Identification Of Areas For Improvement Research Articles

Formalizace základních podnikových znalostí a Unified Modeling Language

The most important priority in our knowledge driven society is the identification of improvement areas and utilization of information and communication technologies. Business knowledge is considerable resource of business competition advantage. The organisations have huge amount of data and using them with the connecting of people factor (knowledge and skill) is a big challenge for all business skateholders. Mainly my diagrams brings to this area an orderliness and recommended structure.The article deals with several UML class diagrams, which are used for business concepts modeling, especially for business resources, business events and business rules modeling. These concepts are the business concepts in which may be the knowledge stored in particular. The diagrams simplify the knowledge artefacts, clarify the knowledge content and formalize knowledge structure. It is presented some views at business concepts, business actors and their role, business events and contracts and business document and its distribution in structured form, which is graphical and understandable for everybody in business.

FORMÁLNÍ LOGIKA PODNIKOVÝCH PRAVIDEL

Identification of improvement areas and utilization of information and communication technologies have gained value and priority in our knowledge driven society. Rules define constraints, conditions and policies of how the business processes are to be performed but they also affect the behavior of the resource and facilitate strategic business goals achieving. They control the business and represent business knowledge. The research works about business rules show how to specify and classify business rules from the business perspective and to establish an approach to managing them that will enable faster change in business processes and other business concepts in all areas of the business. In concrete this paper deals with four approaches to business rules formalization, i. e. notation of OCL, inference rules, decision table and predicate logic and with their general evaluation. The article shows also the advantages and disadvantages of these approaches of formalization. They are the example of every mentioned approach.

Clinical pathways and quality metrics.

273 Background: UPMC CancerCenter (UPMC) participates in a number of nationally recognized quality programs and strives to maximize quality through continuous improvement of the quality measures endorsed by these programs. Clinical pathways are potential aid in driving quality improvement through decision support and measurement. Methods: When deficiencies are identified, UPMC’s quality team develops improvement strategies including working with its pathways vendor (Via Oncology) on the placement of key decision support prompts and required data fields within its physician-facing pathways portal. Gaps in data completeness have also been identified as an opportunity to use pathways for more complete data collection during chart abstraction as well as interim reporting. Results: Due to the success above, UPMC continues to actively engage with pathways as a tool to drive adherence to and capture complete data for quality measures. If release of the UPMC data is approved by the quality measurement organization(s), UPMC will share the results of its quality measures in the full poster. Conclusions: Pathways are a tool for promoting adherence to quality measures by oncologists through the use of a point of care decision support system. Pathways are also a source of reporting quality measures across all patients in time period which allows for interim measurements and proactive identification of improvement areas. [Table: see text]

The Post‐2015 Development Agenda: The Role of Surgical Care in Improving Health

During the past decade and a half, the global health landscape has been characterised by efforts to achieve the millennium development goals (MDGs). These eight health-related objectives agreed upon by the international health community were established in the millennium declaration. The formalisation of these goals and the predefined essential services needed to achieve them has garnered political priority and has been promoted through multiple institutions and organizations [1]. However, as the year 2015 approaches, and with it the target date to achieve the MDGs, attention is increasingly been drawn to the health architecture of the post-MDG era and the health priorities for this next chapter of international health promotion [2]. Key considerations include how to best place health in the post-2015 agenda. With a sizeable proportion of disease burden reducible by surgical intervention [3] coupled with the current inequitable distribution of surgical services globally [4], it is clear that surgical care should play an important role in improving health in the post-2015 era. The challenge of improving access to surgical care in many lowand middle-income countries (LMICs) is well documented in the literature [3]; barriers to care include insufficient accessibility, affordability, availability, and acceptability of care, compounded by a lack of an adequate surgical workforce [5]. Despite these challenges, improving access to surgical care has been shown to be a cost-effective and sustainable intervention that can have simultaneous and reciprocal benefits within a health system [3], and for society as a whole by promoting development through the enhancement of equity, improving economic status by limiting time spent out of work due to disability, and strengthening health systems. Achieving universal health coverage alone, in the 15 years following 2015, will not be enough to ensure that populations currently burdened with disease begin to experience improvements in health. Prevention programmes (for example to reduce road traffic accidents) and continued public health promotion and education accompanied by timely access to healthcare must be imperative to discussion on the post-2015 development agenda. To adequately comprehend the burden of surgical disease in LMICs and evaluate progress towards tackling it, there is a need to establish appropriate metrics to quantify the burden. The utility of relevant metrics will be evident in their ability to aid identification of areas for improvement in terms of operative and postoperative care, infrastructure, human resources, availability of surgical procedures, and essential surgical equipment. Such metrics can also aid in informing global health discourse on surgical care priority setting and advocacy to achieve sustained global awareness in the role of surgery as a post-MDG global health priority. In the year 2000, 189 countries adopted the millennium declaration and set international objectives, which have resulted in tangible gains in global health. In the year 2030, will we acknowledge that our post-MDG era achieved comparable improvements in global health, or will we lament a missed opportunity?

