Continuous Quality Improvement Methods Research Articles

Investigating the Effectiveness of Continuous Quality Improvement Methods in Preventing the Phenomenon of Pseudo-Poor Electrocardiogram Procedure by Nurses in an Emergency Care Unit

Objective: To investigate the effect of applying continuous quality improvement methods on preventing the phenomenon of pseudo-poor electrocardiogram (ECG) procedures by nurses in the emergency care unit. Methods: The study was conducted in Shangluo Central Hospital Shaanxi from August 2020 to August 2021, and 200 emergency patients who received ECG during this period were selected for the comparative study, and grouped into two groups: the control group was given routine management, while the experimental group was managed by continuous quality improvement. The two groups were compared in terms of pseudo-differences in ECG procedures. Results: The patients in the experimental group had a higher rate of qualified ECG readings and procedures, and a lower rate of pseudo-errors and nursing disputes, all of which were significantly different from the control group (P < 0.05), which is significant, and the experimental group had a better effect. Conclusion: When ECG examination is carried out in the emergency care unit, the application of continuous quality improvement management methods is conducive to improving the quality of ECG examination, reducing the incidence of pseudo-discrepancy, and providing a reliable reference for clinical diagnosis and treatment.

Promotion of school readiness in home visiting: creating a key driver diagram for continuous quality improvement

ABSTRACT School readiness is a topic of great interest to early childhood and maternal child health initiatives, such as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. However, there is a lack of information about best practices or strategies in home visiting and their relative effectiveness in improving school readiness, making this topic appropriate for improvement through Continuous Quality Improvement (CQI) methods. In 2022, Alabama developed a Key Driver Diagram (KDD) for improving school readiness efforts within the home visiting programme using synchronous online focus groups as a method of qualitative data collection with early childhood and home visiting experts. Findings from this study include development of a KDD that includes aims, key drivers, and secondary drivers. The KDD represents the first of many steps toward a unified theory of change. Future efforts will include development of a CQI change package and testing change ideas in the field.

Calculation and appraisal of the course outcomes of the electronics course

The purpose of this research work was to assess and evaluate the course outcomes of the electronics course of the Bachelor of Science in Electrical and Electronic Engineering program incorporating higher-order thinking skills and complex engineering problem-solving skills among the students. This course is one of the essential course courses of BSc in EEE program of study and as such, its course outcomes are associated with three program outcomes. To compute and appraise the course outcomes of this course and hence its impact on the program outcomes, we used direct assessment data from various formative and summative assessment tests during a particular semester. For this purpose, an assessment plan was prepared and then test data were used to evaluate the outcome. Finally, statistical analysis is performed to check whether a particular student cohort of electronics courses could achieve this or not. All of the 46 participating students have attained the benchmark set before the start of the course. Finally, course survey results and a few recommendations are provided as a measure of the continuous quality improvement method. Keywords: Assessment; course outcome; electronics; evaluation; outcome-based education

Effect of an Emergency Department Process Improvement Package on Suicide Prevention

