Continuous Improvement Approach Research Articles

A comprehensive review of the literature on continuous improvement approaches in food services management

Continuous improvement (CI) have been recognised as one of the most effective ways to improve organisational performance. However, there is a lack of research on this topic from a food service perspective. Thus, the aim of this work is to explore the adoption of CI-focused methodologies in food services and to understand how they contribute to improving the performance of these services. Critical success factors and barriers to the implementation of CI are also analysed. This systematic review was conducted using the PRISMA methodology and a total of 43 studies were included in the analysis. This review shows that CI is effective in improving operations and performance, as well as increasing stakeholder satisfaction in the food service sector. Additionally, the review reveals that CI-focused tools are mainly used in problem identification, waste identification, planning, operations, and logistics. Human-related issues are the most frequently mentioned when it comes to the factors determining the success or failure of CI in food services.

Beyond competence and retention: Developing a comprehensive evaluation framework for a rural primary care nurse practitioner residency program.

With the rise in nurse practitioner (NP) residency programs, evaluations have largely focused on retention and competency completion for residents. There is a need for expanded evaluation to ensure the sustainability of NP residency programs, to ensure timely adaptations to address resident satisfaction, and to solidify a long-term pathway of NPs well prepared for rural practice. We created a family nurse practitioner (FNP) residency program with a comprehensive evaluation framework to prepare residents for practice in rural settings. The evaluation framework was developed through collaborative engagement of an external evaluation team, program leadership, and clinical site representatives. The evaluation framework of the FNP residency program combined resident assessment and holistic program evaluation, using a rapid continuous quality improvement (QI) approach. The evaluation considered three distinct perspectives: the resident, the peer coach, and the clinical site. The rapid continuous QI approach allowed program leadership to respond swiftly to programmatic challenges, improve the residency program in response to residents' reported experiences, and emphasize sustainability for continued program impact, while assessing residents' learning and performance. The program's data-driven evaluation approach has demonstrated its success in meeting the goals of the Health Resources and Services Administration funding by increasing the number of primary care providers in rural settings. The program's expansion and continued success have further validated the efficacy of this evaluation framework in assessing, improving, and ensuring the sustainability of APRN residency programs. This article calls for the adoption of similar evaluation strategies in future residency programs to promote their long-term success and impact in rural health care settings.

Ceramic additive manufacturing and microstructural analysis of tricalcium phosphate implants using X-ray microcomputed tomography

Additive manufacturing (AM) of ceramic bone implants from tricalcium phosphate (TCP) offers several benefits for bone regeneration and defect treatment. TCP scaffolds, e.g. featuring lattice or gyroid geometries, can effectively induce bone ingrowth and integration, showing a high potential in the treatment of large bone defects, e.g. as filler material for large bone defects. A major advantage of TCP is its osteoconductivity making it an effective choice for a broad range of orthopedic and dental applications. In addition, AM allows for the possibility to create precise, patient-specific implants with controllable mechanical properties. Those properties can be controlled by the implants' microstructure, e.g. in relation to bulk density and internal porosity. In this contribution, eleven resorbable bone implants were produced from β-tricalcium phosphate (β-TCP) in order to quantify the internal porosity in three dimensions using microcomputed tomography (μ CT). All components were manufactured using an extrusion-based process and scanned using an industrial μCT system at a voxel size of 10 μm. Two samples were physically prepared to allow a high-resolution μCT analysis at a voxel size of 1 μm. Results show that post-processed image data enables the non-destructive inspection of highly complex ceramic AM implants. Using μCT we were able to quantify internal porosity in β-TCP bone implant and quantify the geometry and distribution of wall thicknesses in the gyroid geometry. However, a detailed microstructural analysis is only possible using high-resolution μCT volume data, e.g. in relation to internal porosity. The findings emphasize that ceramic AM is able to produce complex components. However, NDT using μCT is crucial in the development of new materials and geometries. μCT provides high-resolution insights into the internal and external structure of ceramic AM components. It plays a critical role in detecting internal features, including small-scale porosity and delamination which are crucial for the integrity and functionality of medical implants. Moreover, μCT provides volumetric data that supports the design and manufacturing process at various stages, enabling an iterative approach of continuous improvement in mechanical performance and osseointegration.

Precision Workforce Management for Radiographers: Monitoring and Managing Competences with an Automatic Tool.

