Quality Improvement Management Research Articles

#2389 Enhancing immunoglobulin A nephropathy management: insights from the IGAN-MIC project

Abstract Background and Aims Immunoglobulin A nephropathy (IgAN) comprises a substantial proportion of primary glomerulonephritis cases in China, yet comprehensive nationwide data regarding its diagnosis and treatment are lacking. The Immunoglobulin A Nephropathy Management Quality Improvement Initiative Project in China (IGAN-MIC) seeks to establish an IgAN cohort collaboration network to comprehend real-world IgAN management practices in China. Method The IGAN-MIC project convened 15 Chinese experts from 14 regions to form an expert committee to develop a registry of IgAN patients to evaluate regional differences in IgAN management from 2015 to 2024. The registry will involve comprehensive data collection from electronic medical records, encompassing key aspects including demographic and clinical characteristics, renal biopsies, diagnoses, comorbidities, laboratory findings, and treatment modalities, facilitating a detailed analysis of disease progression and changes in treatment strategies from initial diagnosis through subsequent follow-up periods. Results The IGAN-MIC project has garnered applications from 78 healthcare institutions, with 7 of them already incorporated into the initiative and initiated data collection. As of January 1, 2024, the project has enrolled 543 pathologically confirmed IgAN patients diagnosed between 2015 and 2023 from these 7 centers. At the time of diagnosis, the median (IQR) of age was 38.00 (30.00, 48.00) years; 54.51% were females; the median (IQR) of eGFR was 75.41 (51.93, 104.09) mL/min/1.73 m2 and the median (IQR) 24-hour urinary protein was 1263.50 (645.30, 2362.64) mg/day. For these patients, the utilization rates of RAS inhibitors (RASi), SGLT2 inhibitors (SGLT2i) and glucocorticoids at initial treatment were 53.41%, 3.51%, and 42.73% respectively. The utilization rate of SGLT2i from 2022 to 2023 was 9.90%, as the first indication for SGLT2i in CKD was approved in China in September 2022. A detailed outline of patient baseline characteristics is presented in Table 1 below. Conclusion These initial findings in the registry showed that the Chinese IgAN patients were young, had mildly reduced renal function, and with massive proteinuria at the time of initial diagnosis. For initial treatment, only half of the patients received RASi, and only one tenth received SGLT2i. More education needs to be focused on promoting guideline-directed medical therapies in the future. Given that nationwide data on Chinese IgAN patients are limited, the IGAN-MIC project is anticipated to broaden its registry to include more healthcare institutions and Chinese IgAN patients in the future, with the aim of providing a more in-depth understanding of the changing clinical presentations and ongoing follow-up scenarios among IgAN patients, contributing crucial insights to the clinical management of IgAN.

Towards Quality Management Procedures in 3D Cadastre

The 3D cadastre presents a modern approach to the development of cadastral information systems, with the role of improving current cadastral systems and overcoming the challenges of a 2D-based approach. Technological advancements, standardization, and scientific research in recent decades have contributed to the development and definition of the 3D cadastre. This positioned the 3D cadastre as an integral part of the future of land administration. However, every country needs to define a solution for itself based on its own legal system and cadastral tradition, while at the same time relying on international standardization and research. Once a 3D cadastral system is developed, it is crucial to ensure the monitoring, evaluation, and maintenance of both the quality of the cadastral data and the system itself throughout its lifecycle. Since 3D cadastres involve geometric data, quality management procedures must address both geometric and alphanumeric data. In this paper, we analyze and present the quality management procedures that should be included during designing, implementing, and maintaining a 3D cadastral system. Some examples based on real cadastral data were used to emphasize the need for improvement in quality management. The presented quality management procedures require further development in order to meet country-specific requirements and to fully support the 3D cadastre information systems.