Suicide is a leading cause of deaths in the US. Although the emergency department (ED) is an opportune setting, ED-initiated interventions remain underdeveloped and understudied. To determine if an ED process improvement package, with a subfocus on improving the implementation of collaborative safety planning, reduces subsequent suicide-related behaviors. The Emergency Department Safety Assessment and Follow-up Evaluation 2 (ED-SAFE 2) trial, a stepped-wedge cluster randomized clinical trial conducted in 8 EDs across the US, used an interrupted time series design with three 12-month sequential phases: baseline, implementation, and maintenance. A random sample of 25 patients per month per site 18 years and older who screened positive on the Patient Safety Screener, a validated suicide risk screener, were included. The primary analyses focused on those who were discharged from the ED, while secondary analyses focused on all patients who screened positive, regardless of disposition. Data were collected on patients who presented for care from January 2014 to April 2018, and data were analyzed from April to December 2022. Each site received lean training and built a continuous quality improvement (CQI) team to evaluate the current suicide-related workflow in the ED, identify areas of improvement, and implement efforts to improve. Each site was expected to increase their universal suicide risk screening and implement collaborative safety planning for patients at risk of suicide who were discharged home from the ED. Site teams were centrally coached by engineers experienced in lean CQI and suicide prevention specialists. The primary outcome was a composite comprising death by suicide or suicide-related acute health care visits, measured over a 6-month follow-up window. Across 3 phases, 2761 patient encounters were included in the analyses. Of these, 1391 (50.4%) were male, and the mean (SD) age was 37.4 (14.5) years. A total of 546 patients (19.8%) exhibited the suicide composite during the 6-month follow-up (9 [0.3%] died by suicide and 538 [19.5%] of a suicide-related acute health care visit). A significant difference was observed for the suicide composite outcome between the 3 phases (baseline, 216 of 1030 [21%]; implementation, 213 of 967 [22%]; maintenance, 117 of 764 [15.3%]; P = .001). The adjusted odds ratios of risk of the suicide composite during the maintenance phase was 0.57 (95% CI, 0.43-0.74) compared with baseline and 0.61 (0.46-0.79) compared with the implementation phase, which reflect a 43% and 39% reduction, respectively. In this multisite randomized clinical trial, using CQI methods to implement a department-wide change in suicide-related practices, including the implementation of a safety plan intervention, yielded a significant decrease in suicide behaviors in the maintenance period of the study. ClinicalTrials.gov Identifier: NCT02453243.

Chile: Universal Collection, Open Access, and Innovation in the Use of Attendance and Absenteeism Data

In Chile, attendance is recognized as an important component of school quality and educational equity. The Chilean education system has clear, standardized definitions that apply country-wide, and a good registration system for school attendance that compiles national databases containing student-level, daily attendance, absences, and withdrawals for all children attending public schools. Moreover, these data are publicly available via open access, which allows the entire education community and the Ministry of Education access to all schools’ data in an organized, centralized manner. These data contribute to ongoing scholarship about the impacts of attendance and absenteeism on education outcomes. In practice, schools use attendance data to monitor progress toward goals. The Ministry of Education uses data to calculate and pay school subsidies that are linked directly to average monthly attendance in accordance with Chilean law, and to classify schools into categories of education quality. Chilean Fundación Educacional Oportunidad uses attendance data and continuous quality improvement methods to promote attendance and prevent chronic absenteeism with more than 150 schools via a regional Learning Network. Meanwhile, the Learning Network fills an important gap by repurposing the nationally reported data to calculate and focus on individual-level attendance and by creating opportunities for practitioners to learn together how to promote attendance and prevent chronic absenteeism. This paper describes the context of Chile and its educational system; the definition, recording, reporting and use of attendance data; and the methods, outcomes and lessons learned by the regional Learning Network.

Absenteeism prevention in preschools in Chile: Impact from a quasi-experimental evaluation of 2011–2017 Ministry of Education data

IntroductionIn 2007, to promote social equity, Chile expanded coverage and subsidies for early childhood education (ECE). Fundación Educacional Oportunidad (OFE) aimed to improve ECE quality through its professional development program for teachers and school leaders, Un Buen Comienzo (UBC). An experimental evaluation showed that high levels of absenteeism moderated UBC’s impact: despite moderate to large positive impacts on preschool quality, only children who attended most frequently experienced positive impacts on targeted language and literacy skills. In 2012, OFE began prioritizing attendance promotion and chronic absenteeism prevention.MethodsUsing a Breakthrough Series Collaborative (BTS) that combines continuous quality improvement methods and networked peer learning, OFE tested a theory of change and several innovations, including Absenteeism Committees comprised of school teams and families; a new real-time data platform; and a set of universal and targeted strategies to apply with families at risk for chronic absenteeism. In 2014-2015, OFE expanded the UBC program to nineteen schools in Chile’s VI Region, five of which prioritized attendance promotion. This study describes the intervention strategies and BTS implementation approach, and we use publicly available Ministry of Education databases to analyze rates of absences and chronic absenteeism in public preschools in Chile’s VI region from 2011 to 2017 (n = 1,218 children per year; 63,689 child-months of data), comparing rates between UBC schools that prioritized attendance (n = 5), UBC schools that did not prioritize attendance (n = 14), and non-UBC schools (n = 27).ResultsChildren missed, on average, 14.0%–14.4% of schooldays. Rates of chronic absenteeism were 50.9%–54.2%. Statistical Process Control charts show an initial increase in the percentage of days absent per child each month (13.4% to 16.3%) in UBC Schools prioritizing attendance, followed by a decrease to 12.9%. The percentage of children with chronic absenteeism decreased from 54.2% to 35%. Interrupted time series analyses suggest that these reductions can be attributed to UBC participation.DiscussionThis study (1) replicates findings from prior research indicating that absenteeism rates are sufficiently high among Chilean preschoolers to diminish ECE’s potential benefits, and (2) demonstrates the effectiveness of multi-level strategies implemented using continuous improvement methods and networked peer learning to promote attendance and reduce chronic absenteeism.

