Continuous Improvement Initiatives Research Articles

Determinants of Accounting Student Readiness to Face the World of Work

In the Indonesian context, the disparity in the quality of university graduates vis-à-vis workforce expectations remains a significant phenomenon. This research sets out to investigate the crucial determinants affecting the readiness of accounting students to navigate the professional realm, focusing on knowledge in the world of work, soft skills, and locus of control. Employing a survey methodology with a questionnaire, data were meticulously analyzed using multiple linear regression through the SPSS program. The findings underscore a positive correlation between knowledge in the world of work, soft skills, locus of control, and the work readiness of accounting students at the Faculty of Economics and Business, Udayana University. Although the overall work readiness scores are commendable, the study advocates for continuous maintenance and improvement initiatives to optimize students' preparedness for the workforce. The implication is that Udayana University, and potentially other educational institutions, could play a pivotal role by actively facilitating activities geared towards enhancing students' workplace skills. By doing so, these institutions contribute not only to academic excellence but also to the practical readiness of graduates for the professional challenges they will encounter in the world of work.

Measuring and Analyzing the Process Capability of Productivity – An Applied Study in the Al-Tahady Factory for the Production of Filters

This study addressed concerns related to increased percentages of damaged and re-worked production, heightened demand for factory products, and lack of awareness of the approved Sigma (σ) level during manufacturing, and associated deviations in the manufacturing process. The primary research problem was to assess the manufacturing process's stability and capability to consistently produce conical filters that meet required specifications. The study followed a sample-based approach, where twenty samples, each containing four observations, were collected continuously over a period of seven days. For each sample, the mean (X ̅) and range (R) were calculated. The mean X-Double bar of 319.32 and the average range R-bar of 0.848 were obtained through data analysis. The main findings revealed that, on average, the manufacturing process was relatively close to the target value (X-Double bar = 319.32). However, the presence of several data points outside the control limits indicated potential variability in the process. The average range (R-bar = 0.848) highlighted certain variations in the manufacturing process, which might contribute to issues like damaged or re-worked production. The study identified the need for further investigation to determine the root causes of these variations, which could include machine malfunctions, material fluctuations, or operator errors. By addressing these concerns and reducing process variability, the factory can enhance product quality, decrease waste, and improve customer satisfaction. In conclusion, continuous process monitoring and improvement initiatives, such as Six Sigma, are essential for achieving greater process capability in conical filter manufacturing. This research contributes valuable insights into process performance and provides a basis for implementing corrective actions to ensure consistent product quality and meet customer demands.

Designing Enhanced Recovery After Surgery Protocols in Neurosurgery: A Contemporary Narrative Review.

Enhanced Recovery After Surgery (ERAS) protocols have revolutionized the approach to perioperative care in various surgical specialties. They reduce complications, improve patient outcomes, and shorten hospital lengths of stay. Implementation of ERAS protocols for neurosurgical procedures has been relatively underexplored and underutilized due to the unique challenges and complexities of neurosurgery. This narrative review explores the barriers to, and pioneering strategies of, standardized procedure-specific ERAS protocols, and the importance of multidisciplinary collaboration in neurosurgery and neuroanesthsia, patient-centered approaches, and continuous quality improvement initiatives, to achieve better patient outcomes. It also discusses initiatives to guide future clinical practice, research, and guideline creation, to foster the development of tailored ERAS protocols in neurosurgery.

Trend in breakdown of total cost of care for medical oncology over time: Learnings from the Oncology Care Model and implications for future oncology value-based care.