Optimizing work shifts in healthcare is crucial for maintaining high standards of service delivery and fostering professional development. This study delves into the emerging field of skill-oriented work shift optimization, focusing specifically on radiographers within the healthcare sector. Through the development of Skills Retention Monitoring (SRH), this research aims to enhance skill monitoring, workload management, and organizational performance. In this study, several key highlights emerged: (a) Introduction of the SRH tool: The SRH tool represents a resource-efficient solution that harnesses existing software infrastructure. A preliminary version, focusing on the radiographers' professional profile, was released, and after several months of use, it demonstrated effectiveness in optimizing work based on competency monitoring. (b) The SRH tool has thus demonstrated the capacity to generate actionable insights in the organizational context of radiographers. By generating weekly reports, the SRH tool streamlines activity management and optimizes resource allocation within healthcare settings. (c) Application of a Computer-Assisted Web Interviewing (CAWI) tool for pre-release feedback during a training event. (d) Strategic importance of a maintenance and monitoring plan: This plan, rooted in a continuous quality improvement approach and key performance indicators, ensures the sustained effectiveness of the SRH tool. (e) Strategic importance of a transfer plan: Involving professional associations and employing targeted questionnaires, this plan ensures the customization of the tool from the perspective of each profession involved. This is a crucial point, as it will enable the release of tool versions tailored to various professions operating within the hospital sector. As a side result, the tool could allow for a more tailored and personalized medicine both by connecting the insights gathered through the SRH tool with the right competencies for healthcare professionals and with individual patient data. This integration could lead to better-informed decision making, optimizing treatment strategies based on both patient needs and the specific expertise of the healthcare provider. Future directions include deploying the SRH tool within the Pisa hospital network and exploring integration with AI algorithms for further optimization. Overall, this research contributes to advancing work shift optimization strategies and promoting excellence in healthcare service delivery.

Entrepreneurial Culture and Continuous Improvement to Handle Environmental Turbulence

Abstract The purpose of this study is to understand how organizations behave when faced with turbulent external environments characterized by rapid change, uncertainty, and unpredictability. We look at different dimensions of environmental turbulence, for example, regulatory forces, economic changes, and political changes that directly shape organizational strategies. Literature suggests that while dealing with market dynamics companies must go beyond traditional paradigms to embrace a proactive approach toward change thus making decisions that shape new potential opportunities and being always ready to act and react swiftly according to market changes. Entrepreneurial firms can indeed lead to innovative interventions, driving market developments. The research utilizes a single case study approach that is somewhat revealing to explore the strategic responses of a firm in a resource-based industry facing globalization pressures. There are two broad streams identified: Continuous Improvement and Entrepreneurial Culture. Corporate strategy regarding market dynamics impact and internationalization efforts falls under the category of continuous improvement approaches which emphasize coping with external contingencies. The second macroaggregate on Entrepreneurial Culture deals with stakeholder orientation, organizational agility, and the influence of entrepreneurial ideas and values in corporate responses to disruption. The firm is actively involved in shaping its own future by taking a change-focused approach that involves both forwardthinking management decisions but also an entrepreneurial mindset. This study will contribute to the literature on firm’s organizational learning, focusing on how to strategize in turbulent environments. Furthermore, the study will provide a holistic view of different resources and components of a change that are extensively analysed independently in the literature. Thus, looking at how they are combined for company success.

Adapting SEL interventions to meet student needs: A research-practice partnership supporting students with emotional disabilities

Implementing school-based social-emotional learning (SEL) interventions requires consideration of both evidence-based practices as well as contextual fit based on student needs. One key approach to adapting SEL interventions is through research-practice partnerships between researchers, practitioners, and school district leaders. The current paper explores the ways a research-practice partnership supports an inclusive education intervention, called the Path Program, designed to support elementary students with emotional disabilities through both structural elements and evidence-based practices. Using the research-practice exchange in the Path Program to support a continuous improvement approach to adaptation, the Path Program uses a Plan Do Study Act cycle to continually infuse SEL activities with a trauma-informed approach to meet student needs. The paper offers crucial information for SEL interventions on the strengths of leveraging research-practice partnerships for program adaptation as well as implementation. Impact statementThe current paper importantly sheds light on ways to leverage a research-practice partnership to support intervention adaptation and implementation to better meet student needs while maintaining evidence-based practices. Specifically, the paper details the importance of infusing SEL activities with trauma-informed practices to meet students with emotional disabilities’ needs and the ways a research-practice partnership supports that process. The paper informs researchers, practitioners, and school leaders on ways to use partnerships to develop stronger SEL interventions.

