Collaborative Quality Research Articles

Overcoming the not-invented-here syndrome in healthcare: The case of German ambulatory physiotherapists' adoption of digital health innovations.

Healthcare is characterized by professional, organizational, and institutional boundaries. Digital health innovations can help overcome these boundaries by providing information access to all healthcare professionals. Such innovations emerge from inputs from different health professionals at different positions along the entire care process and have the potential to substantially change the way in which interprofessional tasks are performed among the involved professionals. Consequently, as less empowered professionals, physiotherapists may resist the adoption of digital health innovations in particular if the innovation is dominated by physicians, and thus the not-invented-here syndrome may become a major barrier. We aim to examine whether the origin of a digital health innovation affects German physiotherapists' adoption decision and whether the collaboration quality and physiotherapists' proactive job crafting behavior may help overcome adoption barriers. We applied a mixed-method sequential design with a qualitative study one in which we interviewed 20 physiotherapists to provide exploratory insights, and a quantitative study two in which we tested our proposed hypotheses with survey data including an experimental vignette from 165 physiotherapists. Physiotherapists adopt digital health innovations developed by their own professional group more likely than digital health innovations developed by physicians. Our results also confirm that physiotherapists' job crafting behavior and the quality of the collaboration with physicians weaken the resistance against physician-driven innovations. Our study underlines (1) the need to involve allied health professionals as physiotherapists in digital health innovation development, (2) the relevance of interprofessional collaboration in daily practice and, (3) an open mind set of allied health professionals to cope with innovation adoption barriers.

Optimization Of CIPP Evaluation Model as An Escalation of Educational-Industrial Collaboration Program

The importance of industrial and vocational collaboration in producing competent graduates is evident. However, there are still issues with the collaboration between industry and educational institutions, including the lack of appropriateness in the collaboration, the mismatch between student competencies in vocations and industry requirements, and inadequate alignment of graduate outcomes with industry needs. This research aims to explore the differing perspectives of universities, vocational schools, and industries in West Sumatra, Bandung, and Malang on the formation of CIPP components. Additionally, it seeks to reveal the direct and indirect influences between CIPP components—context, input, process, and product—to enhance the quality of cooperation and collaboration between industry and universities in Indonesia. The research employs a mixed-method approach, combining quantitative and qualitative methods. The samples include vocational schools, involving teachers and leaders, and universities, involving lecturers and leaders in West Sumatra, Bandung, and Malang. The research instruments consist of a questionnaire and an interview guide. Both qualitative and quantitative data analysis techniques are applied, including descriptive analysis, difference tests using two-way ANOVA, and factor analysis tests using the SMART PLS application. Based on the findings, it is concluded that the evaluation results encompass the Context, Input, Process, Product (CIPP) variables in an ideal vocational school-university-industry collaboration model. The results indicate a direct and indirect positive influence between CIPP components. However, the evaluation results also highlight existing problems, necessitating improvements. This research contributes by providing recommendations for the collaboration program to enhance input capacity and generate relevant outcomes. In terms of input, the value is classified as very good, emphasizing the need for improvement in the dimensions of the context components, especially the competency environment, stakeholders, and policies that support optimal cooperation. Recommendations in the product section aim to increase student competency achievement.

MEMBANGUN BUDAYA AKADEMIK DI SEKOLAH MENENGAH: INTERVENSI PELATIHAN PENULISAN ILMIAH DI KABUPATEN MAJENE

Scientific writing training for teachers in the district of Majene has been organized by the Postgraduate of Makassar State University as part of the Community Service (PKM). The activities are designed to empower teachers in developing and sharpening their skills in scientific writing, with the hope that this will have an impact on improving the quality of education and academic collaboration at the local level. Through a participatory approach, the training offers an interactive platform for teachers to learn the basics of scientific writing, receive direct feedback from sources, and collaborate with fellow participants. This interaction, which combines theory with practice, gives participants an in-depth understanding of the research, writing, and publication process. Furthermore, by leveraging the expertise of the source, participants gain insight into the standards and expectations of the wider academic community. The post-training evaluation showed rejoicing results. The majority of participants increased confidence in writing and felt better prepared to participate in academic discussions and contributions to scientific publications. This increase confirms the effectiveness of the training approach adopted. This initiative, apart from its success in improving teacher writing skills, also shows the great potential of collaboration between higher education institutions and secondary schools. With partnerships like this, there is an opportunity to boost innovation and sustainable capacity-building in education and research in Indonesia.

