Potential Process Improvements Research Articles

Potential process improvements to increase coverage of human papillomavirus vaccine in schools – A focus on schools with low vaccine uptake

IntroductionHuman papillomavirus (HPV) vaccination is offered in Australia through school-based programs. While HPV vaccination coverage is high, coverage of the full course of vaccination is suboptimal in Australia and there is a drop in coverage between the first and third doses. This study aimed to describe the drivers of low HPV vaccination coverage in Western Australian (WA) schools and barriers and enablers to improving vaccine coverage. This paper focusses on process and system-level factors. Materials and methodsThis was a mixed methods study. We analysed WA vaccination coverage data by school, undertook an online survey targeting the individuals responsible for the HPV vaccination program in their schools and school nurses, and compared survey findings and HPV vaccine dose three coverage in schools with 50 or more students in the eligible cohort. We also conducted focus groups with students and interviews with parents in schools with low HPV vaccine coverage. ResultsSchools with low HPV vaccine coverage had low coverage for the first dose of HPV vaccine as well as a higher drop off between first and third doses compared to schools with higher HPV vaccine coverage. Respondents from low and middle HPV vaccine coverage schools reported more issues with return of consent forms, low parental literacy, language barriers, absenteeism and difficulty contacting parents compared to schools with high coverage. Parents and students raised a number of challenges in relation to HPV vaccination including student absenteeism, language barriers, and issues with the return of consent forms. ConclusionsA multifaceted approach to improving HPV vaccination coverage should be targeted at schools with low coverage. Based on our findings, these actions should include a range of approaches to obtaining parental consent and intensive follow up with students who are absent on vaccination days.

A parallel multi-fidelity optimization approach in induction hardening

Purpose Reliable modeling of induction hardening requires a multi-physical approach, which makes it time-consuming. In designing an induction hardening system, combining such model with an optimization technique allows managing a high number of design variables. However, this could lead to a tremendous overall computational cost. This paper aims to reduce the computational time of an optimal design problem by making use of multi-fidelity modeling and parallel computing. Design/methodology/approach In the multi-fidelity framework, the “high-fidelity” model couples the electromagnetic, thermal and metallurgical fields. It predicts the phase transformations during both the heating and cooling stages. The “low-fidelity” model is instead limited to the heating step. Its inaccuracy is counterbalanced by its cheapness, which makes it suitable for exploring the design space in optimization. Then, the use of co-Kriging allows merging information from different fidelity models and predicting good design candidates. Field evaluations of both models occur in parallel. Findings In the design of an induction heating system, the synergy between the “high-fidelity” and “low-fidelity” model, together with use of surrogates and parallel computing could reduce up to one order of magnitude the overall computational cost. Practical implications On one hand, multi-physical modeling of induction hardening implies a better understanding of the process, resulting in further potential process improvements. On the other hand, the optimization technique could be applied to many other computationally intensive real-life problems. Originality/value This paper highlights how parallel multi-fidelity optimization could be used in designing an induction hardening system.

Model predictive control simulation, implementation and performance assessment of a coal comminution circuit

This paper describes the simulation, implementation and performance assessment of model predictive control (MPC) for a coal communition circuit, and describes, as far as can be ascertained, the first implementation of MPC in the coal processing industry.Dynamic models of an actual coal comminution circuit were derived in previous publications using the principle of mass conservation with unknown parameters that were identified with actual plant production data. The identified dynamic models are used in nonlinear MPC simulations to determine the process control objectives and to calculate a potential process improvement in throughput. This increase in potential throughput was estimated to be 5% and was used as motivation in a business case to obtain funding to implement MPC on the actual plant.After performing a tender process, General Electric was contracted to implement the MPC. The MPC was implemented successfully on the comminution system and compared to current manual plant operational performance. After evaluating the MPC through a statistical performance assessment, it was found that throughput was improved by a significant 8.22%. The methodology followed is presented in this paper and the improved production throughput motivates for further MPC technologies to be implemented at other plant operations.

