Science topic

Quality Improvement - Science topic

The attainment or process of attaining a new level of performance or quality.
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Radiology is a victim of its own success. Marked improvement in coverage and turn-around time, principally achieved through technology, has been met with ever increasing pressure for even improved metrics.  Academic departments are sacrificing their defining qualities to improve TAT and faculty surveys, hiring radiologists to work 24/7 in reading rooms that once allowed solo residents to transition to independent practice.  At what point does academic medicine stand up for what it believes in? At what point does there cease to be a significant difference between academics and private practice?
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I was even more surprised after the comment by Deborah Jean Verran that no answers/comments have been made in the five years after that!
Dr Darel E Heitkamp raises a very interesting point. In my community, a lot of academic departments have followed the trends of radiology practices/facilities in the private sector and have lost the "ethos" that was highlighted. The consultant/attending staff are pushed to report more and more. Nobody stands up, they just leave and take the "if you can't beat them, join them" approach. Those of us left behind get even more disillusioned.
Another value-add activity I have found is multi-disciplinary conferences.
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Can anyone suggest a published Quality Improvement study based on SQUIRE 2.0 guidelines for reading?
Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) September 15 , 2015)
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Hi Mr. Pillai;
I would recommend you to visit my publication called "Lean thinking: using 6S and visual management for efficient adverse event closure" which has been published in the BMJ Open Quality. I followed the SQUIRE guidelines as much as possible (95%).
Please, visit my page on Research gate & look up the title above to read.
Hopefully would be helpful.
Thanks
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In summary, I am designing a quality improvement project to increase guideline adherence. After taking a baseline test, I will randomize the participants into control and intervention groups based on their baseline score, so that the mean scores of the groups are comparable. Then I will educate the intervention group and do a post-experiment test in the end of the study and compare the groups.
So is this a randomized clinical trial? Can it somehow be considered a controlled before after study? And most importantly, do I absolutely need to register this study on clinicaltrials.gov for it to publishable?
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Need also such information
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Measuring the quality of education provided by the higher education institutes is very important to enhance the effectiveness learning. There many organisations working on different tools and techniques to measure the level of quality of education. The expected answer will help to explore current practices and to develop new measures or techniques.
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I agree with Dr.
William M. Hayden Jr.
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Ces derniers jours nous avons remarqué de bonnes choses sur le climat et l'environnement. Par exemple, on note une nette amélioration de la qualité de l'air. Une pause planétaire de deux mois a montré la diminution des émissions de gaz carbonique et de dioxyde d’azote (NO2). Sachant que la pollution atmosphérique a un effet important sur le climat.
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In recent days we have noticed good things about the climate and the environment. For example, there has been a marked improvement in air quality. A two-month global break has shown a reduction in carbon dioxide and nitrogen dioxide (NO2) emissions. Knowing that air pollution has a significant effect on the climate.
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We provide technical assistance to both district health teams and site level facility QI teams. BUT, the teams give feedback of not understanding QI and i thought this could be an attitudinal response since they look at QI as an additional task in thier routine work!
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You might like to use the framework I helped to develop at The Health Foundation which focuses on mindset, The Habits of Improvers:
See also this project:
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Kindly share the key strategies, techniques and practices which makes the learning process indeed effective. The key ingredients for quality teaching.
Note: it is not focused on a quality teacher; rather on how can learning take place more effectively.
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That's what we need in the Arab and Islamic worlds nowadays ...@@@
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The legal status or the medico-legal significance of officially approved or endorsed clinical decision support and quality improvement tools like; (i) 'Evidence-Based' Clinical Practice Guidelines, (ii) Protocols, (iii) Integrated Care Pathways, and (iv) Policies and Procedures has been a long-standing debate that often have a positive or even a negative effect on the compliance of different healthcare providers especially physicians.
I would like to open a discussion on your perspective and perception of that concept and what is the reality in your healthcare context in your country or region (insight from all clinical specialties is appreciated)?
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Let me approach this question from a different perspective.
Clinical Practice Guidelines, Protocols, and Policies and Procedures are generally in the category of the so-called soft laws or norms. Soft norm refers to some quasi-legal instruments, rules or guidelines of behaviour that are neither strictly binding in nature nor completely lacking legal significance such as non-binding resolutions, declarations, and guidelines created by governments and private organizations.
Those various kinds of quasi-legal instruments, within the context of the healthcare sector, may include guidelines, policy declarations, or codes of conduct that set standards of conduct couched in the normative moods. Soft norms are usually not directly binding or enforceable in accordance with formal techniques of international law but are capable of exerting a powerful influence over the behaviour of the parties to which it applies. Soft norm is not an alternative to the ‘traditional’ lawmaking, but rather, a complement to it. It is fast becoming a major ‘legalisation form’ of the norm-like activities of private and public-private crossbreed authorities where the new type of informal soft norm has come to be primarily relied on by such authorities owing to its flexible and context-dependent nature.