Academic program enhancement supporting the success of undergraduate nursing students and graduates

Nursing program administrators, faculty, academic success coaches, and remediation specialists have implemented many interventions in support of baccalaureate nursing students' retention and graduates' NCLEX-RN® first-time pass rates. A private university's undergraduate nursing program's team incorporated additional evidence-based interventions aimed improving students' achievement of benchmarks following a 3-year decline in NCLEX-RN pass rates. Interventions expanded the prelicensure academic program's activities using a continuous quality improvement approach. A simulation center was constructed and a director was hired. A consultant also facilitated faculty engagement in curricular revisions. A new position, coordinator tutor/remediation specialist, was filled and the academic success coach launched interventions that complemented an initial and subsequent strategies for success initiative. New interventions were trialed and evaluated and became integral to students' and graduates' success. The academic success coach's commitment to students' achievements promoted their engagement in interventions. Pass rates increased and were sustained. Examples of interventions, supported by evidence, are presented in tables for review. A logic model depicts components of the program plan and its interventions as augmented by prospective strategies and remediation interventions. Continuous quality improvement processes will continue. Students and graduates have commented positively on the benefits of the assorted, success-promoting interventions.

Using Appreciative Inquiry to Understand Workload Reasonability

This article describes an organizational continuous process improvement project using Appreciative Inquiry to evaluate staff members’ perception of their unreasonable workload, as indicated in the Federal Employee Viewpoint Survey. The goal for approaching the management-directed study was to use AI to frame the conversation around the lifegiving forces aspects AI brings to the organization rather than a traditional continuous process improvement approach in which we would investigate a problem, identify issues, and propose solutions to correct it.

Remote area nurses' experiences of workplace safety in very remote primary health clinics: A qualitative study.

To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics. This qualitative study used online semi-structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management. The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia. Fifteen Remote Area Nurses participated in the study. Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses. Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge. Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements. COREQ reporting guidelines were followed. A panel of six Remote Area Nurses collaborated in the development of this project.

Towards a Continuous Temporal Improvement Approach for Real-Time Business Processes

Towards a Continuous Temporal Improvement Approach for Real-Time Business Processes

Energy efficiency analysis: A household digital transformation

<p>Nowadays, the increased demand for energy and electrification associated with higher production costs from renewable and cleaner sources has driven up prices, impacting the industrial, commercial, and residential sectors. With a direct influence on the development of these economic sectors, its direct and indirect impacts to products and services have become important to find more efficient ways and best practices on energy use to support sustainable development. Aiming to shed light on this topic, and how individuals and society behave in this energy market transformation, this article explores opportunities for reducing electricity consumption through the use of modern technologies, such as of monitoring, optimization, automation, and adjustment of routines. At the same time, it is also our intention to bring to the surface a discussion around the rational use of everyday resources and raising the awareness of its impact to individuals and institutions. At its core, this work consists of continuous data collection of single devices and equipment in regard to status, energy consumption, and other relevant data of a typical household. Through behavioral changes and introduction of smart home automation techniques, it was possible to trace a parallel comparison between different scenarios and their influence on the energy consumption without negative impact to the comfort of individuals. Seeking a continuous improvement approach, extensive iterations were conducted, and it was possible to notice not only an energy efficiency improvement, but at the same time gains in living standards and safety. The significant results observed over subsequent months and years highlight not only practical and financial benefits, but also increased awareness and behavioral changes toward the rational use of electricity in households.</p>

Kaizen-mindfulness a twin continuous improvement approach at workplace: A qualitative exploratory study