Kaizen event approach: a case study in the packaging industry

PurposeThe purpose of this paper is twofold: first, a case study on the application of lean production principles in a manufacturing facility is presented to demonstrate the impact of frequent and systematic use of a Kaizen event on quality and delivery performance. Second, the detailed description and analysis of the Kaizen event and its impact are provided, including a comprehensive analysis of the role of Kaizen events on employee participation and motivation.Design/methodology/approachThe study utilizes a Kaizen event’s case study data with the help of various waste detection and elimination tools and techniques. Changes in overall productivity along with potential long-term improvements in the delivery process are also analyzed and documented.FindingsPre- and post-quality measures are provided to demonstrate the results of the event on the production quality and on the performance of the overall manufacturing processes. Qualitative findings regarding performance measurements and the impact on the employees are reported.Research limitations/implicationsThe Kaizen team applied analytical techniques to one manufacturing site in North America of a company that has a manufacturing presence in 20 different countries.Originality/valueKaizen studies involving packaging operations are quite limited. This study fills this gap by detailing the Kaizen event implementation in a packaging delivery and dispensing systems manufacturer for the cosmetic industry. The implementation of this Kaizen event is detailed along with the data and techniques utilized for process improvement. The study also reports findings regarding the impact of the Kaizen event on employee participation.

Capacity assessment and estate planning - the therapeutic importance of the individual

Demand for legal capacity assessments is increasing, especially assessments of financial capacity for estate planning purposes such as wills and enduring powers of attorney. This article proposes that such assessments will be improved by taking greater account of the client experience, including individual and relational factors and processes, and considering the practice framework.A literature review was undertaken with a two-fold aim: firstly, to understand the fundamentally important perspective (inclusive of these experiences) of the evaluee; and, secondly, to identify potential improvements in the capacity assessment process with a view to informing best practice. No studies were identified that directly addressed the individual perspective in capacity assessments. Case studies and commentaries that indirectly discuss the individual perspective were therefore analysed to identify any potential issues and recommendations. This analysis showed that individual factors, such as the evaluee's functional and disease status, and relational factors, such as trust, should be considered by examiners. This review demonstrates that there is a significant gap in the literature examining the individual's perspective and experiences in capacity assessments, as well as, any impact this may have on the assessment process and outcomes. Further research into this vital perspective is needed so that the experiences of those undergoing assessments can help inform best practice and ensure that optimal processes are adopted when assessing the capacity necessary to make legally recognised decisions. This article examines the importance of the participant perspective and experiences in capacity assessments through the novel lens of therapeutic jurisprudence. It includes practice suggestions and provides the direction for this future research.

Abstract NS2: Electronic Stroke Outcome Reporting to Enhance Practice Improvement and Education Among Emergency Nurses, A Pilot Study

Background: Feedback is an effective mechanism to change provider behavior. However, emergency department (ED) nurses who transfer acute stroke patients, rarely receive patient outcomes. Interviews with ED nurses found that knowledge of outcomes was a source of job satisfaction, education, and potential process improvement. Purpose: The purpose of this program was to develop an electronic tool to report acute stroke patient outcomes to ED nurses. We sought to evaluate the feasibility and usability of this tool. Methods: We piloted this project in May 2018 in Nashville, TN at three EDs. Staff were identified through leadership using emails and fliers and they could specify their communication preference (email or text). Clinical presentation, operational metrics (e.g., ED arrival-to- CT), 72 hour clinical status, and interesting images (e.g., CT scan) for patients with a stroke alert were reported in a de-identified manner ( Figure ). We assessed usefulness and likelihood to change, and were able to claim continuing education credit. Simple descriptive statistics were calculated. Results: We enrolled 107 nurses and identified 56 stroke outcomes, 55 of which had at least one nurse registered. Nurses preferred email updates (79.4%) over text and viewed outcomes 41 out of 113 opportunities (36.2%). Nurses reported (N=17) a mean usefulness score (out of 100) of 81.9 (SD 15.3) and a likelihood to change (N=14) of 38.4 (SD 28.9). Four nurses either initiated or completed the continuing education activity. Conclusions: Electronic stroke outcome reporting is feasible and useful to ED nurses. Continuing education may not influence patient follow-up. The time required to summarize and create the update limits scalability but may be addressed through automatic electronic data pulls. In conclusion, an electronic tool may be an effective mechanism to communicate inter-organizational patient outcomes and may be a source of education of best practices in acute stroke care.

Performance analysis and carbon reduction assessment of an integrated syngas purification process for the co-production of hydrogen and power in an integrated gasification combined cycle plant

The integrated gasification combined cycle (IGCC) is prominent in coal-based power plants because of its high efficiency and environmental benefit. Because of global warming, the integration of a carbon capture process (CCP) into the IGCC is exigent. In this study, performance analysis of an integrated syngas purification process was performed for a 500 MW-class IGCC. First, various carbon capture efficiencies were investigated to elucidate the most economical carbon capture efficiency, and a carbon capture efficiency of 90% was recommended. This value includes sour gas (H2S) removal cost, and it is essential for coal-power plants regardless of carbon capture. Thus, the net carbon capture cost was calculated from the difference in the operating costs of the integrated syngas purification process with/without a CCP. The net carbon capture cost per ton of CO2 was determined as approximately 21 USD. In addition, the exergy analysis and H2 co-production from the integrated syngas purification process with pressure swing adsorption (PSA) were presented to suggest the direction of the potential process improvement and carbon reduction assessment. The study can contribute towards decision-making related to investment in near-future candidate technologies for increasing efficiency and carbon emissions.

