement. (United States)

    Crowl, Ashley; Sharma, Anita; Sorge, Lindsay; Sorensen, Todd


    To discuss the fundamentals of the Model for Improvement and how the model can be applied to quality improvement activities associated with medication use, including understanding the three essential questions that guide quality improvement, applying a process for actively testing change within an organization, and measuring the success of these changes on care delivery. PubMed from 1990 through April 2014 using the search terms quality improvement, process improvement, hospitals, and primary care. At the authors' discretion, studies were selected based on their relevance in demonstrating the quality improvement process and tests of change within an organization. Organizations are continuously seeking to enhance quality in patient care services, and much of this work focuses on improving care delivery processes. Yet change in these systems is often slow, which can lead to frustration or apathy among frontline practitioners. Adopting and applying the Model for Improvement as a core strategy for quality improvement efforts can accelerate the process. While the model is frequently well known in hospitals and primary care settings, it is not always familiar to pharmacists. In addition, while some organizations may be familiar with the "plan, do, study, act" (PDSA) cycles-one element of the Model for Improvement-many do not apply it effectively. The goal of the model is to combine a continuous process of small tests of change (PDSA cycles) within an overarching aim with a longitudinal measurement process. This process differs from other forms of improvement work that plan and implement large-scale change over an extended period, followed by months of data collection. In this scenario it may take months or years to determine whether an intervention will have a positive impact. By following the Model for Improvement, frontline practitioners and their organizational leaders quickly identify strategies that make a positive difference and result in a greater degree of

  20. Challenges of using quality improvement methods in nursing homes that "need improvement". (United States)

    Rantz, Marilyn J; Zwygart-Stauffacher, Mary; Flesner, Marcia; Hicks, Lanis; Mehr, David; Russell, Teresa; Minner, Donna


    Qualitatively describe the adoption of strategies and challenges experienced by intervention facilities participating in a study targeted to improve quality of care in nursing homes "in need of improvement". To describe how staff use federal quality indicator/quality measure (QI/QM) scores and reports, quality improvement methods and activities, and how staff supported and sustained the changes recommended by their quality improvement teams. A randomized, two-group, repeated-measures design was used to test a 2-year intervention for improving quality of care and resident outcomes in facilities in "need of improvement". Intervention group (n = 29) received an experimental multilevel intervention designed to help them: (1) use quality-improvement methods, (2) use team and group process for direct-care decision-making, (3) focus on accomplishing the basics of care, and (4) maintain more consistent nursing and administrative leadership committed to communication and active participation of staff in decision-making. A qualitative analysis revealed a subgroup of homes likely to continue quality improvement activities and readiness indicators of homes likely to improve: (1) a leadership team (nursing home administrator, director of nurses) interested in learning how to use their federal QI/QM reports as a foundation for improving resident care and outcomes; (2) one of the leaders to be a "change champion" and make sure that current QI/QM reports are consistently printed and shared monthly with each nursing unit; (3) leaders willing to involve all staff in the facility in educational activities to learn about the QI/QM process and the reports that show how their facility compares with others in the state and nation; (4) leaders willing to plan and continuously educate new staff about the MDS and federal QI/QM reports and how to do quality improvement activities; (5) leaders willing to continuously involve all staff in quality improvement committee and team activities so

  1. [Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice]. (United States)

    Godény, Sándor


    In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.

  2. Methods for evaluation of small scale quality improvement projects. (United States)

    Harvey, G; Wensing, M


    Evaluation is an integral component of quality improvement and there is much to be learned from the evaluation of small scale quality improvement initiatives at a local level. This type of evaluation is useful for a number of different reasons including monitoring the impact of local projects, identifying and dealing with issues as they arise within a project, comparing local projects to draw lessons, and collecting more detailed information as part of a bigger evaluation project. Focused audits and developmental studies can be used for evaluation within projects, while methods such as multiple case studies and process evaluations can be used to draw generalised lessons from local experiences and to provide examples of successful projects. Evaluations of small scale quality improvement projects help those involved in improvement initiatives to optimise their choice of interventions and use of resources. Important information to add to the knowledge base of quality improvement in health care can be derived by undertaking formal evaluation of local projects, particularly in relation to building theory around the processes of implementation and increasing understanding of the complex change processes involved.

  3. Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories. (United States)

    Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine


    A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

  4. Improving a mother to child HIV transmission programme through health system redesign: quality improvement, protocol adjustment and resource addition.

    Directory of Open Access Journals (Sweden)

    Michele S Youngleson

    Full Text Available BACKGROUND: Health systems that deliver prevention of mother to child transmission (PMTCT services in low and middle income countries continue to underperform, resulting in thousands of unnecessary HIV infections of newborns each year. We used a combination of approaches to health systems strengthening to reduce transmission of HIV from mother to infant in a multi-facility public health system in South Africa. METHODOLOGY/PRINCIPAL FINDINGS: All primary care sites and specialized birthing centers in a resource constrained sub-district of Cape Metro District, South Africa, were enrolled in a quality improvement (QI programme. All pregnant women receiving antenatal, intrapartum and postnatal infant care in the sub-district between January 2006 and March 2009 were included in the intervention that had a prototype-innovation phase and a rapid spread phase. System changes were introduced to help frontline healthcare workers to identify and improve performance gaps at each step of the PMTCT pathway. Improvement was facilitated and spread through the use of a Breakthrough Series Collaborative that accelerated learning and the spread of successful changes. Protocol changes and additional resources were introduced by provincial and municipal government. The proportion of HIV-exposed infants testing positive declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and postnatal HIV testing from 79% to 95% compared to baseline. CONCLUSIONS/SIGNIFICANCE: System improvement methods, protocol changes and addition/reallocation of resources contributed to improved PMTCT processes and outcomes in a resource constrained setting. The intervention requires a clear design, leadership buy-in, building local capacity to use systems improvement methods, and a reliable data system. A systems improvement

  5. Quality of life assessment in domestic dogs: An evidence-based rapid review. (United States)

    Belshaw, Z; Asher, L; Harvey, N D; Dean, R S


    Assessment of quality of life (QoL) is an important, increasingly popular outcome measure in veterinary research and practice, particularly in dogs. In humans, QoL is commonly assessed by self-reporting and since this is not possible for animals, it is crucial that instruments designed to measure QoL are tested for reliability and validity. Using a systematic, replicable literature search strategy, the aim of this study was to find published, peer-reviewed instruments for QoL assessment in dogs and to assess the quality of these. CAB Abstracts and PubMed were searched in July 2013 using terms relevant to dogs, wellbeing and QoL. Inclusion and exclusion criteria were applied. When instruments were not published in full, authors were contacted to obtain them. Criteria were applied to assess the quality, validity and reliability of the 52 instruments obtained. Twenty-seven additional instruments used in peer-reviewed publications were not included because they had not been fully described in the publication or were not provided by authors upon request. Most of the instruments reviewed (48/52) were disease-specific rather than generic. Only four publications provided a definition of QoL or wellbeing. Only 11/52 instruments demonstrated evidence of assessing reliability or validity, and the quality of these instruments was variable. Many novel, unvalidated instruments have been generated and applied as clinical outcomes before it was known whether they measured QoL. This rapid review can be used to identify currently available and validated canine QoL instruments, and to assess the validity and quality of new or existing instruments. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. (United States)

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


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

  7. Intensive-care unit lungs - possibilities to improve the quality

    Energy Technology Data Exchange (ETDEWEB)

    Fund, G.; Fischedick, A.R.; Hartenauer, U.


    X-ray lung diagnosis in an intensive-care unit makes special demands on technique, imaging and on the physician's experience. The quality of image interpretation and evaluation is considerably improved by superimposing the technical data on the X-ray image and by using an antiscatter grid cassette. Proper evaluation of the parameters important for diagnosis is improved by registration of the data on the X-ray film; taking a maximum possible score of 100 as reference value, quality of evaluation is improved from 66.5 points to 71.8 points by data registration on the film itself, whereas the simultaneous use of an antiscatter grid cassette improves the score still further, namely, to 84.3 points. The importance of the clinical condition of the patient, and of the type of breathing chosen, for assessing the chest X-ray, is emphasized.

  8. How the ESRD quality incentive program could potentially improve quality of life for patients on dialysis. (United States)

    Moss, Alvin H; Davison, Sara N


    For over 20 years, the quality of medical care of the Medicare ESRD Program has been a concern. The Centers for Medicare and Medicaid Services have implemented the ESRD Quality Incentive Program, which uses the principles of value-based purchasing; dialysis providers are paid for performance on predefined quality measures, with a goal of improving patient outcomes and the quality of patient care. The ESRD Quality Incentive Program measures have been criticized, because they are largely disease oriented and use easy-to-obtain laboratory-based indicators, such as Kt/V and hemoglobin, that do not reflect outcomes that are most important to patients and have had a minimal effect on survival or quality of life. A key goal of improving quality of care is to enhance quality of life, a patient-important quality measure that matters more to many patients than even survival. None of the ESRD Quality Incentive Program measures assess patient-reported quality of life. As outlined in the National Quality Strategy, the Centers for Medicare and Medicaid Services are holding providers accountable in six priority domains, in which quality measures have been and are being developed for value-based purchasing. Three measures-patient experience and engagement, clinical care, and care coordination-are particularly relevant to quality care in the ESRD Program; the 2014 ESRD Quality Incentive Program includes six measures, none of which provide data from a patient-centered perspective. Value-based purchasing is a well intentioned step to improve care of patients on dialysis. However, the Centers for Medicare and Medicaid Services need to implement significant change in what is measured for the ESRD Quality Incentive Program to be patient centered and aligned with patients' values, preferences, and needs. This paper provides examples of potential quality measures for patient experience and engagement, clinical care, and care coordination, which if implemented, would be much more likely to

  9. Improving quality of life in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, D.N.; Esmann, S.; Jemec, G.B.


    Hidradenitis suppurativa is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL) and related psychosocial morbidity. Current knowledge...... on improving QoL in patients with hidradenitis suppurativa is therefore reviewed. The literature is limited but indicates that there are two ways of improving patients' QoL: therapy of the somatic disease or psychosocial interventions....

  10. How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement. (United States)

    Akdemir, Nesibe; Lombarts, Kiki M J M H; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde


    Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. The challenge for accreditors is to find the right


    Directory of Open Access Journals (Sweden)

    Alfian Nur Ubay


    Full Text Available This research was aimed at designing strategies for improving total quality management at CV XYZ and PT HIJ. The research locations were selected intentionally with the consideration that the company is a middle class company that started to apply a study in line with the research topic. The experts were chosen using an approach method. This research used a descriptive approach and quantitative analysis through questionnaires using purposive sampling. The stages began with data processing, i.e. testing the questionnaire quality through validity and reliability tests, making a causality diagram, evaluating the implementation levels of each company by giving evaluation scales based on the existing condition, making House of Quality (HOQ using QFD methods, and then analyzing the problem solutions produced from the QFD methods with 5W + IH analysis, and finally determining the improvement priorities using Fuzzy AHP methods. The results were the strategies for improving total quality management /TQM of CV XYZ, namely the factor that plays the most important role was improving the quality management performance. The actor that has the competence to carry out the TQM improvement is the director. The prioritized goal to be achieved is a commitment to improve the quality of goods and services.  The prioritized strategy used in improving TQM is carrying out SOP consistently.Keywords: strategies, improvement, TQM, manufacturing company, fuzzy AHPABSTRAKPenelitian ini bertujuan merancang strategi peningkatan manajemen mutu terpadu pada CV XYZ dan PT HIJ. Pemilihan lokasi penelitian dilakukan secara sengaja dengan pertimbangan bahwa perusahaan tersebut merupakan perusahaan kelas menengah yang mulai menerapkan kajian sesuai dengan topik penelitian. Penentuan pakar dilakukan dengan metode pendekatan secara sengaja. Adapun penelitian ini menggunakan pendekatan deskriptif dan analisa kuantitatif dengan menyebarkan kuesioner secara sengaja (purposive sampling

  12. NSQIP-Based Quality Improvement Curriculum for Surgical Residents. (United States)

    Mrdutt, Mary M; Isbell, Claire L; Regner, Justin L; Hodges, Bonnie R; Munoz-Maldonado, Yolanda; Thomas, J Scott; Papaconstantinou, Harry T


    General surgery training has historically lacked a standardized approach to resident quality improvement (QI) education aside from traditional morbidity and mortality conference. In 2013, the ACGME formalized QI as a component of residency training. Our residency chose the NSQIP Quality In-Training Initiative (QITI) as the foundation for our QI training. We hypothesized that a focused curriculum based on outcomes would produce change in culture and improve the quality of patient care. Quality improvement curriculum design and implementation were retrospectively reviewed. Institutional NSQIP data pre-, during, and post-curriculum implementation were reviewed for improvement. A QITI project committee designed a 2-year curriculum, with 3 parts: didactics, focused on methods of data collection, QI processes, and techniques; review of current institutional performance, practice, and complication rates; and QI breakout groups tasked with creating "best practice" guidelines addressing common complications in our NSQIP semi-annual reports. Educational presentations were given to the surgical department addressing reduction of cardiac complications, pneumonia, surgical site infections (SSIs), and urinary tract infections (UTIs). Twenty-four residents completed both years of the QITI curriculum. National NSQIP decile ranks improved in known high outlier areas: cardiac complications, ninth to fourth decile; pneumonia, eighth to first decile; SSIs, tenth to second decile; and UTIs, eighth to third decile. Pneumonia and SSI rates demonstrated statistical improvement after curriculum implementation (p < 0.003). Implementing a QITI curriculum with a full resident complement is feasible and can positively affect surgical morbidity and nationally benchmarked performance. Resident QI education is essential to future success in delivering high quality surgical care. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Improving Indicators in a Brazilian Hospital Through Quality-Improvement Programs Based on STS Database Reports (United States)

    Silva, Pedro Gabriel Melo de Barros e; Baruzzi, Antônio Claudio do Amaral; Ramos, Denise Louzada; Okada, Mariana Yumi; Garcia, José Carlos Teixeira; Cardoso, Fernanda de Andrade; Rodrigues, Marcelo Jamus; Furlan, Valter


    OBJECTIVE To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators. PMID:26934408

  14. Improving Endoscopic Adherence to Quality Metrics in Colonoscopy. (United States)

    Lu, Jonathan J; Decker, Christopher H; Connolly, Sean E


    Appropriate documentation of quality metrics in the endoscopy reports provides evidence that a thorough and complete examination was performed. The aim of our study was to assess compliance with 3 current quality metrics for colonoscopy defined by the American Society for Gastrointestinal Endoscopy. We retrospectively examined colonoscopy reports from 6 gastroenterologists at Ochsner Medical Center for appropriate documentation of the quality of the bowel preparation and photodocumentation of the appendiceal orifice and the ileocecal valve. A performance review and educational session then took place with each physician. Subsequent colonoscopy reports were evaluated to monitor for improvement. Bowel preparation documentation was high before and after the educational sessions (97.5% and 97.2%). Preeducation, the mean photodocumentation rate of the appendiceal orifice was 55% (range, 23%-84%). For the ileocecal valve, the documentation rate was 32.5% (range, 3%-73%). Posteducation, the mean appendiceal orifice labeling increased to an average of 91%, with a median change of 28.5% (P=0.0313). Documentation of the ileocecal valve improved to an average of 73%, a median change of 37.5% (P=0.0625). Although reassessment of subsequent reports will be necessary to evaluate the permanence of this intervention, our evidence suggests that educational sessions can improve the quality and accuracy of documentation of quality metrics during colonoscopies.

  15. Using mobile technology to improve healthcare service quality. (United States)

    Chao, Chia Chen; Jen, Wen Yuan; Li, Yu-Chuan; Chi, Y P; Chen, Chang-I; Feng, Chen Chjeh


    Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given.

  16. Project Hanford management contract quality improvement project management plan

    Energy Technology Data Exchange (ETDEWEB)

    ADAMS, D.E.


    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.

  17. An improved multi-exposure approach for high quality holographic femtosecond laser patterning

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Chenchu; Hu, Yanlei, E-mail:, E-mail:; Li, Jiawen, E-mail:, E-mail:; Lao, Zhaoxin; Ni, Jincheng; Chu, Jiaru; Huang, Wenhao; Wu, Dong [Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026 (China)


    High efficiency two photon polymerization through single exposure via spatial light modulator (SLM) has been used to decrease the fabrication time and rapidly realize various micro/nanostructures, but the surface quality remains a big problem due to the speckle noise of optical intensity distribution at the defocused plane. Here, a multi-exposure approach which used tens of computer generate holograms successively loaded on SLM is presented to significantly improve the optical uniformity without losing efficiency. By applying multi-exposure, we found that the uniformity at the defocused plane was increased from ∼0.02 to ∼0.6 according to our simulation. The fabricated two series of letters “HELLO” and “USTC” under single-and multi-exposure in our experiment also verified that the surface quality was greatly improved. Moreover, by this method, several kinds of beam splitters with high quality, e.g., 2 × 2, 5 × 5 Daman, and complex nonseperate 5 × 5, gratings were fabricated with both of high quality and short time (<1 min, 95% time-saving). This multi-exposure SLM-two-photon polymerization method showed the promising prospect in rapidly fabricating and integrating various binary optical devices and their systems.

  18. Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?

    Directory of Open Access Journals (Sweden)

    Groene Oliver


    Full Text Available Abstract Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more

  19. Improving Service Quality of Rusunawa Implementation Program in Kudus

    Directory of Open Access Journals (Sweden)

    Septiana Pancawati


    Full Text Available Development of housing and settlements are still faced the main problems as follows: the limited supply of homes, inadequate housing that is not supported by infrastructure, environmental facilities and public utilities, as well as the growing slums widespread. Government issues Rusunawa Implementation Program to overcome those problems. However some problems arose in its implementation, such as poor environmental condition, poor building quality, inadequate infrastructure and public services. The objectives of the research are to describe, to analyze, and to interpret things as follows: (1 The management of Rusunawa implementation program in order to improve service quality, (2 Improving service quality of Rusunawa program by the authorities. This research used qualitative method with descriptive approach. Information can be obtained byinterview stakeholders, field observations and documentation. From research findings, there are some records that should be highlighted as follows: (1 Rusunawa construction and its supervision influence the building quality. Low performance of those service providers will result in low building quality and vice versa. (2 Rent arrears are higher, an indication of dissatisfaction Rusunawa residents during they stay there. Keywords: Rusunawa, building condition, service quality

  20. Benchmarking and audit of breast units improves quality of care. (United States)

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


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


    Directory of Open Access Journals (Sweden)

    Andrés Fernández-Companioni


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

  2. Smart Homes to Improve the Quality of Life for All

    NARCIS (Netherlands)

    Aiello, Marco; Aloise, Fabio; Baldoni, Roberto; Cincotti, Febo; Guger, Christoph; Lazovik, Alexander; Mecella, Massimo; Pucci, Paolo; Rinsma, Johanna; Santucci, Giuseppe; Taglieri, Massimiliano


    A home is smart when, being aware of its own state and that of its users, is capable of controlling itself in order to support the user wishes and thus improving their quality of life. This holds both for users with special needs and for those with ordinary domestic needs. In this paper, we overview

  3. Software quality and process improvement in scientific simulation codes

    Energy Technology Data Exchange (ETDEWEB)

    Ambrosiano, J.; Webster, R. [Los Alamos National Lab., NM (United States)


    This report contains viewgraphs on the quest to develope better simulation code quality through process modeling and improvement. This study is based on the experience of the authors and interviews with ten subjects chosen from simulation code development teams at LANL. This study is descriptive rather than scientific.

  4. Training in data definitions improves quality of intensive care data

    NARCIS (Netherlands)

    Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF

    Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS)

  5. Voltage Quality Improvement in Islanded Microgrids Supplying Nonlinear Loads

    DEFF Research Database (Denmark)

    T. Dehghani, Mohammad; Vahedi, Abolfazl; Savaghebi, Mehdi


    The aim of this paper is to improve voltage quality at the terminals of distributed generators (DGs) in an islanded microgrid. To achieve this goal, it is proposed to include separate voltage and current control loops for the fundamental and harmonics frequencies. This way, it is not necessary...

  6. Fonio (Digitaria exilis) in West Africa: towards improving nutrient quality

    NARCIS (Netherlands)

    Koreissi, Y.


    Fonio (Digitaria exilis) in West Africa: Towards improving nutrient quality Abstract Hidden hunger affects a far greater percentage of the world’s population with iron and zinc deficiencies being the most common, particularly affecting women of reproductive

  7. In vitro chemical mutagenesis improves the turf quality of bahiagrass

    NARCIS (Netherlands)

    Kannan, Baskaran; Davila Olivas, N.H.; Lomba, Paula; Altpeter, Fredy


    Bahiagrass (Paspalum notatum Flugge) is a warm season, low-input, perennial turfgrass used for residential lawns and sides of road ways. The turf quality of bahiagrass is limited by its open growth habit, light green color, and prolific production of tall seedheads. Genetic improvement of the

  8. Physician education programme improves quality of diabetes care ...

    African Journals Online (AJOL)

    Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.

  9. Identifying targets for quality improvement in hospital antibiotic prescribing

    NARCIS (Netherlands)

    Spreuwel, P.C. van; Blok, H.; Langelaar, M.F.; Kullberg, B.J.; Mouton, J.W.; Natsch, S.S.


    OBJECTIVES: To audit antibiotic use in a university hospital and to identify targets for quality improvement in a setting with low antibiotic use and resistance rates. METHODOLOGY: A point-prevalence survey (PPS), using a patient-based audit tool for antibiotic use, was executed in the Radboud

  10. Improvement in quality testing of Braille printer output with Euclidean ...

    African Journals Online (AJOL)

    Radial lens distortion is modeled. Machine simulation and experimental results have also been discussed. Quality improvement can be achieved by giving a feedback after finding the distorted edges from image processing of the paper. This approach thus definitely helps the blind reader to avoid disturbances in reading the ...

  11. Improving NAVFAC's total quality management of construction drawings with CLIPS (United States)

    Antelman, Albert


    A diagnostic expert system to improve the quality of Naval Facilities Engineering Command (NAVFAC) construction drawings and specification is described. C Language Integrated Production System (CLIPS) and computer aided design layering standards are used in an expert system to check and coordinate construction drawings and specifications to eliminate errors and omissions.

  12. Quality improvement in primary care: ethical issues explored.

    NARCIS (Netherlands)

    Tapp, L.; Elwyn, G.; Edwards, A.; Holm, S.; Eriksson, T.