69 Background: Tennessee Oncology (TO) is a large, outpatient community oncology practice with over 200 providers and 35 clinical sites of care across Tennessee and northern Georgia. As an Oncology Care Model (OCM) participant, TO received claims data from Medicare during its OCM participation from 2016-2021. TO adopted continuous quality improvement initiatives to succeed in the program. Here we highlight our adoption of biosimilars and implementation of an independent clinical pathway program. Methods: OCM claims data received from Medicare were analyzed to determine total cost of care (TCOC) per the OCM methodology. TCOC subgroup analysis was conducted by percentage of spend over time on therapeutic and supportive care drugs, emergency room utilization, and hospitalizations. Biosimilar adoption and pathway utilization rates were tracked internally. Results: 27,927 OCM episodes were attributed to TO during the study period 2016-2021. During this time frame and as a percentage of TCOC, total drug spending increased from 58% to 71%. Conversely, spending on hospital and emergency room utilization as a percentage of TCOC decreased from 11.6% to 7.9% and 1.4% to 1.0%, respectively. Within drug spending, the ratio of supportive to therapeutic drug costs decreased from 29.5% to 7.5%. Despite increased spend on therapeutic drugs towards the end of the model, pathway adherence was over 90%, and trastuzumab and bevacizumab biosimilar adoption rates were over 86% and 97%, respectively. Conclusions: Relative contributions to TCOC changed over time during OCM. The percentage of costs associated with pharmaceuticals increased, while costs associated with hospitalizations and emergency room utilization decreased. Within costs for pharmaceuticals, there was a significant increase in the percentage of costs for therapeutics versus supportive care drugs. High rates of biosimilar conversion and pathway adherence suggest increased drug spend reflects a change in oncology practice, not an effect of inappropriate utilization. These trends have implications for future developments of oncology value-based care programs.

To err is human: A healthcare organization blueprint towards safety and reliability.

392 Background: In 2019, a comprehensive cancer center was audited by a regulatory agency that identified opportunities to improve the safe delivery of healthcare. Even though the organization has been engaged in multiple continuous improvement initiatives, we found that to run a complex enterprise efficiently, we needed to break silos, learn from the frontline, and educate and train leaders in a psychologically safe environment. The overarching goal is to improve our culture of safety by developing a safety-focused workforce, improving robust processes around high-harm events, increasing transparency/feedback regarding safety events, and advancing the institution towards a High Reliability Organization (HRO)1 with zero preventable patient harm. Methods: Key interventions implemented: 1. Revamped our Root Cause Analysis; 2. Developed a Quality Assurance Performance Improvement (QAPI)2 council with leadership from the enterprise and representatives of the Patient Family Advisory Program, patients of the organization; 3. Implemented a Tiered Readiness Briefing (TRB) 7 days a week; 4. Selection of Serious Safety Event Rate (SSER)3 as the organization's measurement of patient safety and made it transparent; 5. Implementation of a mandatory training program in HRO skills and tools necessary to change behaviour. Training of leadership first goal was to get their buy-in so that the rest of the workforce would comply with the training; 6. Created Priority Focus Areas (PFA) initiatives supported by QAPI, the board, and leadership- providing resources to improve widespread, problem-prone, high-risk issues. Also, a system of accountability. Results: From June 2020 to April 2023- 59% reduction on SSER and sustained rate <0.9; 96% of leaders and 86% of medical faculty trained in HRO; 100% of “Start the Clock” issues identified in TRB are acted on within 24 hrs.; PFA success: the creation of the Blood Shortage Safety Decision Matrix- resulted in no surgery cancellation due to blood shortage. Conclusions: Rigorously implementing HRO principles in a comprehensive and complex cancer center resulted in improved process outcomes and patient safety outcomes that significantly reduced serious safety events.

Revisiting Ishikawa's Original Seven Basic Tools of Quality Control: A Global Study and Some New Insights

The purpose of this global study is to investigate the validity of Dr. Ishikawa's statement that “95% of problems in processes can be solved using the 7 Quality Control (QC) tools” in organizations. An online survey instrument was developed, disseminated, and responded to by a total of 456 senior quality professionals from five different continents. The main finding of this article suggests that less than 25% of participants perceived that the seven tools of QC can solve above 95% of quality problems while 40% of quality professionals stated that they had incorrectly applied the tools “right first time” during the problem solving. Pareto analysis was the most widely used tool across all sectors while the least used tools are scatter diagrams and stratification. The seven QC tools were widely utilized in production or manufacturing areas but least applied in IT and finance functions. The common benefits from the use of seven basic tools of QC in all sectors include: providing structure to the problem-solving efforts; aids problem solving and helps in problem definition, measurement, and analysis. This article presents a list of critical success factors (CSFs) required for the proper application of the seven QC tools including having management support and a commitment to tool usage as well as having a continuous improvement initiative to encourage tool usage. This article is the first global research focused on investigating Dr. Ishikawa's statement: “95% of problems in processes can be solved using the 7 QC tools.” The findings further facilitate an important first step toward understanding the applicability, benefits, CSFs, and challenges to utilizing these tools in organizations across sectors and globally.