PurposeWorld Health Organizations (WHO) (2023) states that governments and employers have a responsibility to uphold that right by providing work that simultaneously prevents workers from experiencing excessive stress and mental health risks. The business environment continues to produce a lot of stress on workers, which includes internal pressures to achieve results and employees suffer the consequences. Some companies have turned to mindfulness as a technique that helps mitigate these consequences and have joined Kaizen as a process improvement technique in the work environment. Therefore, this study has a research purpose: “to comprehend the possible linkage between Kaizen philosophy from an individual perspective, with Mindfulness ZEN Buddhism technique to understand the individual benefit (well-being) of each employee in organizations.” The answer to this represents the research gap in this article. The research questions governing this study are as follows: RQ1: Does Mindfulness is used as Kaizen technique of personal-individual improvement in 21st-century organizations? RQ2: What elements and characteristics of Kaizen and mindfulness can be found working together? And RQ3: Which qualitative impact of mindfulness and Kaizen in the workplace outcome (well-being, performance of the job (process)) and relationships with other employees)?Design/methodology/approachThis research used a qualitative approach due to the recent phenomenon studied. In a certain way, it was used a mixed-method (combination of qualitative data – web search secondary data analysis and qualitative research-Convergence Model). First, it was done an intensive web search with the aim to identify companies' corporate mindfulness programs, along with companies which have applied mindfulness and Kaizen programs. It was identified a group of big companies with global and international presence (“famous” for their products and services) in diverse industrial and service sectors, country of origin and business locations; with the purpose of getting a holistic vision of all organizations which have practice Kaizen and mindfulness. Therefore, this study explored secondary data related to both practices, analyzing reports or briefings published in management magazines and official WEB pages and/or business magazines.FindingsAs a result of the triangulation of the data with its secondary data convergence model and qualitative research, a theoretical framework was reached that shows the benefits of the two combined twin techniques of Kaizen and mindfulness. The worker experiences a path that goes from concentrating on the execution of their processes, following their operating standards (Standardize, Do, Check, Act [SDCA] cycle), going through the evolution to continuous improvement or Plan-Do-Check-Act (PDCA) cycle, experiencing work with concentration-awareness and reducing your daily stress, maintaining high sensitivity to the work process and your environment and finally, discovering an essential life purpose. Finally, worker experiences benefit when there is wide application of both with the SDCA and PDCA cycles such as high motivation, constant learning from your mistakes, day-to-day learning and the Munen Musso (not using the mind).Research limitations/implicationsThe main limitation is the qualitative methodological bias and secondary data research. In addition, to have a theoretical sample. However, the richness of the data helps to overcome this limitation. On the other hand, the qualitative research interviews are for a certain geographical area, therefore, the results cannot be generalized.Practical implicationsThe results of this research can shed light on operations managers in the use of techniques for continuous improvement and improvement of people's quality of life, such as mindfulness. In Mexico, they are beginning to be used jointly (twin techniques) to comply with Regulation 035 of psychosocial risk, the researchers are sure that in other countries it will be used in the same way to comply with regulations. However, the research findings show the benefits that can be provided to workers in organizations by applying Kaizen and Mindfulness together.Originality/valueTo the best of the authors’ knowledge, according to the literature review, this is the first article that explores the relationship between Kaizen and Mindfulness as twin techniques that help improve the individual quality of life of employees in organizations.

Optimizing chemotherapy medication leftover management circuit in a centralized chemotherapy preparation unit: A comprehensive FMECA risk analysis and continuous improvement approach.

Chemotherapy medications are usually having high costs, and new targeted drugs can be especially expensive, representing a challenge on healthcare, particularly in low- and middle-income countries. As cytotoxic leftover management is crucial for reducing medication wastage, the aim of this study is to evaluate and optimize leftover management circuit in NIO'S Pharmacy Centralized Chemotherapy Preparation Unit (CCPU) through a Failure Mode, Effects and Criticality Analysis (FMECA), and propose continuous improvement element to enhance the security of the process. The FMECA were conducted in NIO's CCPU from March to May 2023, then continuous improvement plan was established to enhance the security of the process. The failure modes, their causes, impact, and criticality were assessed through criticality index calculation (CI = severity × frequency × detectability), and the risk concerned safety and effectiveness disruptions in chemotherapy preparation circuit using cytotoxic leftover. Leftover management circuits were described in flowchart form, where 18 failure modes were detected in four different steps of the process from chemotherapy preparation to disposal. Failure with highest critical index were detected in the case of equipment malfunction, improper storage temperature, and humidity. Continuous improvement recommendations were proposed in a table form. FMECA analysis applied to NIO's chemotherapy leftover management process allowed us to evaluate, secure, and optimize the circuit, and to propose several actions to implement in a perspective of continuous improvement.

