Process Action Team Research Articles

Development and Implementation of U.S. Army Guidelines for Managing Soldiers at Risk of Suicide.

Despite significant efforts in suicide prevention over the past several years, suicide rates in the U.S. Army remain largely unchanged. This paper describes a collaborative effort between line-unit leaders, medical personnel, and installation services to synchronize suicide risk identification and communication between these disparate entities. Under the direction of the Installation Director of Psychological Health at Joint Base Lewis-McChord, a Behavioral Health Process Action Team was chartered to identify best practice and formulate policy for identifying and managing service members at risk for suicide. Compliance with the new policy reached 100% within 6 months of implementation, as measured by peer review of records. This installation policy was subsequently identified as a best practice and adopted Army-wide as the standard of practice. Knowledge transfer of research findings into policy and practice is crucial for suicide prevention. The current policy shows good integration of current research with practice in military settings. Combined efforts in crafting policy for risk identification and communication resulted in a policy that was acceptable and feasible from the perspective of commanders and clinicians. Synchronization efforts between commanders, clinicians, and support services are crucial to ensure effective intervention to prevent suicide behavior.

Process action team in health care

Process action team in health care

Use of Multiple Performance Improvement Tools over a Five Year Period To Effect and Maintain Positive Outcomes in the Aspiration Pneumonia Rates of an Acute Care Facility

ISSUE: With a mortality rate of 20-50%, pneumonia is the second most common heathcare associated infection (HAI) and the leading cause of HAI deaths with conservative cost estimates at over $1.2 billion annually. Over the last five years Overton Brooks VA Medical Center has utilized multiple performance improvement tools (i.e. Performance Improvement (PI) Model: Plan, Design, Measure, Assess and Improve, Process Action Team (PAT), Healthcare Failure Mode Effects and Analysis (HFMEA) team, and Root Cause Analysis (RCA) team) to successfully decrease rates of nosocomial aspiration pneumonia in their high risk patient population. PROJECT: With the identification of increased rate of aspiration pneumonia in 1999, a multidisciplinary PAT was charter in January 2000 to review and evaluate tube feeding practices, policies, and equipment. In 2003 in an effort to further reduce aspiration pneumonia rates, a multidisciplinary HFMEA team investigated the vulnerabilities in current patient care processes. Due to the identification of a sentinel event, healthcare acquired aspiration pneumonia death, a RCA team was chartered in January 2005. In all team processes, data collection tools were developed, data was analyzed, continuous monitoring and educational tools were created. RESULTS: The 2000 PAT recommendations resulted in the reduction of the 1999 aspiration pneumonia rate of 0.6/1000 patient days to 0.3 in 2000 and 0.2 in 2001. Recommendations from the 2003 HFMEA team resulted in the incidences of aspiration pneumonia related to vomiting and procedures decreasing from 0.5/1000 patient days in 2003 to 0.4 in 2004 and 0.2 in 2005. No further aspiration pneumonia related deaths have occurred since the implementation of the 2005 RCA recommendations. LESSONS LEARNED: Each of the PI tools utilized over the past five years have proved successful in decreasing the HAI aspiration pneumonia rate. However, the use of multiple PI tools has allowed the focusing of interventions resulting in efficient and effective utilization of finite resources. Further, the continuous monitoring methods required with these PI tools are credited with maintaining the low incidence of aspiration pneumonia in this high risk population.

