Implementing Process Improvement Research Articles

Relevant factors to implement continuous improvement in administrative services of public universities: an action research study

The research presented in this article focuses on enhancing the quality of administrative services in a higher education institution, addressing the scarcity of concrete examples of continuous improvement in public services. The study investigates the applicability and effectiveness of continuous improvement methodologies in a public service context, emphasising the distinct challenges faced by public institutions, such as a culture of silos, in implementing process improvements. The article employs an action research methodology, which involves researchers collaborating with university administrative personnel to identify improvement opportunities, implement solutions, and measure the impact of these initiatives on service quality. The impact of continuous improvement initiatives on the quality of administrative services offered by the university is assessed through participant perceptions, service user feedback, and the improvement of main processes within the university departments. The research identifies several barriers and facilitators to continuous improvement within the university’s administrative services, including organisational culture, employee involvement and commitment, communication, goal clarity, and resource availability. The study provides insight into how these factors influence the success of continuous improvement efforts. Based on the findings, the study offers recommendations for deploying continuous improvement workshops at the university. These recommendations aim to address the identified barriers, leverage facilitators, and enhance the overall quality of administrative services. The article contributes to understanding continuous improvement in public service contexts and provides practical guidance for implementing such initiatives in higher education institutions.

Screening for Quality of Life in a Neurology Tic Clinic Using Quality Improvement Methodology

BackgroundTic disorders in children often co-occur with other disorders that can significantly impact functioning. Screening for quality of life (QoL) can help identify optimal treatment paths. This quality improvement (QI) study describes implementation of a QoL measure in a busy neurology clinic to help guide psychological intervention for patients with tics. MethodsUsing QI methodology outlined by the Institute for Healthcare Improvement, this study implemented the PedsQL Generic Core (4.0) in an outpatient medical clinic specializing in the diagnosis and treatment of tic disorders. Assembling a research team to design process maps and key driver diagrams helped identify gaps in the screening process. Conducting several plan-do-study-act cycles refined identification of patients appropriate to receive the measure. Over the three-year study, electronic health record notification tools and data collection were increasingly utilized to capture patients’ information during their visit. ResultsOver 350 unique patients were screened during the assessment period. Electronic means replaced paper measures as time progressed. The percentage of patients completing the measure increased from 0% to 51.9% after the initial implementation of process improvement, advancing to 91.6% after the introduction of electronic measures. This average completion rate was sustained for 15 months. ConclusionsUsing QI methodology helped identify the pragmatics of implementing a QoL assessment to enhance screening practices in a busy medical clinic. Assessment review at the time of appointment helped inform treatment and referral decisions.

Implementation of Lean Manufacturing Methodology and Its Application: A Literature Review

This study aims to investigate and analyze several previous works of relevant literature on the Lean Manufacturing technique in international journals. The methodology used to review the previous studies was carried out through a survey based on descriptive, qualitative, and bibliographical surveys in International Journal with restriction to the period of publication from 2017 – 2022 published on databases and electronic journals in English with the scope to examine and analyze in-depth the extent to which literature used to discuss results in the selected papers of applying the Lean Manufacturing technique in several case studies. After conducting a survey, only thirty-three articles were found with the theme of the application of Lean Manufacturing and its technique in manufacturing companies. Twenty-one techniques/tools of Lean Manufacturing were found problem-solving for waste time elimination, reducing process cycle times, and implementing process improvement. It is concluded that the most used methodology in waste reduction is Value Stream Mapping.

