Continuous Quality Improvement Research Articles

Co-designing a Health Journey Mapping resource for culturally safe health care with and for First Nations people

Background Many healthcare professionals and services strive to improve cultural safety of care for Australia’s First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals’ perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Results The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care.

The Role of Human Factors in Maintaining Service Quality in Hospitals

The delivery of high-quality healthcare services is a multifaceted endeavor influenced by various factors, among which human factors play a pivotal role. This paper explores the significance of human factors in upholding service quality within hospital settings. Drawing upon interdisciplinary research from fields such as psychology, sociology, and healthcare management, it examines the intricate interplay between healthcare professionals, patients, and organizational structures. In today's healthcare landscape, where patient-centric care is increasingly emphasized, understanding the impact of human factors is paramount. One of the primary focuses is on patient satisfaction, which is not only influenced by clinical outcomes but also by the quality of interactions with healthcare providers. Effective communication between healthcare professionals and patients is essential for building trust, managing expectations, and ensuring informed decision-making. Moreover, the demeanor, empathy, and interpersonal skills of healthcare staff significantly contribute to patients' overall experience and satisfaction levels. Safety is another critical aspect of service quality in hospitals, and human factors play a central role in patient safety initiatives. Research has shown that the majority of adverse events in healthcare are attributable to human error, highlighting the importance of addressing factors such as fatigue, stress, and workload among healthcare professionals. Furthermore, teamwork and collaboration are vital for promoting a culture of safety, where healthcare providers work together cohesively to identify and mitigate risks, thereby enhancing patient outcomes and reducing preventable harm. Effective leadership within healthcare organizations is also instrumental in shaping service quality. Strong leadership sets the tone for organizational culture, values, and priorities, influencing the behavior and performance of healthcare staff. Leaders who prioritize patient-centered care, employee well-being, and continuous quality improvement foster an environment conducive to delivering high-quality services. To optimize service quality, hospitals must invest in staff training, development, and support programs. Ongoing education ensures that healthcare professionals stay abreast of the latest evidence-based practices, technological advancements, and regulatory requirements. Moreover, initiatives to promote staff well-being, such as employee assistance programs, work-life balance initiatives, and resilience training, are essential for preventing burnout and maintaining morale. In conclusion, human factors play a multifaceted role in maintaining service quality in hospitals, encompassing aspects such as communication, teamwork, leadership, and staff well-being. By recognizing the complexities of human interactions within healthcare systems and implementing targeted interventions, hospitals can enhance service delivery, improve patient outcomes, and cultivate a culture of excellence.

High positive predictive value 22q11.2 microdeletion screening by prenatal cell-free DNA testing that incorporates fetal fraction amplification.

22q11.2 deletion syndrome (DS) is a serious condition with a range of features. The small microdeletion causing 22q11.2DS makes it technically challenging to detect using standard prenatal cfDNA screening. Here, we assess 22q11.2 microdeletion clinical performance by a prenatal cfDNA screen that incorporates fetal fraction (FF) amplification. The study cohort consisted of patients who received Prequel (Myriad Genetics, Inc.), a prenatal cfDNA screening that incorporates FF amplification, and met additional eligibility criteria. Pregnancy outcomes were obtained via a routine process for continuous quality improvement. Samples with diagnostic testing results were used to calculate positive predictive value (PPV). 379,428 patients met study eligibility criteria, 76 of whom were screen-positive for a de novo 22q11.2 microdeletion. 22 (29.7%) had diagnostic testing results available, and all 22 cases were confirmed as true positives, for a PPV of 100% (95% CI 84.6%-100%). This performance was based on cases that ranged broadly across FF (5.9%-41.1%, mean 23.0%), body mass index (22.3-44.8, mean 29.9), and gestational age at testing (10.0w-34.6w, median 12.7w). Ultrasound findings in screen-positive pregnancies were consistent with those known to be associated with 22q11.2DS. 22q11.2 microdeletion screening that incorporates FF amplification demonstrated high PPV across both general and high-risk population cohorts.