Developing the Otolaryngology Milestones

Under the guidance of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Otolaryngology (ABOto), a working group of educators, program directors, residency review committee (RRC) members, experts in the specialty, and a resident representative developed the Otolaryngology Milestones with the dual aims of (1) allowing programs to track the educational progress of their residents, culminating in readiness to enter unsupervised practice; and (2) using Milestone data aggregated to the program level to report on otolaryngology programs' educational effectiveness for accreditation purposes. Box Otolaryngology Milestone Working Group and Milestone Advisory Group Otolaryngology Milestone Working Group Terance T. Tsue, MD, University of Kansas School of Medicine, Chair Nasir I. Bhatti, MD, Johns Hopkins University Anthony E. Brissett, MD, Baylor College of Medicine Brian Burkey, MD, Cleveland Clinic Foundation Pamela Derstine, PhD, MHPE, Accreditation Council for Graduate Medical Education (ACGME) Laura Edgar, EdD, CAE, ACGME Noel Jabbour, MD, Children's Hospital of Pittsburgh Abraham Jacob, MD, University of Arizona Medical Center Michael M. Johns III, MD, Emory University Eric J. Kezirian, MD, MPH, Keck School of Medicine of the University of Southern California Daniel J. Kirse, MD, Wake Forest School of Medicine J. Walter Kutz, MD, University of Texas-Southwestern School of Medicine Anna H. Messner, MD, Stanford University School of Medicine Liana Puscas, MD, Duke University School of Medicine Matt Ryan, MD, University of Texas-Southwestern School of Medicine Ivan Wayne, MD, University of Oklahoma Health Sciences Center Otolaryngology Milestone Advisory Group Terance T. Tsue, MD, University of Kansas School of Medicine Timothy Brigham, MDiv, PhD, ACGME Brian Burkey, MD, Cleveland Clinic Sukgi Choi, MD, University of Pittsburgh School of Medicine Michael Cunningham, MD, Boston Children's Hospital Ellen Deutsch, MD, Children's Hospital of Philadelphia Marvin Fried, MD, Albert Einstein College of Medicine, Montefiore Medical Center Sonya Malekzadeh, MD, Georgetown University School of Medicine Brad Marple, MD, University of Texas-Southwestern School of Medicine Anna H. Messner, MD, Stanford University School of Medicine Robert H. Miller, MD, American Board of Otolaryngology Michael G. Stewart, MD, MPH, Weill Cornell Medical College Randal S. Weber, MD, University of Texas MD Anderson Cancer Center

Use of herd management programmes to improve the reproductive performance of dairy cattle