Critical success factors for software process improvement implementation: an empirical study

AbstractIn this article, we present findings from our recent empirical study of the critical success factors (CSFs) for software process improvement (SPI) implementation with 34 SPI practitioners. The objective of this study is to provide SPI practitioners with sufficient knowledge about the nature of issues that play a positive role in the implementation of SPI programmes in order to assist them in effectively planning SPI implementation strategies.Through our empirical study we identified seven factors (higher management support, training, awareness, allocation of resources, staff involvement, experienced staff and defined SPI implementation methodology) that are generally considered critical for successfully implementing SPI. We also report on a literature survey of CSFs that impact SPI and identify six factors (senior management commitment, staff involvement, staff time and resources, training and mentoring, creating process action teams and reviews). We compared our empirical study results with the literature and confirmed the factors identified in the literature, and also identified two new CSFs (SPI awareness and defined SPI implementation methodology) that were not identified in the literature. Finally, we analyzed the CSFs identified by different groups of practitioners and found that they are aware of what is imperative for the successful implementation of SPI programmes. Copyright © 2006 John Wiley & Sons, Ltd.

Using a process action team to improve patient education.

To develop an effective, coordinated, and integrated process for patient education in primary care, the Department of Veterans Affairs, Western New York Healthcare System, launched a process action team. The interdisciplinary team utilized a variety of methods, including flowcharts, cause-and-effect diagrams, and variance matrices. The team developed, implemented, and analyzed a data collection plan involving chart reviews, staff interviews, and patient-staff surveys. An improvement plan was initiated in collaboration with staff. The results highlight the importance of using a data collection plan to understand the causes of problems as well as the need for staff involvement.

STATISTICAL PROCESS CONTROL MODELS IN AGRO-CHAINS

Consumer expectations on quality of food products are very high and tend to increase as well as diversify to include flexible and fast delivery, health, safety and minimal environmental impact. Assurance to conform or even exceed these expectations can no longer come from mass inspection, but has to be founded on intelligent process control, process and product design and continuous improvement. Statistical Process Control (SPC) provides the sound basis for this. Although SPC used to be strongly associated with the statistical tools applied, it is now regarded in general as an indispensable approach to managing processes (Deming (1986), Snee (1990), Joiner (1994), Hare et al. (1995), Hoerl (1995), Does et al. (1997), Roes and Dorr (1997) and Roes (1997)). In the broader context this approach is based upon the principles that: all work is a series of interconnected processes; all processes vary; sources of variation can roughly be distinguished as arising from common causes (inherent to the process as designed) and special causes; understanding the origin of each of these sources of variation is the key to reduction of variation; reduction of variation is the key to quality improvement, productivity and profitability. Statistical methods such as control charts, experimental design, data analysis are applied to uncover causes of variation and thus control and improve the processes. SPC can be implemented on the shop floor by cross-disciplinary teams, called Process Action Teams (PATs). In production processes such teams consist of operators, foremen, process-engineers, maintenance-engineers and other technical personnel involved with the process, and a statistician. A PAT implements SPC for a specific process following a stepwise approach, based on the Plan-Do-Check-Act cycle. This forms a close link between statistical thinking and the scientific method. The main steps are: Definition of the process to be dealt with Diagnosis of the process Actions and measurements Design of feedback control loop Implementation and further improvement (back to I) The result of the phases I through V is usually twofold. The main purpose is to install a control loop with control charts and accompanying out of control action plan (Figure 1). In this control loop, deviations from the normal performance of the process are detected by means of control charts. Subsequently, the shop floor operators follow the out of control action plan to identify and remove the cause as quickly as possible. Concurrently with establishing this control loop, opportunities for improvement arise during process diagnosis and appropriate action is taken or is planned to be taken once control is established. The process diagnosis is a crucial step and includes describing processes using flow-charts and performing a risk analysis based on the Failure Mode and Effect Analysis (FMEA) technique (see Stamatis, 1995). Possible causes and effects critical quality characteristics

