Quality Improvement Model Research Articles

Evaluation of a Vendor-Agnostic Deep Learning Model for Noise Reduction and Image Quality Improvement in Dental CBCT

Background/Objectives: To assess the impact of a vendor-agnostic deep learning model (DLM) on image quality parameters and noise reduction in dental cone-beam computed tomography (CBCT) reconstructions. Methods: This retrospective study was conducted on CBCT scans of 93 patients (41 males and 52 females, mean age 41.2 years, SD 15.8 years) from a single center using the inclusion criteria of standard radiation dose protocol images. Objective and subjective image quality was assessed in three predefined landmarks through contrast-to-noise ratio (CNR) measurements and visual assessment using a 5-point scale by three experienced readers. The inter-reader reliability and repeatability were calculated. Results: Eighty patients (30 males and 50 females; mean age 41.5 years, SD 15.94 years) were included in this study. The CNR in DLM reconstructions was significantly greater than in native reconstructions, and the mean CNR in regions of interest 1-3 (ROI1-3) in DLM images was 11.12 ± 9.29, while in the case of native reconstructions, it was 7.64 ± 4.33 (p < 0.001). The noise level in native reconstructions was significantly higher than in the DLM reconstructions, and the mean noise level in ROI1-3 in native images was 45.83 ± 25.89, while in the case of DLM reconstructions, it was 35.61 ± 24.28 (p < 0.05). Subjective image quality assessment revealed no statistically significant differences between native and DLM reconstructions. Conclusions: The use of deep learning-based image reconstruction algorithms for CBCT imaging of the oral cavity can improve image quality by enhancing the CNR and lowering the noise.

Enabling laboratory readiness and preparedness for the evaluation of suspected viral hemorrhagic fevers: development of a laboratory toolkit.

Viral hemorrhagic fevers (VHFs), such as Ebola virus disease, Marburg virus disease, and Lassa fever, are associated with significant morbidity and mortality and the potential for person-to-person transmission. While most individuals in whom VHF is suspected will ultimately be diagnosed with a non-VHF illness, such patients may present to any United States healthcare facility (HCF) for initial evaluation; therefore, all HCFs must be prepared to evaluate and initiate care for suspect VHF patients, especially if they are acutely ill. Included within this evaluation is the ability to perform basic routine laboratory testing before VHF-specific diagnostic test results are available, as well as rapid malaria testing to assess for a common, dangerous "VHF mimic." To improve laboratory preparedness and readiness in the initial care of suspect VHF patients who may present to acute care hospitals. Plan-Do-Study-Act quality improvement model. Frontline healthcare facilities and their clinical laboratories. We describe the development of a laboratory testing toolkit for a suspect VHF patient that can assist frontline HCFs in providing basic laboratory testing required for the care of these patients. The toolkit provides guidance on infection prevention and control, waste management, occupational health, laboratory test collection, processing, and resulting, in the context of suspect VHF patient evaluation. The toolkit is designed to be readily adapted by any frontline HCF in the US. With the guidance provided, facilities will be able to support safer initial evaluation of VHF suspects and ensure high-quality patient care.

A Holistic Quality Improvement Model for Food Services: Integrating Fuzzy Kano and PROMETHEE II

A Holistic Quality Improvement Model for Food Services: Integrating Fuzzy Kano and PROMETHEE II

Assessing the implementation of a tertiary care comprehensive pediatric asthma education program using electronic medical records and decision support tools

