Quality Improvement Process Research Articles

Modern management model for KAREB Bojonegoro cooperative: Integration of ABM, lean six sigma, and RBV and TPB approaches

In global business competition, ABM helps cooperatives such as KAREB Bojonegoro Cooperative achieve cost efficiency without sacrificing quality. KAREB Cooperative's expenditure is very high, reaching IDR158.82 billion in five years, with the main costs on fuel, labor, and maintenance. Optimizing expenditure and cost management is important to reduce waste, increase efficiency, and profitability. Various studies have shown that Lean Six Sigma and ABM methods increase efficiency, reduce waste, and improve financial performance in various industries with proper implementation and intensive training. However, external factors, recent data, and regional variations, with deficiencies in data and methodology, and challenges in lean sigma implementation have not contributed simultaneously. This study offers the Integration of ABM, RBV, and TPB in Lean Sigma at KAREB Bojonegoro Cooperative because it is suspected that the condition of tobacco processing is not optimal and this approach needs to improve sustainable production efficiency. This study will analyze the implementation of ABM and Lean Sigma for cost control and waste reduction in tobacco drying at Kareb Cooperative with the contribution of Resource-Based View (RBV) and Theory of Planned Behavior (TPB) to improve process quality and optimal resource monitoring. This study uses a qualitative model with a case study method to assess the implementation of Activity-Based Management (ABM) in production cost efficiency, linking it with Lean Six Sigma, Resource-Based View (RBV), and Theory of Planned Behavior (TPB). Key informants from Kareb Cooperative Bojonegoro, including the Head of Production, Accounting, and HR, provided insights into the impact of ABM and internal factors on efficiency. The research instruments included in-depth interviews, observation, and documentation, while the research procedure followed a systematic flow to ensure the validity and relevance of the data. This study states that the implementation of ABM at Kareb Cooperative Bojonegoro allocates costs based on actual activities, improving efficiency and cost control. Costs include procurement of materials (Rp24,375,300,000), production (Rp9,216,862,000), and distribution (Rp6,000,000,000). Lean Sigma focuses on reducing waste such as overproduction, defects, and waiting by improving processes and training. The ability is quite large in identifying production inputs and related costs such as fuel (Rp14,375,300,000), raw materials (Rp10,000,000,000), and production and distribution processes. Waste management such as overproduction and waiting, as well as the implementation of ABM and Lean Sigma, aims to increase efficiency and reduce costs. Evaluation and training are carried out to optimize processes and reduce waste. Setting costs based on activities, while Lean Sigma uses the Just-In-Time (JIT) system. Variable costs are optimized, production is controlled to reduce defects,and distribution and storage are improved for cost efficiency. The keys to success are open communication, management support, and intensive training. The implementation of ABM and Lean Sigma in Kareb Bojonegoro Cooperative effectively reduces costs and waste through training, JIT, and process control. These findings are expected to increase productivity, reduce costs, and improve the competitiveness of cooperatives and provide a model for implementing modern management.

Comparison of Emergency Department Disposition Times in Adult Level I and Level II Trauma Centers

Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers. Methods: We queried the 2017–2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition. Results: Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all P < 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], P < 0.001), discharged home (286 vs 160 min, P < 0.001), non-ICU admissions (234 vs 164 min, P < 0.001), and those requiring surgery (126 vs 101 min, P < 0.001). Conclusion: Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients’ final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.

Capacity assessment for euthanasia in dementia: A qualitative study of 60 Dutch cases.

The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia. We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling). Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient-physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background. Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes.