The Orient Express

The changing health care environment makes customer satisfaction a primary concern for all areas of food service. Well-trained, enthusiastic employees are a food service's most valuable asset in achieving superior customer satisfaction. New employee orientation sets the stage for developing a dynamic team committed to customer service. Recognizing this fact, Nutrition and Food Service formed a Process Action Team (PAT) including employees from all levels of the service to design a comprehensive orientation program for new employees. The PAT's goal was to develop a flexible orientation packet that could be used at all levels of the service. The team initially used flowcharts and variance matrix charts to evaluate the existing orientation program, identifying its strengths and weaknesses. PAT members also sought input from employees throughout the service as well as from neighboring institutions of similar complexity regarding the ideal orientation program. From this information, the PAT developed an orientation checklist, and each PAT member expanded upon particular sections of the checklist. The checklist served as a starting point for developing informational sheets that described the service: for example, vignettes of management positions, do's and don’ts for requesting leave, safety tips, important telephone numbers. The sheets were tailored to the type of employee. For example, the clinical staff and the food service workers have somewhat different dress codes, thus distinct sheets were developed. The orientation packet also included an evaluation component, and the feedback from this instrument suggests that the PAT accomplished its goal of developing a flexible, comprehensive orientation packet that meets the needs of new employees at all levels of the service.

Improving care thorough a medication administration process action team

The article discusses the use of a process action team to improve the medication administration system. The interdisciplinary team suggests alternatives after reviewing current practice, systems, and procedures. After suggested alternatives are applied, the medication dispensing and administration system improves and enhances the delivery of medications to patients. This opportunity to improve care explains the use of the process action team in patient care system improvement.

Total quality management at work—process action team (PAT) mandates competency certification in disinfection/sterilization of patient care equipment: E. Vasquez, LPN,∗ K. Large, RN, LCDR T. Stewart, NC, USN. National Naval Medical Center, Bethesda, MD

Total quality management at work—process action team (PAT) mandates competency certification in disinfection/sterilization of patient care equipment: E. Vasquez, LPN,∗ K. Large, RN, LCDR T. Stewart, NC, USN. National Naval Medical Center, Bethesda, MD

Military pharmacy looks to TQM to satisfy its customers

This article describes a study of problems with the operation of a military base pharmacy. The investigation was accomplished using statistical quality control and operations management tools, including Pareto analysis, survey techniques, and layout analysis. An analysis of customer complaints showed that the time to fill new prescriptions was the major cause of customer discontent. A process action team (PAT) approach was used to ensure that recommended solutions were compatible with local resources.

Interdisciplinary Collaboration in the Special Care Unit—Part II

Collaborative interdisciplinary patient care is enhanced as healthcare professionals in special care units work to implement Joint Commission on Accreditation of Healthcare Organizations' standards for improving organizational performance. This second part of a two-part article provides a practical approach to developing a process action team to review the care of patients receiving mechanical ventilation. As a follow-up to the development of one special care unit committee, this was an important step in the transition from multidisciplinary, discipline-specific care to interdisciplinary, collaborative care.

Role for Risk Communication in Closing Military Waste Sites

Lessons learned from environmental and occupational hazard risk management practices over the past 30 years have led the Department of Defense to explore alternative risk management approaches. Policies for cleanup of environmentally hazardous waste sites are undergoing examination and are being reframed. A Demonstration Risk Communication Program is described which incorporates principles that integrate risk-based scientific information as well as community values, perceptions, and needs in a democratic process that includes the public as an active participant from the earliest stages. A strong scientific foundation for assessment and characterization of risk is viewed as necessary but not sufficient; the public's values must be actively integrated into the negotiated criteria. The Demonstration Program uses a model to prepare the participants and to guide them through the process. A five-step process is presented: (1) create risk communications process action team including at least one member of the specific site audience; (2) professionally train participants on team dynamics including interpersonal communication skills; (3) train risk communicators to deliver a cogent presentation of the message to secure a decision acceptable to both the government and the public; (4) identify existing biases, perceptions, and values held by all participants; and (5) develop risk message incorporating science and values. The process action team approach assumes the participants enter into the effort with the goal of improved environment and safeguarded public health. The team approach avoids confrontational or adversarial interactions and focuses on a dialogue from which a negotiated team response develops. Central to the program is the recognition that communication is only effective when the dialogue is two-way.