Background Self-management education is integral for proper asthma management. However, there is an accessibility gap to self-management education following asthma hospitalizations. Most pediatric patients and their families receive suboptimal or no education. Objective To implement a comprehensive pediatric asthma education program and evaluate subsequent self-management knowledge in patients as well as behavior change outcomes reflected in the frequency of asthma related repeat emergency department visits and hospitalization. The program implementation was informed by the Knowledge to Translation Action Framework and the i-PARIHS model for quality improvement and involved several iterative stages. Methods We implemented a comprehensive asthma education program for the families of all children 0-18 years old who had been admitted for an asthma exacerbation to the Children’s Hospital of Eastern Ontario (CHEO), beginning on April 1, 2018. The program was adapted to the stages of the Knowledge Translation to Action Framework including undertaking an environmental scan, expert stakeholder feedback, reviews, addressing barriers, and tailoring the intervention, along with evaluating knowledge and health outcomes. Education was delivered over 1-2 h in personalized individual or small group settings, within 4 wk of hospital discharge. All education was provided by registered nurses or respiratory therapists who were also certified asthma educators. The EPIC electronic medical record was used to facilitate referral and scheduling of asthma education sessions, and to track subsequent acute asthma visits. We compared the frequency of a repeat asthma emergency department (ED) visit or hospitalization within 1-year following an initial asthma hospitalization for children who would have received comprehensive asthma education, to a historical cohort of children who were hospitalized between April 9, 2017 – Apr 8, 2018, and did not receive asthma education. Results The program had a high enrollment, capturing nearly 75% of the target population. Most families found the program to be acceptable and reported increased knowledge of how to manage asthma. We identified a crude overall 54% reduction in repeat hospitalizations among children 1 year after implementation of the asthma education program (i.e. 10.2% (23/225) repeat hospitalization rate pre- implementation versus 4.8% (11/227) post-implementation). In adjusted time-to event analysis, this reduction was prominent at 3 months among those who received comprehensive asthma education, relative to those who did not, but this improvement was not sustained by 1 year (HR =1.1, 95% CI =0.55- 2.05; p-value = 0.6). Discussion Although we did not find long-term improvements in ED visits, or hospitalizations, in children of caregivers who participated in comprehensive asthma education, the asthma education program holds potential given that most patients found it to be acceptable and that it increased asthma management knowledge. A future asthma education program should include multiple sessions to ensure that the knowledge and behavior change will be sustained, leading ultimately to long-term reductions in repeat ED visits and hospitalizations.

Cultural Event Development Model for Quality Improvement of Tourism Event: Case of the 3rd Fishing Boat Festival in Sungsang Village IV, Banyuasin Regency, South Sumatra Province

Tourism related to events is a representation of the selling power of the location where the event is held. Festival events have an important role in increasing the selling value of destinations, but this study found that the 3rd Fishing Boat Festival event has not been packaged properly and there is no target market database targeted as tourists. This study aims to create a model for the development of cultural festivals, based on 5 basic stages, namely research, design, planning, coordination, evaluation and compiling a template for providing a database of targets and target tourists using the definable, sizeable, reachable, relevant segmentation method. This study used a combination method or mixed method with a sequential explanatory design with a sample of 100 respondents with 3 data collection techniques, namely by direct observation, document study and interview. This research resulted in 5 stages consisting of 40 steps of festival event management, as well as the targeted tourist segmentation profile. The research contributes to the achievement of the goal of improving the quality of cultural events in tourism villages.

Reducing perinatal anoxia related to childbirth – A quality improvement project

ABSTRACT Background Hypoxic-ischemic encephalopathy occurs at a rate of 2–9 cases per 1000 births, with intrapartum hypoxia being the primary cause. Therefore, it is crucial to enhance fetal monitoring during labour, focusing on the delivery process and the interpretation of cardiotocography. Method This study aimed to reduce the incidence of perinatal asphyxia from 1.4 to 0.25 per 1000 live births over a 12-month period at a maternity hospital, utilising principles of Quality Quality Improvement. The flow of pregnant women and its vulnerabilities were analysed using the SIPOC tool and Ishikawa diagram. An action plan was developed based on a guiding diagram and executed through PDSA (Plan-Do-Study-Act) cycles, concentrating on four secondary drivers: training, infrastructure, service efficiency, and effective communication. Results The outcomes indicate a reduction in anoxia from 1.4 to 0.2 per 1000 births, along with a decrease in the average rate of APGAR scores below 7 at the fifth minute from 2.07% to 0.45%, with no change in the c-section delivery rate. Conclusion The implementation of a quality improvement model aimed at redesigning the process of assessing fetal vitality during labour resulted in a reduction in perinatal anoxia at a public hospital in Brazil.

