Continuous Improvement Process Research Articles

Evaluation of food pattern behaviours following nutritional education for health professionals

Abstract Background The “Work Programme - UN Decade of action on nutrition 2016-2025” highlights the importance of implementing Recommendation 19 of the Second International Conference on Nutrition of FAO and WHO related to nutrition education interventions (NEI) for health professionals (HP), in order to develop nutritional skills based on national dietary guidelines and coherent policies relating to food. The Local Health Agency integrated with Trieste University (ASUGI), since 2009, has performed 25 NEI with the formation of 910 HP. Post pandemic, the content of ASUGI’s last 5 NEI, programmed by the prevention plan of the Autonomous Region of Friuli Venezia Giulia, was aligned with the principles of the European Farm to Fork Strategy linked to Sustainable Healthy Diets (SHD). Objectives The objectives of the training programme (TP), approved for Continuing Medical Education, was to change and evaluate food pattern behaviour (FPB) of HP (n = 200) to adhere to the SHD. TP was characterized by a systemic view on complex interconnections between nutritional and sensorial food value, sustainability of food chain systems, evolution of urban food environments, as contexts into which SHD choices can be applied. The 2 days training, spread over 14 hours with 40 participants, concluded with interactive work and experiences to applied knowledge and beginning to make informed healthy dietary choices in practice. Results 6 months after the conclusion of TP it was reported that the percentage of HP who consumed the recommended portions of fruits and vegetables had increased from 62% to 70% and from 28% to 35% respectively, while those who consumed no cured meats, red meats or legumes, changed from 24% to 35%, from 19% to 25%, from 6% to 3% respectively. Conclusions The evaluation of the TP systemic structure has shown its effectiveness in improving some healthy FPB of HP and the importance of applying a continuous improvement process of the program to better adhere to the whole SHD. Key messages • The systemic and integrated structure of nutritional education intervention programs for health professionals contributes to improving their healthy food pattern behaviour. • The relationships between complex policies of food systems and the 17 SDGs included in the training programs on nutrition education are useful for promoting adherence to healthy and sustainable diets.

Infodemics and Vaccine Confidence: Protocol for Social Listening and Insight Generation to Inform Action.

In the fall of 2020, the COVID-19 infodemic began to affect public confidence in and demand for COVID-19 vaccines in the United States. While polls indicated what consumers felt regarding COVID-19 vaccines, they did not provide an understanding of why they felt that way or the social and informational influences that factored into vaccine confidence and uptake. It was essential for us to better understand how information ecosystems were affecting the confidence in and demand for COVID-19 vaccines in the United States. The US Centers for Disease Control and Prevention (CDC) established an Insights Unit within the COVID-19 Response's Vaccine Task Force in January 2021 to assist the agency in acting more swiftly to address the questions, concerns, perceptions, and misinformation that appeared to be affecting uptake of COVID-19 vaccines. We established a novel methodology to rapidly detect and report on trends in vaccine confidence and demand to guide communication efforts and improve programmatic quality in near real time. We identified and assessed data sources for inclusion through an informal landscape analysis using a snowball method. Selected data sources provided an expansive look at the information ecosystem of the United States regarding COVID-19 vaccines. The CDC's Vaccinate with Confidence framework and the World Health Organization's behavioral and social drivers for vaccine decision-making framework were selected as guiding principles for interpreting generated insights and their impact. We used qualitative thematic analysis methods and a consensus-building approach to identify prevailing and emerging themes, assess their potential threat to vaccine confidence, and propose actions to increase confidence and demand. As of August 2022, we have produced and distributed 34 reports to >950 recipients within the CDC and externally. State and local health departments, nonprofit organizations, professional associations, and congressional committees have referenced and used the reports for learning about COVID-19 vaccine confidence and demand, developing communication strategies, and demonstrating how the CDC monitored and responded to misinformation. A survey of the reports' end users found that nearly 75% (40/53) of respondents found them "very" or "extremely" relevant and 52% (32/61) used the reports to inform communication strategies. In addition, our methodology underwent continuous process improvement to increase the rigor of the research process, the validity of the findings, and the usability of the reports. This methodology can serve as a diagnostic technique for rapidly identifying opportunities for public health interventions and prevention. As the methodology itself is adaptable, it could be leveraged and scaled for use in a variety of public health settings. Furthermore, it could be considered beyond acute public health crises to support adherence to guidance and recommendations and could be considered within routine monitoring and surveillance systems.

