Quality Improvement Model Research Articles

Primary healthcare planning, bottleneck analysis and performance improvement: An evaluation of processes and outcomes in a Nigerian context

Operational planning of interventions defines roadmaps, timelines and resources necessary for translating policies into expected health outcomes along the evidence-policy-implementation continuum. However, bottlenecks often hinder the attainment of objectives and the timely delivery of intervention packages leading to sub-optimal performance of health systems. Bottleneck identification, analysis and removal approaches to planning, which requires key stakeholders’ participation, have been recommended to improve health system outcomes in LMICs. This study demonstrates how integration of participatory action research (PAR) within a quality improvement model can help navigate the complexities of health system bottleneck analyses, planning and performance improvement in a Nigerian sub-national context.The study is based on data collected between June 2016 and June 2017, from Chikun LGA in Kaduna State Nigeria. PAR was integrated into a quality improvement model called DIVA (Diagnose-Intervene-Verify-Adjust) applied across selected interventions (eMTCT, Antenatal care, skilled birth attendance, immunization and Integrated Management of Childhood Illnesses). PAR was used to identify and analyse health system bottlenecks, as well as develop, monitor implementation and follow-up on action plans to address them. Evaluations were conducted involving 2 cycles of DIVA. The outputs (bottleneck analysis charts, driver diagrams, operational plans, M/E reports, etc.) from each cycle of the DIVA process were collated and analysed. Bottlenecks identified include availability of human resources for health, availability of health commodities as well as geographical accessibility. These had implications on acceptability and quality of services. Mean Improvements recorded were 20.4%, 14.0% and 10.8% and 11.2%, 7.5%; 5.5% (across eMTCT, maternal health and child health interventions) in the 1 st and 2nd DIVA cycles respectively. This study highlights processes and outcomes of integrating PAR in quality improvement design and operations in health intervention programmes with a focus on health systems strengthening in a Nigerian context. Implementing the DIVA model using a PAR approach may be considered an effective strategy for planning and implementing health interventions in comparable settings.

Using a quality improvement model to enhance community/public health nursing education.

Population-focused practice is an essential component of baccalaureate nursing education. The specialty of community/public health nursing (C/PHN) emphasizes prevention and focuses on the multiple determinants of health to improve population health outcomes. This project addressed two problems. How to: (a) Standardize C/PHN education by utilizing a set of competencies, and (b) Evaluate learning outcomes after using the competencies. As collaborative team applied community/public health competencies to nursing education using the Omaha System and the four phases of the Quality Improvement Model (QIM) and to enhance C/PHN education. The QIM focused on team-based participation with mutual learning and engagement for both students and faculty. Logical thinking and continuous assessment improves the teaching process and prepares students to work in multiple health care environments. Systematic quality improvement enhances population-focused care by providing a foundation for the integration of education and practice.

Using a multisite and multi–health system pharmacy resident program model for care documentation quality improvement

ObjectivesTo implement and evaluate a pharmacy resident documentation peer review process. SettingThe University of Minnesota Postgraduate Year One Pharmacy Residency Program is a multisite program with 25 residents across 16 different health care organizations. Practice descriptionSites within the program provide comprehensive medication management (CMM) services to patients in ambulatory care settings, including participation in the full patient care process of assessment, care plan development, follow-up, and appropriate documentation. Practice innovationIn this innovative peer review process model, residents undergo a deidentified CMM documentation review process with residents from other practice sites, exposing them to different documentation templates and perspectives. EvaluationA workgroup of residency preceptors led by a research team developed a peer review process, which evolved through 3 phases over 2 years in response to resident, preceptor, and administration team feedback. Resident feedback was compiled and analyzed. ResultsForty-two residents responded to the survey (67% response rate); 71% found the review process to be helpful. Residents reported that the process improved their understanding of how to improve patient care documentation (74%), how to provide peer feedback (90%), and the importance of effective interprofessional communication in clinical decision making (81%). DiscussionThe core perceived benefit of the peer review process was exposure to how other health systems and practitioners document CMM. Some residents participate in a peer review process at their home institutions, which may explain some of the lack of perceived benefit. Generalizability of this study is limited by being within a single residency program with a relatively small number of participants. ConclusionPharmacy residents found a peer review process of documentation to be helpful during their residency education. The process exposed residents to different documentation practices at various health care systems, which led to ideas of how to improve documentation and provided a foundation for how to provide peer feedback in practice.

Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co‐production in an atrial fibrillation “learning café”

BackgroundAn improvement initiative sought to improve care for atrial fibrillation (AF) patients; many felt insecure about how to cope with AF.ObjectiveTo reveal AF patients' and professionals' experiences of pilot‐testing a Learning Café group education programme, aimed at increasing the patients' sense of security in everyday life.DesignUsing an organizational case study design, we combined quantitative data (patients' sense of security) and qualitative data (project documentation; focus group interviews with five patients and five professionals) analysed using inductive qualitative content analysis.SettingAF patients and a multiprofessional team at a cardiac care unit in a Swedish district hospital.Improvement activitiesTwo registered nurses invited AF patients and partners to four 2.5‐hour Learning Café sessions. In the first session, they solicited participants' questions about life with AF. A physician, a registered nurse and a physiotherapist were invited to address these questions in the remaining sessions.ResultsAF patients reported gaining a greater sense of security in everyday life and anticipating a future shift from emergency care to planned care. Professionals reported enhanced professional development, learning more about person‐centredness and gaining greater control of their own work situation. The organization gained knowledge about patient and family involvement.ConclusionsThe Learning Café pilot test—exemplifying movement towards co‐production through patient‐professional collaboration—generated positive outcomes for patients (sense of security), professionals (work satisfaction; learning) and the organization (better care) in line with contemporary models for quality improvement and with Self‐Determination Theory. This approach merits further testing and evaluation in other contexts.

Assessing geriatric capacity building needs in public hospitals in Mexico.

To conduct a needs assessment of public hospitals in Mexico to determine workforce specific capacity building needs in thecare of older people. The older population in Mexico is growing rapidly. The healthcare system and workforce may not be prepared to handle the needs of older people, especially those with chronic illnesses who are also disadvantaged socioeconomically. Determining workforce and system needs is important to strategically develop capacity. A needs assessment using a pragmatic qualitative approach structured this study. Semi-structured interviews and focus groups were conducted with healthcare professionals at five public hospitals in Mexico. Directed content analysis techniques analysed the data. Ninety-two healthcare professionals participated in the study. Three themes emerged, including geriatric service delivery, social changes and human resources for health. Participants reported a lack of gerontology knowledge and related clinical skills deficits to provide care for hospitalised elders and expressed emotional distress related to the lack of resources in their institutions. All healthcare professionals expressed strong concern at the social toll the ageing population had on families. The support of government organisations emerged as a facilitator for adoption of geriatric care principles. This qualitative study uncovered important data to inform the implementation of quality improvement and capacity building models for older people care in Mexico. There appears to be strong potential for a culturally appropriate translation of high-income country older people care models within the Mexican healthcare context. Findings suggests there is a need to increase geriatric capacity building among helathcare professionals in Mexico. This will be an important step in improving care for hospitalised older people.

Purposeful Hourly Rounding by Nurses: A Best Practice Implementation Project

Purpose: The project aimed to improve the patient satisfaction and safety through implementation of purposeful hourly rounding by nurses. Materials and Method: The FADE Quality Improvement model was used to guide the process. A video assisted training programme was developed about purposeful hourly rounding protocol. Direct observation of staff nurses was done followed by training programme to assess timeliness and utilization of a protocol when rounding. A follow-up audit was conducted to determine compliance with the same criteria. For the project aim, pre- and post-intervention data related to nursing sensitive elements of patient satisfaction and safety was compared. Results: The purposeful hourly rounding concept was selected for implementation because it is evidence based practice and appeared to be beneficial in all IPD wards. The video assisted training programme was presented to all nurses working in wards. Nurses expressed appreciation that they were consulted, trained and their feedback was incorporated into tool before it was implemented. Resources needed to implement the protocol were identified and those were provided. Conclusion: Nurses have the ability to improve patient satisfaction and patient safety outcomes by utilizing purposeful hourly rounding concept which serves to improve patient communication and staff responsiveness. Having supportive resources, structured approach and involving all levels of staff, to meet patient needs during their hospital stay was a key factor for success.

