Continuous Improvement Program Research Articles

Driving Blind: Why We Need Standardized Performance Assessment In Teacher Education

In this article we argue that standardized teaching performance assessments (TPAs) offer a uniquely valuable resource for learning and improvement of practice in teacher education. The affordances of TPAs as opportunities for learning are identified at four levels, including those for teacher candidates, individual faculty, organizational learning at the program level, and organizational networks that span program boundaries. We conclude that TPAs can provide motivation and direction for continuous program improvement efforts, contribute to the development of a common and concrete language of practice, and accelerate the professionalization of teaching.

A Study of Kaizen Practices in SMEs Involved in Manufacturing: An Empirical Evaluation of North Karnataka

Micro, small and medium enterprises (MSMEs) play a crucial role in the sustainable growth of both the emerging and the developed economies. Implementing quality in systems and products manufactured is a new imperative for small and medium enterprises. Only the firms which manage quality and productivity on a continuous basis can sustain and compete in the global scenario. This study has been undertaken to know whether continuous improvement programmes are implemented in the same way in small and medium manufacturing enterprises; to know the status of kaizen practices among the SMEs; to understand the impact of kaizen practices on SMEs.

Completeness of coronary revascularization and survival: Impact of age and off-pump surgery

We conducted a multicenter observational cohort study of the effect of completeness of revascularization on long-term survival after coronary artery bypass grafting. We also investigated the impact of age and off-pump surgery. The Veterans Affairs Continuous Improvement in Cardiac Surgery Program was used to identify all patients (N=41,139) with left main and 3-vessel coronary artery disease who underwent nonemergency coronary artery bypass grafting from October 1997 to April 2011. The primary outcome measure, all-cause mortality, was compared between patients with complete revascularization and patients with incomplete revascularization. Survival functions were estimated with the Kaplan-Meier method and compared by using the log-rank test. Propensity scores calculated for each patient were used to match 5509 patients undergoing complete revascularization to 5509 patients undergoing incomplete revascularization. A subgroup analysis was performed in patients aged at least 70 years and patients who underwent off-pump coronary artery bypass grafting. In the unmatched groups, several risk factors were more common in the incomplete revascularization group, as was off-pump coronary artery bypass grafting. In the matched groups, risk-adjusted mortality was higher in the incomplete revascularization group than in the complete revascularization group at 1 year (6.96% vs 5.97%; risk ratio [RR], 1.17; 95% confidence interval [CI], 1.01-1.34), 5 years (18.50% vs 15.96%; RR, 1.16; 95% CI, 1.07-1.26), and 10 years (32.12% vs 27.40%; RR, 1.17; 95% CI, 1.11-1.24), with an overall hazard ratio of 1.18 (95% CI, 1.09-1.28; P<.0001). The hazard ratio for patients aged 70 years or more was 1.125 (95% CI, 1.001-1.263; P=.048). The hazard ratio was 1.47 (95% CI, 1.303-1.655) for the unmatched off-pump coronary artery bypass grafting group and 1.156 (95% CI, 1.000-1.335) for the matched off-pump coronary artery bypass grafting group. Incomplete revascularization is associated with decreased long-term survival, even in elderly patients. Surgeons should consider these findings when choosing a revascularization strategy, particularly if off-pump coronary artery bypass grafting is contemplated.

The Eyeball Test

As physicians, we strive to provide the most appropriate care for our patients and to provide them with accurate assessments of both the risks and benefits they can expect to realize. Unfortunately, as humans, we are notoriously bad at estimating risk.1,2 However, as the choices of treatments for cardiac disease expand, accurate assessment of risk becomes increasingly important. A patient with coronary artery disease may have the option of medical therapy, coronary artery bypass grafting, or percutaneous intervention. Transcatheter aortic valve replacement may soon be a viable alternative to surgical aortic valve replacement for patients with aortic valve disease. For patients to be able to make the choice that best suits their goals, they must have accurate information regarding risks and benefits. Article see p 151 In the current article, Jain et al3 compared cardiac surgeons’ assessments of mortality after coronary artery bypass grafting and valve surgery and that calculated from the Veterans Affairs Continuous Improvement in Cardiac Surgery Program (VA CICSP) risk model with actual mortality rates. The focus of the study was perioperative mortality; however, 1- and 5-year mortality rates were also considered. Although neither the statistical risk model nor surgeon estimates were perfect, the risk models performed somewhat better at all time points. Both the risk models and the surgeons’ estimates were better at estimating perioperative mortality than they were at estimating late mortality. These findings are informative and may help us to improve our estimates of procedural risk. When examining the predictive validity of a risk model (or surgeons’ estimates), 2 factors are regularly used: calibration and discrimination. Calibration measures to what degree the model assigns risk to the population, or in a population of 100 patients with an estimated mortality risk of 3%, were there 3 observed deaths? The current article …

