Implementation Of Improvement Program Research Articles

Implementation of a multi-site neonatal simulation improvement program: a cost analysis

BackgroundTo improve patient outcomes and provider team practice, the California Perinatal Quality Care Collaborative (CPQCC) created the Simulating Success quality improvement program to assist hospitals in implementing a neonatal resuscitation training curriculum. This study aimed to examine the costs associated with the design and implementation of the Simulating Success program.MethodsFrom 2017–2020, a total of 14 sites participated in the Simulating Success program and 4 of them systematically collected resource utilization data. Using a micro-costing approach, we examined costs for the design and implementation of the program occurring at CPQCC and the 4 study sites. Data collection forms were used to track personnel time, equipment/supplies, space use, and travel (including transportation, food, and lodging). Cost analysis was conducted from the healthcare sector perspective. Costs incurred by CPQCC were allocated to participant sites and then combined with site-specific costs to estimate the mean cost per site, along with its 95% confidence interval (CI). Cost estimates were inflation-adjusted to 2022 U.S. dollars.ResultsDesigning and implementing the Simulating Success program cost $228,148.36 at CPQCC, with personnel cost accounting for the largest share (92.2%), followed by program-related travel (6.1%), equipment/supplies (1.5%), and space use (0.2%). Allocating these costs across participant sites and accounting for site-specific resource utilizations resulted in a mean cost of $39,210.69 per participant site (95% CI: $34,094.52-$44,326.86). In sensitivity analysis varying several study assumptions (e.g., number of participant sites, exclusion of design costs, and useful life span of manikins), the mean cost per site changed from $35,645.22 to $39,935.73. At all four sites, monthly cost of other neonatal resuscitation training was lower during the program implementation period (mean = $1,112.52 per site) than pre-implementation period (mean = $2,504.01 per site). In the 3 months after the Simulating Success program ended, monthly cost of neonatal resuscitation training was also lower than the pre-implementation period at two of the four sites.ConclusionsEstablishing a multi-site neonatal in situ simulation program requires investment of sufficient resources. However, such programs may have financial and non-financial benefits in the long run by offsetting the need for other neonatal resuscitation training and improving practice.

THE IMPACT OF THE USE OF ACCOUNTING SOFTWARE ON THE ACCURACY OF FINANCIAL INFORMATION AN ANALYTICAL STUDY OF THE OPINIONS OF A SAMPLE OF EMPLOYEES AT AL-MURABBA SOFTWARE SOLUTIONS COMPANY

In today's dynamic business landscape, the use of accounting software has become increasingly widespread, promising to enhance efficiency and accuracy in financial management processes. This study aims to know the impact of using accounting software on the accuracy of financial information within organizations. To achieve the research objectives, a questionnaire was distributed to employees of Al-Murabba Software Solutions Company, and by compiling results from both theoretical frameworks and practical insights, this research provides valuable implications for companies that aim to benefit from accounting software for financial management. It provides recommendations to improve program implementation strategies, enhance user training programs, and enhance data security measures to increase the accuracy and reliability of financial information. This study also contributes to the ongoing discourse on the role of technology in modern accounting practices and emphasizes the importance of aligning software adoption with organizational goals to achieve greater financial accuracy and effective decision-making.

Sustainability of an enhanced recovery pathway after minimally invasive gynecologic oncology surgery

ObjectiveSame day discharge is safe after minimally invasive gynecology oncology surgery. Our quality improvement peri-operative program based on enhanced recovery after surgery principles led to an increase in same day...

Analisis Kendala Program Peremajaan Sawit Rakyat (PSR) terhadap Potensi Pertumbuhan Ekonomi Petani Sawit Rakyat.