Soft norms are preferred for a variety of reasons. For instance, it is preferred to solve straightforward situations in which the existence of a focal point is enough to generate compliance, or loss avoidance theory, where a non-compliance with a hard law could attract higher sanctions to deter more violations. Soft-law instruments cope better with diversity and provide greater flexibility to cope with uncertainty and allow for adjustments over time. Therefore, soft-norm instruments are easier to negotiate, less costly, and allow parties to be more ambitious and engage in “deeper” cooperation than they would if they had to worry about enforcement.
Conversely, hard law refers generally to legal obligations that are legally binding on, and therefore, enforceable by the parties involved before a court. Generally, hard-law instruments allow parties to commit themselves more credibly to agreements, to avoid the increased cost of reneging due to sanctions. Hard-law instruments have direct legal effects and create mechanisms for the interpretation of the legal commitments, and for enforcement of commitments through either courts or alternative dispute-settlement bodies.
It may seem to be a good question to ask, why adopting a “soft norm” while we already have the hard law. Critics of hard law have raised a number of significant issues. For instance, hard law tends to be set of fixed rules, for universal application, presupposes a prior knowledge, and is difficult to change. While on the other hand, soft norms allow for flexibility, diversity, experimentation and adjustments, and internalization of the hard laws themselves in order to ease in enforcement and to achieve an optimal outcome.
In the contemporary situation that needs flexible compliance with, and enforcement of the laws to achieve maximum results, the application of a hybrid of soft and hard law would seem imperative. Soft norms, by their design, encourage adherence to the standards and allows for substantial flexibility in methods to reach sustainability that fit with their institutional needs and peculiarities, supplementing the hard law that includes a set of fixed rules that define what constitutes a wrongful act and provides sanctions for noncompliance with these rules serving as deterrents.
Coming back to your question as to which one of Clinical Practice Guidelines, Protocols, or Policies and Procedures is preferred, I would say that they all the same in terms of legal weight. Although under some jurisdiction they do not form a legal weight, it is still used as a base fr establishing the legal duty of care, and the standard of care before finally deciding if the health professional is liable in negligence. For instance, see Bolam v Friern Hospital Management Committee [1957] 1 WLR 583 under the UK jurisdiction. Under some other jurisdictions, non-compliance with Clinical Practice Guidelines, Protocols, or Policies and Procedures could carry legal liability (See Article 31 of the Saudi Law on Practicing Healthcare Professions). It is an offence to violate relevant codes of practice or acts contrary to professional conduct or ethics, which could attract disciplinary action that includes a warning, fine (up to 10,000 riyals or revocation of licence Article 33).
While I did not specifically answer your question, I thought it is an opportunity to give a different perspective o the question.
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How to measure "Quality tools in Higher education" .?
please suggest some methodology part for this
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It depends on the field of study and the specificity of the study's issues. Other quality research tools in higher education will be key in the fields of artistic studies, different for business, different for polytechnics, different for natural sciences, humanities, etc. Each study, taking into account the specificity of problems, issues, specializations, and improved skills, differ significantly. The only thing that can combine is the achievements of graduates in their professional work, in which graduates use the knowledge and skills they use to study. But this issue can often not be a universal measure of the quality of education if a significant part of graduates after graduation do not work in their learned professions, professions and specialties, but only undertake work completely unrelated to the completed field of study, even when they have completed a given field of study with good results. this is the case in some countries.
Regards
Dariusz Prokopowicz
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How do you measure the performance/utilization of a healthcare department/clinic? What methods/approaches/techniques/tools do you use or suggest? You have to consider the human factor. The resources of healthcare include nurses, doctors, technicians, assistants, etc.
Is the performance of a doctor measured by the number of patients treated? Or is the time spent by a nurse with patients, or is the performance of a clinic/department/hospital measured by the number of patients treated during the day?
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Dear Atalan,
Hello
First of all, I would like to thank you for asking this question and making this discussion!
Performance evaluation/assessment has been always one of the most interesting as well as important issues to study in different scientific/academic disciplines. In this regards, it could be interesting that this issue has been addressed prevalently in all academic studies and/or researches which are somehow related to the medical management.
As a short answer to your question, I respectfully recommend you to take the following steps;
1. Try to have an operational (not theoretic) definition for performance for your concerned medical units (departments).
2. Try to find a set of indices characterizing the notion of performance for your concerned medical departments.
3. Data gathering by standard or researcher – made questionnaires based on the performance indices defined during the previous step in order to quantitatively measure the indices.
4. Utilize the Data Envelopment Analysis (DEA) methodology to analyze and also compare the performance of unites included in the concerned medical department (or even, comparison of all different medical centers/departments in your research scope)
I hope the above could help you solve your problem!
Good luck!
Ali
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Are there any standardised tools for appraising Quality Improvement projects?
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The most important tools for appraising QIPs are CMMI and SPICE / ISO 15504 / ISO 330xx. There are different variants of these models, depending on the industry you are looking at, and several differents versions were created over time.