There has been a long history of herd health and production management programmes in many dairy industries around the world, but evidence for the efficacy of such programmes is limited. In response to a perceived decline in fertility of dairy cows, a herd reproductive management programme (InCalf) was introduced in New Zealand in 2007. This programme uses a management cycle approach that includes an assessment of the current herd status, identification of areas for improvement, development of a plan, implementation of this plan and finally a review process. The programme uses facilitators who work with farmers either in a one-to-one manner or in a formalised group setting that involves a series of meetings over a 12-month period (the farmer action group). The hypothesis that involvement in a reproductive management programme would improve herd reproductive performance was tested using a herd-level controlled randomised study (the National Herd Fertility Study) involving herds in four geographic regions of New Zealand over 2 years. Within each region, herds were ranked on the basis of the 6-week in-calf rate (i.e. the proportion of the herd pregnant in the first 6 weeks of the seasonal breeding programme) in the year preceding commencement of the study and then randomly assigned to be involved in a farmer action group or left as untreated controls. The key outcome variable of the study was the 6-week in-calf rate. Pregnancy diagnosis was undertaken at 12 weeks after the start of the seasonal breeding programme, which allowed determination of conception dates and hence calculation of the 6-week in-calf rate. Additional measurements including heifer live weight and body condition score (pre-calving and pre-mating) were undertaken to test whether treatment resulted in measurable changes in some of the key determinants of herd reproductive performance. Involvement in the farmer action group of InCalf resulted in a 2 percentage point increase in the 6-week in-calf rate (P=0.05). The following additional observations were made in herds involved in the farmer action group relative to control herds: heifers had live weight closer to target; the pre-mating body condition score of cows was higher; and oestrous detection rates were higher. It was concluded that involvement in this herd reproductive management programme improved reproductive outcomes in this New Zealand study. However, to achieve substantial improvements in herd reproductive performance at the regional or national level a greater response to the programme and a high uptake of such programmes is required, as well as use of other industry-level tools such as genetic management programmes.

Visa at a tertiary hospital

To analyze the visa application process and his activity at a tertiary hosipital. Descriptive study of the drug s visa activity during the period April 2011-April 2012. We designed a database and defined categories on the study variables: patients and recipes. For patients admitted to the Visa Unit, issues detected were recorded based on a previously established classification. 6738 patients were included. They involved the visa of 8,465 recipes. The visa was applied to 170 drugs and nutrition products different, being the majority Tacrolimus. During this period, we detected a total of 420 incidents being the most frequent «No clinical document» (46.67%) and the «Formal completion errors» (28.57%). This work has allowed a more detailed analysis of the activity, the types of incidents and the identification of areas for improvement.

Strategic Capabilities and Performance in Women‐Owned Businesses in Mexico

The dire economic situation in Mexico, with its high rate of unemployment, makes it necessary for many women to find some form of economic activity to provide income for their families. Although such conditions could encourage the creation of new firms, the results of the Global Entrepreneurship Monitor 2006 eport show a gap between the number of women involved in nascent and young entrepreneurship initiatives and the number who owns established firms. This gap may indicate that the firms created need to improve their competitiveness and their ability to survive.The model proposed adopts the resource‐based view of the firm as a theoretical framework from which to study how entrepreneurial orientation, market orientation, and learning orientation, as well as the interactions between them, influence the achievement of competitive advantage and superior performance in businesses owned by women. Our investigation analyzes businesses established and managed by women in exico and registered with the sociación exicana de ujeres mpresarias . (exican ssociation of usiness omen) and the ed de mpresarias del nstituto acional de ujeres (omen ntrepreneurs etwork of the ational omen's nstitute). To gather the information needed, the study used a questionnaire as a measuring instrument. The results are based on the 90 complete answers received from the questionnaires distributed.The results show that all of relationships in our model are positive except the hypothesis that learning orientation mediates in the relationship between market orientation and performance. The results suggest that entrepreneurial orientation reinforces the effect of two capabilities, market orientation and learning orientation, on firm performance. They also reaffirm that the three capabilities assessed may lead an organization to differentiate itself from its competitors by improving its performance. In addition to contributing to the literature on female entrepreneurship, the results have important implications for management. Understanding the relationships between capabilities and the performance of women‐owned businesses in exico can permit the identification of areas for improvement to promote the growth and survival of this type of firm.