Innovative Financial Management in Higher Education: A Multi-Scale Deep Learning Approach for Risk Reduction and Quality Enhancement

This paper presents a novel university financial management system leveraging multi-scale deep learning. With rising college enrollment and teaching complexities, traditional financial models require adaptation to mitigate risks and improve management quality. The system integrates hardware and software innovations: multiple sensors enhance data scanning, coordinated by a central coordinator, ensuring comprehensive financial database coverage. Software-wise, a structured database establishes attribute-based financial connections, crucial for weight assignment. Employing a multilayer perceptual network topology, a full interconnection model based on multi-scale deep learning facilitates profound data extraction. Experimental evaluations demonstrate the system's superior financial risk assessment capabilities compared to traditional approaches, extracting a broader spectrum of financial parameters for comprehensive risk warnings. By embracing multi-scale deep learning, this system promises significant advancements in university financial management, enhancing adaptability and risk mitigation in college finance departments.

Review of soil environment quality in India near coal mining regions: current and future predictions.

Production and utilization of coal are one of the primary routes of accumulation of Toxic Elements (TEs) in the soil. The exploration of trends in the accumulation of TEs is essential to establishing a soil pollution strategy, implementing cost-effective remediation, and early warnings of ecological risks. This study provides a comprehensive review of soil concentrations and future accumulation trends of various TEs (Cr, Ni, Pb, Co, Cu, Cd, Zn, Fe, Mn, and As) in Indian coal mines. The findings revealed that average concentrations of Cr, Mn, Ni, Cu, Zn, Pb, and Co surpass India's natural background soil levels by factors of 2, 4.05, 5.32, 1.77, 9.6, and 6.15, respectively. Geo-accumulation index values revealed that 27.3%, 14.3%, and 7.7% of coal mines are heavily polluted by Ni, Co, and Cu, respectively. Also, the Potential Ecological Risk Index indicates that Cd and Ni are primary contaminants in coal mines. Besides, the health risk assessment reveals oral ingestion as the main exposure route for soil TMs. Children exhibit a higher hazard index than adults, with Pb and Cr being major contributors to their non-carcinogenic risk. In addition, carcinogenic risks exist for females and children, with Cr and Cu as primary contributors. Multivariate statistical analysis revealed that TEs (except Cd) accumulated in the soil from anthropogenic sources. The assessment of future accumulation trends in soil TE concentrations reveals dynamic increases that significantly impact both the ecology and humans at elevated levels. This study signifies a substantial improvement in soil quality and risk management in mining regions.

Establishment of the quality management system for occupational diseases diagnosis

The quality management system of occupational diseases diagnosis is belonged to one part of the hospital quality management system. It must be adhered to the quality management concept of comprehensive, full staff and whole process. To establish and improve the quality management system should be included: (1) Formulated a quality management manual for occupational disease diagnosis, including organization construction, rules and regulations, responsibilities, work flow, operating procedures and clinical pathways, standard instrument, etc. (2) Managed the document of occupational diseases diagnosis. (3) The continuous improvement of quality management. The quality management of occupational diseases diagnosis focuses on the mastery and implementation of the manual by employees, which is reflected in the continuous improvement of daily work, internal assessment and external assessment.

Quality of analgesic care in labor: A cross-sectional study of the first national register-based benchmarking system.

Unlike other types of acute pain, labor pain is considered physiological. Due to the heterogeneous management during labor, there is a lack of intention to define quality of care of peripartal analgesia. This study presents the first results of the national register for this evaluation. This prospective cross-sectional study, conducted in five different German level-three hospitals, included women after vaginal childbirth between January 2020 and January 2022. A validated questionnaire was completed 24 h postpartum, including information about labor pain, satisfaction, and expectations regarding analgesia. Data were centrally recorded with obstetric records using the database of the QUIPS (Quality Improvement in Postoperative Pain Management) Project. A total of 514 women were included. On an 11-point Numerical Rating Scale, pain intensity during labor was severe (8.68 ± 1.8) while postpartal pain was 3.9 (±2.1). The second stage of labor was considered the most painful period. Only 62.6% of the parturients obtained pharmacological support, with epidural being the most effective (reduction of 3.8 ± 2.8 points). Only epidural (odds ratio [OR] 0.22) and inhalation of nitrous oxide (OR 0.33) were protective for severe pain. In benchmarking, a relation between satisfaction, pain intensity, and the use of epidural was found; 40.7% of the women wished they had received more analgesic support during labor. This study highlights deficiencies in analgesic management in high-level perinatal centers, with more than 40% of parturients considering actual practices as insufficient and wishing they had received more analgesic support, despite the availability of analgesic options. Using patient-reported outcomes can guarantee qualitative tailored analgesic care in women.