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I am conducting a systematic/narrative/ scoping review to explore the quality of reporting the statistical analysis in Quality Improvement studies. I have 263 articles that have met my inclusion criteria. Due to my dissertation time limitation, I decided to take a random sample of the 263 articles. Is that a valid methodological approach? And, if yes would you recommend any reference where this has been done/discussed before?
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Wafa - your response to Tamara and Jordan doesn't seem to be a narrative review. In such a review you look for what 'emerges' - rather than a pre-determined thing like stats thresholds.
The attached chapter may assist on conducting a literature review. It's nursing-related - but the principles are generic. I also attach an example of a concept analysis and a discourse analysis.
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The study by Josko and Ferreira (2017), explained a use for Data Visualization(DV) in quality assessment paradigms which they call a “Data Quality Assessment process (DQAp):
  • They highlight that the problem with using DV in this manner is not in the value of what it can provide visually, but the complexity and knowledge required. 
  • They indicate the need for DV tools to be contextually aware of what is considered “Quality” vs “Defect” therefore requiring such methods to be constructed based on specific requirements which will not be possible for all sources of data.
What is your thought regarding the use of Data Visualization tools as a DQAp? Let's discuss!!
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Thank you for your detailed answer. May I assume that you agree but there need to be more things for data quality assessment?
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In my research paper, to bring some evidence, I need to take screenshots of my codes. To this end, I am using Screenshot tools, e.g. Free Snipping and FastStone Capture. Also, I am increasing the pictures' DPI to 300 and producing PDF and emf formats of such pictures. However, the quality of pictures is still inadequate when they are placed into Word documents.
I am wondering how to prepare high quality pictures for research papers? especially pictures produced through screenshoting.
Thank you in advance.
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Here I am giving you some suggestions, you may try:
Suggestion 1:
You can enlarge the content before you take a screen shot by pressing cmd + + on Mac or ctrl + + on Windows. This is easier than seeking out a retina computer at times.
Suggestion 2:
There is a paper with some ideas: Mikheev, S.M. and Kurilin, I.V. and Vil’kin, A.M. and Rychagov, M.N. and Lee, HoKeun and Kim, SangHo and Choi, DonChul Improving the print quality of screenshots Pattern Recognition and Image Analysis October 2015, Volume 25, Issue 4, pp 674-684 link.springer.com/article/10.1134/…
Suggestion 3:
A screen shot is literally that...what the user would see on screen. There is no need to make it any higher resolution or sharper than it is. It is what it is and that is what you should show the user.
In other words: It's fine. Just leave it! :)
That said, the lazy solution: If you can run the software or web site on a Retina MacBook, use that, as your screen shot will contain 4x the pixels by default.
If the issue, on the other hand, is that your images are getting fuzzy in software they are being imported into, the issue is potentially that the images are being converted to JPG and resampled. This is common when making PDFs. A workaround for that would be:
  • save screen shots as PNG files by default--not JPGs
  • Make sure your image import settings (or, if PDF, your image compression settings) are set to
· do not resample
· do not convert to JPG
Suggestion 4:
Maximize the size of the image you're taking a screenshot of; make it fill the screen as much as you can.
Use 'Snipimage' to exactly fit the image you want. (Start > All Programs > Accessories ... & I recommend pinning it to the taskbar where it's conveniently there when you want it)
Click File> Send to> Email recipient as attachment
Drag the attachment from the email which opens into a directory, so you've got a copy of it.
Close the email.
Now try putting this image into PowerPoint (or word, or whatever). It behaves much better than the original screenshot.
I hope this will be helpful for you.
Best Wishes
Sukhpal
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I am currently doing a research to investigate whether quality assurance has an impact in improving the performance and standards in Gulf States (Oman, Qatar, UAE, Kuwait, Bahrain, and Saudi Arabia) higher education institutions. The main primary focus of the study are three themes, teaching, governance and ranking. The study proposed to employ resource based view (RBV) as a theoretical framework. The reason behind choosing this theory is because the core research of RBV is performance heterogeneity and capabilities. I want some recommendations or articles that used quality assurance to measure performance improvement in higher education institutions.
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One of the ways to improve the quality in HEI is to adequately prepare for the optimal use of Information and Communication Technology (ITC). These institutes should be run by ITC enabled administrative processes.
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There are two positions on this issue.
1. It is widely believed that the quality of the article is directly related to the quality of the journal in which it is published. And for journals, there are a lot of indicators, such as SJR, Quartile, IF etc. So that, according to this position, SJR (for example) is the measure of the article quality.
2. The second position is set out in the "Statement by three academies..." (October, 2017), which indicates the inadmissibility of assessing the quality of scientific work by bibliometric data, including indicators of the journal. It was recommended to use expert reviews as the main tool for articles quality measurement. But it is not clear how to implement a high-quality expert evaluation of many hundreds of thousands of articles published annually.
Where is the truth, how do you think?
Is it possible to combine these two approaches and how to implement it in practice?