Impact of Team Creativity and Continuous Improvement on Time-To-Market in Retail Industry

This study investigates the relationship between team creativity and continuous improvement practices on the time-to-market performance within the dynamic context of the retail industry. Through a comprehensive analysis of data collected from retail organizations, this research reveals the significant positive impact of fostering team creativity and implementing continuous improvement initiatives on reducing time-to-market for products and services. The findings underscore the strategic significance of nurturing a creative and innovative team culture while concurrently embracing continuous improvement methodologies to enhance the speed and efficiency of bringing retail offerings to market. This study contributes valuable insights for retail practitioners and decision-makers aiming to optimize their time-to-market strategies in an ever-evolving industry landscape.

The Importance of Adapting And Updating The New Supply Chain Capabilities For Sustainability In The Business of Supply Equipment In Oil and Gas Industrial Projects

The supply of equipment in oil and gas industrial projects requires high standards and specifications due to high requirements of safety and reliability. Delay of equipment delivery is very sensitive as the impact will be direct to the whole project, while the delay of project completion will disrupt PSC’s (Partnership Status Contractor’s) initial production. Ultimately, this would disrupt the oil and gas production target of the Government of Indonesia. Operational data show that a lot of delay is caused by the ineffectiveness of supply chain management at PT AMN. These conditions increased complaints and penalties from customers while at the same time decreasing the operational efficiency of PT AMN. To overcome this problem and enhance customer satisfaction it is required to evaluate the existing supply chain capabilities and then adapt, update, and develop new supply chain capabilities. Determine new supply chain capabilities of PT AMN, requires analysis data of PT AMN related to customers' needs, internal assessment, existing supply chain, check-list supply chain capabilities, SWOT analysis, five pillars, the landscape of supply chain technology, game changer and risk management analysis for business sustainability. In terms of determining supply chain capabilities, PT AMN is categorized as an Adaptive Initiative or Continuous Improvement Initiative

Prescription Error

Objective: This research study aimed to investigate prescription errors and their intervention outcomes at Zewditu Memorial Hospital in Addis Ababa, Ethiopia, during the year 2023. The study assessed the prevalence of prescription errors, identified contributing factors, evaluated the effectiveness of medication safety interventions, and examined the impact of adverse drug events on patient outcomes and healthcare costs. Methods: A cross-sectional study design was employed, and data were collected from the hospital's prescription files. Prescription errors were classified into various categories, and the frequency and proportion of errors were calculated. The study also evaluated different medication safety interventions' effectiveness in reducing prescription errors and assessed healthcare professionals' adherence to medication safety protocols. Additionally, the study conducted a cost analysis of adverse drug events to assess their financial implications. Results: The study revealed a prescription error rate of 25.1%, with wrong dosage, drug omission, drug-drug interactions, and illegible prescriptions being the most common error categories. Adverse drug events resulting from prescription errors affected 12.2% of patients, leading to patient harm and increased healthcare utilization. The electronic prescribing system emerged as the most effective intervention, reducing prescription errors by 60.1%. High adherence rates were observed for double-checking high-risk medications and conducting medication safety huddles. However, there was room for improvement in implementing barcoding technology and tall man lettering. Conclusion: Prescription errors and adverse drug events pose significant challenges to medication safety at Zewditu Memorial Hospital. Implementing electronic prescribing systems and enhancing medication reconciliation processes can significantly reduce prescription errors and improve patient outcomes. Furthermore, fostering a culture of safety, promoting interprofessional collaboration, and investing in education and training programs are essential to enhance medication safety practices. Continuous quality improvement initiatives and regular audits should be conducted to address medication safety challenges and support a culture of learning from errors. Policymakers should be engaged to support medication safety initiatives, and multi-center studies are recommended to enhance generalizability.

Program Report: Improving Patient Experience at an Outpatient Clinic Using Continuous Improvement Tools.