Assessing Exergy Efficiency in Computer-Aided Modeled Large-Scale Production of Chitosan Microbeads Modified with Thiourea and Magnetite Nanoparticles

Chitosan, the deacetylated derivative of chitin, is a biopolymer with many applications in different sectors, such as pharmaceutical, food, and wastewater treatment, amongst others. It can be used as a source for synthesizing bioadsorbents modified with chelators and nanoparticles for the removal of pollutants. In this report, we conducted an exergy analysis to evaluate the large-scale production of chitosan-based bioadsorbents modified with iron nanoparticles and chelators. The objective was to identify energy inefficiencies and propose technological enhancements to improve energy utilization. The process was simulated using Aspen Plus V.10® software, enabling the quantification of chemical and physical exergies for the species and streams involved. We calculated process irreversibilities, exergy losses, waste exergy, and utility exergy flows for each stage and the overall process. These findings provide valuable insights into optimizing energy utilization in the production of chitosan-based bioadsorbents. The overall exergy efficiency was 4.98%, with the washing and drying stages of nanoparticles and adsorbent synthesis accounting for the largest contribution to process irreversibilities and exergy destruction. To increase the global exergy efficiency of the process, it is proposed to implement process improvement strategies, such as mass or energy integration, to obtain better energy performance.

The applicability of advanced technologies from the traditional industry to mitigate ergonomic problems in maintenance activities in the mining industry

PurposeMany advanced technologies applied to maintenance are aimed at data analysis and not directly at the execution of activities. Considering the lack of studies that analyze the use of technologies with a focus on aiding maintenance activities, this study aims to investigate the applicability of advanced technologies capable of mitigating ergonomic risks in mining maintenance activities.Design/methodology/approachA mixed-method study approach was performed in the most important Brazilian mining company, where three groups of equipment were observed: pumps, crushers and sieves. Qualitative and quantitative data were collected, including structured interviews with 60 maintenance professionals for the equipment, and a workshop was held to evaluate the applicability of these technologies in the maintenance activity of this equipment.FindingsIt was verified that the load handler, weight cancelers and automatically guided vehicle technologies were assessed as capable of mitigating ergonomic problems of the supporting the weight of parts and tools and the human traction during maintenance activities.Research limitations/implicationsThe study observed only one company, and the five technologies analyzed here are not yet a reality in this sector.Practical implicationsThis research directs maintenance managers in the implementation of process improvements, in the incorporation of technologies capable of mitigating the ergonomic problems experienced by the maintenance professionals. In this way, it is expected to reduce the number of absences from work and improve the working conditions of these professionals.Social implicationsMining activities impact the local economy and are important in the development of technologies that improve productivity and the man–work relationship. The demands of industries for new solutions encourage local technological development through an approximation with university research and development centers. At the same time, it is observed that these centers can help in the formation of competences to act, either in the implementation of these technologies or in their handling. This university–company integration, in addition to benefiting the mining segment, has the potential to expand the solution to different supply chains, which proves to be a relevant social impact.Originality/valueThis study is pioneering in understanding the use of advanced technologies in maintenance activities in the context of the mining industry (extractive primary sector).

