Improvement Plan Research Articles

Positive Deviance Theory: Leveraging Compliments Data to Guide Strategic Planning for Patient Experience Improvement in a Large Rural Health Care System.

Patient-centered care (PCC) has been called for as a solution to improving care quality and patient outcomes. Patient experience, termed care experience, is a measurable aspect of PCC and aligns with coproduction. Identifying patterns of positivity and high performers is a Positive Deviance approach that can inform strategic improvement of the care experience. To identify the characteristics of positive deviances from voluntary, unsolicited compliments from patients and family members about their care experiences. The authors conducted a mixed-method analysis, including content and a thematic analysis of unsolicited comments from patients and families, submitted between January 2021 and January 2022. After removing duplicates and miscategorized comments, 213 compliments were included in the analysis using a single, blinded inductive coding to synthesize thematic statements. The main campus received the most compliments by location (89%); the most widely used patient sentiment was thankful (36.8%). Compassionate (26.8%), together with six others: competent (11.6%), communication (10.6%), cared for (8.5%), care team (8.0%), and supportive (8.0%), made up approximately 80% of drivers of care quality. Physicians (37.3%) and nurses (34.2%) were the most complimented personnel, although surgery (17.0%) were the most complimented services team. Similar characteristics were reported for exemplary individuals and their associated care teams. The results align with previously reported work by the Beryl Institute and CMS 5-star rating on key drivers of patient experience. This approach provides a method by which exemplars can be identified within health systems, and that information is used to guide improvement and organizational planning.

EP186 - Blood transfusion documentation in surgical patients - are we doing it correctly? An audit on the blood transfusion documentation in surgical patients at a district general hospital in the United Kingdom

Abstract Aim Transfusion of blood products is commonly indicated in surgical patients, especially in patients with gastro-intestinal bleeding, gastro-intestinal cancers, and trauma patients. However, the documentation regarding blood transfusion in these patients often does not meet the guidelines. The aim of this clinical audit was to improve the blood transfusion (BT) related documentation in patients of general surgery (GS) at a district general hospital (DGH) in the United Kingdom, in accordance with the national guidelines (Administration of blood components: a British Society for Haematology Guideline) and the local trust guidelines. Method For the 1st-cycle of the audit, we did retrospective study of all adult patients admitted under GS in our DGH from 1st July 2023 to 15th August 2023 (6weeks) who received BT, and their electronic records were assessed with regards to documentation regarding the following criteria: decision to transfuse, patient's consent and understanding, post-transfusion effect and discharge notes. Following this, we had a discussion with the junior doctors in the department, who do these documentation, to make them aware of the BT guidelines, and to improve adherence. The 2nd-cycle included retrospective data collection from 1st September 2023 to 15th October 2023 (6 weeks). Results BT-documentation during the 2nd-cycle showed significant improvement to adherence above 80% in most of the criteria where it needed improvement in the 1st-cycle. Conclusion This clinical audit successfully improved the BT-documentation adherence to the guidelines, showing that through simple educational methods, the documentation practices could be improved significantly. Our plans for subsequent improvement includes posters in the departmental resource room to increase the awareness, and to re-audit in December 2023.

A Study on the Relationship of Business Intelligence and Business Performance Management

In order for corporations to attach their operational and strategic targets with everyday activities, Business Performance Management (BPM) is a important challenge. By making it simpler to make educated decisions and provide useful data, this lets in for comprehensive overall performance management. Not most effective should an enterprise version and track its strategies for BPM to paintings, however it have to additionally model and tune its broader strategies and the assumptions that underpin those plans. Examining the methods, gear, and approaches that make up Business Process Management (BPM) is the number one goal of this newsletter. Along with providing a radical framework that integrates BI and company overall performance control, it will also check out the intrinsic relationship between BPM and BI. This all-encompassing technique to managing agency performance ensures that operational execution and strategic objectives are always in sync by means of promoting continuous improvement and adaptable plans via records-pushed analysis.