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Remember that quality is subjective - where someone writes a technically excellent paper, solving some 100 year old math problem, someone else who reads it finds it boring because it is "just a bunch of equations in weird symbols".
Also: it is very easy to shoot down the first attempts from a junior scientist. I find that this is a much more serious matter, and it should be discussed more. On the one hand, it is very easy to criticise a junior's paper - as she/he hasn't learnt the tricks yet. On the other hand it is important to provide constructive comments even in that case, and I think we are too harsh on the juniors.
What do you think?
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Quality improvement is not a new concept for hospitals. Hospitals have had quality improvement departments and employed related staff for many years.
What is the most important responsibilities of nurses in hospitals for quality improvement?
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I think the most responsibility of a nurse is a real acceptance his/ her role to accomplish the duties that should meet them as a nurse.
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I want to do a research project on manufacturing industries that strive towards quality improvement to minimize the costs and rework.
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There is a lot of work on quality control and improvement, google and do a through review of literature, that will help you to adopt a novel and innovative route.
Thanks
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If you are into industry they be a part of improving the quality of the education system. Just spend some time and answer the 8 questions of the survey form. the link of the same is https://goo.gl/forms/FliD5022yVnQdhMv1
Thanks & regards
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I have filled your Google form
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I am working on the project 'Power quality improvement using D-STATCOM' using MATLAB SIMULINK and willing to learn more about it. I need little bit of guidance from your side. I am trying to reduce harmonic in the system using DSTATCOM and have already achieved power factor correction using DSTATCOM. kindly guide me that which factor exactly affects the reduction of harmonics in the electrical system using Synchronous reference frame theory. Kindly suggest me where am i going wrong in this model? PFA. Thanks.  
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Thanks for the response 
I had used and tunned in PI controller to gain the power factor improvement. Also i had attached non linear load and has imposed harmonics in the system from programmable voltage source in order to check the working of DSTATCOM in case harmonic reduction.
Also I tried changing the values of selected bandwidth for the hysteresis control and got these results.
When I decreased the value of bandwidth between +0.1e-4 to -0.1e-4  (or less), the pf of the system remained somewhere same but it did not effect the THD of the system, whereas when I tried doing opposite i.e., kept the value of bandwidth between +1000 to -1000 (or above)  the THD of system reduced to 4.3% from 6.9% but also reduced to 0.3.  Kindly suggest what should I do for this. Sending you the FFT analysis along with it. PFA
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In the razor and blade market, a new technology is usually incompatible with old technologies. For example, Gillette introduced Fusion technology in 2006 and Fusion is incompatible with Mach and Quattro. Given the incompatibility, what are the factors affecting consumers' upgrading decisions? My understanding is there are three factors: quality improvement, costs (prices) and the inventory of unused blades. And also, does the incompatibility deter the consumers to upgrade to the new technology? 
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You can ask the consumers following the innovation community approach.
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It needs to be something that I can gather quantitative data on to develop processes of care to improve our outcomes.
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This is a link to Child Health Care Quality Toolbox found on the Agency for Healthcare Research and Quality's (AHRQ) website.
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Many site teams demonstrate on displayed charts consistence of good performance for a period of over six months and would want to drop the QI project so that they commence on a new area needing improvement. Experience has showed that because of high staff attrition and turn over, sustainability of good practices is not realized since you've got to retrain and re-couch new providers.
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Diana and William, thank you for sharing your submissions and experiences. Site QI teams adopt changes for testing from consolidated change package harvested from previous QI efforts , on few patients, for a period of three months. If the change works for a team after that action period, they adapt it and scale up the QI efforts for the particular process to cover all patients in care. The site-providers are encouraged to track thier performance using documentation journals and displayed charts [simple run charts that incorporates a median to determine if the change was significant] as part of thier self evidence based evaluation. This might take a year or so depending on the team's commitment. There should be a six points consistence in the performance above the median line to declare an effective change. This does not mean that the team drops focusing on the process. It becomes a routine to monitor the improved process and ensures maintenance of the continued good/best practices. Graduation, therefore here means the team change thier focus to another process that needs improvement and initiates QI projects.
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The main point is to research how IS continuity effects on IS success by understanding how applications' continuity management efforts resonates with other IS quality (service, system & information) factors. The hot question is "can BC investments justified with opportunities of quality improvement instead of using classical "value preservation"?
I would like to know more about similar or related research for having an open discussion about the subject.
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Very interesting question, but no direct answer. In fact continuity of IS is contingent upon various factors including life cycles of organisation, it's products, services, processes and systems. However, IS life cycles should be technology neutral. 
I would suggest to refer to Luftman's model. My book on IT acquisition life cycle model published by IGI could provide some insight.
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I recently took over as divisional lead for clinical audit in my hospital. I noticed, that there seems to be - mildly spoken - a lack of enthusiasm for quality improvement and audit, with the latter really having become a tick box exercise to progress at the ARCP. I am not sure if this is generally the same throughout the NHS in England or specific to our hospital/postgraduate deanery.