Total Quality Management and Corporate Social Responsibility (TQM-CSR) Measurement Items Design and Pilot Test

Objectives: This study aims to design and validate integrated TQM-CSR practices for Private Higher Education Institutions in the UAE, enhancing institutional excellence and stakeholder satisfaction. Methods: An empirical study was conducted, involving 30 Private Higher Education Institutions in the UAE. The methodology included survey-based data collection, statistical analysis, and reliability testing (Cronbach's alpha). Key modifications included the refinement of the TQM-CSR practices measurement scale, through outer loading analysis and item elimination. Findings: The study revealed strong consensus on the effectiveness of integrated TQM-CSR practices in PHEIs, with average scores between 3.77 and 4.22. Particularly effective were practices in Social and Legal Concerns and Educational Services Improvement. The robustness of these practices was confirmed by Cronbach's alpha values ranging from 0.826 to 0.927. The analysis led to the removal of less effective items (CIP5, SFS5), refining the measurement scale. These findings offer significant insights for educational administrators on improving quality management and social responsibility, diverging from and enriching existing literature. Novelty: This study pioneers in empirically validating TQM-CSR integration for quality management and social responsibility in UAE's private higher education sector. Keywords: Total Quality Management, Corporate Social Responsibility, Higher Education, Measurement Development, UAE

School Committees' Effectiveness in the Context of School-based Management Policy

The background of this research is the granting of broad educational autonomy to schools, which is a big concern for the government of Indonesia. School-based Management (SBM) appears as an alternative to the new paradigm of education management offered. One of the characteristics of SBM is inseparable from the participation of the community. School Committee is a forum for parents, communities, stakeholders, and entrepreneurs in school development and can bridge the interests of all the parties. To date, not many School Committees have been able to play an effective role in supporting the implementation of education in schools. One of the contributing factors is that the institutional design is not seriously empowered into an independent and professional institution. This study aimed to examine the effectiveness of school committees in school-based quality improvement management. The study method is qualitative descriptive. Data were collected through interviews, observation, and documentation. Validation of the collected data was done through triangulation techniques. The results showed that thematically the author underlined four important things, namely: first, the school committee has effectiveness as a consideration partner, material support, financial, thought and energy, and learning mediator; second, quality improvement strategies can be achieved through efforts to improve school subject competence and involvement in competitions; third, to measure the results of achievements, an education quality management audit is carried out, and; fourth, the budget as one of the determining factors in achieving school goals and objectives must be optimized by utilizing the flexibility of implementing Law No. 23 of 2014 and optimizing available resources. This research has implications for considerations in the preparation of internal school strategies to prioritize school needs and recommendations related to budget policies and inventory of school components.
 Keywords: effectiveness, School Based Management, School Committee

Comparative analysis of exogenously applied synthetic auxins and micronutrients for effective management of fruit drop and quality improvement in subtropical Japanese plum (Prunus salicina Lindl.)