IO-Link Wireless enhanced factory automation communication for Industry 4.0 applications

Abstract. In the context of the Industry 4.0 initiative, Cyber-Physical Production Systems (CPPS) or Cyber Manufacturing Systems (CMS) can be characterized as advanced networked mechatronic production systems gaining their added value by interaction with the ambient Industrial Internet of Things (IIoT). In this context appropriate communication technologies and standards play a vital role to realize the manifold potential improvements in the production process. One of these standards is IO-Link. In 2016 more than 5 million IO-Link nodes have been produced and delivered, still gaining increasing acceptance for the communication between sensors, actuators and the control level. The steadily increasing demand for more flexibility in automation solutions can be fulfilled using wireless technologies. With the wireless extension for the IO-Link standard, which will be presented in this article, maximum cycle times of 5 ms can be achieved with a probability that this limit will be exceeded to be at maximum one part per billion. Also roaming capabilities, wireless coexistence mechanisms and the possibility to include battery-powered or energy-harvesting sensors with very limited energy resources in the realtime network were defined. For system planning, setup, operation and maintenance, the standard engineering tools of IO-Link can be employed so that the backward compatibility with wired IO-Link solutions can be guaranteed. Interoperability between manufacturers is a key requirement for any communication standard, thus a procedure for IO-Link Wireless testing is also suggested.

"New Media in Education" MOOC: Improving Peer Assessments of Students’ Plans and their Innovativeness

MOOC courses in the fields of new media, entrepreneurship and innovation require pedagogical developers to create a clear and measureable peer assessment process of the innovative plans and projects developed by students. The objectives of our action research are to improve evaluations of students’ plans and their innovativeness in a MOOC based on project-based learning (PBL). We analyzed 789 written peer assessments and grades of 89 PBL plans, which were submitted as part of the requirements in a new MOOC course 'New Media in Education' targeting student teachers. Correlations between final peer project grades and other assessment categories were calculated. A regression analysis model indicates that innovativeness and compatibility of student plans to educational needs are the strongest predictors final peer grades. Based on the research findings, we propose potential improvements in the peer assessment process, including additional guidelines for the assessment of innovativeness and other categories of PBL plans based on new media and digital pedagogy.

Challenges and potential improvements in the admission process of patients with spinal cord injury in a specialized rehabilitation clinic \u2013 an interview based qualitative study of an interdisciplinary team

BackgroundThe admission process of patients to a hospital is the starting point for inpatient services. In order to optimize the quality of the health services provision, one needs a good understanding of the patient admission workflow in a clinic. The aim of this study was to identify challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic from the perspective of an interdisciplinary team of health professionals.MethodsSemi-structured interviews with eight health professionals (medical doctors, physical therapists, occupational therapists, nurses) at the Swiss Paraplegic Centre (acute and rehabilitation clinic) were conducted based on a maximum variety purposive sampling strategy. The interviews were analyzed using a thematic analysis approach.ResultsThe interviewees described the challenges and potential improvements in this admission process, focusing on five themes. First, the characteristics of the patient with his/her health condition and personality and his/her family influence different areas in the admission process. Improvements in the exchange of information between the hospital and the patient could speed up and simplify the admission process. In addition, challenges and potential improvements were found concerning the rehabilitation planning, the organization of the admission process and the interdisciplinary work.ConclusionThis study identified five themes of challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic. When planning adaptations of process steps in one of the areas, awareness of effects in other fields is necessary. Improved pre-admission information would be a first important step to optimize the admission process. A common IT-system providing an interdisciplinary overview and possibilities for interdisciplinary exchange would support the management of the admission process. Managers of other hospitals can supplement the results of this study with their own process analyses, to improve their own patient admission processes.

