Continuous Quality Improvement Research Articles

A Deeper Reflection on the Integration of the Pharmacists’ Patient Care Process

ObjectiveGiven the importance of developing student understanding and application of the Pharmacists’ Patient Care Process (PPCP), programs may be able to use successful approaches from other institutions to enhance their curricular and experiential learning and assessment of student outcomes. The study objective was to explore successful methods of integrating the PPCP and outline areas of challenge. MethodsThis study used a qualitative study design with semistructured interviews to gain insight from participants’ lived experiences. Pharmacy faculty members participating in a national survey or who were authors of articles about PPCP initiatives were recruited to provide greater detail about building successful and innovative curricula. Thematic analysis identified commonalities and differences among the interviewed participants. ResultsA total of 10 interviews were conducted. The following 4 overarching themes arose from the data: discussions around intentional integration of the PPCP across multiple core courses may foster innovations in teaching strategies; intentional integration alone does not equate to PPCP integration across the curriculum; intentional integration may enhance program assessment; and PPCP data from experiential coursework may not be widely used in curricular continuous quality improvement. ConclusionPharmacy programs will ideally involve the entire faculty, including experiential and basic and social/administrative science members, in weaving the PPCP throughout the curriculum. Rigorous assessment can better inform interventions related to student competency in various steps of the PPCP. Pharmacy programs should also clarify how data obtained from preceptors observing student performance in each of the PPCP steps are used to assess student mastery of this critical skill.

A Study on the Recent Trends of Entrepreneurship in Exports

The determinants of participation in international business is a well- researched area with in both economics and business management disciplines. Such studies have largely highlighted factors external to the firm. A few enquiries in the small and medium sector have looked person- specific factors as explaining the difference in behavior between exporters and non-exporters. Taking off from these two streams, this paper delves deep into the exporting behavior of small- and medium-sized enterprises (SMEs) in two specific sectors after considering the dimensions of entrepreneur, enterprise and environment. Entrepreneurship is the sustainable driving force and stable source of economic development, and it is an important guarantee for the continuous improvement of export product quality and high-quality economic development. This paper selects entrepreneurship and export product quality as research objects. It measures the export product quality at the enterprise level using data from the China Industrial Enterprise Database and the China Customs Import and Export Trade Database. Furthermore, based on matching entrepreneurship at the macro-level and the export product quality at the micro-level, the impact and mechanism of entrepreneurship on the export product quality are empirically examined. It was found that entrepreneurial innovation and entrepreneurship further significantly contribute to the improvement of export product quality by promoting the total factor productivity of enterprises. Entrepreneurial innovation and entrepreneurship do not significantly contribute to the export product quality of state-owned and collective enterprises, while they significantly contribute to privately-owned, independent legal entities, Hong Kong–Macao–Taiwan, and foreign-funded enterprises. Furthermore, the promoting effect on privately-owned and independent enterprises is greater than that on Hong Kong–Macao–Taiwan and foreign-funded enterprises. Further analysis shows that improving the rule of law, reducing excessive government intervention, and improving the market mechanism for products and production factors, as well as vigorously developing the non-state-owned economy, will all be conducive to the cultivation and development of entrepreneurs and better promotion of the improvement of export product quality.

Organizational learning in surgery in Tanzania's health system: a descriptive cross-sectional study.

