Continuous Improvement Plan Research Articles

Design and implementation study of a Permanent Selective Collection Program (PSCP) on a University campus in Brazil

The selective collection and recycling of municipal solid waste are presented as stages of an integrated program of solid waste management to minimize the environmental impact of the treatment and final disposal of solid waste. Therefore, this program aims to save natural resources, such as energy and raw materials, in the manufacture of new products and to conserve areas for sites, such as to minimize the use of existing landfill sites, and to minimize the need for new waste treatment sites. A university is composed of educational professionals aware of their societal responsibilities, and, therefore, they play a fundamental role in the management of the university's solid waste. This study presents the design and implementation of a Permanent Selective Collection Program (PSCP) at the Federal University of Itajubá (Universidade Federal de Itajubá, UNIFEI), Itajubá-MG, Brazil. The material requirements for initiating the PSCP have been identified, and an action plan for continuous program improvement, which is initially based on the collection of performance indicator data for the PSCP campus, has been developed. Finally, the data from the PSCP performance indicators and software from the United States Environmental Protection Agency, the Landfill Gas Generation Model (LandGEM) and the Waste Reduction Model (WARM), were used to evaluate the impact of implementing PSCP in terms of energy and the generation of greenhouse gases (GHG). The results were promising, showing that there has been an improvement, since the inception of PSCP in 2006, in separating materials for selective collection, even though paper (41.00wt%), plastic (6.00wt%) and organic matter (26.00wt%) are still highly generated wastes. The WARM simulations for a scenario in which 90% of the waste is sent for recycling resulted in an economy of −7tCO2 or −74.91GJ (on an energy basis). The LandGEM (USEPA) simulations estimated 1424.60kWh of energy in the peak production year.

Impact on integration of Lean Manufacturing and Six Sigma in various applications - a review

Lean Manufacturing is a concept of improving the speed and efficiency of an organization by eliminating waste. On the other hand Six Sigma is a continuous improvement plan that is proposed to reduce variability. This paper presents the concept of integrating Lean manufacturing and six sigma, and the approach how the two concepts are merged in industries to increase the product through put and to improve the quality of the product by reducing the process variability. An approach to L6σ is also reviewed along with its Application.

The Broad Street Pump

FigureI recall the great anticipation of my first class in medical epidemiology where we learned the principles of incidence, prevalence, point prevalence, transmission of disease, vectors, hosts, fomites, and so on. The class seemed daunting and unimaginably boring. Despite this initial impression, the instructor had an unmistakable aura about him that was accentuated by his gold-rimmed, rounded spectacles. He was a sage US Army Colonel and physician who specialized in “tropical medicine.” You could easily imagine him wearing a British khaki uniform, complete with Bermuda shorts and a pith helmet, tromping around in faraway places. Unexpectedly, the instructor began the session with a story about the “Broad Street pump.” This single story ignited and held my interest in the concepts of medical investigation, the basics of epidemiology, and preventive medicine, even to this day. In 1854, the English physician (the father of epidemiology) John Snow discovered the link to the lethal cholera epidemic, which killed tens of thousands of people in England between 1831 and 1854. Although the etiology of cholera was unknown, the strong belief at the time was that it was caused by breathing vapors, a “miasma,” or foul air. In 1854, the London suburb of Soho was the epicenter of an endemic cholera outbreak that led to 500 deaths in 10 days.1–3 Snow used what are now known as epidemiologic principles to investigate the causation through interviewing people (cases) who were stricken with cholera and those who were not. He compared the incidence and prevalence of those who lived in the “surveillance” area with and without the disease. Snow discovered that the commonality between those with the disease was where they drew their drinking water—the Broad Street Well. One major source of evidentiary contamination was a case of a mother washing diapers and dumping the waste into a leaky cesspool, just 3 feet from the Broad Street pump, which was probably the tip of the iceberg. Through meticulous recordkeeping and epidemiologic interviewing techniques, Snow was able to triangulate commonalities and establish causation. He observed that all of its victims drew their drinking water from the same well. Snow removed the pump handle, and the epidemic ended. The infamous Broad Street pump is now a memorial to the triumph of medical epidemiology. Although cholera was endemic to London in the 19th century, its original reservoir was in the Ganges Delta in India. And during the 20th century, 6 subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961 and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries. We now know that cholera is spread by contaminated water and not from person to person. And finally, we now have vaccines for cholera.1–3 This month’s continuing medical education activity on page 35 is a primer on medical intelligence in wound care. Wound care professionals who operate at the point of service need to develop core competencies in gathering intelligence data about incidence and prevalence of pressure ulcers. In this case, the intelligence is in the form of gathering epidemiological information to be used by the institution providing and improving care, to feed the data to interested parties in general, and, in particular, to payers, hospital credentialing, and accreditation organizations. In addition, the use of prevalence and incidence data can be used to implement the plan-do-study-act cycle for quality improvement and clinical management, patient care, and educational continuous quality improvement plans, especially as we move into an area of accountable care and pay for performance.4 Recently at the 27th Anniversary Clinical Symposium several of the poster winners included epidemiologic studies demonstrating the importance of using statistical measures in wound care and reducing the incidence of new pressure ulcers in a given hospital organization. One case used a multinational study to illustrate the applicability of the use of data to institute prevention programs and improve patient outcomes. Medical surveillance in wound management is a strategy that is as important as any.FigureRichard “Sal” Salcido, MD