This study aims to analyze the effect of the community oil palm replanting program on the economic growth of community oil palm farmers in Batu Bara Regency. This research uses quantitative methods with multiple linear regression analysis techniques. Primary data was obtained from 75 respondents of smallholder oil palm farmers in Batu Bara District. The results showed that administration and human resources have a positive and significant influence on the economic growth of smallholders. Meanwhile, oil palm land, facilities and infrastructure, and sustainability have no influence on the economic growth of smallholders. This study implies that it is important to increase training and technical support for assistants and smallholders. The government needs to provide financing and incentives to encourage farmers' participation in the smallholder oil palm replanting program. A holistic economic growth strategy is needed, such as diversification of oil palm products, improvement of the value chain, and integration with other sectors. It is necessary to build strong cooperation with relevant stakeholders to improve program implementation and maximize economic benefits for smallholders.

Supporting underrepresented students in health sciences: a fuzzy cognitive mapping approach to program evaluation

BackgroundThe Students Training in Academia, Health, and Research (STAHR) Program at the University of Missouri-Kansas City (UMKC) strives to help students from low-income families that have experienced educational challenges due to poverty and prepare them to enter, persist, and graduate from a health sciences degree program at UMKC. Students in the program participated in fuzzy cognitive mapping (FCM) sessions to ensure that all voices of the program were heard to improve program implementation, and student success, and contribute to an equitable educational environment.MethodsFuzzy Cognitive Mapping sessions for the 2020–2021 cohort of students (n = 52) were conducted to assess the strengths and weaknesses in program implementation, especially through the beginning of the COVID-19 pandemic. Students’ maps were coded by a team of researchers and then confirmed using confirmatory factor analysis.ResultsStatistical analyses reveal that mentorship, workshops, and social support helped students to work toward their goal of obtaining a professional health sciences degree, while a lack of time, remote learning, and outside stressors inhibited their opportunities for success.ConclusionsThe findings from a multipronged analysis of mapping data demonstrate the value of this innovative approach to the field, especially when looking to incorporate student voices.

Histological, immunohistochemical and serological investigations of the ovary during follicular phase of estrous cycle in Saidi sheep

BackgroundSaidi sheep are the most abundant ruminant livestock species in Upper Egypt, especially in the Assiut governorate. Sheep are one of the most abundant animals raised for food in Egypt. They can convert low-quality roughages into meat and milk in addition to producing fiber and hides therefore; great opportunity exists to enhance their reproduction. Saidi breed is poorly known in terms of reproduction. So this work was done to give more information on some hormonal, oxidative, and blood metabolites parameters in addition to histological, histochemical and immunohistochemical investigations of the ovary during follicular phase of estrous cycle. The present study was conducted on 25 healthy Saidi ewes for serum analysis and 10 healthy ewes for histological assessment aged 2 to 5 years and weighted (38.5 ± 2.03 kg).ResultsThe follicular phase of estrous cycle in Saidi sheep was characterized by the presence of ovarian follicles in different stages of development and atresia in addition to regressed corpus luteum. Interestingly, apoptosis and tissue oxidative markers play a crucial role in follicular and corpus luteum regression. The most prominent features of the follicular phase were the presence of mature antral (Graafian) and preovulatory follicles as well as increased level of some blood metabolites and oxidative markers. Here we give a new schematic sequence of ovarian follicles in Saidi sheep and describing the features of different types. We also clarified that these histological pictures of the ovary was influenced by hormonal, oxidative and blood metabolites factors that characterizes the follicular phase of estrous cycle in Saidi sheep.ConclusionThis work helps to understanding the reproduction in Saidi sheep which assist in improving the reproductive outcome of this breed of sheep. These findings are increasingly important for implementation of a genetic improvement program and utilizing the advanced reproductive techniques as estrous synchronization, artificial insemination and embryo transfer.

