Effective Quality Improvement Strategies Research Articles

QUALITY ASSURANCE METHODS FOR CONTROLLING THE PARAMETERS OF CONNECTIONS OF MACHINES IN THE BUILDING MATERIALS INDUSTRY

The article examines modern methods for ensuring quality in the control of connection parameters in mechanical engineering. Emphasis is placed on using the Pareto method to identify key defects that significantly affect product quality and the Fishbone cause-and-effect diagram to determine the root causes of issues. An integrated approach is proposed, including analytical tools, improved technological control, and personnel training. These methods enable minimizing defects, enhancing product reliability, and optimizing production processes. The research results can be utilized to implement effective quality improvement strategies in manufacturing systems.

Improving School Mental Health via National Learning Collaboratives With State and Local Teams: Components, Feasibility, and Initial Impacts.

School systems need practical and effective quality improvement strategies to advance school mental health promotion, prevention, and treatment services. Collectively, these efforts can be used to promote child and adolescent mental health, well-being, and academic success. The current study reports on the feasibility, initial impacts of, and recommendations from a national, multi-level learning collaborative conducted by the National Center for School Mental Health, University of Maryland School of Medicine and administered throughout the United States. The mixed-methods evaluation results support the feasibility of a learning collaborative and reinforce its positive initial impact on comprehensive school mental health system change. Participants indicated comprehensive school mental health quality improvements such as collaboration across diverse partners and spread of evidence-informed best practices that support high-quality services for students. The multi-level learning collaborative model is promising for future efforts to advance the dissemination of comprehensive school mental health systems and other state and local system change efforts. School mental health learning collaboratives may help address the ongoing youth mental health crisis by promoting high-quality mental health supports and services for youth.

Assessing hospital differences in low-risk cesarean delivery metrics in Florida

Unnecessary cesarean deliveries lead to increased maternal and neonatal morbidities and mortalities. In 2020, Florida had a cesarean delivery rate of 35.9%, the third highest in the nation. An effective quality improvement strategy to reduce overall cesarean delivery rates is to decrease primary cesarean deliveries in low-risk births (nulliparous, term, singleton, vertex). Of note, 3 nationally accepted hospital measures of low-risk cesarean delivery rates include the nulliparous, term, singleton, vertex; Joint Commission; and Society for Maternal-Fetal Medicine metrics. Comparing metrics is necessary because accurate and timely measurement is essential to support multihospital quality improvement efforts to reduce low-risk cesarean delivery rates and improve the quality of maternal care. This study aimed to assess differences in hospital low-risk cesarean delivery rates in Florida using 5 different metrics of low-risk cesarean delivery rate based on (1) risk methodology, nulliparous, term, singleton, vertex; Joint Commission; and Society for Maternal-Fetal Medicine metrics, and (2) data source, linked birth certificate and hospital discharge records and hospital discharge records only. This was a population-based study of live Florida births from 2016 to 2019 to compare 5 approaches to calculating low-risk cesarean delivery rates. Analyses were performed using linked birth certificate data and inpatient hospital discharge data. The 5 low-risk cesarean delivery measures were defined as follows: nulliparous, term, singleton, vertex birth certificate; Joint Commission-linked used Joint Commission exclusions; Society for Maternal-Fetal Medicine-linked used Society for Maternal-Fetal Medicine exclusions; Joint Commission hospital discharge with Joint Commission exclusions; and Society for Maternal-Fetal Medicine hospital discharge with Society for Maternal-Fetal Medicine exclusions. Nulliparous, term, singleton, vertex birth certificate was based on data from birth certificates and not using linked hospital discharge data. Designated as nulliparous, term, singleton, vertex, it does not exclude other high-risk conditions. The second and third measures (Joint Commission-linked used Joint Commission exclusions and Society for Maternal-Fetal Medicine-linked used Society for Maternal-Fetal Medicine exclusions) use data elements from the full-linked dataset to designate nulliparous, term, singleton, vertex and excluded several high-risk conditions. The last 2 measures (Joint Commission hospital discharge with Joint Commission exclusions; and Society for Maternal-Fetal Medicine hospital discharge with Society for Maternal-Fetal Medicine exclusions) were based on data from hospital discharge data only and not using linked birth certificate data. These measures generally reflect term, singleton, and vertex because parity could not be assessed adequately on hospital discharge data. Hospital differences between these 5 measures were calculated overall and by neonatal intensive care unit level. Overall, the median of hospital low-risk cesarean rates decreased across the measures, from NTSV-BC 30.7%, to Joint Commission linked 29.1%, and Society for Maternal Fetal Medicine hospital discharge 29.2% with a large decrease to Joint Commission hospital discharge 19.4% and Society for Maternal Fetal Medicine hospital discharge 18.1%. A similar trend was seen by neonatal intensive care unit level. For each of the measures, level II had the highest median low-risk cesarean rates (nulliparous. term, singleton, vertex birth certificate) 32.7%, Joint Commission linked (31.4%), Society for Maternal Fetal Medicine linked: 31.1%, Society for Maternal Fetal Medicine hospital discharge 19.3%), except for level III Joint Commission hospital discharge (20.0%). A comparison of the median number of low-risk births overall and by neonatal intensive care unit level showed a decreasing number across the linked and hospital discharge measures. Again, a wide gap in low-risk cesarean delivery rates was identified between linked measures and hospital discharge measures. However, this gap narrowed as hospital rates increased. Quality monitoring of low-risk cesarean delivery rates measured by the nulliparous, term, singleton, vertex metric using the birth certificate was fairly accurate and provided timely assessment for use by Florida hospitals. The nulliparous, term, singleton, vertex birth certificate rates were comparable with low-risk metrics using the linked data source. Overall, metrics used within the same data source had similar rates, with the Society for Maternal-Fetal Medicine metric having the lowest rates. Across data sources, metrics using hospital discharge data only resulted in substantially underestimated rates because of the inclusion of multiparous women and should be interpreted with caution.

