Continuous Improvement Cycle Research Articles

Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities

BackgroundYouth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. Methods/designADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DiscussionFindings have the potential to increase SUD need identification, referral to services, and treatment for YJS.

WITHDRAWN: Assessment of physical enablers of retail store environment using fuzzy logic approach

The primary purpose of this study is to evaluate the physical enablers in retail store environments using fuzzy logic approach. Evaluation of physical attributes is essential for the success of retail stores and the key role in consumer buying behavior. This study evaluates the Impact of Physical Enablers Index (IPEI) that contributes to the positive purchase decision of the consumer in the retail store environment and identifies the weaker physical attributes that inhibit the retail store's effectiveness. The findings of the study suggest that the IPEI of the case fashion store is “very high impact” (fuzzy range: 5.20, 6.49 and 7.72). This framework serves as a ready tool kit for retail store management to assess their current IPEI and it would be helpful for continuous IPEI improvement cycles.

Single-item lot-based supplying and batch production under a bilateral capacity reservation: A partnership structure

This paper studies a single-item lot-based supplying and batch production under a bilateral capacity reservation contract based on a partnership structure in which some suppliers, a manufacturer, and a third-party logistics provider are connected through long-term cooperation agreements. This configures a partnership supply chain and promotes the manufacturer’s performance in a continuous improvement cycle. Since in this paper, it is assumed that the products are perishable, there is not any inventory storage. Moreover, due to a settled contract, the final products are delivered by third-party logistics corporate providing vehicles according to the products’ features, their expiration time lengths, customers’ demands and other considerations in each period. Thus, the delivery batch size, which is equal to the vehicle capacity in a full truckload mode, is targeted for the manufacturer operations resulting in a dynamic improvement environment. In this problem, respect to the performance level of the manufacturer, in each period, a certain capacity is reserved at each selected supplier level according to the appointed batch deliveries. Here, in addition to the ordinary costs incurred due to ordering and delivery processes, some penalties are imposed for orders/delivers exceeding or falling behind the reserved capacity. After investigating the computational complexity of the problem, we propose three dynamic programming algorithm as well. Finally, numerical results and some potential future researches are presented.

Asynchronous Peer Teaching Using Student-Created Multimodal Materials

This paper reports on asynchronous peer teaching in which learners create multimodal explanations or tutorials for future cohorts. Japanese learners of English work individually or in teams to produce video and audio explanations. Multimodal explanations that meet the quality requirements are uploaded to the respective course websites housed on the university server. The aim is that student audio-visual developers learn during the creation process and student users learn from the multimodal resources developed. Each year a new cohort of students makes a new set of explanations. The mean quality of the multimodal explanations increases annually as the less useful or less popular video and audio files are replaced. This creates a continuous cycle of incremental improvement.

DETERMINING THE APPROACH TO QUALITY IN THE CONSTRUCTION OF THE PROCESS LANDSCAPE OF THE ODESSA POLYTECHNIC STATE UNIVERSITY

. The object of this research is the process landscape model of an institution of higher education. In this study, the relationship of the upper levels of the continuous improvement cycles with the cycles of the lower levels was established. It is proposed to determine the relationship of the levels of continuous improvement processes through the “Do” phase so that this phase of the top level process is implemented by the full cycle of the subprocess. The initial positions and sequence of actions for building the landscape of the quality management system were determined; for this, it was necessary to determine the context of the university's activities; determine the processes by categories and their degree of detail; determine the sequence of processes of different categories and the relationship between them. For the implementation of innovative solutions, reengineering of the process as a whole, the Plan-Do-Check-Act cycle has been proposed to be supplemented with the “S-start” phase. This phase should initiate the creation of certain processes, which after the start should develop independently without the intervention of top management. The analysis of the process landscape was carried out in accordance with the stated goals and their suitability in accordance with the context of the organization's activities. The carried out work value is that educational institutions can use the scientific research results presented in the article to build their own educational institution quality management system process landscape taking into account the requirements of ISO 9001:2015, ISO 21001:2018, standards and guidelines ESG 2015; the article exposes ways to integrate ESG recommendations into the ISO standards requirements structure.