I have done quite an extensive literature research on the subject and have come up with a survey regarding "Audit knowledge, attitudes and barriers".
I was wondering if anybody - particularly trainees would be interested to help me distribute this survey in different hospitals and if interested help in the analysis of the data afterwards. A similar, slightly adapted questionnaire could also be distributed amongst final year medical students.
Identifying issues is the first step to improve the situation.
Best wishes,
Immo
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I have seen the the HQIP guidance and do agree with Nancy's statement regarding attitudes towards audit being shaped by the organisation as a whole. As "organisation" I do regard the wider NHS, though. Trainees have been formed/influenced in various hospitals through their careers, the lack of enthusiasm here seems to be something that is not limited to trainees who have come from a certain hospital or postgraduate school of medicine.
I have sent a message to Lauren and Mohammed regarding the project.
Could anybody else who is interested please send me a contact email via Researchgate messenger, I shall send more information out about the project after the Easter break.
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I am researching challenges with internal audits in context of agile software development within an ISO 9001:2008 TickIT certified organisation. I am interested in studies covering alternative non-intimating approaches or means to avoiding the philosophical conflict between a hierarchical approach (ISO 9000 auditing) and a collaborative methodology (Agile development)
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I am familiar with the TickIT, its earlier version, and auditing process. When an external auditor is conducting a compliance audit to verify compliance to the standard's requirements, that is a standard audit.
When an internal audit conducted by one or more trained internal quality auditors, they collaborate with the auditee(s) to review the process, corresponding documentation, and records to identify opportunities for improvement. So, collaborative internal audits are or can be conducted when performing internal audits to improve processes.
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Six Sigma and Lean are two major improvement tools used by the U.S. corporations. Their effectiveness is a different issue, and none wants to discuss it. What are normal measures of quality in EU, and what are typical tools used for quality improvement?
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In the UK a number of large and small industries have started using lean and six sigma. Public sector organisations like NHS in particular are involved in several lean and six sigma projects. You may also refer to following papers on lean and six sigma that will give you a broad overview of what companies in EU/UK think about these tools
Belekoukias, I., Garza-Reyes, J. A., & Kumar, V. (2014). The impact of lean methods and tools on the operational performance of manufacturing organisations. International Journal of Production Research, 52(18), 5346-5366.
L. Kirham, J. A. Garza-Reyes, V. Kumar, and J. Antony, (2014), Prioritisation of operations improvement projects in the European manufacturing industry, International Journal of Production Research, 52 (18 ), 5323-5345
J. H. Lee, J. A. Garza-Reyes, V. Kumar, L. Rocha-Lona, N. Mishra, (2013), A comparative study of the implementation status of Lean Six Sigma in South Korea and the UK, Advances in Sustainable and Competitive Manufacturing Systems, Lecture Notes in Mechanical Engineering, 1489-1502
S. Withers, J. A. Garza-Reyes, V. Kumar, and L. Rocha-Lona, (2013), A Case Study Improvement of a Testing Process by Combining Lean Management, Industrial Engineering and Automation Methods, International Journal of Engineering and Technology Innovation (IJETI), 3 (3), 134-143
P.J. Byrne, V. Kumar, and M. Brady, (2013), The Role of Process Improvement in Healthcare: A Case Study of A Large Irish Hospital, 20th International Annual European Operations Management Academy (EurOMA) conference,  7th-12th June 2013, Dublin, Ireland
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I need to document in a quality management system, the performance of good practice in a maintenance department.
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Any single machine in an operating system has a schedule of preventive maintenance even your cell phone and laptop, I personally worked for food industries for over 18 yrs main points to focus are
planning- safety precautions-issuing  work orders - completion of work orders-
 for breakdowns when the machine stops, the above route should be followed
We were using   very advanced software
 one is Pragma on Key 4
 and the other is Sage
 kindly google for these two soft wares and  you will find a satisfying answer to your question
 regards       
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The question is directed to the existence of intangible factors that could explain the success or failure of a process of continuous improvement. Do you have any experience or know of previous work to develop this theme?
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Hope the attached paper helps you too. Professor Jiju Antony, Heriot Watt University, Edinburgh, Scotland
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I want to start a quality improvement research at my hospital. I had picked a topic and made my plan, but I saw one article that did the similar thing I was planing to do. I am not sure if I should continue on with the project, and will it get published? Please let me know what you think
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Go ahead! The prime value of any Quality improvement projects is for you and your unit, since you first and foremost want to improve care for your patients, and that is always important.
Secont, contex is always different from unit to unit, so if another unit finds or do not find effect of an intervention, this does not mean that you necessary will get the same results.
And in the end, if you want to publish results, its always good to have comparisons, not at least in your discuusiion about the validity of your results.
Good luck!
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I am searching for literature (evidence) about implementing Lean, to quality improvement, after an institute fails accreditation.
Can somebody give me a hint?
Thanks in advance,
Marian Schumacher
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Krishnan,
Thank you for sending me your opinion and some literature.