A novel perspective of Australian primary care dietetics: Insights from an exploratory study using complex adaptive systems theory

AimsEffective quality improvement strategies are essential to enhancing outcomes of dietetic care. Interventions informed by complex adaptive systems theory have demonstrated effectiveness in other healthcare settings. This study aimed to explore primary care dietetics practice using complex adaptive systems theory and to identify factors that individuals across the healthcare system can examine and address to improve the quality of dietetic care.MethodsQualitative analysis of semi‐structured interviews of healthcare consumers and professionals involved in the provision of dietetic care. Data collection and analysis was guided by a complexity‐informed conceptual framework. The Framework Method was used to code transcripts and identify themes describing primary care dietetics.ResultsTwenty‐three consumers and 26 primary care professionals participated. Participants described dietetic care as being delivered by individuals organised into formal and informal systems that were influenced by the wider environment, including legal, economic, and socio‐cultural systems. Dietitians described interactions with consumers as a learning opportunity and sought education, mentoring, or supervision to address knowledge and skill gaps. Relationships underpinned transfer of information between individuals.ConclusionComplex adaptive systems theory proved to be a useful conceptual framework for primary care dietetics. Factors identified at the macro (e.g., funding), meso (e.g., professional networks), and micro (e.g., consumer education) levels should be examined and addressed to improve the quality of dietetic care.

P-P50 Analysis of the efficiency of the hepatobiliary multidisciplinary team meeting to identify quality improvement strategies

Abstract Background The multidisciplinary team meeting is the mainstay of management of patients with hepatopancreatobiliary (HPB) cancer and is considered the gold standard of care. Disadvantages of these meetings include large numbers of patients to be discussed covering multiple super-specialities over a short time span. This can lead to decision fatigue amongst clinicians. Logistical factors such as information technology and presence of clinicians with relevant expertise may also hamper the progress of the meeting. The aim of this study was to analyse the efficiency of our HPB MDT with a view to identifying multi-factorial quality improvement interventions. Methods 13 weeks of prospectively generated multidisciplinary team meeting outcomes were analysed from our departments weekly 150-minute long MDT meeting between 01/06/21 and 24/08/21. Patient demographics and pathology were noted. The number of overall discussions in each meeting were recorded. Number of patients in each sub-category (1. Regional pancreatic cancer service, 2. Hepatocellular carcinoma or liver adenoma, 3. pancreatic cystic neoplasms, 4. Gallbladder cancer and cholangiocarcinoma, 5. Pancreatic neuroendocrine tumours and 6. Other) were recorded. The number of patients without a recorded outcome was collated and reasons for no outcome being generated were categorised. Results 174/ 869 patients (20 %) did not receive an outcome from the meeting and were carried forward to the next week. Of the patients carried forward to the next week; 33/177 (18.6%) had no available histopathology following biopsies. Of these 33 patients, 23 did not have post-operative histopathology yet available for discussion. 82/177 (46 %) patients did not have the relevant investigations performed or available to move the discussion forward. These investigations were wide ranging and included radiological and endoscopic interventions. Of these, 19 patients (2 % over-all) had not had images sent across from a peripheral centre. 3 patients required both histology and radiology for further discussion. 59/869 (6%) of patients were not discussed due to time constraints. This equated to an average of 4 patients per meeting. Conclusions This study demonstrates the breadth and depth of a general HPB MDT. Strategies are required to simplify the MDT process to allow for time for discussion of the most complex patients, in particular those requiring surgery. Multifactorial reasons for a lack of MDT outcome at any single meeting have been found in this study. This signifies that a more robust triage process involving multiple specialities needs to be considered. Logistical factors also need to be in place allowing for transfer of relevant images from peripheral units. Histopathology reporting takes time and appropriate expectations for the availability of these results needs to be in place. The next step in this study is to identify and implement effective quality improvement strategies to improve outcome rates and allow more time for complex case discussions.