Applying lean production system philosophy to reduce patient waiting time in healthcare services: Simulation-based optimization and validations through experiment

Value stream mapping (VSM) is an initial and critical tool for deploying lean concepts in the manufacturing and service sectors, including hospitals. Therefore, the aim of this research is to analyze the current working environment of a radiology department, identify the wastes in the operations by mapping the current patient flow, and test the best possible improvement plan with the help of discrete event simulation modeling using the Arena platform to develop an optimum future map to mitigate the wastes. Therefore, the current patient flow in the x-ray section of a radiology department was mapped using VSM for two types of patients named routine (RP) and procedure (PP). VSM results highlighted a high waiting time (TWT) of 188 and 3732 min for RP and PP. A total of seven scenarios were developed and analyzed to determine the impact of changes on five key performance indicators. Simulation results of the current scenario showed that there were 567 patients coming out of the system with a lead time of 200 and 926 min for RP and PP. Total waiting time obtained for RP and PP was 177 and 860 min, with a maximum wait time of 31 min/patient and an average of 43 patients in the system (WIP). The simulation results of the seventh scenario provided the best results, with 6% improvement in the number of patients getting out of the system and 75% and 55% decreased lead time for RP and PP. Total waiting time for RP and PP was reduced by 80% and 60%, with WIP falling by 62%. Arena Optimizer showed that by adding a technician and radiologist to the system, the optimum patient waiting time in the queue would be 6 min, and the lead time for RP and PP would be (160) and (884 min), respectively. Based on it, a future VSM was created; it provided a reduction of 72% and 60% in (TWT) for RP and PP, which could improve the number of patients to be entertained by the radiology services without adding any new x-ray machines. The results of the present case provide healthcare planners with a road map to discover the waste in operations since the monetary investment and organizational dedication required drive out non-value activities. Therefore, simulation helps to select the best possible improvement strategy for the system without pausing and making physical changes in busy and complex units of hospitals.

Quality management system practices and employee performance in logistics companies: Basis for continuous improvement plan

Quality management system practices and employee performance in logistics companies: Basis for continuous improvement plan

Multi-Institutional Study of Referral Patterns for Gynecologic Oncology Consultation.

Evaluation by a gynecologic oncologist (GO) is associated with improved clinical outcomes for patients with gynecologic cancers, yet little is known about health care factors that influence patients' referrals to GO. Medical records of 50 consecutive new patients seen in GO clinics at each of six referral centers across the United States were reviewed. Patient and disease characteristics were collected along with referral indication, evaluation and referral dates, diagnostic procedures, provider specialties, and zone improvement plan (ZIP) code of up to three referring providers per patient. The primary outcome was interval between first evaluation and referral. Univariate associations were evaluated with Chi-square and Wilcoxon rank-sum tests and multivariable associations with negative binomial regression models. Secondary outcome was prolonged time to GO referral, defined as greater than the 75th percentile. Logistic regression was used for multivariable modeling. Three hundred patient records were analyzed. The median time from first health care encounter to referral was 15 days (IQR, 5-43). The mean distance from residence to GO was 39.8 miles (standard deviation, 53.8). Seventy-one percent of GO referrals were initiated by obstetrician-gynecologists, 9% by family physicians, and 6% internists. Presentation-to-referral interval was 76% shorter for patients evaluated by an emergency medicine clinician (exp(Beta), 0.24; 95% CI, 0.11 to 0.53; P < .001). Public insurance was associated with 1.47 times longer time to referral compared with private insurance (exp(Beta), 1.47; 95% CI, 1.05 to 2.04; P = .001). Residents of nonmetropolitan ZIP codes were less likely to have prolonged time to referral (odds ratio [OR], 0.288; P = .017). Distance from residence to GO (per 10 miles) increased the likelihood of prolonged time to referral (OR, 1.10; P = .010). Interventions are needed to improve recognition and referral of patients for gynecologic oncology evaluation. Community outreach and engagement with obstetrician-gynecologists should be prioritized to improve times to referral.