Integrating Activity-based Costing with Continuous Enhancement: A Strategic Approach to Operational Efficiency and Cost Management

The main objective of this research is to show how integrating activity-based costing (ABC) with continuous improvement processes can enhance cost management and operational efficiency. The development of automated firms and global firms has necessitated a shift in principles and measurement accuracy. The principles and concepts have been modified based on economic theory, moving from stable continuous improvement to continuous enhancement, or Kaizen enhancement. The accuracy of the proposed costing system has improved by using modified activity-based costing. The current research has focused on multi-variation in explanatory variables, including the costing system and the degree of enhancement. The suggested costing system should include the modified version of activity-based costing and the new form of continuous enhancement system. The concept of an intelligent supply chain has led to the idea of a cooperative game between all parties in the firm/chain. Intelligent automated systems are closed-loop systems where all members are partners, aiming to maximize global benefits. Resilient considerations indicate different attempts to measure and estimate the multi-effects of externalities and other external effects. This work has closed-to-open excess quantitative models, achieving the cooperative state between different partners. Findings show that ABC helps manufacturing and service sectors identify non-value-adding activities, optimize resource allocation, and reduce costs by providing detailed insights into the true cost of operations. Its integration with continuous improvement strategies amplifies these benefits, enabling businesses to streamline processes, improve efficiency, and enhance profitability. ABC is a valuable tool for identifying non-value-adding activities and optimizing resource allocation. By providing a more accurate understanding of how resources are consumed, ABC can help organizations improve their efficiency, reduce costs, and enhance customer satisfaction.

Appraising correlation between international organisation for standardisation 50001 and green productivity: A study of workers in Baiji, Iraq

Studies have shown that the progress and success of companies are achieved through their ability to improve energy performance and preserve the environment. It would translate to environmentally friendly products. However, there is a paucity of studies regarding the International Organisation for Standardisation (ISO) 50001 and its role in enhancing environmentally friendly products in developing countries such as Iraq. This study investigates the correlation between ISO 50001 standards and green productivity among Baiji's refinery workers in Iraq. Utilising a structured questionnaire, data from 128 respondents were analysed using descriptive and inferential statistics. Results indicate a significant positive correlation between ISO 50001 and green productivity, underscoring the importance of energy management training in enhancing productivity and environmental protection. As part of the study’s implications, it suggests increasing the company’s management’s attention to training in energy management and green productivity. Its positive impact on improving productivity and protecting the environment through continuous improvement of inputs, processes, outputs, and feedback to the company cannot be overstated.

Capacity assessment for euthanasia in dementia: A qualitative study of 60 Dutch cases.

The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia. We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling). Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient-physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background. Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes.

Improving group problem solving through awareness of members’ problem-solving preferences

PurposeMany groups in organisations are unsuccessful in problem solving. However, the principle of continuous improvement necessitates that organisations refine their employees’ problem-solving skills. In this mixed-method, field-based lab experiment, we explored the impact of a treatment to enhance the quality of group problem-solving processes.Design/methodology/approachWe focused on the structured problem-solving process in Kaizen Events by differentiating six consecutive phases. About 16 Kaizen Event groups (101 members) participated in a field-based lab experiment that used a lean simulation game to establish a group problem-solving context. Data were collected via video, surveys and group interviews. We examined if a high-quality process is strengthened through group members’ elevated awareness of problem-solving preferences. About 11 groups received a treatment of tailor-made individual feedback to increase awareness of their problem-solving preferences. Additionally, we repeated the experiment in five control groups, where member preferences were not shared.FindingsIn the treatment groups, where problem-solving preferences had been shared, we observed a clear improvement in Kaizen Event process quality and higher problem-solving self-efficacy levels. Moreover, their self-reported Kaizen Event behaviour had changed. Within the control groups, the participants also reported that their problem-solving self-efficacy had improved, but this did not have a positive impact on the quality of the objectively measured Kaizen Event process.Originality/valueBy combining insights from operations management and organisational behaviour, we demonstrate that the structured Kaizen Event problem-solving process improves when group members’ individual problem-solving preferences are shared. We thus add an individual-level variable to the extant models of Kaizen Event success factors. Our results provide fresh insights into how to improve the continuous improvement process within organisations. Kaizen Event stakeholders and their facilitators are offered guidance on how to increase one’s awareness of own and others’ problem-solving preferences in group-based problem-solving events.

