Quality Improvement Management Research Articles

Investigation of the build orientation effect on magnetic properties and Barkhausen Noise of additively manufactured maraging steel 300

Additive manufacturing allows the production of complex geometries with freedom for layers construction. Build orientation causes mechanical anisotropy and may affect the crystallographic structure enabling custom-tailored properties for the product. Despite the production advantages provided by the Powder Bed Fusion (PBF) process, some inherent defects, such as porosity and residual stress need monitoring to guarantee the agreement with the material application’s requirements. Thus, this study examined the magnetic properties and the residual stress of maraging steel 300 specimens built by PBF in three build orientations (XYZ, XYZ-45, and YZX). The Rowland Ring method enabled the assessment of the static magnetization curve and the quasi-static hysteresis loop. The Barkhausen Noise (BN) characterization followed the Design of Experiments (DOE) to investigate anisotropic effects in two perpendicular directions along the surface (φ = 0° and φ = 90°). Magnetic permeability, coercivity, remanence, and power loss changed according to the build orientations used in the PBF process, and possible reasons for these changes associated with the PBF process are discussed. Moreover, residual stresses evaluated by X-ray diffraction for the three build orientations correlated to BNrms with r = 0.99 when φ = 90°. The XYZ specimen revealed a compressive stress, which also decreased the BN intensity, though XYZ-45 and YZX presented tensile residual stresses. Thus, the Barkhausen Noise could be used to inspect the residual stress of parts produced by PBF with different build orientations, improving quality management.

Work Competency Standards as a Strategy for Company Operations Effectiveness

This study aims to provide awareness to company management in developing competencies for its employees. Coaching employees with relevant competencies can improve management quality standards. Based on the classification, this research is classified as applied research (Applied research) with qualitative data. Researchers provide a strategy for developing company quality by increasing the competence of personnel. The researcher triangulated the data by summarizing various scientific sources and related regulations, then validated it by filtering the opinions of management resource practitioners in the company. As a result, the company has effectiveness in developing the competence of its employees. SOPs that are collaborated with competency elements for each stage of operation guarantee the minimum standard quality of the products and services issued. Companies that do not increase their personnel capacity or quality will easily fall behind other companies. Further research is expected to have quantitative measurements so that they can prove the meaning of competency development in company profitability and efficiency

The 2020 annual report of DataDerm: The database of the American Academy of Dermatology

TheAmerican Academy of Dermatology launched DataDerm in 2016 as the clinical data registry platform of the American Academy of Dermatology. DataDerm is approved by the Centers for Medicare & Medicaid Services as a Qualified Clinical Data Registry for the Merit-Based Incentive Payment System. The ultimate purpose of DataDerm is to provide dermatologists with a registry and database that will serve as a vehicle to advance the specialty in the domains of science, discovery, education, quality assessment, quality improvement, advocacy, and practice management. DataDerm is currently the largest clinical registry and database of patients receiving dermatologic care in the world. As of December 31, 2019, DataDerm contained data from 10,618,879 unique patients and 32,309,389 unique patient visits. Depending on the reporting period, 800 to 900 practices (representing 2400-2600 clinicians) actively participate in DataDerm by submitting data. This article provides the first of a planned series of annual updates of the status of DataDerm. The purpose of this article is to present the rationale for the creation, maintenance, history, and current status of DataDerm, as well as the future plans for DataDerm.

Sustainable quality control mechanism of heavy truck production process for Plant-wide production process

To overcome disability and default in process quality control and failure of traditional quality management in job shop manufacturing and customised orders, which are important issues in lean production, we investigate a sustainable quality control of plant-wide production process. In this paper, we construct the mechanisms consisting of pre-production quality prevention, quality control of production process and post-production feedback, using modified turtle diagram and VDA-based evaluation model. After the application of the mechanism in a large heavy truck enterprise in Chine for three years, the average benefit of the enterprise reached 36.58 million yuan, the gross loss of the single after-sales service decreased by 37.4%, and the net loss decreased by 21.1%, which indicates improvement of capacity of sustainable development. Case above in our paper shows that the mechanism we put forward is effective and practical for continuous improvement of quality management and sustainable development of enterprises. Besides, it provides a further supplement to existing lean production theory.