Methodology for Implementing Document Management Systems to Support ISO 9001:2008 Quality Management Systems

A Methodology for implementing Document Management Systems to support ISO 9001:2008 Quality Management Systems requirements is proposed in this paper. This methodology consists of six steps that executed in a cycle allows to obtain the optimal Document System. The proposal begins with the definition of ISO 9001:2008 document requirements; followed by the evaluation of the existing Document Management System in the organization; the identification of document strategies; the design of the Document Management System; its implementation, and finally the definition of the continuous improvement plan to guarantee the fulfillment of the initially detected requirements.

Exploring Values and Value Streams by BPM method solved by Lean Management tool

This paper suggests a continuous improvement plan that can satisfy customer's value and eliminate waste in the enterprise business process. In order to explore the applicability of lean management principles in the enterprise business process, the five fundamental concepts (specify value, identify the value stream, flow, pull, and perfection) of lean management are being used as a stable and proved approach. In addition, Business Process Management is applied as a new method to constantly improve the elimination of waste in the enterprise business process. This can be accomplished by the lean management concept. Moreover business process problems, such as overlapping work, redoing work, communication gaps, inflexible processes, and obscure processes, have the possibility of being solved by lean management. Lean management has traditionally been adopted by manufacturing industries to improve operations through the identification and elimination of all forms of waste basically. The construction industry has also adopted this philosophy, primarily in the field of projects. In order to increase an organization's competitiveness and productivity, lean management is needed in the any business process as well as in the field. The intent of this work is to explore a method of introducing lean management which continuously improves any business processes. The five fundamental concepts (specify value, identify the value stream, flow, pull, and perfection) of lean management as an approach are being adapted in this project to improve quality of the processes. Hence the main objective of this paper to apply the tool of lean and six sigma management to improve the elimination of waste in the enterprises business process. Followed by a literature review which provides a brief summary of lean thinking and six sigma along with challenges might face while implementing. A case study follows that demonstrates how; Business Process Management is applied as a tool, method to constantly improve the business process.