Organizational learning is critical for delivering safe, high-quality surgical care, especially in low- and middle-income countries (LMICs) where perioperative outcomes remain poor. While current investments in LMICs prioritize physical infrastructure, equipment, and staffing, investments in organizational learning are equally important to support innovation, creativity, and continuous improvement of surgical quality. This study aims to assess the extent to which health facilities in Tanzania's Lake Zone perform as learning organizations from the perspectives of surgical providers. The insights gained from this study can motivate future quality improvement initiatives and investments to improve surgical outcomes. We conducted a cross-sectional analysis using data from an adapted survey to explore the key components of organizational learning, including a supportive learning environment, effective learning processes, and encouraging leadership. Our sample included surgical team members and leaders at 20 facilities (health centers, district hospitals, and regional hospitals). We calculated the average of the responses at individual facilities. Responses that were 5+ on a 7-point scale or 4+ on a 5-point scale were considered positive. We examined the variation in responses by facility characteristics using a one-way ANOVA or Student's t-test. We used univariate and multiple regression to assess relationships between facility characteristics and perceptions of organizational learning. Ninety-eight surgical providers and leaders participated in the survey. The mean facility positive response rate was 95.1% (SD 6.1%). Time for reflection was the least favorable domain with a score of 62.5% (SD 35.8%). There was variation by facility characteristics including differences in time for reflection when comparing by level of care (P = .02) and location (P = .01), and differences in trying new approaches (P = .008), capacity building (P = .008), and information transfer (P = .01) when comparing public versus faith-based facilities. In multivariable analysis, suburban centers had less time for reflection than urban facilities (adjusted difference = -0.48; 95% CI: -0.95, -0.01; P = .046). Surgical team members reported more positive responses compared to surgical team leaders. We found a high overall positive response rate in characterizing organizational learning in surgery in 20 health facilities in Tanzania's Lake Zone. Our findings identify areas for improvement and provide a baseline for assessing the effectiveness of change initiatives. Future research should focus on validating the adapted survey and exploring the impact of strong learning environments on surgical outcomes in LMICs. Organizational learning is crucial in surgery and further research, funding, and policy work should be dedicated to improving learning cultures in health facilities.

Fundamentals of Emergency Initial Assessment: A Comprehensive Review

Emergency initial assessment is a critical process in emergency medicine, ensuring that patients receive timely and appropriate care based on the severity of their condition. This comprehensive review explores the fundamental principles of emergency initial assessments, focusing on the primary and secondary survey methods, including the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure). The review also discusses the essential tools and techniques used during assessments, such as vital signs monitoring, diagnostic tools, and triage systems. Best practices and guidelines from leading medical organizations are highlighted, alongside evidence-based approaches that improve patient outcomes. Additionally, the review addresses common challenges faced during emergency assessments, such as time constraints, resource limitations, and communication barriers. By emphasizing the importance of continuous training, technological advancements, and quality improvement initiatives, this review aims to provide healthcare professionals with a solid foundation for performing effective emergency initial assessments. The article concludes by identifying areas for future research and potential innovations that could further enhance emergency care practices.

Moving from Prove to Improve: A collaborative continuous quality improvement process for advancing clinical and translational science

Moving from <i>Prove</i> to <i>Improve</i>: A collaborative continuous quality improvement process for advancing clinical and translational science

Chinese expert consensus on surgical continuous quality improvement goals in esophageal cancer and esophagogastric junction cancer (2024 edition)

Improving the quality and efficiency of surgical diagnosis and treatment guarantees the outcome for most patients with esophageal cancer and esophagogastric junction cancer, and the continuous quality improvement mechanism oriented to the "textbook outcome" is the best choice. To ensure the successful implementation of the "Quality Control Indicators for Standardized Diagnosis and Treatment of Esophageal Cancer in China (2022 Version)" aligning with it more effectively is crucial. The Expert Committee on Quality Control of Esophageal Cancer at the National Cancer Center leads work teams comprised of multidisciplinary experts, particularly those in thoracic surgery, to establish a consensus. The current consensus comprises eight "textbook outcomes" to standardize, promote, and consolidate surgical quality management and continuously improve the surgical quality of esophageal cancer and esophagogastric junction cancer.

Association between Neonatal Outcomes and Admission Hypothermia among Very Preterm Infants in Chinese Neonatal Intensive Care Units: A Multicenter Cohort Study.