Application of Kaizen Principles to a Large Cochlear Implant Practice: A Continuous Quality Improvement Initiative at Mayo Clinic.

To remove barriers and improve access for patients seeking cochlear implantation. Prospective quality improvement study at a large tertiary academic care center. A Kaizen quality improvement model was applied over the course of a year. Four weeklong meetings were used to identify areas for improvement and remediation. Data were collected at baseline, 90-days, and 1-year postcompletion of the project. Outcome measures included lead times, defined as the wait time between first contact with the clinic and the first appointment, and the wait time between surgery and activation, and cycle times defined as the total test time needed to determine cochlear implant candidacy, and total time needed to complete initial activation. The total inventory kept as clinic stock was also calculated RESULTS:: Kaizen team members collected data for each outcome measure. After the Kaizen principles were applied, the following outcomes were observed: median lead times between first contact with the clinic to candidacy testing, candidacy testing to surgery, and surgery to activation of the implant remained stable from baseline to 1-year follow-up. Median cycle time for candidacy testing decreased from 7.3 hours at baseline to 3.0 hours at 1-year follow-up. Cycle times for initial activation of the device did not change over time. The total inventory of clinic stock was reduced by 31%. Though outcomes for lead and cycle times varied, implementation of Kaizen principles was found to be an effective method for completing this quality improvement project at a large cochlear implant program overall. 3a.

Real Time Power Quality Improvement Model for North West General Hospital (NWGH)

Real Time Power Quality Improvement Model for North West General Hospital (NWGH)

Multidisciplinary Effort to Decrease Time From Admission to Chemotherapy on an Inpatient Oncology Unit.

There are no national standards for time between patient arrival and the initiation of scheduled chemotherapy (time to chemotherapy [TTC]). Delays in this process have a negative impact on patient care and the use of health care resources. At the University of Virginia Cancer Center, mean TTC in 2015 was 12.1 hours and mean length of stay (LOS) was 5.45 days at baseline. We formed a multidisciplinary team that participated in ASCO's Quality Training Program. We aimed to improve TTC by 10% over 6 months. We used Plan-Do-Study-Act (PDSA) cycles as quality improvement (QI) models and used XmR charts to evaluate the interventions. The first PDSA cycle involved amending the chemotherapy consent process; mean TTC and LOS improved to 9.3 hours and 4.65 days, respectively. The second PDSA cycle involved shifting pharmacist review of chemotherapy orders to before admission rather than after patient arrival. Mean TTC remained at 9.4 hours (net 22% improvement from baseline) and LOS improved to 4.33 days (net 21% improvement). Our team surpassed the 10% improvement goal for TTC. This QI project faced a few limitations. Our baseline data set was a retrospective cohort review. In addition, oncology patients have a wide range of individual clinical needs that may have an impact on TTC. Delays in TTC have an impact on oncologic care at many medical centers. Our project highlights the need for guidance on this issue. We recommend that other institutions form multidisciplinary teams and also use QI tools to assess delays and implement changes.

An SVC based Power Quality Improvement Model for Consumers Connected to Weak Busses in Distribution Systems

Power quality is a major concern considering weak bus systems. In order to improve power quality, residential consumers go with voltage stabilizers as a cheap solution consequently overstressing weak busses. Industrial consumers use other alternatives like switched capacitor banks to cope with low power factor but the limitation is step-wise reactive power injection which does not meet the changing load requirements. Real time improvement requires constant monitoring and real-time injection of Volt-Ampere-Reactive (VAR) which is possible with the help of a Static VAR Compensator (SVC). An SVC based Power Quality Improvement (PQI) is proposed in this paper which addresses the real time varying reactive VAR requirement with reduced harmonic content.

Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting

ObjectiveTo describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. DesignProspective cohort quality improvement project. SettingEighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. ParticipantsPatients admitted to ACIR between December 2015-November 2016 (N=788). InterventionsAn interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. Main Outcome Measures(1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. ResultsThe adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001). ConclusionsImplementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.

NewSTEPs: A model for continuous quality improvement in newborn screening programs

NewSTEPs: A model for continuous quality improvement in newborn screening programs

Implementation of a Comprehensive Diabetic Foot Exam Protocol in Rural Primary Care

Background: Patients with type-2 diabetes mellitus have an increased risk for foot ulcerations and lower extremity amputations. Evidence-based practice guidelines recommend annual foot screening at least yearly for patients with type-2 diabetes. Comprehensive foot exams that include assessments for loss of protective sensation and peripheral artery disease prove beneficial in reducing morbidity and decreasing the incidence of diabetic foot ulcerations. Despite the known benefits of preventive screenings, a limited number of rural providers adhere to well-established treatment guidelines for patients with type-2 diabetes. Purpose/Aim: The purpose of this quality improvement project was to increase the number of comprehensive foot examinations for adults with type-2 diabetes mellitus in rural primary care. The overarching aim was that 75% of adult patients with type-2 diabetes would consistently experience a comprehensive foot exam and risk assessment within 15 weeks of project initiation. Methods: The quality improvement project design involved the introduction of a comprehensive diabetic foot exam protocol in four Rural Health Clinics. Utilizing the Plan-Study-Do-Act quality improvement model, retrospective data was collected from 60 patients to evaluate the percent of patients with type-2 diabetes that received a foot exam in 2017. Educational programs were presented to primary care providers and clinic nurses to introduce the protocol. The project implementation occurred as a 1-week pilot in one Rural Health Clinic then system-wide for 14 weeks. Results: The retrospective data revealed 42% of patients with type-2 diabetes received a foot exam in 2017. All primary care providers and clinic nurses attended educational sessions on screening guidelines and protocol introduction. Following the 15-week project, 68% of patients with type-2 diabetes experienced a comprehensive foot exam and risk assessment. Conclusions: Implementation of a clinically relevant tool in rural primary care resulted in significant improvement in primary care provider adherence to recommended diabetes foot screening guidelines. Keywords: Type-2 Diabetes, Rural, Adults, Foot Exam, Guidelines DOI: https://doi.org/10.14574/ojrnhc.v19i1.560

Development of a Quality Improvement Curriculum in a Pediatric Emergency Medicine Fellowship.

Quality improvement (QI) is a science of systematic analysis and improvement of health care delivery systems. Working knowledge of QI models is imperative to professional development of future pediatric emergency medicine practitioners. The Accreditation Council for Graduate Medical Education has established a list of QI and patient safety expectations for trainees. In order to address educational needs in this area, we have created a novel QI curriculum for pediatric emergency medicine fellows that include didactic sessions, active participation in QI projects, and mentorship by QI faculty. As a part of the curriculum, fellows are required to participate in variety of QI and patient safety activities, such as Morbidity and Mortality conferences, QI and Patient Case Review committees, and Clinical Care Guideline work groups. As a measure of success, fellows who have participated in this curriculum have shared their successful QI work at the local and national levels. This goal of this report is to share our experience in order to provide other institutions a framework for their own curriculum development.

Mathematical Model for Improvement of Concrete Quality

To obtain high-quality concrete constructions it is not enough to execute it only in concrete of high class. One of the effective ways to improve the reliability and durability of concrete is its reinforcing by various kinds of fibers. The article presents the researching results of the influence of brands of portland cement and disperse reinforcing by polyethylene terephthalate fibers (PET-fiber) on concrete durability. Standard compression tests of the cubical prototypes of fine-grained sand concrete made of two brands of portland cement – PC400 and PC500 with different percentage of PET-fibers have been conducted. The optimum content of PET-fiber, wherein there is a maximum increase of durability of fine-grained fiber-reinforced concrete, has been set.