Trends in the process and outcome indicators of type 2 diabetes care: a cohort study from Eastern Finland, 2012\u20132017

BackgroundEvidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland.MethodsThe data consist of all adults with type 2 diabetes (identified from the EHRs using ICD-10 codes) who used primary or specialized care services in North Karelia during 2012–2017. The diabetes care was evaluated using the measurement activity, treatment levels, and the achievement of the treatment targets for HbA1c and LDL as care indicators. Logistic and linear models with generalized estimating equations were used to assess the differences between years, sexes, and age groups.ResultsThe proportion of patients with annual measurement varied between 75.8 and 78.1% for HbA1c and between 67.4 and 69.1% for LDL during a five-year follow-up. The changes in average levels were moderate: a 0.2% (2 mmol/mol) increase for HbA1c and a 0.1 mmol/l decrease for LDL. Anyway, the proportion of patients meeting the treatment target for HbA1c decreased from 72.7 to 67.3% (age-adjusted decrease: 5.7%p, 95% CI: 4.5–6.9) and for LDL it increased from 53.4 to 59.5% (age-adjusted increase: 5.6%p, 95% CI: 4.2–7.0). Women were measured and met the HbA1c target level more often compared with men. Conversely, men met the LDL target level more often than women, and the age-adjusted difference between sexes increased smoothly from 7.9%p to 11.7%p.ConclusionsThe achievements in relation to type 2 diabetes care in North Karelia are very good, but no major improvement was observed during follow-up. HbA1c levels had a rising tendency and LDL levels declining tendency indicating quality improvement in LDL management, but challenges in further improvement in glucose control.

Medical Quality Control in a General Hospital Based on Plan-Do-Check-Act Cycle

Objective: There are many difficulties for health information management in large general hospital. The aim of this study is to provide an objective basis for better application of Plan-Do-Check-Act (PDCA) cycle quality management mode in the hospital medical quality control. Method: The PDCA cycle were applied in all the departments in a large general hospital. The main evaluation indicators before and after application of PDCA was compared and comprehensively analyzed. Result: The main evaluation indicators in various departments can reflect the differences before and after application of PDCA. After the application of PDCA, the main evaluation indicators were improved in all the departments (P < 0.05). The improvement of doctor's theoretical knowledge level and the medical quality basic indicators compliance rate need the continuous application of PDCA for at least one year. Conclusion: The perfection of PDCA can promote continuous improvement of medical quality management in various departments, so as to improve the hospital medical quality.

Medical Quality Control in a General Hospital Based on Plan-Do-Check-Act Cycle

Objective: There are many difficulties for health information management in large general hospital. The aim of this study is to provide an objective basis for better application of Plan-Do-Check-Act (PDCA) cycle quality management mode in the hospital medical quality control. Method: The PDCA cycle were applied in all the departments in a large general hospital. The main evaluation indicators before and after application of PDCA was compared and comprehensively analyzed. Result: The main evaluation indicators in various departments can reflect the differences before and after application of PDCA. After the application of PDCA, the main evaluation indicators were improved in all the departments (P < 0.05). The improvement of doctor's theoretical knowledge level and the medical quality basic indicators compliance rate need the continuous application of PDCA for at least one year. Conclusion: The perfection of PDCA can promote continuous improvement of medical quality management in various departments, so as to improve the hospital medical quality.

Does Organisational Climate Improve Quality Management Practice? Empirical Evidence from Egyptian Higher Education

This study investigated the influence of organizational climate on quality management practices in Egyptian public universities. The study used a quantitative research design method. The sample consists of 150 respondents selected through both stratified sampling and simple random sampling to get a real population representation and minimization of the sampling bias. The research used the questionnaire as an instrument that involved 23 items, distributed to four disciplines: staff freedom, resource adequacy, decision making participation, and quality management practice for data collection by the researcher. The instrument was validated by experts from the Department of Education, Utara Malaysia University, through the face and content validation. Data collected were analyzed using Structural Equation Modelling (SEM) which was employed for data analysis method through AMOS statistical software based on the parametric SEM in AMOS 22.0. Findings from the study revealed that resource adequacy has a significant and positive effect on quality management practices. Meanwhile, decision-making participation has no significant effect on quality management practices. Furthermore, the study indicates that male academic staffs have a significantly higher level of organizational climate than female academic staffs in the Egyptian Higher institution. It was recommended that the university management systems be developed and it is the climate in the light of quality management stander and giving academic staff a clear role in expressing their opinion as conducting discussion plans on decision making with the participation of all employees' levels at the university.

