Capacity For Continuous Improvement Research Articles

AI-powered fertility assessment tool

The integration of artificial intelligence (AI) into fertility assessment and treatment presents a promising solution to the pervasive issue of infertility, offering individuals and couples personalized insights and recommendations on their reproductive health journey. By harnessing machine learning algorithms, an AI-powered fertility assessment tool analyzes diverse datasets encompassing demographic and clinical variables to generate comprehensive fertility profiles. These profiles provide predictions of fertility potential, identification of risk factors for infertility, and tailored recommendations for lifestyle modifications or medical interventions. The tool's adaptability and capacity for continuous improvement through user feedback and updated research ensure the relevance and effectiveness of its recommendations, while stringent privacy measures safeguard sensitive information. Preliminary testing demonstrates high accuracy and user satisfaction, highlighting the tool's potential to transform reproductive healthcare by streamlining assessments, reducing diagnostic uncertainties, and facilitating early interventions. However, the responsible implementation of AI-powered tools requires careful consideration of ethical, regulatory, and societal implications to ensure equitable access and mitigate algorithmic biases. Overall, AI-powered fertility assessment tools signify a significant advancement in reproductive medicine, offering hope and empowerment to individuals and couples navigating the complexities of fertility challenges.

Quality by Design-driven Analytical Method: A Quality Risk Management-Based Liquid Chromatography Method for Daclatasvir and Characterization of its Putative Degradants by LC-MS/MS

Background:: Antiviral drugs can cure more than 95 percent of people with hepatitis C, but the inaccessibility of quality affordable medicines and the lack of their uninterrupted supply pose a major challenge. Impurities in drugs have a significant impact on their quality and are one of the substantial causes of drug recalls, ultimately leading to the unavailability of the drug in the market. Hence, there is a need for a robust, quality risk management and quality by design-driven analytical method that can detect the antiviral drug, Daclatasvir dihydrochloride, in the presence of its probable impurities. Objective:: This study aimed to develop a Quality by Design-driven stability- indicating liquid chromatography method for Daclatasvir dihydrochloride and the characterization of its putative degradants by LC-MS. Method:: The fishbone diagram and quality risk assessment investigated twenty-four process parameters and concluded that three risk parameters, i.e., flow rate, buffer pH, and stationary phase type, were the critical process parameters. The critical quality attributes viz. resolution between impurity 6 and DCV and impurity 2 & 3 (Rs˃1.5), the shape of the peak of DCV which is decided by the Number of Theoretical Plates (NTP˃5000), and the retention time of Daclatasvir (tR14-23 mins) were optimized using a two-level three-factor full factorial design with five center points. Results:: The optimized method is stability-indicating in its true sense as it can separate the sample with its degradants generated in basic (three), acidic (two), oxidative (H2O2: three, Azobisisobutyronitrile: one), photo (three), and dry heat (one) conditions. Degradants structures were elucidated, and degradation routes were established, using LC-MS and LC-MS/MS analyses. Conclusion:: The drug is highly susceptible to acid, base hydrolysis, and oxidation degradation conditions and poses a significant risk to the analytical method to fail in system suitability criteria. Hence, a robust and flexible chromatographic method with the capacity for continuous improvement was developed and successfully validated within the criteria of design space.

The impacts of middle managers' ambidexterity, continuous improvement, and organizational agility on business performance: A knowledge-based view

Purpose: Using the knowledge-based view as the theoretical lens, this study aims to assess the effect of middle managers’ ambidexterity, continuous improvement and organizational agility on the business performance within the manufacturing and service industries.Design/methodology/approach: Quantitative survey was carried out using questionnaire whose data were collected from 197 middle managers’ responses collected in 2021. Structural Equation Modeling was used to analyze the direct and mediation relationships.Findings: The results demonstrated that the relationship between middle managers’ ambidexterity and business performance was insignificant but fully mediated by continuous improvement capacity and organizational agility. In both manufacturing and service sectors, our research also confirmed that middle managers have an important role in building continuous improvement capacity and organizational agility. The interchange between exploration and exploitation capabilities is an important competency that today’s middle managers should have.Originality/value: This study is amongst the first to investigate the phenomenon of middle managers’ ambidexterity in both manufacturing and service sectors from the knowledge-based view theory. The new knowledge is generated from the in-depth investigation of how middle managers interchangeably use their exploiting and exploring capabilities to achieve their business performances.