Operational Excellence: Process optimization for competitive edge

This study explores the concept of operational excellence and the role of process optimization in gaining a competitive edge for organizations. Operational excellence involves the continuous improvement of business processes to increase efficiency, reduce waste, enhance quality, and improve overall performance. The study reviews established methodologies such as Lean, Six Sigma, and Total Quality Management (TQM) that provide structured approaches to achieving operational efficiency. It also examines the impact of emerging technologies, including artificial intelligence (AI), machine learning (ML), and the Internet of Things (IoT), in driving data-driven decision-making and enhancing process optimization. Additionally, the study highlights the importance of leadership in fostering a culture of continuous improvement and collaboration across departments, ensuring alignment with strategic objectives. The integration of sustainability into operational strategies is discussed as a means to not only improve efficiency but also meet corporate social responsibility goals. The relationship between process optimization and innovation is also explored, showing how operational excellence can free up resources for research and development (R&D) and foster a culture of innovation. Despite the focus on these established practices and technologies, the study acknowledges limitations, particularly the challenges faced by small and medium-sized enterprises (SMEs) and service oriented sectors in implementing these strategies. The study concludes that operational excellence, supported by technological advancements and a strong organizational culture, is essential for organizations to navigate competitive markets, improve customer satisfaction, and achieve long-term success. This research offers valuable insights for businesses aiming to enhance operational performance and sustain their competitive advantage through continuous process optimization and innovation.

Implementation of Machine Learning in the Categorization of Improvement Areas for Kaizen Submissions

This paper explores the synergy between Kaizen methodologies and Machine Learning, with the goal of improving the efficiency of categorizing areas of improvement. The implementation of Machine Learning algorithms, utilizing the ML.NET tool, has proven to be highly advantageous. These algorithms automate the categorization of Kaizen proposals based on structured data and predefined labels. This automation significantly reduces manual workload, expedites the classification process, and ultimately accelerates decision-making within the realm of continuous improvement. Furthermore, the application of machine learning has improved the categorization accuracy, reduced the risk of human errors, and ensured a more precise assignment to the relevant categories. This, in turn, enhances the quality of the collected information, facilitating well-informed decision-making. Additionally, the automated categorization has streamlined the process for users submitting Kaizen proposals, eliminating the need for manual category selection. This reduces cognitive load and promotes active engagement in the continuous improvement process. Furthermore, the system has introduced a category-based incentive structure, where users accrue points corresponding to the category assigned to their Kaizen proposals. These points can be exchanged for items provided by the company, acting as an additional incentive for active employee participation in the continuous improvement process. In conclusion, the integration of Machine Learning with the ML.NET tool has become a valuable tool for optimizing the management of improvement proposals, resulting in a marked enhancement in efficiency, accuracy, and user engagement in the categorization process.

A-188 Modal Failure and Effects Analysis, FMEA methodology, as a strategy to increase patient safety