    PURPOSE: Quality improvement (QI) processes in family medicine are becoming increasingly complex. Their influence on the organisation of the sector and on the daily work processes is profound and increasing. The literature indicates that many ethical issues are arising from QI work. Therefore this

  13. The Application of Fishbone Diagram Analisis to Improve School Quality

    Directory of Open Access Journals (Sweden)

    Slameto Slameto


    Full Text Available The research problems are: 1 What steps are to take in a program development aimed at improving the quality of school using a fishbone analysis? 2 Is the program model using fishbone analysis  effective and efficient in meeting the school’s needs to improve its quality? This is research and developmental which comprises 3 phases, namely Preliminary Study, Model Development, and Evaluation/Model Testing. The qualitative data come from the input of management experts and the result of interviews/FGD with stakeholders. The quantitative data are obtained from the assessment of management experts on the product draft, the observation sheets for the field study on the standards of education, and the try out. Data analisis on the validation result uses a descriptive analysis technique. Data from the questionnaire are analyzed by descriptive statistical technique. The results are: 1 the developmental steps in the school quality improvement program by way of fish bone analysis have gone through 6 phases, 2 the research product using fish bone diagram has proved to be simple, applicable, important, controllable, as well as adaptable. Furthermore, it is communicable, so that it has been effective and efficient in meeting the school’s needs for making its educational quality improved.

  14. Quality improvement through clinical communities: eight lessons for practice. (United States)

    Aveling, Emma-Louise; Martin, Graham; Armstrong, Natalie; Banerjee, Jay; Dixon-Woods, Mary


    Approaches to quality improvement in healthcare based on clinical communities are founded in practitioner networks, peer influence and professional values. However, evidence for the value of this approach, and how to make it effective, is spread across multiple disciplines. The purpose of this paper is to review and synthesise relevant literature to provide practical lessons on how to use community-based approaches to improve quality. Diverse literatures were identified, analysed and synthesised in a manner that accounted for the heterogeneity of methods, models and contexts they covered. A number of overlapping but distinct community-based approaches can be identified in the literature, each suitable for different problems. The evidence for the effectiveness of these is mixed, but there is some agreement on the challenges that those adopting such approaches need to address, and how these can be surmounted. Key lessons include: the need for co-ordination and leadership alongside the lateral influence of peers; advantages of starting with a clear programme theory of change; the need for training and resources; dealing with conflict and marginalisation; fostering a sense of community; appropriate use of data in prompting behavioural change; the need for balance between "hard" and "soft" strategies; and the role of context. The paper brings together diverse literatures with important implications for community-based approaches to quality improvement, drawing on these to offer practical lessons for those engaged in improving healthcare quality in practice.

  15. Caring, learning, improving quality and doing research: Different ...

    African Journals Online (AJOL)

    The aim of this article is to describe the similarities between the consultation process, the quality improvement (QI) process, action- and problem-based learning and participatory action research (PAR). We feel this understanding adds value to our work in enabling personal development as practitioners, fostering teamwork ...

  16. Strategies to Improve the Quality of Health Care - Learning from ...

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

    Improving access to primary health care and the quality of services in Latin American countries is urgently needed to address high health inequities in the region. Lessons learned from two successful campaigns promoting maternal and child health in Chile and Uruguay could provide insights for further health reforms and ...

  17. Student Evaluations of Teaching: Improving Teaching Quality in Higher Education (United States)

    Hammonds, Frank; Mariano, Gina J.; Ammons, Gracie; Chambers, Sheridan


    Student evaluations of teaching (SET) are widely used in both North America and the UK as a means of documenting and improving teaching quality. This article discusses current research on SET administration and interpretation in both regions. Sections of the article are dedicated to various problems associated with SETs and how these may be…

  18. Physician education programme improves quality of diabetes care

    African Journals Online (AJOL)

    Physician education programme improves quality of diabetes care. D G van Zyl, P Rheeder. Background. Diabetes mellitus is a common chronic disease needing long-term glycaemic control to prevent complications. Guidelines are available for achievement of optimal glycaemic control, but these are seldom properly.

  19. Placement of riparian forest buffers to improve water quality (United States)

    Mark D. Tomer; Michael G. Dosskey; Michael R. Burkart; David E. James; Matthew J. Helmers; Dean E. Eisenhauer


    Riparian forest buffers can improve stream water quality, provided they intercept and remove contaminants from surface runoff and/or shallow groundwater. Soils, topography, hydrology, and surficial geology detemine the capability of forest buffers to intercept and treat these flows. This paper describes landscape analysis techniques for identifying and mapping...

  20. Improving the quality of endoscopic polypectomy by introducing a ...

    African Journals Online (AJOL)

    Ahmed Gado


    Apr 6, 2013 ... rates, patient comfort, detection rate of microscopic colitis and the yield of histological sampling in patients with suspected colorectal cancer by introducing a CQAP.8–10 In this study we report improving the quality of endoscopic polypectomy by introducing a CQAP. Cecal intubation, complete polyp.

  1. Controlled release fertilizer improves quality of container longleaf pine seedlings (United States)

    R. Kasten Dumroese; Jeff Parkhurst; James P. Barnett


    In an operational trial, increasing the amount of nitrogen (N) applied to container longleaf pine seedlings by incorporating controlled release fertilizer (CRF) into the media improved seedling growth and quality. Compared with control seedlings that received 40 mg N, seedlings receiving 66 mg N through CRF supplemented with liquid fertilizer had needles that were 4 in...

  2. A measurement instrument for spread of quality improvement in healthcare

    NARCIS (Netherlands)

    S.S. Slaghuis (Sarah); M.M.H. Strating (Mathilde); R.A. Bal (Roland); A.P. Nieboer (Anna)


    textabstractAbstract Objective. The aim of this study was to develop and test a measurement instrument for spread of quality improvement in healthcare. The instrument distinguishes: (i) spread of work practices and their results and (ii) spread practices and effectiveness. Relations between spread

  3. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen Jais; Møller, Morten H; Larsson, Heidi


    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...

  4. Leadership, Medication Administration, and Knowledge Retention: A Quality Improvement Project (United States)

    Treister, Pamela


    A leadership and quality improvement project was undertaken in order to assist undergraduate baccalaureate nursing students in knowledge retention for medication administration during their senior semester in nursing school. Specific changes in curriculum were implemented to assist these undergraduate baccalaureate nursing students at a suburban…

  5. Quality Improvement: Appropriate episiotomies in a district hospital

    African Journals Online (AJOL)

    A multidisciplinary team did a quality improvement project to reduce the number of episiotomies. The results of the project were positive: the episiotomy rate decreased from 66,2% to 25,3% and the episiotomy dehiscence rate dropped from 2,28% to 0,7%. This had a positive impact also on patient satisfaction and staff ...

  6. Quality Improvement: Appropriate episiotomies in a district hospital ...

    African Journals Online (AJOL)

    A multidisciplinary team did a quality improvement project to reduce the number of episiotomies. The results of the project were positive: the episiotomy rate decreased from 66,2% to 25,3% and the episiotomy dehiscence rate dropped from 2.28% to 0.7%. This had a positive impact also on patient satisfaction and staff ...

  7. Improving high quality, equitable maternal health services in Malawi ...

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

    Malawi has high rates of maternal mortality despite concerted efforts to increase the rate of births at health facilities. In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve the quality of health services. Similar initiatives have proven ...

  8. Nutritional quality and utilization of local and improved cowpea ...

    African Journals Online (AJOL)

    Cowpeas are grown for their leaves and grains both of which are used as relish or side dishes together with the staple food. Little information is available on the nutritional quality of local and improved cowpea varieties grown in Tanzania as well as the recipes in which they are ingredients. This study was done to investigate ...

  9. Improving Lecture Quality through Training in Public Speaking (United States)

    Mowbray, Robert; Perry, Laura B.


    Lecturing is a common instructional format but poor lecturing skills can detract from students' learning experiences and outcomes. As lecturing is essentially a form of public communication, training in public speaking may improve lecture quality. Twelve university lecturers in Malaysia participated in a six-week public speaking skills training…

  10. Improving the quality of asphalt coating with carbon nanomodifiers (United States)

    Larisa, Urkhanova; Nikolay, Shestakov; Aleksandr, Semenov; Natalya, Smirnyagina; Irina, Semenova


    This article deals with the possibility of modifying the binder by adding carbon nanomodifier to bitumen to improve the quality of asphalt. Addition of 0.05%-0.5% of nanomodifier significantly changes the properties of bitumen. Asphalt with this astringent has increased strength, heat resistance and shear resistance.

  11. Willingness to Pay for Improved Environmental Quality among ...

    African Journals Online (AJOL)

    Nekky Umera

    The t-values for beta co-efficients are also significant. Conclusion. This paper examined the willingness to pay for improved environmental quality among people living around the two functional landfills (Olushosun and Abule Egba) in Lagos metropolis using the contingent valuation method. Three important facts emerged ...

  12. Physician Perceptions of Performance Feedback in a Quality Improvement Activity. (United States)

    Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E


    Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.


    Directory of Open Access Journals (Sweden)

    Rodica HINCU


    Full Text Available The purpose of the present article is to identify the role of the investment in higher education as a way of quality of life improvement. In regard to this matter, the international practice uses some representative indexes which reflect the quality of life and/or education levels. Out of the multitude of these indexes, it was chosen the ones which involve the Republic of Moldova in their classifications. The Republic of Moldova is a low income country, where the human capital is the main resource which offers a competitive advantage. Also, it was analysed the public expenditures for the education. The amount and the efficiency of these investments influence the multiplication grade, and the impact on the education in the way that it ensures the quality of life improvement.

  14. Sustainability in the AAP Bronchiolitis Quality Improvement Project. (United States)

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


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

  15. Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality. (United States)

    Backman, Chantal; Vanderloo, Saskia; Forster, Alan John


    Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today's health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  16. Rapid assessment of quality of deer antler slices by using an electronic nose coupled with chemometric analysis

    Directory of Open Access Journals (Sweden)

    Guojie Xu

    Full Text Available Deer antler is a precious animal-sourced traditional Chinese medicine. We aimed to rapidly assess the quality of deer antler slices by electronic nose so that we can ensure medical safety. In this study, response intensity of the electronic nose was favorably optimized, and samples were well assessed by using an electronic nose based on LDA model. The results obtained herein suggested that electronic nose could be an effective method to rapidly assess the quality of deer antler slices, and could also be an important tool for categorization of complex aroma mixtures for the control of quality of drugs or food.

  17. Rapid assessment of antimicrobial resistance prevalence using a Lot Quality Assurance sampling approach. (United States)

    van Leth, Frank; den Heijer, Casper; Beerepoot, Mariëlle; Stobberingh, Ellen; Geerlings, Suzanne; Schultsz, Constance


    Increasing antimicrobial resistance (AMR) requires rapid surveillance tools, such as Lot Quality Assurance Sampling (LQAS). LQAS classifies AMR as high or low based on set parameters. We compared classifications with the underlying true AMR prevalence using data on 1335 Escherichia coli isolates from surveys of community-acquired urinary tract infection in women, by assessing operating curves, sensitivity and specificity. Sensitivity and specificity of any set of LQAS parameters was above 99% and between 79 and 90%, respectively. Operating curves showed high concordance of the LQAS classification with true AMR prevalence estimates. LQAS-based AMR surveillance is a feasible approach that provides timely and locally relevant estimates, and the necessary information to formulate and evaluate guidelines for empirical treatment.

  18. Myoinositol administration improves survival and reduces myelinolysis after rapid correction of chronic hyponatremia in rats. (United States)

    Silver, Stephen M; Schroeder, Barbara M; Sterns, Richard H; Rojiani, Amyn M


    When chronic hyponatremia is rapidly corrected, reaccumulation of brain organic osmolytes is delayed and brain cell shrinkage occurs, leading to the osmotic demyelination syndrome (ODS). We hypothesized that treatment with myoinositol, a major organic osmolyte, could prevent ODS. Severe hyponatremia was induced in adult male rats by administration of arginine vasopressin and intravenous infusion of dextrose and water. Sixty-four hours after induction of hyponatremia, all animals underwent rapid correction of hyponatremia with infusion of hypertonic saline over 4 hours, increasing the serum sodium from 105 to 135 mM; half of the animals were also given myoinositol intravenously beginning 20 minutes before correction and continuing for 28 hours. Serum sodium concentrations were equivalent in both groups at all time points. At 7 days, 7 of 8 animals that received myoinositol survived compared with one of the 9 control animals (p myoinositol. Animals were killed 96 hours after correction of hyponatremia was begun. Myoinositol-treated animals had significantly fewer demyelinating lesions than mannitol (2.25 +/- 1.1 versus 6.42 +/- 1.4 lesions/brain, p myoinositol administration improves survival and reduces myelinolysis after rapid correction of chronic hyponatremia in rats.

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

    Directory of Open Access Journals (Sweden)

    Tang Wai Mun


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

  20. Technical Note: Rapid prototyping of 3D grid arrays for image guided therapy quality assurance

    Energy Technology Data Exchange (ETDEWEB)

    Kittle, David; Holshouser, Barbara; Slater, James M.; Guenther, Bob D.; Pitsianis, Nikos P.; Pearlstein, Robert D. [Department of Radiation Medicine, Epilepsy Radiosurgery Research Program, Loma Linda University, Loma Linda, California 92354 (United States); Department of Radiology, Loma Linda University Medical Center, Loma Linda, California 92354 (United States); Department of Radiation Medicine, Loma Linda University, Loma Linda, California 92354 (United States); Department of Physics, Duke University, Durham, North Carolina 27708 (United States); Department of Electrical and Computer Engineering and Department of Computer Science, Duke University, Durham, North Carolina 27708 (United States); Department of Radiation Medicine, Epilepsy Radiosurgery Research Program, Loma Linda University, Loma Linda, California 92354 and Department of Surgery-Neurosurgery, Duke University and Medical Center, Durham, North Carolina 27710 (United States)


    Three dimensional grid phantoms offer a number of advantages for measuring imaging related spatial inaccuracies for image guided surgery and radiotherapy. The authors examined the use of rapid prototyping technology for directly fabricating 3D grid phantoms from CAD drawings. We tested three different fabrication process materials, photopolymer jet with acrylic resin (PJ/AR), selective laser sintering with polyamide (SLS/P), and fused deposition modeling with acrylonitrile butadiene styrene (FDM/ABS). The test objects consisted of rectangular arrays of control points formed by the intersections of posts and struts (2 mm rectangular cross section) and spaced 8 mm apart in the x, y, and z directions. The PJ/AR phantom expanded after immersion in water which resulted in permanent warping of the structure. The surface of the FDM/ABS grid exhibited a regular pattern of depressions and ridges from the extrusion process. SLS/P showed the best combination of build accuracy, surface finish, and stability. Based on these findings, a grid phantom for assessing machine-dependent and frame-induced MR spatial distortions was fabricated to be used for quality assurance in stereotactic neurosurgical and radiotherapy procedures. The spatial uniformity of the SLS/P grid control point array was determined by CT imaging (0.6x0.6x0.625 mm{sup 3} resolution) and found suitable for the application, with over 97.5% of the control points located within 0.3 mm of the position specified in CAD drawing and none of the points off by more than 0.4 mm. Rapid prototyping is a flexible and cost effective alternative for development of customized grid phantoms for medical physics quality assurance.

  1. The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes

    NARCIS (Netherlands)

    Winters, S.; Kool, R. B.; Klazinga, N. S.; Huijsman, R.


    To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate

  2. The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes

    NARCIS (Netherlands)

    Winters, S.; Kool, R.B.; Klazinga, N.S.; Huijsman, R.


    OBJECTIVE: To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. DESIGN: A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships

  3. Improving the quality of patient handover on a surgical ward. (United States)

    Bradley, Alison


    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  4. Quality improvement in basic histotechnology: the lean approach. (United States)

    Clark, David


    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.

  5. Improving the quality of nursing documentation: An action research project

    Directory of Open Access Journals (Sweden)

    Elisha M. Okaisu


    Full Text Available Background: Documentation is an important function of professional nursing practise. In spite of numerous improvement efforts globally, inadequate documentation continues to be reported as nurse authors investigate barriers and challenges. Objectives: The project aimed to improve nurses’ documentation of their patient assessments at the CURE Children’s Hospital of Uganda in order to enhance the quality of nursing practise. Method: An action research methodology, using repeated cycles of planning, intervention, reflection and modification, was used to establish best practise approaches in this context for improving nurses’ efficacy in documenting assessments in the patient record. The researchers gathered data from chart audits, literature reviews and key informant interviews. Through analysis and critical reflection, these data informed three cycles of systems and practise modifications to improve the quality of documentation. Results: The initial cycle revealed that staff training alone was insufficient to achievethe project goal. To achieve improved documentation, broader changes were necessary, including building a critical mass of competent staff, redesigned orientation and continuing education, documentation form redesign, changes in nurse skill mix, and continuous leadership support. Conclusion: Improving nursing documentation involved complex challenges in this setting and demanded multiple approaches. Evidence-based practise was the foundation of changes in systems required to produce visible improvement in practise. The involved role of leadership in these efforts was very important.

  6. Is your client's back pain "rapidly reversible"? Improving low back care at its foundation. (United States)

    Donelson, Ronald


    To convey a valuable and greatly misunderstood paradigm for evaluating and treating low back pain (LBP) and its extensive scientific evidence. Low back pain is a highly prevalent and very expensive health dilemma. But by using a paradigm called Mechanical Diagnosis and Therapy (a.k.a. McKenzie methods), it is now possible to identify a very large LBP subgroup whose pain is rapidly reversible, meaning that it can often be eliminated quickly, with return to full function using a single, patient-specific direction of simple, yet precise, end-range low back exercises and some posture modifications. This interesting subgroup includes patients with both acute and chronic LBP as well as both LBP-only and sciatica with neural deficits. This special form of clinical assessment can detect which patients are in this large, rapidly reversible subgroup and which ones are not. Of the numerous studies targeting Mechanical Diagnosis and Therapy (MDT), three have focused on patients whose persisting pain had led to recommendations of disc surgery where 50% were then found to still have a rapidly reversible disc problem with high rates of nonsurgical rapid recovery. If patients are never assessed in this way, this reversibility remains undiscovered and these patients commonly undergo potentially unnecessary surgery. Armed with knowledge of this subgroup, how to identify it, the considerable supportive scientific evidence and strongly beneficial implications of utilizing this MDT paradigm, case managers are positioned to have an immensely positive impact on the care of LBP. Tremendous cost savings and greatly improved clinical outcomes are available by utilizing this form of evidence-based MDT care.

  7. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review

    Directory of Open Access Journals (Sweden)

    Kouyoumdjian Fiona


    Full Text Available Abstract Background Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. Methods A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. Results Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations

  8. Acanthamoeba keratitis: improving the Scottish diagnostic service for the rapid molecular detection of Acanthamoeba species. (United States)

    Alexander, Claire Low; Coyne, Michael; Jones, Brian; Anijeet, Deepa


    Acanthamoeba species are responsible for causing the potentially sight-threatening condition, Acanthamoeba keratitis, which is commonly associated with contact lens use. In this report, we highlight the challenges faced using conventional laboratory identification methods to identify this often under-reported pathogen, and discuss the reasons for introducing the first national service in Scotland for the rapid and sensitive molecular identification of Acanthamoeba species. By comparing culture and molecular testing data from a total of 63 patients (n = 80 samples) throughout Scotland presenting with ocular eye disease, we describe the improvement in detection rates where an additional four positive cases were identified using a molecular assay versus culture. The testing of a further ten patients by confocal imaging is also presented. This report emphasizes the importance of continuing to improve clinical laboratory services to ensure a prompt, correct diagnosis and better prognosis, in addition to raising awareness of this potentially debilitating opportunistic pathogen.

  9. Rapid changes in brain structure predict improvements induced by perceptual learning. (United States)

    Ditye, Thomas; Kanai, Ryota; Bahrami, Bahador; Muggleton, Neil G; Rees, Geraint; Walsh, Vincent


    Practice-dependent changes in brain structure can occur in task relevant brain regions as a result of extensive training in complex motor tasks and long-term cognitive training but little is known about the impact of visual perceptual learning on brain structure. Here we studied the effect of five days of visual perceptual learning in a motion-color conjunction search task using anatomical MRI. We found rapid changes in gray matter volume in the right posterior superior temporal sulcus, an area sensitive to coherently moving stimuli, that predicted the degree to which an individual's performance improved with training. Furthermore, behavioral improvements were also predicted by volumetric changes in an extended white matter region underlying the visual cortex. These findings point towards quick and efficient plastic neural mechanisms that enable the visual brain to deal effectively with changing environmental demands. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes (United States)

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


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

  11. Improving best-phase image quality in cardiac CT by motion correction with MAM optimization. (United States)

    Rohkohl, Christopher; Bruder, Herbert; Stierstorfer, Karl; Flohr, Thomas


    100% and of the RMSD value by 81%. The corresponding maximum improvements for the registration-based approach were 20% and 40%. In phases with very rapid motion the registration-based algorithm obtained better image quality, while the image quality of the MAM algorithm was superior in phases with less motion. The image quality improvement of the MAM optimization was visually confirmed for the different clinical cases. The proposed method allows a software-based best-phase image quality improvement in coronary CT angiography. A short scan data interval at the target heart phase is sufficient, no additional scan data in other cardiac phases are required. The algorithm is therefore directly applicable to any standard cardiac CT acquisition protocol.

  12. The role of quality control circles in sustained improvement of medical quality. (United States)

    Wang, Lin-Run; Wang, Yang; Lou, Yan; Li, Ying; Zhang, Xing-Guo


    We used quality control circles (QCC) followed by the PDCA Deming cycle and analyzed the application of QCC to the sustained improvement of a medical institution in Zhejiang province. Analyses of the tangible and intangible achievements of QCC revealed that the achievement indices for reductions in internal errors, reductions in costs, improvements in the degree of patient satisfaction, improvements in work quality, and improvements in economic performance were 109.84% ± 16.47%, 135.04% ± 50.33%, 126.26% ± 53.69%, 100.58% ± 22.83%, and 104.07% ± 5.45%, respectively. The improvements in these areas were 61.12% ± 13.2%, 60.47% ± 28.91%, 34.41% ± 22.96%, 49.22% ± 25.39%, and 73.70% ± 5.24%, respectively. The intangible achievements were reflected as follows: 5% of QCC members showed an activity growth value of 1-2 points, 83% 1-2 points, 12% more than 2 points. As a result, QCC activity showed prominent results in fostering long-lasting improvement in the quality of medical institutions in terms of both tangible and intangible factors. In short, QCC can be used as an effective tool to improve medical quality.