We aimed to investigate the relationship between admission hypothermia and outcomes among very preterm infants (VPIs) in neonatal intensive care units (NICUs) in China. We also investigated the frequency of hypothermia in VPIs in China and the variation in hypothermia across Chinese Neonatal Network (CHNN) sites. This retrospective cohort study enrolled infants with 240/7 to 316/7 weeks of gestation with an admission body temperature ≤37.5 °C who were admitted to CHNN-participating NICUs between January 1 and December 31, 2019. A total of 5,913 VPIs were included in this study, of which 4,075 (68.9%) had hypothermia (<36.5 °C) at admission. The incidence of admission hypothermia varied widely across CHNN sites (9-100%). Lower gestational age (GA), lower birth weight, antenatal steroid administration, multiple births, small for GA, Apgar scores <7 at the 5th minute, and intensive resuscitation were significantly associated with admission hypothermia. Compared with infants with normothermia (36.5-37.5 °C), the adjusted odds ratios (ORs) for composite outcome among infants with admission hypothermia <35.5 °C increased to 1.47 (95% confidence interval [CI], 1.15-1.88). The adjusted ORs for mortality among infants with admission hypothermia (36.0-36.4 and <35.5 °C) increased to 1.41 (95% CI, 1.09-1.83) and 1.93 (95% CI, 1.31-2.85), respectively. Admission hypothermia was associated with a higher likelihood of bronchopulmonary dysplasia, but was not associated with necrotizing enterocolitis ≥stage II, severe intraventricular hemorrhage, cystic periventricular leukomalacia, severe retinopathy of prematurity, or sepsis. Admission hypothermia remains a common problem for VPIs in a large cohort in China and is associated with adverse outcomes. Continuous quality improvement of admission hypothermia in the future may result in a substantial improvement in the outcomes of VPIs in China. · Admission hypothermia is common in VPIs.. · The incidence of admission hypothermia in VPIs remains high in China.. · Admission hypothermia is associated with adverse outcomes in VPIs..

The Antiretroviral Pregnancy Registry: Three decades of prospective monitoring for birth defects.

Antiretrovirals (ARVs) are life-saving drugs used for the treatment and prevention of HIV infection and antiviral drugs (AVs) for the treatment of chronic HBV infection. ARVs have proven highly effective in reducing perinatal HIV transmission, however the risk of birth defects from prenatal exposure to ARVs/AVs is an ongoing concern. The Antiretroviral Pregnancy Registry (APR), an international, prospective exposure-registration cohort study, monitors ARV and AV use in pregnancy for early signals of teratogenicity. This communication reports results of 30-years' experience of ARV/AV exposure during pregnancy and lessons learned through continuous quality improvement. Birth defect prevalence is estimated and compared to internal and external groups. Statistical inference is based on exact methods for binomial proportions. Between 2006 and 2023, cumulative enrollment more than tripled from 6893 to 25 960 pregnancies and ARVs/AVs monitored increased from 29 to 222. Through January 2023, there were 21 636 live births and 631 outcomes with birth defects, for overall prevalence of 2.9/100 live births (95% CI 2.7, 3.2). The birth defect prevalence was 3.0% (95% CI 2.7%, 3.3%) among first trimester exposures and 2.8% (95% CI 2.5%, 3.2%) among second/third trimester exposures (prevalence ratio 1.04 [95% CI 0.89, 1.21]). Birth defect prevalence is not statistically significantly different between first trimester ARV/AV pregnancy exposures compared to second/third trimester exposures and is also not different from two population-based surveillance systems: 2.72/100 live births reported in the Metropolitan Atlanta Congenital Defects Program (MACDP); and 4.17/100 live births from the Texas Birth Defects Registry (TBDR).

Continuous Quality Improvement in the Substance Abuse and Mental Health Services Administration's Technology Transfer Center Network: A Process Evaluation.

In healthcare and related fields, there is often a gap between research and practice. Scholars have developed frameworks to support dissemination and implementation of best practices, such as the Interactive Systems Framework for Dissemination and Implementation, which shows how scientific innovations are conveyed to practitioners through tools, training, and technical assistance (TA). Underpinning those aspects of the model are evaluation and continuous quality improvement (CQI). However, a recent meta-analysis suggests that the approaches to and outcomes from CQI in healthcare vary considerably, and that more evaluative work is needed. Therefore, this paper describes an assessment of CQI processes within the Substance Abuse and Mental Health Services Administration's (SAMHSA) Technology Transfer Center (TTC) Network, a large TA/TTC system in the United States comprised of 39 distinct centers. We conducted key informant interviews (n = 71 representing 28 centers in the Network) and three surveys (100% center response rates) focused on CQI, time/effort allocation, and Government Performance and Results Act (GPRA) measures. We used data from each of these study components to provide a robust picture of CQI within a TA/TTC system, identifying Network-specific concepts, concerns about conflation of the GPRA data with CQI, and principles that might be studied more generally.