Implementing the Patient Self-Determination Act

An interdisciplinary process action team developed policies and procedures for implementation of the Patient Self-Determination Act. Specific roles were defined for all involved in the process: Admissions Office, Unit Nurse, Social Worker, Attending Physician, Medical Records, Public Affairs, Patient Administration, Legal Office, Medical Library, Medical Law and Chaplain. An educational effort provides orientation for the hospital staff and the community on development of advance directives by patients.

An Approach to Turn–Key Communications Suites for New Construction Ships

ABSTRACT“Turn‐Key” is an innovative approach for the design, acquisition, integration, and installation of Radio Communications Systems for new construction ships. It has been developed by the Space and Naval Warfare Systems Command (SpaWar) to cope with the growing problem of ships being delivered to the fleet with outdated or obsolete communications technology. The Turn‐Key approach provides both performance and affordability benefits.Under the traditional ship design process, the baseline configuration of the communications suite is effectively frozen 5–7 years before delivery of the ship. In the current fixed price shipbuilding environment, the costs of engineering change proposals (ECPs) to implement communications suite design changes have become prohibitive. The design inflexibility created by these schedule and cost constraints affects the Navy's ability to implement communications technology advancements in new construction ships. At the point of delivery, most new construction ships already have an inherent “bow‐wave” of required communications subsystem/equipment upgrades which must be accomplished under the Fleet Modernization Program.Under the turn‐key approach, the Navy assumes full responsibility for design, acquisition, land‐based system integration, and (in some cases) shipboard installation and test of the communications suite. The shipbuilder provides necessary electrical power, ventilation, and cooling services, based on established allocations. This approach greatly reduces the Navy's GFI requirements and ECP costs to the shipbuilder and thereby gains the design flexibility necessary for incorporation of up‐to‐date communications technology prior to ship delivery. Since the shipbuilding ECP cost penalties associated with implementing communications technology upgrades are reduced, the turn‐key approach enables performance improvements while providing affordability benefits.The turn‐key approach already has been used successfully for installation of the communications suites on a number of auxiliary and special mission ship classes, and the results have been praised by InSurv. Now proposed for application to surface combatants and amphibious ships, the turn‐key approach is also the subject of an ongoing NavSea Total Quality Leadership (TQL) Process Action Team addressing improvements to the ship design, acquisition, and construction process. By attaining design flexibility and affordable performance benefits, the turn‐key approach serves as a prototype process improvement for integration of the entire range of command, control, communications, computers, and intelligence (C4I) systems.

APPLICATION OF A SYSTEMS ENGINEERING APPROACH TO OPTIMIZE THE DOD PROGRAM MANAGEMENT PROCESSES

ABSTRACTThe U.S. Army Missile Command (MICOM) has utilized a traditional, functional systems engineering approach for weapon system development. However, the advent of the concurrent engineering philosophy highlighted that the success of a defense program could be enhanced by applying a systems engineering approach to managing or determining programmatic requirements. A Process Action Team was established at MICOM to develop an optimized systems engineering process for weapon systems development, which includes the philosophy of concurrent engineering. This paper presents a case study of the team's findings.

Process Action Team Handbook (State of the Art Report (SOAR) 8), Reliability Analysis Center, 1992. Number of pages: 91. Price: $80.00 (U.S.A. and Canada), $90.00 (elsewhere)

Process Action Team Handbook (State of the Art Report (SOAR) 8), Reliability Analysis Center, 1992. Number of pages: 91. Price: $80.00 (U.S.A. and Canada), $90.00 (elsewhere)

Total quality management: getting started

This paper gives guidelines for starting a Total Quality Management (TQM) programme using Organizational Development (OD) intervention techniques to gain acceptance of the programme. It emphasizes human behaviour and the need for collaborative management and consensus in organizational change. Lessons learned stress the importance of choosing a skilled TQP facilitator, training process action teams, and fostering open communication and teamwork to minimize resistance to change.