  13. Interventions to improve water quality for preventing diarrhoea. (United States)

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


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

  14. Improving water quality in China: Environmental investment pays dividends. (United States)

    Zhou, Yongqiang; Ma, Jianrong; Zhang, Yunlin; Qin, Boqiang; Jeppesen, Erik; Shi, Kun; Brookes, Justin D; Spencer, Robert G M; Zhu, Guangwei; Gao, Guang


    This study highlights how Chinese economic development detrimentally impacted water quality in recent decades and how this has been improved by enormous investment in environmental remediation funded by the Chinese government. To our knowledge, this study is the first to describe the variability of surface water quality in inland waters in China, the affecting drivers behind the changes, and how the government-financed conservation actions have impacted water quality. Water quality was found to be poorest in the North and the Northeast China Plain where there is greater coverage of developed land (cities + cropland), a higher gross domestic product (GDP), and higher population density. There are significant positive relationships between the concentration of the annual mean chemical oxygen demand (COD) and the percentage of developed land use (cities + cropland), GDP, and population density in the individual watersheds (p investments in environmental restoration and reforestation, the water quality of Chinese inland waters has improved markedly, which is particularly evident from the significant and exponentially decreasing GDP-normalized COD and ammonium (NH 4 + -N) concentrations. It is evident that the increasing GDP in China over the past decade did not occur at the continued expense of its inland water ecosystems. This offers hope for the future, also for other industrializing countries, that with appropriate environmental investments a high GDP can be reached and maintained, while simultaneously preserving inland aquatic ecosystems, particularly through management of sewage discharge. Copyright © 2017 Elsevier Ltd. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Zora Arsovski


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

  16. Areas for quality improvements in heart failure care: quality of care from the family members' perspective. (United States)

    Ängerud, Karin Hellström; Boman, Kurt; Brännström, Margareta


    The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care. To describe family members' perceptions of quality of HF care in an outpatient setting. A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV. Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members. Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care. © 2017 Nordic College of Caring Science.

  17. The 'Alternative Quality Contract,' based on a global budget, lowered medical spending and improved quality. (United States)

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E


    Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups, more so in the second year than in the first. Overall, participation in the contract over two years led to savings of 2.8 percent (1.9 percent in year 1 and 3.3 percent in year 2) compared to spending in nonparticipating groups. Savings were accounted for by lower prices achieved through shifting procedures, imaging, and tests to facilities with lower fees, as well as reduced utilization among some groups. Quality of care also improved compared to control organizations, with chronic care management, adult preventive care, and pediatric care within the contracting groups improving more in year 2 than in year 1. These results suggest that global budgets with pay-for-performance can begin to slow underlying growth in medical spending while improving quality of care.

  18. Breast cancer practice guidelines: evaluation and quality improvement. (United States)

    Edge, S B


    The utility of practice guidelines in breast cancer management remains unproved. This paper examines the scope and goals of published guidelines and their utility in the process of breast cancer treatment quality improvement. Although existing breast cancer guidelines vary widely in scope and intent, they provide a framework for meaningful quality-of-care evaluation. Among the few comprehensive breast cancer guideline programs are those developed by the Ontario Cancer Treatment Practice Guidelines Initiative, the Revlon/UCLA Breast Center, the Association of Community Cancer Centers (ACCC), the Society of Surgical Oncology (SSO), and the National Comprehensive Cancer Network (NCCN). Ultimately, guidelines will prove useful only if they are utilized as part of a comprehensive program to improve quality, cost-effectiveness, and outcomes. To accomplish this, they must include mechanisms for revision and evaluation. The evaluation of guideline utility in quality improvement, particularly in breast cancer care, is a complex long-term process, which should include input from practitioners, institutions, payors, and government.


    Directory of Open Access Journals (Sweden)

    J. BULLA


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

  20. Nutritional quality of Australian breakfast cereals. Are they improving? (United States)

    Louie, Jimmy Chun Yu; Dunford, Elizabeth K; Walker, Karen Z; Gill, Timothy P


    The nutritional quality of Australian breakfast cereals is not systematically monitored despite the importance of breakfast for general health. We examined whether the nutritional quality of Australian breakfast cereals has improved between 2004 and 2010, and whether any change could be detected after the introduction of Daily Intake Guide (DIG) front-of-pack labelling. Supermarket surveys were conducted in 2004 and 2010 using the same methodology to collect information from the nutrition information panels of Australian breakfast cereals and the nutrient content of cereals was compared by year. Breakfast cereals with and without DIG labelling in 2010 were also compared. Nutritional quality was assessed using UK Traffic Light criteria. No significant difference was detected in nutritional composition of breakfast cereals between 2004 and 2010. There was no notable improvement in nutritional composition of breakfast cereals marketed as the same product in both years. Overall there has been little improvement in the nutritional quality of Australian breakfast cereals in the 6 year period. A large proportion of Australian breakfast cereals were considered high sugar. In conclusion, the introduction of DIG labelling does not appear to have promoted product reformulation, and breakfast cereals carrying DIG labels were not consistently healthier. Copyright © 2012 Elsevier Ltd. All rights reserved.


    Directory of Open Access Journals (Sweden)

    BULLA, J.


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

  2. Improving the quality of health care: what's taking so long? (United States)

    Chassin, Mark R


    Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices.

  3. Quality and productivity improvement program (PPKP) from alumni perspective (United States)

    Ruza, Nadiah; Mustafa, Zainol


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

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

    Directory of Open Access Journals (Sweden)

    Asgar Aghaei Hashjin

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

  5. A continuous quality improvement pilot study: impact on nutritional care quality. (United States)

    Simmons, Sandra F; Schnelle, John F


    All long-term care facilities are supposed to engage in quality improvement activities in an effort to improve care quality. The purpose of this pilot study was to teach long-term care staff how to conduct continuous quality improvement (CQI) related to nutritional care. Research staff conducted CQI training in one 48-bed pilot site with designated staff members. Supervisory staff were taught a standardized direct observational protocol, which was implemented weekly by both facility and research staff, to monitor defined nutritional care processes under the control of direct care staff. In addition, direct care staff received feedback on a weekly basis about care process implementation. Following initial training and 12 weeks of CQI implementation, there were improvements in all 5 nutritional care processes related to the adequacy and quality of daily feeding assistance care provision according to both facility and research staff data. Weekly CQI implementation required approximately 1 hour of supervisory staff time and less than 15 minutes of direct care staff time to receive feedback. Both initial training and weekly CQI implementation were effective and required less than 2 hours of total staff time per week. Long-term care staff in this pilot site were able to improve nutritional care quality using a standardized direct observational protocol to guide CQI activities.

  6. Improving meat quality through cattle feed enriched with mate extract

    DEFF Research Database (Denmark)

    de Zawadzki, Andressa

    to have significant effects on the averaged concentration of polar metabolites that are of relevance for meat quality. The major metabolic differences between control group (no supplements) and broilers fed different levels of -acids were achieved using 30 ppm of supplement. As determined by EPR spin...... proteins from animals fed with hops -acids showed to be less susceptible to oxidation when compared to control group.Mate and hops -acids extracts demonstrated to be promising additives to feedlot for, respectively, cattle and broilers and can improve the oxidative stability, nutritive value, sensory...... quality, and consumer acceptance of meat....

  7. Means for improving quality of inert gas in refineries

    Energy Technology Data Exchange (ETDEWEB)

    Aspel, N.B.; Ryzhikova, T.L.


    Reconstruction measures proposed for existing inert gas units built in the U.S.S.R. during 1957-60 to bring the gas quality up to the level required for use in modern reformers and hydrotreaters involve chiefly supplying clean LPG or natural gas to the furnaces, better purification, and improved drying. The capital and operating costs involved in such reconstructions are given; and current requirements for the quality of inert gas used in regenerating catalytic reforming catalysts, in system purging and catalyt regeneration in hydrotreating gasoline, kerosine, and diesel distillates, and in isomerization of a pentane/hexane cut, etc. are tabulated.

  8. Power Quality Improvements in Wind Diesel Power Generation System

    Directory of Open Access Journals (Sweden)

    Omar Feddaoui


    Full Text Available Generation of electricity using diesel is costly for small remote isolated communities. At remote location electricity generation from renewable energy such as wind can help reduce the overall operating costs by reducing the fuel costs. However, the penetration of wind power into small diesel-based grids is limited because of its effect on power quality and reliability. This paper focuses on the combination of Wind Turbine and Diesel Generator systems for sustained power generation, to improve the power quality of wind generation system. The performances of the optimal control structure are assessed and discussed by means of a set of simulations.

  9. ISO 15189:2003--quality management, evaluation and continual improvement. (United States)

    Burnett, David


    The requirements of ISO 15189:2003 are discussed in the context of a process- and outcome-based quality management model in which the user's needs are the central focus. The requirements of ISO 15189:2003 are examined in terms of organisation and a quality management system, stressing the importance of evidence, document control, and control of records and clinical material. Examples are provided from the areas of resource management, and pre-examination, examination and post-examination processes. In the final section the importance of evaluation and continual improvement is presented in relation to internal audit and external assessment, non-conformity, corrective and preventative action and management review.

  10. The maturing of the quality improvement paradigm in the SEL (United States)

    Basili, Victor R.


    The Software Engineering Laboratory uses a paradigm for improving the software process and product, called the quality improvement paradigm. This paradigm has evolved over the past 18 years, along with our software development processes and product. Since 1976, when we first began the SEL, we have learned a great deal about improving the software process and product, making a great many mistakes along the way. Quality improvement paradigm, as it is currently defined, can be broken up into six steps: characterize the current project and its environment with respect to the appropriate models and metrics; set the quantifiable goals for successful project performance and improvement; choose the appropriate process model and supporting methods and tools for this project; execute the processes, construct the products, and collect, validate, and analyze the data to provide real-time feedback for corrective action; analyze the data to evaluate the current practices, determine problems, record findings, and make recommendations for future project improvements; and package the experience gained in the form of updated and refined models and other forms of structured knowledge gained from this and prior projects and save it in an experience base to be reused on future projects.

  11. Multidisciplinary intensive rehabilitation treatment improves sleep quality in Parkinson's disease. (United States)

    Frazzitta, Giuseppe; Maestri, Roberto; Ferrazzoli, Davide; Riboldazzi, Giulio; Bera, Rossana; Fontanesi, Cecilia; Rossi, Roger P; Pezzoli, Gianni; Ghilardi, Maria F


    Sleep disturbances are among the most common non-motor symptoms of Parkinson's disease (PD), greatly interfering with daily activities and diminishing life quality. Pharmacological treatments have not been satisfactory because of side effects and interactions with anti-parkinsonian drugs. While studies have shown that regular exercise improves sleep quality in normal aging, there is no definitive evidence in PD. In a retrospective study, we determined whether an intense physical and multidisciplinary exercise program improves sleep quality in a large group of patients with PD. We analyzed the scores of PD Sleep Scale (PDSS), which was administered twice, 28 days apart, to two groups of patients with PD of comparable age, gender, disease duration and pharmacological treatment. The control group (49 patients) did not receive rehabilitation, The treated group (89 patients) underwent a 28-day multidisciplinary intensive rehabilitation program (three one-hour daily sessions comprising cardiovascular warm-up, relaxation, muscle-stretching, balance and gait training, occupational therapy to improve daily living activities). At enrolment, control and treated groups had similar UPDRS and PDSS scores. At re-test, 28 days later, UPDRS and total PDSS scores improved in the treated (p intensive rehabilitation treatment may have a positive impact on many aspects of sleep in PD.

  12. Automation of information decision support to improve e-learning resources quality

    Directory of Open Access Journals (Sweden)

    A.L. Danchenko


    Full Text Available Purpose. In conditions of active development of e-learning the high quality of e-learning resources is very important. Providing the high quality of e-learning resources in situation with mass higher education and rapid obsolescence of information requires the automation of information decision support for improving the quality of e-learning resources by development of decision support system. Methodology. The problem is solved by methods of artificial intelligence. The knowledge base of information structure of decision support system that is based on frame model of knowledge representation and inference production rules are developed. Findings. According to the results of the analysis of life cycle processes and requirements to the e-learning resources quality the information model of the structure of the knowledge base of the decision support system, the inference rules for the automatically generating of recommendations and the software implementation are developed. Practical value. It is established that the basic requirements for quality are performance, validity, reliability and manufacturability. It is shown that the using of a software implementation of decision support system for researched courses gives a growth of the quality according to the complex quality criteria. The information structure of a knowledge base system to support decision-making and rules of inference can be used by methodologists and content developers of learning systems.

  13. Learning from large-scale quality improvement through comparisons. (United States)

    Ovretveit, John; Klazinga, Niek


    To discover lessons from 10 national health and social care quality programmes in the Netherlands. A mixed-methods comparison using a 'quantitative summarization of evidence for systematic comparison'. Each research team assessed whether there was evidence from their evaluation to support or refute 17 hypotheses about successful implementation of quality programmes. The programme managers carried out a similar assessment. Their assessments were represented as scores which made it possible to carry out a cross-case analysis to assess factors affecting the success of large-scale quality programmes. The researchers who evaluated each of the programmes and the leaders who organized each programme. Health and social care service organizations and national organization, which led the quality improvement programmes. This study did not make an intervention but compared experiences and evaluations of interventions carried out by national organization to health and social care service organizations to help these organizations to improve their services. The success of the national programmes, and the learning achieved by the programme organizations and care service delivery organizations. The method provided a way to summarize and compare complex information. Common factors which appeared to influence success in implementation included understanding of political processes, leader's influencing skills, as well as technical skills to manage projects and apply improvement and change methods. Others could use a similar method to make a fast, broad level, but systematic comparison across reports of improvements or programmes. Descriptions, and then comparisons of the programmes, reveal common factors which appeared to influence success in implementation. There were groups of factors which appeared to be more important for the success of certain types of programmes. It is possible that these factors may also be important for the success of large-scale improvement programmes in

  14. Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta. (United States)

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


    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

  15. Modified preparation and rapid quality control test for technetium-99m-tetrofosmin. (United States)

    Patel, M; Owunwanne, A; Tuli, M; al-Za'abi, K; al-Mohannadi, S; Sa'ad, M; Jahan, S; Jacob, A; al-Bunny, A


    The objectives of this study were to: modify the preparation of 99mTc-tetrofosmin by using twice the amount of 99mTcO4- recommended by the manufacturer; evaluate the use of miniaturized rapid paper chromatography (MRPC) for quality control (QC) testing; and determine the in vitro stability of the modified preparation using MRPC. Two preparations of 99mTc-tetrofosmin were made: one with 4.4-8.8 GBq (120-240 mCi) and the other with 13.9-17.6 GBq (380-480 mCi) 99mTcO4-, referred to as regular and modified preparations, respectively. Routine QC tests were performed using MRPC and instant thin-layer chromatography/silica-gel (ITLC/SG) systems. The preparations were injected into 58 patients. Planar and SPECT images of stress and rest studies were obtained. The technical quality of the SPECT images was graded visually by four observers. Heart-to-lung and heart-to-background ratios were calculated from the planar images. The QC testing procedure took 4.18 +/- 0.15 min with MRPC and 54 +/- 5.3 min with ITLC/SG systems. The percent labeling efficiency, as determined by both techniques, ranged from 95.6 +/- 1.6 to 97.2% +/- 0.8%. Both preparations were stable up to 6 hr after reconstitution. There was no difference between the cardiac-to-lung and cardiac-to-background ratios of the two preparations. The results indicate that MRPC is a faster and effective chromatographic technique for routine QC testing of 99mTc-tetrofosmin. Doubling the amount of 99mTcO4- used in preparing 99mTc-tetrofosmin did not affect its in vitro stability, its efficacious use in patients or the technical quality of the images.


    Energy Technology Data Exchange (ETDEWEB)

    Nelson, E.


    The Savannah River National Laboratory implemented a constructed wetland treatment system (CWTS) in 2000 to treat industrial discharge and stormwater from the Laboratory area. The industrial discharge volume is 3,030 m{sup 3} per day with elevated toxicity and metals (copper, zinc and mercury). The CWTS was identified as the best treatment option based on performance, capital and continuing cost, and schedule. A key factor for this natural system approach was the long-term binding capacity of heavy metals (especially copper, lead, and zinc) in the organic matter and sediments. The design required that the wetland treat the average daily discharge volume and be able to handle 83,280 m{sup 3} of stormwater runoff in a 24 hour period. The design allowed all water flow within the system to be driven entirely by gravity. The CWTS for A-01 outfall is composed of eight one-acre wetland cells connected in pairs and planted with giant bulrush to provide continuous organic matter input to the system. The retention basin was designed to hold stormwater flow and to allow controlled discharge to the wetland. The system became operational in October of 2000 and is the first wetland treatment system permitted by South Carolina DHEC for removal of metals. Because of the exceptional performance of the A-01 CWTS, the same strategy was used to improve water quality of the H-02 outfall that receives discharge and stormwater from the Tritium Area of SRS. The primary contaminants in this outfall were also copper and zinc. The design for this second system required that the wetland treat the average discharge volume of 415 m{sup 3} per day, and be able to handle 9,690 m{sup 3} of stormwater runoff in a 24 hour period. This allowed the building of a system much smaller than the A-01 CWTS. The system became operational in July 2007. Metal removal has been excellent since water flow through the treatment systems began, and performance improved with the maturation of the vegetation during

  17. Accounting for quality: on the relationship between accounting and quality improvement in healthcare. (United States)

    Pflueger, Dane


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

  18. Improved Savitzky-Golay-method-based fluorescence subtraction algorithm for rapid recovery of Raman spectra. (United States)

    Chen, Kun; Zhang, Hongyuan; Wei, Haoyun; Li, Yan


    In this paper, we propose an improved subtraction algorithm for rapid recovery of Raman spectra that can substantially reduce the computation time. This algorithm is based on an improved Savitzky-Golay (SG) iterative smoothing method, which involves two key novel approaches: (a) the use of the Gauss-Seidel method and (b) the introduction of a relaxation factor into the iterative procedure. By applying a novel successive relaxation (SG-SR) iterative method to the relaxation factor, additional improvement in the convergence speed over the standard Savitzky-Golay procedure is realized. The proposed improved algorithm (the RIA-SG-SR algorithm), which uses SG-SR-based iteration instead of Savitzky-Golay iteration, has been optimized and validated with a mathematically simulated Raman spectrum, as well as experimentally measured Raman spectra from non-biological and biological samples. The method results in a significant reduction in computing cost while yielding consistent rejection of fluorescence and noise for spectra with low signal-to-fluorescence ratios and varied baselines. In the simulation, RIA-SG-SR achieved 1 order of magnitude improvement in iteration number and 2 orders of magnitude improvement in computation time compared with the range-independent background-subtraction algorithm (RIA). Furthermore the computation time of the experimentally measured raw Raman spectrum processing from skin tissue decreased from 6.72 to 0.094 s. In general, the processing of the SG-SR method can be conducted within dozens of milliseconds, which can provide a real-time procedure in practical situations.

  19. Image quality improvement of polygon computer generated holography. (United States)

    Pang, Xiao-Ning; Chen, Ding-Chen; Ding, Yi-Cong; Chen, Yi-Gui; Jiang, Shao-Ji; Dong, Jian-Wen


    Quality of holographic reconstruction image is seriously affected by undesirable messy fringes in polygon-based computer generated holography. Here, several methods have been proposed to improve the image quality, including a modified encoding method based on spatial-domain Fraunhofer diffraction and a specific LED light source. Fast Fourier transform is applied to the basic element of polygon and fringe-invisible reconstruction is achieved after introducing initial random phase. Furthermore, we find that the image with satisfactory fidelity and sharp edge can be reconstructed by either a LED with moderate coherence level or a modulator with small pixel pitch. Satisfactory image quality without obvious speckle noise is observed under the illumination of bandpass-filter-aided LED. The experimental results are consistent well with the correlation analysis on the acceptable viewing angle and the coherence length of the light source.

  20. Patient Safety and Quality Improvement Education in Otolaryngology Residency

    Directory of Open Access Journals (Sweden)

    Nausheen Jamal MD


    Full Text Available Since publication of the Institute of Medicine’s report To Err Is Human in 1999, patient safety and health care quality have become hot topics in the parlance of modern medical care. The Accreditation Council for Graduate Medical Education now requires integration of these topics into resident education, with evidence of trainee involvement in Patient Safety and Quality Improvement (PSQI projects. Research in other disciplines indicates that interactive, experiential learning leads to the highest quality PSQI education. Otolaryngology as a field has been slow to adopt these changes into its residency curricula due to competing educational demands and lack of faculty expertise. The author reports preliminary experience with integration of an online module-based curriculum that addresses both of these issues.

  1. Leveraging Health Information Technology to Improve Quality in Federal Healthcare. (United States)

    Weigel, Fred K; Switaj, Timothy L; Hamilton, Jessica


    Healthcare delivery in America is extremely complex because it is comprised of a fragmented and nonsystematic mix of stakeholders, components, and processes. Within the US healthcare structure, the federal healthcare system is poised to lead American medicine in leveraging health information technology to improve the quality of healthcare. We posit that through developing, adopting, and refining health information technology, the federal healthcare system has the potential to transform federal healthcare quality by managing the complexities associated with healthcare delivery. Although federal mandates have spurred the widespread use of electronic health records, other beneficial technologies have yet to be adopted in federal healthcare settings. The use of health information technology is fundamental in providing the highest quality, safest healthcare possible. In addition, health information technology is valuable in achieving the Agency for Healthcare Research and Quality's implementation goals. We conducted a comprehensive literature search using the Google Scholar, PubMed, and Cochrane databases to identify an initial list of articles. Through a thorough review of the titles and abstracts, we identified 42 articles as having relevance to health information technology and quality. Through our exclusion criteria of currency of the article, citation frequency, applicability to the federal health system, and quality of research supporting conclusions, we refined the list to 11 references from which we performed our analysis. The literature shows that the use of computerized physician order entry has significantly increased accurate medication dosage and decreased medication errors. The use of clinical decision support systems have significantly increased physician adherence to guidelines, although there is little evidence that indicates any significant correlation to patient outcomes. Research shows that interoperability and usability are continuing challenges for

  2. Development of a Quality Improvement Curriculum in Physician Assistant Studies. (United States)

    Kindratt, Tiffany B; Orcutt, Venetia L


    The purpose of this project was to develop and evaluate a curriculum for physician assistant (PA) students addressing knowledge, skills, and attitudes (KSA) toward quality improvement (QI). Students (N = 77) completed a pretest rating their KSA. A curriculum was developed to improve KSA among didactic and clinical students. Two department-wide QI projects were developed for student participation. Students completed a posttest after completing curriculum components and changes in KSA had been measured. Postcurriculum implementation, QI knowledge, and skills increased significantly in most areas. Large improvements were seen in knowledge of Plan, Do, Study, Act models and life cycles of QI projects (p curriculum model (1) was effective at improving students' QI knowledge and skills; (2) allowed students to participate in community-based QI projects; and (3) can be used by other PA programs looking to enhance their QI curriculum.