Relationships between lean bundles and firm performance: a meta-analysis on the moderating role of national culture differences

PurposeEvolved from Toyota’s shop floor in Japan, lean bundles are universally accepted for boosting manufacturing performance. However, extant literature shows mixed findings on the effectiveness of lean bundles in non-Japanese settings. This meta-analysis is aimed at understanding the influence of national culture (NC) differences on the lean bundles-performance relationships.Design/methodology/approachA total of 224 effects from 12,569 observations across 48 empirical studies from 14 countries are meta-analyzed. Also, weighted least squares (WLS) meta-regression using NC scores from the Global Leadership and Organizational Behavior Effectiveness (GLOBE) study are conducted to test the moderating effect of NC dimensions.FindingsThe meta-analysis reveals a positive association between the lean bundles and firm performance; though, the strength of the association varies across the individual lean bundles. The meta-regression results show that lean practices are more effective in countries that value high future orientation, high collectivism, low-performance orientation and high assertiveness.Originality/valueThe results contribute to the literature on the role of local cultural influence on strategies and decisions related to the implementation of continuous improvement (CI) programs in cross-cultural settings.

Addressing Pediatric Toxic Stress During Initial Attention-Deficit/Hyperactivity Disorder Evaluations

Assessing for adverse childhood experiences (ACEs)/toxic stress (TS) is vital to comprehensive care for pediatric patients; however, no current national guidelines for pediatric ACEs/TS screening exist. Because of the similarity in externalizing behaviors for attention-deficit/hyperactivity disorder (ADHD) and elevated ACEs/TS scores, ACEs and TS need to be addressed with patients and families when evaluating for ADHD. Implementation of a quality improvement program to standardize ACEs/TS screening during all initial ADHD evaluation visits in a private pediatric clinic resulted in increased provider awareness of ACEs/TS, with an overall screening rate of 71%.

Urban-rural differences in seasonal malaria chemoprevention coverage and characteristics of target populations in nine states of Nigeria: a comparative cross-sectional study.

Differences between urban and rural contexts in terms of sociodemographic characteristics, geographical features and risk perceptions may lead to disparities in coverage and related outcomes of community-based preventive interventions, such as seasonal malaria chemoprevention (SMC). This study investigated urban-rural differences in SMC coverage and other programme outcomes, as well as child and caregiver characteristics of target populations in nine implementing states in Nigeria during the 2022 SMC round. This is a comparative cross-sectional study based on comprehensive end-of-round household surveys conducted in nine states where SMC was delivered in Nigeria in 2022. Data of 11,880 caregiver-child pairs were included in the analysis. Rural-urban differences in SMC outcomes and child and caregiver characteristics were assessed, first by using Pearsons' chi-square test for independence for categorical variables. Univariate multilevel mixed-effect logistic regression models, with random intercepts for cluster units, were used to quantify the strength of association between location and each SMC coverage and related outcomes. Significant urban-rural differences were observed in caregivers' sociodemographic characteristics, such as age, gender, level of education, occupation status and health-seeking behaviour for febrile childhood illnesses. Disparities were also seen in terms of SMC coverage and related outcomes, with lower odds of the receipt of Day 1 dose direct observation of the administration of Day 1 dose by community distributors, receipt of the full three-day course of SMC medicines and receipt of SMC in all cycles of the annual round among children residing in urban areas, compared with those residing in rural areas. Similarly, urban-dwelling caregivers had lower odds of being knowledgeable of SMC and believing in the protective effect of SMC than rural-dwelling caregivers. Findings highlight observable urban-rural disparities in SMC programme delivery and related outcomes, as well as target population characteristics, underscoring the need for context-specific strategies to ensure optimal delivery of SMC and improve programme implementation outcomes in urban settings.

Common reasons for non-participation during the outcome measurement process: wheeled mobility service delivery quality improvement reporting