Abstract 28: Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru

Abstract Purpose: In many countries, implementation planning for delivery of cancer screening services functions as a ‘top-down’ process, often resulting in fragmentation and bottlenecks at points of service delivery. Participatory engagement of health system planners and actors from across cancer screening and treatment continuum involved with implementation, planning, and adaptation is hypothesized to lead to plans that have a higher likelihood of adoption and sustainability. We tested the feasibility of conducting a 4-day series of participatory ‘design workshops’ for implementation of the recently initiated HPV screening program in the DIRIS Lima Norte (DLN) region of Peru. Methods: The workshop agendas were co-designed by the Peruvian Ministry of Health (MINSA) and the National Cancer Institute (NCI) using principles of participatory action research, implementation science, and systems thinking. The workshop objectives were to clarify the goals and processes of the HPV cervical screening program and reflect on the initial implementation experience. Workshop design was attentive to a) building trust among the health system planners and actors, b) surfacing misconceptions and process bottlenecks, c) equitable representation of perspectives on the process from all levels of the screening system, and d) shared decision-making in actions to improve the system. Results: Through real-time participatory reflection and process mapping of the screening program, context-specific challenges were rapidly identified. The process maps helped participants gain a shared understanding of the complexity of the screening system and quickly identified how one part of the system can create barriers for proximal and distal parts of the system. Participants mentioned feeling detached from the distal barriers before the workshops but now understood their role in the decision-making and problem-solving processes and demonstrated a willingness to work with the regional director to implement process improvements in the system, specifically to ensure women testing positive received the appropriate follow-up care. Conclusion: Rapid embedded implementation research using facilitated workshops with broad health system representation to reflect on the processes and procedures was an acceptable quality improvement activity. MINSA plans to replicate this experience in other regions and to continue to create a culture of trust and establishment of learning health systems. Citation Format: Fatou Jallow, Andrea Matos Orbegozo, Maria Del Carmen Caruhapoma, Víctor A. Palacios, Milagros Montes, Carlos Santos, Margarita Correa-Mendez, Aubrey Villalobos, Alejandro Salicrup, Jose Jeronimo, Laura Nervi, Patti Gravitt, Julia Gage. Design Workshops: Participatory Co-Design and Iterative Adaptation of Cervical Cancer Screening Implementation Plans in Peru [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 28.

Implementing process improvements to enhance distress screening and management

While distress is prevalent among individuals living with cancer, distress management has not been optimized across cancer care delivery despite standards for screening. This manuscript describes the development of an enhanced Distress Thermometer (eDT) and shares the process for deploying the (eDT) across a cancer institute by highlighting improvements at the provider, system, and clinic levels. Focus groups and surveys were used at the provider-level to outline the problem space and to identify solutions to improve distress screening and management. Through stakeholder engagement, an eDT was developed and rolled out across the cancer institute. Technical EHR infrastructure changes were implemented at the system-level to improve the use of the distress screening findings and generate automated referrals for specialty services. Clinic workflows were adapted to improve screening and distress management using the eDT. Stakeholder focus group participants (n=17) and survey respondents (n=13) found the eDT to be feasible and acceptable for distress identification and management. System-level technical EHR changes resulted in high accuracy with patient identification for distress management, and 100% of patients with moderate to severe distress were connected directly to an appropriate specialty provider. Clinic-level workflow changes to expand eDT use improved compliance rates with distress screening from 85% to 96% over a 1-year period. An eDT that provides more context to patient-reported problems improved identification of referral pathways for patients experiencing moderate to high distress during cancer treatment. Combining process improvement interventions across multiple levels in the cancer care delivery system enhanced the success of this project. These processes and tools could support improved distress screening and management across cancer care delivery settings.

Enhancing Strategic Learning Through the Implementation of Robust Process Improvement in a Specialized Tertiary Care Hospital.

Performance improvement (PI) in healthcare is essential to improve health, patient experience, and reduce costs. PI projects became low, inconsistent and weakly-sustained in our hospital. The low number and low sustainability were scarcely in alignment with our strategic goal to become a high reliability organization (HRO). This was due to lack of standardized knowledge and ability to initiate and sustain PI projects. Therefore, a structured framework was developed, followed by the building of capacity and capability in the use of robust process improvement (RPI) amidst the COVID-19 pandemic. A team of healthcare quality professionals collaborated with Hospital Performance Improvement-Press Ganey for hospital-wide quality improvement project. The team received training on RPI from Press Ganey and created the framework to use . This framework is based on the Institute for Healthcare Improvement Model for Improvement, Lean, Six Sigma, and FOCUS-PDSA (Find-Organize-Clarify-Understand-Select-Plan-Do-Study-Act). Thereafter, the team of internal coaches organized an RPI training course that consisted of 6 sessions, for clinical and nonclinical staff , using classroom and virtual sessions during the pandemic. This course was increased to eight sessions to avoid information overload. Process measures were collected using a survey to obtain feedback, whereas outcome measures were from the number of completed projects and their effects related to costs, access to care, waiting time, number of harms, and compliance. Participation and submission improved after three PDSA (Plan-Do-Study-Act) cycles. This resulted in an increased number of completed and sustained projects from 50 in 2019 to 94 in 2020 and continued to rise to 109 in 2021. There were 140 and 122 certified RPI coaches in 2020 and 2021, respectively. Although there was a decrease in the number of certified coaches in 2021, the number of completed projects was higher than in 2020. The overall effect of these completed projects by the third quarter of 2021 showed improvement in access to care by 39%, compliance to standards of care by 48%, satisfaction by 8%, and reduction in costs by 47,010 SAR, in waiting time of 170 hours, and in the number of harms by 89. This quality improvement project led to enhanced capacity of staff as seen in the increased number of certified RPI coaches, thereby increasing the submission and completion of projects in 1 year. Its sustainability during the 2 succeeding years continued to enhance project completion and maintenance, bringing quality improvement benefits to the organization and the patients.