The Factors Affecting the Impacts of Using the School Improvement Plan (SIP) on Students' Academic Achievement in Malaysia

While professional learning communities are hailed as the solution to raising teacher quality in Malaysia, other nations, such as the UK and Canada, have started to deprivatize teaching. This theory is predicated on the notion that teaching is a collaborative endeavor in which educators grow as individuals and professionals. Rather, it is a cooperative process in which teacher learning enhances student learning. Furthermore, the traditional classroom is rapidly changing to accommodate the needs of students in the twenty-first century while also encouraging the deprivatizing teaching approach. Consequently, this study presents a curriculum-change implementation strategy one school uses to meet Malaysia's evolving understanding of learning in and for the twenty-first century. Narrating a series of anticipated strategic events clarifies the importance of using distributive leadership as an essential tool for supporting educational enhancement and highlights the benefits of consultative techniques. This study aims to determine the variables that influence how the School Improvement Plan (SIP) affects Malaysian students' academic performance. Using a Google Form approach, this study used a quantitative research design, an effective and systematic way to collect quantifiable data. According to this survey, teacher leadership factors have the most significant impact on students' academic success compared to the other two factors. The results of this study suggested a theoretical framework that forecasts the related factors—principal instructional leadership, teacher leadership, and conducive school environment—that influence the effects of implementing the School Improvement Plan (SIP) on students' academic achievement in Malaysia.

Abstract P406: Transforming Clinical Practices for Blood Pressure Management in Community Health Centers through Timely Data and Technical Support

Introduction: Blood pressure (BP) control can prevent major adverse cardiac events and is monitored through various means, including the Centers for Medicare and Medicaid Services 165 metric for BP control - an annual reporting metric for community health centers (CHCs) within the Uniform Data System framework that becomes accessible 6 months after the conclusion of the reporting period. In pursuit of more immediate indicators related to BP management, the National Hypertension Control Initiative (NHCI) initiated collaboration with a population health platform to support select CHCs with rapidly available data on 19 BP-related metrics. Hypothesis: With technical support and regular access to data, CHCs can implement timely clinical practice and process changes. Methods: To support CHCs in using the population health platform, NHCI staff provided technical assistance in a rapid cycle performance improvement (RCPI) to 10 interested CHCs. This opportunity allowed CHCs to partner with NHCI staff to review BP related metrics in the population health platform and to identify opportunities for clinical process and practice changes. Over an 8-week period from October to December 2023, 7 CHCs were actively involved in a series of 5-6 structured 30–60-minute meetings with both NHCI registered nurse and quality improvement staff. These meetings reviewed BP metrics, mapped clinical workflows for improvement, and supported data analytics. CHCs often chose 1-2 BP metrics for focus, concentrating on incremental change and short-term improvement. Results: Among participating CHCs that reported, they revealed successful or anticipated adjustments in team responsibilities and clinical processes, including leadership involvement and new methods. Limitations included CHC staff engagement, time, concerns with data reliability, and familiarity with the population health platform. Most reporting CHCs shared that their goals were greatly impacted by access to readily available performance data and that they plan to continue using the population health platform to affect performance moving forward. Conclusions: For participating CHCs, individualized guidance based on timely data may have been helpful in analyzing workflows and procedures, assessing clinical care practices, and implementing quality improvement plans. Frequent data may allow CHCs to make clinical practice and process changes to efficiently measure impact and more quickly improve BP control than standard methods.

Geographic Patterns of Youth Suicide in San Diego County

ObjectiveOur objectives were to evaluate for any cluster patterns of youth suicide deaths and characterize the level of child opportunity in the communities where suicide deaths occurred. MethodsDecedents <18 years were identified from San Diego County Medical Examiner death reports from 2000 to 2020. We mapped decedents’ residential Zone Improvement Plan (ZIP) codes and calculated suicide rates per 10,000 youths. ZIP codes identified in overlapping spatial statistical approaches — the spatial scan statistic and Local Moran with Empirical Bayes (EB) rates — were considered a cluster for the final analysis. We obtained Child Opportunity Index (COI) scores for each ZIP code to determine if there were differences in: 1) ZIP codes with suicide deaths compared to ZIPs with no deaths 2) differences in distribution of suicide death rates across quintiles of COI. ResultsScan statistic identified 25 ZIP codes within a cluster (RR 2.6, P = 0.00066). Local Moran with EB rates identified two ZIP codes as a high-high cluster (P < 0.05). The location identified as a cluster in both approaches was in Alpine. The median COI for ZIP codes with suicide deaths was higher at 63.5 (IQR 38–83) compared to 47 (IQR 22.5–75.5) for ZIP codes without suicide deaths. There was a significant difference in suicide rates between Very Low and Moderate levels of Overall opportunity (P = .013). ConclusionWe identified a cluster of youth suicides in one of the most populous counties in the country. These findings serve to inform policies and prevention programs that aim to mitigate youth suicide mortality.