  3. Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement. (United States)

    Ovretveit, John; Mittman, Brian; Rubenstein, Lisa; Ganz, David A


    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.

  4. Model-driven approach to data collection and reporting for quality improvement. (United States)

    Curcin, Vasa; Woodcock, Thomas; Poots, Alan J; Majeed, Azeem; Bell, Derek


    Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the data required for local improvement initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or not routinely collected. Furthermore, improvement teams are often restricted in time and funding thus requiring inexpensive and rapid tools to support their work. Hence, the informatics challenge in healthcare local improvement initiatives consists of providing a mechanism for rapid modelling of the local domain by non-informatics experts, including performance metric definitions, and grounded in established improvement techniques. We investigate the feasibility of a model-driven software approach to address this challenge, whereby an improvement model designed by a team is used to automatically generate required electronic data collection instruments and reporting tools. To that goal, we have designed a generic Improvement Data Model (IDM) to capture the data items and quality measures relevant to the project, and constructed Web Improvement Support in Healthcare (WISH), a prototype tool that takes user-generated IDM models and creates a data schema, data collection web interfaces, and a set of live reports, based on Statistical Process Control (SPC) for use by improvement teams. The software has been successfully used in over 50 improvement projects, with more than 700 users. We present in detail the experiences of one of those initiatives, Chronic Obstructive Pulmonary Disease project in Northwest London hospitals. The specific challenges of improvement in healthcare are analysed and the benefits and limitations of the approach are discussed. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  5. An improved design of water-soluble propofol prodrugs characterized by rapid onset of action. (United States)

    Lang, Bing-Chen; Yang, Jun; Wang, Yu; Luo, Yun; Kang, Yi; Liu, Jin; Zhang, Wen-Sheng


    Phosphate ester prodrugs of propofol (fospropofol, HX0969W) were designed to avoid the unsatisfactory water solubility of the parent drug. However, in previous clinical trials, there were reported prodrug side effects such as paresthesia and pruritus. The accumulation of a phosphate ester component was found to be the main culprit. To exclude this potential risk, we designed 2 amino acid propofol prodrugs (HX0969-Gly-F3, HX0969-Ala-HCl) based on the lead compound (HX0969) by introducing the amino acid group into the structures of the propofol prodrugs. We hypothesized that the improved propofol prodrugs could not only eliminate those adverse effects but also retain their rapid action and good water solubility. The lead compound HX0969 was synthesized by the sodium borohydride-iodine system. HX0969W, HX0969-Gly-F3, and HX0969-Ala-HCl were synthesized from HX0969. The solubility of fospropofol, HX0969W, HX0969-Gly-F3, and HX0969-Ala-HCl in normal saline was tested. The bioconversions from those prodrugs to propofol in different physiological media (rat plasma, rhesus monkey plasma, and rat hepatic microsomes) were determined in vitro. An in vivo test in the rats was performed to measure the 50% effective dose (ED50) of the 4 propofol prodrugs. Their action onset time and duration time were also measured after their equipotent doses were given. (1) The water solubility of fospropofol, HX0969W, HX0969-Gly-F3, and HX0969-Ala-HCl was 461.46 ± 26.40 mg/mL, 189.45 ± 5.02 mg/mL, 49.88 ± 0.58 mg/mL, and 245.99 ± 4.83 mg/mL, respectively; (2) The hydrolysis tests in both the rat plasma and the rhesus monkey plasma revealed that the 2 amino acid prodrugs released propofol to a greater extent at a more rapid rate than the 2 phosphate prodrugs during the testing period of 5 hours. All 4 prodrugs released propofol rapidly in the presence of rat hepatic enzymes; (3) Compared with the previous prodrugs (fospropofol, HX0969W), the 2 novel compounds (HX0969-Gly-F3, HX0969-Ala

  6. Personal informatics in practice: Improving quality of life through data

    DEFF Research Database (Denmark)

    Li, Ian; Medynskiy, Yevgeniy; Froehlich, Jon


    Personal informatics refers to a class of software and hardware systems that help individuals collect personal information to improve self-understanding. Improving self-understanding can foster self-insight and promote positive behaviors: healthy living, energy conservation, etc. The development...... of personal informatics applications poses new challenges for human-computer interaction and creates opportunities for applications in various domains related to quality of life, such as fitness, nutrition, wellness, mental health, and sustainability. This workshop will continue the conversations from the CHI...

  7. Quality Improvement Project to Reduce Delayed Vaccinations in Preterm Infants. (United States)

    Cuna, Alain; Winter, Lindy


    Preterm infants are especially vulnerable to infectious diseases. Although vaccinations are a safe and effective measure to protect preterm infants from vaccine-preventable diseases, delays in vaccinations are not uncommon. The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit. The Plan-Do-Study-Act model of quality improvement was adopted to develop, test, and implement interventions aimed at improving timely vaccination of preterm infants. The primary outcome measure of interest was the rate of on time vaccination, which was defined as the proportion of medically eligible preterm infants who received vaccinations within 2 weeks of the recommended schedule. Baseline on time vaccination rate was only 36%. Following several Plan-Do-Study-Act cycles, a steady increase in on time vaccinations of eligible infants was observed, and a new baseline on time vaccination rate of 82% was achieved. Simple interventions implemented within the context of Plan-Do-Study-Act cycles are effective in improving timely vaccinations among preterm infants. Future research that focuses on vaccinations in preterm infants is needed to further reinforce the safety and efficacy of vaccines. Effective methods on how to disseminate and apply this knowledge to practice should also be studied.Video Abstract available at

  8. Measuring, evaluating and improving hospital quality parameters/dimensions--an integrated healthcare quality approach. (United States)

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


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

  9. Quality-based financial incentives in health care: can we improve quality by paying for it? (United States)

    Conrad, Douglas A; Perry, Lisa


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

  10. Improving Quality Using Architecture Fault Analysis with Confidence Arguments (United States)


    Improving Quality Using Architecture Fault Analysis with Confidence Arguments Peter H. Feiler Charles B. Weinstock John B. Goodenough...Design 8 2.3 Architecture Fault Modeling and Analysis with EMV2 8 2.4 Confidence Map Concepts and Notation 11 Overview of the Stepper-Motor System...Comparison of the SMS Designs 43 Establishing Confidence in the SMS 45 6.1 Confidence Maps for SMS 45 CMU/SEI-2015-TR-006 | SOFTWARE ENGINEERING

  11. Studying and simulating transformer configuration to improve power quality

    Directory of Open Access Journals (Sweden)

    Oscar J. Peña Huaringa


    Full Text Available This paper presents a study and simulation of transformer configurations to improve power quality; it provides theoretical support based on the expansion of the Fourier series and analysis of symmetrical components. A test system was set up in the laboratory, taking measurements and checking configuration effectiveness in reducing the system’s harmonic content. The configurations were modelled with PSCAD / EMTDC software, using two 6 pulse rectifiers as test loads and two variable speed drives.

  12. Science Partnerships Enabling Rapid Response: Designing a Strategy for Improving Scientific Collaboration during Crisis Response (United States)

    Mease, L.; Gibbs, T.; Adiseshan, T.


    The 2010 Deepwater Horizon disaster required unprecedented engagement and collaboration with scientists from multiple disciplines across government, academia, and industry. Although this spurred the rapid advancement of valuable new scientific knowledge and tools, it also exposed weaknesses in the system of information dissemination and exchange among the scientists from those three sectors. Limited government communication with the broader scientific community complicated the rapid mobilization of the scientific community to assist with spill response, evaluation of impact, and public perceptions of the crisis. The lessons and new laws produced from prior spills such as Exxon Valdez were helpful, but ultimately did not lead to the actions necessary to prepare a suitable infrastructure that would support collaboration with non-governmental scientists. As oil demand pushes drilling into increasingly extreme environments, addressing the challenge of effective, science-based disaster response is an imperative. Our study employs a user-centered design process to 1) understand the obstacles to and opportunity spaces for effective scientific collaboration during environmental crises such as large oil spills, 2) identify possible tools and strategies to enable rapid information exchange between government responders and non-governmental scientists from multiple relevant disciplines, and 3) build a network of key influencers to secure sufficient buy-in for scaled implementation of appropriate tools and strategies. Our methods include user ethnography, complex system mapping, individual and system behavioral analysis, and large-scale system design to identify and prototype a solution to this crisis collaboration challenge. In this talk, we will present out insights gleaned from existing analogs of successful scientific collaboration during crises and our initial findings from the 60 targeted interviews we conducted that highlight key collaboration challenges that government

  13. Teaching Evaluation: A Critical Measure for Improving the Quality of Education (United States)

    Ji, Zhou


    In the coming period, the main task for China's higher education system is to improve the quality of education, and the key to improving the quality of education is to improve the quality of teaching. Teaching evaluations are a critical measure for improving the quality of teaching. The work of evaluating teaching at institutions of higher…

  14. Data quality improvement of a multicenter clinical trial dataset. (United States)

    Zaccaria, Gian Maria; Rosati, Samanta; Castagneri, Cristina; Ferrero, Simone; Ladetto, Marco; Boccadoro, Mario; Balestra, Gabriella


    Medical datasets are usually affected by several problems, such as missing values, inconsistencies, redundancies, that can influence the data mining process and the extraction of useful knowledge. For these reasons, a preprocessing phase should be performed for improving the overall quality of data and, consequently, of the information that may be discovered from them. In this study we applied five steps of data preprocessing to improve the quality of a large dataset derived from a multicenter clinical trial. Our dataset included 298 patients enrolled in a prospective, multicenter, clinical trial, characterized by 22 input variables and one class variable (MIPI value). In particular, data coming from different medical centers were firstly integrated to obtain a homogeneous dataset. The latter was normalized to scale all variables into smaller and similar intervals. Then, all missing values were estimated by means of an imputation step. The complete dataset was finally discretized and reduced to remove redundant variables and decrease the amount of data to be managed. The improvement of data quality after each step was evaluated by means of the patients' classification accuracy using the KNN classifier. Our results showed that the proposed pipeline produced an increment of more than 20% of the classification performances. Moreover, the highest growth of accuracy was obtained after missing value imputation, whereas the discretization and feature selection steps allowed for a significant reduction of variables to be managed, without any deterioration of the information contained in data.

  15. Assessing local resources and culture before instituting quality improvement projects. (United States)

    Hawkins, C Matthew


    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.

  16. Using Rapid Improvement Events for Disaster After-Action Reviews: Experience in a Hospital Information Technology Outage and Response. (United States)

    Little, Charles M; McStay, Christopher; Oeth, Justin; Koehler, April; Bookman, Kelly


    The use of after-action reviews (AARs) following major emergency events, such as a disaster, is common and mandated for hospitals and similar organizations. There is a recurrent challenge of identified problems not being resolved and repeated in subsequent events. A process improvement technique called a rapid improvement event (RIE) was used to conduct an AAR following a complete information technology (IT) outage at a large urban hospital. Using RIE methodology to conduct the AAR allowed for the rapid development and implementation of major process improvements to prepare for future IT downtime events. Thus, process improvement methodology, particularly the RIE, is suited for conducting AARs following disasters and holds promise for improving outcomes in emergency management. Little CM , McStay C , Oeth J , Koehler A , Bookman K . Using rapid improvement events for disaster after-action reviews: experience in a hospital information technology outage and response. Prehosp Disaster Med. 2018;33(1):98-100.

  17. Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa. (United States)

    Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P


    Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI

  18. Assessment of willingness to pay for improved air quality using contingent valuation method

    Directory of Open Access Journals (Sweden)

    S. Akhtar


    Full Text Available Rapid urbanization and severe air quality deterioration in Pakistan have increased citizens’s concern towards air pollution. This study, conducted in November, 2016, aimed to develop relationship between degraded air quality and resident’s willingness to pay for improved air quality in city of Lahore, Pakistan through contingent valuation method to quantify an individual’s willingness to pay for improved air quality. Hypothetical market was created and 250 respondents, selected through random sampling, were asked to respond to pre tested questionnaire. Results revealed that 92.5% of respondents showed positive willingness to pay and average predicted willingness to pay by each person was $9.86 per month. Respondents were willing to pay $118 per year which was 1.27% of their mean monthly income. Stepwise regression model was used to develop relationship between independent variables and willingness to pay. Most parameters accompanied by econometric analysis elaborated expected results. Results disclosed that annual household income, symptoms of respiratory diseases and self observed air pollution pointedly impact willingness to pay. It is concluded that despite of the fact that Pakistan is among the lower income countries with no rigid budget allocation for improvement in air quality, people of Pakistan are willing to pay to reduce air pollution load. One of the factor which effected the positivity of willingness to pay is that, a quite large number of people were suffering from pollution related respiratory disorders like asthma, chronic bronchitis, wheezing, cough, and chest congestion. Only 7.5% of respondents were not interested to pay for improved air quality which reported unconcerned attitude and lack of environmental awareness.

  19. Measuring and improving cardiopulmonary resuscitation quality inside the emergency department. (United States)

    Crowe, Christopher; Bobrow, Bentley J; Vadeboncoeur, Tyler F; Dameff, Christian; Stolz, Uwe; Silver, Annemarie; Roosa, Jason; Page, Rianne; LoVecchio, Frank; Spaite, Daniel W


    To evaluate CPR quality during cardiac resuscitation attempts in an urban emergency department (ED) and determine the influence of the combination of scenario-based training, real-time audiovisual feedback (RTAVF), and post-event debriefing on CPR quality. CPR quality was recorded using an R Series monitor-defibrillator (ZOLL Medical) during the treatment of adult cardiac arrest patients. Phase 1 (P1; 11/01/2010-11/15/2012) was an observation period of CPR quality. Phase 2 (P2; 11/15/2012-11/08/2013) was after a 60-min psychomotor skills CPR training and included RTAVF and post-event debriefing. A total of 52 cardiac arrest patients were treated in P1 (median age 56 yrs, 63.5% male) and 49 in P2 (age 60 yrs, 83.7% male). Chest compression (CC) depth increased from 46.7 ± 3.8mm in P1 to 61.6 ± 2.8mm in P2 (p CPR feedback, and post-event debriefing was associated with improved CPR quality and compliance with CPR guidelines in this urban teaching emergency department. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Effects of rapid chilling of carcasses and time of deboning on weight loss and technological quality of pork semimembranosus muscle. (United States)

    Tomović, Vladimir M; Petrović, Ljiljana S; Džinić, Natalija R


    The effect of rapid air chilling of carcasses in the first 3 h of chilling at -31°C (then at 2-4°C, till 24 h post-mortem) and the possibility of earlier deboning (8 h post-mortem) after rapid air chilling, compared to conventional air chilling (at 2-4°C, till 24 h post-mortem) on weight loss and technological quality (pH value, tenderness, drip loss, cooking loss and colour - L(∗)a(∗)b(∗) values) of pork M. semimembranosus was investigated. Under the rapid chilling conditions, weight loss was 0.8% at 8 h post-mortem and increased to 1.4% at 24 h post-mortem when weight loss was 2.0% under conventional chilling. Carcasses that were rapid chilled had significantly lower (Pchill treatment (32.7, 24.2, 19.1 and 5.1°C, respectively). Rapid chilling reduced significantly (Pchill treatment (5.88). Compared to conventional chilling, in M. semimembranosus deboned in different time post-mortem, rapid chilling had a positive significant effect on drip loss (Pchilling i.e. rapid chilling and earlier deboning had neither positive nor negative significant effects (P>0.05) on other investigated technological quality parameters of M. semimembranosus (tenderness, a(∗) value and b(∗) value) compared to conventional chilling.

  1. Recent advances in rapid and non-destructive assessment of meat quality using hyperspectral imaging (United States)

    Tao, Feifei; Ngadi, Michael


    Meat is an important food item in human diet. Its production and consumption has greatly increased in the last decades with the development of economies and improvement of peoples' living standards. However, most of the traditional methods for evaluation of meat quality are time-consuming, laborious, inconsistent and destructive to samples, which make them not appropriate for a fast-paced production and processing environment. Development of innovative and non-destructive optical sensing techniques to facilitate simple, fast, and accurate evaluation of quality are attracting increasing attention in the food industry. Hyperspectral imaging is one of the promising techniques. It integrates the combined merits of imaging and spectroscopic techniques. This paper provides a comprehensive review on recent advances in evaluation of the important quality attributes of meat including color, marbling, tenderness, pH, water holding capacity, and also chemical composition attributes such as moisture content, protein content and fat content in pork, beef and lamb. In addition, the future potential applications and trends of hyperspectral imaging are also discussed in this paper.

  2. A rapid assessment of the quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania

    Directory of Open Access Journals (Sweden)

    Mbwele Bernard


    Full Text Available Abstract Background While child mortality is declining in Africa there has been no evidence of a comparable reduction in neonatal mortality. The quality of inpatient neonatal care is likely a contributing factor but data from resource limited settings are few. The objective of this study was to assess the quality of neonatal care in the district hospitals of the Kilimanjaro region of Tanzania. Methods Clinical records were reviewed for ill or premature neonates admitted to 13 inpatient health facilities in the Kilimanjaro region; staffing and equipment levels were also assessed. Results Among the 82 neonates reviewed, key health information was missing from a substantial proportion of records: on maternal antenatal cards, blood group was recorded for 52 (63.4% mothers, Rhesus (Rh factor for 39 (47.6%, VDRL for 59 (71.9% and HIV status for 77 (93.1%. From neonatal clinical records, heart rate was recorded for3 (3.7% neonates, respiratory rate in 14, (17.1% and temperature in 33 (40.2%. None of 13 facilities had a functioning premature unit despite calculated gestational age Conclusion Key aspects of neonatal care were found to be poorly documented or incorrectly implemented in this appraisal of neonatal care in Kilimanjaro. Efforts towards quality assurance and enhanced motivation of staff may improve outcomes for this vulnerable group.

  3. Visual attention distracter insertion for improved EEG rapid serial visual presentation (RSVP) target stimuli detection (United States)

    Khosla, Deepak; Huber, David J.; Martin, Kevin


    This paper† describes a technique in which we improve upon the prior performance of the Rapid Serial Visual Presentation (RSVP) EEG paradigm for image classification though the insertion of visual attention distracters and overall sequence reordering based upon the expected ratio of rare to common "events" in the environment and operational context. Inserting distracter images maintains the ratio of common events to rare events at an ideal level, maximizing the rare event detection via P300 EEG response to the RSVP stimuli. The method has two steps: first, we compute the optimal number of distracters needed for an RSVP stimuli based on the desired sequence length and expected number of targets and insert the distracters into the RSVP sequence, and then we reorder the RSVP sequence to maximize P300 detection. We show that by reducing the ratio of target events to nontarget events using this method, we can allow RSVP sequences with more targets without sacrificing area under the ROC curve (azimuth).

  4. The GLAaS algorithm for portal dosimetry and quality assurance of RapidArc, an intensity modulated rotational therapy

    Directory of Open Access Journals (Sweden)

    Fogliata Antonella


    Full Text Available Abstract Background To expand and test the dosimetric procedure, known as GLAaS, for amorphous silicon detectors to the RapidArc intensity modulated arc delivery with Varian infrastructures and to test the RapidArc dosimetric reliability between calculation and delivery. Methods The GLAaS algorithm was applied and tested on a set of RapidArc fields at both low (6 MV and high (18 MV beam energies with a PV-aS1000 detector. Pilot tests for short arcs were performed on a 6 MV beam associated to a PV-aS500. RapidArc is a novel planning and delivery method in the category of intensity modulated arc therapies aiming to deliver highly modulated plans with variable MLC shapes, dose rate and gantry speed during rotation. Tests were repeated for entire (360 degrees gantry rotations on composite dose plans and for short partial arcs (of ~6 or 12 degrees to assess GLAaS and RapidArc mutual relationships on global and fine delivery scales. The gamma index concept of Low and the Modulation Index concept of Webb were applied to compare quantitatively TPS dose matrices and dose converted PV images. Results The Gamma Agreement Index computed for a Distance to Agreement of 3 mm and a Dose Difference (ΔD of 3% was, as mean ± 1 SD, 96.7 ± 1.2% at 6 MV and 94.9 ± 1.3% at 18 MV, over the field area. These findings deteriorated slightly is ΔD was reduced to 2% (93.4 ± 3.2% and 90.1 ± 3.1%, respectively and improved with ΔD = 4% (98.3 ± 0.8% and 97.3 ± 0.9%, respectively. For all tests a grid of 1 mm and the AAA photon dose calculation algorithm were applied. The spatial resolution of the PV-aS1000 is 0.392 mm/pxl. The Modulation Index for calculations resulted 17.0 ± 3.2 at 6 MV and 15.3 ± 2.7 at 18 MV while the corresponding data for measurements were: 18.5 ± 3.7 and 17.5 ± 3.7. Partial arcs findings were (for ΔD = 3%: GAI = 96.7 ± 0.9% for 6° rotations and 98.0 ± 1.1% for 12° rotations. Conclusion The GLAaS method can be considered as a valid

  5. Improved Neural Signal Classification in a Rapid Serial Visual Presentation Task Using Active Learning. (United States)

    Marathe, Amar R; Lawhern, Vernon J; Wu, Dongrui; Slayback, David; Lance, Brent J


    The application space for brain-computer interface (BCI) technologies is rapidly expanding with improvements in technology. However, most real-time BCIs require extensive individualized calibration prior to use, and systems often have to be recalibrated to account for changes in the neural signals due to a variety of factors including changes in human state, the surrounding environment, and task conditions. Novel approaches to reduce calibration time or effort will dramatically improve the usability of BCI systems. Active Learning (AL) is an iterative semi-supervised learning technique for learning in situations in which data may be abundant, but labels for the data are difficult or expensive to obtain. In this paper, we apply AL to a simulated BCI system for target identification using data from a rapid serial visual presentation (RSVP) paradigm to minimize the amount of training samples needed to initially calibrate a neural classifier. Our results show AL can produce similar overall classification accuracy with significantly less labeled data (in some cases less than 20%) when compared to alternative calibration approaches. In fact, AL classification performance matches performance of 10-fold cross-validation (CV) in over 70% of subjects when training with less than 50% of the data. To our knowledge, this is the first work to demonstrate the use of AL for offline electroencephalography (EEG) calibration in a simulated BCI paradigm. While AL itself is not often amenable for use in real-time systems, this work opens the door to alternative AL-like systems that are more amenable for BCI applications and thus enables future efforts for developing highly adaptive BCI systems.