Improving Patient-Centered Care for End-Stage Renal Disease Patients at a Community Palliative Setting.

End-stage renal disease (ESRD) is a complex medical condition growing fastest in Americans 65 years and older. Despite its chronic nature, fewer than 10% of these patients have had advanced care planning. A chart audit (n = 20) of the palliative patients at a community palliative program revealed that no patient had a conversation about prognostication, 10% (n = 2) about the burden of kidney disease, 30% (n = 6) had coordination of care with the nephrologist, and 35% (n = 7) had engaged in end-of-life planning. This project aimed to increase patient-centered care for ESRD patients to 80% in 90 days. The project utilized the Plan-Do-Study-Act quality improvement model in four 2-week rapid cycles with 2 focus improvement areas. The 2 core interventions were patient screening for preferences and values and providing the right care for palliative management utilizing a checklist. At the end of the project, patient-centered right care for ESRD increased from a baseline of 24% to 94%. Patient engagement scores increased from a baseline of 3.2 to 4.9 on a 5-point Likert scale, with 5 being the highest supporting a shared decision model of care in improving patient-centered right care.

Implementation of Quality Improvement System in a National Health System.

There is a continued need to improve the quality of health care services and the health outcomes associated with that care. Quality improvement model and the Learning Health System framework have emerged as potential methods to achieve the goals of better care and enhanced outcomes. Few practical tools and approaches have been developed to assist with the initiation of quality improvement and development of a Learning Health System. The Department of Veterans Affairs developed and deployed a national system to assist and organize improvement projects and serve as a database for learning. During its first 5 years of use, 7397 quality improvement projects were completed using the electronic tool. National implementation of a structured tool for quality improvement is possible.

Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program.

Multimodal lifestyle interventions, employing food as medicine, stand as the recommended first-line treatment for obesity. The Shared Medical Appointment (SMA) model, where a physician conducts educational sessions with a group of patients sharing a common diagnosis, offers an avenue for delivery of comprehensive obesity care within clinical settings. SMAs, however, are not without implementation challenges. We aim to detail our experience with three implementation models in launching a virtual integrative health SMA for weight management. Eligible patients included individuals 18 years of age or older, having a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 or greater with at least one weight related comorbidity. The Practical, Robust Implementation and Sustainability Model (PRISM), Plan, Do, Study, Act (PDSA), and the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) models were applied to guide the implementation of the Supervised Lifestyle Integrative Medicine (SLIM) program, a virtually delivered, lifestyle medicine focused SMA program, in a weight management clinic within a major health system. We describe how these models, along with attendance for the initial cohorts, were used for decision-making in the process of optimizing the program. 172 patients completed the SLIM program over two years. Attendance was lowest for sessions held at 8:00 AM and 4:00 PM compared to sessions at 10:00 AM, 1:00 PM, and 3:00 PM, leading to only offering midday sessions (p = 0.032). Attendance data along with feedback from patients, facilitators, and administrative partners led to changes in the curriculum, session number and frequency, session reminder format, and intake visit number. The use of implementation and quality improvement models provided crucial insight for deployment and optimization of a virtual, lifestyle medicine focused SMA program for weight management within a large healthcare system.

Enhancing nutritional formula expiry monitoring: A quality improvement project in a tertiary-level hospital in Riyadh, Saudi Arabia.