Abstract Background Patient safety during the clinical care process is considered a priority in healthcare. Failure Mode and Effects Analysis (FMEA) is a proactive and systematic method of process evaluation and is used to identifying where and how each phase of the analytical process could fail allowing the detection of the causes and the effects they produce on the quality of the results that are issued. A regular use of this tool makes possible to identify the most critical steps, propose improvement strategies and evaluate their impact. The aim of the study is to evaluate applicability of the FMEA tool to identify errors in the pre analytical, analytical, and post analytical phase of a clinical laboratory as well as the main causes and effects, to reduce them by proposing improvement strategies Methods For each phase into which the laboratory activity is divided, the frequency and type of errors that are made and their final consequences on the patient are evaluated. A risk index (NPR=OxDxS) is calculated for each error considering the frequency with which it occurs (O), the ease with which it is detected (D) and the severity of the consequences on the patient (S). Values goes from 1 (rarely) to 10 (often). Improvement actions are proposed for all errors with a risk index greater than 100 and this index is re-evaluated after the implementation of that improvement measures. This same analysis is performed for three times over the last 10 years (in 2014, 2019 and 2023). Results In FMEA analysis carried out in 2014, a total of 40 errors were identified in the pre-analytical phase (63.5% of the total), 12 in the analytical phase and 11 in the post-analytical phase. 50% of the total errors detected required improvement strategies because they had an NPR≥100 value. In the 2023 evaluation, a total of 27 errors were identified in the pre-analytical phase, 10 in the analytical phase, and 5 in the post-analytical phase but only 6 required improvement strategies, which represents an 80% reduction in the most critical errors for patient safety. However, the pre-analytical phase continues to be the most critical, as it continues to account for 64% of the total errors identified, including the lack of identification of the patient or sample and the inadequate prior preparation of the patient. In analytical and post-analytical phases, the NPR values obtained in 2023 decrease significantly over analysis carried out in 2014 and its not needed to apply improvement strategies. Automation and the IT tools significantly reduce the number of errors with high NPR values, but it is undoubtedly the involvement of service professionals that makes the difference over the years. Conclusions The use of the FMEA methodological tool allows the design of appropriate indicators to detect and reduce errors in the clinical laboratory. Its application as part of a good quality control allows a continuous improvement in the laboratory process and consequently a guarantee of quality for the patient

Cross-border capital flows and low-carbon economic development: Examining the impact of foreign shareholding

This study utilizes data from Shanghai and Shenzhen A-share listed companies from 2011 to 2021 to explore the impact of foreign shareholding on the development of a low-carbon economy and the underlying mechanisms. Findings show that foreign shareholding significantly reduces corporate carbon emissions and promotes corporate environmental responsibility and low-carbon transformation. The paper further investigates how foreign shareholding reduces carbon emissions by increasing corporate investments in environmental protection and driving green innovation. Foreign participation is found to improve the efficiency of corporate resource allocation and innovation capabilities, allowing for continuous improvements in low-carbon technologies and production processes. The study also examines the effect of corporate environmental strategies and green technology advancement on the relationship between foreign shareholding and carbon emissions, revealing the heterogeneity of foreign investment impacts on low-carbon development under different corporate environments and capabilities.

Getting mammograms shouldn’t be so bumpy: Improving mammogram workflow in VA community care.

345 Background: The interplay between VA-based care and Community Care (CC) has long been important for continuity of patient care, though transitioning care between the two is often fraught with problems. Mammograms ordered at VA San Diego (VASD) are often deferred to Community Care; while this process should be smooth and seamless, it is instead challenging to navigate, with inconsistent rates of completion and results often not relayed to patients leading to delayed/missed diagnoses. We applied extensive QI methodology towards overhauling the VASD Community Care Mammogram workflow to improve rates of CC mammogram completion and results released to patients in a timely manner. Methods: We evaluated the CC mammogram workflow and implemented interventions at VASD from 01/2022-04/2023. An A3 was used for tracking process improvement. Using Lean Six Sigma process improvement strategies, we identified several problematic areas within the CC Mammogram workflow that are prone to errors and can lead to patient safety issues. Weekly meetings/interviews were set up to identify pain points with the primary users to allow for continuous process evaluation and improvement. Primary outcome was the frequency with which a CC mammogram order had mammogram completed and result released to patient within the expected timeframe by VISN 22 metrics (BIRADS 0,3,4,5,6 <7 days and BIRADS 1,2 <14 days to notification). Results: Process mapping of the VASD CC mammogram process revealed significant waste and failure modes. Notably among these was the splintered tracking systems used across multiple users and lack of automated follow-up reminders. Multiple PDSAs involved standardizing workflow by developing an SOP that focused on standardization of tracking orders/results, creating automated task reminders, while also adding backup systems and double-checks. To centralize and standardize the patient tracking process, we repurposed the Coordinated Care Tracking System (CCTS), a VA-based tool that is used for tracking patients in other departments and creating reminders for follow up, while storing patient data in a centralized location. We also redesigned and streamlined the mammogram ordering menu within CPRS. Implementation of the above interventions increased monthly rates of mammograms completed and reported to patients in a timely manner from a median of 67.5% to 100% in all BIRADS groups by 10/2022, and sustained at 100% through 04/2023. Conclusions: Standardization of workflow and incorporation of CCTS software into the CC Mammogram process led to an appreciable improvement in rates of CC mammogram scheduling and timely result notifications. Improved tracking of CC mammogram patients has the potential to prevent unnecessary patient harm. It is worth considering whether CCTS and a similar standardized process should be incorporated into other CC programs, as these issues are not unique to VASD mammograms.

