Continuous Quality Improvement Practices Research Articles

Relationship of knowledge sharing and innovation intention on the continuous quality improvement in university setting

This study assessed the changed knowledge sharing system and innovative intention towards continuous quality improvement in one university system in the Philippines. This descriptive study was participated by 261 faculty members of five schools of a university system. It made use of a modified questionnaire as its primary data gathering instrument, having an excellent remark of its 0.925 Cronbach’s Alpha. The data were encoded, tallied and interpreted using different statistical tools such as frequency distribution, ranking, weighted mean and F-Test, Shapiro-Wilk Test, Spearman rho, and were further analyzed and interpreted through PASW version 26 using 0.05 alpha levels. From the results, it was concluded that there has been a strong response of the university towards knowledge sharing system and its teachers possess a strong innovative intention. Further, there is a strong positive presence of continuous quality improvement practices regarding the different processes of the university system. Moreover, there is a high relationship regarding knowledge sharing system, innovative intention, and continuous quality improvement. The results of the study imply a need to develop a continuous quality improvement plan.

CONTINUOUS QUALITY IMPROVEMENT (CQI) PRACTICE IN VOCATIONAL COLLEGES

Continuous quality improvement (CQI) is an important element in quality management. This is because CQI is a key factor in improving the quality of education and ensuring that improvements in teaching and learning activities are continuously implemented. The implementation of CQI in Vocational Colleges (VCs) is increasingly being carried out in line with the application of the outcome-based learning (OBE) approach. However, reports from the board of accreditation showed differences in CQI practices for several programs under the same institution. Thus, this study can give a clear picture of CQI practice in VCs. This study was conducted to identify CQI practices in VCs and make comparisons of practice based on demographic factors namely gender, age, and teaching field. This survey-based study used questionnaires as a research instrument. The respondents of the study consisted of 87 VCs lecturers in the states of Selangor and Kuala Lumpur. Descriptive and inferential statistical analysis was used to attain the practice level and make comparisons on demographic factors. The findings of the study found that the practice of CQI in VCs was at a high level. However, there were significant differences based on demographic factors for the age group in the dimensions of customer focus and teamwork. This study could provide input to the Vocational Educational and Training Department (BPLTV) on the practice of CQI in VCs. With this input, actions and improvement measures can be planned and implemented to improve VCs. Therefore, it is hoped that this study could be a platform for improvement in VCs quality management.

INTEGRATED AVIATION TRAINING CURRICULUM TRANSFORMATION: THE ROLE OF STRATEGIC LEADERSHIP AND CONTINUOUS QUALITY IMPROVEMENT PRACTICES

The integrated aviation training curriculum has been implemented to ensure high-quality aviation personnel training in Malaysia. However, the implementation process seemed to be at a slow pace which requires serious attention to strategic leadership and continuous quality improvement practices, especially in aviation training establishments. Therefore, this paper basically aims to discuss the level of strategic leadership and continuous quality improvement through the implementation of an integrated aviation training curriculum among local aviation academies. Additionally, the relationship between strategic leadership and continuous quality improvement practices will also be highlighted. The research utilized a quantitative approach with a survey design to address the research objectives. The respondents were 60 employees chosen from selected flying training academies using stratified random distribution. Descriptive data were collected through the adapted version of the “Strategic Leadership Questionnaires” and the “Continuous Quality Improvement Climate Survey”. Findings indicated that the levels of studied variables were high. Inferential statistics showed that there was a significant positive relationship between strategic leadership and continuous quality improvement practices. Based on the above findings, this paper provides important evidence for the aviation academy management board, national aviation authority, and the aviation community at large with regards to the primary role of strategic leadership and continuous quality improvement practices through the implementation of an integrated aviation training curriculum.

A Continuous Quality Improvement Intervention to Improve Antenatal HIV Care Testing in Rural South Africa: Evaluation of Implementation in a Real-World Setting.

Background: We evaluated continuous quality improvement (CQI) targeting antenatal HIV care quality in rural South Africa using a stepped-wedge cluster-randomised controlled trial (Management and Optimisation of Nutrition, Antenatal, Reproductive, Child health, MONARCH) and an embedded process evaluation. Here, we present results of the process evaluation examining determinants of CQI practice and ‘normalisation.’ Methods: A team of CQI mentors supported public-sector health workers in seven primary care clinics to (1) identify root causes of poor HIV viral load (VL) monitoring among pregnant women living with HIV and repeat HIV testing among pregnant women not living with HIV, and (2) design and iteratively test their own solutions. We used a mixed methods evaluation with field notes from CQI mentors (‘dose’ and ‘reach’ of CQI, causes of poor HIV care testing rates, implemented change ideas); patient medical records (HIV care testing by clinic and time step); and semi-structured interviews with available health workers. We analysed field notes and semi-structured interviews for determinants of CQI implementation and ‘normalisation’ using Normalisation Process Theory (NPT) and Tailored Implementation of Chronic Diseases (TICD) frameworks. Results: All interviewed health workers found the CQI mentors and methodology helpful for quality improvement. Total administered ‘dose’ was higher than planned but ‘reach’ was limited by resource constraints, particularly staffing shortages. Simple workable improvements to identified root causes were implemented, such as a patient tracking notebook and results filing system. VL monitoring improved over time, but not repeat HIV testing. Besides resource constraints, gaps in knowledge of guidelines, lack of leadership, poor clinical documentation, and data quality gaps reduced CQI implementation fidelity and normalisation. Conclusion: While CQI holds promise, we identified several health system challenges. Priorities for policy makers include improving staffing and strategies to improve clinical documentation. Additional support with implementing clinical guidelines and improving routine data quality are needed. Normalising CQI may be challenging without concurrent health system improvements.