Nerve monitoring in endocrine surgery: Practice patterns differ among surgeons for parathyroidectomy and thyroidectomy

BackgroundIt is unknown whether intraoperative nerve monitoring is associated with reduced vocal cord dysfunction after parathyroidectomy. We aimed to investigate intraoperative nerve monitoring use among Collaborative Endocrine Surgery Quality Improvement Program surgeons and factors associated with vocal cord dysfunction after parathyroidectomy. MethodsPatients who underwent parathyroidectomy included in the Collaborative Endocrine Surgery Quality Improvement Program (2014–2022) were identified. The annual percent change in parathyroidectomies performed with intraoperative nerve monitoring was calculated using joinpoint regression. Multivariable logistic regression was used to compare outcomes between patients undergoing parathyroidectomy with/without intraoperative nerve monitoring. To compare surgeon-specific trends, Collaborative Endocrine Surgery Quality Improvement Program thyroidectomy and parathyroidectomy datasets (2014–2021) were combined. Parathyroidectomies performed by surgeons who used intraoperative nerve monitoring consistently in thyroidectomy were identified. Factors associated with intraoperative nerve monitoring were examined using multivariable logistic regression. ResultsA total of 9,813 patients underwent parathyroidectomy. Intraoperative nerve monitoring was used in 49% of cases (n = 4,818). There was an increase in parathyroidectomies with intraoperative nerve monitoring from 2014 to 2018 (annual percent change 22.2, P = .01), followed by a plateau (2018–2022 annual percent change −0.66, P = .85). Few patients (0.44%, n = 43) developed vocal cord dysfunction. Vocal cord dysfunction was not associated with intraoperative nerve monitoring (adjusted odds ratio 0.92, P = .75). Whereas 41% (n = 56/138) of surgeons used intraoperative nerve monitoring routinely in parathyroidectomy, 65% (n = 90/138) used it routinely in thyroidectomy. Among surgeons who used intraoperative nerve monitoring routinely in thyroidectomy, only 57% used it routinely in parathyroidectomy; factors associated with intraoperative nerve monitoring during parathyroidectomy included reoperation (adjusted odds ratio 2.51, P < .01), secondary/tertiary hyperparathyroidism (adjusted odds ratio 1.42, P = .02), multiglandular disease (adjusted odds ratio 1.76, P < .001), and non-localized disease (adjusted odds ratio 1.65, P < .001). ConclusionEndocrine surgeons use intraoperative nerve monitoring selectively. Surgeons who routinely use intraoperative nerve monitoring during thyroidectomy are more likely to use it during parathyroidectomy. Future studies should determine who may benefit most from intraoperative nerve monitoring in parathyroidectomy.

Educators’ Perspectives on the Main Challenges and Opportunities for Implementing Digital Solutions in Learning and Teaching

The gap between technological progress and education is one of the international issues that needs to be addressed. Further education of educators is considered one of the best solutions [1]. Nevertheless, schools struggle with the requirements set by national and international authorities, lacking guidance and support [2, 3, 4]. This research aims to identify the primary challenges and opportunities for implementing the use of digital solutions in learning and teaching. The research questions are as follows: (1) What are the primary challenges for educators when implementing digital solutions in learning and teaching? and (2) What are the key opportunities for educators when implementing digital solutions in learning and teaching? This study examines the reflections and evaluations of educators’ learning experiences in a two-year national-level further education programme aimed at enhancing and advancing their pedagogical digital competence. Throughout the course, educators regularly filled out surveys reflecting on the quality of collaboration in their support groups, their progress towards their professional development goals, their main challenges, and their greatest successes in learning and implementing digital solutions in practice. The study analysed 8,636 responses from educators using a mixed-methods design. Quantitative data analysis was used for the Likert scale questions, while deductive and inductive qualitative analysis was used for the open-ended questions. The results show that many of the factors’ educators mentioned as successes in their learning experience were also mentioned as significant challenges, such as learning to use new digital solutions, applying digital solutions in their work, collaborating with colleagues to learn and implement new digital solutions, and effectively managing time to achieve set goals. Educators need dedicated time to experiment with digital solutions, engage in practical and peer-oriented learning approaches, develop a shared vision, foster collaboration, and receive support to enhance their competence and confidence in utilising digital solutions.