Management of Higher Education Institutions in Uncertain Times: The Perspectives of University College

The purpose of this paper is to determine the state of management in university college, based on a review of academic literature. The aim is to provide university college with the best management evidence that inform their focus and models for quality improvement. Despite the growing role and importance of university colleges, they still strive to compete in increasingly uncertainty, difficult and challenging conditions. This paper is framed as a research informed analysis of key capabilities that managers will need to draw on in times of uncertainty. It is based on higher education literature as well as the researchers own observations. A framework of university college domain of practice is proposed to assist managers to deal with foreseeable future. The said domains or capabilities include: Setting Direction; develop the institution; develop staff; focus on teaching, learning and research; self management; influence others, and taking it into a broader context.

Product quality improvement model considering quality investment in rework policies and supply chain profit sharing

The aim of this paper is to develop an optimization model for quality improvement by considering quality investment in rework policies and supply chain profit sharing. To improve product’s quality, the decision of process target and its tolerance is important since it directly affects the defective rate, manufacturing cost, and loss to customer due to the deviation of product from its specification. In this research, two rework policies are considered. In the first policy, the rework is done by using the same manufacturing facility, while in the second policy a new process facility was added for rework. Quality improvement in the supply chain environment is also necessary. Hence, profit sharing system is added in the model to strengthen the commitment of the suppliers in improving component quality. In the system, the manufacturer shares the profits to the supplier if the supplier can meet or exceed the quality target specified by the manufacturer. A comparison is given to determine the best quality improvement policy between those two policies considering profit sharing system. From the results of the optimization, the managers can make economic investment decision economically to correct a defective product through cost optimization model and to choose the best option toward the goal of least unit production cost. By using this model, the decision-maker can evaluate any quality investment in order to achieve significant financial return.

Quality improvement initiatives in rheumatology: an integrative review of the last 5 years.

We reviewed recent quality improvement initiatives in the field of rheumatology to identify common strategies and themes leading to measurable change. Efforts to improve quality of care in rheumatology have accelerated in the last 5 years. Most studies in this area have focused on interventions to improve process measures such as increasing the collection of patient-reported outcomes and vaccination rates, but some studies have examined interventions to improve health outcomes. Increasingly, researchers are studying electronic health record (EHR)-based interventions, such as standardized templates, flowsheets, best practice alerts and order sets. EHR-based interventions were most successful when reinforced with provider education, reminders and performance feedback. Most studies also redesigned workflows, distributing tasks among clinical staff. Given the common challenges and solutions facing rheumatology clinics under new value-based payment models, there are important opportunities to accelerate quality improvement by building on the successful efforts to date. Structured quality improvement models such as the learning collaborative may help to disseminate successful initiatives across practices. Review of recent quality improvement initiatives in rheumatology demonstrated common solutions, particularly involving leveraging health IT and workflow redesign.

PENGKADERAN DA’IAH MELALUI PELATIHAN RETORIKA DAKWAH (KELOMPOK KAJIAN IBU-IBU ‘CENGKIR GATI’ DI DUSUN SAWAHAN NOGOTIRTO GAMPING SLEMAN)

Training cadre is a learning process that is carried out in stages and continuously in accordance with the levels, achievements, situations and specific needs that enable a cadre to develop all his potential potentials, physical abilities, and social morals. Preaching rhetoric is the art of talking about influencing others through messages. It is a branch of communication science that discusses how to convey messages to others through the art of talking so that preaching messages can be received. Through a series of dedication activities under the title of Development of Islamic Life Quality Improvement Model which is carrying out the regeneration of the community through training on methods and motivation in preaching, and microteaching / practicing. This service is expected to be able to answer the problems of the community in order to stay alive the Mother Study group 'Cengkir Gati' in Dusun Sawahan Nogotirto Gamping Sleman, Region of Yogyakarta.

Quality Improvement Models in Residency Programs.

Quality Improvement Models in Residency Programs.