Process Improvement Plans Research Articles

Финансовое планирование в процессе исполнения бюджета

Issues relating to process improvement and cash planning are relevant because they allow to identify the operational use of temporarily free budget funds and forward them to the provision of budget expenditures.

A Mixed-Methods Approach to Understanding Community Participation in Community Health Needs Assessments.

Nonprofit hospitals are exempt from paying taxes. To maintain this status, they must provide benefit to the community they serve. In an attempt to improve accountability to these communities and the federal government, the Patient Protection and Affordable Care Act of 2010 includes a provision that requires all nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address identified health priorities every 3 years. This Act's provision, operationalized by a regulation developed and enforced by the Internal Revenue Service, mandates the involvement of public health agencies and other community stakeholders in the completion of the CHNA. To better understand community participation in nonprofit hospital-directed community health assessment and health improvement planning activities. Using a 2-phased, mixed-methods study design, we (1) conducted content analysis of 95 CHNA/implementation plan reports and (2) interviewed hospital and health system key informants, consultants, and community stakeholders involved in CHNA and planning processes. Community participation was assessed in terms of types of stakeholders involved and the depth of their involvement. Our findings suggest that many hospitals engaged and involved community stakeholders in certain aspects of the assessment process, but very few engaged a broad array of community stakeholder and community members in meaningful participation throughout the CHNA and health improvement planning process. Vast improvements in community participation and collaborative assessment and planning can be made in future CHNAs. On the basis of the findings, recommendations are made for further research. Practice implications include expanding community engagement and participation by stakeholder and activity type and using a common community health improvement model that better aligns hospital CHNA processes and implementation strategies with other organizations and agencies.

Getting quality data back to frontline providers.

196 Background: Oncology quality performance metrics may be improved by establishing a coordinated process for getting data back to providers. However, establishing ownership of quality metric data can be a challenge, especially in a large, integrated health system. Methods: Aurora Cancer Care’s team developed quality charters and a coordinated process for its 15-hospital, integrated health system that outlines a course of action for metric selection, data distribution, peer review and development of process improvement plans. A weighted tool was developed and implemented to prioritize measure selection. The weighted tool described and scored each quality measure against its performance improvement opportunity, ease in data collection, national benchmarks, regulatory and reimbursement impact, value to the patient and consideration of the resources required to implement change. The final score was used to prioritize and select measures. The System Multidisciplinary Disease-Specific Quality Subcommittees established quality measures. Abstraction began, outliers were reviewed and results were disseminated to the System Cancer Leadership Council as well as the 15 hospitals via the Regional Cancer Quality Subcommittees (RCQS). The RCQS chairs and quality directors meet quarterly with the system quality liaison to ensure the communication of data back to the front-line providers. Results: We found a rise in the percentages of invasive rectal cancers diagnosed with endorectal ultrasound or magnetic resonance imaging (no stage IV) (2012: 76%, 2013: 84%) and treated with total mesorectal excision (no stage IV) (2012: 72%, 2013: 87%). In addition, increases in the examination of at least 12 regional lymph nodes for invasive colorectal cancer (2012: 93%, 2013: 98%; p<0.05) and partial, rather than total, nephrectomy for renal cancer patients with T1a tumors (2012: 71%, 2013: 95%; p<0.05) were statistically significant. Conclusions: Though our coordinated process to get quality data back to providers continues to evolve, our front-line providers have shown greater enthusiasm for the data, engaged in behavior modification and become more accountable with process improvement plans that are integral to establishing the best patient outcomes.

Anesthesia Quality and Safety

Anesthesia Quality and Safety

Improving Public Health Through State Health Improvement Planning

State health improvement plans (SHIPs) identify priorities for making the greatest impacts on health promotion and disease prevention, specific to the needs of state populations. Both SHIPs and the state health assessments on which they are based are prerequisites for Public Health Accreditation Board national accreditation. To identify and evaluate existing SHIPs to develop guidance to support health departments in the state health improvement planning process. In 2010, the Association of State and Territorial Health Officials (ASTHO) conducted a comprehensive search for existing SHIPs. A systematic evaluation of existing SHIPS was accomplished by means of primary source document review using a standardized data collection form. Using data derived from these SHIPs and guidance from a workgroup of practitioners, ASTHO developed the ASTHO SHIP Guidance and Resources (SHIP Guidance) Framework. The search yielded 25 states (49%) having a SHIP completed or in progress. Fifteen states (29%) had no SHIP but had a Healthy People plan, and 10 states (20%) had no SHIP or Healthy People plan. No information was available for 1 state. Findings were reviewed, evaluated, and incorporated into the SHIP Guidance. The SHIP Guidance provides a framework for the implementation, monitoring, and evaluation of a SHIP process using 12 key steps. As public health/health care integration and accreditation readiness activity grows, multisector engagement through a SHIP will continue to be a priority for state public health and improving health outcomes. The SHIP Guidance provides a systematic, flexible approach for states conducting or updating state health assessments and SHIPs.