Evaluating and Prioritizing of Performance Indices of Environment Using Fuzzy TOPSIS

One of the integral elements of sustainable development is to maintain environmental standards and to minimize environmental losses resulting from the development. Key environmental indices are used in developed countries to improve the performance of an environmental management system (EMS) along with their strategic goals. This paper aims to present a comprehensive approach for decision-makers to evaluate and prioritize environmental indices using a technique for order performance by similarity to an ideal solution (TOPSIS) as one of the most powerful and practical tools in multi attributed decision making (MADM) problems in the fuzzy environment. Considered indices for prioritizing of performance indices of Environment include specific, measurable, attainable, realistic, time-sensitive (SMART) indices. Results show that, Air quality Index, Sound Pressure Level, Green Space Index, CO 2 and CH 4 Emission rate index, Energy index, have the first to sixth rank in the field of performance selective indices. This research helps managers and decision makers in Environment to determine and rank the performance indices of environment in the organization and finally design an appropriate and practical plan for continuous improvement.

Evaluating and prioritizing of performance indices of environment using fuzzy TOPSIS

One of the integral elements of sustainable development is to maintain environmental standards and to minimize environmental losses resulting from the development. Key environmental indices are used in developed countries to improve the performance of an environmental management system (EMS) along with their strategic goals. This paper aims to present a comprehensive approach for decision-makers to evaluate and prioritize environmental indices using a technique for order performance by similarity to an ideal solution (TOPSIS) as one of the most powerful and practical tools in multi attributed decision making (MADM) problems in the fuzzy environment. Considered indices for prioritizing of performance indices of Environment include specific, measurable, attainable, realistic, time-sensitive (SMART) indices. Results show that, Air quality Index, Sound Pressure Level, Green Space Index, CO2 and CH4 Emission rate index, Energy index, have the first to sixth rank in the field of performance selective indices. This research helps managers and decision makers in Environment to determine and rank the performance indices of environment in the organization and finally design an appropriate and practical plan for continuous improvement. Keywords: Environment Performance Indices, Sustainable development, TOPSIS, Fuzzy

Evaluating and prioritizing of performance indicators of health, safety, and environment using fuzzy TOPSIS

Nowadays, paying attention to health management, safety, and environment systems and their subdivisions in organizations has been increased. Misusing of suitable indicators for supervision, assessment, and improvement of these systems leads to poor organization’s performance, shortage in knowledge growth, organization abilities, and lack of understanding in periodic evaluation of organization’s improvement plans. Although, much literature review has been done on indicators related to health, safety, and environment (HSE), a few studies have been done on prioritizing of performance indicators of HSE and presenting a structured method for correction of present mismatches in successful and effective implementation. This paper aims to present a comprehensive approach for decision makers to evaluate and prioritize HSE’s indicators using technique for order performance by similarity to ideal solution (TOSIS) as one of the most powerful and practical tools in multi criteria decision making (MCDM) problems in the fuzzy environment. Considered indicators for prioritizing of performance indicators of HSE include specific, measurable, attainable, realistic, time-sensitive (SMART) indicators. Results show that number of held HSE committees, HSE training, number of HSE studies, check attempts indicators, and average of cost per damage have the first to fifth rank in the field of performance selective indicators. This research helps managers and decision makers in HSE to determine and rank the performance indicators of HSE in the organization and finally design an appropriate and practical plan for continuous improvement. Key words: Performance indicator, health, safety and environment, technique for order performance by similarity to ideal solution (TOPSIS), fuzzy.

A Case Study of Continuous Improvement Process in the Department of Civil Engineering at Qassim University

This paper presents a continuous improvement process developed and implemented for the B.Sc. Program in Department of Civil Engineering (DOCE), College of Engineering, Qassim University, Saudi Arabia. The continuous improvement plan is based on an integrated set of strategies aimed at establishing and implementing a structured process that translates educational objectives into measurable outcomes, and specifies feedback tracks for corrective actions. As a result of setting some direct and indirect measures, the program success is assessed and the level of achievement of the educational outcomes is evaluated. This assessment process relates to the personal soft skills as well as the technical knowledge that the students acquire throughout their course of study. The documentation of the continuous improvement process describes two intersecting assessment loops; slow and fast. The slow loop refers to the process by which the program executives examine the achievement of educational outcomes. The fast loop refers to the process by which we assess the degree to which the program graduates achieve the developed program objectives. The stages of developing and implementing the program educational objectives, outcomes and the assessment plan for the engineering programs are presented. Preliminary results from a pilot implementation are also discussed. Improvements are already evident in the areas of teaching effectiveness, assessment of student learning and involvement of all the constituencies. Based on these procedures, the ABET visit to the DOCE had achieved great success and the program was fully accredited in August 2010. The next visit to the department is going to be in 2016.