Foliar application of plant growth regulators and micronutrients is a rapid uptake strategy of plant-feeding directly through leaves irrespective of soil condition. This experiment was conducted to assess the impact of the foliar application of synthetic auxins and micronutrients on subtropical Japanese plum (Prunus salicina Lindl.) fruit yield and quality. The experiment was performed in a plum orchard based on a completely randomized block design with nine treatments and three replications. The foliar treatments included NAA 15 ppm, NAA 15 ppm + urea 2%, 2,4-D 10 ppm, 2,4-D 10 ppm + urea 2%, borax 0.50%, borax 0.50% + urea 2%, ZnSO4 0.50%, ZnSO4 0.50% + urea 2%, and control (sprayed with distilled water) applied as a two spray in 15 days interval after fruit set. Foliar application of NAA 15 ppm + urea 2% led to least fruit drop followed by highest fruit yield. The fruit physicochemical attributes including fruit length and diameter, fruit weight, pulp weight, total soluble solids, titratable acidity, sugars, and ascorbic acid were also significantly improved by foliar spray of NAA 15 ppm + urea 2%. However, all the treatments were ineffective in improving anthocyanin and total phenol content of ‘Satluj Purple’ plum. The results further revealed that reduced fruit drop followed by highest fruit yield with foliar application of NAA 15 ppm + urea 2% was associated with reduced activity of cell wall degrading enzymes viz., cellulase and polygalacturonase at abscission zone.

The U.S. President's Malaria Initiative's Support for Improving the Quality of Malaria Case Management Services: Fifteen Years of Progress and Learning.

Since its launch in 2005, the U.S. President's Malaria Initiative's (PMI) investment in malaria case management has evolved based on lessons learned from its support to countries. An initial focus on updating malaria treatment policies to adopt artemisinin-based combination therapies achieved limited success, in part because of the poor quality of diagnostic and treatment services in targeted countries. In response, the PMI supported the development, refinement, and expansion of Outreach Training and Supportive Supervision (OTSS), a quality improvement approach that combines structured, competency-based supervision with corrective measures, including on-the-job training, coaching, troubleshooting, action planning, and timely follow-up. With 15 years of experience, the OTSS approach has been adopted by more than a dozen countries, and its effectiveness in improving the quality of malaria case management services has been documented. Through the PMI Impact Malaria Project, launched in 2018, the OTSS approach was expanded beyond case management of uncomplicated malaria to support quality improvement of inpatient management of severe malaria and malaria in pregnancy services delivered through antenatal care clinics. The OTSS platform also enabled targeted countries to respond rapidly to the COVID-19 pandemic by adding modules related to clinical management and laboratory diagnosis of suspected cases. The OTSS approach has been established as an effective approach to improve the quality of clinical malaria services and can be expanded to cover other health priorities. Further innovations to improve the quality of inpatient and community-based services, and further integration and institutionalization of OTSS into country health systems are needed.

Experiences in Improving the Quality of Community-Based Fever Management from Three Malaria-Endemic African Countries.

The WHO affirms that trained, supervised, and supported community health workers (CHWs) can deliver high-quality health services effectively and has called for documentation of enabling factors, needs, and implementation strategies of successful CHW programs. In response, the U.S. President's Malaria Initiative Impact Malaria Project conducted a study to document implementation approaches, best practices, and lessons learned for quality improvement (QI) of community-based fever management in Madagascar, Malawi, and Mali. The team conducted 10 key informant interviews (KIIs) with individuals at national, regional, and district levels using an open-ended interview guide tailored to each level, and a desk review of documents and materials related to community-based QI. Each country's community health landscape and QI approaches were summarized into four categories identified during the KIIs (training, supervision, coaching/mentoring, and review meetings) and compared. Results found that Madagascar, Malawi, and Mali all had well-defined community health strategies that include QI, but countries could not extend their full package of community-based QI approaches to all CHWs as a result of limited human and financial resources. Vertical funding for health programs limits the scope and coverage of QI approaches, especially at the community level. Recommendations from key informants for strengthening community-based QI included integrating QI approaches to improve cost efficiency, to define roles and responsibilities more clearly, to engage communities and all health system levels in implementation, and to digitize QI tools. Increased financial and skilled human resources are needed for community-based QI activities to achieve their intended effect.