Superintendents’ perceptions of the school improvement planning process in the southeastern USA

The purpose of this study of school improvement planning in the southeastern USA was to establish the current view of the process through the eyes of the district superintendents. The answers to the questions were consistently mixed. Generally, the presence of school improvement planning is prevalent in the large majority of districts. However, the data indicate a lack of fidelity to the process between superintendents’ beliefs regarding the process and how they perceive those tasked with development and implementation of the process. Given that school improvement planning is an internationally accepted process, the findings have implications not just for the USA but for international audiences as well. The authors make two recommendations: (1) significant further research into the effects of the process on student learning, and (2) continued research into the reasons for the lack of congruency indicated here between district expectations and school development and implementation.

Reducing Radiation Exposure in the Neonatal Intensive Care Unit: How a Process Improvement Plan Can Have Wide-Reaching Effects

PROBLEM Ionizing radiation has the potential to cause remote cancers, which represents a risk when using x-rays for medical diagnosis. It has been postulated that radiation exposure from diagnostic medical x-rays in the pediatric age group is significant [1]. Radiation exposure and the otential for radiation-induced cancers ave become an important patient afety issue with increasing public wareness. Radiation dose reduction re becoming an important part of raiology process improvement plans articularly in pediatrics [2, 3, 4]. Radition reduction was the main goal of a rocess improvement and patient afety plan initiated by the administraion and pediatric radiology staff at UNY Downstate Medical Center. he plan focused on the neonatal inensive care unit (NICU).

Study on Application of Process Analysis in Mechanical Processing Industry

This paper primarily makes an analysis and study on existing production processes adopted in production lines of mechanical processing industry, and adopts methods of process analysis and work analysis, principles of “ECRS”, 5W1H questioning and improvement analysis sheets and relevant techniques to perform detailed analysis on the existing production processes in respect of complicated process settings, unreasonable processes and other problems in processes of production. According to field observations and data collected, measures are proposed to solve such problems like low efficiency in material flows, waiting of parts, long hauling distance etc. and process improvement plans are made on basis of facilitating reasonable material flows and benefits maximization. The results of analyses and appraisals on new plans show the efficiency of production processes has been improved effectively, which will make it possible that enterprises reduce costs and enhance their competitiveness further.

Effective factors on sustainability of manufacturing processes, overcoming shrinkage in improved processes

Although process owners, theorists and scholars have various viewpoints about effective ways of improvement of processes, they have consensus on two important subjects. First, process improvement activities have an extraordinary effect on increasing efficiency and second, there are barriers against consistency and maintenance of current level of improved processes. In enterprise level, it is easier to talk about problems of sustainability of processes than suggesting a formula including related factors. In this article, an abstract is presented about findings of a broad study on companies executing process improvement plans. The study aims to recognize and analyze effective factors on sustainability of improved processes, using discriminate regression and a model for sustainable improved processes. To do this, using multi criteria decision making (MCDM) and experts’ viewpoints, effective factors on sustainability of process improvement activities are determined. Then, a sixteen-factor model resulted from experts’ viewpoints is applied in the form of questionnaires to gather the related data from 75 manufacturing processes in some major Iranian companies. In this analysis, the criteria include trends and percentage of improvements. Among the sustainability factors, a formal system for recording problems has the highest effect on discrimination of sustained processes (with a high ranking level from the experts’ viewpoints). In addition, documentation and standardization of processes are in the second level from both academic and industrial professionals' viewpoints. In sustainability of manufacturing processes in the aforementioned companies, a clear picture about necessity of improvement is in the third level (albeit, from experts’ viewpoint, it’s in the fifth level). As a result, some factors such as a list of daily problems of processes, clear perception of the necessity of improvement, process monitoring and standardization are selected as independent or predictive variables with a significant effect on discrimination of two sustainability groups (as dependent variables).