Nutrition is a vital part of any treatment plan. This may include providing nutritional formulas during hospitalization and afterward. However, reported incidents showed that we had issues with nutritional formula expiry monitoring at our hospital with low compliance to Joint Commission International Standards (MMU.3.1): "There is a process for storage of medications and nutritional products that require special consideration." Therefore, a "Nutritional Formula Expiry Monitoring" project was created to decrease hospital safety incidents related to expired nutritional formulas from an average of 28 in 2015 to zero by 2018. A quality improvement model was developed to map the existing formula processes. Several proposed ideas were tested including performing a hospital-wide audit to examine possible risks and practices, developing a hospital policy, flow charts, forms, and audit tools, and providing educational presentations. A total of 40 units in the hospital were included in the implementation. After implementing all the change ideas, the system for monitoring the expiry of the nutritional formula was standardized, and the number of reported incidents related to the nutritional formula decreased from 28 in the third quarter of 2015 to one in the first quarter of 2018. This project provided step-by-step instructions for improving storing, delivering, and monitoring of nutritional formula. Consequently, the incidences of expired formula and cost wasting were successfully decreased, which increased safe administration and prevented patients from receiving expired nutritional formula. This project can be implemented in various healthcare settings.

Genetic Effects of Grain Quality Enhancement in Indica Hybrid Rice: Insights for Molecular Design Breeding

Improving rice quality remains a crucial breeding objective, second only to enhancing yield, yet progress in quality improvement lags behind yield. The high temperature and ripening conditions in Southern China often result in poor rice quality, impacting hybrid rice production and utilization. Therefore, to address this challenge, analyzing the molecular basis of high-quality traits is essential for molecular design breeding of high-quality hybrid rice varieties. In this study, we investigated the molecular basis of grain shape, amylose content, gel consistency, gelatinization temperature, and aroma, which influence rice quality. We discovered that quality related alleles gs3, GW7TFA, gw8, chalk5, Wxb, ALKTT, and fgr can enhance rice quality when applied in breeding programs. Polymerization of gs3, GW7TFA, gw8, and chalk5 genes improves rice appearance quality. The gs3 and GW7TFA allele polymerization increasing the grain’s length-width ratio, adding the aggregation of gw8 allele can further reducing grain width. The chalk5 gene regulates low chalkiness, but low correlation to chalkiness was exhibited with grain widths below 2.0 mm, with minimal differences between Chalk5 and chalk5 alleles. Enhancing rice cooking and eating quality is achieved through Wxb and ALKTT gene polymerization, while introducing the fgr(E7) gene significantly improved rice aroma. Using molecular marker-assisted technology, we aggregated these genes to develop a batch of indica hybrid rice parents with improved rice quality are obtained. Cross-combining these enhanced parents can generate new, high-quality hybrid rice varieties suitable for cultivation in Southern China. Therefore, our findings contribute to a molecular breeding model for grain quality improvement in high-quality indica hybrid rice. This study, along with others, highlights the potential of molecular design breeding for enhancing complex traits, particularly rice grain quality.

Analysis of factors affecting in-hospital emergency response capability based on objective assessment