Assessing the impact of alternative continuous improvement programmes in a flow shop using system dynamics

We use a system dynamics simulation model based on the Factory Physics perspective to study the cumulative effect of continuous improvement in arrival variability, process variability, defect rate, time to failure, repair time and set-up time on operating curves in a flow-shop environment. We find that small, simultaneous improvements at multiple locations in the line can provide reductions in cycle time comparable to, or sometimes superior to, those obtained by a major improvement at a single location. The reduction of process variability is often an excellent alternative to reducing the mean of a parameter, because process variability at a given station affects not only that station, but all downstream stations due to its impact on flow variability. Improvements at non-bottleneck stations also have significant benefits, again by reducing the variability of flow to the bottleneck station. These results suggest a broader interpretation of some aspects of the Theory of Constraints, and help explain the successful results of the Toyota Production System.

Ontario’s Quality Assurance Framework: A Critical Response

Ontario’s Quality Assurance Framework (QAF) is reviewed and found not to meet all five criteria proposed for a strong quality assurance system focused on student learning. The QAF requires a statement of student learning outcomes and a method and means of assessing those outcomes, but it does not require that data on achievement of intended learning outcomes be collected, analyzed and used for continuous program improvement. By failing to be a strong framework for quality assurance, it cannot be used to demonstrate that institutions of higher education in Ontario have achieved high quality, in the “fitness-for-purpose” sense of that concept. As a result, the QAF assures only a “shooting the moon” version of quality, where having a target (the moon), aimed at carefully in a standardized way, is treated as proxy for actually hitting the target (learning outcomes).

Human critical success factors for kaizen and its impacts in industrial performance

This article presents the results of a survey with 13 main activities related to human factors that are executed during kaizen implementation process and were integrated in four independent latent variables (management commitment, education, communication and motivation) that are associated to 14 benefits obtained after its implementation that were grouped in three dependent latent variables (process, workers and customers). The survey was applied to persons with responsibilities in continuous improvement programs and projects in companies located in Mexico. Independent and dependent variables were integrated in a structural equation model that was evaluated using partial least squares algorithms WarpPLS® for finding causal relations among them. Results indicate that management commitment and education are the main factors that guarantee the success for kaizen implementation programs, but that is moderated by a good communication for having good operational process performance for better workers and customer satisfaction.

A Sustainable Process for Continuous Program Improvement towards Accreditation

ABET accreditations assure the relevant professional community and to the world at large, that a program meets the quality standards set by a technical profession. Although ABET (Accreditation Board for Engineering and Technology) is primarily focused on the US programs; on invitation, it may extends it services to programs outside the US. Programs at the College of Engineering, Sultan Qaboos University, were among the first to be accredited by ABET (2006-08) in the Arabia Gulf. The preparation for such accreditation started in earnest in 2001. Such preparation is in-progress to get ready for another one coming up in Fall 2013. In this presentation, we attempt to share our experiences in developing necessary steps for suitable Continuous Quality Improvement toward the accreditation. ABET accreditation is based on eight general criteria. Here, the discussion focuses on criteria (iii) Student Outcomes and (iv) Continuous Improvement. It describes how the Student Outcomes were subdivided into sub-outcomes to make it easier for direct measurement, assessment and evaluation. We will use Chemical Engineering Program at the College of Engineering, Sultan Qaboos University as a case to highlight the importance of Faculty Corporation, curriculum alignment, students’ awareness and record/feedback towards effective quality improvement for the program.

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.