Accrual Quality Improvement Program for clinical trials.

The Early Phase Cancer Prevention Clinical Trials Program (Consortia), led by the Division of Cancer Prevention, National Cancer Institute, supports and conducts trials assessing safety, tolerability, and cancer preventive potential of a variety of interventions. Accrual to cancer prevention trials includes the recruitment of unaffected populations, posing unique challenges related to minimizing participant burden and risk, given the less evident or measurable benefits to individual participants. The Accrual Quality Improvement Program was developed to address these challenges and better understand the multiple determinants of accrual activity throughout the life of the trial. Through continuous monitoring of accrual data, Accrual Quality Improvement Program identifies positive and negative factors in real-time to optimize enrollment rates for ongoing and future trials. The Accrual Quality Improvement Program provides a web-based centralized infrastructure for collecting, analyzing, visualizing, and storing qualitative and quantitative participant-, site-, and study-level data. The Accrual Quality Improvement Program approaches cancer prevention clinical trial accrual as multi-factorial, recognizing protocol design, potential participants' characteristics, and individual site as well as study-wide implementation issues. The Accrual Quality Improvement Program was used across 39 Consortia trials from 2014 to 2022 to collect comprehensive trial information. The Accrual Quality Improvement Program captures data at the participant level, including number of charts reviewed, potential participants contacted and reasons why participants were not eligible for contact or did not consent to the trial or start intervention. The Accrual Quality Improvement Program also captures site-level (e.g. staffing issues) and study-level (e.g. when protocol amendments are made) data at each step of the recruitment/enrollment process, from potential participant identification to contact, consent, intervention, and study completion using a Recruitment Journal. Accrual Quality Improvement Program's functionality also includes tracking and visualization of a trial's cumulative accrual rate compared to the projected accrual rate, including a zone-based performance rating with corresponding quality improvement intervention recommendations. The challenges associated with recruitment and timely completion of early phase cancer prevention clinical trials necessitate a data collection program capable of continuous collection and quality improvement. The Accrual Quality Improvement Program collects cumulative data across National Cancer Institute, Division of Cancer Prevention early phase clinical trials, providing the opportunity for real-time review of participant-, site-, and study-level data and thereby enables responsive recruitment strategy and protocol modifications for improved recruitment rates to ongoing trials. Of note, Accrual Quality Improvement Program data collected from ongoing trials will inform future trials to optimize protocol design and maximize accrual efficiency.

175 Benchmarking MICHR’s Clinical and Translational Science production as a continuous quality improvement initiative.

OBJECTIVES/GOALS: In line with NCATS funding requirements, the Michigan Institute for Clinical and Health Research (MICHR) established a continuous quality improvement (CQI) process and used the process to guide the implementation of a benchmarking project to evaluate and set goals for MICHR’s production of Clinical and Translational Science manuscripts. METHODS/STUDY POPULATION: We aimed to increase the number of Clinical and Translational Science papers MICHR produces and to set a reasonable goal for improvement. Benchmarking was used to obtain a baseline and inform the identification of a reasonable goal for improvement. 11 Peer institutions were identified with similar funding levels. 1,225 Publications from 2022 for all 12 CTSAs were obtained from NIH Reporter. All publications were reviewed by title to identify probable CTS content. Two staff reviewers confirmed a total of 108 CTS publications across all CTSAs, and coded each paper to characterize the theoretical approach, method (quantitative and/or qualitative), analytic method and topic. All publications that were selected for benchmarking were also tracked and compared using Altmetrics for Institutions and Overton platforms. RESULTS/ANTICIPATED RESULTS: A total of 108 CTS publications were produced by 12 benchmarked CTSAs in 2022; of those, 70% (77) regarded research infrastructure, 37% (41) regarded research methods, and 15% (16) regarded clinical care. Over half, 53% (58), of the benchmarked papers are empirical research papers; of those, 67% (39) used quantitative methods, 28% (16) used qualitative methods, and 5% (3) used mixed methods. A clear majority of the benchmarked papers, 70% (76), provided only descriptive analyses, 18% (19) provided inferential analyses, and 12% (13) provided predictive analyses. We identified an opportunity to produce more manuscripts with descriptive analyses of research infrastructure. In the long-term, we saw an opportunity to produce predictive analyses of translational initiatives designed to impact clinical care. DISCUSSION/SIGNIFICANCE: The benchmarking results helped MICHR identify goals for its production of Clinical and Translational Science to fill gaps in the field. Expanding the scope of this benchmarking project might achieve greater interrater reliability using larger representative sets of publications drawn from institutions across the CTSA Consortium.