Mejoramiento de la calidad en la recepción de materias primas, mediante la implementación de un plan de muestreo por variables

Objective: To guarantee the adequate inspection of raw material and packaging material by the inspection-receipt area by implementing an effective sampling plan that allows reducing the percentage of defective raw material and its impact on the production process. Methodology: It is based on the continuous improvement cycle (PHVA) within which a diagnosis is made to determine the current state of the inspection process, which will allow defining new action strategies aimed at standardizing the inspection process, through the implementation of a sampling plan by variables based on the MIL-STD 414 standard, once implemented, this process is documented, at the same time the integration of suppliers is carried out, through periodic evaluations in order to know the dynamics of the new inspection process and work only with those suppliers committed to the quality of their inputs. Contribution: Reduction of the percentage of defective raw material, from 21% to 13%, which means an acceptable quality level of the materials of 87%.

Assessing Implementation Fidelity in a Community Health Improvement Plan

This paper describes and analyzes a pre-post non-experimental process evaluation in a Community Health Improvement Plan and the building of evidence for program improvement in the Plan, Do, Check and Act (PDCA) continuous improvement cycle with a focus on the Check and Act steps. The findings will help stakeholders to gain insight into plan implementation and consider necessary design and process adjustments. An overall mean completion rate of 60.44% was recorded with achievement scores ranging from 0% (goals 4 and 5) to 87.92% (goal 1). At the mid-point of implementation, completion for each priority issue was as follows: completion and fidelity rates for action steps addressing healthy behaviors priority issue was 78.05%, the implementation rate for action steps addressing Health Care Capacity, Access, and Delivery priority issue was 43.38%; and the completion rate for action steps addressing changes in policy systems, environment priority issue was at 50%. The level of implementation completion for each priority issue and corresponding action steps aligns with the degree of issue complexity predicted in the conceptual framework. These patterns suggest that initiatives that addressed fundamental causes of poor health status are harder to implement as evidenced by lower completion and fidelity rates.

Adolescent transition to adult care for HIV-infected adolescents in Kenya (ATTACH): study protocol for a hybrid effectiveness-implementation cluster randomised trial

IntroductionSuccessfully transitioning adolescents to adult HIV care is critical for optimising outcomes. Disclosure of HIV status, a prerequisite to transition, remains suboptimal in sub-Saharan Africa. Few interventions have addressed both...

E-learning based on the adaptive learning model: case study in Serbia

Today’s education faces many challenges related to learning and teaching efficiency, effectiveness, and costs. Contemporary research shows that the learning environment with the ability to adapt to individual needs, requirements, and competencies of students, facilitates the learning process and leads to improved learning outcomes and achievements. Nevertheless, learning management systems (LMS) that are often used in e-learning typically provide a limited level of adaptivity. The goal of this paper is to introduce an adaptive e-learning model which enables personalized learning experience and more intelligent decision making. It consists of the students’ model, the adaptation module, the expert system for data analysis and decision making, the repository of learning objects, and database of educational methods. The designed model provides adaptivity through a learning management system, considering individual characteristics of the student, such as their learning styles and prior knowledge. It is capable to adapt course content, structure, and assessment based on the specific student’s needs and performance. The model is implemented within the widely used open-source LMS, which makes it more usable and easier to deploy. The process of applying the proposed model is illustrated with a higher education case study that shows how the recommended method is applied for a successful transition to an adaptive form of learning. The model has been tested through experiment during which a group of students attended traditional non-adaptive e-learning course, and the other group attended the adaptive e-learning course. The results of data analysis showed that students who learned from an adaptive course achieved better performance in various aspects. The proposed adaptive model can enhance educational processes in terms of improving learning performance, personalized application of teaching/learning methods, as well as continuous improvement cycle.

Os DESAFIOS E BENEFÍCIOS DA ISO 9001:2015 NA ESCOLA SUPERIOR DA MAGISTRATURA TOCANTINENSE (ESMAT)