Medida de la importancia de las dimensiones de la satisfacción en la provisión de servicios de salud

ObjectiveIdentifying users’ perceptions of the quality of care is essential to improve health services delivery. The main objective of this article was to describe the application of a methodology to identify factors that facilitate the identification of areas for improvement. MethodA questionnaire was applied in three health areas in Catalonia (Spain) (primary care [n=332], outpatient specialty care [n=410] and hospital emergency care [n=413]) to measure user satisfaction and assess the importance given to the aspects analyzed. ResultsThe main areas for improvement in primary care identified by an importance-performance analysis involved the time devoted to patients as well as health professionals’ willingness to listen to their views. In hospital emergency care, the main area of improvement was related to the hospital's physical conditions. ConclusionsThe tools designed and implemented by the Catalan Health Service (Spain) have proved to be valid for the detection of priority areas to improve service delivery and promote regional equity.

Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica

ObjectiveTo evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. MethodAn “ad hoc” designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables ResultsThe main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. ConclusionsThe very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement.

National survey of alcohol treatment agencies in England: Characteristics of treatment agencies

Background: To map and contact all specialist alcohol treatment services in England and to investigate the characteristics of responding agencies.Methods: A national cross-sectional survey of alcohol treatment agencies in England. A questionnaire was designed to gather information about agency characteristics, including the service structure, staffing, modalities of treatment, and associated funding.Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7%) responded to the survey. Variations in agency characteristics were noticed across geographical regions, as well as across sectors. The estimated annual spending on alcohol treatment was £217 million.Conclusions: Whereas the regional variation in agency characteristics has implications for access to particular types of treatment, the inter-sector variation has implications for the allocation of funding. The estimated annual spending of £217 million is greater than previous national estimates. A national framework for alcohol service mapping could benefit identification of areas for improvement and lead to more successful treatment outcomes.

Identification of performance indicators for emergency centres in South Africa: results of a Delphi study

BackgroundEmergency medicine is a rapidly developing field in South Africa (SA) and other developing nations. There is a need to develop performance indicators that are relevant and easy to measure. This will allow identification of areas for improvement, create standards of care and allow inter-institutional comparisons to be made. There is evidence from the international literature that performance measures do lead to performance improvements.AimsTo develop a broad-based consensus document detailing quality measures for use in SA Emergency Centres (ECs).MethodsA three-round modified Delphi study was conducted over e-mail. A panel of experts representing the emergency medicine field in SA was formed. Participants were asked to provide potential performance indicators for use in SA, under subheaders of the various disciplines that are seen in emergency patients. These statements were collated and sent out to the panel for scoring on a 9-point Lickert scale. Statements that did not reach a predefined consensus were sent back to the panellist for reconsideration.ResultsConsensus was reached on 99 out of 153 (65%) of the performance indicators proposed. These were further refined, and a synopsis of the statements is presented, classified as to whether the statements were thought to be feasible or not in the current circumstances.ConclusionsA synopsis of the useful and feasible performance indicators is presented. The majority are structural and performance-based indicators appropriate to the development of the field in SA. Further refinement and research is needed to implement these indicators.Electronic supplementary materialThe online version of this article (doi:10.1007/s12245-010-0240-6) contains supplementary material, which is available to authorized users.

Enhancing Reflection Skills Through Learning Portfolios: An Empirical Test

This article reports the findings of an empirical study of the effectiveness of portfolios as learning tools in a sample of MBAs. The results showed that portfolio use was positively related to reflection, defined here as the conscious awareness and questioning of personal experience, a search for alternative explanations and interpretations, and identification of areas for improvement. The positive relationship between portfolio use and improved reflection remained significant irrespective of students’ entering GMAT, gender, work status, and age. But the strength of the relationship between portfolio use and reflection score declined with increasing GPA. Age, gender, GPA, and work status did influence students’ willingness to voluntarily participate in the portfolio program. The study provides one of the first systematic tests of the usefulness of portfolios as learning tools. Given the effort and cost of their implementation, this is an important contribution. The implications of the study for schools considering portfolio use are discussed and recommendations are offered for implementation.