Marian
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hi all.
i am working on ECG signals. and i designed a filter to eliminate some noises of that signal. now i want see ,how much signal's quality is improved using this filter. i need to calculate SNR ,before and after filtering. so this is question:
which relationship is better to calculate SNR? calculate by means of mean power of signal and noise? or calculate by means of variance?
thanks for your help
regards
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Hi Mohammadreza,
SNR is the acronym for Signal to Noise Ratio which in turn is an abbreviated term for "Signal Power to Noise Power Ratio." This idea was developed in the very early days of radio communication to characterize the quality of the reception of radio signals.
If I remember correctly, H. Friis and D. O. North worked on the definition of Noise Factor (Noise Figure) back in the 1940s. Noise factor is the ratio of the SNR at the input to the SNR of the output of any device such as a filter or amplifier. These are both measured in the "information bandwidth" of the desired signal.
One of the most important issues that affect the computation of SNR is the precise definitions of the Signal Power and Noise Power. In radio communication this is usually the Power in the transmitted signal (or its information content) and the equivalent noise power within the bandwidth of a filter used to filter the signal with the minimum bandwidth possible.
In the case of an ECG, the "signal" is a pseudo-stationary waveform, and over short time durations, a "power" can be defined. The "noise" is a combination of random noise in the tranducers and electronics.
Here are the steps I would apply to your efforts:
1. Define the power of the ECG signal. This is related to its variance or mean-square value.
2. Define the power of the noise. This is the variance or mean-square value of the ECG instrument output when the transducers are not connected to a patient.
3. Calculate the input SNR (SNRin) as the ratio of these input values.
4. Design or acquire a matched filter for the ECG signal or, less optimally, a minimum bandwidth filter that passes nearly all of the spectrum of the ECG signal as determined by an FFT. This is effectively the "information bandwidth."
5. Repeat steps #1 and #2 for the output of the filter.
6. Calculate the output SNR (SNRout) as the ratio of these output values.
7. Compute the SNR improvement factor (analogous to Noise Factor) as the ratio of OUTPUT SNR to INPUT SNR.
Hope this helps. Good luck.
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I am a third year adult nursing student and am doing the above topic for my dissertation.  I am interested in the fact that overweight parents often perpetuate this condition, and that their children are often also overweight.  I would be grateful for any information that is available.
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I would look into the motivational literature and how encouraging the meeting of the basic psychological needs impact an individual's consistent pursuit of behavior change. As Christian indicated, support is key. Support fosters connection and that sense of belonging so important to optimal development and sustained behavior change. A child's behavior is dependent and influenced by the parent's behavior. Throwing a child into a fat camp may help short term, but when they come back into the same environment without their caregivers changing they will likely move back into negative behavior patterns. Check out the role of multisystemic treatment. The role of the parents are also dependent upon the age of the child and interventions should vary according the their developmental level (for how the parents are treated as well as the children). 
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I am working on assessment of CQI in an organization and it is my first involvement in such work. your Assistance will be appreciated.
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Hi Deborah,
Based on common concerns in most of organizations such as:
are customers satisfied with organization products and services?
are those involved in organization activities aligned with organization goals and objectives?
are those involved with and/or affected by organization activities satisfied with these activities?
is workflow of activities in the organization smooth and done with least bureaucracy?
does anybody have all necessary  information on time to be able to do his/her job properly?
are valuable resources of the organization wasted in product and services delivery processes?
are equipment and facilities always ready to work and functioning well?
will new products and services be offered on time to the market?
major areas of improvement  can be determined, categorized and later subdivided into smaller areas up to the point that include all processes, activities, and tasks.
Then, improvement objectives can be determined, prioritized, and planned to be reached in appropriate six month or annual improvement cycles.
Detailed procedures for these processes can be found in Hoshin Kanri  literature.     
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Can it be that the most authors and researchers have neglected and still do not follow the demands of the following ISO norms (with year of coming into effect): 15193 (2002); 15194 (2002); 15195 (2003); 17511 (2003); 18153 (2003) and especially: ISO/PDTS 25680.8: Use of external quality assessment schemes in the assessment of the performance of in vitro diagnostic examination procedures? This European Standard was approved by CEN on 2 March 2004 as EN 14136. Why do most published papers in this area not perform the minimum performance test by taking part in an inter-laboratory trial with real samples and not with pure aqueous solutions without a possibly interfering matrix (e.g., in bio-sensing: enzyme-poisoning, denaturing reagents, proteases, drug-metabolites, etc.)?
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While I agree that papers providing only a matrix-free calibration plot are virtually useless as far as real-world sensing is concerned and should not be published, I believe that many researchers are not interested in commercializing their devices, but are more interested in advancing the state of the art by developing novel approaches to solving problems.  In these cases, the technology is then available for those in the sensor industry to develop into marketable devices.  Not everyone is an entrepreneur who is interested in commercialization, but this should not preclude them from doing good analytical research.