Parental involvement in postoperative pain management among children in a urology ward: A best practice implementation project.

Postoperative pain has adverse effects on children with urological problems, including sleep disturbances, incision dehiscence, bleeding and delayed recovery. Accurate parental assessment of children's behaviours and responses could help to manage postoperative pain. We aimed to implement evidence-based practice for parental involvement in a urology ward, to increase parents' participation in children's postoperative pain management. The project was conducted in a paediatric urology ward using the framework and methods of the Fudan University Evidence-Based Nursing Center's Evidence-based Continuous Quality Improvement Model. Fifteen audit criteria were used to represent best practice recommendations for parental involvement in postoperative pain management. A pre-implementation audit was conducted with 211 randomly sampled children and parents. Obstacles, promoting factors and key strategies were analysed, and evidence-based interventions implemented to improve compliance. A follow-up audit using the same audit criteria was conducted with 202 children and parents to assess the effect of targeted strategies on compliance with best practice. The SQUIRE guidelines were followed. At the baseline audit, compliance with the evidence-based criteria was 0%-71.5%; only five audit criteria achieved a compliance rate > 60%. After best practice implementation, the follow-up audit showed compliance improvements for all criteria; compliance for three criteria improved to 100%. This best practice implementation project improved parents' participation in children's postoperative pain management. The findings demonstrate how audits can promote best practice in postoperative pain management for children. Additional studies will be conducted to address children's postoperative life quality based on best practice.

PENYUSUNAN STANDAR PROSEDUR OPERASI PRODUKSI BERDASARKAN CPPB-IRT DAN WISE PADA INDUSTRI RUMAH TANGGA ANEKA SNACK 3E

Quality is one of many important aspects that need to be improved and maintained to make sure manufacturers have competitive advantage to meet consumer’s needs. Aneka Snack 3E as a home industry that produces banana and onion chips needs to improve and keep the product quality to be able to compete with other competitors. However, quality control system at Aneka Snack 3E was uncontrolled because the company did not have Standart Operating Procedure (SOP). This research conducted to arrange and implement production’s SOP which include alternative solution from quality improvement of Aneka Snack 3E. The SOP was arranged based on CPPB-IRT (Cara Produksi Pangan yang Baik untuk Industri Rumah Tangga) and WISE (Work Improvement in Small Enterprises) with DMAIC (Define, Measure, Analyze, Improve and Control) cycle as continuous quality improvement method to solve problems to the root. This research identified 31 deviations within production process to CPPB-IRT and Wise. Each causes of those deviations were analyzed and resulting 33 documents to solve the problems. Those documents contain 12 work procedures, 13 work instructions, and 8 forms. The evaluation results show that of the 33 documents made, as many as 18 documents or 55% of documents are considered very applicable and as many as 15 documents or 45% of documents are considered applicable to the Aneka Snack 3E production process. Based on these, with permission of Aneka Snack 3E’s owner, those documents is set to become production’s SOP that needed to be supervised and implemented by Aneka Snack 3E.Keywords: cara produksi pangan yang baik untuk industri rumah tangga, standard operational procedure, quality,work improvement in small enterprises.