Patient satisfaction with prompt and high-quality healthcare services plays a pivotal role in healthcare settings. The delivery of high-quality services within the healthcare sector is closely associated with continuous quality improvement (CQI), which is an incremental and progressive process that prioritizes the safety of all participants, favorable outcomes, systematic processes, and a regulated and improved working environment, particularly in later stages. Surprisingly, these aspects are less frequently explored in Middle Eastern countries. Thus, this research paper aims to assess the impact of quality services on patient satisfaction in tertiary care clinics located in the Middle East. To improve the quality of services in our clinic, we employed patient feedback as a valuable resource. We proactively reached out to all patients who had visited our hospital via mobile phone messages and requested their feedback on the services they received. Approximately 5% of all visitors responded and completed a comprehensive questionnaire. The majority of respondents expressed satisfaction with the services provided across various departments. However, they also offered valuable suggestions that helped us identify further areas for improvement and enhance the overall patient experience within our clinic. Drawing upon the feedback received, we meticulously considered the identified issues, redesigned our policies, and implemented strategic changes. Following the implementation of these new approaches, we once again sought patients' feedback on the quality of our services. Patient feedback highlighted the significant impact of optimized service delivery methods, resulting in a substantial increase in patient satisfaction. Overall, this study sheds light on the vital factors that can enhance patients' experience in outpatient clinics, emphasizing the importance of integrating patient feedback into continuous quality improvement initiatives. By utilizing this approach, healthcare providers, administrators, and researchers can effectively improve service quality and patient satisfaction. Consequently, this research paper serves as a valuable reference for public health stakeholders, administrators, and researchers in their pursuit of delivering exceptional healthcare experiences.

Designing the Knowledge Management Strategy to Foster Continuous Improvement and Innovation in the Transportation Company

In the contemporary business landscape, organizations and enterprises harness their knowledge as a distinctive competitive advantage to compete with competitors. The emergence of new technology-based transportation services along with the unprecedented COVID-19 pandemic has prompted Limosin Sejahtera, one of the business units of PT. Transportasi Inovatif Indonesia recognizes the importance of knowledge management as a strategic approach to leverage its knowledge assets. Through the APO Knowledge Management Assessment Tool and stakeholder interview, the research identifies several challenges that hinder the organization’s ability to leverage its knowledge assets effectively and impede innovation and continuous improvement initiatives. APO KM Assessment shows that KM maturity has already reached the Expansion level. The results then serve as a pivotal reference point, guiding the identification of precise strategies that have the potential to elevate knowledge management (KM) practices and lead the organization to foster continuous improvement and innovation culture.

Preventing Risks of Infections and Medication Errors in IV therapy (PRIME): a patient safety initiative.

Two major avoidable reasons for adverse events in hospital are medication errors and intravenous therapy-induced infections or complications. Training for clinical staff and compliance to patient safety principles could address these. Joint Commission International (JCI) consultants created a standardised, 6-month training programme for clinical staff in hospitals. Twenty-one tertiary care hospitals from across south-east Asia took part. JCI trained the clinical consultants, who trained hospital safety champions, who trained nursing staff. Compliance and knowledge were assessed, and monthly audits were conducted. There was an overall increase of 29% in compliance with parameters around medication preparation and vascular access device management. The programme improved safe practice around preparing medications management and managing vascular access devices. The approach could be employed as a continuous quality improvement initiative for the prevention of medication errors and infusion-associated complications.

The Role of Psychological Safety in Team Communication: Implications for Human Resource Practices