Improving Quality on Indonesia Curriculum Management: Reactualizing Total Quality Management as Methods

This research is a analysis of some of the problems that arise in efforts to improve quality in curriculum management in Indonesia. Where, the system is still different between one region and another. Therefore, a concept that is deeply rooted and has proven its use in education is needed to be applied in Indonesia. So this paper offers TQM as a quality tool that can be used thoroughly in Indonesia. This research uses a qualitative approach with a descriptive-analytical approach. From the results of the paper, it can be concluded that the system developed by TQM can unify the methods of assessment and quality improvement in curriculum management.
 Highlights:
 
 Standardization: TQM facilitates uniformity in assessment and quality enhancement methods.
 Adaptability: TQM offers flexibility to accommodate diverse regional needs within a standardized framework.
 Systemic Integration: Implementing TQM can unify curriculum management practices across different regions in Indonesia.
 
 Keywords: Obstacle, Practicum, Science, Elementary School

Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study.

Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). Evidence-based nursing-sensitive quality indicators for the CSSD were established.

Quality Improvement in Anesthetic Management of Patients with Left Ventricular Assist Device Support Presenting for Non-Cardiac Surgery: A Single Center Experience.

With the growing number of left ventricular assist device (LVAD) recipients requiring non-cardiac surgery and the limited availability of cardiac anesthesiologists, our study reviewed non-cardiac surgeries in HeartMate III patients with LVAD at our institution. We focused on anesthesiologist roles, detailing patient characteristics, anesthetic management, and outcomes and identifying improvement opportunities in this specialized care setting. A retrospective chart review was conducted of all patients with LVAD who underwent non-cardiac surgery at our institution between 2017 and 2022. Patient demographics, surgical characteristics, anesthetic management, and 30-day mortality rates were also assessed. A total of 23 patients were identified, with 17 (73.9%) males and a median age of 61 [53.5, 67.5] years. Cardiac anesthesiologists were present in nine (39.1%) cases. Elective surgeries were more common (73.9%), with intermediate-risk surgeries accounting for 52.2% of all surgeries. General anesthesia was administered to 18 patients (78.3%), with a median duration of 40 [24, 63.5] min. A single patient required reoperation because of bleeding, and two patients (8.7%) experienced 30-day mortality. Despite guidelines lacking detail, involving non-cardiac anesthesiologists in certain cases is essential. Sharing our experience aims to enhance the evolving discourse on non-cardiac surgeries for patients with LVAD, improving their outcomes and safety.

Investigating the Effectiveness of Continuous Quality Improvement Methods in Preventing the Phenomenon of Pseudo-Poor Electrocardiogram Procedure by Nurses in an Emergency Care Unit

Objective: To investigate the effect of applying continuous quality improvement methods on preventing the phenomenon of pseudo-poor electrocardiogram (ECG) procedures by nurses in the emergency care unit. Methods: The study was conducted in Shangluo Central Hospital Shaanxi from August 2020 to August 2021, and 200 emergency patients who received ECG during this period were selected for the comparative study, and grouped into two groups: the control group was given routine management, while the experimental group was managed by continuous quality improvement. The two groups were compared in terms of pseudo-differences in ECG procedures. Results: The patients in the experimental group had a higher rate of qualified ECG readings and procedures, and a lower rate of pseudo-errors and nursing disputes, all of which were significantly different from the control group (P &lt; 0.05), which is significant, and the experimental group had a better effect. Conclusion: When ECG examination is carried out in the emergency care unit, the application of continuous quality improvement management methods is conducive to improving the quality of ECG examination, reducing the incidence of pseudo-discrepancy, and providing a reliable reference for clinical diagnosis and treatment.

When rules turn into tools: An activity theory-based perspective on implementation processes and unintended consequences.