Adverse Drug Reactions in Moderate Sedation: Process Improvement During a Pandemic

Background: A gap analysis identified the need for process improvement surrounding the identification and reporting of adverse drug reactions related to moderate sedation. A change to documentation was selected to address this gap. The challenge was disseminating the change in a meaningful way during a time of high census and limited staffing due to the COVID-19 pandemic. Complex adaptive systems theory was used to plan interventions in the current climate. Methods: Process improvement was organized into Plan-Do-Study-Act cycles guided by the gap analysis, literature, and aims. Quantitative data analysis was conducted using chart audits and a Likert survey. Interventions: Adoption of end-user-redesigned documentation was completed over time using one-on-one instruction, brief just-in-time education sessions at huddles, and ongoing feedback. Results: The survey results demonstrated a significant increase in adverse event knowledge (p = <0.01) and documentation confidence following just-in-time training (p < .01). Chart audits revealed an increase in identification of adverse events (p=0.03). Conclusions: Using a theory-based approach to implement process improvement is a successful way to create change in a challenging environment. Identification of adverse drug reactions related to moderate sedation increased, which is essential for evaluation and safe administration.

1076: QUALITY IMPROVEMENT INITIATIVE TO PREVENT FLUID OVERLOAD IN PEDIATRIC INTENSIVE CARE UNIT PATIENTS

Introduction: Fluid administration for critically ill children frequently exceeds hydration requirements and is associated with increased morbidity and mortality. The global aim of this ongoing single-center quality improvement (QI) initiative is to standardize and implement process improvement tools to detect and prevent fluid overload (FO) in patients admitted to the Pediatric Intensive Care Unit (PICU). Our SMART aim is to reduce the incidence of percent fluid overload (%FO) >/= 10% at 72 hours of PICU admission by 20% in the first 6 months. Methods: In collaboration with key stakeholders, we used Plan-Do-Study Act (PDSA) QI methodology to develop electronic health record (EHR)-based tools and education sessions to help providers detect and prevent FO in PICU patients. We conducted a retrospective chart review with a convenience sample to obtain baseline metrics. We assessed current FO understanding and perceptions of proposed interventions with anonymous surveys distributed to PICU attendings, fellows, residents, advanced practice providers and nurses. In April 2022, we implemented a single screen “Fluid Management accordion” within our EHR that displays all clinical markers used to evaluate a patient’s fluid status, and an EHR-based %FO calculator. In July 2022, we added PICU admission order set modifications to include a total fluid goal. Outcome metrics are collected monthly. Quarterly follow up surveys began in July 2022 and will trend intervention impact and perceptions. Results: Chart review (n=562) revealed a 40% baseline incidence of %FO >/= 10% at 72 hours of PICU admission. Pre-implementation, most respondents (n=115) agreed that we could improve our awareness to patients’ fluid status (92%) and that using standardized EHR orders and tools would be helpful (76%). Few (27%) reported knowing how to calculate %FO. Three months after initial EHR tool launch, many survey respondents (n=49) reported using the fluid management accordion at least once (40%) and 43% reported knowing how to calculate %FO. Six-month implementation data will be available in October 2022. Conclusions: To date we have standardized EHR-based tools for FO detection. We suspect that with continued education and feedback we will likely see a reduction in %FO incidence in our PICU population.