Implementing continuous improvement processes in oil and gas operations: A model for enhancing product service line performance

In the dynamic and highly competitive oil and gas industry, operational efficiency and performance are critical to sustaining growth and profitability. Continuous improvement processes are essential for enhancing Product Service Line (PSL) performance, driving operational excellence, and maintaining a competitive edge. This review presents a comprehensive model for implementing continuous improvement processes specifically tailored for the oil and gas sector, focusing on optimizing PSL performance. The proposed model integrates key principles of continuous improvement, including incremental changes, feedback loops, and iterative enhancements, within the context of the oil and gas industry's unique operational environment. It outlines a systematic framework for defining objectives, setting performance metrics, and identifying areas for improvement. The model emphasizes the importance of establishing a dedicated continuous improvement team, providing targeted training, and developing robust processes for ongoing monitoring and evaluation. The review highlights various tools and techniques, such as Lean principles, Six Sigma methodologies, and Root Cause Analysis (RCA), which are pivotal in identifying inefficiencies, reducing waste, and enhancing the overall quality of PSL operations. By incorporating these tools, organizations can achieve significant advancements in operational performance and cost-effectiveness. Case studies from industry leaders are examined to illustrate successful implementations of the continuous improvement model and to derive lessons learned. These case studies provide valuable insights into effective strategies and highlight the impact of continuous improvement on PSL performance. Challenges associated with implementing continuous improvement in the oil and gas sector are also addressed. Issues such as resistance to change, resource constraints, and difficulties in measurement are discussed, along with proposed solutions including change management strategies, efficient resource allocation, and the development of robust measurement systems. The review concludes by exploring future directions for continuous improvement in oil and gas operations, considering emerging technological trends and the integration of digital transformation initiatives. Recommendations for ongoing improvement are provided, emphasizing the importance of continuous feedback loops and adaptability to evolving industry standards. This model serves as a strategic guide for oil and gas organizations seeking to enhance their PSL performance through systematic and sustained continuous improvement efforts, ultimately contributing to their long-term success and operational excellence.

Maintaining and Improving Virtual Call Centers for Public Health: The CUNY Recovery Corps Experience.

In the early stages of the COVID-19 pandemic in New York City, individuals who tested positive, exposed contacts, and their families faced significant challenges in accessing essential resources for successful quarantine and isolation. These resources included alternative housing, food access, grocery delivery, missed wage assistance, transportation for household members, medical care, and more. The City University of New York (CUNY) Recovery Corps emerged as an innovative virtual resource navigation service to connect New Yorkers to essential resources and later to vaccinations, treatment, and services for Long COVID. The program prioritized reaching people living in underserved and under-resourced neighborhoods. Over 3years, it made a substantial impact, reaching 374728 New Yorkers and connecting 135147 to crucial resources. Implementing a successful virtual navigation center amidst a global pandemic posed unique challenges. It required well-established systems to provide services, manage staff, build community, and both assure and improve service quality. Continuous quality assurance and process improvement efforts resulted in a nearly 10-point increase in successful client-resource connections program-wide, with individual navigators showing improvements of up to 20%. Staff-led initiatives, such as population-specific resource guides and incentive awards, boosted morale and cohesion. Providing continuous professional development opportunities and requested training including trauma-informed care, self-care, and strategies for managing grief contributed to staff retention and improved client interactions. The CUNY Recovery Corps provides a blueprint for setting up navigation services for emergency response and supporting health and social services. The current paper delves into the intensive quality improvement efforts, program management infrastructure, and staff support that made this program a success. By applying these lessons on establishing and maintaining a virtual call center prioritizing the client's well-being and staff strengths, policymakers and social service leaders can effectively address various health and social service needs proactively rather than rebuilding after each disaster.