EVALUATION OF A STANDARDIZED CARE BUNDLE ON READMISSIONS AMONG PATIENTS HOSPITALIZED WITH AN ACUTE EXACERBATION OF COPD

SESSION TITLE: Tuesday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) are common and associated with poor outcomes, including frequent hospitalization and increased mortality. There is evidence to support the positive effects of multiple AECOPD prevention measures, including smoking cessation, pulmonary rehabilitation, proper medication use, and adherence to vaccination schedules to improve symptoms and quality of life and reduce hospitalizations. However, variability in outcomes suggests that these treatments are not uniformly applied and highlight an evidence gap in implementation strategies that improve best-practice care. We hypothesized that implementing an evidence-based, comprehensive order set deployed as a clinical pathway, would improve documented receipt of targeted care elements and decrease post-hospitalization acute care encounters for patients who were hospitalized with AECOPD. METHODS: We conducted a stepped-wedge, randomized controlled trial at eight North Carolina hospitals within Atrium Health, a large integrated healthcare system. Participating hospitals were randomized to the sequential crossover from usual care to clinical pathway implementation, with two additional hospitals implementing the clinical pathway every two months. Patients ≥40 years of age were enrolled between 4/9/17 and 2/11/18 and had a discharge diagnosis of AECOPD (primary or secondary, ICD10 code: J44.1). Patients were identified in near-real time using a data-driven algorithm applied daily to each hospital’s census. Pathway elements included: 1) verification of AECOPD diagnosis and active management of care by a COPD navigator; 2) education regarding COPD and basic self-management skills; 3) standard pharmacologic bundle of systemic steroids, empiric antibiotics, and bronchodilators; and 4) standard discharge recommendations for follow-up and testing. We captured post-discharge acute care utilization as any non-elective inpatient, observation, or emergency department encounter at any of Atrium Health’s hospitals within 60 days of discharge. RESULTS: There were 2,353 encounters among hospitals using the clinical pathway and 2,479 among hospitals using usual care. Hospitals using the clinical pathway had a 20% increase in use of the comprehensive order set (65.9% vs 45.1%; Odds Ratio [OR]=2.35, p<0.001). There was a 10% relative reduction in 60-day post discharge acute care utilization among hospitals using the clinical pathway compared to usual care (39.1% vs 43.6%; OR=0.80, p=0.041). CONCLUSIONS: An evidence-based clinical pathway for COPD patients reduces post discharge acute care utilization over usual care. CLINICAL IMPLICATIONS: Additionally, our findings define an effective quality improvement strategy to implement best-practice care within an integrated health system to improve the value of care delivered to the large population of patients with AECOPD. DISCLOSURES: No relevant relationships by Justin Bilancia, source=Web Response No relevant relationships by Amy Clary, source=Web Response no disclosure on file for Timothy Hetherington; No relevant relationships by Daniel Howard, source=Web Response No relevant relationships by Constance Krull, source=Web Response No relevant relationships by Jason Roberge, source=Web Response No relevant relationships by Nigel Rozario, source=Web Response

A case study of community-based distribution and use of Misoprostol and Chlorhexidine in Sokoto State, Nigeria