  6. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. (United States)

    Chassin, M R; Galvin, R W


    To identify issues related to the quality of health care in the United States, including its measurement, assessment, and improvement, requiring action by health care professionals or other constituencies in the public or private sectors. The National Roundtable on Health Care Quality, convened by the Institute of Medicine, a component of the National Academy of Sciences, comprised 20 representatives of the private and public sectors, practicing medicine and nursing, representing academia, business, consumer advocacy, and the health media, and including the heads of federal health programs. The roundtable met 6 times between February 1996 and January 1998. It explored ongoing, rapid changes in health care and the implications of these changes for the quality of health and health care in the United States. Roundtable members held discussions with a wide variety of experts, convened conferences, commissioned papers, and drew on their individual professional experience. At the end of its deliberations, roundtable members reached consensus on the conclusions described in this article by a series of discussions at committee meetings and reviews of successive draft documents, the first of which was created by the listed authors and the Institute of Medicine project director. The drafts were revised following these discussions, and the final document was approved according to the formal report review procedures of the National Research Council of the National Academy of Sciences. The quality of health care can be precisely defined and measured with a degree of scientific accuracy comparable with that of most measures used in clinical medicine. Serious and widespread quality problems exist throughout American medicine. These problems, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers

  7. Quality Improvement, Quality Assurance, and Benchmarking: Comparing two frameworks for managing quality processes in open and distance learning

    Directory of Open Access Journals (Sweden)

    Alistair Inglis


    Full Text Available Managing quality processes become critically important for higher education institutions generally, but especially for institutions involved in open and distance learning. In Australia, managers of centers responsible for open and distance learning have identified two frameworks that potentially offer ways of conceiving of the application of quality processes: the Quality Framework published in Inglis, Ling, and Joosten (1999; and the Benchmarking Framework published in McKinnon, Walker, and Davis (2000. However, managers who have been considering applying one or other framework within their institutional contexts have had to face the issue of how they should choose between, or combine the use, of these frameworks. Part of their dilemma lies in distinguishing among the related functions of quality improvement, quality assurance, and benchmarking. This article compares the frameworks in terms of their scope, institutional application, structures, and method of application, and then considers what implications the similarities and differences between the frameworks have for their use.

  8. Assuring the quality of quality assurance: seeding abnormal slides into the negative Papanicolaou smears that will be rapid rescreened. (United States)

    Clarke, Joanne; Thurloe, Julia K; Bowditch, Ron C; Roberts, Jennifer M


    Rapid rescreening (RR) of negative Papanicolaou smears (PS) is used in many countries as a quality-assurance measure. Seeding of abnormal slides has been suggested as a way to increase the sensitivity of this procedure. Since 2004, the authors have carried out RR with seeding before issuing reports. In this article, they describe their experience. Abnormal seeds were sourced from the previous day's high-grade cases, both squamous and glandular. Slides were evaluated for the 'degree of difficulty' (which was defined as the number of fields required to find (fields-to-find [FTF]) the abnormality), relabeled, and redotted to make them indistinguishable from the routine RR work. The number of seeds found/missed, the identity of the screener, the type of seeded abnormality, the degree of difficulty of the seed, and the mapping technique used all were recorded. The cytologists also were surveyed about their views on seeding. Overall, 14.8% of 3082 high-grade seeds were missed during RR. There was no relation between seeds missed and the mapping technique used. However, the difficulty of the seed was relevant to the number missed and ranged from 8.3% when the FTF was 10 (P = .000). The difference between intraepithelial seeds and invasive seeds was significant for squamous seeds (P = .031) but not for glandular seeds. Glandular seeds also were more likely to be missed than squamous seeds (23.1% vs 14.3%; P = .002). Most cytologists believed that seeding was a good idea and that seeds increased their level of vigilance. The authors' experience demonstrated that routine seeding is practicable for both conventional and liquid-based slides. With the advent of the human papillomavirus vaccine, abnormalities will become rarer, and seeding will be necessary to maintain the alertness of cytologists. (c) 2008 American Cancer Society.

  9. Improving quality measures in colonoscopy and its therapeutic intervention. (United States)

    Horiuchi, Akira; Tanaka, Naoki


    Colonoscopy with polypectomy has been shown to reduce the risk of colon cancer. The critical element in the quality of colonoscopy in terms of polyp detection and removal continues to be the performance of the endoscopist, independent of patient-related factors. Improved results in terms of polyp detection and complete removal have implications regarding the development of screening and surveillance intervals and the reduction of interval cancers after negative colonoscopy. Advances in colonoscopy techniques such as high-definition colonoscopy, hood-assisted colonoscopy and dye-based chromoendoscopy have improved the detection of small and flat-type colorectal polyps. Virtual chromoendoscopy has not proven to improve polyp detection but may be useful to predict polyp pathology. The majority of polyps can be removed endoscopically. Available polypectomy techniques include cold forceps polypectomy, cold snare polypectomy, conventional polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection. The preferred choice depends on the polyp size and characteristics. Other useful techniques include colonoscopic hemostasis for acute colonic diverticular bleeding, endoscopic decompression using colonoscopic stenting, and transanal tube placement for colorectal obstruction. Here we review the current knowledge concerning the improvement of quality measures in colonoscopy and colonoscopy-related therapeutic interventions.

  10. Study on quality improvement of palm trunk by thermoplastic impregnation (United States)

    Rosli, F.; Ghazali, C. M. R.; Abdullah, M. M. A. B.; Hussin, K.


    Due to abundance of palm trunk waste, palm trunk can be used as alternative raw material of wood composites to replace future timber. However, the morphological of palm trunk is not truly woody material, so the quality improvement was studied by thermoplastic impregnation at different soaking time. The effect of thermoplastic resin impregnation on the morphological, physical and mechanical was investigated in this study. It was found that the amount of resin uptake to the palm trunk ranged from 3.85% to 6.25%. The density, thickness swelling and water absorption of treated palm trunk significantly improved. While, the modulus of rupture (MOR) and modulus of elasticity (MOE) of treated palm trunk was greater than untreated. This findings in this study indicated that thermoplastic resin would be considered alternative to formaldehyde-based resin to improved properties of palm trunk. At the request of all authors and with the approval of the proceedings editor, article 020268 titled, "Study on Quality Improvement of Palm Trunk by Thermoplastic Impregnation," is being retracted from the public record due to the fact that it is a duplication of article 020153 published in the same volume.

  11. Phase imaging quality improvement by modification of AFM probes' cantilever. (United States)

    Skibinski, J; Rebis, J; Kaczmarek, L; Wejrzanowski, T; Plocinski, T; Rozniatowski, K


    Imaging of the surface of materials by atomic force microscopy under tapping and phase imaging mode, with use of modified probes is addressed. In this study, the circularly shaped holes located in varying distance from the probe base, were cut out by focused ion beam. Such modification was a consequence of the results of the previous experiments (probe tip sharpening and cantilever thinning) where significant improvement of image quality in tapping and phase imaging mode has been revealed. The solution proposed herein gives similar results, but is much simpler from the technological point of view. Shorter exposition time of the tip onto gallium ions during FIB processing allows to reduce material degradation. The aim of this modification was to change harmonic oscillators' properties in the simplest and fastest way, to obtain stronger signal for higher resonant frequencies, which can be advantageous for improving the quality of imaging in PI mode. Probes shaped in that way were used for AFM investigations with Bruker AFM nanoscope 8. As a testing material, titanium roughness standard sample, supplied by Bruker, was used. The results have shown that the modifications performed within these studies influence the oscillation of the probes, which in some cases may result in deterioration of the imaging quality under tapping mode for one or both self-resonant frequencies. However, phase imaging results obtained using modified probes are of higher quality. The numerical simulations performed by application of finite element method were used to explain the results obtained experimentally. Phenomenon described within this study allows to apply developed modelling methodology for prediction of effects of various modifications on the probes' tip, and as a result, to predict how proposed modifications will affect AFM imaging quality. © 2017 The Authors Journal of Microscopy © 2017 Royal Microscopical Society.

  12. An empirical model of water quality for use in rapid management strategy evaluation in Southeast Queensland, Australia. (United States)

    de la Mare, William; Ellis, Nick; Pascual, Ricardo; Tickell, Sharon


    Simulation models have been widely adopted in fisheries for management strategy evaluation (MSE). However, in catchment management of water quality, MSE is hampered by the complexity of both decision space and the hydrological process models. Empirical models based on monitoring data provide a feasible alternative to process models; they run much faster and, by conditioning on data, they can simulate realistic responses to management actions. Using 10 years of water quality indicators from Queensland, Australia, we built an empirical model suitable for rapid MSE that reproduces the water quality variables' mean and covariance structure, adjusts the expected indicators through local management effects, and propagates effects downstream by capturing inter-site regression relationships. Empirical models enable managers to search the space of possible strategies using rapid assessment. They provide not only realistic responses in water quality indicators but also variability in those indicators, allowing managers to assess strategies in an uncertain world. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. An evaluation of a frontline led quality improvement initiative. (United States)

    Flynn, Rachel; Hartfield, Dawn


    Purpose The Edmonton Zone, one of five Zones in Alberta Health Services (the health system in the province of Alberta, Canada), established a quality management framework (QMF) as a means to improve the delivery of high quality health care in the spring of 2014. The purpose of this research study was to understand the factors that facilitated or hindered the implementation of a quality improvement (QI) initiative for hand hygiene led by a newly formed frontline unit quality council (UQC), a part of the QMF, based out of the pediatric intensive care unit (PICU) at the Stollery Children's Hospital in the Edmonton Zone. This research will provide an understanding of the newly established QMF in the Edmonton Zone and the factors needed to foster the ongoing development of frontline UQC that do improvement work as part of their daily routine. Design/methodology/approach Using a qualitative case study research design data were collected using semi-structured open-ended interviews with six key stakeholders (one registered nurse, one physician, one patient case manager, medical director for QI, clinical QI consultant and director of clinical QI) involved in UQC at the PICU. Findings Individual, unit and organizational level factors were identified as influencing the function of the UQC. Leadership and work culture were the key facilitating factors to success and lack of QI training and personnel/dedicated time were perceived barriers to completing the QI initiative. Originality/value The findings from this research illustrate that frontline UQC are able to impact positive sustained change early in their establishment as part of a larger QMF. It is important, however, for the system to foster ongoing development of capacity and capability of these frontline UQC to ensure sustained success of the larger systems change.

  14. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design. (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary


    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  15. Application of near-infrared spectroscopy for the rapid quality assessment of Radix Paeoniae Rubra (United States)

    Zhan, Hao; Fang, Jing; Tang, Liying; Yang, Hongjun; Li, Hua; Wang, Zhuju; Yang, Bin; Wu, Hongwei; Fu, Meihong


    Near-infrared (NIR) spectroscopy with multivariate analysis was used to quantify gallic acid, catechin, albiflorin, and paeoniflorin in Radix Paeoniae Rubra, and the feasibility to classify the samples originating from different areas was investigated. A new high-performance liquid chromatography method was developed and validated to analyze gallic acid, catechin, albiflorin, and paeoniflorin in Radix Paeoniae Rubra as the reference. Partial least squares (PLS), principal component regression (PCR), and stepwise multivariate linear regression (SMLR) were performed to calibrate the regression model. Different data pretreatments such as derivatives (1st and 2nd), multiplicative scatter correction, standard normal variate, Savitzky-Golay filter, and Norris derivative filter were applied to remove the systematic errors. The performance of the model was evaluated according to the root mean square of calibration (RMSEC), root mean square error of prediction (RMSEP), root mean square error of cross-validation (RMSECV), and correlation coefficient (r). The results show that compared to PCR and SMLR, PLS had a lower RMSEC, RMSECV, and RMSEP and higher r for all the four analytes. PLS coupled with proper pretreatments showed good performance in both the fitting and predicting results. Furthermore, the original areas of Radix Paeoniae Rubra samples were partly distinguished by principal component analysis. This study shows that NIR with PLS is a reliable, inexpensive, and rapid tool for the quality assessment of Radix Paeoniae Rubra.

  16. Quality improvement in radiography in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail:


    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  17. Effectiveness of a quality improvement curriculum for medical students

    Directory of Open Access Journals (Sweden)

    Kimberly M. Tartaglia


    Full Text Available Introduction: As health systems find ways to improve quality of care, medical training programs are finding opportunities to prepare learners on principles of quality improvement (QI. The impact of QI curricula for medical students as measured by student learning is not well delineated. The aim of this study is to evaluate the effectiveness of a QI curriculum for senior medical students as measured by student knowledge and skills. Methods: This study was an observational study that involved a self-assessment and post-test Quality Improvement Knowledge Application Tool (QIKAT for intervention and control students. A QI curriculum consisting of online modules, live discussions, independent readings and reflective writing, and participation in a mentored QI project was offered to fourth-year medical students completing an honor's elective (intervention group. Senior medical students who received the standard QI curriculum only were recruited as controls. Results: A total of 22 intervention students and 12 control students completed the self-assessment and QIKAT. At baseline, there was no difference between groups in self-reported prior exposure to QI principles. Students in the intervention group reported more comfort with their skills in QI overall and in 9 of the 12 domains (p<0.05. Additionally, intervention students performed better in each of the three case scenarios (p<0.01. Discussion: A brief QI curriculum for senior medical students results in improved comfort and knowledge with QI principles. The strengths of our curriculum include effective use of classroom time and faculty mentorship with reliance on pre-existing online modules and written resources. Additionally, the curriculum is easily expandable to larger groups of students and transferable to other institutions.

  18. Improving laboratory data entry quality using Six Sigma. (United States)

    Elbireer, Ali; Le Chasseur, Julie; Jackson, Brooks


    The Uganda Makerere University provides clinical laboratory support to over 70 clients in Uganda. With increased volume, manual data entry errors have steadily increased, prompting laboratory managers to employ the Six Sigma method to evaluate and reduce their problems. The purpose of this paper is to describe how laboratory data entry quality was improved by using Six Sigma. The Six Sigma Quality Improvement (QI) project team followed a sequence of steps, starting with defining project goals, measuring data entry errors to assess current performance, analyzing data and determining data-entry error root causes. Finally the team implemented changes and control measures to address the root causes and to maintain improvements. Establishing the Six Sigma project required considerable resources and maintaining the gains requires additional personnel time and dedicated resources. After initiating the Six Sigma project, there was a 60.5 percent reduction in data entry errors from 423 errors a month (i.e. 4.34 Six Sigma) in the first month, down to an average 166 errors/month (i.e. 4.65 Six Sigma) over 12 months. The team estimated the average cost of identifying and fixing a data entry error to be $16.25 per error. Thus, reducing errors by an average of 257 errors per month over one year has saved the laboratory an estimated $50,115 a year. The Six Sigma QI project provides a replicable framework for Ugandan laboratory staff and other resource-limited organizations to promote quality environment. Laboratory staff can deliver excellent care at a lower cost, by applying QI principles. This innovative QI method of reducing data entry errors in medical laboratories may improve the clinical workflow processes and make cost savings across the health care continuum.

  19. Can a flowchart improve the quality of bystander cardiopulmonary resuscitation? (United States)

    Rössler, B; Ziegler, M; Hüpfl, M; Fleischhackl, R; Krychtiuk, K A; Schebesta, K


    Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model. After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants' confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed. Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024. Time to chest compressions was significantly longer in the flowchart group (60±24 s vs. 23±18 s, p<0.0001). Participants in the flowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7±2 vs. 5±2, p=0.0009). A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers' confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. A state-wide obstetric hemorrhage quality improvement initiative. (United States)

    Bingham, Debra; Lyndon, Audrey; Lagrew, David; Main, Elliott K


    The mission of the California Maternal Quality Care Collaborative is to eliminate preventable maternal death and injury and to promote equitable maternity care in California. This article describes California Maternal Quality Care Collaborative's (CMQCC's) statewide multistakeholder quality improvement initiative to improve readiness, recognition, response, and reporting of maternal hemorrhage at birth and details the essential role of nurses in its success. In partnership with the State Department of Maternal, Child, and Adolescent Health, CMQCC identified maternal hemorrhage as a significant quality improvement opportunity. CMQCC organized a multidisciplinary, multistakeholder task force to develop a strategy for addressing obstetric (OB) hemorrhage. The OB Hemorrhage Task Force, co-chaired by nurse and physician team leaders, identified four priorities for action and developed a comprehensive hemorrhage guideline. CMQCC is using a multilevel strategy to disseminate the guideline, including an open access toolkit, a minimal support-mentoring model, a county partnership model, and a 30-hospital learning collaborative. In participating hospitals, nurses have been the primary drivers in developing both general and massive hemorrhage policies and procedures, ensuring the availability of critical supplies, organizing team debriefing after a stage 2 (or greater) hemorrhage, hosting skills stations for measuring blood loss, and running obstetric (OB) hemorrhage drills. Each of these activities requires effort and leadership skill, even in hospitals where clinicians are convinced that these changes are needed. In some hospitals, the burden to convince physicians of the value of these new practices has rested primarily upon nurses. Thus, the statewide initiative in which nurse and physician leaders work together models the value of teamwork and provides a real-time demonstration of the potential for effective interdisciplinary collaboration to make a difference in the

  1. Do quality improvement collaboratives’ educational components match the dominant learning style preferences of the participants?

    NARCIS (Netherlands)

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


    markdownabstractBackground: Quality improvement collaboratives are used to improve healthcare by various organizations. Despite their popularity literature shows mixed results on their effectiveness. A quality improvement collaborative can be seen as a temporary learning organization in which

  2. Smoothing depth maps for improved steroscopic image quality (United States)

    Tam, Wa James; Alain, Guillaume; Zhang, Liang; Martin, Taali; Renaud, Ronald


    A technique to improve the image quality of stereoscopic pictures generated from depth maps (depth image based rendering or DIBR) is examined. In general, there are two fundamental problems with DIBR: a depth map could contain artifacts (e.g., noise or "blockiness") and there is no explicit information on how to render newly exposed regions ("holes") in the rendered image as a result of new virtual camera positions. We hypothesized that smoothing depth maps before rendering will not only minimize the effects of noise and distortions in the depth maps but will also reduce areas of newly exposed regions where potential artifacts can arise. A formal subjective assessment of four stereoscopic sequences of natural scenes was conducted with 23 viewers. The stereoscopic sequences consisted of source images for the left-eye view and rendered images for the right-eye view. The depth maps were smoothed with a Gaussian blur filter at different levels of strength before depth image based rendering. Results indicated that ratings of perceived image quality improved with increasing levels of smoothing of the depth maps. Even though the depth maps were smoothed, a negative effect on ratings of overall perceived depth quality was not found.

  3. Improving safety and quality: how can education help? (United States)

    Walton, Merrilyn M; Elliott, Susan L


    National efforts to improve the quality and safety of health care present challenges for medical education and training. Today's doctors need to be skilled communicators who know how to identify, prevent and manage adverse events and near misses, how to use evidence and information, how to work safely in a team, how to practise ethically, and how to be workplace teachers and learners. These competencies (knowledge, skills and attitudes) are set out in the National Patient Safety Education Framework (NPSF) of the Australian Council for Safety and Quality in Health Care. The NPSF is designed to help medical schools, vocational colleges, health organisations and private practitioners develop curricula to enable health professionals to work safely. The NPSF describes what doctors (depending on their level of knowledge and experience) can do to demonstrate competencies in a range of quality and safety activities. Medical schools, vocational colleges, health organisations and private practitioners need to work collaboratively with one another and with other health professionals to ensure that patient safety and quality curricula are implemented and evaluated, and that valid and reliable assessments of learning outcomes are developed. Interdisciplinary and vertically integrated education and training are needed, incorporating innovative methods, to create a safer health care system.

  4. Improving Service Quality by Using Organizational Citizenship Behavior: Iranian Evidence

    Directory of Open Access Journals (Sweden)

    Nour-Mohammad Yaghoubi


    Full Text Available Nowadays, with increasing service industries, service marketing and service quality have become an important challenge to organizations. The attempts of organizations in this situation are witnesses to this matter. In the past years, the organizations tried to reach service quality appropriation and satisfaction of self-external customers by concepts and approaches of external marketing. One of the important features of service is the direct interaction with customers and having customer-oriented behaviors. Furthermore, with introducing the internal marketing and the important roles of it, an internal customer of organizations, on achievement of organizational plans, was noted to internal marketing more and more than before. So, the study researchers are going to argue about internal marketing and the effect of it on organizational citizenship behaviors and service quality and the important role of it on development and improvement of service quality by using organizational citizenship behaviors. For this purpose, first the researchers have studied internal marketing and its important components and then have done the same to the other items and finally have applied a quantitative study on all of them. It should be mentioned that the researchers have employed SPSS 17.0 and Lisrel 8.54 for data analysis. The findings of the present study illustrated that there is an appropriate interaction among all the items, which has been studied here and the structural equations for the conceptual framework of this study are goodness of fit.

  5. Patient safety reporting systems: sustained quality improvement using a multidisciplinary team and "good catch" awards. (United States)

    Herzer, Kurt R; Mirrer, Meredith; Xie, Yanjun; Steppan, Jochen; Li, Matthew; Jung, Clinton; Cover, Renee; Doyle, Peter A; Mark, Lynette J


    Since 1999, hospitals have made substantial commitments to health care quality and patient safety through individual initiatives of executive leadership involvement in quality, investments in safety culture, education and training for medical students and residents in quality and safety, the creation of patient safety committees, and implementation of patient safety reporting systems. At the Weinberg Surgical Suite at The Johns Hopkins Hospital (Baltimore), a 16-operating-room inpatient/outpatient cancer center, a patient safety reporting process was developed to maximize the usefulness of the reports and the long-term sustainability of quality improvements arising from them. A six-phase framework was created incorporating UHC's Patient Safety Net (PSN): Identify, report, analyze, mitigate, reward, and follow up. Unique features of this process included a multidisciplinary team to review reports, mitigate hazards, educate and empower providers, recognize the identifying/reporting individuals or groups with "Good Catch" awards, and follow up to determine if quality improvements were sustained over time. Good Catch awards have been given in recognition of 29 patient safety hazards identified since 2008; in each of these cases, an initiative was developed to mitigate the original hazard. Twenty-five (86%) of the associated quality improvements have been sustained. Two Good Catch award-winning projects--vials of heparin with an unusually high concentration of the drug that posed a potential overdose hazard and a rapid infusion device that resisted practitioner control--are described in detail. A multidisciplinary team's analysis and mitigation of hazards identified in a patient safety reporting process entailed positive recognition with a Good Catch award, education of practitioners, and long-term follow-up.