MENEROKA PELAKSANAAN AMALAN PENAMBAHBAIKAN KUALITI BERTERUSAN DI SEKOLAH AGAMA: PERBEZAAN BERDASARKAN FAKTOR DEMOGRAFI

In line with Malaysia's aspiration to be a center of educational excellence in the region, the National Education System has implemented an education reform program as a platform to meet the continuing quality improvement needs at all levels of educational institutions. Hence, this study aims to examine the continuous quality improvement practices in religious schools that have gained public attention lately. Cross-sectional survey method was applied in the data collection process. The instrument used consists of two parts, namely Demographic Section and Continuous Quality Improvement Climate questionnaires. A total of 478 respondents comprising senior religious teachers in Kelantan were involved in the study. Stratified random sampling methods were used in the sample selection process. The findings show that religious schools adopt high-quality continuous improvements in all dimensions. However, there are significant differences based on demographic and dimension aspects. Therefore, school development factors and elements in continuous quality improvement practices should be properly addressed by stakeholders in every level of educational management.

Anemia Management and Audit Feedback Practices for Reducing Overuse of RBC Transfusion: A Laboratory Medicine Best Practice Systematic Review and Meta-Analysis.

To evaluate the effectiveness of anemia management and audit with feedback practices in reducing overuse of RBC transfusion. This review follows the Centers for Disease Control and Prevention's Laboratory Medicine Best Practice Systematic Review (A-6) method. We searched the literature and solicited unpublished studies on practices to reduce overuse of RBC transfusions as measured by reductions in units transfused and proportion of patients transfused. Thirteen studies on preoperative anemia management and three studies on audit feedback practices met inclusion criteria. Strength of evidence was high to moderate for reducing the number of units and proportion of patients transfused. Preoperative anemia management reduces the proportion of patients transfused and units of RBCs transfused. Audit with feedback across cases, physicians, and/or service areas, as part of a continuous quality improvement practice, reduces the proportion of patients and units of RBCs transfused.

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.

Introducing a legal mandate for basic medical education accreditation in Korea.

Introducing a legal mandate for basic medical education accreditation in Korea.

Systematic Barriers to the Effective Delivery of Home Dialysis in the United States: A Report From the Public Policy/Advocacy Committee of the North American Chapter of the International Society for Peritoneal Dialysis

Home dialysis, currently underused in the United States compared with other industrialized countries, likely will benefit from the newly implemented US prospective payment system. Not only is home dialysis less expensive from the standpoint of pure dialysis costs, but overall health system costs may be decreased by more subtle benefits, such as reduced transportation. However, many systematic barriers exist to the successful delivery of home dialysis. We organized these barriers into the categories of educational barriers (patient and providers), governmental/regulatory barriers (state and federal), and barriers specifically related to the philosophies and business practices of dialysis providers (eg, staffing, pharmacies, supplies, space, continuous quality improvement practices, and independence). All stakeholders share the goal of delivering home dialysis therapies in the most cost- and clinically effective and least problematic manner. Identification and recognition of such barriers is the first step. In addition, we have suggested action plans to stimulate the kidney community to find even better solutions so that collectively we may overcome these barriers.

Barriers to Adoption of Evidence-Based Prehospital Airway Management Practices in California

Objective. To describe current prehospital airway management practices for adults and children and barriers to adoption of evidence-based airway management practices in California. Methods. We surveyed local medical directors of California's 31 emergency medical services (EMS) agencies regarding prehospital airway management, including provider scope of practice, continuous quality improvement practices, and perceptions regarding barriers to the implementation of evidence-based airway management practices. The survey instrument was a Web-based, closed-response form (www.surveymonkey.com) that medical directors could access by an e-mailed link provided by investigators. Medical directors were contacted by phone, mail, and e-mail to request their participation in the Web-based survey. Results. Twenty-five of 31 (81%) EMS medical directors completed the survey. Five medical directors completed surveys for two agencies over which they had responsibility. All responding medical directors employ bag–mask ventilation (BMV), airway adjuncts, and adult endotracheal intubation (ETI), which are procedures widely accepted in EMS practice. Rapid-sequence intubation (RSI), which has been shown to cause harm in certain patient subgroups, was not employed by any of the respondents. Prehospital pediatric ETI, which has been shown not to provide any benefit over BMV, was employed by 22 of 25 (88%) medical directors. Thirteen of 23 (57%) respondents identified “more evidence is needed” or “these results do not apply to my EMS system” as the top reasons to continue the practice of prehospital pediatric ETI. Conclusions. The results of our study suggest that in areas of EMS where robust evidence exists, medical directors (100%) will discontinue or not adopt skills that potentially harm patients, such as RSI, but are unlikely (12%) to discontinue procedures that show no benefit to patients (such as pediatric ETI). Barriers to adoption of evidence-based practice include difficulty in generalizing results of studies across diverse EMS systems and perceived lack of evidence that the procedure should be abandoned.