To analyze the factors affecting the quality of cardiopulmonary resuscitation (CPR) performed by medical staff in hospital and to explore the training methods to enhance their in-hospital emergency response capabilities. A cross-sectional study was conducted, involving medical staff of intensive care unit (ICU) and general internal medicine wards in China-Japan Friendship Hospital in December 2021. The American Heart Association (AHA) resuscitation quality improvement (RQI) model was used to evaluate the skills of the subjects in performing external chest compressions and bag-mask ventilation on adult and infant simulators. While ICU subjects were undergoing RQI model objective assessment, two instructors also provided subjective scoring for their operations. The study compared the differences in RQI model objective assessment scores between ICU and general internal medicine ward subjects, between doctors and nurses, in the RQI model objective scoring for adult and infant resuscitation, in the scoring differences of different positions for chest compressions, and the differences between traditional subjective scoring and RQI objective scoring when ICU subjects were assessed for compression and ventilation. A total of 75 medical staffs were enrolled, consisting of 50 from the ICU (including 24 doctors and 26 nurses) and 25 from the general internal medicine wards (including 10 doctors and 15 nurses). The ICU medical staff's scores for adult resuscitation skills were significantly higher than those of the general internal medicine ward medical staff [adult compression score: 82.5 (66.0, 96.5) vs. 65.0 (52.5, 74.5), adult ventilation score: 82.0 (68.8, 98.0) vs. 61.0 (48.0, 82.0), both P < 0.01]. The nursing group's compression scores for both adult and infant were significantly higher than those of the doctor group [adult compression score: 77.0 (68.5, 89.5) vs. 63.0 (40.8, 90.3), infant compression score: 54.4±25.1 vs. 41.5±18.5, both P < 0.05]. The compression and ventilation scores for the infant were significantly lower than those for adult resuscitation [compression score: 48 (29, 65) vs. 76 (58, 90), ventilation score: 56 (42, 75) vs. 76 (60, 96), both P < 0.01]. When the rescuer was positioned on the right side of the model, the compression score for the adult significantly increased [79.0 (65.0, 92.0) vs. 65.0 (51.3, 77.0), P < 0.05]. The ICU medical staff's traditional subjective scores of compression and ventilation assessments for adult were significantly higher than the RQI model objective scores [adult compression score: 88.8 (79.4, 92.5) vs. 82.5 (66.0, 95.5), adult ventilation score: 95.0 (80.0, 98.1) vs. 82.0 (68.8, 98.0), both P < 0.01]. Rich experience in emergency rescue is related to the improvement of CPR skills, and performing chest compressions from the right side of the adult model is more effective. Objective scoring of resuscitation skills based on the RQI model may more accurately reflect the performance of the trainees.

Comprehensive molecular pathology review service to reduce barriers to precision oncology in rural eastern North Carolina.

11129 Background: ECU Health system serves a rural 29-county region where cancer mortality rates exceed those of the state’s remaining 71 counties combined. Insufficient tissue and lack of local infrastructure contribute to suboptimal precision oncology care. We aimed to enhance the clinical utility of send-out molecular tests for patients with solid cancers through a quality improvement (QI) initiative. Methods: We used the EPIDEM model of QI to explore, promote, and implement a molecular review service, which includes intervening on send-out molecular orders that would otherwise have been insufficient for the requested molecular pathology test. The interventions include combining blocks, sending alternative specimens, and/or modifying testing strategy. We documented cases in a molecular send-out database and electronic health records, evaluated the service's impact, and modified it to include an orderable molecular consultation. Results: In 2023, We reviewed 699 send-out comprehensive genomic tests on solid tumors (173 cytology, 192 resections, 332 biopsies), including 582 (83.3%) advanced cancers. In total, there were 576 sufficient reports. Actions taken on 185 orders (26.5% of reviewed cases) led to 156 reported results. Of these, 70 showed clinically significant findings, and 31 patients received targeted therapy because of those interventions. In March 2023, we initiated a formal consultation service with in-depth review. From 3/3/2023-1/29/2024, we performed 50 pre-test (e.g., specimen to use, testing strategy, tumor origin testing) and 60 post-test (e.g., result interpretation, treatment based on molecular data) consultations; 10 patients received both pre and post-test support. The molecular pathologist tended to initiate post-test, while clinicians preferentially initiated pre-test consultations (p&lt;.01). Clinician-initiated consultations were more frequent in community practices (p &lt;.01). Conclusions: Even without the resources for in-house testing, our molecular review service provides essential pre- and post-analytic support by successfully rescuing cases that would have otherwise been insufficient molecular tests and by providing comprehensive consultative support. The positive impact and reception among community oncologists suggest that our strategy holds potential to alleviate barriers to precision oncology in underserved areas. [Table: see text]

Developing a Model for Product Quality Prediction and Improvement Using the Decision Tree Algorithm and Data Envelopment Analysis – a Case Study: Manufacturers of the Tiba Anti-roll Bar in Iran

Developing a Model for Product Quality Prediction and Improvement Using the Decision Tree Algorithm and Data Envelopment Analysis – a Case Study: Manufacturers of the Tiba Anti-roll Bar in Iran

Rapid Implementation of the Virtual Clinic Concept in an Oncology Department to Minimize the Exposure of Patients with Cancer to COVID-19.