The Drivers of Farmers&amp;rsquo; Participation in Collaborative Water Management: A French Perspective

Collaborative management has developed as a main approach to solving complex environmental problems such as diffuse water pollution from agriculture. This paper aims to understand the drivers of farmers’ participation in collaborative water quality management. The role of farm characteristics, farmers’ profiles and farmers’ social networks is more particularly investigated while taking into account transaction costs. The study relies on a statistical analysis of data collected in two drinking water catchments in France. The results show that larger, more profitable farms with more equipment and access to off-farm income are more likely to participate in collaborative processes for water quality management. Furthermore, farmers’ involvement in agricultural and nonagricultural networks has a strong positive influence on their participation. These results suggest that significant costs, including transaction costs, are associated with farmers’ participation in collaborative management. Targeted support for smaller, financially constrained farms and less-connected farmers could enhance the effectiveness of the collaborative approach to diffuse pollution control.

Ensuring Networks Work Well: Development of a Self-evaluation Tool for Network Quality in Community Health Promotion

Abstract: Background: Networks are an essential component of community-based health research. Community-based networks require a high degree of collaboration, and the quality of this collaboration is a key factor for intervention success. As such, it is important to measure collaboration quality through network evaluation. Established tools, such as social network analysis, primarily measure connections between network members as opposed to network quality. Additionally, only few tools developed for this purpose are used in practice. Methods: This paper describes the process of developing a network assessment tool to measure the quality of network collaboration in practice. To this end, we collaborated with practice partners from a community-based health promotion network and the community health service. We adopted a mixed-methods approach consisting of a literature review and a needs assessment involving practical experts in Germany. On this basis, we developed a new network evaluation tool, the Self-Evaluation Tool for Network Quality Assessment by Practitioners in Community Health Promotion (SNAP-HP), in cyclic-iterative collaboration with our practice partners. Conclusions: The next steps include piloting, evaluating, and adapting the SNAP-HP for final open access.

Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses.

There is strong evidence that exercise reduces falls in older people living in the community, but its effectiveness in residential aged care is less clear. This systematic review examines the effectiveness of exercise for falls prevention in residential aged care, meta-analysing outcomes measured immediately after exercise or after post-intervention follow-up. Systematic review and meta-analysis, including randomised controlled trials from a Cochrane review and additional trials, published to December 2022. Trials of exercise as a single intervention compared to usual care, reporting data suitable for meta-analysis of rate or risk of falls, were included. Meta-analyses were conducted according to Cochrane Collaboration methods and quality of evidence rated using the Grading of Recommendations Assessment, Development and Evaluation approach. 12 trials from the Cochrane review plus 7 new trials were included. At the end of the intervention period, exercise probably reduces the number of falls (13 trials, rate ratio [RaR] = 0.68, 95% confidence interval [CI] = 0.49-0.95), but after post-intervention follow-up exercise had little or no effect (8 trials, RaR = 1.01, 95% CI = 0.80-1.28). The effect on the risk of falling was similar (end of intervention risk ratio (RR) = 0.84, 95% CI = 0.72-0.98, 12 trials; post-intervention follow-up RR = 1.05, 95% CI = 0.92-1.20, 8 trials). There were no significant subgroup differences according to cognitive impairment. Exercise is recommended as a fall prevention strategy for older people living in aged care who are willing and able to participate (moderate certainty evidence), but exercise has little or no lasting effect on falls after the end of a programme (high certainty evidence).