Implementing Lean Six Sigma Concepts in Audiology Practices

Implementing Lean Six Sigma Concepts in Audiology Practices

Assessment of electronics course outcomes

Electronics as a course is one of the essential courses in the BSc EEE program and its outcomes are indicators of success. The main aim of this research work is to assess and evaluate the course outcomes of the electronics course of the Bachelor of Science in Electrical and Electronic Engineering program, incorporating higher-order thinking skills and complex engineering problem-solving skills among the students. To compute and appraise the course outcomes of this course and hence its impact on the program outcomes, we used direct assessment data from various formative and summative assessment tests during a particular semester. Finally, statistical analysis is performed to check whether a particular student cohort of electronics courses could achieve this or not. All of the participating students have attained the benchmark set before the start of the course. Finally, course survey results and a few recommendations are provided as a measure of the continuous quality improvement method.
 
 Keywords: Assessment; Electronics; Evaluation; OBE; CO.

The Application of Continuous Quality Improvement Methods at Universities in the Opinion of Students and Lecturers of the University of Lodz

Abstract Research background: Total Quality Management – TQM consists in managing an organization in which the continuous striving for quality based on the Deming Cycle is an important assumption. Even though the ‘product’, in reference to higher education, is not the same as in reference to industry, higher education can be improved in terms of quality and the manner of conducting classes, and administrative work by applying the TQM methods. Purpose: The main purpose of the research conducted at the University of Lodz was to identify and compare the determinants affecting the opinion of the students and lecturers on the assessment of the possibilities and effectiveness of introduction of the CQI methods in the Polish higher education. Research methodology: Multivariate statistical methods – cluster analysis were used for the analysis and cross tabulations. Results: Students and lecturers of the University of Lodz positively evaluated the CQI methods. The research shows most of the assumptions of the CQI concept can be adapted to the conditions of work at Polish universities; 68.92% of respondents stated that the CQI methods may be perceived as a concept of improvement of the quality of a university institution; 89.86% of respondents believe that the CQI methods are appropriate on the concept of the improvement of the quality of given classes/lectures. Novelty: The value of this paper is a contribution to the debate on needs and improving the quality of education at Polish universities.

Daily Hand-Off of Chronic Stroke Neurorehabilitation Patients to Expert Clinicians, With Resulting Significant Coordination Improvement: Care Model Development and Implementation

Background: New models of care delivery are necessary to meet workforce needs while delivering expert care in neurorehabilitation. Therefore, we sought to develop and assess the implementation of a new model of care for neurorehabilitation using a 5-member team of therapists (5-Team Model) for the treatment of individuals with chronic stroke, rather than a conventional single-therapist model. Methods: A mixed methods approach was employed; continuous quality improvement methods and quasi-experimental pre-test/post-test methods were used to assess the effectiveness of the new model. Six chronic stroke patients participated in an upper limb neurorehabilitation motor learning protocol 5 days/week, 5 hours/day (60 sessions; 300 hours); treatment was administered using the 5-Team Model approach to treatment. Results: Mean improvement on the Fugl Meyer (FM) was 11.5 points. All six participants demonstrated improvement on Fugl Meyer that was within or beyond the minimal clinically important difference (MCID) range of 4.25-7.25 points for chronic stroke. Results indicated that the 5-Team Model was effective in implementing care. Conclusions: The 5-Team Model for neurorehabilitation was successfully implemented, with patient hand-off every day to a different therapist; it produced clinically significant improvement on a measure of coordination (FM) which is comparable to or better than prior reports from a standard care model. This new model of care met the needs of the research team workforce for flexibility, while maintaining the level of quality of care. Successful implementation required addressing a series of hindering factors in an iterative manner and enhancing promoting factors. These elements included the context within which the change was implemented, the methods used in implementing the change, the evidence that the change was successful, and communication that the change was successful. The context requirements included existing framework and participating model members who were willing to exert the required effort for success, model champions. This high level of enthusiastic participation along with strong leadership contributed to long-term success, sustainability.

WaSH CQI: Applying continuous quality improvement methods to water service delivery in four districts of rural northern Ghana.