How a System Is Closing the Evidence-Based Data Management Gap.

To translate raw data into information that is understandable and actionable, healthcare leaders must leverage decision-making tools that can drive strategic innovation, improve processes, and shape the future of healthcare. Continuous changes in healthcare delivery require constant monitoring of an expanding range of data. Population demographics, psychographics, and availability of care all must be considered, as well as provider practice patterns, patient utilization, clinical and service quality, costs, and many other key variables over time. RWJBarnabas Health is navigating significant changes in its approach to managing data. A unified operating model is driving standardization, continuous quality improvement, and cost reductions across the system. The solution is based on an electronic health record system designed to meet the needs of the entire system, an array of carefully selected external data sources, and a business intelligence tool to enable leaders to quickly draw insights from all the available data.

Case study in using value stream mapping in online graduate education

Given the rise in demand for online, graduate degree programs there is a need to guide program planning and evaluation professionals within institutions of higher education to utilize continuous quality improvement (CQI) strategies. Using principles of design thinking and CQI, the purpose of this case study was to describe a CQI project that sought to develop a better understanding of adult students’ experience progressing through their plan of study in an online doctoral program. As part of the CQI project, value stream mapping (VSM) was used to gain visibility and perspective on the actions required by faculty and staff to guide students through their plan of study. The VSM process provided information that led to conversations that furthered the CQI efforts and led to changes in the adult education program that would benefit all students. Improvement processes that lead to better quality and more positive experiences for users are valuable. This case study demonstrates the processes, challenges, lessons, and future directions in the use of VSM to better understand online graduate programs designed for adult learners.

APPEAL: a toolkit for attracting people who inject drugs with hepatitis C to healthcare systems

Abstract Aim The “APPEAL” toolkit was developed to address the challenges in diagnosing people who inject drugs (PWID) with hepatitis C (HCV) and engaging them with healthcare systems. It introduces an ecosystemic approach based on health and well-being literacy across awareness, prevention and diagnosis dimensions of the hepatitis C’s care cascade (CC) for PWID. Subject and methods The framework incorporated a scoping review and thematic analysis of 54 studies, alongside contributions from 57 hepatitis C key opinion leaders across seven countries. The toolkit is structured around five main axes: problems, solutions, outputs, outcomes and feedback process, employing a holistic perspective that considers economic, legal and social contexts. Eighteen policy prescriptions (PP) are proposed and supported by selective references to ensure relevance and applicability. Results The APPEAL toolkit facilitates a strategic workflow for policymakers, health authorities and patient advocacy organizations, guiding them through action flowcharts to evaluate and enhance their interventions within the hepatitis C’s CC for PWID. Notably, its implementation demonstrated potential in identifying and attracting PWID to hepatitis C treatment pathways, contributing to increased diagnostics, education on risk behaviours and raising overall disease awareness. The toolkit’s intelligent cycle system supports accountability, enabling continuous data-driven improvement and innovation in addressing hepatitis C. Conclusion The APPEAL toolkit was developed to attract PWID living with HCV to healthcare systems in a proactive manner. By managing information and fostering education on HCV, it aims to amplify awareness, prevention and diagnosis. The toolkit’s design and functionality underscore the importance of continuous quality improvement and the potential for its use in internal or external quality audits of healthcare services related to hepatitis C.

Is Competency-Based Medical Education being implemented as intended? Early lessons learned from Physical Medicine and Rehabilitation.

As competency-based medical education (CBME) curricula are introduced in residency programs across Canada, systematic evaluation efforts are needed to ensure fidelity of implementation. This study evaluated early outcomes of CBME implementation in one Canadian Physical Medicine and Rehabilitation program that was an early adopter of CBME, with an aim to inform continuous quality improvement initiatives and CBME implementation nationwide. Using Rapid Evaluation methodology, informed by the CBME Core Components Framework, the intended outcomes of CBME were compared to actual outcomes. Results suggested that a culture of feedback and coaching already existed in this program prior to CBME implementation, yet faculty felt that CBME added a framework to support feedback. The small program size was valuable in fostering strong relationships and individualized learning. However, participants expressed concerns about CBME fostering a reductionist approach to the development of competence. Challenges existed with direct observation, clear expectations for off-service training experiences, and tracking trainee progress. There was trepidation surrounding national curricular change, yet the institution-wide approach to CBME implementation created shared experiences and a community of practice. Program evaluation can help understand gaps between planned versus enacted implementation of CBME, and foster adaptations to improve the fidelity of implementation.