  6. A new function of rapid eye movement sleep: improvement of muscular efficiency. (United States)

    Cai, Zi-Jian


    Previously I demonstrated that the slow wave sleep (SWS) functioned to adjust the emotional balance disrupted by emotional memories randomly accumulated during waking, while the rapid eye movement (REM) sleep played the opposite role. Many experimental results have unambiguously shown that various emotional memories are processed during REM sleep. In this article, it is attempted to combine this confirmed function of REM sleep with the atonic state unique to REM sleep, and to integrate a new theory suggesting that improvement of muscular efficiency be a new function of REM sleep. This new function of REM sleep is more advantageous than the function of REM sleep in emotional memories and disinhibited drives to account for the phylogenetic variations of REM sleep, especially the absence of REM sleep in dolphins and short duration of REM sleep in birds in contrary to that in humans and rodents, the absence of penile erections in REM sleep in armadillo, as well as the higher voltage in EEG during REM sleep in platypus and ostrich. Besides, this new function of REM sleep is also advantageous to explain the association of REM sleep with the atonic episodes in SWS, the absence of drastic menopausal change in duration of REM sleep, and the effects of ambient temperature on the duration of REM sleep. These comparative and experimental evidences support the improvement of muscular efficiency as a new and major function of REM sleep. Copyright © 2015 Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    M. Shilpa


    Full Text Available Robust design methodology aims at reducing the variability in the product performance in the presence of noise factors. Experiments involving simultaneous optimization of more than one quality characteristic are known as multiresponse experiments which are used in the development and improvement of industrial processes and products. In this paper, robust design methodology is applied to optimize the process parameters during a particular operation of rotary driving shaft manufacturing process. The three important quality characteristics of the shaft considered here are of type Nominal-the-best, Smaller-the-better and Fraction defective. Simultaneous optimization of these responses is carried out by identifying the control parameters and conducting the experimentation using L9 orthogonal array.

  8. Improving the Quality of Published Chemical Names with Nomenclature Software

    Directory of Open Access Journals (Sweden)

    Gernot A. Eller


    Full Text Available This work deals with the use of organic systematic nomenclature in scientific literature, its quality, and computerized methods for its improvement. Criteria for classification of systematic names in terms of quality/correctness are discussed and applied to a sample set of several hundred names extracted from the literature. The same structures are named with three popular state-of-the-art nomenclature programs – AutoNom 2000, ChemDraw 10.0, and ACD/Name 9.0. When comparing the results, all nomenclature tools show a significantly better performance than 'average chemists'. One program allows the generation not only of IUPAC names but also of CAS-like index names that are compared with the officially registered names. The scope and limitations of nomenclature software are discussed and a comparison of the programs' actual capabilities is given.

  9. Capability studies, helpful tools in process quality improvement

    Directory of Open Access Journals (Sweden)

    Simion Carmen


    Full Text Available Ability of processes to meet customer’quality requirements has become essential for providing competitive advantages such as cost savings, reducing the number of nonconfoming products or increasing customer satisfaction. This paper aims to conduct a capability study for a swaging process (that ensures an assembly dimension of a key product characteristic (the outer diameter of a new part, related to the concept of capability and performance indices and how these metrics can be used and interpreted to become powerful tools for decision making. To achieve the goal of the paper, the following key aspects were analyzed: capability of the measurement system capability (gage R&R, production equipment (machine capability and process capability/performance during the first serial production. The analysis was performed with Minitab® 17, the most commonly used software for quality improvement.

  10. Improving eggshell quality at high temperatures with dietary sodium bicarbonate. (United States)

    Balnave, D; Muheereza, S K


    Two experiments were conducted that confirmed the hypothesis that a dietary bicarbonate supplement will improve eggshell quality in hens at high temperatures as long as feed is consumed during the period of eggshell formation. End-of-lay hens were maintained on continuous light at temperatures of 30 and 35 C. Individual egg weights and shell quality measures for each hen were calculated as a proportion of the initial values determined during an acclimatization period at 25 C. Improvements in shell breaking strength in both experiments were observed as a result of supplementing control diets with 1% sodium bicarbonate (NaHCO3). This response to NaHCO3 was not a reflection of a reduced rate of lay or egg mass output, as these were similar or inferior on the control diets. Similar feed intakes on the control and NaHCO3 diets indicated that the response was not related to differences in calcium intakes. Supplements of zinc methionine and ascorbic acid proved to be inferior to NaHCO3. Improvements in egg weight were associated with the introduction of continuous lighting.


    Directory of Open Access Journals (Sweden)

    Mariola Ścisłowska


    Full Text Available The paper presents the results of research focused on the investigations of the possibilities to use biochar to improve the quality and productivity of soils. Biochar is a material similar to the commonly known charcoal obtained from the thermolysis process (a process similar to dry distillation of wood. The structure and technical properties of biochar depend on the type of biomass which is produced and the thermal decomposition process conditions: process time, temperature and atmosphere. It was found that a positive effect of biochar on the soil properties is manifested through the improvement of soil fertility, better water retention, improvement of the cation exchange, and the regulation of the pH. The biochar used in the present study was obtained by autothermal thermolysis of biomass at 300 °C. Three types of biochars of different origin were used. The biochar samples were subjected to ultimate and proximate analysis, as well as structural and porosimetric investigations. The experimental research were also conducted on the experimental test field and gave a positive effect of the presence of biochar on soil quality and plant yield. Biochar introduced into soil allows for long-term storage of carbon. The introduction of biochar to soil has a positive effect on plant growth, higher dose resulted in an increase in biochar and plant mass.

  12. Asan medical information system for healthcare quality improvement. (United States)

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


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

  13. Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science. (United States)

    Ryan, Rosemary W; Harris, Karen K; Mattox, Lisa; Singh, Olivine; Camp, Melanie; Shirey, Maria R


    Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process. A critical appraisal of the literature was conducted, which supports the importance of evidenced-based practice improvement, collaborative change process, and professional role of nursing leadership. Limited evidence exists related to practice strategies for nursing leaders to implement sustainable change at the unit level for successful alignment of resources. Strategies based on Rogers' Diffusion of Innovation Theory are recommended to address the gap in the literature. The strategies aim to increase meaningful knowledge or the "why," create a tipping point, and implement sustainable change starting with the end in mind. Nurse leaders are a central component for driving alignment and implementing change at the unit level. Uses of the described evidenced-based strategies have implications for nursing practice, education, and scholarship.

  14. The Importance of Employment Contract for Umsida Quality Employees Improvement

    Directory of Open Access Journals (Sweden)

    Noor Fatimah Mediawati


    Full Text Available The absence of employment contracts in UMSIDA recognized cause some problems. Especially in improving the performance of employees. Issues a little more disturbing harmonious labor relations between employees and UMSIDA. In the terminology of the Labour Act, employment contract terms it is known as the Employment Agreement. Where the existence of labor agreement / contract employment is expected to harmonize the working relationship with the employer in accordance with the applicable rules. The existence of employment contracts is also a legal instrument which according to researchers ought to be put forward in efforts to increase the qualifications and competence of employees. By contract it will also avoid things that are not desirable in an employment relationship, because each party will always carry out their rights and responsibilities are aligned and balanced. Tranquility in the work and the guarantee of legal protection are expected to improve employee performance especially towards quality UMSIDA 2020. So this study explored further the urgency employment contract once its design. How To Cite: Mediawati, N., & Phahlevy, R. (2015. The Importance of Employment Contract for Umsida Quality Employees Improvement. Rechtsidee, 2(2, 141-156. doi:

  15. Integrating health promotion with quality improvement in a Swedish hospital. (United States)

    Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese


    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  16. Issues of therapeutic communication relevant for improving quality of care (United States)

    Popa-Velea, O; Purcărea, VL


    Communication issues are extensively considered a topic of high interest for improving the efficacy of the therapeutic act. This article aimed to overview several issues of therapeutic communication relevant for improving quality of care. A number of 15 bibliographic resources on these topics published in peer-reviewed journals between 1975 and 2010, and indexed in PubMed, ProQuest and EBSCO databases were examined, to seek for evidence regarding these data. Results highlight a number of communication problems commonly reported in the literature, such as the lack of physician communicational skills or their deterioration, the persistence of an asymmetric therapeutic communicational model, communication obstacles brought by the disease itself or by several variables pertaining to the patient, including specific demographic and psychological contexts. Equally, literature reports ways of improving therapeutic communication, such as optimizing the clinical interview, better time management techniques or assertiveness. Integration of communication training in the bio-psycho-social model of care and monitoring parameters like adherence and quality of life as tools reflecting also a good therapeutic communication can be valuable future approaches of obtaining better results in this area. PMID:27057247

  17. Working Smarter Not Harder: Using a Pedagogical-Based Model in the Rapid Development of Quality Hybrid Courses (United States)

    Rust, Jodi E.


    This descriptive case study explored how repurposing and a pedagogical-based instructional design model, the multimodal model (Picciano, 2009), were used to create quality courses in a rapid development setting at a Midwestern land grant university. Data triangulation was used to secure data from faculty member interviews, course syllabi, and…

  18. Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers

    Directory of Open Access Journals (Sweden)

    Edna Namiko Izuka


    Full Text Available OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME. METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001 and posterior nasal floor (2.8 mm, p < 0.001. Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001, oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066. The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia.

  19. The impact of rapid aneuploidy detection (RAD) in addition to karyotyping versus karyotyping on maternal quality of life

    NARCIS (Netherlands)

    Boormans, E. M. A.; Birnie, E.; Oepkes, D.; Bilardo, C. M.; Wildschut, H. I. J.; Creemers, J.; Bonsel, G. J.; van Lith, J. M. M.

    Objective To assess the impact of rapid aneuploidy detection (RAD) combined with fetal karyotyping versus karyotyping only on maternal anxiety and health-related quality of life. Methods Women choosing to undergo amniocentesis were selected into group 1, i.e. receiving a karyotype result only (n =

  20. Individualized choice in prenatal diagnosis : the impact of karyotyping and standalone rapid aneuploidy detection on quality of life

    NARCIS (Netherlands)

    Boormans, E. M. A.; Birnie, E.; Oepkes, D.; Boekkooi, P. F.; Bonsel, G. J.; van Lith, J. M. M.


    Objective To assess the reasons and perceptions of women who are offered a choice between karyotyping and standalone rapid aneuploidy detection (RAD) and to compare the impact of both tests on anxiety and health-related quality of life Methods In this prospective comparative study, women undergoing

  1. Process Improvement to Enhance Quality in a Large Volume Labor and Birth Unit. (United States)

    Bell, Ashley M; Bohannon, Jessica; Porthouse, Lisa; Thompson, Heather; Vago, Tony

    The goal of the perinatal team at Mercy Hospital St. Louis is to provide a quality patient experience during labor and birth. After the move to a new labor and birth unit in 2013, the team recognized many of the routines and practices needed to be modified based on different demands. The Lean process was used to plan and implement required changes. This technique was chosen because it is based on feedback from clinicians, teamwork, strategizing, and immediate evaluation and implementation of common sense solutions. Through rapid improvement events, presence of leaders in the work environment, and daily huddles, team member engagement and communication were enhanced. The process allowed for team members to offer ideas, test these ideas, and evaluate results, all within a rapid time frame. For 9 months, frontline clinicians met monthly for a weeklong rapid improvement event to create better experiences for childbearing women and those who provide their care, using Lean concepts. At the end of each week, an implementation plan and metrics were developed to help ensure sustainment. The issues that were the focus of these process improvements included on-time initiation of scheduled cases such as induction of labor and cesarean birth, timely and efficient assessment and triage disposition, postanesthesia care and immediate newborn care completed within approximately 2 hours, transfer from the labor unit to the mother baby unit, and emergency transfers to the main operating room and intensive care unit. On-time case initiation for labor induction and cesarean birth improved, length of stay in obstetric triage decreased, postanesthesia recovery care was reorganized to be completed within the expected 2-hour standard time frame, and emergency transfers to the main hospital operating room and intensive care units were standardized and enhanced for efficiency and safety. Participants were pleased with the process improvements and quality outcomes. Working together as a team

  2. An opinion paper: emphasis on white muscle development and growth to improve farmed fish flesh quality. (United States)

    Videler, J J


    Due to rapid depletion of wild stocks, the necessity to cultivate fish is eminent. Current fish farming practices seek to improve flesh quality. The notion that white muscles are the main target of the fishing industry is emphasized. A novel approach is suggested based on the development of white muscles in wild fish from eggs to adults. A compilation of facts about white muscle structure, function and ontogeny is followed by an account of the changes in swimming behaviour and performance related to the use of white muscle during growth from larva to adult. Ecological data narrate early swimming performance with white muscle development and growth, unveiling some of the important natural selection factors eliminating weak swimmers and poor growers from the breeding stock. A comparison between fish culture practise and natural conditions reveals fundamental differences. New approaches following wild breeding processes promise several important advantages regarding the quality of white muscle.

  3. Partnering health disparities research with quality improvement science in pediatrics. (United States)

    Lion, K Casey; Raphael, Jean L


    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. Copyright © 2015 by the American Academy of Pediatrics.

  4. Can mental healthcare nurses improve sleep quality for inpatients? (United States)

    de Niet, Gerrit; Tiemens, Bea; Hutschemaekers, Giel

    This article describes a pilot study that was carried out to in order to gain an indication as to whether mental healthcare nurses can apply evidence-based interventions for sleep problems effectively in inpatient mental health care. The study had a pre-test/post-test design and a comparison group was used. The study was performed on three psychiatric admission wards, located in three different towns in one province of The Netherlands. The participants were inpatients (18-60 years old) admitted owing to severe mental health problems like psychotic, mood or anxiety disorders. Of the newly admitted patients, 62.8% perceived having a sleep problem. Two brief, evidence-based interventions were introduced on two of the wards: the first with stimulus control (SC) as active component; the second with music-assisted relaxation (MAR). A third ward, with no interventions other than usual care, served as a point of comparison. Sleep quality was monitored using the Richards-Campbell Sleep Questionnaire (RCSQ). The change score means of the treatment groups were compared with the mean score of the comparison group by means of a t-test. Estimates of effect were calculated. The results of this study showed that MAR produced a statistically significant improvement of sleep quality and showed a large effect size. The total RCSQ score did not improve significantly. SC failed to produce statistically significant improvement of sleep quality, nor of the RCSQ total score. This pilot study provided a strong indication that mental health nurses can apply MAR effectively. No such indication was found for stimulus control.

  5. Triage quality control is missing tools-a new observation technique for ED quality improvement. (United States)

    Malmström, Tomi; Harjola, Veli-Pekka; Torkki, Paulus; Kumpulainen, Salla; Malmström, Raija


    Correct assessment of patient urgency is critical to ensuring patient safety in emergency departments (EDs). Although significant time and effort have been devoted to developing triage systems, less attention has been paid to the development of quality control. The aim of this study is to introduce and test observation technique, which enables identifying of patient groups at risk of erroneous assessment in triage. The introduced technique is aimed to be less laborious to use than existing triage quality control methods. The study developed an observation technique for identifying patients with possible erroneous assessments in triage. Data sample for the observation technique is carried out with survey form filled in by nurse. Hospital ED with ~74 000 patient visits annually. Consecutive adult patients in an ED for baseline study period of 14 days (1774 patients) in 2010 and control study period of 4 days (541 patients) in 2012. Triage observation technique for continuous improvement of triage performance. Primary measures of triage improvement were triage accuracy and nurses' ability to predict patient admissions. With the observation technique the ED staff was able to identify patient groups at risk for erroneous triage. Under-triage related mostly to patients with chest pain, shortness of breath, collapse, stomach pain and infections. Instead injures and muscular skeletal symptoms were seldom undertriaged even though they are common. EDs can control triage quality with simple observation technique. The usability of observation technique and triage quality improvement process were good.

  6. 42 CFR 460.132 - Quality assessment and performance improvement plan. (United States)


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assessment and performance improvement plan...-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.132 Quality assessment and performance improvement plan. (a) Basic rule. A PACE organization must have a written quality...

  7. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    Directory of Open Access Journals (Sweden)

    Michelle L. Allen


    Full Text Available Background: Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected.Aim: This project was aimed at educating health care workers (HCWs in a primary health care clinic to increase diabetic foot screening practices. Setting: A primary health care clinic in the Western Cape province of South AfricaMethods: A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle.Results: HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR analysis showed promise for continuing quality improvement cycles.Conclusion: The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle.

  8. Improving breast cancer care through a regional quality collaborative. (United States)

    Breslin, Tara M; Caughran, Jamie; Pettinga, Jane; Wesen, Cheryl; Mehringer, Ann; Yin, Huiying; Share, David; Silver, Samuel M


    Regional collaborative organizations provide an effective structure for improving the quality of surgical care. With low complication rates and a long latency between surgical care and outcomes such as survival and local recurrence, quality measurement in breast cancer surgery is ideally suited to process measures. Diagnostic biopsy technique for breast cancer diagnosis is measurable and amenable to change at the provider level. We present initial results from our analysis of institutional variation in surgical and core needle biopsy use within a regional breast cancer quality collaborative. Established in 2006, the Michigan Breast Oncology Quality Initiative (MiBOQI) consists of 18 hospitals collecting data on breast cancer care using the National Comprehensive Cancer Centers Network (NCCN) Oncology Outcomes Database Project platform to analyze and compare breast cancer practices and outcomes amongst member institutions. Institutional review board approval is obtained at each site. Data are submitted electronically to the NCCN and analyzed for concordance with practice guidelines. Aggregate and blinded data are shared with project directors and institutions at collaborative meetings, and ongoing practice patterns are observed for change. We analyzed variation in breast biopsy technique for initial cancer diagnosis over time and between institutions. Diagnostic biopsies were categorized as core needle, surgical excisional, surgical incisional, and other surgical biopsy. Procedural data for 8,066 patients treated for breast cancer between November 1, 2006 and December 31, 2009 were analyzed. The mean patient age was 59.5 years (range, 25.4-90.0 years). Within MiBOQI, 21% of patients underwent surgical biopsy for initial diagnosis. The percentage of patients undergoing surgical biopsy ranged from 8% to 37%, and the majority of surgical biopsies were classified as excisional biopsies. Patients with ductal carcinoma in situ were more likely to undergo surgical biopsy

  9. Sparse-SEMAC: rapid and improved SEMAC metal implant imaging using SPARSE-SENSE acceleration. (United States)

    Otazo, Ricardo; Nittka, Mathias; Bruno, Mary; Raithel, Esther; Geppert, Christian; Gyftopoulos, Soterios; Recht, Michael; Rybak, Leon


    To develop an accelerated SEMAC metal implant MRI technique (Sparse-SEMAC) with reduced scan time and improved metal distortion correction. Sparse-SEMAC jointly exploits the inherent sparsity along the additional phase-encoding dimension and multicoil encoding capabilities to significantly accelerate data acquisition. A prototype pulse sequence with pseudorandom ky -kz undersampling and an inline image reconstruction was developed for integration in clinical studies. Three patients with hip implants were imaged using the proposed Sparse-SEMAC with eight-fold acceleration and compared with the standard-SEMAC technique used in clinical studies (three-fold GRAPPA acceleration). Measurements were performed with SEMAC-encoding steps (SES) = 15 for Sparse-SEMAC and SES = 9 for Standard-SEMAC using high spatial resolution Proton Density (PD) and lower-resolution STIR acquisitions. Two expert musculoskeletal (MSK) radiologists performed a consensus reading to score image-quality parameters. Sparse-SEMAC enables up to eight-fold acceleration of data acquisition that results in two-fold scan time reductions, compared with Standard-SEMAC, with improved metal artifact correction for patients with hip implants without degrading spatial resolution. The high acceleration enabled by Sparse-SEMAC would enable clinically feasible examination times with improved correction of metal distortion. Magn Reson Med 78:79-87, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  10. Vendor management: a model for collaboration and quality improvement. (United States)

    Friedman, M D; Bailit, M H; Michel, J O


    The Massachusetts Medicaid agency, also known as the Division of Medical Assistance, has developed a quality-driven approach for managing its managed care suppliers. Such an approach has, as its foundation, principles of continuous quality improvement (CQI). Suppliers participate in an annual process whereby CQI goals are negotiated between the division and its suppliers. The division then works with suppliers to achieve such goals. A cornerstone of the division's approach is the notion that data can highlight an unlimited number of opportunities for improvement and that pursuit of such opportunities will ultimately result in meaningful improvements in the health status of recipients who are served by the division. The agency's approach involves five key steps: 1) the development of contractual terms and purchasing specifications; 2) the identification of improvement priorities; 3) the negotiation of improvement goals; 4) efforts directed at meeting improvement goals and measurement of success; and 5) collaboration to achieve mutual objectives. Overall, suppliers report many benefits of collaborative participation in CQI activities with the division. Suppliers have enhanced their understanding of the importance of meeting the needs of the customer and have further accrued benefits resulting from discussions with managed care vendors throughout the site regarding benchmarking of efforts and CQI efforts. Conversely, suppliers are challenged by the need to balance and allocate resources to meet increasing demands, which are not always consistent, from various purchasers, including the division. The division has been challenged in the evolution of its contract management strategy by an uneven level of knowledge among managed care vendors regarding CQI; goal setting and measurement issues; the length of time and level of effort required to develop good relationships with suppliers; and the critical importance of comparable, valid, and timely submission of data. Over the

  11. Effectiveness of green infrastructure for improvement of air quality in urban street canyons. (United States)

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


    Street-level concentrations of nitrogen dioxide (NO(2)) and particulate matter (PM) exceed public health standards in many cities, causing increased mortality and morbidity. Concentrations can be reduced by controlling emissions, increasing dispersion, or increasing deposition rates, but little attention has been paid to the latter as a pollution control method. Both NO(2) and PM are deposited onto surfaces at rates that vary according to the nature of the surface; deposition rates to vegetation are much higher than those to hard, built surfaces. Previously, city-scale studies have suggested that deposition to vegetation can make a very modest improvement (<5%) to urban air quality. However, few studies take full account of the interplay between urban form and vegetation, specifically the enhanced residence time of air in street canyons. This study shows that increasing deposition by the planting of vegetation in street canyons can reduce street-level concentrations in those canyons by as much as 40% for NO(2) and 60% for PM. Substantial street-level air quality improvements can be gained through action at the scale of a single street canyon or across city-sized areas of canyons. Moreover, vegetation will continue to offer benefits in the reduction of pollution even if the traffic source is removed from city centers. Thus, judicious use of vegetation can create an efficient urban pollutant filter, yielding rapid and sustained improvements in street-level air quality in dense urban areas.