Objective The purpose of this paper is to describe non-participation during the outcome measurement step of the wheeled mobility service delivery process (WMSDP) based on the Functional Mobility Assessment (FMA)-Uniform Dataset (UDS) Registry. Introduction The WMSDP is a standard framework for the provision of wheeled mobility devices, and several factors influence the client’s experience throughout the process. Patient-reported outcomes are one way to measure the client’s experience as part of a quality improvement program. Methods A retrospective descriptive study was conducted on the FMA-UDS Registry to measure the response rate during the outcome measurement step of the WMSDP and describe the reasons an individual did not complete the FMA-UDS. The FMA-UDS was examined at two time points: pre-delivery and post-delivery of the wheeled mobility device. Results As of September 2, 2021, 10,253 cases have been entered into the FMA-UDS Registry. 2,247 cases were no longer participating pre-delivery, and an additional 3,905 cases were no longer participating post-delivery. The most common reasons for non-participation in the FMA-UDS pre-delivery and post-delivery included: equipment not delivered; provider no longer participating in the FMA-UDS; funding issues; no new equipment; client opted out; loss in contact; deceased; returned equipment; and other. Discussion The type and frequency of non-participation in the outcome measurement step of the WMSDP is critical to understanding why individuals participate in outcome measures and provides insight into the barriers and facilitators for the implementation of quality improvement programs.

A surrogate safety analysis at sharp gore areas of diverging freeway ramps using micro simulation under congested traffic conditions

Safety at the gore areas near diverging ramps is very crucial during planning and implementation of highway safety improvement programs. Limited research has been conducted on safety at the gore areas on arterial roads. This study aims at investigating the impact of improving a sharp gore area in Lincoln, Nebraska by performing a micro simulation before-and-after study with respect to its underlying state of safety and congestion. Data on travel times and traffic volumes for peak hours are incorporated after successful calibration to find out how a geometric intervention can decrease mobility issues as well as the likelihood of crash involvement. This study has utilized VISSIM software package to run the simulation however, to perform safety analysis, Surrogate Safety Assessment Model (SSAM) is used which is developed by the Federal Highway Administration (FHWA). During the model calibration, custom driving behaviors are created to represent driving tendencies of familiar drivers. The simulation results indicated that by adding an auxiliary lane near the gore area, the mobility issues such as bottle necks, lane changing dilemmas and queue lengths are substantially decreased. However, geometric interventions such as provision of a separate lane, increasing ramp spacing, nose spacing, deceleration area and queue storage area considerably reduced the likelihood of rear-end and lane changing crashes. Surrogate safety assessment in diverging ramps, particularly for sharp gores, has not previously been studied, and this study can serve as a primary footmark for future research on ramp-gores safety.

Implementation of the Resuscitation Quality Improvement Program in a System of Hospitals: A Map for Success

Implementation of the Resuscitation Quality Improvement Program in a System of Hospitals: A Map for Success

Popular vote as a form of online dialogue between government and society

The authors consider the popular vote as a mechanism of convergent movement of power and society in the context of the formation and development of the digital public sphere. The theoretical and methodological basis of communication between government and society is analyzed. The search for modern forms of dialogue between government and society is made in the context of discussions on the use of remote electronic voting (DEG) in the electoral process. The role, opportunities, prospects and risks of online voting in Russian regional and municipal practice are assessed, in particular, in the implementation of the program "Formation of a comfortable urban environment", which is a positive experience of equal and effective interaction between government and society, offers one of the possible directions of public dialogue, the essence of which is the transition from an archaic subject-object models for intersubjective communication. The research is based on a dialectical understanding of socio-cultural processes and phenomena, on general scientific and logical methods of cognition. Statistical, institutional and comparative methods are used. The scientific novelty lies in the study of online voting as an effective form of achieving public consensus within the framework of a specific federal program. It is noted that online voting corresponds to the electoral culture of Russian society, its conventional features. The necessity of broad inclusion of citizens in the discussion and implementation of land improvement programs and other socially significant projects is substantiated. The motives that provide these programs with significant public support are revealed. The data characterizing the quality of the urban environment in the Central Federal District are summarized and analyzed. The conclusion is made about the relationship between the popular vote and the growth of the urban space quality index. The resources of the urban environment quality index and the popular vote are evaluated as conditions for the formation of a healthy competitive field, where the main engine is awareness of the responsibility of the administration and residents of the region for the prestige of their region. Recommendations are formulated on the institutionalization of online voting to solve problems that determine the current regional and municipal agenda.