Improving group problem solving through awareness of members’ problem-solving preferences

PurposeMany groups in organisations are unsuccessful in problem solving. However, the principle of continuous improvement necessitates that organisations refine their employees’ problem-solving skills. In this mixed-method, field-based lab experiment, we explored the impact of a treatment to enhance the quality of group problem-solving processes.Design/methodology/approachWe focused on the structured problem-solving process in Kaizen Events by differentiating six consecutive phases. About 16 Kaizen Event groups (101 members) participated in a field-based lab experiment that used a lean simulation game to establish a group problem-solving context. Data were collected via video, surveys and group interviews. We examined if a high-quality process is strengthened through group members’ elevated awareness of problem-solving preferences. About 11 groups received a treatment of tailor-made individual feedback to increase awareness of their problem-solving preferences. Additionally, we repeated the experiment in five control groups, where member preferences were not shared.FindingsIn the treatment groups, where problem-solving preferences had been shared, we observed a clear improvement in Kaizen Event process quality and higher problem-solving self-efficacy levels. Moreover, their self-reported Kaizen Event behaviour had changed. Within the control groups, the participants also reported that their problem-solving self-efficacy had improved, but this did not have a positive impact on the quality of the objectively measured Kaizen Event process.Originality/valueBy combining insights from operations management and organisational behaviour, we demonstrate that the structured Kaizen Event problem-solving process improves when group members’ individual problem-solving preferences are shared. We thus add an individual-level variable to the extant models of Kaizen Event success factors. Our results provide fresh insights into how to improve the continuous improvement process within organisations. Kaizen Event stakeholders and their facilitators are offered guidance on how to increase one’s awareness of own and others’ problem-solving preferences in group-based problem-solving events.

A prescription audit in the ear, nose and throat outpatient department, in a tertiary care hospital: a descriptive cross-sectional study

Background: Prescription audit is a quality improvement process aimed at enhancing patient care and outcomes by reviewing prescriptions. It provides feedback to healthcare providers, (HCPs) to identify areas for improvement and ensure the quality of prescriptions. This study aims to analyse the prescription patterns and prescribing behaviour of doctors using world health organization (WHO) recommended core prescribing indicators and prescription audit guidelines from national health mission (NHM), India and implement action plan accordingly. Methods: A descriptive observational cross-sectional study was conducted for one month in the ear, nose and throat outpatient department (ENT OPD) of KMC-RI, Hubballi. A total of 96 prescriptions were analysed using WHO-recommended core indicators and additional indicators from a prescription audit template. An action plan was created to enhance prescription quality. Results: All the prescriptions contained complete demographic details of the patients, OPD registration name and date of consultation. Handwriting was legible in all 96 prescriptions with a score of 100%. Two lowest performing attributes were identified using prescription audit tool namely, allergy status and generic name with a score of 7% and 37.9% respectively. The study revealed that average number of drugs encountered was 1.9, the percentage of drugs prescribed by generic name was 37.9%, percentage of encounters with an injection prescribed was 2.08% and percentage of drugs prescribed from NLEM was 37.9%. Conclusions: The prescription audit revealed that most prescriptions adhered to WHO standards. However, improvements are needed in documenting allergy status and prescribing by generic name. An action plan with a defined timeline has been prepared to provide feedback, aiming to enhance prescription quality and ensure better healthcare outcomes.

Implementation of Genetic Carrier Screening at Gynecologic-Related Visits

ObjectiveTo increase patients’ knowledge and access to genetic carrier screening (GCS) in a gynecologic setting by implementing a protocol to universally offer GCS education and screening to reproductive-age women during the preconception period at gynecologic-related visits. DesignThe model for improvement quality improvement process model was used to guide this initiative. Local Problem/SettingScreening for genetic disease has been a part of preconception and genetic care for the past 50 years. Despite its longstanding presence and better accessibility and affordability of testing, there are no established protocols to universally offer screening to reproductive-age women during preconception care in the United States. The project was implemented at an outpatient gynecology clinic in Phoenix, Arizona. ParticipantsFifty-one women ages 18 to 51 years. Intervention/MeasurementsA protocol was implemented to universally offer expanded GCS and health education to reproductive-age women during the preconception period at gynecologic-related visits. Women’s responses to being offered GCS and the rationale for their response was documented on a spreadsheet. ResultsAll 51 participants were offered GCS during their visit. None of those 51 participants had any previous knowledge of GCS. All 51 participants declined GCS; reasons included the following: would consider it once closer to childbearing (53%), did not have any childbearing plans (31.3%), did not have any further childbearing plans (9.8%), or were not worried about the possibility of genetic disease (5.8%). None cited cost as a reason for declining GCS. After project completion, 3 of the 51 participants returned to the clinic to undergo GCS, and the clinic has adopted the intervention described here as its standard of care for patients who meet criteria for GCS. ConclusionIt is imperative to provide health education about GCS to women during preconception care so that they can make informed choices about family planning.