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Or unintended consequences from false results? i.e. safety and accuracy, at what cost? Reference your favorite papers, but anecdotal opinions welcome too.
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Great question. If one starts with the premise that [value] = [quality] / [cost] and believes that we should focus on maximizing value, then the question can be re-focused as "when do we see incremental quality result from optimizing diagnostic accuracy?"  This relates to the patient population (diagnosing pre-malingnant colon polyps has a very different meaning for an 88 year old than for a 52 year-old), the illness (missing a diagnosis of iron deficiency is not as important as missing a diagnosis of HIV because of the seriousness of the illness and the public health implications), and the operating characteristics of the tests (over-screening for colon cancer with fecal occult blood testing might lead to unneccessary, expensive, and not-risk-free colonoscopies because there are a lot of false-positives). I believe, anecdotally, that the biggest errors we make in assessing the value of diagnostic tests are (1) focusing on sensitivity and specificity instead of likelihood ratios; after all, Bayes' theorem works with likelihood ratios, and (2) assuming that tests have similar operating characteristics in all patient populations. Using a ferritin value to detect iron deficiency makes sense in young healthy women, but not in hospitalized patients, but this type of issue has not been well characterized for many diagnostic tests that we assume work well in all populations but may not.
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I'm exploring accreditation related activities and therefore am interested in physician engagement strategies, specifically in the context of developing countries. 
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The Joint Commission has done a lot of work on cultural competency which may be of help
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What would be a valid definition of Institutional Effectiveness? Can it be achieved or will it always be chasing continuous quality improvement?  
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It seems to me, Aeron, that you have two questions here: "what is it?" and "can we do it?"  If we're going to achieve institutional effectiveness to any extent, it will be because we have a defined goal, so I'm glad you bring up the question.   Like Dr. Al-khresheh, I believe that institutional effectiveness is complex and multi-faceted.  I like the way he emphasizes mission alignment, for which continual quality improvement is crucial.  Also, factors such as strategic planning and adaptability play a part.  On a practical level, educational leaders have to make hard decisions about how to allocate resources, when to pursue technological innovations, and so on.  Deciding on measurable outcomes, as Ms. Koko points out, provides a path toward making those decisions and achieving incremental improvements.  I believe there will always be something to improve upon, though.
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Coffee is an agricultural product with a quality-based price. The value of coffee increases significantly with improvements in quality, which are necessary to obtain new markets. Better understanding of storage factors and the advent of new forms of bagging permit extension of coffee storage times. These developments are of immense importance for preserving product quality. Preservation of product quality over longer periods of storage secures a longer sales period for growers and guarantees better prices. Developing country like Ethiopia farmers are still challenged with techniques of storage and preservation for their coffee beans. Some of the recent researches like Ribeiro et al. 2011 in their publication on the title: “Storage of green coffee in hermetic packaging injected with CO2” is suggested as good recommendation. Can you share me other storage and preservation techniques that help the quality of coffee improvement?
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Provide farmers with information would be a start. I spent a couple nights on a coffee farm in Indonesia many years ago, and was surprised to see the beans sitting in the middle of the common room, waiting for the price to go up.
It struck me that there must be a better way. Some form of cooperative buying and selling would almost certainly make it easier for them to improve this highly suboptimal storage system. But I think trust is not always very high. The credibility of the system would probably be a greater challenge than any technical aspects or need for cash to get things started. The cash could come from farmers, paid by some advance deposit of beans for sale.
I think you're asking more about technical questions, but I think the social side will be a greater roadblock in a very significant share of situations. Most countries with lots of coffee production have a coffee marketing board. I would think that would be the level of action to diffuse info and ideas for more local levels of coordination.
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Quality initiatives can predict any development. Therefore, it needs to be measured from the leaders' perspective. Scale of measurement can be categorical or interval.
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Yes. I think they can be measured in terms of:
a) Student satisfaction,
b) Faculty satisfaction,
c) Impact on society,
d) Knowledge generated
e) Technology transfers.
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Is it real, imaginary or just that expectations have gone up?
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There may be many definitions of "quality management", but I like that one: quality management is "the act of overseeing all activities and tasks needed to maintain a desired level of excellence."
The word "desired" is very important. The "desired level of excellence" might be: "our product should break after 24 months, so the customer will buy another one". And the quality management systems are really working - the manufacturers are succesful at maintaining the desired level of excellence, aren't they? ;-)
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Your study is just the kind that I was looking for. Only yesterday we were discussing the matter of challenges presented to frontline health providers when different organizations or initiatives introduce quality improvement with different names. We did not discuss it from the perspective of conflict of interest, rather one of confusion, but now I am thinking that in the confusion conflict of interest can arise. Kenya is in process of developing a quality improvement policy supported by development partners with passionate interest in improving health service delivery and are convinced that one strategy for addressing confusion is harmonization or standardization. It is just as well to start thinking about conflict of interest as well. It would be useful to read some more work dealing with conflict of interest as well as misunderstandings. This will facilitate the design of appropriate continuing education, support and mentorship.