Reliability Study of High-Density EBGA Packages Using the Cu Metallized Silicon

The reliability of high-density enhanced ball grid array (EBGA) packages using the eight-layer Cu metallization silicon was discussed. The key failure mechanisms included the die cracking (in the vicinity of the edge) and thin film delamination. It was noticed that the failure was unique to the Cu metallization silicon. The large package body size (45 mm2) and the die size (approximately 15 mm2 ) provided additional manufacturing and reliability challenges. The die-edge defects induced during the wafer sawing process were exhibited to be the culprits of the die cracking and the thin film delamination failures. Additionally, the height of die attach fillets significantly influenced the stresses on the die edge, and the excessive fillet height was found to help extend initial cracks at the edge of the silicon. The results demonstrated the adoption of a dual-step wafer sawing scheme and resin blades would control the defects and reduce the failure rate dramatically. A mixture of low-stress encapsulation and die attach materials would help improve the overall reliability of the packages as well. The solder joint reliability of the package was very robust based on the board-level reliability testing results. The statistical analysis of the test results confirmed that most of the die cracking and thin film delamination failures were early-life failures and random. A good sample screening scheme and the process improvement procedure would help improve the reliability and insure the customer a low failure rate for the lifetime of the product. The predicted reliability of the package met the application life needs for the products with process improvement plans in place.

EFFECTIVE MANAGEMENT AND IMPLEMENTATION OF THE IMO-IPIECA REGIONAL OIL SPILL PREPAREDNESS AND RESPONSE PROGRAMME FOR CENTRAL & WESTERN AFRICA (GI-WACAF)

ABSTRACT The GI WACAF programme is led and funded jointly by the IMO and IPIECA members. Its purpose is to improve oil spill preparedness and response capability across 21 coastal states of West and Central Africa. Launched in 2006, this programme takes earlier IMO/IPIECA work forwards in a newly focused, structured and sustained manner to progress tangible change. The programme faces many challenges with rapidly increasing oil activities in the region and a generally low level of current preparedness; set against improvements needing to suit individual country circumstances and also be consistent and coordinated across the region. Reference is made in this Paper to the IMO'S strategy for oil spill preparedness and response (OPRC Convention 1990). Drawing these together, the six Key Elements of Preparedness, which underpin the GI-WACAF programme, are summarised. The GI-WACAF programme has a Project Coordinator, working under the guidance of the IMO and IPIECA funding members. An action plan was developed after consultation with government and oil industry representatives from the countries in the region, taking the six Elements of Preparedness and translating them into a workable plan for action and improvement. This Paper describes the programme management system and the key features critical to make tangible progress. These include Clarity of Purpose; Commitment from Key Stakeholders; a gap analysis on the Elements of Preparedness and measurable objectives; a Network of ‘Implementers’ and ‘Influencers at different levels of government and industry; follow-up and monitoring of results and achievement; and a Biennial Review to ensure process improvement and action planning. Through this refocused and business-like approach, demonstrate success is being achieved, and will be illustrated in the Paper. Every country and region has unique circumstances but the underlying principles of oil spill preparedness and response are common. This Paper has relevance for any organisation involved in change/improvement processes; both in setting programme objectives and in the essential programme management and implementation.

Investigating product development process reliability and robustness using simulation

This paper uses the design structure matrix to model and simulate the performance of product development processes. Although simulation is a powerful tool for analysing process performance, its ability is limited by the availability of accurate input information. Design structure matrix simulation requires process data that is hard to assess or estimate directly from development participants. In this paper, we propose a methodology that allows a more practical estimation of an important simulation input parameter: rework probability. Furthermore, we show how this assessment method (combined with simulation) allows managers to evaluate process improvement plans based on two resultant process measures: reliability and robustness. The method is illustrated with a real application from the automotive industry.

A practitioner’s guide to light weight software process assessment and improvement planning

Software process improvement (SPI) is challenging, particularly for small and medium sized enterprises. Most existing SPI frameworks are either too expensive to deploy, or do not take an organizations’ specific needs into consideration. There is a need for light weight SPI frameworks that enable practitioners to base improvement efforts on the issues that are the most critical for the specific organization. This paper presents a step-by-step guide to process assessment and improvement planning using improvement framework utilizing light weight assessment and improvement planning (iFLAP), aimed at practitioners undertaking SPI initiatives. In addition to the guide itself the industrial application of iFLAP is shown through two industrial cases. iFLAP is a packaged improvement framework, containing both assessment and improvement planning capabilities, explicitly developed to be light weight in nature. Assessment is performed by eliciting improvements issues based on the organization’s experience and knowledge. The findings are validated through triangulation utilizing multiple data sources. iFLAP actively involves practitioners in prioritizing improvement issues and identifying dependencies between them in order to package improvements, and thus establish a, for the organization, realistic improvement plan. The two cases of iFLAP application in industry are presented together with lessons learned in order to exemplify actual use of the framework as well as challenges encountered.