Quality Improvement Decisions in Service Supply Chains with Collaborative and Free-Riding Behaviors

The dominant position of a member within a service supply chain plays a crucial role in fostering a willingness to improve service quality. Consequently, this study examines a service supply chain comprising a supplier and an integrator, aiming to investigate the influence of four different power structures, namely, supplier-led, integrator-led, supplier–integrator power balance, and supplier–integrator centralized decision, on the decision-making process for service quality improvement by members. The findings highlight that the optimal willingness to improve service quality in a service supply chain is not necessarily infinitely close to 100%, and is influenced by factors such as revenue share, cost, effect, and dominant position. In cases where the collaborative improvement effect is weak, even the dominant member may display a limited willingness, rendering centralized decision-making meaningless. If the collaborative improvement effect surpasses the combined independent improvement effects, the dominant position can help strengthen willingness, although it may not always result in higher profits. Conversely, a power-balanced scenario can be advantageous in achieving the highest profit for the entire supply chain.

The translation-to-policy learning cycle to improve public health.

Learning Health Systems (LHSs) have not directly informed evidence-based policymaking. The Translation-to-Policy (T2P) Learning Cycle aligns scientists, end-users, and policymakers to support a repeatable roadmap of innovation and quality improvement to optimize effective policies toward a common public health goal. We describe T2P learning cycle components and provide examples of their application. The T2P Learning Cycle is based on the U.S. Department of Veterans Affairs (VA) Office of Research and Development and Quality Enhancement Research Initiative (QUERI), which supports research and quality improvement addressing national public health priorities to inform policy and ensure programs are evidence-based and work for end-users. Incorporating LHS infrastructure, the T2P Learning Cycle is responsive to the Foundations for Evidence-based Policymaking Act, which requires U.S. government agencies to justify budgets using evidence. The learning community (patients, providers, clinical/policy leaders, and investigators) drives the T2P Learning Cycle, working toward one or more specific, shared priority goals, and supports a repeatable cycle of evidence-building and evaluation. Core T2P Learning Cycle functions observed in the examples from housing/economic security, precision oncology, and aging include governance and standard operating procedures to promote effective priority-setting; complementary research and quality improvement initiatives, which inform ongoing data curation at the learning system level; and sustainment of continuous improvement and evidence-based policymaking. The T2P Learning Cycle integrates research translation with evidence-based policymaking, ensuring that scientific innovations address public health priorities and serve end-users through a repeatable process of research and quality improvement that ensures policies are scientifically based, effective, and sustainable.

Critical Appraisal of Evidence for DNP-Prepared Nurses.

This is the fourth article in a new series designed to provide readers with insight into educating nurses about evidence-based decision-making (EBDM). It builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step and EBP 2.0: Implementing and Sustaining Change (to access both series, go to https://links.lww.com/AJN/A133). This follow-up series on EBDM will address how to teach and facilitate learning about the evidence-based practice (EBP) and quality improvement (QI) processes and how they impact health care quality. This series is relevant for all nurses interested in EBP and QI, especially DNP faculty and students. The brief case scenario included in each article describes one DNP student's journey. To access previous articles in this EBDM series, go to https://links.lww.com/AJN/A256.