Green core competence and firm performance in a post‐conflict country, Iraq

AbstractGreen core competence theory proposes that green core competence is needed for green innovation performance and, in turn, firm performance. We demonstrate that this theory applies in post‐conflict Iraq where green innovation performance was conditional on commitment to sustainable management and development of green technology and skills. Data from 238 Iraqi executives showed that green product and process innovation performance increased with green core competence, but only when the firm invested in people and R&D or, in the case of green process innovation, top management demonstrated authentic commitment to sustainable practices. The moderation effects of R&D investment and top management commitment reflect the national context in Iraq, where R&D investment is low and management is often constrained by inflexible bureaucracy. As countries emerge from conflict, investment in modernization of companies' internal structure, management, and capacity for continuous improvement is required if core competence is to be translated into innovation performance.

Identifying Contextual Factors and Strategies for Practice Facilitation in Primary Care Quality Improvement Using an Informatics-Driven Model: Framework Development and Mixed Methods Case Study.

BackgroundThe past decade has seen increasing opportunities and efforts to integrate quality improvement into health care. Practice facilitation is a proven strategy to support redesign and improvement in primary care practices that focuses on building organizational capacity for continuous improvement. Practice leadership, staff, and practice facilitators all play important roles in supporting quality improvement in primary care. However, little is known about their perspectives on the context, enablers, barriers, and strategies that impact quality improvement initiatives.ObjectiveThis study aimed to develop a framework to enable assessment of contextual factors, challenges, and strategies that impact practice facilitation, clinical measure performance, and the implementation of quality improvement interventions. We also illustrated the application of the framework using a real-world case study.MethodsWe developed the TITO (task, individual, technology, and organization) framework by conducting participatory stakeholder workshops and incorporating their perspectives to identify enablers and barriers to quality improvement and practice facilitation. We conducted a case study using a mixed methods approach to demonstrate the use of the framework and describe practice facilitation and factors that impact quality improvement in a primary care practice that participated in the Healthy Hearts in the Heartland study.ResultsThe proposed framework was used to organize and analyze different stakeholders’ perspectives and key factors based on framework domains. The case study showed that practice leaders, staff, and practice facilitators all influenced the success of the quality improvement program. However, these participants faced different challenges and used different strategies. The framework showed that barriers stemmed from patients’ social determinants of health, a lack of staff and time, and unsystematic facilitation resources, while enablers included practice culture, staff buy-in, implementation of effective practice facilitation strategies, practice capacity for change, and shared complementary resources from similar, ongoing programs.ConclusionsOur framework provided a useful and generalizable structure to guide and support assessment of future practice facilitation projects, quality improvement initiatives, and health care intervention implementation studies. The practice leader, staff, and practice facilitator all saw value in the quality improvement program and practice facilitation. Practice facilitators are key liaisons to help the quality improvement program; they help all stakeholders work toward a shared target and leverage tailored strategies. Taking advantage of resources from competing, yet complementary, programs as additional support may accelerate the effective achievement of quality improvement goals. Practice facilitation–supported quality improvement programs may be opportunities to assist primary care practices in achieving improved quality of care through focused and targeted efforts. The case study demonstrated how our framework can support a better understanding of contextual factors for practice facilitation, which could enable well-prepared and more successful quality improvement programs for primary care practices. Combining implementation science and informatics thinking, our TITO framework may facilitate interdisciplinary research in both fields.

PISA – Hvað svo? Nokkur leiðarstef um innleiðingu menntaumbóta

Niðurstöður PISA 2018 verða gerðar opinberar í byrjun desember 2019. Af því tilefni má búast við víðtækri umræðu í samfélaginu um menntamál og um gæði íslenska menntakerfisins. Þessari grein er ætlað að vera innlegg í þá umræðu og þá einkum um æskileg viðbrögð eða aðgerðir til að bæta menntun íslenskra barna og ungmenna. Dregin er saman nýleg þekking um farsælar menntaumbætur og reynt að varpa ljósi á hvaða hagnýtu þýðingu hún kann að hafa fyrir umbótastarf hér á landi. Á grunni þeirrar þekkingar eru sett fram sjö leiðarstef sem gagnlegt er að hafa til hliðsjónar við innleiðingu umbótastarfs, þau eru: Nám og kennsla í brennidepli; aðstæðubundnar aðgerðir; samstarfsmiðuð nálgun og samvirkni; fagleg forysta, þekking og hæfni; menntarannsóknir; fjölskyldur og samfélag; og jöfnuður á öllum stigum kerfisins. Til nánari útskýringar er sett fram eitt dæmi um umbætur sem byggja á þessum leiðarstefjum.