What are the features of high-performing quality improvement collaboratives? A qualitative case study of a state-wide collaboratives programme

ObjectivesDespite their widespread use, the evidence base for the effectiveness of quality improvement collaboratives remains mixed. Lack of clarity about ‘what good looks like’ in collaboratives remains a persistent problem....

大数据背景下西部地区高校科技创新效率提升研究

With the advent of the big data era, data has become an important resource to promote social progress and development. The western region has rich scientific and technological resources and educational resources, but compared with the eastern region, there is still a certain gap in its scientific and technological innovation ability and efficiency. By establishing the evaluation index system of the efficiency of science and technology innovation in universities under the background of big data, this paper analyzes the problems of improving the efficiency of science and technology innovation in western China, and puts forward the strategy of improving the efficiency of science and technology innovation in western China based on the innovation ecological mechanism. The research shows that the evaluation of scientific and technological innovation efficiency in universities in western China focuses on input and output indicators, and the establishment of an innovation ecological mechanism with internal improvement, external support, collaborative quality improvement and cooperative interconnection will promote the improvement of the efficiency of scientific and technological innovation. The research results provide theoretical basis and practical guidance for the improvement of scientific and technological innovation efficiency in universities in western China.

A bibliometric analysis of research on multiple criteria decision making with emphasis on Energy Sector between (2019-2023)

In the present study, a bibliometric analysis of research works that have been conducted over the last five years in connection to Multiple Criteria Decision making (MCDM) and its application in the energy sector is presented. In the beginning, a statistical study of influential publications, journals, countries/territories, and authors was carried out. In the following step, an analysis was performed based on four distinct time periods to determine the evolving patterns of authors' cooperation structure and study themes. According to the findings, there has been a rise in the quality of collaboration between writers, as well as an increase in the number of publications and authors who have contributed to the study on MCDM during the last five years. Researchers should be able to successfully conduct investigations in linked domains with the assistance of the complete and scientific analysis of MCDM. It also concludes that there are more opportunities in the future in the field of energy applications with MCDM, and this can be encouraging for researchers from both fields, as well as those from the industrial and economic fields, to consider MCDM in their utilization of energy alternatives and to make decisions that are informed by such findings.

Analysis of collaborative control of dairy product supply chain quality based on evolutionary games: Perspectives from government intervention and market failure

Dairy quality affects the health and quality of life of consumers. Implementing supply chain management and collaborative quality control is an effective way to solve dairy quality problems. Based on the perspective of the combination of market failure and government intervention, this paper analyzes the conditions for the realization of collaborative quality control between dairy farmers and dairy processors. At the same time, this paper uses relevant data to verify the applicability of the model and the accuracy of the conclusions. The findings show that both low yields and high spillovers lead to market failures. When farmers adopt advanced prevention strategies and dairy processors adopt advanced inspection strategies with low yields, basic prevention and basic inspection will be the best combination of quality control strategies for both parties. In this case, the government should subsidize the advanced control strategy to provide adequate subsidies. This will provide incentives for both parties to work together to ensure the quality of dairy products. Secondly, when farmers adopt advanced prevention strategies or dairy processors adopt advanced inspection strategies yields increase but spillover rates are higher. Advanced prevention, basic inspection or basic prevention, advanced inspection would be the optimal combination of strategies for both parties. At this point, the government should increase the penalties. The simulation results further indicate that the government subsidy is more effective for dairy farmers. Government penalties have both the positive and negative reinforcing effects.

Reducing Preventable Bleeding Visits and Institutional Factor Costs for Patients with Bleeding Disorders with a Prospective Quality Improvement Project