A Pilot Study of Proactive Team REBOA to Avoid Delays to Definitive Care

As experience using resuscitative endovascular balloon occlusion of the aorta (REBOA) has expanded over the past few years, best practices for implementing a REBOA program have emerged. Early practice was single-surgeon focused, but we have learned that a team approach to REBOA practice is common in successful programs. Key components of our contemporary team approach are defining a patient selection algorithm, uniform acceptance of early CFA access, full team training, regular case reviews, and implementation of a process improvement program. This team approach to REBOA has resulted in numerous benefits for trauma patients with, most importantly, a significantly decreased time to definitive hemorrhage control. Here, we describe our experience and outcomes as a Level 1 Trauma Center implementing a REBOA program, shifting our hemorrhage control paradigm from reactive to proactive, and subsequently improving time to both temporary and definitive hemorrhage control maneuvers.

Using DMAIC for in-plant logistic activities improvement

Goal: In-plant logistics activities are important for increasing the performance of the supply chains, so our research aims to study the application of Six Sigma tools for in-plant logistics activities in the cement industry. Our research contributes to the literature by developing a real case study that provides insights into the practical implementation of continuous improvement programs. Design / Methodology / Approach: This study uses the Industrial Case Study in a large cement plant, a branch of a multinational business group, in Brazil’s Middle-west region. This research applies Define, Measure, Analyze, Improve, Control (DMAIC) guidelines with Statistical Process Control tools for solving a real problem for out-control processes. From this, we propose an improvement plan to correct flaws in the in-plant cement loading and unloading process (in-plant logistics). Results: The results suggest that based on the control chart, the studied in-plant logistics activities were out of control. These processes exhibit a high variability, between 3σ and 5σ, presenting 26 problems with causes related to machine, measure, and human resources. An out-control action plan was proposed aiming for improvements to solve these problems. Limitations of the investigation: On the out-control action plan, this study presents an improvement proposal. The action plan does not fully develop the control step for DMAIC. Practical implications: Managers in the cement industry can use our case for insights and learning about improvement programs, especially for the in-plant logistics activities addressing processing-based manufacturing environments. Originality / Value: Our research contributes a real case study that applies the DMAIC methodology, with a specific focus on in-plant logistics activities. By developing the application of improvement programs within the cement industry, our study offers practical insights into how processing industries can effectively implement such programs.

Employee attitudes toward suicide prevention and Counseling on Access to Lethal Means: initial findings from an academic medical center implementing the Zero Suicide framework.

Zero Suicide is a strategic framework designed to transform a healthcare system's suicide prevention activities. In 2020, University of Utah Health launched a Zero Suicide program and Counseling on Access to Lethal Means (CALM) training for its employees. In 2022, the healthcare system surveyed its workforce's attitudes toward suicide prevention and CALM. We sought to evaluate employees' attitudes and behaviors toward suicide prevention and CALM training following the launch of the Zero Suicide program. A Zero Suicide Workforce Survey was administered online through REDCap to all University of Utah Health employees. The analytic sample included 3,345 respondents. We used two-portion z-tests to compare the proportions of respondents who (1) completed CALM training and (2) did not yet complete the CALM training because they felt it was irrelevant to their position by different employee characteristics. More than half of the respondents in the analytic sample were directly interacting with patients who may be at risk for suicide (57.6%). About 8.4% of the respondents had completed CALM training. Among those who had not yet completed CALM training, 9.5% indicated they did not think CALM was relevant to their job. Respondents knowledgeable about warning signs for suicide and respondents who were confident in their ability to respond when suspecting elevated suicide risk were significantly more likely to complete CALM training. This evaluation provides important insights from the workforce of a large academic medical center implementing a Zero Suicide program, including insights on opportunities for improving program implementation and evaluation.