Application of Statistical Process Control in Automotive Manufacturing

This research looks at how “statistical process control”, or SPC, is used in the automotive sector and highlights how it can improve production efficiency, lower defect rates, and improve process quality. SPC is crucial to the monitoring and control of the complex assembly processes and strict quality standards that define the automobile sector. The efficiency of several SPC methods, including control charts and process capability analysis (Cp and Cpk), in preserving process stability and fulfilling quality criteria is assessed in this study. The study shows how these technologies may detect process variations and direct appropriate adjustments to optimize output using simulated data analysis. The results highlight how crucial SPC is to attaining consistent product quality and reliability, which raises performance and safety requirements in the automotive sector.

Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description

BackgroundInnovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point—the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated—may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care.MethodsThis qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study.ResultsTo accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system.ConclusionsWe identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems.Trial registrationClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3.

Atrial Fibrillation Prevalence In Ischemic Strokes In An Irish Hospital. Spotlight On Anticoagulation Failure In Patients On Direct Oral Anticoagulants

Abstract Background Global atrial fibrillation (AF) burden in acute ischemic stroke patients approximates at 30%. An Audit in 2022, in the concerned hospital identified lack of compliance and under-dosing as major causes of ischemic strokes whilst on direct acting anticoagulants (DOACs). This year, we sought repeat the audit of process with focus on ischemic strokes with pre-existing AF patients established on DOACs, to study trends related to anticoagulation failure. Methods The study was a retrospective observational audit study of all patients admitted with a diagnosis of acute ischemic stroke to the concerned hospital from January 2023 to December 2023 who had known diagnosis of atrial fibrillation and were prescribed a DOAC prior to their admission in the concerned hospital with an ischemic stroke. Patients were identified via HIPE coding and in-hospital stroke registry. Data was collected via charts review, compiled via flow charts, graphs and excel sheets, and studied. Results 143 patients were admitted to the hospital’s stroke service with ischemic stroke in the set time frame. 46 (32%) had Atrial Fibrillation (AF) which was deemed to be the cause of their stroke. 29 (20.2%) had pre-existing diagnosed AF, and 22 of those patients were prescribed DOACs. In all patients already on DOACs, compliance was found questionable or lack of in 11 (50%). 8 (36.3%) patients were on low dose (adjusted dose DOACs). 3 patients were diagnosed with DOAC failure without cause. All new and existing AF patients not anticoagulated, were commenced on anticoagulation. Conclusion The audit showed under dosage and poor compliance were major causes of anticoagulation failure in stroke patients who were anticoagulated with DOACs. Similar results were noted as secondary results in last year’s audit in the concerned hospital. As part of quality improvement process, a specialist DOAC clinic was being set up with further audit process planned for the coming year.

Nursing perception towards the impact of JCI accreditation on the quality of care in a university hospital in Palestine: a cross-sectional study