Human health risks associated with multipath exposure of groundwater nitrate and environmental friendly actions for quality improvement and sustainable management: A case study from Texvalley (Tiruppur region) of India

The present research was attempted to examine the human health risks due to nitrate contamination in the groundwater of Texvalley (Tiruppur region) of southern India. Groundwater samples (n = 40) were picked up from open wells (shallow aquifer) and tube wells (deep aquifer) during January 2020, and laboratory examination was conducted for various major physicochemical constituents. Nitrate concentration varied from 10 to 290 mg/l with a mean of 83.45 mg/l. About 58% (n = 23) of the wells exceeded the recommended limit (>45 mg/l) of World Health Organisation, which spread over an area of 335.16 km2. Among this, 45% of the samples (n = 18) represented shallow aquifers (depth < 15 m), and 13% of them (n = 5) represented deep aquifers (depth > 15 m). Synthetic fertilizers, cow dung and sheep manure, industrial discharge, septic tank leakage and municipal solid waste disposal are the major sources of nitrate pollution in this region. The USEPA health risk assessment model was applied in this study to assess hazard quotients (HQ) according to the NO3− exposure in various age groups of inhabitants through two different pathways such as drinking (HQoral) and skin contact (HQdermal). Eventually, total hazard index (THI) was obtained for all the groundwater samples for different age groups. According to THI, 87%, 78%, 66%, 60%, 56% and 48% of the samples contain health risks (THI >1) for infants, kids, children, teens, adults and aged people, respectively. The study finally recommended seven environmental friendly actions for the groundwater quality improvements and for the sustainable health management.

Cost Estimation Methods in Quality Management and Continuous Improvement

This paper investigated cost estimation methods and continuous improvement in terms of project management planning, as well as the factors that influenced these actions. Estimating the cost was one of the most imperative tasks to be done by the managers for a project. Key factors, such as cost, size, schedule, quality, people resources, maintenance costs, and complexity, were usually estimated in the beginning of project development. The techniques used for cost estimation included data composed from past projects that were combined with mathematical formulae to get the closest estimation. In regards to continuous improvement, the four-step quality model (PDCA cycle) was used as an ongoing effort to improve products or services. PDCA stands for plan, do, check, and act, which were the steps to successfully implement change. Notably, project management, when tasked with cost estimation and continuous improvement, was challenged to cope with evolving and situational alterations, which required a different set of skills.

Knowledge level of beneficiary farmers of ATMQIC regarding cultivation practices of Rabi crop demonstrations in Jaipur district of Rajasthan

Agriculture Technology management Quality Improvement Center (ATMQIC)project of Rastriya Krishi Vikas Yojana was started in Shri Karan Narendra Agriculture University, Jobner to provide a ‘single window’system for farmers. Keeping in view the facts the study was conducted in three selected villages of Jaipur district of Rajasthan and 120 respondent farmers were selected from these three selected villages through proportional allocation to the size of the population.The knowledge of ATMQIC beneficiary farmers was measured and found that majority of respondents (74) of ATMQIC (61.67 %) belonged to middle level of knowledge categories, followed by high (15.83 %) and low ( 22.50%) knowledge categories of respondents of ATMQIC about rabi crop demonstrations. The Rabi crop wise findings of the study indicated that majority of respondents of ATMQIC were found to have adequate knowledge regarding cultivation techniques of Barley crop followed by wheat, mustard and fenugreek crops.

Implementation of Educational Policy in Indonesia

One of the goals of the state is to educate the nation. Education is the right of every Indonesian citizen regardless of social status, economic status, ethnicity, ethnicity, religion, and gender. ‘Education for all’ ensures educational services are provided for students who have physical or mental barriers, economic and social barriers or geographical barriers. In the era of regional autonomy the strategic policies adopted by the Directorate General of Primary and Secondary Education related to education policy are: (1) management of school-based quality improvement; (2) education based on community participation (community-based education); (3) using learning paradigms or learning paradigms; (4) the Government also plans education based on Broad Base Education System (BBE). The policy implementation process can only begin if the goals and objectives that were originally general in nature have been detailed, action programs have been designed and a number of funds/ costs have been allocated to realize these goals and objectives.&#x0D; Keywords: implementation, educational policy, Indonesia

Strengthening the clinical laboratory workforce in Cambodia: a case study of a mixed-method in-service training program to improve laboratory quality management system oversight