Evaluation of software tools supporting outcomes-based continuous program improvement processes

The Canadian engineering accreditation board (CEAB) mandate tasked each engineering programto assess student outcomes in the form of graduate attributes and develop a data-informed continuous program improvement stemming from those assessments. Administering, collecting and organizing the breadth assessment data is an extensive process, typically centralized through the use of software tools such as learning management systems (LMS), content management systems (CMS), continuous program improvement systems (CPI). These systems serve av ariety of roles, ranging from course content delivery, elearning, distance education, learning outcomes assessment, outcomes data management and learning outcomes analytics. Vendors have been developing various solutions to accommodate the shift towards outcomes based assessment as part of a continuous improvement processes.This paper will compare and contrast software tools supporting outcomes based assessment as part of acontinuous improvement process such as eLumen, Canvas, Moodle, WaypointOutcomes, Desire2Learn and LiveText.

The Process of Continual Improvement of Engineering Programs at the University of Manitoba: Now and Next

This paper describes the process that has been implemented for continual improvement of the Engineering programs at the University of Manitoba. The continuous improvement process developed is founded on: (i) assessment of graduate attributes, (ii) evaluation of student success, and (iii) further improvement of the programs. Graduate attributes are assessed both directly and indirectly. The direct assessment of attributes is through course-embedded procedures, while the indirect assessment is through compilation of many activities at both the Program, Department and Faculty levels, as well as via effective feedback from the students and the external engineering community. Together these assessments provide important information for the newly- established Curriculum Management Committee (CMC) to identify/prioritize needs, make recommendations and oversee the implementation of improvements. We describe steps taken to ensure a sustainable continuous program improvement process.

The development and use of Provider Profiles at the organizational and systems level

While the use of quality of life-related personal outcomes has been broadly reported during the last decade, little attention has been paid to the use of such data as a basis for developing and using Provider Profiles at the organizational and systems level. This article illustrates a way in which these evidence-based outcomes may be used not only to improve clinical decisions, but also managerial and policy strategies. To that end, the quality of life of 11,624 social service recipients was assessed by means of the application of the GENCAT Scale, a questionnaire to assess quality of life according to the eight-domain model (Schalock & Verdugo, 2002). Data were analyzed at organizational and the systems level in order to develop Provider Profiles. Once implemented, these profiles can be used to compare individuals in different diagnostic groups, develop province-level performance standards, encourage continuous program improvement, and guide the development of evidence-based policies

Performing Coronary Artery Bypass Grafting Off-Pump May Compromise Long-Term Survival in a Veteran Population

There are ample data regarding the short-term outcomes of on-pump and off-pump coronary artery bypass grafting (CABG), but little is known about the long-term survival associated with these approaches. Using the Veterans Affairs (VA) Continuous Improvement in Cardiac Surgery Program, we identified all VA patients (n = 65,097) who underwent primary isolated CABG from October 1997 to April 2011. The primary outcome measure was all-cause mortality. Age, 17 preoperative risk factors, and year of operation were used to calculate propensity scores for each patient. A greedy-match algorithm using the propensity scores matched 8,911 off-pump with 26,733 on-pump patients. Survival functions were estimated by the Kaplan-Meier method and compared by using the log-rank test. In the complete cohort, off-pump was used in 11,629 of 65,097 (17.9%) operations. For the matched cohort, the median follow-up was 6.7 years (interquartile range, 3.72 to 9.35 years). Risk-adjusted mortality did not differ significantly between the off-pump and on-pump groups at 1 year (4.67% vs 4.78%; risk ratio [RR], 0.98; 95% confidence interval [CI], 0.88 to 1.09) or 3 years (9.21% vs 8.89%; RR, 1.04; 95% CI, 0.96 to 1.12). However, risk-adjusted mortality was higher in the off-pump group at 5 years (14.47% vs 13.45%; RR, 1.08; 95% CI 1.02 to 1.15) and 10 years (25.18% vs 23.57%; RR, 1.07; 95% CI, 1.03 to 1.12). Overall, the hazard ratio for off-pump vs on-pump was 1.06 (95% CI, 1.00 to 1.13; p = 0.04). Off-pump CABG may be associated with decreased long-term survival. Further studies are needed to identify the reasons behind this finding.