  12. Learning leadership skills in practice through quality improvement. (United States)

    Gamble, James; Vaux, Emma


    The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.

  13. Quality improvement – rival or ally of practice development?

    Directory of Open Access Journals (Sweden)

    Gavin Lavery


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

  14. Using DSP technology to improve sound quality in active speakers


    Magnusson, Mattias


    Aditus Science has developed a system to improve the sound quality in speaker systems, using DSP technology. Software developed in MATLAB is being used to make measurements of the speakers via microphones. Based on those results, the parameters for the signal processing in the DSP can be set. A prototype model of the system was used as hardware when the software was developed. The system has several analog and digital inputs and outputs over SPDIF, Ethernet, 3.5mm analog stereo plug etcetera....

  15. A resident-led quality improvement initiative to improve obesity screening. (United States)

    Laiteerapong, Neda; Keh, Chris E; Naylor, Keith B; Yang, Vincent L; Vinci, Lisa M; Oyler, Julie L; Arora, Vineet M


    Instruction on quality improvement (QI) methods is required as part of residency education; however, there is limited evidence regarding whether internal medicine residents can improve patient care using these methods. Because obesity screening is not done routinely in clinical practice, residents aimed to improve screening using QI techniques. Residents streamlined body mass index (BMI) documentation, created educational materials about obesity, and launched an obesity screening QI initiative in a residency clinic. Residents designed plan-do-study-act cycles focused on increasing awareness and maintaining improvements in screening over a 1-year period. Documentation rates were collected at baseline, 2 weeks, 6 months, and 1 year post-intervention. At 1 year, obesity treatment rates also were collected. BMI documentation rates after 1 year were higher than baseline (43% vs 4%, P improve screening.

  16. Improving organizational capacity to address health literacy in public health: a rapid realist review. (United States)

    Willis, C D; Saul, J E; Bitz, J; Pompu, K; Best, A; Jackson, B


    Despite the growing significance of health literacy to public health, relatively little is known about how organizational capacity may be improved for planning, implementing and sustaining health literacy interventions. This study aimed to connect decision makers in a public health agency with evidence of how organizational capacity may be improved for delivering health literacy services. A rapid realist review of published and grey literature was conducted by a partnership between the Public Health Agency of Canada (PHAC) and the InSource Research Group. Realist review methodology attempts to understand what works for whom under what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms and their relationship to outcome. This review was completed in collaboration with a reference panel (comprised of a broad range of PHAC representatives) and an expert panel. Literature searching was conducted using three databases supplemented with bibliographic hand searches and articles recommended by panels. Data were extracted on key variables related to definitions, strategies/interventions associated with increased organizational capacity, contextual factors associated with success (and failure), mechanisms activated as a result of different strategies and contexts, key outcomes, and evidence cited. Strategies found to be associated with improved organizational capacity for delivering health literacy services may be classified into three domains: (1) government action; (2) organizational/practitioner action; and (3) partnership action. Government action includes developing policies to reinforce social norms; setting standards for education; conducting research; and measuring health literacy levels. Organizational/practitioner action relates to appropriate models of leadership (both high-level government engagement and distributed leadership). Innovative partnership action includes collaborations with media outlets, those producing

  17. Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer's disease

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    Gross Hyman


    Full Text Available Abstract Background Recent clinical studies point to rapid and sustained clinical, cognitive, and behavioral improvement in both Alzheimer's disease and primary progressive aphasia following weekly perispinal administration of etanercept, a TNF-alpha inhibitor that acts by blocking the binding of this cytokine to its receptors. This outcome is concordant with recent basic science studies suggesting that TNF-alpha functions in vivo as a gliotransmitter that regulates synaptic function in the brain. We hypothesized that perispinal etanercept had the potential to improve verbal function in Alzheimer's disease, so we included several standarized measures of verbal ability to evaluate language skills in a clinical trial of perispinal etanercept for Alzheimer's disease. Methods This was a prospective, single-center, open-label, pilot study, in which 12 patients with mild-to-severe Alzheimer's disease were administered etanercept, 25–50 mg, weekly by perispinal administration for six months. Two additional case studies are presented. Results Two-tailed, paired t-tests were conducted comparing baseline performance to 6-month performance on all neuropsychological measures. Test batteries included the California Verbal Learning Test-Second Edition, Adult Version; Logical Memory I and II(WMS-LM-II from the Wechsler Memory Scale-Abbreviated; the Comprehensive Trail Making Test (TMT; Boston Naming Test; and letter(FAS and category verbal fluency. All measures revealed a significant effect except for the Boston Naming Test and the TMT-4, with WMS-LM-II being marginally significant at p = .05. The FAS test for letter fluency was most highly significant with a p Conclusion In combination with the previously reported results of perispinal etanercept in Alzheimer's disease and primary progressive aphasia, these results further argue that larger scale studies of this therapeutic intervention, including Phase 3 trials, are warranted in dementias. In addition

  18. Nonformal Education in Improving Quality of Life of Underprivileged Children

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    Abdullah Al Mamun


    Full Text Available This study explores the role of Non-formal Primary Education (NFPE in improving the quality of the life of underprivileged children in Bangladesh considering their economic, health, environmental issues and life skills. It uses a mixed method approach of research where three NGOs which run NFPE programs were selected purposefully. Data were derived from six NGO officers, nine teachers, ninety students and eighteen guardians by using two sets of questionnaires for NGO officers and teachers, an interview schedule for guardians and 9 focus group discussions with the students. The findings show that there is no income generating program initiated by the organizations for the learners along with education. So, the scope of their income has reduced. But their daily life behavior and skills have improved. Besides, their awareness on health and environmental issues have increased. The findings lead to some recommendations which will give insights to policy makers and professionals engaged in this field.

  19. Process engineering for primary care: Quality improvement and population health

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    William Riley


    Full Text Available A fundamental paradox of the health care delivery systems in many industrialized nations is that desired population health metrics are often not achieved despite large expenditures in the health care delivery system. For example, the United States commits nearly 18% of its GDP to the health care delivery system, the largest amount of any nation, yet is 37th in achieving health or health care delivery metrics. This article addresses how general practice can be an important driver of population health in the Chinese health care delivery system through the application of quality improvement methods. The article shows examples of how the cause-and-effect diagram, the process map, and the plan, do, study, act (PDSA cycle are important techniques to assist primary care practitioners for improving population health.

  20. Effectiveness of the Spirometry 360 Quality Improvement Program for Improving Asthma Care: A Cluster Randomized Trial. (United States)

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

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

  1. Comparing different methods for fast screening of microbiological quality of beach sand aimed at rapid-response remediation. (United States)

    Testolin, Renan C; Almeida, Tito C M; Polette, Marcus; Branco, Joaquim O; Fischer, Larissa L; Niero, Guilherme; Poyer-Radetski, Gabriel; Silva, Valéria C; Somensi, Cleder A; Corrêa, Albertina X R; Corrêa, Rogério; Rörig, Leonardo R; Itokazu, Ana Gabriela; Férard, Jean-François; Cotelle, Sylvie; Radetski, Claudemir M


    There is scientific evidence that beach sands are a significant contributor to the pathogen load to which visitors are exposed. To develop beach quality guidelines all beach zones must be included in microbiological evaluations, but monitoring methods for beach sand quality are relatively longstanding, expensive, laborious and require moderate laboratory infrastructure. This paper aimed to evaluate the microorganism activity in different beach zones applying and comparing a classical method of membrane filtration (MF) with two colorimetric screening methods based on fluorescein (FDA) and tetrazolium (TTC) salt biotransformation to evaluate a new rapid and low-cost method for beach sand microbiological contamination assessments. The colorimetric results can help beach managers to evaluate rapidly and at low cost the microbiological quality of different beach zones in order to decide whether remedial actions need to be adopted to prevent exposure of the public to microbes due to beach sand and/or water contamination. Copyright © 2017. Published by Elsevier Ltd.

  2. Laboratory system strengthening and quality improvement in Ethiopia

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    Tilahun M. Hiwotu


    Full Text Available Background: In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA programme was initiated in 45 Ethiopian laboratories.Objectives: This article discusses the implementation of the programme, the findings from the evaluation process and key challenges.Methods: The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hoursfor cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star ratinglevels.Results: Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p < 0.01; and 42% and 53% for cohort II (p < 0.01,respectively. The p-value for difference between cohorts was 0.07. At the exit audit, 61% ofthe first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified.Conclusion: Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities.

  3. Laboratory system strengthening and quality improvement in Ethiopia

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    Tilahun M. Hiwotu


    Full Text Available Background: In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA programme was initiated in 45 Ethiopian laboratories. Objectives: This article discusses the implementation of the programme, the findings from the evaluation process and key challenges. Methods: The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hoursfor cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star ratinglevels. Results: Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p < 0.01; and 42% and 53% for cohort II (p < 0.01,respectively. The p-value for difference between cohorts was 0.07. At the exit audit, 61% ofthe first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified. Conclusion: Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities.

  4. Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs. (United States)

    Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A


    The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The

  5. 42 CFR 438.240 - Quality assessment and performance improvement program. (United States)


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assessment and performance improvement... Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and performance... PIHP have an ongoing quality assessment and performance improvement program for the services it...

  6. Doctors in China: improving quality through modernisation of residency education. (United States)

    Zhu, Jiming; Li, Wenkai; Chen, Lincoln


    There is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. To improve understanding for the Chinese model, we present a comparative perspective with systems from the UK and USA. To succeed, the 5 + 3 model will need to overcome major challenges of accreditation and certification, alternative education pathways, and China's unique degree and credentialing system. We conclude by reviewing the challenges of clinical competencies in China, especially the complementarity of specialist training and general practitioner training, which are essential for the quality and equity of China's health-care system. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Improving labeling efficiency in automatic quality control of MRSI data. (United States)

    Pedrosa de Barros, Nuno; McKinley, Richard; Wiest, Roland; Slotboom, Johannes


    To improve the efficiency of the labeling task in automatic quality control of MR spectroscopy imaging data. 28'432 short and long echo time (TE) spectra (1.5 tesla; point resolved spectroscopy (PRESS); repetition time (TR)= 1,500 ms) from 18 different brain tumor patients were labeled by two experts as either accept or reject, depending on their quality. For each spectrum, 47 signal features were extracted. The data was then used to run several simulations and test an active learning approach using uncertainty sampling. The performance of the classifiers was evaluated as a function of the number of patients in the training set, number of spectra in the training set, and a parameter α used to control the level of classification uncertainty required for a new spectrum to be selected for labeling. The results showed that the proposed strategy allows reductions of up to 72.97% for short TE and 62.09% for long TE in the amount of data that needs to be labeled, without significant impact in classification accuracy. Further reductions are possible with significant but minimal impact in performance. Active learning using uncertainty sampling is an effective way to increase the labeling efficiency for training automatic quality control classifiers. Magn Reson Med 78:2399-2405, 2017. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.


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    Lăcrămioara RADOMIR


    Full Text Available The purpose of this study is twofold: 1. examine the relationship betweenservice quality dimensions and customer satisfaction with bank territorialunits; 2. establish which quality measure method out of the four considered inthis study should be applied in order to better determine the areas that needfurther improvement and investment. In this respect, we performed PrincipalComponent Regression (PCR and considered direct importance andperformance measures as well. Our results reveal that human resourceshave the greatest impact on customers’ satisfaction with bank territorial unitsand that both “Convenience and Efficiency” and “Bank personnel” are thedimensions that bank management should consider in their efforts to improveand maintain the service quality level. To the best of our knowledge, this isthe first study which tries to emphasize the relationship between servicequality dimensions and Romanian customers’ satisfaction with bank territorialunits. The main limit of the study lies in the fact that data were collectedamong the customers of a single bank. Nevertheless, it provides valuableinformation about the Romanian market and ought to be considered astarting point for further studies.

  9. Applying Quality Function Deployment Model in Burn Unit Service Improvement. (United States)

    Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi


    Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives.

  10. Multifaceted quality improvement initiative to decrease pediatric asthma readmissions. (United States)

    Krupp, Nadia L; Fiscus, Cindy; Webb, Russell; Webber, Emily C; Stanley, Teresa; Pettit, Rebecca; Davis, Ashley; Hollingsworth, Judy; Bagley, Deborah; McCaskey, Marjorie; Stevens, John C; Weist, Andrea; Cristea, A Ioana; Warhurst, Heather; Bauer, Benjamin; Saysana, Michele; Montgomery, Gregory S; Howenstine, Michelle S; Davis, Stephanie D


    Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.

  11. Infliximab improves quality of life in patients with Crohn's disease. (United States)

    Lichtenstein, Gary R; Bala, Mohan; Han, Chenglong; DeWoody, Kimberly; Schaible, Thomas


    The aim of this study was to assess the effect of infliximab on quality of life in patients with active Crohn's disease (CD) inadequately responsive to concomitant therapies. We examined responses to the Inflammatory Bowel Disease Questionnaire (IBDQ) from patients enrolled in a previously reported, randomized, placebo-controlled study. Patients with active CD received a single intravenous infusion of either placebo or infliximab 5, 10, or 20 mg/kg. Most patients received stable doses of mesalamine, corticosteroids, azathioprine, or 6-mercaptopurine throughout the study. Changes from baseline in overall IBDQ score and individual dimensions at 4 weeks postinfusion were compared. Patients treated with infliximab had a significantly larger improvement in overall IBDQ score than those treated with placebo at 4 weeks (p doing leisure or sports activities (p = 0.011), and being extremely or very satisfied with their personal life (p = 0.046). They also significantly differed in responses regarding fatigue, frustration, ability to work, general well-being, depression, anxiety, and anger resulting from bowel problems. These results indicate that infliximab significantly improved quality of life in patients with active CD, increasing their ability to work and participate in leisure activities, and decreasing feelings of fatigue, depression, and anger.

  12. Combating the 'Sick Building Syndrome' by Improving Indoor Air Quality

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    Pongchai Nimcharoenwon


    Full Text Available Research indicates that many of symptoms attributed to the Sick Building Syndrome in air-conditioned office buildings are a result of considerably reduced negative ions in the internal atmosphere and that replacing the depleted negative ions can improve indoor air quality. This paper describes a method used to develop a formula (DOF-NIL formula for calculating the amount of negative ions to be added to air-conditioned buildings, to improve air quality. The formula enables estimates to be made based on how negative ions in the air are reduced by three main factors namely, Video Display Terminals (VDT; heating, ventilation and air conditioning (HVAC and Building Contents (BC. Calculations for a typical air-conditioned office, are compared with an Air Ion Counter instrument. The results show that the formula, when applied to a typical air-conditioned office, provides an accurate estimate for design purposes. The typical rate of additional negative-ions (ion-generating for a negative ion condition is found to be approximately 12.0 billion ions/hr for at least 4 hour ion-generating.

  13. Implantable cardioverter defibrillator deactivation: a hospice quality improvement initiative. (United States)

    Kraynik, Sally E; Casarett, David J; Corcoran, Amy M


    Dying patients whose implantable cardioverter defibrillators (ICDs) continue to deliver shocks may experience significant pain, and the National Quality Forum has endorsed routine deactivation of ICDs when patients near the end of life. The overarching goal of this quality improvement project was to increase rates of ICD deactivation among hospice patients. ICD deactivation rates pre- vs. post-intervention; and clinicians' knowledge and confidence regarding ICD management. A multifaceted intervention included clinical tools, education, and standardized documentation templates in the electronic medical record. The proportion of patients whose ICD was deactivated increased after the intervention (pre- vs. post-intervention: 39/68, 57% vs. 47/56, 84%; odds ratio 3.88; 95% confidence interval 1.54-10.37; P = 0.001). Clinicians' knowledge and confidence regarding ICD management improved (pre- vs. post-intervention median questionnaire scores: 5 vs. 9 on a scale of 0 to 10; Wilcoxon signed-rank test Z = -5.01; P < 0.001). A multifaceted intervention can increase rates of ICD deactivation among patients near the end of life. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  14. Assessing quality improvement in health care: theory for practice. (United States)

    Kleinman, Lawrence C; Dougherty, Denise


    To review the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care. Conceptual model, informed by literature review. To optimize learning across QI studies requires the integration of small-scale theories (middle-range theories, theories of change) within the context of larger unifying theories. We propose that health care QI research would benefit from a theory that describes the operations of health care delivery, including the multiplicity of roles that interpersonal interactions play. The broadest constructs of the model are entry into the system, and assessment and management of the patient, with the subordinate operations of access; recognition, assessment, and diagnosis; and medical decision-making (developing a plan), coordination of care, execution of care, referral and reassessment, respectively. Interpersonal aspects of care recognize the patient/caregiver as a source of information, an individual in a cultural context, a complex human being, and a partner in their care. Impacts to any and all of these roles may impact the quality of care. Such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies. The articulation of such a theory may simultaneously provide guidance for the QI researcher and an opportunity for refinement and improvement.

  15. Systematic infrared image quality improvement using deep learning based techniques (United States)

    Zhang, Huaizhong; Casaseca-de-la-Higuera, Pablo; Luo, Chunbo; Wang, Qi; Kitchin, Matthew; Parmley, Andrew; Monge-Alvarez, Jesus


    Infrared thermography (IRT, or thermal video) uses thermographic cameras to detect and record radiation in the longwavelength infrared range of the electromagnetic spectrum. It allows sensing environments beyond the visual perception limitations, and thus has been widely used in many civilian and military applications. Even though current thermal cameras are able to provide high resolution and bit-depth images, there are significant challenges to be addressed in specific applications such as poor contrast, low target signature resolution, etc. This paper addresses quality improvement in IRT images for object recognition. A systematic approach based on image bias correction and deep learning is proposed to increase target signature resolution and optimise the baseline quality of inputs for object recognition. Our main objective is to maximise the useful information on the object to be detected even when the number of pixels on target is adversely small. The experimental results show that our approach can significantly improve target resolution and thus helps making object recognition more efficient in automatic target detection/recognition systems (ATD/R).

  16. Appreciative Inquiry for Quality Improvement in Primary Care Practices (United States)

    Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.


    Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective. PMID:21192206

  17. Presenting Symptoms and Dysphagia Screen Predict Outcome in Mild and Rapidly Improving Acute Ischemic Stroke Patients. (United States)

    Gadodia, Gaurav; Rizk, Nibal; Camp, Deborah; Bryant, Katja; Zimmerman, Susan; Brasher, Cynthia; Connelly, Kerrin; Dunn, Joshua; Frankel, Michael; Ido, Moges Seymour; Lugtu, James; Nahab, Fadi


    There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes. Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home. There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Low-volume high-intensity interval training rapidly improves cardiopulmonary function in postmenopausal women. (United States)

    Klonizakis, Markos; Moss, James; Gilbert, Stephen; Broom, David; Foster, Jeff; Tew, Garry A


    This study compared the effects of a 2-week program of low-volume high-intensity interval training (HIT) with the effects of higher-volume moderate-intensity continuous training (CT) on cardiopulmonary and vascular functions in postmenopausal women. Twenty-two postmenopausal women were randomly assigned to undertake six HIT (n = 12) or CT (n = 10) sessions for 2 weeks. HIT sessions consisted of ten 1-minute intervals of cycling exercise at 100% of peak power output separated by 1 minute of active recovery. CT sessions involved 40 minutes of continuous cycling at 65% of peak power output. Variables assessed at baseline and 2 weeks included cardiopulmonary function (ventilatory threshold, peak oxygen uptake), macrovascular endothelial function (flow-mediated dilation of the brachial artery), and microvascular function (reactive hyperemia and local thermal hyperemia of forearm skin). Eighteen participants completed the study (HIT, 11; CT, 7). Adherence to the exercise programs was excellent, with 107 of 108 sessions completed. Despite substantially lower total time commitment (∼2.5 vs. ∼5 h) and training volume (558 vs. 1,237 kJ) for HIT versus CT, increases from baseline in peak oxygen uptake achieved significance (P = 0.01) for the HIT group only (Δ = 2.2 mL kg min; P for interaction = 0.688). Improvements in exercise test duration were observed in both groups (HIT, 13%; CT, 5%; P for interaction = 0.194). There were no significant changes in macrovascular or microvascular function in either group. The findings suggest that low-volume HIT is feasible and can lead to rapid improvements in cardiopulmonary function in postmenopausal women.

  19. Ripening for improving the quality of inoculated cheese Rhizopus oryzae

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    Full Text Available Estikomah SA, Sutarno, Pangastuti A 2010. Ripening for improving the quality of inoculated cheese Rhizopus oryzae. Nusantara Bioscience 2: 1-6. Cheese is dairy product resulted from fermented milk in which the fermentation process can be done by lactic acid bacteria or fungus. Rhizopus oryzae is able to produce lactic acid, protease and lipase. The ripening process changes the taste and texture. The purpose of this study is ripening to improve the quality of inoculated cheese R. oryzae. In this research the ripening was conducted the concentration variation of temperature (5oC, 10oC, 15oC, and time (7 days, 14 days. The procedure of research consisted of two steps, namely un-ripened cheese preparation followed by ripening cheese preparation. Cheese produced in this study analyzed the value of pH, fat content, protein content, amino acid levels and identification of microbe with ANOVA then followed by DMRT at 5% level of significance. Data results were analyzed with the like’s nonparametric statistical test, followed by Fridman Wilcoxon Signed Rank Test (WSRT at 5% level significance. The results showed that the preferred ripened cheese panelist was at a temperature of 15oC for 14 days. Ripening conditions affect pH, fat content, protein content and do not affect the levels of amino acids that formed ripened cheese. The best quality ripened cheese i.e. at a temperature of 15°C for 14 days, had a pH value of 4.40, the highest protein content of 9.78%, and fat content of 35.02%. The results of identified microbe in un-ripened cheese and ripened cheese include Enterococcus hirae (Enterococcus faecalis, Bacillus subtilis, and Aspergillus sp.