Providing optimal care to patients with bleeding disorders requires specialized physician, laboratory, pharmacy, nursing, and institutional resources best achieved at Hemophilia Treatment Centers (HTCs). Current systems for managing the care of a resource intensive patient population may be suboptimal. We observed frequent bleeding related hospitalizations and emergency room (ER) visits in patients with bleeding disorders treated at our HTC that could have been potentially prevented by changes in outpatient care delivery. We initiated a prospective quality improvement (QI) project to improve care delivery and to reduce preventable bleeding related hospitalizations and ER visits for adult patients treated at our HTC. The interventions targeted patient-level and systems-level factors contributing to preventable visits, and barriers to care in our patient population. We compared preventable bleeding related hospitalizations and ER visits, institutional factor cost, use of prophylaxis in severe hemophilia, primary care physician attainment, and patient electronic portal enrollment before and after the QI intervention. In our population of adult patients with bleeding disorders (N=88), the intervention significantly reduced the primary outcome of preventable bleeding hospitalization or ER visit (P=0.0082, Figure), and reduced such visits by 85.4%, meeting the pre-specified criteria for success. Institutional factor acquisition costs to treat preventable bleeding were reduced by 94.5%, from $11,800 to $640 per patient per year; a projected savings of $982,088 yearly. Use of factor prophylaxis in patients with severe hemophilia increased from 58.8% to 100%, attainment of a primary care physician increased from 69.4% to 86.4%, and use of the electronic patient portal increased from 53.2% to 83%; all secondary outcomes met pre-specified criteria of success and were statistically significant. HTC clinic visit attendance was low at 55.2%. The majority of patients (71.6%) had at least one outpatient urgent episode (mean 0.72 episode per year), and 93% had non-urgent management (mean 9.3 episodes per year) occurring outside of a clinic visit. These data demonstrate that concerted outpatient management of patients with bleeding disorders with a quality improvement framework can reduce preventable hospitalization and ER visits. Decreased inpatient utilization resulted in substantial reductions in factor costs at the health system level. The clinical effort required to achieve these results was substantial, and required frequent provider engagement outside of regular clinic visits. The HTC can improve patient outcomes and reduce institutional costs from preventable bleeding episodes by supporting a collaborative quality improvement process led by physician, nursing, and laboratory coagulation experts.

“Two Years Later I’m Still Just as Angry”: A Focus Group Study of Emergency and Internal Medicine Physicians on Disrespectful Communication

Phenomenon: Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. Approach: In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center. Findings: We organized focus group results into four overarching categories related to disrespectful communication: characteristics and context (including specific phrasing that members from each department interpreted as disrespectful, effects of listener engagement/disengagement, and the tendency for communication that is not in-person to result in misunderstanding and conflict); differences across training levels (with disrespectful communication more likely when participants were at different training levels); the individual correspondent’s tendency toward perceived rudeness; and negative/long-term impacts of disrespectful communication on the individual and environment (including avoidance and effects on patient care). Insights: In the context of predominantly positive descriptions of interdepartmental communication, participants described episodes of perceived disrespectful behavior that often had long-lasting, negative impacts on the quality of the learning environment and clinical work. We created a conceptual model illustrating the process and outcomes of these interactions. We make several recommendations to reduce disrespectful communication that can be applied throughout the hospital to potentially improve patient care, interdepartmental collaboration, and trainee and faculty quality of life.

The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty: An Analysis of Neighborhood Deprivation Indices.

Social determinants of health (SDOH) are important factors in the delivery of orthopaedic care. The purpose of this study was to investigate the relationship between outcomes following total knee arthroplasty (TKA) and both the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI). The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was utilized to identify TKA cases for inclusion. Demographic characteristics and medical history were documented. The SVI, its subthemes, and the ADI were analyzed. Outcome data included length of stay, discharge disposition, postoperative change in the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), 90-day incidences of emergency department (ED) visits, readmission, death, deep venous thrombosis (DVT) and/or pulmonary embolism (PE), periprosthetic fracture, implant failure, periprosthetic joint infection (PJI), and all-cause reoperation. Database cross-referencing was completed to document aseptic and septic revisions beyond 90 days postoperatively. Bivariate quartile-stratified and multivariable analyses were used to associate deprivation metrics with outcomes. A total of 19,321 TKA cases met inclusion criteria. Baseline patient characteristics varied among the SVI and/or ADI quartiles, with patients of non-White race and with a greater number of comorbidities noted in higher deprivation quartiles. Higher SVI and/or ADI quartiles were correlated with an increased rate of discharge to a skilled nursing facility (p < 0.05). A higher SVI and/or ADI quartile was associated with increased incidences of ED visits and readmissions postoperatively (p < 0.05). DVT and/or PE and long-term aseptic revision were the complications most strongly associated with higher deprivation metrics. Upon multivariable analysis, greater length of stay and greater incidences of ED visits, readmissions, DVT and/or PE, and aseptic revision remained significantly associated with greater deprivation based on multiple metrics. Greater deprivation based on multiple SVI subthemes, the composite SVI, and the ADI was significantly associated with increased length of stay, non-home discharge ED visits, and readmissions. The SVI and the ADI may be important considerations in the perioperative assessment of patients who undergo TKA. Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Modern robotics platform associated with reduced 90-day complications in hospital setting