Comparing health outcomes among hospitals: the experience of the Lombardy Region

In recent years, governments and other stakeholders have increasingly used administrative data for measuring healthcare outcomes and building rankings of health care providers. However, the accuracy of such data sources has often been questioned. Starting in 2002, the Lombardy (Italy) regional administration began monitoring hospital care effectiveness on administrative databases using seven outcome measures related to mortality and readmissions. The present study describes the use of benchmarking results of risk-standardized mortality from Lombardy regional hospitals. The data usage is part of a general program of continuous improvement directed to health care service and organizational learning, rather than at penalizing or rewarding hospitals. In particular, hierarchical regression analyses - taking into account mortality variation across hospitals - were conducted separately for each of the most relevant clinical disciplines. Overall mortality was used as the outcome variable and the mix of the hospitals' output was taken into account by means of Diagnosis Related Group data, while also adjusting for both patient and hospital characteristics. Yearly adjusted mortality rates for each hospital were translated into a reporting tool that indicates to healthcare managers at a glance, in a user-friendly and non-threatening format, underachieving and over-performing hospitals. Even considering that benchmarking on risk-adjusted outcomes tend to elicit contrasting public opinions and diverging policymaking, we show that repeated outcome measurements and the development and dissemination of organizational best practices have promoted in Lombardy region implementation of outcome measures in healthcare management and stimulated interest and involvement of healthcare stakeholders.

Critical success factors for Kaizen implementation in manufacturing industries in Mexico

Kaizen is one of the most important methodologies used to manage continuous improvement in the maquiladora industry located in Ciudad Juarez, Chihuahua, Mexico; however, it is frequently implemented without obtaining the expected results. This article presents the results of a survey with 37 main tasks associated with Kaizen implementation and it was applied to personnel with responsibilities in continuous improvement programs in companies located in Ciudad Juarez, Mexico. The survey was validated using a rational validation, judge validation, and statistical validation using the Cronbach alpha index. A factor analysis by principal components and varimax rotation was applied for finding the critical success factors for Kaizen; results indicate that seven factors are the most important: education and training in operators, communication process, documentation and evaluation of projects results, human resources integration, management commitment, and customer focus.

The impact of simultaneous continuous improvement in setup time and repair time on manufacturing cycle times under uncertain conditions

We develop a system dynamics model to examine the cumulative effects of continuous improvement programmes for repair and setup times on the cycle time of a simple single-stage production system. The relationship between system performance and repair and setup times is captured using the Factory Physics approach. We find that modest rates of improvement in multiple areas in parallel yield cumulative benefits over time comparable with those obtained by a large reduction in a single parameter, especially when there is significant uncertainty in the degree of improvement that can be obtained, or in the degree to which improvements can be sustained over time. These results provide an insight into the success of the Toyota Production System and related lean manufacturing approaches where continuous improvement is an ongoing activity across the work environment.

Model/Framework for Addressing Continuous Improvement Projects Effectively and Efficiently using Six Sigma Methodology. Case Study of Automotive Auxiliary Company

Received: 29 October 2012 Abstract Accepted: 26 November 2012 The purpose of this work is to develop a model for implementing an effective and efficient Continuous Improvement projects, aimed at increasing the performance of production processes. In particular, it aims to innovate in the way of deploying a Program Improvement in the company to make this process run as efficiently as possible. Although continuous improvement programs are some of the tools that are commonly used in industrial environments to increase the performance of their processes, it has become clear that there is a need to develop a continuous improvement model that will be implemented efficiently, and its results will remain over time. Also, it has been found that the model mentioned previously should serve to develop the foundations of an Organization which learns quickly and continuously.

Clinical Outcomes in Adult and Pediatric Ewing Sarcoma: A Single Institution Comparative Study

oncology web page to an encrypted database. Forms initially were reviewed at monthly quality assurance meetings. Starting in May 2010, a process improvement team consisting of physician, physicist, dosimetrist, therapist, and nursing group representative met weekly to improve workflow and decrease errors. This group was expanded to non-clinical staff in 2011. Form review priority criteria, solution criteria, and meeting ground rules were set in advance of the first team meeting. Spreadsheets were used to present the forms. Actions, owners, and completion dates were assigned at each meeting. Results: Over 1,182 process improvement reports were recorded. Efforts resulted in many operational changes in the department. In addition to first day therapist chart checklists, physics and dosimetry chart checklists were added and electronically recorded in the every patient’s chart. Table indexing was developed for all patients to minimize potential for wrong site treatment. A Linear Accelerator Field Definition Chart was created to include unique differences in treatment parameters and a Field Definition Chart was created showing screen capture examples of different linear accelerator parameters. Machine parameter spreadsheets were created and are being used by dosimetrists and physicists. Data demonstrated increased adoption by staff over time with increased PIF submission. Forms for incidents reaching the patient decreased, during the same time period that total number of fields treated and complexity of patient set-up increased (Table). Conclusions: The number of errors reaching patients can be positively affected by a continuous improvement program. A continuous quality improvement program can be implemented at a large tertiary teaching institution that can be adapted for smaller radiation oncology departments. Author Disclosure: T. Meier: None. B. Hugebeck: None. T. Kovacs: None. C. Belfi: None. J. Suh: G. Consultant; Abbott Oncology. M. Kolar: None. S. Chao: None.