In the fast-paced environment of contemporary workplaces, characterized by a focus on innovation and collaboration, effective team communication stands out as a critical factor for organizational success. At the heart of such communication dynamics lies the concept of psychological safety—a shared belief within teams that encourages individuals to express themselves without fear of negative consequences. Recognized as a fundamental element for high-performing teams, psychological safety is now undergoing a paradigm shift in human resource (HR) practices, which traditionally concentrated on recruitment, training, and performance management. As organizations navigate the complexities of the global market, understanding and fostering psychological safety within teams have become imperative. This paper explores the multifaceted dimensions of psychological safety in team communication and its implications for contemporary HR practices. The groundwork for psychological safety was laid by Edgar Schein, whose seminal research emphasized the importance of trust and mutual respect in organizational settings. Drawing from social psychology theories, Schein highlighted psychological safety as a facilitator for authentic expression and constructive dialogue. Amy Edmondson's subsequent research further underscored the pivotal role of psychological safety, particularly in fostering open communication, learning, and innovation within teams. Psychological safety, defined as the perceived safety of interpersonal interaction, influences team communication and performance significantly. Various factors such as role-based characteristics, organizational trust, and empowering leadership contribute to its establishment. Trust moderates the relationship between work locus of control and psychological safety. Training interventions and individualized attention from managers have also been identified as means to enhance psychological safety, especially in interprofessional teams where it is crucial for effective communication and decision-making. Within psychologically safe teams, members feel empowered to voice opinions, share ideas, and challenge norms without fear of reprisal. This openness fosters a culture of constructive feedback and continuous improvement, driving innovation and problem-solving initiatives. Vulnerability, as advocated by Brené Brown, plays a crucial role in this context, facilitating authentic engagement and deeper relationships among team members. With the rise of remote work and virtual collaboration, the importance of psychological safety becomes even more pronounced. HR practices must adapt to foster psychological safety in virtual teams, leveraging technology to promote inclusivity and mitigate communication barriers.

Current State of Peer Learning in Radiology: A Survey of ACR Members

PurposePeer learning (PL) programs seek to improve upon the limitations of score-based peer review and incorporate modern approaches to improve patient care. The aim of this study was to further understand the landscape of PL among members of the ACR in the first quarter of 2022. MethodsMembers of the ACR were surveyed to evaluate the incidence, current practices, perceptions, and outcomes of PL in radiology practice. The survey was administered via e-mail to 20,850 ACR members. The demographic and practice characteristics of the 1,153 respondents (6%) were similar to those of the ACR radiologist membership and correspond to a normal distribution of the population of radiologists and can therefore be described as representative of that population. Therefore, the error range for the results from this survey is ±2.9% at a 95% confidence level. ResultsAmong the total sample, 610 respondents (53%) currently use PL, and 334 (29%) do not. Users of PL are younger (mode age ranges, 45-54 years for users and 55-64 years for nonusers; P < .01), more likely to be female (29% vs 23%, P < .05), and more likely to practice in urban settings (52% vs 40%, P = .0002). Users of PL feel that it supports an improved culture of safety and wellness (543 of 610 [89%]) and fosters continuous improvement initiatives (523 of 610 [86%]). Users of PL are more likely than nonusers to identify learning opportunities from routine clinical practice (83% vs 50%, P < .00001), engage in programming inclusive of more team members, and implement more practice improvement projects (P < .00001). PL users’ net promoter score of 65% strongly suggests that users of PL are highly likely to recommend the program to colleagues. ConclusionsRadiologists across a breadth of radiology practices are engaged in PL activities, which are perceived to align with emerging principles of improving health care and enhance culture, quality, and engagement.

An Effective, Functional Approach to the Medical Operations Coordination Cell Structure

Introduction:Effectively responding to an incident across jurisdictions and coordinating with regional and jurisdictional partners is extremely challenging. The COVID-19 pandemic exemplified the need to develop an operational structure which would serve as a regional medical operations hub. Although there has been guidance for using a Medical Operations Coordination Cell (MOCC), the concept can be difficult to apply and develop for the specific needs of varying regions and jurisdictional entities.Method:The Mountain Plains Regional Disaster Health Response System (MPRDHRS) has developed a Medical Emergency Operations Center (MEOC) to address gaps in response coordination efforts across the six state Region VIII within the United States. This MEOC has been developed to synchronize and integrate existing systems and processes to manage the medical components of a response. This center is similar to other MOCC concepts. However, in a novel approach, the MPRDHRS organized a response framework that focuses on functional roles based on the specific needs of our region with response coordination and personnel availability. This organization is similar to the use of emergency support functions in a jurisdictional EOC.Results:While developing the MEOC, a local Lean team collaborated with the MPRDHRS on continuous improvement initiatives. Drills, workshops, and exercises were used to test the MEOC and offer just in time training to MPRDHRS members to staff different positions within the MEOC. The MEOC was activated for an incident response within the MPRDHRS region with many lessons learned.Conclusion:The MEOC is a new, developing system augmented to meet the needs of regional partners. The system was developed using feedback and ideas from partners, process improvement experts, and internal team members. Additionally, lessons learned from incidents and applications of drills, workshops, and exercises will be shared to leverage within any organization.