Improvement of enterprise risk visualization: risk mapping

The object of the study is the risks that disrupt the accomplishment of any enterprise's missions. Therefore, mastering these risks is a significant asset for organizations and the overall health of the enterprise. Thus, working comprehensively on organizational risk prevention enables the enterprise to formulate a strategy aimed at guarding against all risk factors. Simultaneously, it identifies areas where more targeted actions need to be undertaken, potentially leading to positive changes within the company. To achieve this and allow for a robust and reliable assessment for better governance of harmful elements in the enterprise, we have used the risk mapping method. It is a data visualization tool aimed at highlighting vulnerabilities in various processes and activities that an organization faces, even allowing for informed decisions to prevent and cope with risks. Risk mapping is defined as the approach of identifying, evaluating, prioritizing, and managing risks inherent in an enterprise's activities. It even delves into a thorough investigation of all managerial, operational, and support processes that activities require implementing. This mapping technique is based on an objective, structured, and documented description of existing risks. The assessment allows for a more detailed analysis of initial and residual risks at all levels of the enterprise, thereby facilitating the development of a prioritized action plan accompanied by an analysis of its funding. This obligation is part of a continuous improvement approach to the quality of life and working conditions, even engaging in a sustainable management process. As a case study, we have chosen to focus on the SAIDAL Group of Constantine. Through this case study, we aim to illustrate the practical implications and benefits of using risk mapping as a strategic tool for risk management in a complex organizational context. Now, having a risk map not only promotes a proactive approach to risk mitigation but also contributes to broader goals of continuous improvement and sustainable risk management practices: a necessity for any enterprise.

Remote symptom monitoring alerts for nurses: Removing the noise.

379 Background: Within remote symptom monitoring (RSM) programs, nurses may respond to many symptom alerts in a given day. The shift to standard-of-care delivery necessitates adding this responsibility to an already strained nursing workforce. Thus, selecting the right symptoms to alert is critical and requires care to minimize non-actionable alerts. Little is known about strategies to reduce alert burden on nursing. Methods: In this quality improvement initiative, we aimed to improve the nurse’s perception of alert utility and minimize “noise” or alerts that were not actionable. A continuous quality improvement approach, with multiple Plan Do Study Act (PDSA) cycles, was conducted based on nursing feedback. Modifications were captured, described, and categorized. Alert details prior to and after changes are described. Descriptive statistics were calculated using frequencies and percentages for categorical variables. Results: In PDSA cycle 1, we allowed nurses to set an expected level for specific symptoms to “snooze” alerts for up to 1 month in June 2021. Snoozed alerts did not trigger to nurses. Overall, 5.8% (405/7029) of symptom alerts were snoozed from late June 2021-May 2023 (Alert Redundancy Change). In PDSA cycle 2, an option “I don’t want a call back” was added for patients in late January 2022; 42.8% (2394/5595) of subsequent symptom alert surveys requested no call back from the nurse (Survey Response Threshold Change). In PDSA cycle 3, nurses reported that “insomnia” was not actionable weekly. This was encountered in 7.2% (170/2368) of surveys prior to removal at the end of June 2022. “Insomnia” was replaced with “rash”, which generated alerts in 6.5% (295/4549) of surveys (Survey Content Change). In PDSA cycle 4, nurses identified that hospitalized patients generated alerts that were not appropriate for outpatient action. The system was modified to add a banner bar highlighting to the nurse that the patient was hospitalized and alert could be closed with a response of “patient hospitalized” late February 2023. Following implementation, a total of 9.1% (35/384) enrolled patients either self-selected or a navigator marked them as hospitalized and therefore their surveys were paused and/or the nurse was able to close the alert selecting “patient hospitalized”. (Survey Location Change). With these changes, there were 9.9% (97/975) surveys in May 2023 with at least one actionable alert. Conclusions: Modifications to alert systems can reduce the number of non-actionable alerts that nursing must address in real-world settings, thus minimizing burden on staff.