Quality improvement collaborative approach to COVID-19 pandemic preparedness in long-term care homes: a mixed-methods implementation study

BackgroundThe devastating impact of the COVID-19 pandemic on long-term care (LTC) homes underscores the importance of effective pandemic preparedness and response. This mixed-methods, implementation science study investigated how a virtual-based...

Prioritising national healthcare service issues from free text feedback – A computational text analysis & predictive modelling approach

Patient experience surveys have become a key source of evidence for supporting decision-making and continuous quality improvement within healthcare services. To harness free-text feedback collected as part of these surveys for additional insights, text analytics methods are increasingly employed when the data collected is not amenable to traditional qualitative analysis due to volume. However, while text analytics techniques offer good predictive capabilities, they have limited explanatory features often required in formal decision-making contexts, such as programme monitoring or evaluation. To overcome these limitations, this study integrates computational text and predictive modelling as part of a Computational Grounded Theory method to determine the effect of quality gaps in care dimensions and their prioritisation from free-text feedback. The feedback was collected as part of a national survey to support decisions on continuous improvement in Maternity Services in Ireland. Our approach enables (1) operationalising the service quality lexicon in the context of maternity care to explain the effect of quality gaps in care dimensions on overall satisfaction from free-text comments; and (2) extending the service quality lexicon with two organisational and political decision-making concepts: “Salience” and “Valence”, for prioritising perceived quality gaps. These methodological affordances enable the extension of service quality theory to explicitly support the prioritisation of improvement decisions which before now required additional decision frameworks. Results show that tangibles-, process-, and reliability-related care issues have the highest importance in our study context. We also find that hospital contexts partly determine the relative importance of gaps in care dimensions.

Assessment of college-physical-education: A practical study to enhance pedagogy and learning outcomes

The evaluation of the quality of college physical education classroom teaching has become an important research direction, but now there are problems with inconsistent standards, lack of scientific, and standardization in the evaluation indicators of university physical education classroom teaching quality. To address this issue, this paper explores how to standardize the evaluation indicators for the quality of university physical education classroom teaching, and proposes corresponding improvement plans for this issue. The research results indicate that standardization reform can improve the scientific and objective evaluation of the quality of university physical education classroom teaching, providing effective reference for promoting the continuous improvement of university physical education classroom teaching quality.

Competency scale of quality and safety for greenhand nurses: instrument development and psychometric test

BackgroundGuaranteeing nursing service safety and quality is a prioritized issue in the healthcare setting worldwide. However, there still lacks a valid scale to measure the quality and safety competencies of newly graduated nurses globally.MethodsThis scale was developed in two phases. In Phase One, a literature review and three-round e-Delphi were conducted to generate the initial item pool; while in Phase Two, five experts tested the content validity of the scale. The construct validity was evaluated using confirmatory factor analysis (CFA), and the data were collected among 1,221 newly graduated nursing students between May, 2017 and August, 2017. Finally, the internal consistency reliability and test-retest reliability were tested.ResultsThe final version’s Competency Scale of Quality and Safety (CSQS) was confirmed by the CFA involving 64 items in six dimensions, including patient-center care, safety, evidence-based practice, collaboration and teamwork, continuous quality improvement, and informatics. The results of data showed that the data supported the modified model of CSQS (Standardized Root Mean Square Residual = 0.03, p = 0.053, Adjusted Goodness of Normed Fit Index = 1.00, Root Mean Square Error of Approximation = 0.007, Fit Index = 0.95, Goodness of Fit Index = 0.97, χ2/df = 1.06), and the standardized factor loadings of items were from 0.59 to 0.74 (p < 0.05). The internal consistency reliability of the total scale was 0.98, and the test-retest reliability was 0.89.ConclusionsCSQS was a valid and reliable instrument to measure the safety and quality abilities of greenhand nurses, and could be fully utilized by nursing students, greenhand nurses, nursing educators, as well as hospital nursing managers.