THE WORLD-CLASS SCM MANAGER

Supply Chain Management is the optimized operation of the supply chain. It requires someone who can optimize the resources while at the same time interacting with the forces that cause pressures against the supply chain. It requires someone who can develop a strategic plan for continuous optimization and improvement. It requires a supply chain manager. So what is a supply chain manager? This individual is someone who can identify the critical resources that move through the supply chain; someone who can identify the forces that come into play and that affect the performance of these resources; and someone who can use this information to develop goals, objectives, and a strategy around which to optimize the flow of the supply chain. This sounds like a big task, and it is. But numerous tools are available to help you with this task, and as we move forward we will learn more about these tools. There are several types of managers, and they can be categorized in numerous ways. One type is the sunrise manager who has a view toward the future, as opposed to the sunset manager who fights fires in the here and now. Another way to classify managers is to consider their attitudes toward their subordinates. The two extremes are the authoritarian manager and the participative manager.

Undergraduate acoustical engineering programs at the University of Hartford.

The University of Hartford has two undergraduate engineering programs in the area of acoustics: (1) the Bachelor of Science in Mechanical Engineering (BSME) with Acoustics Concentration and (2) the Bachelor of Science in Engineering with a major in Acoustical Engineering & Music. The first curriculum is part of a BSME degree program that has required courses in vibration as well as engineering acoustics since the 1960s. The Acoustical Engineering & Music degree is a unique program that was instituted in 1976, where applicants must have the equivalent math and science background required of all engineering students and also must successfully pass the entrance requirements of the Hartt School (University of Hartford’s music conservatory)—including the audition. Both programs encompass the same engineering vibrations and acoustics courses, as well as the same acoustics projects sequence. Alumni of both undergraduate programs have successfully obtained positions in consulting (architectural and environmental) audio product and A/V design, musical instrument design, hearing- and psychoacoustic-related design, noise control, as well as pursued graduate degrees. The use of real world industry-sponsored acoustic projects for engineering design courses throughout the curriculum will be described, as well as the programs’ continuous improvement plan and accreditation status.

Taking Aim at Infusion Confusion

A comprehensive multidisciplinary approach was used to improve drug infusion safety in an acute care hospital in Melbourne, Australia. This project aimed to reduce the potential for drug infusion-related error, improve drug infusion safety for patients, and encourage incident reporting to inform and guide continuous quality improvement projects. The project applied a systems approach to medication safety, using redesign strategies such as continuous quality improvement (plan, do, study, and act) and re-engineering. Key safety design concepts such as standardization, simplification, and forcing functions were also used.