BackgroundThis study investigates nursing staff perceptions regarding the impact of Joint Commission International (JCI) accreditation on the quality of care within a university hospital in Palestine. The research specifically examines how the accreditation process influences nursing practices, patient results, and overall healthcare quality in a challenging environment marked by unique operational and external pressures.MethodsThe study was conducted at An-Najah National University Hospital (NNUH), a university hospital in Palestine, using a cross-sectional survey design. The structured questionnaire employed in the study was based on the Donabedian model, which evaluates the process and outcome dimensions of healthcare quality influenced by JCI accreditation. The questionnaire consisted of 47 items, divided into ten main subsections. These subsections included participants’ demographical information (6 items), quality measurement and analysis (4 items), leadership, commitment and support (4 items), use of data (4 items), strategic quality planning (4 items), human resources education and training (4 items), quality management (4 items), quality results (4 items), staff involvement (5 items), and benefits of accreditation (8 items). The questionnaire was rigorously designed to assess both the quality processes and quality results. The eight subscales evaluated various aspects, such as leadership commitment, strategic planning, and staff involvement. To ensure reliability, the internal consistency of the survey was confirmed with a high Cronbach’s alpha score, demonstrating the tool’s robustness and reliability in capturing the intended data.ResultsThe study of 180 nurses overwhelmingly supported the positive impact of JCI accreditation on hospital quality improvement processes. More than 90% of respondents acknowledged the role of accreditation in improving resource utilization, meeting population needs, and promoting professional standards and values ​​among staff. Statistical analyses, including Pearson correlation and stepwise regression, highlighted strong positive associations between quality process variables and quality results. In particular, leadership commitment, strategic planning, and staff engagement were found to be significant predictors of improved quality results.ConclusionsThis study’s findings demonstrate that JCI accreditation significantly positively impacts nurses’ perceptions of care quality at NNUH. The study underscores the importance of international accreditation in driving quality improvements in healthcare, particularly in settings with unique challenges such as those faced in Palestine. These insights are crucial for policymakers and healthcare administrators aiming to enhance care standards through accreditation in similar environments.

Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation.

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling. In addition, in recognition that high-quality cardiac rehabilitation programs regularly monitor their processes and outcomes and engage in an ongoing process of quality improvement, we introduce a new core component of program quality. High-quality program performance will be essential to improve widely documented low enrollment and adherence rates and reduce health disparities in cardiac rehabilitation access.

Understanding a new wrinkling behavior of annular grooved panel during flexible free incremental sheet forming

Wrinkling behavior of sheet metal by inappropriate process parameters and the resultant variation of thickness and microstructure during incremental sheet forming (ISF) have significant impact on forming stability and geometric profile. The wrinkling-related mechanism is yet to be well understood, which make it difficult to effectively control wrinkling defects during ISF. In the present work, the wrinkling behavior and related mechanism of a typical annular grooved panel are investigated during a novel flexible free ISF process. Experiments demonstrate that during this ISF process, the sheet material sequentially undergoes 4 deformation modes: contacting state under plane strain condition, contracting state with only elastic deflection, thickening state under uniaxial compression condition, and wrinkling state where the circumferential compressive stress exceeds the critical wrinkling stress. The evolution of these deformation modes is dominantly caused by the increasing of edge contraction and circumferential stress, which are induced by the bending moment from the forming tool and auxiliary sheets. Based on the mechanism, an analytical model is developed to predict the wrinkling behavior, by which the corresponded sheet thickness, bending moment, circumferential compressive stress and critical wrinkling stress during the wrinkling process could be comprehensively calculated. Experimental results validate that the analytical model can accurately predict the wrinkling behavior under different process parameters, material properties and auxiliary sheet materials. Through microstructural characterization, numerical simulation and analytical modeling, the influence of process parameter and material property on wrinkling behavior is systematically investigated, along with the variation of sheet thickness and microstructure under different wrinkling modes. This work enhance a deep understanding of wrinkling behavior during ISF process, thereby providing effective methods for process optimization and quality improvement.

Influences of fiber orientation and process parameters on diamond wire sawn surface characteristics of 2.5D Cf/SiC composites

2.5D Cf/SiC composite materials are widely used in aerospace high-temperature components, optical system structural components and other fields due to their excellent performance. For the cutting of 2.5D Cf/SiC composites, diamond wire saw cutting process has great potential for application. In this study, experiments were conducted on cutting 2.5D Cf/SiC composites with diamond wire saw along different fiber orientations (P0°, P90°, V90°) and different process parameters. The effects of fiber orientation, feed speed, and wire speed on the surface morphology, surface waviness profile, and roughness of the as-sawn surface were analyzed. The results show that fiber orientation significantly affects the fiber damage mode and surface quality of the as-sawn surface, with the surface quality of the slices ranked as V90°>P0°>P0°. The surface morphology and surface roughness improves with decreasing feed speed and increasing wire speed. However, surface waviness profile peak-valley (PV) values increases with increasing the feed speed and wire speed. The study provides experimental references for process optimization and quality improvement in diamond wire saw cutting of 2.5D Cf/SiC composite materials.