BackgroundLaboratory diagnostic testing service delivery and compliance with international standards for laboratory quality are directly influenced by laboratory workforce competency. Many hospital laboratories in constrained resource settings such as Cambodia struggle to cope with the training needs of laboratory professionals in an environment of competing healthcare development priorities. Resource-limited countries need an adaptable and effective approach to provide laboratory professionals with job-specific quality oversight training to ensure the accuracy, timeliness, and reliability of diagnostic services.Case presentationHere, we describe the results of an in-service training and mentoring program conducted with the Cambodia Ministry of Health at 12 tertiary-level hospital laboratories to drive improvements in laboratory quality management systems toward ISO 15189 accreditation, which demonstrated significant progress between baseline and outcome audits in a concurrent study. This case study describes the program, and evaluates how the four primary activities, including actionable gap assessments and planning, centralized and in situ training curriculum, in-person mentoring, and remote tele-mentoring via video communication technologies, contributed towards quality improvement in the participating laboratories. We evaluated participant responses to Likert scale and free response questions from program and training evaluation surveys, and we used thematic analysis to develop a model of best practices within the program’s four primary activities to inform future training approaches. Of these activities, participants agreed most highly that in-person visits and planning based on gap assessments contributed to their learning and ability to improve laboratory operations. Tele-mentoring was rated lowest by participants, who were critical of excessive group dialogue and distraction during web-conferencing; however, feedback suggests both in-person and remote mentoring contribute to continuing education, accountability to action, and peer collaboration and problem solving to improve workforce efforts toward improved quality management systems.ConclusionsWe recommend here a package of in-service training activities for laboratory quality management system improvement initiatives in resource constrained settings that includes needs-based curricula and personalized action plans for participants; interactive and on-site training workshops; and in-person mentoring, complemented with well managed and regular tele-mentoring that focuses on knowledge retention, accountability to goals, and collaborative problem solving. Our model presents an adaptable approach to human resource development for quality improvement in medical laboratories.

Improving Public Sector Management at Scale? Experimental Evidence on School Governance India

We present results from a large-scale experimental evaluation of an ambitious attempt to improve management quality in Indian schools (implemented in 1,774 randomly-selected schools). The intervention featured several global “best practices” including comprehensive assessments, detailed school ratings, and customized school improvement plans. It did not, however, change accountability or incentives. We find that the assessments were near-universally completed, and that the ratings were informative, but the intervention had no impact on either school functioning or student outcomes. Yet, the program was perceived to be successful and scaled up to cover over 600,000 schools nationally. We find using a matched-pair design that the scaled-up program continued to be ineffective at improving student learning in the state we study. We also conduct detailed qualitative interviews with frontline officials and find that the main impact of the program on the ground was to increase required reporting and paperwork. Our results illustrate how ostensibly well-designed programs, that appear effective based on administrative measures of compliance, may be ineffective in practice. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

IMPLEMENTASI MANAJEMEN MUTU PUSKESMAS TERHADAP KOMITMEN PEGAWAI DALAM MEWUJUDKAN PRODUKTIVITAS KERJA

To guarantee that quality improvement, performance improvement and application of risk management carried out continuously at Public Health Center (Puskesmas), external assessment is required by using established standards, that is through the accreditation mechanism. This study aims to determine the effect quality management of Public Health Center to employee commitment in realizing productivity performance. The recent implementation of Public Health Center accreditation is used as an implementation of Public Health Center quality management with expectations can improve the quality of health services. However, there are several studies say that accreditation has no effect on improving the quality of Public Health Center. The number of samples used was 32 respondents. The data obtained were analyzed using PLS (Partial Least Square) analysis techniques through SmartPLS 3.0 softwere. The results showed that the accreditation of Public Health Center for Individual Health Work Group (Pokja UKP) significantly negative related to organizational commitment, the accreditation of Public Health Center for Individual Health Work Group (Pokja UKP) significantly positive related to performance productivity and then organizational commitment significantly negative related to performance productivity.Keywords: accreditation of Public Health Center (Puskesmas), Individual Health Work Group (Pokja UKP), Employee Commitment, Productivity Performance.

品質マネジメントの改善・発展・活用の道 ～中小企業のQMS モデルの研究～

品質マネジメントの改善・発展・活用の道 ～中小企業のQMS モデルの研究～

Understanding resistance in lean implementation in healthcare environments: an institutional logics perspective

While lean thinking has been used in healthcare for almost two decades, its efficacy has been debated extensively by researchers and practitioners alike. This ongoing debate is largely due to the varied results of its implementation; and resistance to change is considered to be the primary reason behind this variation. This study adopts an institutional logics perspective to analyze the nature of this resistance by drawing attention to how clinical staff make judgements about the appropriateness, acceptability and legitimacy of lean thinking. To conceptualize resistance, a systematic literature review based on 33 published studies depicting lean implementations was conducted, which helped to develop a nuanced understanding of resistance and its causes. Subsequently, 47 semi-structured interviews were undertaken with Quality Improvement managers regarding their experience with implementing lean thinking in 15 New Zealand District Health Boards. These interviews were used to identify and evaluate strategies used to minimize resistance within the implementation of lean initiatives in healthcare organizations. The findings of this research suggest that typically there are three strategies adopted by quality improvement managers—(1) communication strategies to create a better narrative for lean implementation; (2) cooperation strategies, which encourage the adherents of lean and medical logics to work together on shared problems, creating opportunities for them to learn about other logics; and (3) performance management strategies with the help of incentives and commitment devices to create a supportive environment for lean implementation. Together, these strategies work to improve the availability, accessibility, and activation of lean thinking logic in healthcare.

Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula

Background/PurposeThis study evaluated compliance with a multi-institutional quality improvement management protocol for Type-C esophageal atresia with distal tracheoesophageal fistula (EA/TEF). MethodsCompliance and outcomes before and after implementation of a perioperative protocol bundle for infants undergoing Type-C EA/TEF repair were compared across 11 children's hospitals from 1/2016–1/2019. Bundle components included elimination of prosthetic material between tracheal and esophageal suture lines during repair, not leaving a transanastomotic tube at the conclusion of repair (NO-TUBE), obtaining an esophagram by postoperative-day-5, and discontinuing prophylactic antibiotics 24 h postoperatively. ResultsOne-hundred seventy patients were included, 40% pre-protocol and 60% post-protocol. Bundle compliance increased 2.5-fold pre- to post-protocol from 17.6% to 44.1% (p < 0.001). After stratifying by institutional compliance with all bundle components, 43.5% of patients were treated at low-compliance centers (<20%), 43% at medium-compliance centers (20–80%), and 13.5% at high-compliance centers (>80%). Rates of esophageal leak, anastomotic stricture, and time to full feeds did not differ between pre- and post-protocol cohorts, though there was an inverse correlation between NO-TUBE compliance and stricture rate over time (ρ = −0.75, p = 0.029). ConclusionsCompliance with our multi-institutional management protocol increased 2.5-fold over the study period without compromising safety or time to feeds and does not support the use of transanastomotic tubes. Level of EvidenceLevel II. Type of StudyTreatment Study.

Quality Standards in Online Education: The ISO/IEC 40180 Framework

As higher education institutions (HEIs) make growing use of online education, enhancing and ensuring quality in online education (QOE) have become increasingly important for their competitiveness. Researchers and both national and international organizations have developed a variety of models, frameworks and guidelines for QOE. However, selecting from these a holistic quality framework that meets the needs and requirements of HEIs is challenging. This study reviews current QOE frameworks, guidelines and benchmarks used in diverse contexts, with reference to an analysis of 72 publications between 2000 and 2019, then introduces the ISO/IEC 40180 framework for quality assurance, quality management and quality improvement in IT-enhanced learning, education and training. The findings show that while no holistic quality framework for open education exists currently, ISO/IEC 40180 is a flexible and adaptable framework for revolutionary organizational change, meeting the needs of multiple stakeholders of educational organizations at the macro, meso and micro levels. Therefore, HEIs seeking to foster growth, competitiveness and international recognition are advised to consider adopting the ISO/IEC 40180 framework, which should be integrated into national quality education standards.

Adaptation and Piloting for Hospice Social Workers of Aliviado Dementia Care, a Dementia Symptom Management Program.

Forty-five percent of hospice patients currently have a primary or secondary diagnosis of Alzheimer's disease or related disorders. However, few programs have focused specifically on assisting hospices in providing evidence-based symptom management to persons living with dementia (PLWD). To adapt and pilot the training component of Aliviado Dementia Care, a dementia symptom management quality improvement program originally developed for home healthcare, for use by social workers as part of the hospice interdisciplinary team. A prospective pre-post design was utilized, measuring knowledge, confidence, and attitudes at baseline, and immediately and 1-month post-training. Analysis was performed using paired t-tests and repeated measures ANOVA. Hospice social workers currently practicing in the United States with at least 1 year of experience. The Dementia Symptom Knowledge Assessment and a post-training continuing education evaluation form. Forty-six subjects were enrolled, of whom 26 completed the first post-test and 23 both post-tests. There was a poor baseline level of knowledge and confidence in caring for PLWD. Significant improvements occurred following training, particularly in implementing non-pharmacologic interventions for behavioral and psychological symptoms of dementia (BPSD) (16.64% increase, p < .0001) and confidence in managing behavioral symptoms (16.86%, p = .01) and depression (25.18%, p < .0001). Changes were maintained over time. All respondents were either very satisfied or satisfied with the quality and content of the program. The training modules of Aliviado Dementia Care were successfully tailored for use by hospice social workers, showing significant improvement in knowledge and confidence in caring for behavioral symptoms in PLWD. Future work will examine whether the larger program, including this training, can subsequently improve patient outcomes in hospice.