Application of Virtual Reality (VR) in Health, Safety and Environment Subject for Fire Exit Training Module

The significance and extraordinary effectiveness of using VR technology into health, safety, and environment (HSE) education are highlighted. It addresses the many benefits that VR has to offer, especially when it comes to fire exit training, by giving students engaging, involving, and profound learning experiences. The research highlights the seamless incorporation of VR into Health, Safety and Environment (HSE) courses, where VR simulations serve as important tools for teaching crucial evacuation tactics and encouraging students' in-depth understanding and preparedness for actual fire emergencies. This study investigates students' responses regarding their understanding in one of the HSE subject following the implementation of VR technology. Valuable student feedback has been gathered through comprehensive surveys, enabling a continuous process of improvement and refinement for the HSE program. Overall, this research stands as a compelling testament to the profound impact of VR in optimizing learning outcomes and fostering a heightened sense of safety awareness in professional environments.

Sustainability and Quality of Life in Marginalized Areas: An Impact Evaluation of a Community Center in Santa Fe, Mexico

The aim of this paper is to present the results of an impact evaluation of a community center in health, capacity building, and digital access, which form an approximation of quality of life, in the population of Santa Fe town in Mexico City, from 2022 to 2024. The methodology is quantitative, using an impact index and the differences in differences (DD) technique. The data were obtained from primary sources with surveys undertaken via questionnaires. The center is operated by a private university and funded by private firms. The results show a positive impact of 0.287127 out of 1 on the weighted impact index, which allows us to consider this program successful in improving the quality of life of the target population. Through impact evaluation, the effectiveness of interventions and opportunities for improvement are identified, fostering collaboration among local actors, including community members, state-run public programs, and community centers. This collaborative effort improves the quality of life, creating a sustainable community wherein each actor addresses specific needs. Impact evaluation plays a crucial role in measuring sustainability because it is a continuous improvement process that, when combined with other actions, enhances the community’s overall well-being.

Strategy to Improve the Quality of Madrasah Education Through Madrasah Diniyah (Madin) in Min 16 Bener Meriah Aceh

The purpose of this study was to determine the concept of organizing Madrasah Diniyah (Madin) Min 16 in Aceh. The concept of Madrasah Diniyah (MADIN) at MIN 16 Bener Meriah has the following characteristics: focusing on customers, both internal and external customers, having a high obsession with quality, using a scientific approach in decision making and problem solving, having a long-term commitment, requiring teamwork, continuous process improvement, providing education and training, providing controlled freedom, unity of purpose, and involving and empowering human resources. Meanwhile, the implementation of Integrated Quality Improvement Management in Madrasah includes Quality Strategy Planning (vision, mission, objectives, long-term institutional strategy, monitoring and evaluation), improving process quality (curriculum and learning process), improving the quality of Human Resources. Resources (HR), improving environmental quality, improving service quality, improving output quality

Quality improvement in medicines regulation: a retrospective analysis of the Pharmacy Board of Sierra Leone before and during quality management system implementation

BackgroundNational Medicines Regulatory Authorities like the Pharmacy Board of Sierra Leone are responsible for protecting and promoting public health, implementing regulatory standards, and maintaining a supply chain with an assured supply of medical products that are safe, effective, and of good quality. This retrospective study assesses the identification of substandard and falsified medicines, the changes in the functions and key indicators of assessment, and the quality improvement changes of the Pharmacy Board of Sierra Leone.MethodsData was obtained from 2013 to 2021 records using a data collection tool to collate and review all relevant information to address the different objectives. All data were sourced from the Department of Quality Assurance and the Department of Enforcement and Narcotics at the Pharmacy Board of Sierra Leone. The review also included, identified substandard and falsified medicines, the World Health Organisation Global benchmarking self-assessment tool, and internal and external audit records of the quality management system of all twelve departments of the Pharmacy Board of Sierra Leone.ResultsThe study showed marked changes in identifying substandard and falsified medicines by the Pharmacy Board of Sierra Leone during ISO 9001:2015 implementation (2017- 2020) compared to Pre-ISO 9001:2015 implementation (2013- 2016). Critical functions of the Pharmacy Board of Sierra Leone from the assessment of the WHO GBT ML in 2016 and 2021 showed that several indicators had been addressed during ISO 9001:2015 certification with improvement in the level of maturity for the quality management systems and Pharmacovigilance functions. There was also an improvement in identifying non-conformances and a commitment to continuous improvement of processes during ISO 9001:2015 implementation.ConclusionsThis study revealed that regular checks through standard assessment, internal audits, and standard management review processes that generate follow-up actions, timelines, and a commitment to identifying correction, and corrective actions for non-conformances are essential quality improvement tools for the efficient functioning of an institution (Pharmacy Board of Sierra Leone). Our study revealed that commitment to continuous implementation of proper quality management system could significantly improve institutional efficiency, thereby improving service delivery and customer satisfaction.