O ambiente organizacional muda diariamente. Os desafios surgem a partir de fatores externos e internos, impactando diretamente os resultados obtidos. Com o advento da internet e das redes sociais, uma miríade de informações é projetada sobre o gestor que, sem a capacidade de analisar todos os dados, pode tomar decisões que trarão dissabores para a própria organização. Embora o acesso à informação tenha crescido exponencialmente, o conhecimento aplicado ainda carece de ferramentas de gestão que minimizem os riscos associados à má gestão. Nesse sentido, a ISO 9001, a mais famosa metodologia de gestão conhecida, destaca-se como principal mecanismo de apoio ao planejamento e gestão das organizações. Fundamentada no ciclo de Deming ou ciclo de melhoria contínua, a ISO 9001 se caracteriza como uma ferramenta de gestão estruturada no planejamento (P), execução (D), monitoramento (C) e correção (A) de ações que objetivam a implementação eficaz da estratégia proposta por uma organização. Embora tenha aplicação prática e traga benefícios tangíveis em qualquer tipo de empresa (públicas e privadas), a metodologia tem desafios a serem superados. O presente artigo apresenta a sistemática de implantação do sistema de gestão da qualidade na Escola Superior da Magistratura Tocantinense (ESMAT), baseado na norma ABNT NBR ISO 9001:2015 – Sistema de Gestão da Qualidade. A implantação desse modelo de gestão em uma instituição pública é pioneira no segmento, não encontrando estudos de casos anteriores e resultados estatísticos que forneçam dados para uma análise comparativa. O presente artigo servirá, portanto, como case introdutório da aplicação prática dos princípios da qualidade no ambiente jurídico do estado do Tocantins.

Practical Application of Plan–Do–Check–Act Cycle for Quality Improvement of Sustainable Packaging: A Case Study

The research aims to give practical instructions for applying Plan–Do–Check–Act (PDCA) cycle in a packaging process. Eco-friendly, recycled material and a new packaging method for quality improvement and cost efficiency of heavily fragile product packaging are studied in this paper. A case study was conducted at GPEM laboratory, Vietnamese German University, Vietnam. In this case study, the current packaging style with Styrofoam material was analyzed and replaced by new packaging material and methods after applying the PDCA cycle for continuous quality improvement. Targets of the research were to find the new packaging method using friendly environment materials, to improve the quality, and to reduce the defect ratio due to packaging for fine-stone round surface fountains. Moreover, the extra cost should not be higher than 20% compared with the current packaging cost. The article proposes a simplified way that focuses on the combination of quality tools in the PDCA multiple phases to solve these problems. The quality tools are applied effectively through the PDCA cycle from collecting data, defining, analysis, testing, evaluation, and making decisions. New packaging design was been produced and tested successfully. One hundred percent of new packaging boxes for the mid-weight fountains (under 15 kg) passed the dropping test condition. Nearly 10% of the heavier weight products (above 15 kg) still had some small cracks on their top and bottom due to drop tests. Another PDCA cycle is recommended to continue applying for achieving a thorough solution. The conducted results show that PDCA is an effective method to tackle the damage product issue due to inappropriate packaging material and technique. It also brings good solutions for balancing sustainable packaging improvement and reducing the cost to ensure profit for companies. Besides contributing a guide reference for PDCA deployment, the authors intend to inspire practitioners and researchers to broaden exploration of the PDCA applications for sustainable packaging methodology. The research analysis shows that the PDCA methodology should be applied for defect reduction and quality enhancement in the packaging field. The field currently lacks systematic guidance for continuous improvement.

Implementation of multidisciplinary clinical pathways in a highly complex health institution

Clinical pathways or structured multidisciplinary care plans are a tool to standardize clinical practice. The aim of this article is to describe and propose a methodology for the development of clinical pathways in a highly complex health institution. We used the guidelines of the European Quality of Care Pathway, which are based on a 4-stage model: definition and diagnosis, development, implementation and continuity. To make this process operational, we incorporated the project management methodology (PMO). The implemented methodology contemplates the generation of an institutional governance structure responsible for the coordination of the project and the prioritization of the clinical processes to be standardized. The implementation of each clinical pathway was carried out in four steps, namely team generation, development, planning and implementation, and continuous improvement. With this methodology, 23 clinical pathways were developed between 2014 and 2018. Their implementation significantly reduced hospitalization days and their variability, optimized the use of resources and standardized clinical records. The standardization of clinical processes allowed the development of new skills such as the generation of clinical projects, an institutional methodology for managing change and sustainability through cycles of continuous improvement.

Curriculum Changes and Trends 2010-2020: A Focused National Review Using the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II.