An investigation of the relationships between organizational factors, business process improvement, and ERP success

PurposeThe purpose of this paper is to present an empirical investigation into the relationships between the selected organizational variables, business process improvement (BPI) and enterprise resource planning (ERP) success.Design/methodology/approachIt is based on a sample of 96 firms operating in an Asian (Hong Kong) setting. Non‐parametric statistical tests are conducted on the sample.FindingsIt has found that the extent of BPI is positively related to ERP success, and senior management support of BPI (MSB), and senior management support of IT (MSI) and CEO‐IT distance are negatively related. However, it has also found that there exist no statistically significant relationships between approaches to business process changes and BPI, between MSI and ERP success, and between CEO‐IT distance and MSB. It has also yielded divergent findings for the impacts of CEO‐IT distance on the levels of senior MSI and MSB for the sub‐samples of firms of Western and Asian origin.Research limitations/implicationsThis research has produced empirical evidence in an Asian setting for some of the hypothesized relationships and pointed out that the impacts of certain organizational variables may differ across firms of different geographic (cultural) background. However, it is primarily empirical in nature and is weak in its theoretic underpinning to explain why these organizational variables are adopted in the study.Originality/valueThe findings of this study in an Asian setting add to those conducted in the West, and thus help fill the lacuna of research involving the variables relevant to ERP adoption.

A Study on Street Spatial Design and Effective Width on a Street Sidewalk

In a street design or improvement planning process, interactions between pedestrians and street environments should beconsidered at least implicitly, because they often become obstsuctions for pedestrians walking on the sidewalk. We have nostandani criterion or useful methodology how to design a sidewalk considering with a various environments, such as streetfurniture, sculptures, benches, and vegetations.We collected the data of pedestrians' spatial trajectories along a sidewalk from a field survey using videopicture. Also wedeveloped a visual database system for analyzing pedestrians' behavior efficiently. As a result of a careful observation andanalysis, we can see a pedestrians' trajectory has a tendency toward the center of sidewalk even if the pedestrians are undervarious conditions.'Effective width' as an existent factor of pedestrians' sidevvalk is insufficient for spatial street designconsidering with various street environments.

4.7.3 Assessing Requirements Engineering Processes with the REAIMS Model: Lessons Learned

AbstractOrganizations are becoming increasingly interested in improving their requirements engineering processes. The assessment of the current situation is the first step towards systematic process improvement. The REAIMS model (Sommerville et al. 1997) has been developed to evaluate the status of existing requirements practices. This paper describes an assessment process and two assessment instruments that can help organizations to use the REAIMS model. We evaluated the model, the process and the instruments by performing an assessment in three organizations. The results of the study indicate that the REAIMS model provides useful information for communication, motivation and process improvement planning. REAIMS assessment results are dependent on assessors, and are therefore not reliable for long‐term monitoring and benchmarking as such. A systematic assessment process such as the one described in this paper can improve reliability of assessment results.