Centering the role of community health workers in social risk screening, referral, and follow-up within the primary care setting

BackgroundCommunity health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts.MethodsResearchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona’s major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk.ResultsThe process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting.ConclusionsOur findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona’s FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness.

Integration of IPC/WASH critical conditions into quality of care and quality improvement tools and processes: Bangladesh case study

Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh’s 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.

Sustained Performance of Cardiac Arrest Prevention in Pediatric Cardiac Intensive Care Units.

The Pediatric Cardiac Critical Care Consortium (PC4) cardiac arrest prevention (CAP) quality improvement (QI) project facilitated a decreased in-hospital cardiac arrest (IHCA) incidence rate across multiple hospitals. The sustainability of this outcome has not been determined. To examine the IHCA incidence rate at participating hospitals after the QI project ended and discern which factors best aligned with sustained improvement. This observational cohort study compared IHCA data from the CAP era (July 1, 2018, to December 31, 2019) with data from the 2-year follow-up era (March 1, 2020, to February 28, 2022). Data were obtained from pediatric cardiac intensive care units (CICUs) from 17 PC4 CAP-participating hospitals. The CAP practice bundle was designed to facilitate local practice integration, with the intention to implement, adapt, and continue CAP processes beyond the CAP era. A web-based survey was administered 2 years after the end of the project to estimate CAP-specific QI work. Risk-adjusted IHCA incidence rates across all admissions were compared between study eras. The survey generated a novel hospital-specific QI sustainability score, which is generally reflective of the sum of local CAP work performed. There were no clinically important differences in demographic and admission characteristics between the 13 082 CAP era admissions and 16 284 follow-up admissions (total mean [SD] age, 5.1 [8.4] years; 56.1% male). Risk-adjusted IHCA incidences were not different between the CAP vs follow-up eras (2.8% vs 2.8%; odds ratio, 1.03; 95% CI, 0.89-1.19), suggesting sustained prevention improvement. There was also no difference between eras in risk-adjusted IHCA incidence within medical, surgical, or high-risk subgroups. A lower hospital QI sustainability score was correlated with higher odds for IHCA in the follow-up vs CAP era (correlation coefficient, -0.58; P = .02). Five hospitals had increases of 1% or greater in risk-adjusted IHCA rates in the follow-up era; these hospitals had significantly lower QI sustainability scores and were less likely to have adopted sustainability elements during the CAP era or report persistent engagement for CAP-related QI processes during follow-up. In this cohort study of all CICU admissions across 17 hospitals, IHCA prevention was feasible and sustainable; the established reduction in risk-adjusted IHCA rate was maintained for at least 2 years after the end of the CAP project. Both implementation strategies and continued engagement in CAP processes during the follow-up era were associated with sustained improvement.

Strategy to Improve the Quality of Madrasah Education Through Madrasah Diniyah (Madin) in Min 16 Bener Meriah Aceh

The purpose of this study was to determine the concept of organizing Madrasah Diniyah (Madin) Min 16 in Aceh. The concept of Madrasah Diniyah (MADIN) at MIN 16 Bener Meriah has the following characteristics: focusing on customers, both internal and external customers, having a high obsession with quality, using a scientific approach in decision making and problem solving, having a long-term commitment, requiring teamwork, continuous process improvement, providing education and training, providing controlled freedom, unity of purpose, and involving and empowering human resources. Meanwhile, the implementation of Integrated Quality Improvement Management in Madrasah includes Quality Strategy Planning (vision, mission, objectives, long-term institutional strategy, monitoring and evaluation), improving process quality (curriculum and learning process), improving the quality of Human Resources. Resources (HR), improving environmental quality, improving service quality, improving output quality