Quality Management Team Research Articles

Mitigating Risks in Cone Beam Computed Tomography Guided Online Adaptive Radiation Therapy: A Preventative Reference Planning Review Approach

PurposeOnline adaptive radiotherapy (oART) treatment planning requires evaluating the temporal robustness of reference plans, anticipating the potential changes during treatment courses that may even lead to risks unique to the adaptive workflow. This study conducted a risk analysis of the CBCT-guided adaptive workflow and is the first to assess an adaptive specific reference planning review that mitigates risk in the planning process to prevent events and treatment deficiencies during adaptation. Methods and MaterialsA quality management team of medical physicists, residents, physicians, and radiation therapists performed a fault tree analysis, and failure mode and effects analysis (FMEA). Fault trees were created for under/overdosing targets, treatment deficiencies, as well as assisted in identifying failure modes for the FMEA. Treatment deficiency was defined to include a non-ideal oART plan resulting in treatment with a lower quality plan (either oART or scheduled plan), treatment delay, or cancelling treatment for the day. A reference planning checklist was created to catch failure modes before reaching the patient. Risk priority numbers (RPN=Severity*Detectability*Occurrence) were scored with and without the reference planning checklist to quantify risk mitigation. A root cause analysis was conducted for an event where an adaptive plan failed to generate. ResultsThe reference planning checklist (with items covering patient background, contouring/planning robustness for anatomy variability, and machine limitations) reduced the RPN for all failure modes. Only 1 failure mode with a risk priority number >150 occurred with the reference planning checklist compared to 29 failure modes without, including 14 adaptive specific failure modes. Contouring, planning, setup, scheduling, and documentation errors were identified during the fault tree analysis. 29/70 errors were adaptive specific. The reference planning checklist could address 23/33 for over/under dosing and 28/37 errors for treatment deficiency. The root cause analysis highlighted the need for checking setup prior to adaptive plan delivery, and time-out checklist. ConclusionsThe reference planning checklist improved detection of the failure modes and improves the quality and robustness of the plans produced for oART. It is ideally performed before physician plan review to prevent last minute re-plan (before or after first adaptive treatment) and delay of patient start. The checklist presented can be modified based on failures specific to individual clinics and utilized at various planning steps based on available resources.

Model of Sustainable Belawan Harbor Waters Pollution Management Scheme

This study aims to analyze the impact of industrial activities on water quality in Belawan Port, Medan City. The methods used included field surveys, water sampling, and in-depth interviews with stakeholders and communities around the harbor. The results showed that industrial activities at the port significantly affected water quality parameters such as acidity, heavy metal concentration, and the number of pathogenic microorganisms. In addition, the socio-economic conditions of the community around Belawan Port also affect awareness of the environment and the cleanliness of the waters. This study concludes that water pollution management in Belawan Harbor requires an integrated approach between the government, port management, industry, and local communities. Collaborative efforts are needed to implement more effective and sustainable policies to maintain environmental sustainability in this port area. Key recommendations include the establishment of an Integrated Water Quality Management Team and increased active participation from all stakeholders in keeping the waters and environment around Belawan Port clean.

Total Quality Management and Organisational Performance

The purpose of this study is to evaluate the impact of TQM on organisational performance at First Bank Plc from 2010-2019, data were sourced through secondary means from the bank and annual financial report of the bank for the years2010-2019) and staff of the bank in Ondo state based on Senatorial District in the state. Questionnaire was designed and data collected using 5-Point Likert-Scale questionnaire which was administered on sample of 196 respondents comprises of bank staff, management and customers at the bank in three Senatorial District of the state. The data was analyzed using descriptive statistic in line with graph, Regression Statistical Technique. Five hypotheses formulated were tested using Eview9 at 0.05(5%) level of significance respectively. Findings divulge that there is a significant relationship between all selected variables of employment involvement team work and trust on first bank non-financial performance at (0.090<0.05.) and also was a strong positive relationship between total quality management (TQM) through education and training of staff on market share value (MSV), total quality management (Team work) on employees’ level of job commitment and support that will bring proper total quality management at first bank and lastly, leadership structures and employee involvement on organisational sustainability had improved the standard of first bank by given more credence to the potency of sustainability of the firm at both money and capital market that has brought great performance over the years. However, the study found little research been done regarding several factors directly affected organisational performance in the area of as organisation size, culture and level of innovation. Therefore, future researches could study these impact of Total Quality Management (TQM) on organisational performance. The study recommends that Employees and Customers should be the First Bank most important asset. Thus, this will be supportive through investment in training and development and communication skill. This will enhance the strengthening of the knowledge base of their employees’ thereby enquiring those people to confront the challenges and stay ahead in the industry.