INJURY-ASSOCIATED HYPOTHERMIA: AN ANALYSIS OF THE 2004 NATIONAL TRAUMA DATA BANK

Severe injury and shock are frequently associated with abnormalities in patient body temperature. Substantial increases in mortality have been associated with profound hypothermia, especially below 35 degrees C. The purpose of this study was to further characterize the impact of hypothermia in a large dataset of trauma patients. This study was a retrospective analysis of the 2004 version of the National Trauma Data Bank (NTDB), which contains approximately 1.1 million patients from over 400 trauma centers. Admission temperature was analyzed with respect to mortality, injury severity score (ISS), base deficit (BD), Glasgow Coma Score (GCS), and hospital outcomes. The NTDB contained 701,491 patients with temperatures recorded upon trauma center admission. Of these, 11,026 patients had admission temperatures <35 degrees C, and 802 had temperatures <32 degrees C. Comparison of core temperature versus mortality revealed that as temperature decreased, the mortality rate increased, reaching approximately 39% at 32 degrees C, and remained constant at lower temperatures. Surprisingly, 477 patients (59.5%) survived with temperatures <32 degrees C. Similarly, BD increased as hypothermia worsened until body temperature reached 31 degrees C, below which there was little further increase. Patients with admission temperatures less than 35 degrees C had significantly greater mortality (25.5% vs. 3.0%, P < 0.001) and BD (7.8 vs. 3.7, P < 0.001) when compared with patients with temperatures >or=35 degrees C. In survivors, average ventilator days and intensive care unit (ICU) days were 14.4 and 12.8, respectively, for patients with temperatures <35 degrees C as opposed to more normothermic patients who demonstrated an average of 9.5 ventilator days and 9.1 ICU days (P < 0.001). When grouped by individual ISS, BD level, and GCS motor score, mortality was significantly greater when admission temperature was below 35 degrees C (ISS mean difference = 11.4%, BD mean difference = 22.8%, and GCS motor mean difference = 9.85%). Logistic regression revealed that hypothermia remains an independent determinant of mortality after correction for confounding variables (odds ratio = 1.54, 95% confidence interval 1.40-1.71). Admission hypothermia is associated with greater mortality, increased injury severity, more profound acidosis, and prolonged ICU/ventilator courses. However, although mortality at <32 degrees C is high, patients with temperatures this low do survive. As temperatures drop below 32 degrees C, mortality rates remain constant, which may indicate a threshold below which physiologic mechanisms are unable to correct body temperature regardless of injury severity. Although shock severity is highly indicative of outcome, hypothermia independently contributes to the substantial mortality associated with severe injury.

Lessons in Case Management for the Physician

The emergence and rapid proliferation of case management programmes, quality improvement projects, and continuous improvement plans is a prominent feature of the medical landscape in recent years. This is certainly the case in the public hospitals. The phenomenon is viewed by some doctors, depending on the context in which the measures have been introduced, with either suspicion, resistance, indifference, tacit agreement, or full and positive engagement. Whatever the case in our own institution, case management is beginning to take root in our hospital culture. We need to recognise this fact and to learn how best to cope with it in our everyday practice.

Defining And Assessing Team Skills Of Business And Accountancy Students

The objectives of the project are (1) to define the skills necessary for students to work effectively with others to achieve common goals, and (2) to develop an assessment instrument to measure student progress toward achieving these skills. The defined skill set will form a basis for common expectations related to team skills that will be shared with students and be used by faculty for setting goals, planning curriculum and pedagogy, and assessing student progress. Assessment data will be incorporated into the Division of Business and Accountancy’s Continuous Improvement Plan and assessment cycle. The significance of this project is to ensure and demonstrate student learning related to teamwork, which is one of the key elements of the Division’s newly adopted vision statement. The ability to demonstrate continuous improvement related to the Division’s mission is vital to the re-accreditation of the business program. This project incorporated input from the entire faculty of the Division, and the results will be used by the entire faculty and shared with students in order to communicate expectations. This participative process will serve to enhance the culture of assessment in the Business Division among faculty and students.

Building Portfolios: A Means for Developing Habits of Reflective Practice in Physical Therapy Education

The purpose of this article is to consider the use of portfolios as one method to foster reflective practice in teaching and learning. The authors contend that building a portfolio is a learning experience in and of itself as well as a product for use informative and/or summative assessment of student learning, teacher and practitioner development, and program performance. In a review of the use of portfolios by learners, teachers, and programs, they describe how the purpose and goals of a portfolio serve to guide its design, enactment, and outcome analysis. By engaging in a mentored, collaborative, and reflective process of portfolio development, students, practitioners, and teachers are able to make better sense of what they are doing and plan for continuous improvement stimulated by critical self-assessment of what they have done. The process of building portfolios supports the development of reflective practitioners who continuously assess their own performance and plan for ongoing learning and development.