How to develop standardized work for business processes in the transactional office environment

Standardised Work (STW) is one of the most effective but least utilized Lean tools for business process improvement initiatives in the transactional office environment known as the ‘Lean office’. The STW not only establishes a baseline for continuous improvement initiatives but also facilitates them by giving indications of key improvement opportunities in the present best practice. The STW is a thorough document in which the process workflow is broken into a number of consecutive work elements whose processing times are labelled according to their nature and required resources. Developing the STW for business processes in the manufacturing environment is quite common; however, it is quite rare and limited in the transactional office environment. This is primarily caused by the business-office processes’ complexity or underestimating their influence on overall business success. In this study, we position and highlight the importance of the STW in the Lean office programme and propose a pragmatic and tractable framework for developing the STW for business-office processes through the use of a pilot process. The proposed STW framework was implemented successfully in the pharma industry. Finally, the paper is concluded by discussing the possible obstacles and providing future research directions.

Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project

PurposeThis study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.Design/methodology/approachThe authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.FindingsDMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.Research limitations/implicationsThe project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.Practical implicationsSeveral recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.Originality/valueDMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

A continuous improvement implementation framework for manufacturing companies: a Delphi study-based approach for development and validation

PurposeDue to the absence of industry and region-specific implementation guides, change efforts, in particular continuous improvement implementations, continue to report high failure rates. The purpose of this paper is, therefore, to present a finalised implementation framework specifically tailored for manufacturing companies.Design/methodology/approachA conceptual framework derived from the existing literature is validated, through a Delphi study, by an expert panel to review its content and suitability for a practical application.FindingsThis paper proposes a finalised framework tailored to the practical needs of users. The results of the Delphi approach offer a phased implementation framework that provides an overview of the implementation process of continuous improvement initiatives and the key activities involved. The framework is suitable for use by both business leaders and continuous improvement practitioners with varying degrees of previous implementation experience.Research limitations/implicationsThe research was carried out in the UK and is specifically focused on the manufacturing industry. It is therefore not clear the applicability of the framework presented to other regions and industries. The framework, although validated through several phases of research, still requires practical application and testing.Originality/valueBusiness leaders and continuous improvement practitioners will benefit from having the necessary content presented in a manner that will promote its practical application. It has also been demonstrated that the framework is robust in its content, incorporating the literature findings as well as the experience of an expert panel encompassing 20 people.

Three steps to reduction surgical site infection: presentation of a comprehensive model.

To prevent surgical site infections (SSIs), a three-step model is proposed, which integrates perioperative measures, multidisciplinary collaboration, and continuous quality improvement (CQI) initiatives.

ENGAGING IN CQI TO ENHANCE ADULT PROTECTIVE SERVICES INTAKE AND SCREENING: A QUALITATIVE ANALYSIS

Abstract This qualitative evaluation study was part of a larger Continuous Quality Improvement initiative implemented by the Maryland Department of Human Services Office of Adult Services to improve the Adult Protective Services (APS) screening and intake process statewide. Researchers conducted two 90-minute focus groups via Zoom with 21 intake and screening staff from 14 counties in Maryland in the summer of 2022. Focus group participants were mostly White and African American women with an average of 6.5 years working in adult services. Interviews focused on understanding challenges in APS intake/screening and strategies to overcome those challenges. Each interview was recorded and transcribed verbatim and three researchers used open and axial coding to identify themes. The key challenge expressed by all participants was the difficulty obtaining adequate information from referral sources, in order to discern whether the adult was vulnerable and if the alleged abuse/neglect/exploitation was being committed by a trusted caregiver or fiduciary as defined by state law. Inadequate referral information results in supervisors/screeners making time-consuming follow-up calls to obtain additional information or cases inappropriately screened in for investigation. This challenge was exacerbated by intake workers inexperienced in APS, understaffing, unclear policies and screening tools for APS, and community partners’ and the public’s unfamiliarity with APS services and policy. Strategies to overcome these challenges included additional staff training, public education, additional resources for APS, clearer policies, and improving the APS screening tool. Quality improvement strategies developed from this study that are relevant to APS systems nationwide will be discussed.