Quality Improvement - Science topic

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.

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

Need also such information

I agree with Dr.

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.

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:

That's what we need in the Arab and Islamic worlds nowadays ...@@@

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.

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

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

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.

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.

I don't think enforcing this policy will warranty a positive impact, instead having policy to renew subjects taught by a teacher every year definitely would. In every case it is crucial for the staff to be motivated allowing them teaching the subjects they currently research and have appropriate level of proficiency with

Ikhlas Almukahel ,

Thank you for your detailed answer. May I assume that you agree but there need to be more things for data quality assessment?

Dear Mohammad Sadegh Aslanpour

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:

· 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

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.

A few more:

Paper 5:

Paper 6:

Paper 7:

Paper 8:

Some of the papers are from early to mid 2000’s, but they are all PDF so you can give them a read. Good place to start.

All the best

Martin

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?

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.

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

I have filled your Google form

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

You can ask the consumers following the innovation community approach.

This is a link to Child Health Care Quality Toolbox found on the Agency for Healthcare Research and Quality's (AHRQ) website.

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.

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.

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.

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.

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

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       

Hope the attached paper helps you too. Professor Jiju Antony, Heriot Watt University, Edinburgh, Scotland

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!

Krishnan,

Thank you for sending me your opinion and some literature.

Marian

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). 

Hi Deborah,

Based on common concerns in most of organizations such as:

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.     

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.

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.

The Joint Commission has done a lot of work on cultural competency which may be of help

If you think about university I think it is important to perceive a higher education institution as a set of processes where you have the primary line and supporting line (after Porter, Value Chain Management: http://en.wikipedia.org/wiki/Value_chain). I see from my research that because of an academic culture it is very difficult to measure the primary line at a university/research institute. But definitely we may measure the supporting line and it is a large field for improvements. I have delivered a presentation about quality in HEI - I think it might be helpful for you: http://fjk.org.pl/pl/conferences/download/16 (information about the seminar Quality - New Opening you find here: http://fjk.org.pl/pl/conferences/quality-new-opening). 

Maybe this helps?

Success

Everard

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.

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.

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? ;-)

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

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.

Thank you for you answer.

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.

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

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.

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#