Realist synthesis of a rapid response system in managing mental state deterioration in acute hospital settings.

Mental state deterioration in patients poses significant challenges in healthcare, potentially resulting in adverse outcomes for patients and continued reliance on restrictive interventions. Implementing evidence-based approaches such as a rapid response system that prioritises early identification and intervention can effectively manage adverse outcomes. However, little is known regarding the effectiveness of these interventions. The objective of this synthesis was to test and refine initial programme theories by synthesising evidence to understand what works, for whom and under what circumstances. Based on the realist synthesis methodology, we searched EMBASE, CINAHL, MEDLINE, the Cochrane Library and grey literature for evidence to inform contexts, mechanisms and outcomes on the functioning of a rapid response model. We identified 28 relevant sources encompassing peer-reviewed journal articles and grey literature. This synthesis identified three important elements that contribute to the effectiveness of a rapid response system for managing mental state deterioration: care processes, therapeutic practices and organisational support. Essential elements include improving confidence and clinical skills through training, timely assessment and intervention, teamwork, communication and the creation of governance structures for monitoring and evaluation. To ensure the effectiveness, an organisation must adopt a comprehensive approach that incorporates organisational support, resource allocation, training, clear communication channels and commitment to continuous quality improvement. However, implementing interventions within a complex healthcare system requires thoughtful consideration of the organisational culture and governance structures. By taking a comprehensive and holistic approach to improvement initiatives, organisations can strive to achieve optimal outcomes in managing mental state deterioration and improving patient care.

Regional Transformation: An Integrated System's Approach to Magnet Designation Utilizing High-Reliability Organization Implementation Strategies.

Synergistic opportunity exists between Magnet-aspiring environments and High Reliability Organization (HRO) cultures to elevate safety, quality, new knowledge, continuous improvement, hierarchical flattening, and frontline empowerment. Variation existed across a region's 15 hospitals regarding Magnet-readiness, leadership engagement, journey strategies, and resource capacity. Quality improvement (QI) methodology and a hybrid-hub-spoke-model (HHSM) were used to support region-wide Magnet designation, improve patient outcomes, and advance nursing research. HRO strategies were used region-wide to strengthen implementation and enculturation of Magnet excellence infrastructure. Nine facilities achieved Magnet recognition. Magnet sites demonstrated significantly lower falls with injury ( P =.012), lower health care-associated infections and hospital-acquired pressure injuries than non-Magnet sites. Nursing research studies increased 223%. Utilizing a HHSM and HRO strategies represent effective methods for supporting region-wide Magnet designation and continuous QI.

Implementation of complex engineering problem solving projects in a Malaysian engineering programme

Accreditation bodies mandate incorporating complex problem-solving (CPS) in engineering programmes on top of outcome-based education. However, its attributes are open to interpretation, leading to a lack of consensus on its implementation in engineering curricula. This paper suggests a solution: having CPS in projects, especially for the courses aligned with CPS-related outcomes. To eliminate ambiguities, the characteristics of complex engineering problems (WP) and complex engineering activities (EA) are restated. This ensures a consistent interpretation of WPs and EAs among educators. CPS projects can be phased into four stages: awareness, adoption, growth, and maturity, followed by continual quality improvement at both the course and programme levels. The entire process can span several years. To stay current with the latest academic and industrial developments, implementation should be completed within one accreditation cycle.