PREOPERATIVE PREPARATION: Value, Perspective, and Practice in Patient Care

Preanesthesia preparation will continue to stimulate creativity and debate. Strategies for process improvement will take various shapes and require tools previously unfamiliar to many medical managers. At UNC Health System, anesthesiologists currently are committed to the centralized preanesthesia clinic approach used in PreCare. To date, their strategies have been validated by their institutional measures of success: a 0.7% first-case AM work-up rate, a 5% no PreCare visit rate, a 5% consent problem rate, and a 0% rejected specimen rate, with a 43% blood-draw rate for all patients. As their health system expands, however, other strategies and preparation modalities may become necessary. Telemedicine and Internet-dependent processes are appealing in the highly educated and technologically sophisticated marketplace. As the region becomes increasingly urbanized, local employment patterns prevent easy access to services, and functional compromises, such as bypassing PreCare or reliance on telephone or on-line interviews for preparation, may become necessary. The need to expand PreCare in the near future is already evident. As was found during initial planning, process improvement and space planning are enhanced by computer modeling. UNC Health System employed a proprietary animated simulation modeling (ASM) tool, MedModel, (ProModel, Orem, UT), although other techniques exist for the same purpose. Use of ASM as a strategy management tool allowed generation of ideal space-time-personnel scenarios that could expose potential problems before resources and physical restructuring occurred. ASM also can be used to compare data obtained from real-time observations to any reference scenario, including any that looks at economic measures of process, to help refine strategic visions before instituting tactical solutions. Used in this manner, ASM can reveal physical, temporal, personnel, and policy-related factors not otherwise seen as exerting effects on overall preprocedural preparation processes. Coupled with other classic planning techniques, such as time-motion studies, modified Delphi techniques, customer satisfaction surveys, benchmarking studies, and financial analysis and growth projections, ASM has helped enhance total quality management efforts in PreCare and other planning projects at UNC Health System. Other researchers have used other simulation techniques to assess clinic functions. Operational challenges that exist in preanesthesia preparation clinics place these clinics on the same level as other kinds of medical service clinics. The lessons learned in most clinic settings may be applied in a cross-wise manner to the preanesthesia clinic. Dexter contends that efficient delivery of care that respects patients' time and needs does more than assist the procedural preparation process; it also supports the physician's ethical obligation to the patient to give the best possible care. Documenting patient medical information, education efforts, and maintaining the medical-legal integrity of the preanesthesia preparation materials is another area of increasing concern and research. When hand-held computers capable of linking by way of infrared technologies or that use rented downloadable software to run specific applications become commonly used, the complexity of ensuring privacy will grow. The complexity, however, will not be insurmountable. Privacy problems exist in any information management system, whether paper-based (i.e., reducing redundant forms, eliminating indiscriminant photocopying of records), electronic-based (i.e., encryption, server access, system failure), or both. Electronic conveyance of medical information faces more legal and economic than technical hurdles. The penetration in US households of Internet services presently is less than 40%, whereas the penetration of personal computers is just over 50%. These figures are compared with penetration of corded telephones, televisions, and radios at levels greater tha

2 Integrating Human Factors within Systems Engineering

ABSTRACTThe need to re‐focus attention on Human Factors issues in Systems Engineering has recently taken fresh impetus in the UK, as the cost‐effectiveness of the human element in defence system procurement has been reconfirmed as a critical component in achieving fielded system success.British Aerospace Military Aircraft and Aerostructures (MA&A), in conjunction with the BAe Sowerby Research Centre, has for the past five years been engaged in activities aimed at ensuring that their Systems Engineering process improvement plans take full account of customer driven Human Factors Integration (HFI) requirements. These include the need to identify and manage all aspects of human involvement in the system lifecycle in order to ensure a balanced application of human and machine resources. The overriding aim being to optimise total system cost‐effectiveness.This paper reports the status of these activities and describes the background to this work, the goals of HFI, the BAe initiatives undertaken and gives a personal view of the way forward to the successful integration of HFI principles into systems engineering.

Integrating Public Transportation Facilities and Equipment Management Systems into Capital Improvement Planning Process

A Public Transportation Facilities and Equipment Management System (PTMS), as proposed in the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA), is a tool to assist in the management and utilization of transit facilities and equipment so as to ensure the efficient and effective use of resources. A framework for the application of PTMS elements in the public transit capital improvement planning process is proposed. By using a PTMS as a part of the capital planning process, broad concepts such as needs fulfillment and performance improvement may be embodied in a systematic process to program transit bus capital investments. With data from the Federal Transit Administration’s National Transit Database (NTD), the practical applicability of this framework is investigated in the context of the capital planning process employed by the regional transit authorities and the state transportation agency in Massachusetts. Vehicle replacement needs for a Massachusetts regional transit authority are estimated for a 5-year planning window using the NTD data in conjunction with predictive condition models. These models, developed by Purdue University and the University of Massachusetts at Amherst, use easily quantifiable and objective measures such as age and mileage to predict the future condition of a vehicle. NTD data are also used to identify opportunities for performance-based capital incentives among the Massachusetts regional transit authorities.

Multiperiod Highway Improvement and Construction Scheduling: Model Development and Application

A methodology is presented that emulates the transportation improvement planning process using mathematical optimization techniques. The scheduling problem is formulated as a mixed integer linear program (MILP) and can be considered as a multiperiod network design problem. The three primary model components are discussed: ( a) the input module in which the network, traffic demand, and pool of potential projects are identified over the planning horizon; ( b) the benefits estimation module using network travel time as the benefit criterion; and ( c) the schedule builder, an MILP that attempts to maximize the total benefits subject to annual resources and project precedence constraints. The proposed method is applied in a case-study context to the Lisbon metropolitan region’s network, a portion of Portugal’s highway network, and the results are discussed.