Validación de la versión española del cuestionario sobre la práctica basada en la evidencia en enfermería

The lack of adequate instruments prevents the possibility of assessing the competence of health care staff in evidence-based decision making and further, the identification of areas for improvement with tailored strategies. The aim of this study is to report about the validation process in the Spanish context of the Evidence-Based Practice Questionnaire (EBPQ) from Upton y Upton. A multicentre, cross-sectional, descriptive psychometric validation study was carried out. For cultural adaptation, a bidirectional translation was developed, accordingly to usual standards. The measuring model from the questionnaire was undergone to contrast, reproducing the original structure by Exploratory Factorial Analysis (EFA) and Confirmatory Factorial Analysis (CFA), including the reliability of factors. Both EFA (57.545% of total variance explained) and CFA (chi(2)=2359,9555; gl=252; p < 0.0001; RMSEA=0,1844; SRMR=0,1081), detected problems with items 7, 16, 22, 23 and 24, regarding to the original trifactorial version of EBPQ. After deleting some questions, a reduced version containing 19 items obtained an adequate factorial structure (62.29% of total variance explained), but the CFA did not fit well. Nevertheless, it was significantly better than the original version (chi(2)=673.1261; gl=149; p < 0.0001; RMSEA=0.1196; SRMR=0.0648). The trifactorial model obtained good empiric evidence and could be used in our context, but the results invite to advance with further refinements into the factor "attitude", testing it in more contexts and with more diverse professional profiles.

Refinement: promoting the three Rs in practice

Refinement of scientific procedures carried out on protected animals is an iterative process, which begins with a critical evaluation of practice. The process continues with objective assessment of the impact of the procedures, identification of areas for improvement, selection and implementation of an improvement strategy and evaluation of the results to determine whether there has been the desired effect, completing the refinement loop and resulting in the perpetuation of good practice. Refinements may be science-driven (those which facilitate getting high-quality results) or welfare-driven or may encompass both groups, but whatever the driver, refinements almost always result in benefits to both welfare and science. Refinements can be implemented in all aspects of animal use: improved methodology in invasive techniques, housing and husbandry, and even statistical analyses can all benefit animal welfare and scientific quality. If refinement is not actively sought, outdated and unnecessarily invasive techniques may not be replaced by better methods as they become available, and thus outdated information is passed down to the next generation, causing perpetuation of old-fashioned methods. This leads to a spiral of ignorance, leading ultimately to poor practice, poor animal welfare and poor-quality scientific data. Refinement is a legal and ethical requirement, yet refinements may not always be implemented. There are numerous obstacles to the implementation of refinement, which may be real or perceived. Either way, in order to take refinement forward, it is important to coordinate the approach to refinement, validate the science behind refinement, ensure there is adequate education and training in new techniques, improve liaison between users and make sure there is feedback on suitability of refinements for use. Overall, refinement requires a coordinated ongoing process of critical appraisal of practice and active scrutiny of resources for likely improvements. In the busy world of biomedical research, this process needs help. In order to develop these themes further, a workshop was held at the LASA Winter Meeting 2006, UK, to assist in identifying potential obstacles to refinement, and then to explore and develop strategies for overcoming these obstacles in key areas. A range of strategies appropriate to different circumstances was identified, which should facilitate the implementation of refinements.

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Vía clínica en el infarto agudo de miocardio. Diseño, ensayo piloto y propuesta definitiva

Objective To design a clinical pathway for non-complicated myocardial infarction, perform a pilot study and produce a definitive plan. Material and method A study developed in several stages was designed. Once the process was selected the following steps were performed: literature review, team discussion of the clinical services involved, written design, consensus, pilot study, preliminary discussion of the results, adjustment, and review of the clinical pathway. Results The final proposal for the clinical pathway was achieved after four formal meetings and was modified according to the opinions of a multidisciplinary team. Thus, a task-time matrix was structured. The activities were divided into: identification/notification, treatment, medication, determinations, level of activity, nutrition, preparation for discharge and education. Among the elements identified in the care process that could be improved we found: time to administer thrombolytics; suboptimal use of highly effective medications such as β blockers and aspirin, among others; underuse of the stress test and echocardiogram and unnecessary prolongation of hospital stay. The use of aspirin and β blockers was increased in the pilot study. Conclusions A clinical pathway for the management of patients with non-complicated myocardial infarction was achieved, based on prior analysis of the process and identification of areas for improvement structured in a task-time matrix, ready for implementation. Improvement in some of the proposed indicators was found in the pilot study.