Process variability analysis in make-to-order production systems

AbstractVehicle license number plate production in Nigeria faces high variability in terms of process times and inter-arrival times, resulting in poor production schedule reliability. This study aims to clarify the level of such variation and to provide process improvement strategies within plate production. The specific objectives herein include identifying assignable variables, estimating variability indices and minimizing variation by developing solutions to improve system performance. This study explores the variability pooling method in assessing potential cost-effective process improvements and a case study is conducted on four Nigerian vehicle license number plate production plants in order to demonstrate the applicability of the proposed technique. Structured questionnaires were circulated to plant workers and data collected from plant production records from 2012 to 2015 in seven production lines were analyzed. A preliminary study on the production lines revealed the coefficient of variation (CV)...

Power Pool Transfer Limits: Standardised Process

The Southern African Power Pool (SAPP) is a pool of interconnected electrical utilities in southern Africa. The SAPP hosts a workshop annually between all its constituents to determine the power transfer limits for the interconnected network for the following year. These limits ensure that the power pool remains stable and does not experience a blackout. Consistent processes have led to accurate and consistent results; therefore the aim of this research was to identify the gaps in the SAPP transfer limits studies process compared to international best practice processes. The inconsistencies identified translate to the identified potential process improvements that can be made to the consistency of the SAPP process and therefore the accuracy of the results produced.

Clinical Chart Audits as a Potential Process Improvement Strategy Within the Radiation Therapy Department of a Community-Based Cancer Center

PurposeWithin the health care profession, many organizations rely on routine clinical chart audits to detect areas for enhancement and potential triggers for error. Effective clinician documentation within the electronic treatment record is mandatory should high-quality care be maintained. This study aimed to determine what type of information might be obtained from radiation therapy treatment chart audits. This information would help to inform areas for improvement within the department and to determine whether introducing clinical chart audits as routine would be of benefit. MethodsA chart audit tool was piloted at the host institution and subsequently finalized as a result of the pilot. Clinical chart audits of radiation treatment records (n = 196) were completed over a four-month time span. Data analysis included the calculation of proportions to examine the completeness of each of the identified tasks within the chart audit tool. ResultsAreas of excellent practice (achieving or exceeding a benchmark measurement of 90%) tend to correlate well with tasks that are currently embedded into routine quality assurance checks, such as a checklist. Areas for improvement (below set benchmark) have a commonality; they all required best practices to be followed and did not have a prompt built in to the process. ConclusionsAreas of further related research would focus on engaging radiation therapists in the successful implementation of chart audits within this radiation therapy department.

Production Monitoring and Process Improvement for Floor Panel Manufacturing

Panelized home construction allows for the construction of homes to be completed in a factory, but in only two dimensions, compared to the three dimensional module that is produced in modular construction facilities. Keeping the panels detached until they reach the final destination permits for more efficient transport of panels and allows the factory to be divided into more specialized areas. This paper presents a case study of an established panelized home manufacturer, where the floor production area is identified as an area for potential process improvement. Possible areas for process improvement are identified by conducting a time study, carrying out observation, and constructing a simulation model in which potential process improvements can be tested. Opportunities are identified for process improvement, and the anticipated results of implementing certain changes are quantified through the use of simulation in order to aid management in making decisions regarding which changes are to be implemented and in what order. Some possible areas for improvement of the floor production area, including reducing the waiting time for the multi-function bridge by manually applying glue, aligning the joists in the correct orientation prior to their reaching the floor jig to eliminate the need to rotate the joists, and installing a bridge for sheathing board delivery that eliminates the time spent walking to retrieve the sheathing boards.

A surface acoustic resonator with template-patterned interdigitated fingers

Printed electronics techniques show promise as high-throughput, low-cost methods for fabricating micro-scale device features. In this work, we demonstrate a SAW resonator fabricated through a printing process. Silver nanoparticle ink is introduced to a vapor-permeable template that is patterned with the desired SAW resonator metallization. After the solvent in the ink evaporates, the nanoparticles within the patterned template tightly pack to form the device metallization. Interdigitated resonator electrodes with widths and spacing ranging from 500nm to 1μm were patterned on lithium niobate, corresponding to center frequencies of 2.1–2.4GHz. The maximum quality factor was 13. Limitations and potential process improvements are discussed to improve resonator quality factor in future work.

StratBAM: A Discrete-Event Simulation Model to Support Strategic Hospital Bed Capacity Decisions.