Performance Management and Quality Assurance in Higher Education

This article proposes a framework to promote continuous quality improvement in higher education by bringing performance management and quality assurance together in a single approach. Blending the two systems eliminates the challenges of a two system approach. The study employed a quantitative methodology, with data collected by means of a closed-ended questionnaire administered to academic and administrative staff at four purposely selected public higher education institutions in Zimbabwe’s four major ethnic regions. The questionnaire drew insights from a framework developed by Silimperi et al. (2002) on essential elements for developing quality assurance systems. Fourteen elements were used to determine the possibility of blending the two systems. Of these, nine had a mean score of 4.0, three above 3.5 and two had a mean score of less than 3.5. These results indicate a high likelihood that the systems can be blended.

The utility of performance review systems: A total quality management perspective

AbstractScholars and practitioners alike have argued that performance review is prone to destructive effects and negative outcomes in progressive work organizations with a total quality management (TQM) orientation. Despite its pervasive use and significant consequences at individual, team, and organizational levels across contemporary workplaces, it has remained inadequately explored for its current operational systems and their role in helping employees achieve job mastery and enabling organizations to attain desired quality outcomes. To address this lacuna, this study aims to explore how performance review systems can align with continuous quality improvement in contemporary workplaces that espouse a culture of continuous learning and quality improvement. Given the exploratory and broad scope of the research, it adopts a multiple case study design which offers benefits both in terms of process and outcomes. The findings are indicative of two different performance review systems with very different implications for managing employees and achieving quality outcomes in line with TQM: tactical system with a focus on employee obedience to rigid top‐down control system for achieving conformance quality measures, and a dynamic system with a focus on employee ownership of the quality process for achieving desired quality.

Application of metal cored filler wire for environmental-friendly welding of low alloy steel: experimental investigation and parametric optimization

AbstractMotivated by the crescente demand for eco-friendly and worker-safe welding techniques, this study optimizes current (A), voltage (V), and gas flow rate (GFR) for regulated metal deposition (RMD) welding of ASME SA387 Gr.11 Cl.2 steel. Employing MEGAFIL 237 M metal cored filler wire and a Taguchi L9 orthogonal array, bead-on-plate trials were conducted to evaluate heat-affected zone (HAZ), depth of penetration (DOP), and bead width (BW). A unique dual-pronged optimization approach was implemented. The utility function method, combined with Taguchi’s signal-to-noise (S/N) ratio, maximized desirable and minimized undesirable responses. Additionally, TOPSIS with Taguchi S/N ratio identified the optimal process parameters. Both optimization strategies converged on identical. A = 135 A, V = 14 V, and GFR = 13 L/min. Notably, voltage emerged as the most influential factor in the mean S/N response table, highlighting its critical role in controlling weld quality. The proposed procedures offer a robust framework for determining optimal RMD welding conditions in pipeline applications. This not only enhances weld integrity and worker safety but also paves the way for sustainable manufacturing and continuous quality improvement in the field.

What can nurses learn from patient's needs and wishes when developing an evidence-based quality improvement learning culture? A qualitative study.

Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence-based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence-based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence-based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences. To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence-based quality improvement learning culture. A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi-structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used. Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision-making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse-patient relationship was found to be time-consuming and challenging to restore. Results confirmed the importance of a durable nurse-patient relationship and showed the consequences of nurses' communication on shared decision-making. Insights into patients' care preferences are essential to stimulate the development of an evidence-based quality improvement learning culture within nursing teams and for successful implementation processes.

The Effect of Interprofessional Collaboration and Total Quality Management on the Implementation of Electronic Medical Records In Outpatient Units Mediated By Work Culture

The enactment of government regulations requires every health service facility to maintain electronic medical records as an effort to improve the quality of health services in Indonesia. There are 13,372 healthcare facilities in Indonesia and only 40% have run EMR. Influencing aspects: human data sources, policies, regulations, infrastructure and costs. There are still differences in aspects and responses of doctors and nurses to the implementation of electronic medical records. The importance of interprofessional collaboration through communication, joint decision making, coordination and cooperation, as well as continuous quality improvement through total quality management strategies and work culture of health workers as an effort to improve the quality of health services. The purpose of the study was to analyze the effect of interprofessional collaboration, total quality management on the implementation of electronic medical records in the mediation of work culture simultaneously and partially. The method uses descriptive statistics, quantitative associative correlations and questionnaires. Sampling using systematic random sampling from respondents of 109 health workers in the outpatient installation of RSUD Kabupaten Tangerang. The results showed that there is an influence of interprofessional collaboration and total quality management on the implementation of electronic medical records mediated by work culture.  The coefficient value of the determination of influence on work culture variables and the implementation of electronic medical records of more than 0.75 is included in the medium category. Workshops related to the implementation of electronic edis records and effective communication among interprofessionals need to be conducted and further research can be carried out on the impact and benefits.

The impact of accreditation on continuous quality improvement process in undergraduate medical education programs: A scoping review

Background Accreditation in medical education has existed for more than 100 years, yet the impact of accreditation remains inconclusive. Some studies have shown the effects of accreditation on student outcomes and educational processes at medical schools. However, evidence showing the impact of accreditation on continuous quality improvement of undergraduate medical education programs is still in its infancy. This scoping review explores the impact of accreditation on continuous quality improvement (CQI). Methods This scoping review followed the methodology of the Preferred Reporting Items of Systematic Reviews and the Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist outlined by Arksey and O'Malley (2005). Databases, including PubMed, Medline, ERIC, CINHAL, and Google Scholar, were searched to find articles from 2000 to 2022 related to the accreditation of undergraduate medical education programs and continuous quality improvement. Results A total of 35 full-text articles were reviewed, and ten articles met our inclusion criteria. The quality assurance approach is based on meeting the standards of accreditation. The quality improvement approach is based on striving for excellence. Literature suggests a requirement to move from student outcomes to CQI measures. CQI requires everyone in the organization to take responsibility and accountability, considering quality as the result of every single step or process and leaders supporting improvements in data collection and data analysis for quality improvement. Conclusions The literature on accreditation and CQI are limited in number. More research studies are required to enhance undergraduate medical education accreditation practices' value to medical students, educators, academic leaders, programs, and the public. It was recommended that medical schools embrace the culture and vision perpetuated by the CQI process.

[A cross-sectional survey of delivery room transitional care management for very/extremely preterm infants in 24 hospitals in Shenzhen City].