Quality of health care in inflammatory bowel disease: development of a reliable questionnaire (QUOTE-IBD) and first results

OBJECTIVES: As inflammatory bowel disease is a chronic disorder, usually with an early onset in life, quality of care plays an important role for patients. The aim of this study was to develop a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease. METHODS: Ten generic questions were already available because the questionnaire is based on an existing instrument. Patients with inflammatory bowel disease in seven countries were involved in the development of additional disease-specific items. Validation and first field testing of the total questionnaire (QUOTE-IBD) was performed in The Netherlands. RESULTS: A total of 380 patients cooperated in the development of 13 disease-specific items, with high internal reliability (Cronbach’s α = 0.83). Another 162 patients were involved in validating and testing of the QUOTE-IBD, which consists of 23 items in total. Pearson’s correlation coefficient between QUOTE-IBD and visual analog scale scores of health care items was 0.55. Intraclass correlation coefficient of two assessments was 0.64. First testing showed that patients gave relatively poor marks to some part of health care services, such as providing information about extraintestinal complaints and the psychological as well as physical approach to complaints. CONCLUSIONS: A short, valid, reliable questionnaire was developed to measure the opinions of patients with inflammatory bowel disease on quality of health care. The QUOTE-IBD can be used for identification of areas for improvement, with the aim of optimizing health care in inflammatory bowel disease.

Quality of health care in inflammatory bowel disease: development of a reliable questionnaire (QUOTE-IBD) and first results.

As inflammatory bowel disease is a chronic disorder, usually with an early onset in life, quality of care plays an important role for patients. The aim of this study was to develop a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease. Ten generic questions were already available because the questionnaire is based on an existing instrument. Patients with inflammatory bowel disease in seven countries were involved in the development of additional disease-specific items. Validation and first field testing of the total questionnaire (QUOTE-IBD) was performed in The Netherlands. A total of 380 patients cooperated in the development of 13 disease-specific items, with high internal reliability (Cronbach's alpha = 0.83). Another 162 patients were involved in validating and testing of the QUOTE-IBD, which consists of 23 items in total. Pearson's correlation coefficient between QUOTE-IBD and visual analog scale scores of health care items was 0.55. Intraclass correlation coefficient of two assessments was 0.64. First testing showed that patients gave relatively poor marks to some part of health care services, such as providing information about extraintestinal complaints and the psychological as well as physical approach to complaints. A short, valid, reliable questionnaire was developed to measure the opinions of patients with inflammatory bowel disease on quality of health care. The QUOTE-IBD can be used for identification of areas for improvement, with the aim of optimizing health care in inflammatory bowel disease.

Performance evaluation of a distributed application

Analysing the performance of an application performed on a distributed system is discussed in this paper. An analogy between a distributed system and a production process is portrayed, particularly for an application running on several computers. Consequently, theories of management of production processes are employed to help analyse and manage distributed systems, specifically, the Theory of Constraints (TOC). Using TOC combined with the cost/utilization model, which was initially developed to evaluate the utilization of a single processor and is extended here to handle a distributed system, it is demonstrated how the performance of a distributed system can be examined. The methodology presented here is based on a simple graphic display aimed to allow managers of information systems to locate constrained resources, to optimize the distribution of the computer application, and to examine and pinpoint improper imbalances and fluctuations in the system workload. The model develops into a management decision support tool that may be applied in areas such as buffer policy, assessment of protective capacity, investment in computer resources, and identification of areas for improvement.