Building Capacity for Continuous Improvement of Math and Science Education in Rural Schools


 
 
 
 Schools in 47 high-poverty school districts located mostly along the Atlantic Coast of North Carolina, South Carolina, and Virginia may have a head start on new requirements of the No Child Left Behind (NCLB) Act of 2001, thanks to a $6 million grant from the National Science Foundation. Begun in April 2000, the five-year Coastal Rural Systemic Initiative (CRSI) is striving to stimulate sustainable systemic improvements in science and mathematics education in school districts with a long history of low student expectations, persistent poverty, low teacher pay, and high administrator turnover. The CRSI capacity-building model is designed to address issues in rural school districts that traditionally limit the capacity for creating sustainable improvements in math and science programs. A critical action step is that each school district must sign a cooperative agreement to establish Continuous Improvement Teams (CITs) at the district and school levels. These CITs represent a fundamental system capacity-building change in how decisions are made at the school and district levels—a change that is also fundamental to creating lasting improvements in math and science education programs.
 
 
 
 

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon.

Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and "champions," incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a "learning organization": systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care.

Language, culture and identity at the nexus of professional learning

BackgroundGiven the persistent gap among majority and minority students in international measures of student outcomes, there is growing attention and research focused on teacher knowledge, learning and professional development. Culturally responsive practice has been posited as one way to ameliorate disparities in outcomes. Proponents of culturally responsive practice argue that there is a special knowledge base, skills, processes and experiences that teachers need to have that enable them to work successfully with culturally and linguistically diverse students.Purpose and methodsThis documentary account describes the understandings gained by a team of professional development facilitators as they reframed their work with schools and teachers to focus on developing culturally responsive practices by placing language, culture and identity at the centre of literacy-focused Professional Learning and Development (PLD). Using an appreciative inquiry framework, they sought to identify and increase the use of existing practices that supported a culturally responsive learning environment.ResultsA number of initial lessons were learnt, including the need for PLD facilitators to engage in ongoing and explicit critical reflection on themselves as socio-cultural beings and to become comfortable with leading and engaging in uncomfortable conversations. The co-construction and on-going revision of PLD materials and tools were instrumental in re-centring practice and assumptions about teaching, learning, literacy, as well as challenging existing PLD practices.ConclusionsAlthough the appreciative inquiry framework was found to be critically important for prompting change, it was the interweaving of multiple frameworks that led to competencies that built capacity for continuous improvement and evidence-based practice. This focus on enhancing the practice of PLD facilitators has important implications for improving student achievement.

The Processes Underlying Team Formation in Primary Care: A Qualitative Study

Team-based care has been promoted as central to achieving value in primary care. There is evidence to suggest that effective teams can promote patient-centered care, continuous improvement capacity...

The effect of continuous improvement capacity on the relationship between of corporate social performance and business performance in maritime transport in Singapore

Drawing on organisational learning theory, this study argues that shipping firms with high continuous improvement capacities have better success in transforming corporate social performance (CSP) into business performance. Survey data were collected from 223 shipping firms in Singapore and analysed using multi-sampling analysis, hierarchical regression modelling, and simple slope analysis. The results support the study’s argument and show that business performance is maximised when continuous improvement programmes targeted at CSP are carried out at a gradual pace and at regular intervals. This implies that shipping firms should adopt a dynamic, value-driven approach to improving CSP.

Building District‐Level Capacity for Continuous Improvement in Maternal and Newborn Health

The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop woreda (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other woredas, dubbed "lead" woredas. Community-level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care. Surveys and in-depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated woreda culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes. Respondents reported significant positive changes in many areas of woreda culture and leadership, including involving a cross-section of community stakeholders (increased from 3.0 to 4.6 on 5-point Likert scale), using improvement data for decision making (2.8-4.4), using locally developed and tested solutions to improve CMNH care (2.5-4.3), demonstrating a commitment to improve the health of women and newborns (2.6-4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6-4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the woredas. The themes of community empowerment and focused improvement emerged strongly from the interviews. MaNHEP was able to build capacity for continuous improvement and develop lead woredas. The multifaceted approach to building capacity was critical for the success in creating lead woredas able to serve as models for other districts.