BACKGROUND: Early complications in total knee arthroplasty (TKA) associated with modern robotics platforms integrated with digital balancing technology have not been investigated. OBJECTIVE: The objective was to compare 90-day complication rates between a manual technique and a modern robotic-assisted ligament balancing TKA platform. METHODS: 895 primary TKA procedures from a single surgeon were retrospectively reviewed (614 manual TKA, 281 using a modern robotics platform with an integrated digitally controlled ligament balancing device). Post-operative complications within the 90-day episode of care were recorded by the Michigan Arthroplasty Registry Collaborative Quality Initiative. Differences in complication rates between techniques were further divided into inpatient hospital, outpatient hospital, and ambulatory surgery center (ASC) cohorts. RESULTS: In the pooled hospital cohort and inpatient hospital cohort, ‘Return to OR’ was significantly lower for the robotic assisted group (1.3% vs 5.2% and 0% vs 4.9%, respectively, p&lt; 0.0370). Specifically, the need for manipulation under anesthesia (MUA) was reduced for the robotics group (0.0% vs 2.5%, p= 0.0352). No differences in overall complication rate or cause of complication was found between manual and robotics cases for the hospital outpatient and ASC cohorts (p⩾ 0.68). CONCLUSION: Within the hospital setting, robotic assisted ligament balancing technology was associated with reduced 90-day postoperative complications for ‘Return to OR’ and MUA.

Quality of health care and interdisciplinary collaboration from the perspective of employees and patients

Abstract Introduction. Cooperation in an interdisciplinary team is an important aspect of ensuring the quality and safety of patient care, although the interaction of individuals from different disciplines in the clinical environment can also be hampered by inadequate communication. Aim. This study attempts to fill the research gap and identify professionals’ perceptions of interdisciplinary collaboration and quality measures, the impact of interdisciplinary collaboration on the quality of care in a general hospital and clarify the perspective of patients and healthcare professionals. Material and methods. The case study was conducted using a survey of healthcare professionals (N = 150) and a qualitative approach by interviewing healthcare professionals (N = 47) and patients (N = 20). Results and conclusions. The results of the survey show that the nurses rated all the criteria of interdisciplinary cooperation and individual quality criteria the highest, and the quality of care in general the worst, as they were not satisfied with the implementation due to the lack of staff. The exchange of information did not affect the quality of care because organizational and national authorities did not sufficiently consider the views of staff. In in-depth interviews, patients rate teamwork as poor because they do not get enough explanation and do not feel treated as equal members of the medical team. In in-depth interviews, patients and healthcare professionals are aware of the lack of teamwork among themselves, as well as of the quality of care due to staff shortages in general and especially during the pandemic.

Advancing cardiotomy suction practices for coronary surgery via multidisciplinary collaborative learning