The global pandemic was an emerging challenge that significantly impacted healthcare systems and the delivery of care. Prompt actions and adaptive techniques, such as the virtual clinic, were implemented to ensure the quality and continuity of the care provided. The aim of this quality improvement project was to ensure the smooth implementation and effectiveness of the virtual clinic during the COVID-19 crisis. A specialized team of multidisciplinary healthcare providers was established to systematically ensure the implementation of the virtual clinic within the Department of Oncology. The team used multiple Plan-Do-Study-Act (PDSA) cycles of the quality improvement model to achieve the final goal and facilitate the transition to the virtual clinic. A total of 29 weekly virtual clinic sessions were conducted, covering various oncology services. From March to December 2020, 81% of the scheduled patients (3888) responded to virtual clinic calls. Physicians initiated 234 unplanned virtual clinic calls to follow up on a patient's condition. In addition, 916 medications were shipped to patients as needed. A patient satisfaction survey in May 2020 indicated an overall satisfaction rate of 92% with the virtual clinic process. Staff satisfaction was also high (91%), and 88% of the physicians believed that the virtual clinic would continue beyond the pandemic. Implementing the virtual clinic is achievable through following systematic steps and effectively addressing emerging challenges as required. The concept of the virtual clinic was well accepted by patients and staff.

The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives.

This article introduces the Mountain Model, the first conceptual model for evidence-based practice quality improvement (EBPQI) initiatives. The Mountain Model merges modern evidence-based practice (EBP) and quality improvement (QI) paradigm principles into a unified conceptual framework with the goal of disseminating and sustaining EBPQI projects across health care and related settings. The model was developed within the nursing discipline, but is designed for transdisciplinary implementation through interprofessional teams.

P007 Successful use of patient initiated follow-up in a tertiary paediatric rheumatology service

Abstract Background/Aims Patient initiated follow-up (PIFU) is a national strategy enabling patients or carers to initiate contact with a service rather than a traditional model of routine scheduled appointments. PIFU enables patient empowerment and elective recovery after the Covid-19 pandemic. NHSE identified Paediatrics as appropriate for PIFU, but specific measures are needed to ensure safeguarding of paediatric patients is maintained. Methods With NHSE &amp; I support and extrapolating guidance implementing PIFU in adult rheumatology services, we developed a clinical pathway that included safeguarding/governance structures within Paediatric Rheumatology at Alder Hey Children’s Hospital. Two strategies were developed - PIFU culminating with either a timed return (PEND) or discharge (DISCHARGE) model. A PIFU feasibility study in paediatric rheumatology initially targeted three index conditions (arthritis, mechanical pain and primary Raynaud’s) in March 2022. This was extended within a Plan-Do-Study-Act model of Quality Improvement. Results We placed 536 patients within PIFU pathways (PEND = 297, DISCHARGE = 239). The monthly usage of PIFU increased from &amp;lt;10 patients per month in March 2022 to &amp;gt; 40 patients per month in August 2023 with expansion of PIFU conditions. Within this time frame the number of patients put through the DISCHARGE model increased steadily to 60% of the monthly proportion as clinician confidence in PIFU increased. We demonstrate an 11% (total Rheumatology patients) PIFU rate over the study time frame, with a 2.7% (15/536) reactivation rate. Where calculable, timescale for review following activation was &amp;lt;48 hours. In our experience, patients/families are comfortable with PIFU and feel reassured by the safety-net provided. Decision for PIFU PEND/DISCHARGE is made in partnership with patients/families. As well as increased use within Rheumatology, PIFU use has extended to 80% of clinical teams across Alder Hey. The Trust-wide PIFU rate of 10% in September 2023 is double the original NHS England guidance target of 5%. Conclusion We advocate safety of PIFU in the correct population and its ability to empower patients. Table 1 shows the significant impact that correct use of PIFU can have on increasing capacity for seeing new patients, decreasing time to review and matching the number of patient reviews to referrals. Disclosure W. Calvert: None. J. Spinty: None. L.J. McCann: None. G. Cleary: None.