Building school-wide capacity for improvement: the role of leadership, school organizational conditions, and teacher factors

Education policies for greater accountability of schools assume that schools are capable of building their capacity for continuous improvement. While policy-makers, scholars, and practitioners acknowledge the importance of building school-wide capacity for continuous improvement, empirical evidence to this effect remains thin. In this study, we examine the extent to which school improvement capacity develops over time in a sample of elementary schools in The Netherlands. Leadership practices, school organizational conditions, teacher motivation, and teacher learning were used to measure school-wide capacity for improvement. Mixed-model analysis of longitudinal data from 1,010 teachers of 32 Dutch elementary schools showed that schools are capable of building school-wide capacity, and that sustaining a high level of capacity seemed to be more difficult. The findings suggest that improving leadership may be an important first step in the process of building school-wide capacity.

Kaiser Permanente’s Performance Improvement System, Part 4: Creating a Learning Organization

In 2006, recognizing variations in performance in quality, safety, service, and efficiency, Kaiser Permanente leaders initiated the development of a performance improvement (PI) system. Kaiser Permanente has implemented a strategy for creating the systemic capacity for continuous improvement that characterizes a learning organization. Six "building blocks" were identified to enable Kaiser Permanente to make the transition to becoming a learning organization: real-time sharing of meaningful performance data; formal training in problem-solving methodology; workforce engagement and informal knowledge sharing; leadership structures, beliefs, and behaviors; internal and external benchmarking; and technical knowledge sharing. Putting each building block into place required multiple complex strategies combining top-down and bottom-up approaches. Although the strategies have largely been successful, challenges remain. The demand for real-time meaningful performance data can conflict with prioritized changes to health information systems. It is an ongoing challenge to teach PI, change management, innovation, and project management to all managers and staff without consuming too much training time. Challenges with workforce engagement include low initial use of tools intended to disseminate information through virtual social networking. Uptake of knowledge-sharing technologies is still primarily by innovators and early adopters. Leaders adopt new behaviors at varying speeds and have a range of abilities to foster an environment that is psychologically safe and stimulates inquiry. A learning organization has the capability to improve, and it develops structures and processes that facilitate the acquisition and sharing of knowledge.

Medical Home 2009: What It Is, Where We Were, and Where We Are Today

Medical Home 2009: What It Is, Where We Were, and Where We Are Today

Concepts of change: enhancing the practice of academic staff development in higher education

Achieving change at any level of educational activity is not easy. In terms of teaching practice, developing a positive capacity for continuous improvement may involve deep change with the potential to threaten the core values and personal belief systems of staff and the students whom they teach. Recent theorising and discussion concerning conceptions of teaching and learning is an acknowledgement that the task of achieving change and the role of change supporters is not just a pragmatic one. This paper considers some of the issues faced by academic staff developers attempting to transform teaching practice. The author draws upon late twentieth century philosophy and extensive theorising about educational and organisational change with a view to suggesting this literature's potential to support the work of change supporters, such as academic staff developers.

Building Capacity for School Improvement through Evaluation: Experiences of the Manitoba School Improvement Program Inc.

Abstract: The evolution of the Manitoba School Improvement Program’s (MSIP) approach to evaluation as a means of building schools’ capacity for continuous improvement will be described from the perspective of the MSIP evaluation consultant and in the context of the difficulties inherent in secondary school reform. Drawing on the experiences of the MSIP schools and the data that have been collected by and from the schools over the last seven years, this article will attempt to address two key questions: What have we learned about how to move schools into an empowerment model of evaluation? What are the benefits of empowerment evaluation to educational reform?

Continuous improvement and the mini‐company concept

The key issue of continuous improvement (CI) seems to be the problem of combining extensive employee involvement with market orientation and continuation of CI. In this article we review some existing organisational designs for CI on these three essential characteristics of CI. As an alternative to the shortcomings of current organisational designs for CI we present the mini‐company concept, related to the sociotechnical concept of the self‐managing team. The mini‐company concept incorporates the three key issues: it has a self‐propelling capacity for CI, involving everyone on the shop floor. A constant and market‐oriented source for improvement is found in the clients and suppliers of the mini‐company. Results of an in‐depth case‐study are presented, showing some strong effects of the mini‐company concept.