ObjectiveProfessional standards recommend stopping cardiotomy suction at the termination of cardiopulmonary bypass before protamine administration based on perceived safety concerns. This study evaluated a multidisciplinary collaborative quality-improvement intervention promoting this agreed-upon cardiotomy suction practice during coronary artery bypass grafting (CABG). MethodsA statewide intervention (eg, unblinded surgeon and perfusionist feedback, evidence-based lectures, evaluating barriers to change) involved 32 centers participating in the PERForm (ie, Perfusion Measures and Outcomes) Registry to standardize cardiotomy suction practices at cardiopulmonary bypass termination during CABG. Four non-Michigan registry participating centers were not exposed to collaborative learning. Cardiotomy suction practice was defined as the absence of or stopping cardiotomy suction before protamine administration. The practice changes attributed to the intervention, including Michigan and non-Michigan comparisons, were evaluated with the change of time effect modeled using splines. Multivariable regression was used to evaluate the intervention's associated impact (eg, mortality, reoperation, transfusion). ResultsAmong 10,394 patients undergoing CABG at Michigan centers, 80.7% achieved agreed-upon cardiotomy suction practices. The Michigan centers had nonsignificant changes in agreed-upon cardiotomy suction practices during the preintervention period (P = .24), with significant increased monthly change in practice thereafter, absent adjusted morbidity and mortality increases. The Michigan centers achieved a significantly greater adjusted monthly improvement in agreed-upon practices relative to non-Michigan centers within 7 months after the intervention (adjusted odds ratio for change of trends: 2.53, P < .001). ConclusionsThis initiative demonstrates the effectiveness of multidisciplinary collaborative quality improvement in advancing agreed-upon cardiotomy suction practices without negatively impacting clinical outcomes.

A study of steady-state strategies for collaborative quality improvement in new retail service supply chains considering emotional factors.

How to improve the quality of the new retail service supply chain (RSSC) has become a hot topic for enterprises and consumers. Considering the influence of the new RSSC enterprises' emotional attitude on the decision-making of quality improvement, the theory of rank-dependent expected utility (RDEU) is combined with an evolutionary game, constructing an evolutionary game model of collaborative quality improvement of new RSSC, and analyzing the game strategy choice of each participant in collaborative quality improvement of new RSSC. The study shows that when only one party is emotional, the rationality of retail service integrators will promote the synergistic improvement of the quality of the new RSSC more than functional service providers. Moreover, pessimism and optimism have an inverted U-shaped effect on quality decisions. When both parties have emotions, functional service providers remain optimistic, and retail service integrators remain pessimistic or rational can promote the collaborative improvement of new RSSC quality. In addition, the effects of quality preference, peer mechanism, feedback mechanism, and risk mechanism on the collaborative quality improvement of new RSSC are analyzed. Based on the research findings, relevant countermeasures are proposed to incentivize new retailers to conduct collaborative improvement in quality in terms of establishing an open mechanism for negotiation and consultation, strengthening the emotion management of new retail node firms, and adjusting the transmission of quality signals, with a view to realizing the quality collaborative improvement of the new RSSC.

Timely Assessment of Breathing-Related Distress in Community Palliative Care: A Multidisciplinary Collaborative Quality Improvement Project.

Background: Breathlessness is a common symptom for palliative patients that can cause distress and decrease function and quality of life. Palliative care services in Australia aim to routinely assess patients for breathing-related distress, but timely reassessment is not always achieved. Objective: To improve the timeliness of breathlessness reassessment in a home-based community palliative care service in New South Wales for people with moderate-to-severe breathing-related distress. Breathing-related distress was defined as a Symptom Assessment Score for "breathing problems" of four or more. Methods: This collaborative quality improvement (QI) project between SPHERE Palliative Care CAG, Stanford University mentors, and a Sydney metropolitan specialist palliative care service included a: (1) retrospective chart audit; (2) cause and effect analyses using a fishbone diagram; (3) development and implementation of key drivers and interventions; and (4) a pre-and-post evaluation of the timeliness of reassessment of breathing-related distress and changes in Symptom Assessment Scale scores for "breathing problems." Results: Key interventions included multidisciplinary education sessions to facilitate buy-in, with nurses as case managers responsible for breathlessness reassessment and documentation of scores, access and training in electronic palliative care data entry software, fortnightly monitoring and reporting of breathing-related distress scores, and development of an educational flowchart. The proportion of patients reassessed within seven days of an initial nursing assessment of moderate-to-severe breathing-related distress increased from 34% at baseline to 92% at six months. Conclusion: A local QI project increased the proportion of patients with a timely reassessment of their breathing-related distress in a community palliative care service.