Making valuable energy: Public forums, municipal futures, and infrastructural pathways

This article analyzes public discussions and engagements with Philadelphia’s energy system to highlight the degrees of tension between diverse ethical frames and energy-based strategies of value production. Looking at three different instances and genres of energy-transition planning and expression, we argue that any such tensions or alignments turn on the specific units, categories, and scales of analysis used to construct and understand them. Our first section investigates the spatial and temporal frames of “energy security” embedded in Philadelphia’s infrastructure improvement plan, showing how the meaning and political purchase of the concept of “security” changes across quotidian and infrastructural timescales and across the spatial scale of the household, city, state, and the nation. Section two considers the categories with which the City framed its study of potential decarbonization scenarios, pointing towards the way this schema produced its own seemingly intractable ethical and economic impasses. The third and final section looks at the way diverse members of the public successfully de- and re-constructed the study’s categories, scales, and units of analysis, successfully undermining the study’s “grid of intelligibility” and replacing it with their own more equity-centered alternative. Across these three ethnographic engagements, this article brings the anthropologies of ethics and value together in a novel way, showing their mediated entanglement with and within the sphere of public knowledge production. This, we argue, illustrates the seemingly mundane scalar choices that deeply inform our ethical frames and that, in the end, ultimately allow us to make energy valuable.

Tuition Improvement Plan to Support Learners

Tuition Improvement Plan to Support Learners

델파이 기법(Delphi)을 통한 KBO 코치아카데미 과정 개선방안 도출

The purpose of this study was to identify factors to improve the KBO Coach Academy course through the Delphi technique. In order to achieve the research, participants included former and current coaches of professional baseball teams who had completed the KBO Coach Academy, staff who charge of this course, instructors and professors who lectured in this course. In-depth interviews were conducted with 15 participants in the first and second Delphi survey from March 4 to April 30, 2024. As a result of this study, a total of 6 main-factors were identified, consisting of 'instructors', 'course curriculum', 'course facilities and accommodation', 'operation period', 'regulations and systems', and 'future support plans'. Additionally, 16 sub-factors were finally uncovered as crucial factors for improvement. The significance of this study is to present empirical findings that can be implemented in the future by exploring the problems of the KBO Coach Academy course and suggesting improvement plans. Based on the the factors presented in this study, the KBO Coach Academy should be improved in the future.

Aplikasi metode FMEA sebagai Upaya Pengendalian Kecacatan Produksi Kain Weaving, Studi Kasus: PT X

This study aims to identify and analyze the factors causing defects using Failure Mode and Effect Analysis (FMEA) and formulate improvement plans to improve business processes. The research method used is FMEA analysis to find and reduce the factors causing defects. The results of the analysis show that human factors contribute 25%, material factors 26%, and method factors 24% to defects. The conclusion is that FMEA is effective in identifying the main causes of defects and providing a basis for improving the production process. Keywords: FMEA, Quality, Weaving

Improvement Plan for Prevention of Safety Accidents in Old Facilities

Recently developed buildings are becoming larger, more complex, and higher-rise. After the announcement of the first new city in 1989, other first new cities were created in Bundang New Town in Seongnam-si, Gyeonggi-do, and Ilsan New Town in Goyang-si, where occupancy began in 1992. Subsequently, second new cities were built in 12 locations in 2003. In 2018, third new cities were announced, including the Wangsuk District in Namyangju-si, Gyosan District in Hanam-si, and Gyeyang District in Incheon. The continued announcement of new cities suggests the existence of old equipment in first and second new cities, necessitating the safety management of old facilities. Among major building facilities, cases of safety accidents have been reported due to aging, explosion of refrigerators, fires from aging water substation facilities, and power outages. In December 2018, an accident occurred in which one person was killed and 20 people were injured when a hot water pipe at the regional heating corporation near Baekseok Station in Ilsan ruptured because of aging. Thus, the aging of facilities is a major cause of safety accidents, and the scale of accidents is also increasing, making it urgent to establish improvement measures to counteract the occurrence of accidents in old facilities. To prevent safety accidents in old facilities, this study intends to contribute to safety accident prevention by presenting a replacement standard for the main facility through facility expert surveys and domestic and international useful prior research life management case studies.