Implementation and Case Study of a Clinical Research Data Warehouse in Radiation Oncology

<h3>Purpose/Objective(s)</h3> Radiation oncology generates large volumes of multi-source data that can be harnessed to accelerate personalized cancer care. We describe the implementation of a departmental clinical data warehouse and a case demonstrating application of this tool. <h3>Materials/Methods</h3> Physician stakeholders collaborated with software engineers and developers with domain knowledge in electronic medical records (EMR), cancer registries, and radiation treatment planning systems to design a departmental radiation oncology data warehouse. Data from EMR, radiation treatment planning system, institutional cancer registry, and pathology database were merged by patient medical record number and made accessible via a web application with a graphical user interface (GUI) written in R Shiny and hosted on Shiny Server Pro (RStudio). Data sources are refreshed at weekly to quarterly intervals and extracted to Shiny Server Pro. Team meetings were held every two weeks to refine current data elements, implement process improvements, and improve data quality and integrity. The warehouse can only be accessed by departmental users who have completed data privacy training and attestation under an IRB. Using the data warehouse, we examined radiotherapy fractionation patterns among breast cancer patients in our department. Filters for demographic, prognostic, and treatment characteristics were applied to build cohorts of patients treated with hypofractionated whole breast irradiation (WBI, 2.6-2.7 dose/fraction for 15-16 fractions) and standard fractionated WBI (1.8-2 dose/fraction for 25-30 fractions). <h3>Results</h3> The data warehouse includes 66,078 unique patients seen in our department from 4/28/1997 through 12/7/2021. We identified 2,206 patients diagnosed with breast cancer who received WBI between 2010 and 2020. Use of hypofractionation increased from 16% in 2010 to 71% in 2020. Of the patients who received hypofractionated WBI in 2010, median age was 69 years, 89% had Tis (33%) or T1-2, N0 (56%) tumors, and 67% had right-sided breast cancer, compared to 58 years, 86% (13%, 73%), and 48% in 2020, respectively. Among the patients who received hypofractionated WBI and with known hormone receptor status, 100% in 2010 and 80% in 2020 were ER/PR+/HER2-. These large-scale analyses took minutes to execute and yielded hypofractionation trends similar to those in existing studies. <h3>Conclusion</h3> We created a clinical data warehouse that includes all patients treated in one radiation oncology department and aggregates health information from different data sources into a centralized and user-friendly, web-based GUI console. We used this resource to efficiently examine WBI fractionation patterns in the warehouse over a 10-year period; work is ongoing to continually improve data quality. By leveraging real-time clinical data for secondary uses, this effort can drive precision cancer medicine by making research, quality assessment, and predictive modeling a natural outgrowth of routine patient care.

Implementing process improvements to enhance distress screening and management.