The idea that actions of people, organizations or governments may lead to Unintended Consequences (UICs) is not new. In health, UICs have been reported as a result of various interventions including quality improvement initiatives, health information technology implementation, and knowledge translation, especially those involving translation of broad policies (evidence-based medicine and patient-centred care) or system level improvement into actionable items or tools. While some unintended consequences cannot be anticipated, others may be predictable. In this article, we present a model based on cultural historical activity theory, which may help policy-makers, health leaders, and researchers better anticipate UICs resulting from implementation of new programs or technologies and take action to address them or mitigate their risk of occurrence. We support this model using examples of UICs of implementing family centred care principles, electronic health records, and computerized templates for quality improvement in chronic disease management.

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Quality Improvement Management in Teacher Professional Development

This research aims to evaluate the professional competence of elementary school teachers in Binjai City and the effectiveness of teacher quality management programs and related initiatives in raising teacher competency levels. The term for this kind of study is qualitative descriptive research, and it is a way of gathering information about the people and events studied via written or spoken descriptions. It is based on the individual's background as a whole (holistic) rather than isolating the individual and the organization into variables and examining them. in the context of the whole. Reading various written materials, looking at images, pondering about items, seeing individuals in their immediate environment via interviews, and other activities are all part of the qualitative research design. Qualitative methods are used in this study to obtain data. Researchers often use observation, document analysis, and interviewing in qualitative research as data collection methods. The study's findings demonstrate (1) That the Binjai City Public Elementary School instructors are qualified educators. The quality of instructional materials is correlated with the professionalism of teachers. Professional instructors construct high-quality education or learning processes for students to enjoy participating in the learning process and for school graduates to develop human resources of the highest caliber. (2) In general, educators at Binjai City Public Elementary Schools use a variety of instructional strategies, such as technology-based learning and cooperative learning. (3) Although cooperative learning and technology-based learning are the two learning methodologies that educators constantly use to carry out the teaching and learning process, many Binjai City Public Elementary School instructors have certifications and pursue further education.

Exploring the user-generated content data to improve quality management

PurposeThe focus of this research is to investigate if user-generated content (UGC) generated in the Booking platform can support quality management improvement within the hospitality industry by increasing customer satisfaction and eliminating defects more efficiently. Hence, it contributes to understanding how data-driven companies can rely on customer data to focus on innovation and performance improvement to meet customer requirements, eliminate defects and increase customer satisfaction.Design/methodology/approachFollowing the literature review, information was collected from the digital platform Booking, encompassing 15 hotel industry companies in Portugal Porto and Braga regions, selected due to their high number of customer reviews. This data was organized and categorized, eliminating all unnecessary information for the research and building an Excel database. The database was subsequently analysed with SPSS and Voyant software, performing statistical analysis, hypothesis testing and text-mining techniques to analyse the comments. After these analyses, applying quality tools allowed for more in-depth conclusions.FindingsThe research results highlight that customers' most relevant requirements in the Portuguese hospitality industry are breakfast, parking and a swimming pool. It was also possible to realize that the location is an attractive requirement, the bathroom is a must-be requirement and breakfast is a performance requirement. The results also allowed us to answer the most critical research question: “Is user-generated content a valuable aid to quality?” the answer is yes since it was possible to use the data to find improvements and faults/failures in the services.Originality/valueThe results of this study represent an essential step towards a complete understanding of how to take advantage of UGC within the hospitality industry by establishing a solid base of techniques, methods and quality tools for UGC analysis that can be applied in future research on different industry sectors.

Root Cause Analysis: Unraveling Common Laboratory Challenges.

Diverse errors occur in a pathology laboratory and manual mistakes are the most common. There are various advancements to replace manual procedures with digitized automation techniques. Guidelines and protocols are available to run a standard pathology laboratory. But, even with such attempts to reinforce and strengthen the protocols, the complete elimination of errors is yet not possible. Root cause analysis (RCA) is the best way forward to develop an error-free laboratory, In this review, the importance of RCA, common errors taking place in laboratories, methods to carry out RCA, and its effectiveness are discussed in detail. The review also highlights the potential of RCA to provide long-term quality improvement and efficient laboratory management.