Virtually integrated nursing care: A case study in diffusion of innovations

Bedside nurses are suffering from nurse fatigue owing to excessive workload and work hours. Nurse fatigue results in missed nursing care, which has a direct impact on patient care and safety. Loss of experienced nurses also affects novice nurses, leaving them without strong mentoring. They may suffer from imposter syndrome, which instils self-doubt and limits their professional development, potentially resulting in burnout and attrition. A case study regarding the leadership of the Chief Nursing Officer as aligned with Rogers’ diffusion of innovations theory is presented. There is an initial accumulation of knowledge regarding the innovation, followed by persuasion (through perception of positive attributes to enhance speed of adoption), decision making, actual implementation and confirmation. Use of virtually integrated nursing helped alleviate bedside nurse fatigue by removing overtime hours and reducing workload. The virtually integrated nurses supported the bedside nurses, allowing them additional time in direct patient care, enhancing patient satisfaction and safety. The objective data indicates a decrease in patient fall by over 50 per cent. The integration of virtual nursing reversed the nurse attrition rates. Initial results revealed a 47 per cent reduction in registered nurse turnover. This allowed for retention of experienced nurses, which aids in mentoring novice nurses. The impact of virtually integrated nursing is yet to be completely realised. Based on this case study, the implementation of virtually integrated nursing is possible and beneficial to nursing, patient safety and the bottom line. This innovation had additional positive consequences and led to future considerations regarding continual process improvement and dissemination of knowledge.

Blinded by the Data: When Analytics Overshadows Judgment

This article discusses the potential risks that can emerge when organizations overly on data-driven decision making by focusing excessively on quantitative analysis and metrics to the exclusion of important qualitative human factors. The article explores common pitfalls such as leaders losing sight of broader strategic perspectives and higher-level business drivers when immersed in granular data points, organizational chaos and paralysis resulting from constant A/B testing without clear objectives, over-quantification discounting important but difficult to measure "soft" elements like culture, talent and leadership that profoundly shape performance, and overconfidence in the perceived objectivity of models overlooks inherent biases. The article advocates balancing quantitative and qualitative lenses to gain a more textured understanding of complex dynamics by supplementing metrics with perspectives from ethnography and stakeholder input to provide needed context as numbers alone do not replace prudent application of human judgment and experience, and for data-driven initiatives to achieve tangible impacts, analytics must inform innovation and change management rather than replace continuous improvement processes, such that with moderation and integration of multiple viewpoints, data can empower rather than control strategic decision making.

Inteligencia Artificial, Imagen Médica y Medicina de Precisión: Avances y Perspectivas

The role of artificial intelligence (AI) applied to medical imaging in developing and strengthening personalized medicine is described as a continuous process of improvement, a set of opportunities, and a professional challenge of enormous significance. This paper outlines the main processes in which AI is involved regarding imaging, including data preparation, image harmonization, automatic segmentation of organs and lesions, labeling, extraction of radiomic features, and the development of predictive clinical models. It will also address aspects related to the integration of these solutions into clinical practice to enhance accuracy and efficiency in the care process, diagnosis, and treatment, making it more personalized, efficient, and precise. Projects like PRIMAGE and CHAIMELEON highlight the transformative potential of AI and the fundamental role of interdisciplinary collaboration in realizing this potential, based on ongoing multiprofesional collaboration to address the ethical, regulatory, technical, and clinical challenges that accompany these advancements.