Quality Improvement Model of English Teaching in Universities Based on Big Data Mining

Big data mining in English teaching revolutionizes language instruction by leveraging vast amounts of data to personalize and optimize learning experiences. This approach utilizes sophisticated algorithms to analyze learners' language usage patterns, comprehension levels, and areas of difficulty. This paper presents a novel Quality Improvement Model of English Teaching (QIMET) tailored for universities, integrating big data mining techniques with a Stacked Hashing Edge Computing Model (SHECM). Recognizing the importance of enhancing English language proficiency among university students, particularly in an increasingly globalized educational landscape, this research aims to optimize English teaching methodologies through advanced computational approaches. The proposed QIMET framework leverages big data mining to analyze extensive datasets of student performance, language usage patterns, and instructional effectiveness. By extracting valuable insights from these datasets, educators can identify areas for improvement, tailor teaching materials, and personalize learning experiences to meet individual student needs. Simulation analysis of Across a dataset of 500 university students enrolled in English language courses, QIMET achieves an average improvement of 30% in language proficiency scores compared to traditional teaching methods. Moreover, specific language skills exhibit notable enhancements, with vocabulary acquisition increasing by 25%, grammar comprehension by 20%, and communication skills by 35%. The integration of the SHECM enhances the computational efficiency and scalability of the QIMET framework. Real-time data processing and analysis enable educators to make timely interventions and adjustments to teaching strategies, resulting in more responsive and effective English language instruction.

An Improvement Project in Reducing After-Visit Phone Calls in a Community Pediatric Neurology Clinic: Too Much Communication?

Physicians strive to provide high-quality clinical care, yet after-visit patient telephone calls create extra demands on a clinician's time. Pediatric neurologists are particularly affected by this challenge given the number of patients with chronic illnesses they serve and the volume of worried parents they support. Added workload coupled with a busy office practice increases the likelihood of early physician burnout, which can have downstream effects on the quality of patient care and patient satisfaction. Using the IHI model for quality improvement (abbreviated QI moving forward), QI methodology was used to determine volume and key drivers of patient/family communications after a visit to a pediatric neurology clinic. Interventions aimed at reducing telephone messages by 15% over a 6-month period were put into place. A baseline audit of clinic phone calls was completed in 2019 to develop an overview of after-visit communications. After-visit telephone calls and web-based portal messages were then tracked for 3-week periods in 2019, 2020, and 2021 to understand key trends. A key driver diagram of patient/family communications after a clinic visit was created, and interventions aimed at reducing telephone messages were discussed. These interventions included optimizing MD-RN workflows, synchronous and asynchronous educational initiatives, and changes to our clinic's voicemail phone tree. Our primary outcome measure was the average monthly telephone call volume, and this measure was tracked monthly from November 2020 through December 2022. Similarly, electronic portal message volume was tracked and served as our balancing measure. Physicians, nurses, and patients were primary drivers of phone call volume. After interventions were in place, the average monthly call volume decreased by 30% from a baseline of 293 calls to 203 calls. This change was sustained for at least 1 year. The average monthly portal message volume remained consistent throughout the study period at 359 messages. Both physicians and nurses agree that after-visit patient communication affects their workload. This study illustrates that QI methodology can be used to plan and implement interventions aimed at decreasing after-visit telephone calls.

Management of Leader Quality and Modern Leadership for Religious-Based Higher Education Improvement

This study aimed to analyze in depth and objectively the quality of modern management of leaders and leadership in religious-based higher education in Indonesia to find a model for higher education quality improvement. This research was based on a qualitative approach known as phenomenology. Data collection was carried out through participant observation by interview and document study. Data analysis and interpretation showed that: (1) The main problem was poor management quality; (2) Weak management quality was caused by nerveless leaders and leadership. This primary factor influences other factors, just as they all affect one another.