To investigate the current status of delivery room transitional care management for very/extremely preterm infants in Shenzhen City. A cross-sectional survey was conducted in November 2022, involving 24 tertiary hospitals participating in the Shenzhen Neonatal Data Network. The survey assessed the implementation of transitional care management in the delivery room, including prenatal preparation, delivery room resuscitation, and post-resuscitation management in the neonatal intensive care unit. Very/extremely preterm infants were divided into four groups based on gestational age: <26 weeks, 26-28+6 weeks, 29-30+6 weeks, and 31-31+6 weeks. Descriptive analysis was performed on the results. A total of 140 very/extremely preterm infants were included, with 10 cases in the <26 weeks group, 45 cases in the 26-28+6 weeks group, 49 cases in the 29-30+6 weeks group, and 36 cases in the 31-31+6 weeks group. Among these infants, 99 (70.7%) received prenatal counseling, predominantly provided by obstetricians (79.8%). The main personnel involved in resuscitation during delivery were midwives (96.4%) and neonatal resident physicians (62.1%). Delayed cord clamping was performed in 52 cases (37.1%), with an average delay time of (45±17) seconds. Postnatal radiant warmer was used in 137 cases (97.9%) for thermoregulation. Positive pressure ventilation was required in 110 cases (78.6%), with 67 cases (60.9%) using T-piece resuscitators and 42 cases (38.2%) using a blended oxygen device. Blood oxygen saturation was monitored during resuscitation in 119 cases (85.0%). The median time from initiating transitional care measures to closing the incubator door was 87 minutes. The implementation of delivery room transitional care management for very/extremely preterm infants in the hospitals participating in the Shenzhen Neonatal Data Network shows varying degrees of deviation from the corresponding expert consensus in China. It is necessary to bridge the gap through continuous quality improvement and multicenter collaboration to improve the quality of the transitional care management and outcomes in very/extremely preterm infants.

Characteristics and Release Risk of Phosphorus from Sediments in a Karst Canyon Reservoir, China

With the continuous improvement of surface water environmental quality in China, sediment has gradually become the focus of research on internal pollution in reservoirs. To investigate the forms, distribution, and migration patterns of phosphorus in karst canyon reservoir sediments, we employed an improved sequential graded extraction method to determine phosphorus content in the sediments of the Wanfeng Reservoir. We studied the spatial distribution characteristics and release risk of phosphorus form in the sediments. The results showed that the total phosphorus (TP) content ranged from 79.37 to 438.04 mg·kg−1, while inorganic phosphorus (IP) content ranged from 77.32 to 424.64 mg·kg−1. Iron–aluminum-bound inorganic phosphorus (Fe/Al-Pi) accounted for 36.41% and was found to be the dominant form of IP. Organic phosphorus (OP) content ranged from 1.84 to 13.59 mg·kg−1, with weakly adsorbed organic phosphorus (H2O-Po) being the dominant form of OP. Potentially active inorganic phosphorus (NaHCO3-Pi) showed a highly significant positive correlation (p &lt; 0.01) with Fe/Al-Pi, residual phosphorus (Res-P), and TP. This indicates that potentially active phosphorus (NaHCO3-P) is a significant potential source of phosphorus (P) in the reservoir. Biologically active phosphorus (BAP) content ranged from 66.97 to 201.46 mg·kg−1, with BAP/TP ratios ranging from 55.6% to 59.6%. The risk of phosphorus release from Wanfeng Reservoir sediments is high. The release of various forms of phosphorus from sediments is one of the important factors leading to the deterioration of water quality in the reservoir area in the future. To effectively manage water ecology in karst canyon reservoirs, it is essential to reduce the risk of endogenous phosphorus release.

Dental Service Quality and Patient Satisfaction: Insights From Anutapura General Hospital, Palu City

Introduction: In line with Indonesia's healthcare development, this study investigates the impact of service quality dimensions on patient satisfaction in dental clinics at Anutapura General Hospital, Palu City. Emphasizing health as a fundamental human right, the research aligns with national objectives for comprehensive healthcare efforts.&#x0D; Method: Employing quantitative methods, data from 97 patients was collected through convenience sampling, focusing on dimensions including physical evidence, reliability, responsiveness, assurance, and empathy.&#x0D; Result: Analysis revealed significant correlations between these dimensions and patient satisfaction. Notably, patients perceiving good physical evidence and reliability reported higher satisfaction levels. However, responsiveness showed a positive trend without statistical significance. Assurance and empathy emerged as crucial determinants, significantly influencing patient satisfaction. These findings emphasize the importance of infrastructure investment, staff training, and patient-centered care approaches in enhancing service quality.&#x0D; Conclussion: The study underscores the need for continuous quality improvement efforts to achieve better healthcare outcomes in dental care settings. Prioritizing patient perspectives, fostering trust and empathy in patient-provider relationships, and sustaining quality enhancement initiatives are vital for advancing healthcare quality and patient satisfaction in Indonesia's evolving healthcare landscape.