International aid management in Afghanistan’s health sector from the perspective of national and international managers

PurposeThe primary purpose of international aid is to promote economic and social development around the world. International aid plays an important role in Afghanistan’s healthcare system. The purpose of this study is to investigate international aid management in Afghanistan’s health sector from the perspectives of national and international managers in 2022 and to provide recommendations for the improvement.Design/methodology/approachThe study has a cross-sectional design. The study participants were chosen by random sampling. The sample size was determined based on Yaman’s formula at 110. The data collection tool was the questionnaire provided by International Health Partnership and Related Initiatives. The data were analyzed in two descriptive (mean and percentage) and analytical formats. Independent t-test, Mann-Whitney, Kolmogorov-Smirnov tests and Variance analysis were used to examine the relationships between demographic variables and the scores of each dimension.FindingsThe average scores given to different dimensions of aid management were as following: 1) the donners’ support of the national health strategy: 48/68 ± 16.14 (49%), 2) the predictable financing: 50/23 ± 16.02 (50%), 3) foreign aid on budget: 55/39 ± 20.15 (55%), 4) strengthening public financial management system: 38/35 ± 19.06 (38%), 5) strengthening the supply and procurement system: 40.97 ± 19.55 (41%), 6) mutual accountability: 46.50 ± 19.26 (46%), 7) technical support and training: 50.24 ± 17.33 (50%), 8) civil society involvement: 35.24 ± 18.61(35%), 9) private sector participation: 36 ± 17.55 (36%), and in total the average score was 44.52 ± 13.27 (44%). The difference between the scores given by two groups of managers was not significant. No meaningful relationship was observed between the total score and any of the demographic variables, but there was a weak relationship between work and management experience and total score. The correlation coefficient showed a statistically significant relationship between the different dimensions of the questionnaire. To sum up, the performance in all dimensions of aid management hardly reached 50%. Donors’ support for the national health strategy was not adequate. There were challenges in evidence-based decision-making, developing national health strategies, control and evaluation, the allocation of resources and use of procurement system. The priorities of donors and government were not always similar and mutual responsibility was lacking. Technical assistance and supporting multilateral cooperation are necessary.Originality/valueMost studies on foreign aid focused on its effects on economic growth, poverty and investment and not aid management processes. Without proper aid management, parts of resources are wasted and aims of aid programs cannot be achieved. This study investigates aid management in a developing country from the perspectives of two main stakeholders, international and national managers.Research limitations and implicationsData collection coincided with the change of government in Afghanistan. The situation might be different now. Still, this study provides areas for the improvement of aid management in the studied country. Future studies can build upon the findings of this research and conduct in-depth exploration of areas of aid effectiveness and designing detailed programs of improvement.Practical implicationsInstructions of the Paris Declaration on Aid Effectiveness need to be followed. Particularly, civil society involvement and private sector participation should receive attention. A joint plan for improvement and collaboration of different stakeholders is needed.

Implementing a quality improvement plan to reduce the blood culture contamination rate in pediatric patients: A quasi-experimental study.

Implementing a quality improvement plan to reduce the blood culture contamination rate in pediatric patients: A quasi-experimental study.

Effects of Resource Sharing Networks on Community Anti-Drug Coalitions’ Outcomes: A Social Network Analysis

Substance use-related problems continue to be a national public health crisis despite years of prevention efforts. Community anti-drug coalitions are well positioned to address substance use at local levels. Coalitions often rely on their members to connect to resources they need to address community issues and plan for sustainability over time. Such capacity building occurs through voluntary cooperation among members, making it essential to understand the role network connections play. This study sought to determine whether structural characteristics of coalitions’ resource sharing networks impact members’ perceptions of community improvement and coalition sustainability. Surveys at two timepoints collected data from 68 coalitions in Pennsylvania and Missouri on members’ connections or ties to share information, personnel, money, or other types of collaboration. Analyses examined how coalition-level measurements of sectoral diversity, density, and resource sharing centralization, respectively, were associated with members’ perceptions of community improvement, sustainability planning, and coalition sustainability. Sectoral diversity and centralization were unrelated to study outcomes. Density was also unrelated with perceived community improvement and sustainability planning. However, two facets of cooperative density were positively associated with perceived coalition sustainability: the density of ties to share information and the density of multiple types of collaborative ties. This study suggests that both information and other collaborative ties foster perceived coalition sustainability, although not community improvement.