Maintaining Skin Integrity of Patients Diagnosed With SARS CoV2: A Quality Improvement Project.

This purpose of this quality improvement project was to develop and evaluate a protocol (intervention bundle) designed to prevent pressure injuries in patients admitted with SARS-CoV2 and required prone positioning. The sample comprised 267 patients aged 18years and older, who were admitted with SARS-CoV2 and required prone positioning. Their age ranged from 32 to 76years; a majority (54%, n =145) were intubated. The study setting was an urban 220 bed acute care hospital in Northern California. A task force comprising the quality management team, certified wound care nurses and nursing leadership used the plan-do-study-act cycle completed a quality improvement project designed for preventing pressure injuries among patients admitted with SARS-CoV2 and managed with prone positioning, either with or without mechanical ventilation. The five phases of the quality improvement project were protocol development, education, implementation, and evaluation. Data collection period for this quality improvement was between April 2020 and August 2020. Outcomes were evaluated using descriptive statistics. Sixteen patients (6%) experienced a total of 25 pressure injuries. The time between initial prone placement and change back to supine positioning was 24hours (36±12hours). The most common pressure injuries were deep tissue injuries, primarily over the heels and sacrum. This protocol maintained the skin integrity of 94% of a group critically ill patients admitted with SARS-CoV2 and managed by prone positioning.

ANALISIS BEBAN KERJA TUGAS POKOK DAN TAMBAHAN TIM MANAJEMEN MUTU DI UPTD PUSKESMAS KAHURIPAN KOTA TASIKMALAYA

Less optimal performance is affected by excessive workload. To be able to control the quantity and quality of health services at the Puskesmas, it is necessary to do a workload analysis. The research design used is descriptive-qualitative. The determination of research informants was carried out using a purposive sampling technique. Informants in this study include as many as 10 people. The main tasks of the quality management team are those who serve as junior midwives, health laboratory institutions, first-time general practitioners, supervising nurses, associate dentists, associate nutritionists, environmental sanitationists, and associate general practitioners. Additional duties of the quality management team consist of the person in charge of quality, quality secretary, PPI coordinator, risk management coordinator, patient safety coordinator, K3 coordinator, internal audit coordinator, UKM coordinator, and UKP coordinator. The workload of young specialist midwives, health laboratory personnel, and first specialist general practitioners is included in the excess category. Additional task workload requires employees to carry out quality management tasks with as many as seven people. The suggestion that can be made is to carry out workload analysis related to main and additional tasks so that members who have excessive workload can be identified so that they can redistribute tasks to employees who have less workload. In addition, education and training activities should be carried out so that the implementation of quality management duties is carried out effectively and efficiently.

Passing the Baton: The Role of Healthcare Organizations in Leading Continuing Education Programs in Quality Improvement and Safety

Quality of care continues to be of serious concern in the United States. Part of addressing this concern must include academic programs that produce students with an appreciation of quality management to take up positions in healthcare organizations. Moreover, healthcare organizations must ensure that quality and safety are front of mind for those they employ, especially those in management. This study presents an evaluation of student perception of their readiness to work as part of quality management teams and undertake quality management activities. Majority of the students surveyed agreed that they felt well prepared to participate on a healthcare quality management (QM) team, felt confident in their ability to participate in QM activities, and were extremely confident in their QM skills. Additionally, majority of the respondent indicated that “everyone” was responsible for ensuring quality in the healthcare organization. Healthcare organizations must invest in the professional development of their employees especially in quality management. This may prove to be beneficial to their patients and bottom line.

Quality Management in Indonesia Maritime Education: Is it well implemented?

The adoption of Total Quality Management (TQM) in educational institutions has not been thoroughly optimized, resulting in a wide range of results. This study aims to determine the key features of TQM used by maritime education and training institutes in Indonesia and the results. This study used descriptive quantitative methodologies using eleven institutions, the most extensively used TQM elements as measuring variables, and the findings. The respondents are 16 members of the institution's quality management team. Strategic quality planning (5.99), information and analysis (5.90), involvement of teaching staff and employees (5.86), knowledge and training (5.80), leadership and top management commitment (5.76), and process management were found to be the most often used TQM elements (5.76). Meanwhile, the most significant results of TQM implementation in the sample institutions were improving operational performance (6.06), teaching staff and employee satisfaction (5.90), and customer satisfaction (5.79). This study adds to the empirical literature on TQM in Indonesian maritime educational institutions by identifying the most often used TQM elements and the result achieved.

The road from discovery to healing: What does it take?