ABSTRACTThe United States Agency for International Development/Targeted States High Impact Project supported Sokoto State, Nigeria government in the development of a community-based intervention aimed at preventing post-partum haemorrhage (PPH) and cord infection among women and children, respectively. This paper describes the innovative intervention within the Nigeria health delivery system. It then explains the case study approach to assessing this intervention and summarises findings. Ultimately, the intervention was received well in communities and both drugs were added to the procurement list of all health facilities providing maternity services in the State. Key factors leading to such success include early advocacy efforts at the state-level, broad stakeholder engagement in designing the distribution system, early community engagement about the value of the drugs and concerted efforts to monitor and ensure availability of the drugs. Implementation challenges occurred in some areas, including shortage of community-based health volunteers (CBHVs) and drug keepers, and socio-cultural barriers. To maximise and sustain the effectiveness of such interventions, state government needs to ensure constant drug supply and adequate human resources at the community level, enhance counselling and mobilisation efforts, establish effective quality improvement strategies and implement a strong M&E system.

Health professionals’ experiences of tuberculosis cohort audit in the North West of England: a qualitative study

ObjectivesTuberculosis cohort audit (TBCA) was introduced across the North West (NW) of England in 2012 as an ongoing, multidisciplinary, systematic case review process, designed to improve clinical and public health...

The impact of lean healthcare practice on healthcare performance: the mediating role of supply chain innovation in Malaysian healthcare industry

Recently, organisations must look into quality improvement initiative tools for improving organisational performance. Effective quality improvement strategy such as lean management practices has a potential to provide improvement and effectiveness in healthcare industry. It gives a secure supply chain innovation and organisational performance among healthcare industry. This study investigates the relationship between lean healthcare practice, supply chain innovation and healthcare performance in the Malaysian healthcare industry. The relationships proposed in the framework were tested using structural equation modelling (SEM). Further, the result indicates that lean healthcare practice can assist to excellences in supply chain innovation and improved healthcare performance. Moreover, supply chain innovation also gives a positive impact on healthcare performance.

Patient’s Perception and Expectation of Service Quality in an Endoscopic Ward

Objective: T o determine the service quality of delivered care for people who have undergone endoscopic procedures. Methods: A cross-sectional study was conducted on 172 patients admitted to the endoscopy ward of Imam Reza Hospital at Tabriz University of Medical Sciences in Iran between January to December 2013. quality was obtained through the Service Quality = 10– ( Importance × Performance ) formula, based on the importance, performance and SQ with respect to the patients’ perspective. Independent t-test and ANOVA were applied to investigate the differences in service quality score between categorical variables. Regression analysis was applied to examine the correlation between demographics and SQ scores. Data were analyzed using the SPSS-17 statistical software package. Results: The average scores of importance, performance and SQ of delivered care were 6.45, 0.41 and 7.53 respectively, from zero to 10 scale ((where 10 indicated the top score). The quality of basic amenities and the choice of care provider reached the highest SQ scores. Communication, Safety, Dignity and Autonomy gained poor SQ scores. Females, in comparison to males, had 0.47 lower SQ scores with respect to variances in variables of age and health insurance. Conclusion: Relatively low SQ, perceived by patients admitted to the endoscopy ward, indicates significant room for improvement of the quality of care. As an effective quality improvement strategy, it is recommended to promote the patients’ awareness about the delivered care, care facilities and providers and prepare them to actively participate in the process of care.

The Best Way to Address Maternal and Child Health (MCH) Is Not to Build an MCH Focussed Health System