The Role of the Supervisor in Implementing Supervision to Enhance the Quality of Student Learning Outcomes Through Continuous Improvement

This research explores the role of supervisors, particularly school principals, in improving student learning outcomes through continuous improvement. The study emphasizes the integral role of school principals in educational institutions. The research investigates the three key phases of supervision: planning, implementation, and evaluation. Effective supervision commences with comprehensive planning at the start of the academic year, involving all teachers and school staff. The core of supervised programs lies in their implementation, during which the principal observes teaching, classroom conditions, and student engagement. Subsequently, the evaluation stage involves an analysis of planning and implementation, enabling the identification of strategies and solutions to address issues and achieve continuous improvement. The qualitative methods employed in this research include observation, interviews, and documentation at sekolah menengah pertama katolik (SMPK) Kolese St. Yusup 2 Malang. The results demonstrate that the planning, implementation, and evaluation stages of supervision at SMPK Kolese St. Yusup 2 Malang have successfully adopted a continuous improvement approach. This is evidenced by improvements in teacher effectiveness, social and personality competencies, and student learning outcomes, with notable achievements at local, regional, and national levels. The findings underscore the transformative potential of school principals as agents of change in academic supervision activities.

Improvement Science and the Every Student Succeeds Act: An Analysis of the Consolidated State Plans

ABSTRACT The purpose of this study was to examine the presence of continuous improvement and improvement science in the Consolidated State Plans required by ESSA. Through an exploratory qualitative content analysis, we examined 52 state plans to determine the extent education policies encourage professional educators to use a continuous improvement and improvement science approach to meet educational goals. Our analysis yielded four themes: (a) state plans included continuous improvement, (b) improvement was framed as an outcome to be achieved or a process, (c) plans prioritized the what not the how, and (d) measurement was used for accountability more than improving processes.

Fostering Nursing Faculty Practices Within a University-Based Student Health Care Center

Graduate-level clinical nursing faculty who maintain clinical practice can ensure clinical relevancy in the classroom and serve as clinical preceptors for doctor of nursing practice students. Finding flexible and supportive clinical practice sites can be challenging for nursing faculty. Using a continuous quality improvement approach, an academic-practice partnership was formed between a college of nursing and a university-based student health care center to serve both organizations. Integrating 1 clinical faculty member increased patient visits and provider availability during semesters with high patient demand while offering a flexible clinical environment, increasing preceptor availability, and fostering faculty practices across the college.

Bibliometric analysis of publications on cyber risks in the services sector

Objective: To explore the progress of scientific production on cyber risks that permeate the service sector, identifying relevant researchers and institutions on this theme, measuring the impact, and identifying trends, contributions, and knowledge gaps. In addition, the study seeks to use bibliometric findings to bring academic and managerial contributions to the subject. Methodology: Bibliometric study, using the method of organization and systematization of information (Chueke & Amatucci, 2015; Guedes & Borschiver, 2015), whose structure followed the premises of the laws of Bradford, Lotka, and Zipf, using the scientific databases of the WoS - Web of Science. The bibliometric study enabled the performance of exploratory and descriptive research without the temporal cut, resulting in the identification of 115 publications (December 1995 to February 2023), which allowed measuring and presenting the characteristics and profile of the publications analyzed. Originality: The study revealed a potential for exploring the theme of Cyber Risks in the Services sector, considering the scarcity of scientific production. It also enabled the identification of emerging trends and clusters in service sector activities and the creation of a conceptual model based on the findings of the analyzed publications. Main results: The analyses revealed which sectors of the service economy are most frequently approached in publications related to the theme of cyber risks. These analyses were organized into ten areas, with the following order of relevance (frequency) of publication: Computer Science, Information Systems, Engineering, Business, Finance and Management, Telecommunications, Computer Science Theory Methods, and Computer Science Artificial Intelligence. The bibliometric findings enabled the creation of the conceptual model of Cyber Risks in Services, which proposes a cyclical and continuous improvement approach to deal with vulnerabilities, cyber threats, and consequences. This includes identifying and assessing existing vulnerabilities, implementing mitigation measures, and constantly monitoring threats and their consequences. Theoretical contributions: The conceptual model of Cyber Risks in Services can be a reference for researchers in various fields of action, considering the breadth of the services sector and the interdisciplinary nature of digital risk mitigation. Managerial contributions: Understanding of cyber risks supports the ability of the organization to respond to them, strengthening its security posture and protecting its critical assets and information from cyber threats.

Adenosine triphosphate (ATP) sampling algorithm for monitoring the cleanliness of surgical instruments.

Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation. Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a 'clean' cut-off of 250 Relative Light Units (RLU) and a 'very clean' <100 RLU. The four cleanliness categories were significantly differentiated (P≤0.001). The worst performing locations (hospitals A & C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B & D (P≤0.001). The best performing hospitals (B & D) had failure rates of 7.7% and 2.8%, respectively. The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass/fail methodology.