Medical school curricula have evolved from 2010 to 2020. Numerous pressures and influences affect medical school curricula, including those from external sources, academic medical institutions, clinical teaching faculty, and undergraduate medical students. Using data from the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II, the nature of curriculum change is illuminated. Most medical schools are undertaking curriculum change, both in small cycles of continuous quality improvement and through significant change to curricular structure and content. Four topic areas are explored: cost consciousness, guns and firearms, nutrition, and opioids and addiction medicine. The authors examine how these topic areas are taught and assessed, where in the curriculum they are located, and how much time is dedicated to them in relation to the curriculum as a whole. When examining instructional methods overall, notable findings include (1) the decrease of lecture, although lecture remains the most used instructional method, (2) the increase of collaborative instructional methods, (3) the decrease of laboratory, and (4) the prevalence of clinical instructional methods in academic levels 3 and 4. Regarding assessment methods overall, notable findings include (1) the recent change of the USMLE Step 1 examination to a pass/fail reporting system, (2) a modest increase in narrative assessment, (3) the decline of practical labs, and (4) the predominance of institutionally developed written/computer-based examinations and participation. Among instructional and assessment methods, the most used methods tend to cluster by academic level. It is critical that faculty development evolves alongside curricula. Continued diversity in the use of instructional and assessment methods is necessary to adequately prepare tomorrow's physicians. Future research into the life cycle of a curriculum, as well optional curriculum content, is warranted.

Preparation for the next COVID-19 wave: The European Hip Society and European Knee Associates recommendations

PurposeTo plan for the continuance of elective hip and knee arthroplasty during a resurgence or new wave of COVID-19 infections.MethodA systematic review was conducted using the terms “COVID-19” or “SARS-Cov-2” and “second wave”. No relevant citations were found to inform on recommendations the plan. Therefore, an expert panel of the European Hip Society and the European Knee Associates was formed to provide the recommendations.ResultsOverall, the recommendations consider three phases; review of the first wave, preparation for the next wave, and during the next wave. International and national policies will drive most of the management. The recommendations focus on the preparation phase and, in particular, the actions that the individual surgeon needs to undertake to continue with, and practice, elective arthroplasty during the next wave, as well as planning their personal and their family’s lives. The recommendations expect rigorous data collection during the next wave, so that a cycle of continuous improvement is created to take account of any future waves.ConclusionsThe recommendations for planning to continue elective hip and knee arthroplasty during a new phase of the SARS-Cov-2 pandemic provide a framework to reduce the risk of a complete shutdown of elective surgery. This involves engaging with hospital managers and other specialities in the planning process. Individuals have responsibilities to themselves, their colleagues, and their families, beyond the actual delivery of elective arthroplasty.

Combat Stress Management and Resilience: Adapting Department of Defense Combat Lessons Learned to Civilian Healthcare during the COVID-19 Pandemic.

Combat Stress Management and Resilience: Adapting Department of Defense Combat Lessons Learned to Civilian Healthcare during the COVID-19 Pandemic.

Dynamic Structural Integration: A Metaphor for Creating Conditions to Facilitate Teacher-Centered Organisational Learning

ABSTRACT In teacher inquiry, the metaphor of stance is used to describe a positionality towards teaching that includes questioning classroom practices, engaging in cycles of continuous improvement, and generating knowledge. We expand the metaphor of stance to include a metaphor for complicated movements while maintaining balance – dynamic structural integration (DSI) – an analogy to teachers functioning in schools, as they perform complex actions and conduct teacher inquiry. Their stance informs their movement within DSI. Current research neglects the dynamic, interactive context of teachers, students, and school leaders, and the necessity of structural supports within schools while enacting change. We present a case study of a teacher inquiry, illustrating DSI in a school context, through observations and interviews of teachers and school leaders. Teacher inquiry was informed by colleagues and leaders through strategically designed structural supports within the school; the inquiry, reciprocally informed the school leadership by elevating the voices of teachers and students actively engaged in reform within the classroom, through specifically designed structures. We propose leadership for learning through DSI and describe teachers and school leaders as learners in and with the learning organisation, both supporting, and being informed by, teacher inquiry.