This note advances four inter-related arguments to suggest that building a high quality health system that is intended to address only MCH goals is unlikely to deliver on MCH goals in a cost-effective manner. The note argues that, medically, since the most important drivers of infant, child, and maternal mortality, now are complications such as haemorrhage, sepsis, abortion related complications, hypertensive disorders, and prematurity, it is no longer adequate, even from a pure MCH point of view, for a health system to focus on preventive-promotive messages and limited facility based treatment options. Instead, at the community level, there needs to be clinic based comprehensive basic obstetric and emergency care on offer, and, within a reasonable travel distance, hospital based comprehensive emergency care, including surgical care. The note argues that if, indeed, this is the case then building such a system to serve only MCH needs will not be cost-effective on a DALY-per-Dollar (DPD) basis. The note makes a similar argument regarding fixed investments in workforce and infrastructure, suggesting that any good health system, including one that is expected to focus narrowly on MCH concerns, requires a great deal of fixed investments in workforce and physical infrastructure. If all of these fixed investments are costed only from an MCH point of view then the infrastructure that is built would either be inadequate even for MCH, if limited resources are allocated to it, or would have very low levels of capacity utilisations if the required amount of investment has indeed gone into it. The note suggests that in the presence of shareable indivisible inputs such as medical personnel and infrastructure, serving a much wider range of conditions would be the most cost-effective way to organise the health system. From a financing and political point of view the note goes on to suggest that since, in order to get substantial improvements in MCH outcomes it would be necessary to build much stronger health systems, to do so it would be necessary to “take the Turnpike” and build a broader, more universal, health system, because only by doing so will it be possible to get a stronger political commitment to health and an active engagement in a shared health system from the non-poor, through schemes such as Social Health Insurance. Both of these would be essential to secure the funding necessary to build the requisite health system and to ensure strong support for effective quality improvement strategies. For all of these reasons the note argues that focussing on MCH both at a country and a donor level and building health systems to deliver sharply on MCH goals is unlikely to be an effective strategy to achieve MCH goals. It also suggests that such strategies may in fact hinder the development of broader health systems which can serve a wider population and a wider range of conditions and ultimately hurt the ability of the health system to effect improvements in MCH outcomes, the very goals that the original strategy was designed to deliver on.

The effectiveness of audit and feedback as a quality improvement strategy in residential aged care: a systematic review protocol

Review question/objective The objective of this systematic review is to synthesize the best available evidence for the effectiveness of audit and feedback as a quality improvement strategy. More specifically, the objectives are to identify: 1. What characteristics contribute to an effective audit and feedback cycle in aged care. 2. Whether audit and feedback is an effective quality improvement strategy for improving health outcomes for older people in residential aged care facilities. 3. What the most effective feedback mechanisms as part of an audit and feedback cycle in implementing practice change are. Inclusion criteria Types of participants This review will consider studies that include people aged 65 years or older in nursing homes, long-term care and/or residential aged care. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the effect of (i) audit and feedback or clinical audit alone and (ii) audit and feedback or clinical audit and feedback combined with other interventions as an initial review of available studies indicate that there are limited or no studies that have evaluated the impact of audit and feedback as the sole intervention. Audit and feedback will review the system and process utilized within the audit whilst other interventions will relate to how feedback was provided. The review will consider the system and processes use to develop the audit tool and the outcome of the interventions used to provide feedback. Types of outcomes This review will consider studies that have evaluated the impact on clinical outcome (quality indicators/measures): such as but not limited to behaviors of concern, chemical or physical restraint, end of life, falls and pain.

Effectiveness of Care Pathways in Ideal Hospital Management System: A Review

Hospital is the medical institution where sick or injured people are given medical or surgical care irrespective of their socio-economic status. Health care givers and administrators are considered as health care professionals. The form of hospital services, their organization, development, operation and administration have undergone significant differentiations during the last 20 years. Public dissatisfaction with the traditional role of hospitals has grown vastly which may be attributed to the implementation of issues such as changed quality of life and cost-effectiveness, wide media coverage of system inadequacies, increased demands and awareness of patient’s rights, limited resources in the era of expensive hi-tech medical support systems and traditional approaches of regulatory bodies. Hospitals across the country are searching for effective quality improvement strategies. Implementation of care pathways in the hospital management will improve the quality of care, standardization of care processes, bring into limelight the existing flaws, suggest ways for future improvements, help to utilize resources in a cost effective manner which is essential both in developed as well as developing countries. In this review attempts have been made to highlight on the strategic points like the implementations and utilities of clinical care pathways and its role in the control of emergency medical cases like strokes, importance of timelines and key performance indicators of health administrators, effectiveness of clinical decision making of medical professionals and their overall contribution in the quality improvement of health care and thus hospital management. © 2011 IGJPS. All rights reserved

Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

BackgroundAboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies.MethodsIn Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities.Resultsthe key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs.ConclusionsAddressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.