Reflections on the strategy of hospital development based on the characteristics of new hospitals.

The disease spectrum is constantly changing, meaning patients' medical characteristics are complex and varied, and hospital operations are facing great challenges. To provide a basis for formulating relevant policies, promoting the continuous improvement of medical quality, improving the efficiency of medical services and proposing corresponding countermeasures. Information on the first page of the medical cases of patients discharged from 2020-2021 in the case management system of The Second People's Hospital of Zhangye City was collected, and statistical analysis was performed in terms of the origin, age, gender, occupation and main diagnosis of the patients. The database was established using Excel software, and statistical description was performed using SPSS 23.0 software, in which the main indicators were the number of cases and relative numbers (%). The total number of inpatients in the hospital exhibited an overall upward trend, with the number in 2021 increasing by 40.53% compared with the previous year. Among them, 0.75% of the inpatients resided outside the province and 99.25% resided within the province. The proportion of inpatients within the city was 98.86%, including 85.50% in Ganzhou District and 14.5% in the five surrounding counties (districts). In 2021, the number of inpatients in the five surrounding districts increased by 60.67% compared with the previous year. The occupational structure of the inpatients was mainly farmers, accounting for 64.68%, which was higher than all other occupational groups, while public employees accounted for 17.9%. Inpatients aged 60 years and above accounted for 37.75%. In terms of disease spectrum ranking, circulatory, digestive, respiratory, injury and oncological system diseases ranked in the top five of the presented diseases, accounting for 64.47% of the total number of inpatients. The patients of the new hospital are mainly elderly patients and local farmers. The hospital development should be based on the disease characteristics of this group, improving the diagnosis and treatment capacity of the departments and strengthening the capacity building of the hospital and the level of the medical services.

CO2 synergistic emission reduction and health benefits of PM2.5 reaching WHO-III level in Pearl River Delta

Protecting human health is one of the fundamental goals of continuous air quality improvement. Considering the same sources of CO2 and air pollutants emissions, their emission control measures often have a certain degree of synergistic emission reduction effects To balance the costs and policy efficiency, policy makers should assess the synergistic benefits of CO2 emission reduction when formulating air quality improvement strategies. Aimed at the air quality improvement strategy targeting WHO-III level (i.e. 15 μg/m3) for PM2.5 in the Pearl River Delta (PRD) region, this study evaluates the synergistic CO2 reduction effects and the associated health benefits from this strategy which includes a range of air pollution prevention and control measures. The results of the study show that promoting the attainment of WHO-III for PM2.5 in the PRD region can bring about 74 Mt of synergistic CO2 emission reduction, resulting in an 18% reduction of CO2 emissions in the PRD compared to 2017. Among various measures considered, industrial restructuring, power supply transition and industrial energy consumption transformation exhibit the most pronounced synergistic effects. Therefore, these measures are recommended to be prioritized and promoted in the next stage of air pollution prevention and CO2 emission reduction. Furthermore, when the PM2.5 concentration in the PRD region reaches the WHO-III level, the number of PM2.5-related deaths will be estimated to reduce approximately 5.5 thousand compared to that in the current policy scenario. Through continuous structural transformation and emission reduction efforts, it not only facilitates the decline in regional PM2.5 concentration but also helps more regional residents to live in an environment with a relatively low PM2.5 concentration. In addition, in order to reduce the health impacts of PM2.5, it is recommended that the government should guide people to change their production and living styles in order to reduce pollutant emissions from anthropogenic activities.