352 Background: While distress is prevalent among individuals living with cancer, distress management has not been optimized across cancer care delivery despite standards for screening. This manuscript describes the development of an enhanced Distress Thermometer(eDT) and shares the process for implementing the (eDT) across a cancer institute by highlighting process changes and improvements at the provider, system, and clinic levels. Methods: Focus groups and surveys were used at the provider-level to outline the problem space and to identify solutions to improve distress screening and management. Through stakeholder engagement, an eDT was developed and rolled out across the cancer institute. The eDT included pull down menus for each of the DT problem areas to provide detailed context of the specific issue. EHR infrastructure changes were implemented at the system-level to improve the use of the distress screening findings and generate automated referrals for specialty services. Clinic-level workflows were adapted to improve screening and distress management using the eDT. Patient-level data was collected to examine severity of distress and referral pathway utilization comparisons between original DT and eDT. Results: Stakeholder focus group participants (n = 17) and survey respondents (n = 13) found the eDT to be feasible and acceptable for distress identification and management. System-level technical EHR changes resulted in high accuracy with patient identification for distress management and 100% of patients with moderate to severe distress were connected directly to an appropriate specialty provider. Clinic-level workflow changes to expand eDT use improved compliance rates with distress screening from 86% to 98% over a 1 year period. We are currently analyzing utilization data based on distress screening at the patient level and will provide these results in the final presentation. Conclusions: An eDT that provides more context to patient-reported problems improved identification of referral pathways for patients experiencing moderate to high distress during cancer treatment and enhanced overall clinical use of the eDT. Combining process improvement interventions across multiple levels in the cancer care delivery system enhanced the success of this project. These processes and tools could support improved distress screening and management across cancer care delivery settings.

Improving patient well-being in the United States through care coordination interventions informed by social determinants of health.

Health and well-being are promoted when primary care teams partner with patients and provide care coordination to mitigate risks and promote optimal health. Identification of patients for care coordination is typically based on claim-driven risk assessments. Evidence shows that social determinants of health (SDOH) drive risk for adverse health outcomes but are omitted from existing risk tools. Missed opportunities for care coordination contribute to increased healthcare costs, poorer health outcomes and reduced patient well-being. To address the gap of risk-informed care coordination that includes SDOH, the aim of this project was to implement process improvement of a system's care coordination program through refined patient selection and customised engagement in intensive care coordination. A non-randomised care coordination quality improvement project was conducted at a community health centre in 2020. Inclusion criteria (i.e. presence of risk attribution score, SDOH questionnaire completed) resulted in 540 patients being offered care coordination services; Patients having at least one month of care coordination were included in the analysis (N=216). Analysis included the 216 patients that chose participation and the 324 patients that maintained usual care. Descriptive statistics were generated to distinguish patient demographics, frequency of care coordination contact, and specific SDOH insecurities for both the study and comparison groups. Paired t-tests were incorporated to evaluate statistical significance of the intervention group. Impact on well-being, SDOH barriers, appointment adherence and health outcomes were assessed in both conditions. Intervention condition patients reported improvement in well-being [feeling anxious (t=4.051; p<0.000)] and reduced SDOH barriers [food access (t=4.662; p<0.000); housing (t=2.203; p=0.008)] that were significantly different from the usual care condition in the expected directions. Care coordination based on factors including SDOH risks shows promise in improving patient well-being. Future research should refine this approach for comprehensive risk assessment to intervene and support patient health and well-being.

Evaluation of a cardiac troponin process flow at the chest pain center with the shortest turnaround time.

BackgroundEarly diagnosis of myocardial infarction is crucial in chest pain management and cardiac troponin (cTn) test is an important step in it. Process improvement to shorten the test turnaround time (TAT) may improve patients’ outcomes. The cTn test at chest pain center (CPC) of Zhongshan Hospital had the shortest TAT ever reported, but its process flow was not fully evaluated.MethodsWe performed a stepwise evaluation of CPC cTn TAT and explored the potential factor that might cause delay. The performance of CPC cTn test was also compared with cTn test and human chorionic gonadotropin (HCG) test ordered from emergency department (ED).ResultsAt least 95% of CPC cTn tests were completed in 60 min, while 62% in 30 min. The medians of monthly order‐to‐collect time, collect‐to‐received time, and received‐to‐result time were ~7 min, ~3 min, and ~13 min, respectively. The samples collected at the bedside had longer collect‐to‐received time than the ones collected at the blood draw site next to the laboratory. Compared to ED cTn test and ED HCG test, CPC cTn test took less time in each step. A combination of the sample type switch and the centrifugation time reduction contributed the most to the shortening of TAT, which was reflected in the received‐to‐result time.ConclusionsThe current process flow of CPC cTn test satisfied the requirements of chest pain management, giving an example of how to implement process improvement for emergency medicine to shorten TAT of laboratory tests.