노인장기요양보험 시설서비스에 대한 가족수발자 만족도 영향 요인

This study examined the factors related to family caregiver satisfaction with institutional care services for beneficiaries under the Public Long-Term Care Insurance(PLTCI) system. Determining what contributes to family caregiver satisfaction is a critical step toward implementing effective quality improvement strategies. A national cross-sectional descriptive survey was conducted from November to December 2008, using proportionate quota sampling based on the location and level of Long-Term Care of the beneficiaries. Total 1,745 family caregivers wrote informed consents and 733 (response rate 42%) completed questionnaires, which included caregiver characteristics, organizational resources, primary objective and subjective stressors, perceived quality of services, and family caregiver satisfaction. Family caregivers were satisfied overall with institutional care. In multiple regression analysis, there was a statistically significant difference in degree of family caregiver satisfaction according to caregiver characteristics(relationship to beneficiary), primary objective stressors (insurance type of beneficiary), perceived quality of services(respect to family caregivers` idea, ADL support, expertness of staff, careful concern of staff, fulfillment of client`s requests, and safety of institution`s environment). In public long-term care, satisfaction efforts are in an early stage of development. This study is meaningful as the first attempt to measure family caregiver satisfaction with institutional care for beneficiaries under the PLTCI system, and to identify factors affecting the satisfaction. Among the identified factors, the policy makers, the insurer, and the providers need to pay attention to perceived quality of services, in particular, to improve customer satisfaction. Our findings can provide quality care improvement initiatives in the public long-term care setting.

Bridging the Gap Between Evidence and Practice in Venous Thromboembolism Prophylaxis: The Quality Improvement Process

Venous thromboembolism (VTE) is considered to be the most common preventable cause of hospital-related death. Hospitalized patients undergoing major Surgery and hospitalized patients with acute medical illness have an increased risk of VTE. Although there is overwhelming evidence for the need and efficacy of VTE prophylaxis in patients at risk, only about a third of those who are at risk of VTE receive appropriate prophylaxis. To address the shortfall in VTE prophylaxis, the US Joint Commission and the National Quality Forum (NQF) endorse standardized VTE prophylaxis practices, and are identifying and testing measures to monitor these standards. Hospitals in the USA accredited by Centers for Medicare and Medicaid Services to receive medicare patients will need VTE prophylaxis programs in place to conform to these national consensus standards. This review aims to give background information on initiatives to improve the prevention of VTE and to identify key features of a successful quality improvement strategy for prevention of VTE in the hospital. A literature review shows that the key features of effective quality improvement strategies includes an active strategy, a multifaceted approach, and a continuous iterative process of audit and feedback. Risk assessment models may be helpful for deciding which patients should receive prophylaxis and for matching VTE risk with the appropriate intensity of prophylaxis. This approach should assist in implementing the NQF/Joint Commission-endorsed standards, as well as increase the use of appropriate VTE prophylaxis.

Strategising customer voice-based quality improvement for logistics service providers

The trend towards supply chain globalisation necessitates that local Logistics Service Providers (LSPs) who face intense competition from global integrated LSPs from other countries must generate their logistics quality improvement strategies based on the voice of their customers in the supply chain to retain customers and reduce the turnover rate. Generating appropriate logistics quality improvement strategies for LSPs according to customer demand is an important issue. This study utilises Quality Function Deployment (QFD) to generate the most appropriate quality improvement strategy. QFD analysis transforms the voice of customer into the preference for quality improvement strategies of LSP companies, enabling the most effective quality improvement strategy to be generated. This study classifies LSP companies into five types according to their organisation characteristics and their customer sources. The best quality improvement strategies are determined with empirical data for each type of LSP company. The differences among the analytical results are compared and discussed further.

Generating customer voice based quality improvement strategy for logistics service providers in Taiwan from the perspective of quality function deployment

Logistics Service Providers (LSPs) help connecting buyers and suppliers in supply chains. Hence, logistics quality significantly affects the performance of the supply chain. An intensely competitive business environment necessitates that firms provide services according to customer demand to retain them and reduce the turnover rate. Generating appropriate logistics quality improvement strategies for LSP according to customer demand is an important issue. This study utilises Quality Function Deployment (QFD) to generate most appropriate quality improvement strategy. QFD analysis transforms voice of customer into the preference for quality improvement strategies of LSP company, enabling the most effective quality improvement strategy to be generated. This study classifies LSP companies into five types according to their organisation characteristics and their customer source. The best quality improvement strategies are determined with empirical data for each type of LSP company. The difference among the analytical results are compared and discussed further.