Implementation of the PDCA continuous improvement cycle (Plan-D0-Check-Act) as a tool for improving the quality of the cast AA5083 alloy produced in the foundry laboratory

Production of the high-quality alloy sample using the casting process it is not an easy and simple matter, it is one of the critical difficulties faced by the foundry technologist and researchers. Since the PDCA continuous improvement cycle is a key tool to achieve quality improvement of the product. Therefore, it was applied as an attempt to produce a high-quality cast AA5083 alloy. The main purpose of this paper is to avoid the defects that occur during the production of cast AA5083 alloy using the casting technique, which leads to minimizing product quality. The defects that may take place during the casting process of aluminium alloys have been identified through the literature reviews and taken into consideration to avoid them. The cause-effect diagram (Fishbone-Diagram) was constructed to show the root cause of the defects to avoid them, as well as the PDCA cycle was used to minimize the defects effectively. The results obtained showed that by applying the PDCA continuous improvement cycle and using the quality control tools, the quality of the cast AA5083 alloy can be improved.

A RESULT-ORIENTED FRAMEWORK TO SUPPORT THE LOW-CARBON TRANSFORMATION OF ENERGY SERVICES MARKETS

Today, the scope of energy services markets (ESMs) has expanded worldwide and covered almost all areas of production and consumption of goods and services for both industrial and public appointments, as well as households, mainly due to energy efficiency and renewable energy sources. At the same time, the incompleteness of theoretically grounded bases significantly reduces the pace of these markets development. The purpose of this study is to present the framework for the determination of directions and construct a model of structural organization and functional interaction of the ESMs participants. Such approach allows, by combining resources, capabilities and information, to expand the scope and improve the efficiency and productivity of energy services. A new structure-function model of ESMs participants’ interaction has been developed. In addition, a new organizational mechanism is proposed to support the efficient functioning of the ESMs in the form of a cycle of continuous improvement of the energy services results. The practical significance of the study is to create a conceptual framework for the organization and functioning of ESMs, which allows to systemically assess the new opportunities for such markets in both developed and developing countries.

Mapping the Life Cycle Co-Creation Process of Nature-Based Solutions for Urban Climate Change Adaptation

Developing urban and peri-urban ecosystem services with nature-based solutions (NBS) and participatory approaches can help achieve more resilient and sustainable environments for cities and urban areas in the face of climate change. The co-creation process is increasingly recognised as the way forward to deal with environmental issues in cities, allowing the development of associated methods and tools that have been described and published for specific stages. It is argued that the co-creation process comprises various interlinked stages, corresponding stakeholders, and subsequent methods and tools that need to be mapped and integrated across all stages. In this study, a Life Cycle Co-Creation Process (LCCCP) for NBS is developed, building on continuous improvement cycles and Design Thinking methodologies, and for which the stages and substages, involved stakeholders and engagement methods and tools are mapped and defined. For stakeholders, the actors of an Urban Living Lab (ULL) are adapted to the LCCCP; for the engagement methods and tools, the goals of stakeholder engagement are used as a guide to select examples of co-creation methods and tools. The developed LCCCP comprises five stages, i.e., CoExplore, CoDesign, CoExperiment, CoImplement and CoManagement, creating a unique path that can be followed by practitioners for NBS co-creation.

Synergy of design thinking and process transformation approaches

One of the current digitalization trends is focusing on studying customer experience. At present, when managing personnel, it is necessary to analyse and correctly plan the employee’s path in the company - “Employee Experience”. Properly thought out work environment and business processes, focused not only on clients but also on employees, create a good psychological climate. This, in turn, helps the employee to efficiently solve tasks, get business results, show and be focused on developing their talents. The synergy of design thinking, process transformation and continuous improvement approaches will help to change the organization’s culture, create partnerships between staff and management to ensure the success of the changes. The stages of the process transformation, after the completion of which a cycle of continuous improvement of business processes that underwent transformation begins, have been presented in the article. It has been noted, that design thinking techniques can be used for the development and reengineering of not only products (in the usual sense, as a product or service), but also in principle, technology of activity as such (processes). An example of embedding design thinking methods in the process transformation has been given: HMW, Customer Journey Map, The World Caf6, Current-Future-Barriers, Matrices of positive and negative experience. To demonstrate the incorporation of design thinking methods, one of the most capacious stages of the process transformation was chosen - process design. The presented example of the application of design thinking methods for designing business processes can be detailed after clarifying the features of a particular proj ect, supplemented by other design thinking methods, as well as techniques from the arsenal of continuous improvement and process transformation.