The ability to accurately measure and assess current and potential health care system capacities is an issue of local and national significance. Recent joint statements by the Institute of Medicine and the Agency for Healthcare Research and Quality have emphasized the need to apply industrial and systems engineering principles to improving health care quality and patient safety outcomes. To address this need, a decision support tool was developed for planning and budgeting of current and future bed capacity, and evaluating potential process improvement efforts. The Strategic Bed Analysis Model (StratBAM) is a discrete-event simulation model created after a thorough analysis of patient flow and data from Geisinger Health System's (GHS) electronic health records. Key inputs include: timing, quantity and category of patient arrivals and discharges; unit-level length of care; patient paths; and projected patient volume and length of stay. Key outputs include: admission wait time by arrival source and receiving unit, and occupancy rates. Electronic health records were used to estimate parameters for probability distributions and to build empirical distributions for unit-level length of care and for patient paths. Validation of the simulation model against GHS operational data confirmed its ability to model real-world data consistently and accurately. StratBAM was successfully used to evaluate the system impact of forecasted patient volumes and length of stay in terms of patient wait times, occupancy rates, and cost. The model is generalizable and can be appropriately scaled for larger and smaller health care settings.

Facilitation of Clinical Chart Audits: The Examination of a Potential Leadership Process Improvement Strategy within the Radiation Therapy Department of the R. S. McLaughlin Durham Regional Cancer Centre

Facilitation of Clinical Chart Audits: The Examination of a Potential Leadership Process Improvement Strategy within the Radiation Therapy Department of the R. S. McLaughlin Durham Regional Cancer Centre

Hyaluronan dermal fillers via crosslinking with 1,4-butandiol diglycidyl ether: Exploitation of heterogeneous reaction conditions.

Most of hyaluronan (HA)-based dermal fillers currently available on the market are produced through biopolymer crosslinking with 1,4-butandiol diglycidyl ether (BDDGE). Chemical modification is usually performed on the biopolymer dissolved in a highly alkaline aqueous medium (homogeneous conditions). Heterogeneous conditions for HA reaction with BDDGE were exploited here to obtain competitive HA fillers and to assess potential improvements in production process. Optimal parameters for effective reaction accomplishment were evaluated (e.g., medium composition, temperature and time of reaction). HA was modified with increasing BDDGE/HA equivalents (7-14%) achieving 66-74% (w/w) biopolymer insolubility. Hydrogels exhibited high swelling extent and outstanding resistance to enzymatic degradation decreasing and improving according to crosslinking degree, respectively. Once suspended in physiological solution (20 mg/mL), these products directly formed easy-to-extrude gels through 27-29 G needles. Gel particle dimensions were in the range 10-1000 µm. Rheological analyses revealed decreasing viscosity with the shear rate and G' values in the range 1200-1700 Pa. Overall, results of the in vitro characterization demonstrated the attainment of crosslinked HA particles suitable for application as dermal fillers. These new gels proved superior to similar commercialized products in terms of stability to enzymatic hydrolysis. Further, the protocol assessed allowed interesting improvements over conventional manufacturing procedures.

A method for aggregating ordinal process assessment measures

Process capability and maturity models invariably use an ordinal scale of capability or maturity. Process assessment methods must include ways to aggregate the base assessment measures through to the capability level. As process reference models and assessment models have become more detailed, process assessments have started to assess the processes at lower levels of process attributes. Also, process assessments can assess different divisions of an organization then try to combine the results to form some conclusion about the overall organizational capability. Both circumstances have exposed the problems of aggregating ordinal measures. We propose that these problems can be overcome by converting ordinal base measures to probability distributions. Doing so allows mathematical aggregation to be used at all levels of the measurement model. Although this overcomes a problem, we caution that it also provides an illusion of precision and accuracy where none is justifiable, leading to a tendency to overlook the original purpose of process assessment, which is to identify potential process improvements. Copyright © 2014 John Wiley & Sons, Ltd.

Praxisbericht: Prozessbasiertes Indikatorendashboard. Die Visualisierung von Qualitätssicherungsergebnissen innerhalb standardisierter Prozesse

Process management (PM) is a valuable method for the systematic analysis and structural optimisation of the quality and safety of clinical treatment. PM requires a high motivation and willingness to implement changes of both employees and management. Definition of quality indicators is required to systematically measure the quality of the specified processes. One way to represent comparable quality results is the use of quality indicators of the external quality assurance in accordance with Sect. 137 SGB V—a method which the Federal Joint Committee (GBA) and the institutions commissioned by the GBA have employed and consistently enhanced for more than ten years. Information on the quality of inpatient treatment is available for 30 defined subjects throughout Germany. The combination of specified processes with quality indicators is beneficial for the information of employees. A process-based indicator dashboard provides essential information about the treatment process. These can be used for process analysis. In a continuous consideration of these indicator results values can be determined and errors will be remedied quickly. If due consideration is given to these indicators, they can be used for benchmarking to identify potential process improvements.