Continuous, safely managed water is critical to health and development, but rural service delivery faces complex challenges in low- and middle-income countries (LMICs). We report the first application of continuous quality improvement (CQI) methods to improve the microbial quality of household water for consumption (HWC) and the functionality of water sources in four rural districts of northern Ghana. We further report on the impacts of interventions developed through these methods. A local CQI team was formed and trained in CQI methods. Baseline data were collected and analyzed to identify determinants of service delivery problems and microbial safety. The CQI team randomized communities, developed an improvement package, iteratively piloted it in intervention communities, and used uptake survey data to refine the package. The final improvement package comprised safe water storage containers, refresher training for community WaSH committees and replacement of missing maintenance tools. This package significantly reduced contamination of HWC (p<0.01), and significant reduction in contamination persisted two years after implementation. Repair times in both intervention and control arms decreased relative to baseline (p<0.05), but differences between intervention and control arms were not significant at endline. Further work is needed to build on the gains in household water quality observed in this work, sustain and scale these improvements, and explore applications of CQI to other aspects of water supply and sanitation.

Integration of Continuous Quality Improvement Methods Into Annual Program and Institutional Evaluation.

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires continuous program improvement as part of program evaluation for residency training institutions and programs. To improve the institutional- and program-level evaluation processes, to operationalize a culture of continuous quality improvement (CQI), and to increase the quality and achievement of action items, the Wayne State University Office of Graduate Medical Education (WSU GME) incorporated CQI elements into its program evaluation process. Across 4 academic years, WSU GME phased the following 4 CQI elements into the evaluation process at the program and institutional levels, including the annual program evaluation (APE) and the annual institutional review: (1) An APE template; (2) SMART (specific, measurable, accountable, realistic, timely) format for program and institutional goals; (3) Dashboard program and institutional metrics; and (4) Plan-do-study-act cycles for each action item. Action item goals improved in adherence to the SMART format. In 2014, 38% (18 of 48) omitted at least 1 field, compared with 0% omitting any fields in 2018. More complete action items took less time to resolve: 1.7 years compared with 2.4 years (t (43.3) = 2.87, P = .003). The implementation of CQI in the APE was well received by program leadership. After leveraging CQI methods, both descriptions of institutional- and program-level goals and the time required for their achievement improved, with overall program director and program coordinator satisfaction.

An Enhanced DMAIC Method for Feature-Driven Continuous Quality Improvement for Multi-Stage Machining Processes in One-of-a-Kind and Small-Batch Production

This paper proposes an enhanced DMAIC (eDMAIC) method which succeeds from Six Sigma tool for the machining processes in multi-stage, small-batch or one-of-a-kind (M/S/O) production. As a modification and extension of the popular Six Sigma DMAIC, the eDMAIC method also consists of five phases, i.e., define, measure, analyze, improve, and control. Several specific tools in each phase are offered and how to use them is also interpreted. Then, a continuous quality improvement case is illustrated on how the eDMAIC method carries out in a machining workshop. It is proved that eDMAIC method contributes to a systematic solution when the machining processes are unstable. The eDMAIC method also offers an engineering approach to realizing better quality performances with lower cost in the context of M/S/O production with Six Sigma thinking.

Measuring and improving comprehensive pediatric cardiac care: Learning from continuous quality improvement methods and tools

Quality improvement (QI) is becoming a central part of the work of clinicians throughout healthcare. Continuous quality improvement (CQI), Lean Management Systems (LMS) and Lean Six Sigma (LSS) are management philosophies as well as management methods. They offer an approach, a set of tools, and a way of thinking about how to more effectively assess and study clinical flow, including addressing variation in clinical process and operations. We define CQI as the daily use of QI methods as a regular part of practice engaging all practice staff, constantly measuring structure, processes, outcomes against effective practices (benchmarking), moving from one QI project to the next, pursuing the goal of “The right care for every child every time”. It is based on clear scientific principles, a valid way of measuring change and has theories of reliability and human factors that underpin the interventions.Significant variations in quality of care provided to pediatric patients leading to substandard care have been well documented. For example, in antibiotic prescribing for community acquired pneumonia; pediatric secondhand smoke reduction; screening for diabetes in cystic fibrosis program; and, in depression screening in Type 1 Diabetes. Despite this, not enough pediatric practices are performing continuous quality improvement (CQI) as part of their daily activities.All health care professionals caring for children should consider incorporating quality measurement into their practice. However, we need to focus on what is the right approach to take and the right questions to ask and address the challenges of aggregating scientifically imperfect tests of change. Increasingly, colleagues, patients, payers and certifying agencies expect such measurement to achieve the Triple Aim of better health, better care and lower cost. In addition, new payment models increasingly pay providers for demonstrated value rather than volume, and they expect participation in continuous improvement. Quality Improvement (QI) is a critical component of the American Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part 4. This requires pediatricians to participate in a meaningful manner in two data-driven QI projects every five years. Pediatricians can select quality measures to evaluate whether patient outcomes and experience improve, and if not, identify and overcome barriers. In this paper we discuss performance improvement using CQI and related methods, suggest approaches to help pediatric cardiologists to ask the right questions when seeking to drive improvement, and consider the implications of measurement theory and complexity science for QI and CQI.