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We identified via literature review, 7 common contextual factors key to implementation of the QI programme Productive Ward http://onlinelibrary.wiley.com/doi/10.1111/jonm.12069/abstract A larger review of Lean Healthcare including PW citations we identified 3 main components cited as common impacts... Leadership, empowerment & engagement http://www.emeraldinsight.com/journals.htm?articleid=17102117 The most indepth study of all is from Mary Dixon-Woods http://qualitysafety.bmj.com/content/early/2012/04/27/bmjqs-2011-000760
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I experience as quality manager and consultant in developing countries that in a context of emergent change and turbulence the PDCA-cycle of Shewhart/Deming is not flexible, not fast enough and too limiting to help organisations improve.
I am trying to develop an alternative, focussing on attention, context, commitment, reflection-in-action. In the attachment a draft article on the subject.
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Look at Deming's PDSA cycle (do Google search) and I think you will get a very different impression than you have from you understanding of PDCA.
PDSA is rapid, rigourous and includes both inductive and deductive learning. It can be the fastest way to learn your way to improvement regardless of context and resources.
So please study PDSA a little more before drawing your conclusions.
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How can you reduce the variability of results in visual inspection?
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Thank you for you answer.
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What requirements are being used? How would you define "participation" in a QI project, etc?
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Not to the best of my knowledge. If you would like a copy of the "mind the gap" article please email me directly and I will forward it to you. I attempted to upload it but was unable to do so.
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Misconceptions of traumatic brain injuries are common for both patients and families dealing with these conditions. Values about pain and antidepressant medications may create potential conflict between the health care provider who orders these, the nurse who attempts to administer these medications, and the family who does not value pain and antidepressant medications for alleviating the pain and sense of loss caused by a traumatic brain injury. How can healthcare providers better anticipate the education and collaborative needs of patients and families concerning mild traumatic brain injuries and care plans? And, how does a practitioner best open the dialogue of mental health and misconceptions of mental health?
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Hi Laura,
This is an area that can create a lot of angst for clinicians in understanding what the family and patient require in providing support, education and promoting well-being of the patient, but also recognizing what stage of grief and loss cycle the family may be experiencing. The ability to roll with resistance and change is an important analogy as mental and general healthcare clinicians, we want to provide patient and family centered care while trying to maintain a family systems perspective. Often as we know this takes a multidisciplinary and consistent approach to assist the family and patient in understanding the path to recovery and the available treatment and therapy options.
I hope these articles may be of some help:
What evidence and guidelines exists on how best to resolve conflict through education and patient/family collaboration in plan of care for recovery?
Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005
Collaborative Communication in Pediatric Palliative Care: A Foundation for Problem-Solving and Decision-Making. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151773/
Implementing Team Approaches in Primary and Tertiary Care Settings: Applications from the Rehabilitation Context.
Given et al (2001). Family Support in Advanced Cancer http://onlinelibrary.wiley.com/doi/10.3322/canjclin.51.4.213/pdf
Consumer-oriented interventions for evidence-based
prescribing and medicines use: an overview of systematic
reviews (Review)
Sorry about the long entry, but hope this is some help.
James
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Health Care Quality Measurement may involve making measurement tradeoffs. The attached presentation on AMI quality measurement describes some of these tradeoffs and some approaches to handling them. What has your experience been in dealing with these kinds of measurement challenges?
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We struggle with this a lot in developing quality indicators, especially because we most often rely on hospital administrative claims data, which lacks much of the clinical detail that ideally would be nice to include in measurement. So already in using claims data we've made a trade-off sacrificing the clinical detail found in the medical record for the decreased time and cost of using readily-available claims data. As we develop indicators, we think about the intended purpose (quality improvement, public reporting, pay for performance, research) and how various trade-offs in sensitivity and specificity will impact use of the measure for these various purposes. Sometimes internal validity is more important than generalizability, so then more precision is needed at the cost of more stringent criteria and smaller samples. Other times its more important that a measure be generalizable, and interpretable, even when we know some specificity will be lost. We constantly emphasize thinking about the aggregate rate (for an area, hospital, health plan, etc) rather than individual cases. And above all, we keep in mind this principle: Don't let the perfect become the enemy of the good.
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Faced with a global marketplace characterized by a growing competitiveness, and higher expectations from customers, organizations are more and more under increasing pressure to demonstrate their status as corporate suppliers with good quality management systems, good environmental initiatives, good safety policies, among other practices. To meet such expectations, organizations are increasingly adopting integrated management systems based on internationally recognized standards. Research suggests that integrating management systems may provide significant advantages to organizations. Do you think that the healthcare sector may also benefit from such strategies? Why should healthcare institutions think about such options? Do you know any research paper(s) focused on such questions?
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The National Baldrige Quality Award Standard for Health Care is one set of standards for heath care organztions that has shown some positive benefits towards improving operations and achieving high performance benchmarks in patient care. See link for references: http://www.nist.gov/baldrige/baldrige-120412.cfm#