Total Assessment Audits (TAA) in Iowa

Abstract Traditionally, energy, waste reduction and productivity audits are performed for a manufacturing facility independent of one another. Auditors generally deliver recommendations for improvement based on their specialized expertise (energy, waste reduction, productivity, etc.) without regard to how those recommendations may impact other, sometimes less obvious, subsystems or processes within the facility. The audits are typically performed in isolation from the plant upper management and commonly without adequate knowledge of how inherent interrelated operational constraints may directly or indirectly influence the success of audit recommendations. The Total Assessment Audit (TAA) concept originated from the belief that a manufacturing facility is better served using a holistic approach to problem solving rather than the more conventional isolated approach. The TAA methodology partners the upper management team of a company with a multi-disciplined team of industry-specific specialists to collectively ascertain the core opportunities for improvement in the company and then to formulate a company oriented continuous improvement plan. Productivity, waste reduction, and energy efficiency objectives are seamlessly integrated into a single service delivery with the TAA approach. Nontraditional audit objectives that influence profitability and competitiveness such as business management practices, employee training, human resource issues, etc. are also subject to evaluation in a TAA. The underlying premise of this approach is that the objectives are interrelated and that simultaneous evaluation will produce synergistic results. Ultimately, it is believed that the TAA approach can motivate a manufacturer to implement improvements it might not otherwise pursue if it were focused only on singular objectives.

Using Benchmarking Practices for the Learning Resource Center

Structured ongoing and systematic evaluation is required to ensure up-to-date resources and continuous quality improvement plans to meet the learning needs of the diverse student population and the complex needs of patients. Using benchmarking to achieve evaluation goals in the learning resource center has great merit as schools of nursing respond to consumer demand for improvement, rapid changes resulting from changing patient needs, and the technology explosion.

Building a robust manufacturing strategy

The competitive edge and consequently the survival of organizations in 21st century will depend upon how will they harness their capabilities and supplier capabilities. Striving for technological breakthrough, quality and productivity are absolutely necessary. High performance companies rely heavily on process-oriented thinking, teamwork, involvement and innovations.The principle of TQM coupled with tools like QPD, QFD, SPC, TRIZ and Taguchi Methods help organizations develop robust manufacturing strategies, products and processes as part of continuous improvement plan to survive in the global market. These tools can be incorporated into the classic steps of corporate planning to make strategy work more effectively.

The Application of CQI Principles to Services:: The Case for Hospitalized Patients at Risk for Malnutrition

A multidisciplinary, malnutrition treatment program was developed and implemented at a 395-bed, community hospital to reduce delays in initiating and achieving a therapeutic level of nutrition care for patients identified to have a significant risk for malnutrition (13% of the adult patient population). The project contained a continuous quality improvement (CQI) plan that assessed the effectiveness of the treatment program to achieve these goals. An outcome study was designed to evaluate the impact of nutrition interventions on patient recovery and cost of care. To quantify the impact, the study compared the patient population at high risk for malnutrition both before and after implementation of a malnutrition clinical pathway. Albumin, functional status, and the use of nutrition support (enteral or parenteral) were the variables used to predict outcomes such as length of stay (LOS), discharge disposition and the number of complications. The study required the data sets to be examined and normalized for severity of illness using scaled values of serum albumin. The scaling produced three classes which identified the study population by serum albumin value: (1) >2.7 g/dl, (2) 2.3-2.7 g/dl, and (3) <2.3 g/dl. A cost avoidance of $930,000 was calculated from the reduction of complications when comparable severity of illness between the study groups was considered. Similarly, a $1,008,000 cost avoidance was projected when calculations were made from the reduction in LOS. The application of CQI principles to nutrition care services improved clinical care and clinical effectiveness. The program established a model to effectively allocate existing resources to provide timely and therapeutic nutrition interventions to patients at high risk for malnutrition. A method for the ongoing collection of outcome data has been incorporated into the routine course of nutrition care. This allows for more efficient and frequent performance reviews and CQI.