Contributors to Fidelity of Child Welfare-Related Interventions: A Review

ABSTRACTThis structured literature review of 15 studies explores how practitioner and organizational factors relate to fidelity of specific interventions that have been implemented with children, youth, parents, and/or families served by child welfare systems. The methods used in this review align with the PRISMA methodology for search strategy, data collection and management, and synthesis. The majority of studies measured fidelity at the practitioner level, with a smaller set focused on agency or community levels. Findings across studies were inconsistent regarding the relationship between nine practitioner factors and fidelity. However, at the organizational level, higher fidelity was related to supervisory practices and use of continuous quality improvement methods across multiple studies. Further development is needed to more clearly operationalize child welfare interventions and to test alternative methods for measuring fidelity in child welfare systems.

Evaluating the impact of continuous quality improvement methods at hospitals in Tanzania: a cluster-randomized trial.

To evaluate the impact of implementing continuous quality improvement (CQI) methods on patient's experiences and satisfaction in Tanzania. Cluster-randomized trial, which randomly allocated district-level hospitals into treatment group and control group, was conducted. Sixteen district-level hospitals in Kilimanjaro and Manyara regions of Tanzania. Outpatient exit surveys targeting totally 3292 individuals, 1688 in the treatment and 1604 in the control group, from 3 time-points between September 2011 and September 2012. Implementation of the 5S (Sort, Set, Shine, Standardize, Sustain) approach as a CQI method at outpatient departments over 12 months. Cleanliness, waiting time, patient's experience, patient's satisfaction. The 5S increased cleanliness in the outpatient department, patients' subjective waiting time and overall satisfaction. However, negligible effects were confirmed for patient's experiences on hospital staff behaviours. The 5S as a CQI method is effective in enhancing hospital environment and service delivery; that are subjectively assessed by outpatients even during the short intervention period. Nevertheless, continuous efforts will be needed to connect CQI practices with the further improvement in the delivery of quality health care.

Theory-based metrological traceability in education: A reading measurement network.

Huge resources are invested in metrology and standards in the natural sciences, engineering, and across a wide range of commercial technologies. Significant positive returns of human, social, environmental, and economic value on these investments have been sustained for decades. Proven methods for calibrating test and survey instruments in linear units are readily available, as are data- and theory-based methods for equating those instruments to a shared unit. Using these methods, metrological traceability is obtained in a variety of commercially available elementary and secondary English and Spanish language reading education programs in the U.S., Canada, Mexico, and Australia. Given established historical patterns, widespread routine reproduction of predicted text-based and instructional effects expressed in a common language and shared frame of reference may lead to significant developments in theory and practice. Opportunities for systematic implementations of teacher-driven lean thinking and continuous quality improvement methods may be of particular interest and value.

Process Flow Mapping for Systems Improvement: Lessons Learned

Abstract: This article fills a gap in the evaluation literature by detailing how to conduct process flow mapping: a continuous quality improvement (CQI) method. The importance of process flow mapping and the steps required to complete the method are illustrated in the context of evaluating a cardiac care system. The article discusses several challenges and solutions in conducting process flow mapping, including (a) selecting appropriate subject matter experts, (b) mapping simultaneous processes, (c) terminating mapping, (d) integrating multiple process flow maps, and (e) validating process flow maps. The article concludes by reinforcing the importance for systematically documenting new evaluation methods for dissemination and utility purposes.