Integrating the Theory of Constraints and Six Sigma: Process Improvement Implementation

Businesses apply many management philosophies aiming to manage processes effectively, eliminate bottlenecks and improve their process performance. The most important of these philosophies are the Theory of Constraints and the Six Sigma. These are used separately in process improvement and performance enhancement in many businesses. Recently, an integration model approach of two philosophies has been examined in the literature in an effort to reduce their weaknesses and increase their strong effects. In the literature, three different approaches are identified for the integration model of Theory of Constraints and Six Sigma. In this study, the integration model of Jin, Abdul-Razzak, Elkassabgi, Zhou, &amp; Herrera, (2009) was applied in an industrial enterprise in order to identify and eliminate the root causes of the decline in sales figures. It has been revealed that the integration model can help to identify and eliminate these root causes and how it benefits the business. As a result of the application, an improvement in production cost by 1.56% and 3.55% and an increase in σ value from 1.4 to 2.3 were determined. With this model, constraints in the production process were determined, managed and eliminated.

Implementation of Process Improvements to Facilitate Cardiac CT Re-Credentialing in a Rural Healthcare System.

Background: Because rural providers may experience barriers in achieving the necessary components to successfully re-credential in cardiac computed tomography (Cardiac CT), we evaluated the current system for re-credentialing at our organization and implemented processes to facilitate Cardiac CT re-credentialing for our providers.Methods: Institutional opportunities for Cardiac CT quality assurance (QA) conference attendance, Cardiac CT imaging evaluation, and Cardiac CT continuing medical education (CME) acquisition were assessed in 2009 and 2013. Process improvement strategies were implemented in 2014 including adding electronic media hosting sites, a "hands-on" image interpretation course, and more options for CME acquisition. Pre- and post-educational improvements were evaluated over a 10-year period. The number and type of events hosted, attendees, image review opportunities, and CME credits awarded were assessed and compared at the provider level.Results: Attendance at Cardiac CT QA conferences increased substantially following implemented changes despite fewer certified Cardiac CT providers. Electronic attendance accounted for 26% of this increased attendance, while the "hands on" course provided 43 images for review per year. The number of Cardiac CT CME credits awarded increased substantially, paralleling increased QA and "hands-on" attendance.Conclusion: In rural healthcare systems, institutional strategies can increase provider access to components necessary for Cardiac CT level II re-credentialing. In the COVID-19 era, rural and urban health organizations may find considerable provider benefit and engagement by using similar process improvement methods to help providers meet local and national requirements for certification.

Perbaikan Proses Bisnis Pembuatan Laporan Produksi Harian untuk Memperpendek Lead Time pada Perusahaan Manufaktur Mobil

&lt;p class="abstrak"&gt;This research was conducted at a four-wheeled vehicle manufacturing company located in Jakarta. The average lead time for making the Plant 2 Daily Production Report is currently around 12 minutes. With the long reporting time, this process is considered less efficient. In this research, business process improvement will be carried out by identifying non value-added activities and using business process improvement methodology. In improving the reporting process, Excel Macros will be used. After the implementation of business process improvements, the average time for making Daily Production Reports is reduced to 4 minutes or there is a time saving of 67%.&lt;/p&gt;&lt;p class="abstrak"&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Use of Virtually Facilitated Simulation to Improve COVID-19 Preparedness in Rural and Remote Canada