Top five considerations for improving outcomes in black patients with heart failure: A guide for primary care clinicians

Black patients develop heart failure at younger ages and have worse outcomes such as higher mortality rates compared to other racial and ethnic groups in the United States. Despite significant recent improvements in heart failure medical therapy, these worse outcomes have persisted. Multiple reasons have been provided to explain the situation, including but not limited to higher baseline cluster of cardiovascular risk factors amongst Black patients, inadequate use of heart failure guideline directed medical therapy and delayed referral for advanced heart failure therapies and interventions. Strategic interventions considering social and structural determinants of health, addressing structural inequalities/ bias, implementation of quality improvement programs, early diagnosis and prevention are critically needed to bridge the racial/ ethnic disparities gap and improve longevity of Black patients with heart failure. In this review, we propose evidence-based solutions that provide a framework for the primary care physician addressing these challenges to engender equity in treatment allocation and improve outcomes for all patients with heart failure.

Madrasah Principal Management in Improving the Quality of Research Madrasahs

The research objectives are to (1) describe the planning of the research madrasah quality improvement program. (2) Describe the organization of the research madrasah program. (3) Describe the implementation of the research madrasah program. (4) Describe the supervision of the research madrasah program. The method used is the descriptive qualitative method. Data collection techniques through observation, interviews, and documentation studies. The research subjects were: the head of the madrasah, the deputy head, the research madrasah quality development team, supervisors, committees, teachers and accompanying teachers. Data analysis techniques through data reduction, data presentation, and drawing conclusions. The results showed: (1) Program planning was carried out at the beginning of the year through a working meeting with the madrasah head, deputy head, supervising teachers, supervisors and committees, the formation of a research class, the establishment of a curriculum, the preparation of a research madrasah program work plan. (2) Organizing is done by assigning tasks to teachers who have competence in the field of research, the establishing a research madrasah implementing structure, and the establishing of a quality development unit. (3) Carrying out according to schedule, the research carried out aims to grow students' knowledge, develop a culture of literacy, writing and has participated in several competitions held, such as the MYRES, KOPSI, LIPI, KTI MTs Istiqlal and Robotics events. (4) Supervision has not been carried out properly. This is because there is no special team that has the task as a unit to carry out supervision, and also there is no supervision schedule. The conclusions showed the implementation of this research madrasah quality improvement program is due to program implementation regulations, the commitment of the madrasah principal, the magnitude of student interest, the availability of facilities and infrastructure and the budget for program implementation.

Opportunities and Challenges in Implementing the Covid-19 Response Village Programme

This study evaluates the implementation of the Covid-19 Response Village Programme in Pulau Tiga Plantation Village, Aceh Tamiang District. The results show that the programme implementation has not run optimally because there are obstacles in several aspects. Firstly, in terms of communication, there is a lack of clarity and consistency of information regarding the prevention and control of Covid-19 delivered by the implementing officers. Secondly, limited human resources have an impact on the ineffective implementation of the prevention programme in this village, and can be seen in several activities that are not carried out optimally. In addition, the lack of facilities and infrastructure, especially the unavailability of a special isolation room, causes people who are positive for Covid-19 to undergo independent isolation in their respective homes. Local community participation is also still low in several prevention activity programmes carried out. To improve programme implementation, corrective measures need to be taken, including the preparation of clearer and more consistent information, increasing human resources involved in the programme, and providing adequate facilities for handling Covid-19. It is expected that with these corrective measures, the implementation of the Covid-19 Response Village Programme can run more effectively in protecting public health and reducing the risk of virus transmission in the village area.

Transforming agency in terms of improvement program implementation

This article aims to trace the history and development of agency theory in sociology, various approaches to the content of the term and the methodology of studying the phenomenon. Through the prism of transforming agency theory, the participation of residents in governmental, regional and municipal programs of public spaces improvement can be seen as a model action-structure. A hypothesis is put forward about the reciprocal influence of both components of this model on each other as a guarantee of the effectiveness of the improvement programs implementation. This assumption is verified on the basis of the information obtained during the quantitative stage of the study of the residents attitude to the implementation of improvement programs, which is currently being carried out on the territory of the Samara city district. The study applied result will be a set of recommendations for improving the mechanisms for implementing improvement programs.