A latent profile analysis of rest–activity behavior patterns among community-dwelling older adults and its relationship with intrinsic capacity

Rest–activity behavior clusters within individuals to form patterns are of significant importance to their intrinsic capacity (IC), yet they have rarely been studied. A total of 1253 community-dwelling older adults were recruited between July and December 2021 based on the baseline survey database of the Fujian Prospective Cohort Study on Aging. Latent profile analysis was used to identify profiles of participants based on rest–activity behaviors, whereas logistic regression analysis was carried out to investigate the relationship between profiles and IC. We identified three latent profiles including: (1) Profile 1—labeled “Gorillas”: High physical activity (PA), moderate sedentary behaviors (SB), screen time (ST) and sleep (n = 154, 12%), (2) Profile 2—labeled as “Zebras”: Moderate PA, low SB, ST and high sleep (n = 779, 62%), and (3) Profile 3—labeled as“Koalas”: High SB, ST, low PA and sleep (n = 320, 26%). Logistic regression revealed a negative correlation between low IC and the “Gorillas” profile (β = − 0.945, P < 0.001) as well as the “Zebras” profile (β = − 0.693, P < 0.001) among community-dwelling older adults, with the “Koalas” profile showing the weakest IC compared to the other profiles. The demographic traits i.e., female, older age, living alone, and low educational level also correlated with low IC. Identifying trends of rest–activity behaviors may help in drawing focus on older adults at risk of decreasing IC, and develop personalized improvement plans for IC.

A Hybrid Markov-SPC Approach to Assess Cost Differences in Urgent Care Utilization Using Patient-Reported Data in Inflammatory Bowel Disease.

Cost is a key outcome in quality and value, but it is often difficult to estimate reliably and efficiently for use in real-time improvement efforts. We describe a method using patient-reported outcomes (PROs), Markov modeling, and statistical process control (SPC) analytics in a real-time cost-estimation prototype designed to assess cost differences between usual care and improvement conditions in a national multicenter improvement collaborative-the IBD Qorus Learning Health System (LHS). The IBD Qorus Learning Health System (LHS) collects PRO data, including emergency department utilization and hospitalizations from patients prior to their clinical visits. This data is aggregated monthly at center and collaborative levels, visualized using Statistical Process Control (SPC) analytics, and used to inform improvement efforts. A Markov model was developed by Almario et al to estimate annualized per patient cost differences between usual care (baseline) and improvement (intervention) time periods and then replicated at monthly intervals. We then applied moving average SPC analyses to visualize monthly iterative cost estimations and assess the variation and statistical reliability of these estimates over time. We have developed a real-time Markov-informed SPC visualization prototype which uses PRO data to analyze and monitor monthly annualized per patient cost savings estimations over time for the IBD Qorus LHS. Validation of this prototype using claims data is currently underway. This new approach using PRO data and hybrid Markov-SPC analysis can analyze and visualize near real-time estimates of cost differences over time. Pending successful validation against a claims data standard, this approach could more comprehensively inform improvement, advocacy, and strategic planning efforts.

Increasing Productivity of the Welding Process on the H-Beam Production Line by Approach RCA (Root Cause Analysis) at Pt. XYZ

This research was conducted at a company operating in the construction sector in Cikarang. The researcher conducted direct research on the welding process. The main process of focus in this research is on welding quality defects of the Slag Inclusion type. After knowing the main problem that is the cause of a defect, then carry out an improvement plan using the Root Cause Analysis (RCA) method, which is a method of repairing causal factors by analyzing what, how, and why a factor that causes a defect can occur with the aim of finding the root cause so that There needs to be changes to avoid errors. The RCA method has 2 approaches, namely the Fishbone diagram and 5 whys. Therefore, the author took the title "Increasing the Productivity of the Welding Process in the H-beam Production Line Using the RCA (Root Cause Analysis) Approach at Pt. XYZ” Root Cause Analysis (RCA) is a tool designed to understand the root cause of an event's problems based on causality in a process. The main factor that causes defects is humans who are careless when working, who do not see or observe the material when they want to start work or even underestimate the work. So implementing SOPs is very necessary to regulate workers so they don't work as they please, and outdated machines can hamper production and improve the quality of main raw materials.