BackgroundThe Alberta Health Services’ Provincial Simulation Program (eSIM) is Canada's largest simulation program. The eSIM mobile simulation program specializes in delivering simulation-based education (SBE) to rural and remote communities (RRC). During the COVID-19 pandemic, a quality improvement project involving rapid cycle in situ virtually facilitated simulation (VFS) for COVID-19 airway management and health systems preparedness in RRC was successfully implemented. MethodsBetween April 24 and July 31, 2020, a team of six rural simulationists (four nurses and two physicians) provided 24 VFS sessions with virtual debriefing to 200 health care providers distributed across 11 RRC in Alberta and the Northwest Territories, covering a geographic area of approximately 169,028 km2. ResultsVideo analysis of sequential VFS rapid cycle sessions using a standardized observational tool indicated decreased personal protective equipment (PPE) breaches by 36.6% between the first and third cycles. Teams demonstrated increased competency with airway management such as correct use of bag-valve-mask ventilation, and implementation of health system process improvements, such as incorporation of an intubation checklist. Improvements occurred on average over 2.2 rapid cycles completed within 1.3 weeks per RRC. Postsession self-reported participant electronic surveys indicated self-reported improvement in clinical management, teamwork behavior, and health systems issues outcome measures which were categorized based on the Crisis Resource Management and Systems Engineering Initiative for Patient Safety (SEIPS) frameworks. Of the 48 survey respondents, 86.1% reported that VFS was equivalent or superior to in-person simulation. The cost of VFS was 62.9% lower than comparable in-person SBE. ConclusionVFS provides a rapidly mobilizable and cost-effective way of delivering high-quality SBE to geographically isolated communities.

Implementing process improvement initiative: the role of visualisation and standardisation methods

PurposeDue to the difficulties organisations face in implementing process improvement initiatives (PIIs), this research explores how visualisation and standardisation of business processes help organisations achieve PIIs to improve organisational performance.Design/methodology/approachA multi-staged case study strategy that analyse qualitative data and performs a process modelling analysis of quantitative data.FindingsThe paper makes two main contributions to existing knowledge. Firstly, it explains how taking the visualised and standardised methods on PIIs can reduce service delivery times and enhance organisational performance. Secondly, it demonstrates how adopting these dual methods offers a better chance of increasing organisational performance than using only a single method.Research limitations/implicationsAlthough the paper considers the flexibility in the standardisation of business processes as it gives scope for innovation and creativity on the part of the process, it did not consider if flexibility is possible without breaking the standardised working way. Hence, future research can consider this. Also, future research can hypothesise the BPM model and test for statistical generalisability.Originality/valueThe research offers new insight into how and when both visualisation and standardisation of PIIs can benefit organisations.

Software Process Improvement Implementation Issues in Small and Medium Enterprises That Develop Healthcare Applications

Software Process Improvement (SPI) intends to recuperate software processes to realize high quality software. But numerous SPI initiatives predominantly in the case of software Small and Medium Enterprises (SMEs) are failed to achieve desired results as certain issues occur during this progression. Objective of this research work is to facilitate the efficacious SPI implementation in the case of software SMEs that develop healthcare applications. The study identifies and ranks common SPI implementation issues in the case of related SMEs. For this purpose, two questionnaire surveys have been performed by involving relevant software industry practitioners. In the first survey, by providing a literature-based list of SPI issues, we have solicited respondents to choose common issues or resistant factors for SPI in the case of SMEs that deal with healthcare application development. We have also requested the practitioners to mention the issues that they have been generally spotting during the SPI in case of pertinent SMEs but have not been mentioned in the given list. During the second survey, by employing two rounds of the Delphi method, practitioners have ranked the commonly transpiring SPI issues regarding SMEs that deal with the development of healthcare applications. The ranking is based on the issues' impact having four categories: catastrophic, serious, tolerable and insignificant. To incorporate various SMEs standards that are followed worldwide, the concept of 'common/shared range standard' is presented. The study identifies 26 SPI issues in the case of SMEs that develop healthcare applications whereas top 10 issues instigate from finance and management. To enable swift and fruitful SPI in the case of pertinent SMEs, this study suggests that the 26 identified issues must be tackled proactively whereas financial and managerial issues must be given top priority.