Effect of lot-size reduction and continuous improvement programmes on work in process and utilisation: a study for single-machine and flow-shop environments

This article examines how six continuous improvement programmes (arrival variability, process variability, defect rate, time to failure, repair time, and set-up time), together with lot-size reduction, affect work in process (WIP) and utilisation in two different manufacturing environments: single-machine and flow-shop. The main tool we use to attain this goal is a combined system dynamics/factory physics approach proposed by Godinho Filho and Uzsoy [2011. The effect of shop floor continuous improvement programs on the lot size – cycle time relationship in a multi-product single-machine environment. The International Journal of Advanced Manufacturing Technology, 52, 669–681]. Results that emerged include (i) improvement in mean set-up time and variability (process and arrival for the flow-shop environment) has the largest effect on WIP reduction for the majority of scenarios evaluated in this article; (ii) improvement in arrival variability and small simultaneous improvements in all variables help to stabilise the amount of WIP downstream in the flow-shop environment even when large lot sizes are used; (iii) only a lot-size reduction combined with a set-up improvement programme, or small, simultaneous improvements in all variables, presents relevant effects to reduce workstation utilisation.

Invited Commentary

This study by Okada and colleagues [1Okada K. Omura A. Kano H. et al.Short and midterm outcomes of elective total aortic arch replacement combined with coronary artery bypass grafting.Ann Thorac Surg. 2012; 94: 530-536Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar] presents a large (n = 200) institutional experience with total aortic arch replacement (TAR) performed to treat nondissecting aneurysm. The 30-day mortality for the entire cohort was remarkably low at 0.5%, and hospital mortality was 3.5%. The authors examined the surgical outcomes of TAR with and without coronary artery bypass grafting (CABG). Unadjusted outcomes for the patients who underwent both TAR and CABG included higher operative mortality, lower survival, and a higher incidence of major cardiac and cerebrovascular events. Although CABG was associated with prolonged operative times—reflecting the greater complexity of a combined procedure—only operative time emerged as an important independent predictor of both perioperative and mid-term mortality. In established cardiac risk models, including the STS model and the Veterans Affairs Continuous Improvement in Cardiac Surgery Program, the addition of CABG to valve procedures increases risk independently of other patient-related comorbidities. In fact, in the Japanese thoracic aortic surgery model (cited by the authors as reference 9), the addition of unexpected CABG to a thoracic aortic procedure was independently associated with increased 30-day mortality, and the addition of any CABG was associated with an increased rate of the composite outcome of major morbidity and mortality. Beyond the immediate perioperative risk posed by CABG, coronary artery disease is a clearly an additional life-limiting disease that is palliated by CABG but perhaps not cured. Therefore, one would expect the TAR-plus-CABG cohort to have worse long-term survival than the TAR-only cohort. Although this study had an impressive sample size for a single-center TAR series, the number of patients and events is small; therefore, the study might not have had enough power to detect any increase in risk caused by the addition of CABG to TAR. The confidence intervals in some instances are wide and in others approach or encompass 1.0. Regardless of how concomitant CABG might affect TAR outcomes, this study serves as a good example of the excellent short- and mid-term outcomes achieved in modern-day TAR performed at an experienced center. These results set the bar high for emerging endovascular and hybrid approaches to treating aortic arch aneurysms. Short and Midterm Outcomes of Elective Total Aortic Arch Replacement Combined With Coronary Artery Bypass GraftingThe Annals of Thoracic SurgeryVol. 94Issue 2PreviewThis study was performed to investigate the early and late outcomes of total aortic arch replacement (TAR) with or without coronary artery bypass grafting (CABG). Full-Text PDF