How Credible Is the 25-Year Photovoltaic (PV) Performance Warranty?—A Techno-Financial Evaluation and Implications for the Sustainable Development of the PV Industry

To support the bankability of PV projects, PV manufacturers have been offering some of the longest warranties in the world, typically in the range of 25–30 years. During the warranty period, PV manufacturers guarantee that the degradation of PV modules will not exceed 0.4–0.6% each year, or the buyer can at any time make a claim to the manufacturer for replacement or compensation for the shortfall. Due to PV popularity, the performance warranty terms have become more and more competitive each year. However, long-term PV operating data are very limited, and the bankruptcy of PV manufacturers has been quite common. Without a proper methodology to assess the adequacy of the warranty fund (WF) reserves of PV manufacturers, the 25-year performance warranty can reflect an empty promise. To ensure sustainable development of the PV industry, this study develops a probability-weighted expected value method to determine the necessary WF reserve based on benchmark field degradation data and a prevailing degradation cap of 0.55% per year. The simulation results show that, unless the manufacturer’s degradation pattern is significantly better than the benchmark degradation profile, 1.302% of the sales value is required for the WF reserve. To the best of our knowledge, this is the first study that provides WF reserve requirement estimation for 25-year PV performance warranties. The results will provide transparency for PV investors and motivation for PV manufacturers to engage in continuous quality improvement, as all such achievements can now be reflected in the annual report results of manufacturers.

Relationship of knowledge sharing and innovation intention on the continuous quality improvement in university setting

This study assessed the changed knowledge sharing system and innovative intention towards continuous quality improvement in one university system in the Philippines. This descriptive study was participated by 261 faculty members of five schools of a university system. It made use of a modified questionnaire as its primary data gathering instrument, having an excellent remark of its 0.925 Cronbach’s Alpha. The data were encoded, tallied and interpreted using different statistical tools such as frequency distribution, ranking, weighted mean and F-Test, Shapiro-Wilk Test, Spearman rho, and were further analyzed and interpreted through PASW version 26 using 0.05 alpha levels. From the results, it was concluded that there has been a strong response of the university towards knowledge sharing system and its teachers possess a strong innovative intention. Further, there is a strong positive presence of continuous quality improvement practices regarding the different processes of the university system. Moreover, there is a high relationship regarding knowledge sharing system, innovative intention, and continuous quality improvement. The results of the study imply a need to develop a continuous quality improvement plan.

Peningkatan Pengelolaan Pendidikan Anak Usia Dini Melalui Implementasi Manajemen Pendidikan

The aim of this research is to elucidate the improvement of Early Childhood Education management at Attoriq Pamekasan through the implementation of educational management. The research method employed is qualitative descriptive, using interviews, observation, and documentation as data-gathering techniques. Data processing involves data reduction, data presentation, and conclusion drawing. The research findings illustrate that Attoriq PAUD School has a planning process involving full participation from the headmaster, teachers, and students to achieve clear goals and address existing problems. The organization is conducted considering management principles such as workforce grouping, authority determination, and time discipline. Each school member has their own responsibilities in line with the school's vision and mission. Implementation of educational activities aims to maintain discipline, adhere to instructions, and prioritize collective interests. The headmaster provides guidance and bonuses as appreciation for hard work and cooperation. Regular supervision is conducted to ensure all activities are in accordance with the plan and to identify and address weaknesses for continuous improvement of education quality.

Analisis Pengaruh Total Quality Management terhadap Kinerja Operasional pada Industri Putra Bali Rattan Furniture di Kecamatan Mayang Kabupaten Jember

The aim of this research is to analyze the effect of total quality management with 4 indicators, namely customer satisfaction, employee empowerment, continuous quality improvement, and management based on facts on operational performance at the Putra Bali Rattan Furniture Industry in Mayang District, Jember Regency. This research is research using a combination approach (mix methods). A sample of 65 respondents was obtained using a saturated sampling technique. Data was obtained using questionnaires and interviews with the owner and 5 consumers and then analyzed using regression analysis. In processing research data, researchers used the SPSS version 22 application. The research results show that 3 of the 4 X variables, namely customer satisfaction, employee empowerment, and continuous quality improvement have a positive and significant effect on operational performance. Meanwhile management variables based on facts have a negative effect on operational performance. The positive influence of the customer satisfaction variable is also supported by the results of interviews which state that the company has implemented 4 indicators of customer satisfaction and in line with this, operational performance has also increased. In conclusion, customer satisfaction, employee empowerment, and continuous quality improvement have a positive and significant effect on operational performance, while management based on facts has a negative effect. Keywords: Customer Satisfaction, Employee Empowerment, Management Based on Facts, Operational Performance , Quality Improvement Sustainable