  20. Quality improvement in primary care: ethical issues explored. (United States)

    Tapp, Laura; Elwyn, Glyn; Edwards, Adrian; Holm, Søren; Eriksson, Tina


    Quality improvement (QI) processes in family medicine are becoming increasingly complex. Their influence on the organisation of the sector and on the daily work processes is profound and increasing. The literature indicates that many ethical issues are arising from QI work. Therefore this paper aims to identify the experiences of professionals involved in planning and performing QI programmes in European family medicine on the ethical implications involved in those processes. Four focus groups were carried out with 29 general practitioners (GPs) and administrators of general practice quality work in Europe. Two focus groups comprised EQuiP members and two focus groups comprised attendees to an invitational conference on QI in family medicine held by EQuiP in Barcelona in November 2006. Four overarching themes were identified, including implications of using patient data, prioritising QI projects, issues surrounding the ethical approval dilemma and the impact of QI. Each theme was accompanied by an identified solution. Prioritising is necessary and in doing that GPs should ensure that a variety of work is conducted so that some patient groups are not neglected. Transparency and flexibility on various levels is necessary to avoid harmful consequences of QI in terms of bureaucratisation, increased workload and burnout on part of the GP and harmful effects on the doctor-patient relationship. There is a need to address the system of approval for national QI programmes and QI projects utilising more sophisticated methodologies. This study provides data from GPs who are experienced quality improvers across 17 countries. Many ethical issues were identified and it was possible to clearly map the themes and their relationships and to summarise the identified solutions from an international perspective.

  1. Improving permanent magnetic properties of rapidly solidified nanophase RE-TM-B alloys by compositional modification

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Z.W. [School of Materials Science and Engineering, South China University of Technology, Guangzhou 510640 (China); School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798 (Singapore); Department of Engineering Materials, University of Sheffield, Sheffield S1 3JD (United Kingdom)], E-mail:; Liu, Yan; Deheri, P.K.; Ramanujan, R.V. [School of Materials Science and Engineering, Nanyang Technological University, Singapore 639798 (Singapore); Davies, H.A. [Department of Engineering Materials, University of Sheffield, Sheffield S1 3JD (United Kingdom)


    Rapid solidification is one of the most important techniques to produce nanocrystalline rare-earth-transition metal-boron (RE-TM-B) hard magnetic materials. To achieve high performance on these NdFeB-based alloys, compositional modification and microstructure optimization have been frequently employed. In this short review, various substitutions and doping elements have been discussed regarding to their behaviors in adjusting the individual or combined hard magnetic properties as well as the microstructure based on our recent results. It has been demonstrated that Pr and Dy enhance coercivity {sub j}H{sub C}, whereas Sm reduces {sub j}H{sub C} due to their effects on intrinsic properties. Co improves the thermal stability as well as the microstructure. Introducing Fe{sub 65}Co{sub 35} is a possible approach to enhance the magnetization and maximum energy product (BH){sub max}. As a doping element, Ta was found to play an important role to obtain an appropriate combination of magnetic properties for this type of alloys.

  2. A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients. (United States)

    Kuo, James C; De Silva, Madhawa; Diwakarla, Chandra; Yip, Desmond


    Cancer patients may find it challenging to access timely advice and care. We evaluated the improvement in delivering ambulatory care in establishing a Rapid Assessment Clinic (RAC) in a cancer center. Patients receiving chemotherapy who presented for assessment at the RAC from September 2013 to June 2014 were included for review. Patient demographics, tumor characteristics, presenting complaints, time to assessment, total time spent at the RAC and assessment outcome were extracted. Similar data for cancer patients presented to the emergency department (ED) but were appropriate for RAC assessment from February 2012 to August 2012 were reviewed for comparison. For patients with febrile neutropenia, time to empirical antibiotic therapy was also reviewed and analyzed. Comparing to ED presentation (n = 152), patients reviewed at the RAC (n = 217) had a shorter waiting time to medical review (28.5 vs 40 min, P = 0.12), shorter total time spent for review (3.1 vs 9.7 hrs, P care, resulting in a lower rate of hospital admission and inpatient length of stay for cancer patients. There was, however, no difference in the management of febrile neutropenia. © 2016 John Wiley & Sons Australia, Ltd.

  3. Improved rapid magnitude estimation for a community-based, low-cost MEMS accelerometer network (United States)

    Chung, Angela I.; Cochran, Elizabeth S.; Kaiser, Anna E.; Christensen, Carl M.; Yildirim, Battalgazi; Lawrence, Jesse F.


    Immediately following the Mw 7.2 Darfield, New Zealand, earthquake, over 180 Quake‐Catcher Network (QCN) low‐cost micro‐electro‐mechanical systems accelerometers were deployed in the Canterbury region. Using data recorded by this dense network from 2010 to 2013, we significantly improved the QCN rapid magnitude estimation relationship. The previous scaling relationship (Lawrence et al., 2014) did not accurately estimate the magnitudes of nearby (estimates earthquake magnitudes within 1 magnitude unit of the GNS Science GeoNet earthquake catalog magnitudes for 99% of the events tested, within 0.5 magnitude units for 90% of the events, and within 0.25 magnitude units for 57% of the events. These magnitudes are reliably estimated within 3 s of the initial trigger recorded on at least seven stations. In this report, we present the methods used to calculate a new scaling relationship and demonstrate the accuracy of the revised magnitude estimates using a program that is able to retrospectively estimate event magnitudes using archived data.

  4. Paediatric early warning scores on a children's ward: a quality improvement initiative.

    LENUS (Irish Health Repository)

    Ennis, Linda


    The aim of this quality improvement initiative was to incorporate a paediatric early warning score (PEWS) and track and trigger system in the routine care of children in an acute general children\\'s ward at a regional hospital in the Republic of Ireland. In the absence of a nationally recommended specific PEWS strategy, a local plan was developed. The experience of structuring and implementing the PEWS and track and trigger system is presented in this article. Data from the first year of use were collected to evaluate the clinical utility and effectiveness of this system. In the busy acute children\\'s service, the PEWS initiative was found to benefit processes of early detection, prompt referral and timely, appropriate management of children at potential risk of clinical deterioration. Nursing staff were empowered and supported to communicate concerns immediately and to seek rapid medical review, according to an agreed PEWS escalation plan. Outcomes were significantly improved.

  5. Paediatric early warning scores on a children's ward: a quality improvement initiative. (United States)

    Ennis, Linda


    The aim of this quality improvement initiative was to incorporate a paediatric early warning score (PEWS) and track and trigger system in the routine care of children in an acute general children's ward at a regional hospital in the Republic of Ireland. In the absence of a nationally recommended specific PEWS strategy, a local plan was developed. The experience of structuring and implementing the PEWS and track and trigger system is presented in this article. Data from the first year of use were collected to evaluate the clinical utility and effectiveness of this system. In the busy acute children's service, the PEWS initiative was found to benefit processes of early detection, prompt referral and timely, appropriate management of children at potential risk of clinical deterioration. Nursing staff were empowered and supported to communicate concerns immediately and to seek rapid medical review, according to an agreed PEWS escalation plan. Outcomes were significantly improved.

  6. The Costs of Participating in a Diabetes Quality Improvement Collaborative: Variation Among Five Clinics. (United States)

    Sathe, Neha A; Nocon, Robert S; Hughes, Brenna; Peek, Monica E; Chin, Marshall H; Huang, Elbert S


    Quality improvement collaboratives (QICs) support rapid testing and implementation of interventions through the collective experience of participating organizations to improve care quality and reduce costs. Although QICs have been societally cost-effective in improving the care of chronic diseases, they may not be adopted by outpatient clinics if their costs are high. Diabetes QICs warrant reexamination as secular trends in the quality of diabetes care, new care guidelines for diabetes, and evolving strategies for quality improvement may have altered implementation costs. The costs over the first four years-from June 2009 through May 2013-of an ongoing diabetes QIC were characterized by activities and over time. The QIC, linking six clinics on Chicago's South Side, tailored interventions to minority populations and built community partnerships. Costs were calculated from clinic surveys regarding activities, labor, and purchases. Data were obtained from five of the six participating clinics. Cost/diabetic patient/year ranged across clinic sites from $6 (largest clinic) to $68 (smallest clinic). Clinics spent 62%-88% of their total QIC costs on labor. The cost/diabetic patient/year changed over time from Year 1 (range across clinics, $5-$51), Year 2 ($11-$84), Year 3 ($4-$57), to Year 4 ($4-$80), with costs peaking at Year 2 for all clinics except Clinic 4, where costs peaked at Year 4. Cost experiences of QICs in clinics were di- verse over time and setting. High per-patient costs may stem from small clinic size, a sicker patient population, and variation in personnel type used. Cost decreases over time may represent increasing organizational learning and efficiency. Sharing resources may have achieved additional cost savings. This practical information can help administrators and policy makers predict, manage, and support costs of QICs as payers increasingly seek high-value health care.

  7. Continuous quality improvement in nephrology: a systematic review. (United States)

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


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

  8. Improved statistical method for temperature and salinity quality control (United States)

    Gourrion, Jérôme; Szekely, Tanguy


    Climate research and Ocean monitoring benefit from the continuous development of global in-situ hydrographic networks in the last decades. Apart from the increasing volume of observations available on a large range of temporal and spatial scales, a critical aspect concerns the ability to constantly improve the quality of the datasets. In the context of the Coriolis Dataset for ReAnalysis (CORA) version 4.2, a new quality control method based on a local comparison to historical extreme values ever observed is developed, implemented and validated. Temperature, salinity and potential density validity intervals are directly estimated from minimum and maximum values from an historical reference dataset, rather than from traditional mean and standard deviation estimates. Such an approach avoids strong statistical assumptions on the data distributions such as unimodality, absence of skewness and spatially homogeneous kurtosis. As a new feature, it also allows addressing simultaneously the two main objectives of an automatic quality control strategy, i.e. maximizing the number of good detections while minimizing the number of false alarms. The reference dataset is presently built from the fusion of 1) all ARGO profiles up to late 2015, 2) 3 historical CTD datasets and 3) the Sea Mammals CTD profiles from the MEOP database. All datasets are extensively and manually quality controlled. In this communication, the latest method validation results are also presented. The method has already been implemented in the latest version of the delayed-time CMEMS in-situ dataset and will be deployed soon in the equivalent near-real time products.

  9. Evaluating a community-based program to improve healthcare quality: research design for the Aligning Forces for Quality initiative. (United States)

    Scanlon, Dennis P; Alexander, Jeffrey A; Beich, Jeff; Christianson, Jon B; Hasnain-Wynia, Romana; McHugh, Megan C; Mittler, Jessica N; Shi, Yunfeng; Bodenschatz, Laura J


    The Aligning Forces for Quality (AF4Q) initiative is the Robert Wood Johnson Foundation's (RWJF's) signature effort to increase the overall quality of healthcare in targeted communities throughout the country. In addition to sponsoring this 16-site, complex program, the RWJF funds an independent scientific evaluation to support objective research on the initiative's effectiveness and contributions to basic knowledge in 5 core programmatic areas. The research design, data, and challenges faced in the evaluation of this 10-year initiative are discussed. A descriptive overview of the evaluation research design for a multi-site, community based, healthcare quality improvement initiative is provided. The multiphase research design employed by the evaluation team is discussed. Evaluation provides formative feedback to the RWJF, participants, and other interested audiences in real time; develops approaches to assess innovative and under-studied interventions; furthers the analysis and understanding of effective community-based collaborative work in healthcare; and helps to differentiate the various facilitators, barriers, and contextual dimensions that affect the implementation and outcomes of community-based health interventions. The AF4Q initiative is arguably the largest community-level healthcare improvement demonstration in the United States to date; it is being implemented at a time of rapid change in national healthcare policy. The implementation of large-scale, multi-site initiatives is becoming an increasingly common approach for addressing problems in healthcare. The evaluation research design for the AF4Q initiative, and the lessons learned from its approach, may be valuable to others tasked with evaluating similar community-based initiatives.

  10. Improving health promotion using quality improvement techniques in Australian Indigenous primary health care

    Directory of Open Access Journals (Sweden)

    Nikki ePercival


    Full Text Available While some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centres. Our study objectives were to: (a describe the scope and quality of health promotion activities; (b describe the status of health centre system support for health promotion activities; and (c introduce a CQI intervention and examine the impact on health promotion activities and health centres systems over two years. Baseline assessments showed sub-optimal health centre systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health centre systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence based health promotion by engaging front line health practitioners in decision making processes about the design/redesign of health centre systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff and members of the local community to address organisational and policy level barriers.

  11. Applying Quality Improvement into Systems-based Learning to Improve Diabetes Outcomes in Primary Care. (United States)

    Moreo, Kathleen; Sapir, Tamar; Greene, Laurence


    In the U.S., where the prevalence of type 2 diabetes has reached epidemic proportions, many patients with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs). To address gaps in the quality of diabetes care, national quality measures have been established, including patient-centered measures adopted by the Centers for Medicare and Medicaid Services for its Shared Savings Program for ACOs. From a patient-centered perspective, high-quality diabetes care depends on effective communication between clinicians and patients, along with patient education and counseling about medications and lifestyle. We designed and implemented a quality improvement (QI) program for 30 primary care physicians treating patients with type 2 diabetes in three structurally similar but geographically diverse ACOs. Retrospective chart audits were conducted before (n = 300) and after (n = 300) each physician participated in accredited continuing medical education (CME) courses that focused on QI strategies. Randomly selected charts were audited to measurably assess essential interventions for improved outcomes in type 2 diabetes including the physicians' documentation of patient counseling and assessment of side effects, and patients' medication adherence status and changes in hemoglobin A1C (A1C) and body mass index (BMI). Paced educational interventions included a private performance improvement Internet live course conducted for each physician, small-group Internet live courses involving peer discussion, and a set of enduring materials, which were also multi-accredited for all clinicians in the physician's practice. Continual improvement cycles were guided by analysis of the baseline chart audits, quantitative survey data, and qualitative feedback offered by participants. To extend the benefit of the education, the enduring materials were offered to the interprofessional team of clinicians throughout the U.S. who did

  12. A framework for healthcare quality improvement in India: The time is here and now!

    Directory of Open Access Journals (Sweden)

    P Varkey


    Full Text Available Healthcare in India has been undergoing rapid changes in the last decade. As demand outpaces supply, quality improvement (QI initiatives and tools can be beneficial to enhance safe, effective, efficient, equitable and timely care. Healthcare quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. This article discusses the framework for QI and reviews the Plan-Do-Study-Act (PDSA, Lean and Six Sigma methodologies, and briefly discusses key patient safety and quality measurement concepts. The PDSA cycle assists in testing the ideas through small tests of change or "pilots". Six Sigma aims at reducing variations in processes, and the Lean methodology predominantly focuses on enhancing process efficiency and eliminating non-value added steps in the process. It is likely that such structured problem solving approaches will provide an objective and systematic method of enhancing quality in healthcare institutions across India. As increasing attention being is paid on enhancing the quality of life through the Quality Council of India and accreditation of hospitals in India through the International Organization for standardization and National Accreditation Board for hospitals and healthcare providers, a focus on QI by institutional leaders and healthcare providers is key to enhancing the safety and quality of healthcare in India. Central to this also will be leadership buy-in, identification of a core faculty or team that will be the initiators of change, a respect for the need for faculty training and education in QI, measurement of issues to identify key priorities to focus on, and enhanced information systems where resources permit the same.

  13. A framework for healthcare quality improvement in India: the time is here and now! (United States)

    Varkey, P; Kollengode, A


    Healthcare in India has been undergoing rapid changes in the last decade. As demand outpaces supply, quality improvement (QI) initiatives and tools can be beneficial to enhance safe, effective, efficient, equitable and timely care. Healthcare quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. This article discusses the framework for QI and reviews the Plan-Do-Study-Act (PDSA), Lean and Six Sigma methodologies, and briefly discusses key patient safety and quality measurement concepts. The PDSA cycle assists in testing the ideas through small tests of change or "pilots". Six Sigma aims at reducing variations in processes, and the Lean methodology predominantly focuses on enhancing process efficiency and eliminating non-value added steps in the process. It is likely that such structured problem solving approaches will provide an objective and systematic method of enhancing quality in healthcare institutions across India. As increasing attention being is paid on enhancing the quality of life through the Quality Council of India and accreditation of hospitals in India through the International Organization for standardization and National Accreditation Board for hospitals and healthcare providers, a focus on QI by institutional leaders and healthcare providers is key to enhancing the safety and quality of healthcare in India. Central to this also will be leadership buy-in, identification of a core faculty or team that will be the initiators of change, a respect for the need for faculty training and education in QI, measurement of issues to identify key priorities to focus on, and enhanced information systems where resources permit the same.

  14. Better IVF outcomes following improvements in laboratory air quality. (United States)

    Khoudja, Rabea Youcef; Xu, Yanwen; Li, Tao; Zhou, Canquan


    It has been proved that air quality is crucial for the success of IVF because of the presence of volatile organic compounds (VOCs), microbes, and perfumes, all of which can be harmful to embryo development in vitro. Therefore IVF laboratories are equipped with high efficiency particulate air (HEPA), and activated carbon filters plus positive pressure for air particulate control, with or without CODA system. Here we introduce a new technology using specially treated Honeycomb matrix media aligned in the Landson ™ series system for our laboratory air purification and its impact on IVF outcome. Air samples were collected outside and inside the laboratory, and intra-incubator at three different time points, before and after changing carbon filters and after Landson system installation, and we correlated air compounds measure variation with IVF outcome from 1403 cycles. An improvement of air quality was confirmed with passages of total VOCs from 0.42 mg/m(3), 30.48 mg/m(3), 9.62 mg/m3, to 0.1 mg/m(3), 2.5 mg/m(3), 2.19 mg/m(3) through 0.07 mg/m(3), 0.16 mg/m(3), 0.29 mg/m(3), outside the laboratory, inside laboratory and intra-incubator respectively at three separated air sampling times. A clear decrease was observed in some VOCs such as formaldehyde, ethylene, acethylene, propylene, SO2, pentane, NOx, benzene, Hallon-1211, CFC and alcohol. At the same time a significant difference (Psystem installation and the first testing time TT1 before carbon filter change in fertilization rate 83.7 % vs 70.1 %, embryo cleavage rate 97.35 % vs 90.8 %, day 5 blastocyst formation rate 51.1 % vs 41.7 %, and pregnancy/implantation rates 54.6 %, 34.4 % vs 40.6 %, 26.4 %. Air purification by the new technology of Landson ™ series significantly improved IVF laboratory air quality, and embryo quality, thus increased pregnancy and implantation rates.

  15. The ethics of using quality improvement methods in health care. (United States)

    Lynn, Joanne; Baily, Mary Ann; Bottrell, Melissa; Jennings, Bruce; Levine, Robert J; Davidoff, Frank; Casarett, David; Corrigan, Janet; Fox, Ellen; Wynia, Matthew K; Agich, George J; O'Kane, Margaret; Speroff, Theodore; Schyve, Paul; Batalden, Paul; Tunis, Sean; Berlinger, Nancy; Cronenwett, Linda; Fitzmaurice, J Michael; Dubler, Nancy Neveloff; James, Brent


    Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their relationship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings and concluded that QI is an intrinsic part of normal health care operations. Both clinicians and patients have an ethical responsibility to participate in QI, provided that it complies with specified ethical requirements. Most QI activities are not human subjects research and should not undergo review by an institutional review board; rather, appropriately calibrated supervision of QI activities should be part of professional supervision of clinical practice. The group formulated a framework that would use key characteristics of a project and its context to categorize it as QI, human subjects research, or both, with the potential of a customized institutional review board process for the overlap category. The group recommended a period of innovation and evaluation to refine the framework for ethical conduct of QI and to integrate that framework into clinical practice.

  16. Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review. (United States)

    Prince, Lisa K; Little, Dustin J; Schexneider, Katherine I; Yuan, Christina M


    The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice-based learning and systems-based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty-specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty-specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. Nephrology-specific didactic material exists to assist nephrology fellows and faculty mentors in designing and implementing quality improvement projects. Nephrology is notable among internal medicine subspecialties for the emphasis placed on adherence to quality thresholds-specifically for chronic RRT shown by the Centers for Medicare and Medicaid Services Quality Incentive Program. We have developed a nephrology-specific curriculum that meets Accreditation Council for Graduate Medical Education and Clinical Learning Environment Review requirements, acknowledges regulatory quality improvement requirements, integrates with ongoing divisional quality improvement activities, and has improved clinical care and the training program. In addition to didactic training in quality improvement, we track trainee compliance with Kidney Disease Improving Global Outcomes CKD and ESRD quality indicators (emphasizing Quality Improvement Program indicators), and fellows collaborate on a yearly multidisciplinary quality improvement project. Over the past 6 years, each fellowship class has, on the basis of a successful quality improvement project, shown milestone achievement in Systems-Based Practice and Practice-Based Learning. Fellow quality improvement projects have improved

  17. Elevated guideway cost-ride quality studies for group rapid transit systems (United States)


    A methodology is developed for relating cost to ride quality in elevated guideway : system design, based upon directly relating guideway structural properties and : construction tolerances to both cost and ride quality. It is illustrated in detail : ...

  18. Creating a business case for quality improvement research: expert views, workshop summary

    National Research Council Canada - National Science Library

    Chao, Samantha


    The Institute of Medicine (IOM) convened the workshop "Creating a Business Case for Quality Improvement and Quality Improvement Research" on October 15, 2007, in Washington, DC, to develop a better understanding of the economic...

  19. San Francisco Bay Water Quality Improvement Fund Points, SF Bay CA, 2015, US EPA Region 9 (United States)

    U.S. Environmental Protection Agency — The San Francisco Bay Water Quality Improvement Fund is a competitive grant program that is helping implement TMDLs to improve water quality, protect wetlands, and...

  20. Coordination mechanisms for quality improvement and market access in Ethiopian potato value chains

    NARCIS (Netherlands)

    Abebe, G.K.


      Market access for smallholders in developing countries often requires the improvement of product quality. As products are traded in value chains, quality improvement entails the coordination of activities and decisions by all actors in the chain. Thus, enhancing smallholders’