Education and career choices are two major life decisions.1 One who considers a degree in Medicine may ask: “am I up to the challenge,” “am I curious about how medicine improves life,” and “do I care profusely about human life?” Practicing clinical medicine is the most common path; but, not all those with a career in Medicine are physicians. There are researchers in the basic sciences, and there are inventors and innovators of biomedical devices. All those working in Medicine start with valuing and pursuing the improvement of life.
 The ideal medical school integrates disciplines for a complete understanding of medicine.2 Two of the articles in this edition describe challenges facing Philippine medical schools. The first article re-evaluates the adjustment factor used in the admission process. The second article highlights flexibility and innovation in the sudden shift to online learning.
 The MD-PhD Program connects scientific research with clinical practice. In the US, this program started in the 1950s and expanded through the Medical Scientist Training Program to more than 90 active MD-PhD programs in 2016.3 The country’s first MD-PhD Program started in 2010 at the University of the Philippines College of Medicine (UPCM). One of our physician-scientist graduates authored an article on the pharmacologic potential of locally harvested edible mushrooms.
 Many other UPCM graduates do research at the Philippine General Hospital. As an academic medical center, it houses “a large and diverse sample of patients, experienced and interested investigators, with organizational support.”4 In this edition, physician trainees and faculty authored or mentored seven studies. They study various disease and systems processes with the goal of health promotion.
 Three articles studied hospital processes related to health service delivery. Radiation oncologists explored delays in repeated CT simulation for the radiation of head and neck cancer patients. Ophthalmologists formed a time quality management team to reduce the total consultation time at their outpatient clinic. OB-GYN sonologists looked at methods of manual disinfection of transvaginal probes to keep patients safe while undergoing such procedures.
 Two articles studied the epidemiology of cerebrovascular diseases and neoplasms (periampullary malignancies), two of the top causes of mortality in the country. Two other studies looked at diseases that affect the quality of life: visual impairment in the young, and the use of a modified approach to hip arthroplasty.
 Case reports remain valuable sources of unusual information and new ideas.5 This edition also features a case report on a rare childhood malignancy found in an elderly patient who was successfully treated.
 The road from discovery to healing can take many forms as exemplified by the 11 articles in this edition of Acta Medica Philippina. Publication is a step on the road from discovery to healing. To complete the journey is to implement their findings in clinical practice. Many implementation challenges exist due to differing approaches.6
 The road from discovery to healing is not an easy one. We hope to close the gap between evidence and practice; we contribute to an ever-evolving and growing body of knowledge; and we offer the best treatment to our patients, the lives we value the most.
 
 Jean Anne B. Toral, MD, MSc Department of Obstetrics and Gynecology College of Medicine and Philippine General Hospital University of the Philippines Manila Coordinator for Research and Chief of the Expanded Hospital Research Office, Philippine General Hospital
 
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 Camilleri AR. What are life’s biggest decisions? [Internet]. 2021 [cited June 2022]. Available from: https://www.psychologytoday.com/us/ blog/life-s-biggest-decisions/202101/what-are-lifes-biggest-decisions
 Napier S. Rapid response: the characteristics of an ideal medical school. BMJ. 2019; 323:1437.
 Harding CV, Kahn JR, Akabas MH, Andersen OS. History and outcomes of fifty years of physician-scientists training in medical scientist training programs. Acad Med. 2017 Oct; 92(10):1390-8.
 Pinsky WW. The roles of research in an academic medical center. The Ochsner Journal. 2000 Oct; 2(4):201-2.
 Loubon CO, Culquichicon C, Correa R. The importance of writing and publishing case reports during medical training. Cureus. 2017 Dec;9(12):e1964.
 Kristensen N, Nymann C, Konradsen H. Implementing research results in clinical practice – the experiences of healthcare professionals. BMC Health Sciences Research. 2016; 16:48.

The American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee's Three Priority Quality Indicators for Screening Colonoscopy Services.

Colorectal cancer is the third most commonly diagnosed cancer in men and women in the United States. Small polyps are slow to grow and turn to cancer, which provides time for screening and removal of the precancerous polyps so that colorectal cancer is prevented. Quality colonoscopy services are essential to ensure all polyps are found and removed as the final step of colorectal cancer screening. The American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee developed quality indicators for colonoscopy services. The Committee prioritized 3 quality indicators for screening colonoscopies: the frequency of (1) adenoma detection in asymptomatic patients at average risk; (2) adherence to the surveillance intervals for postpolypectomy, postcancer resection, or the 10-year interval for the average-risk patients with good bowel preparations who had negative colonoscopies; and (3) visualization of the cecum by notation and landmark photographic documentation. Gastroenterology nurses, endoscopists, and the quality management team can use the Plan-Do-Study-Act method of quality improvement to meet the established performance targets and prevent interval cancers.

Organizational Resilience and Change Management: Inputs to Management Effectiveness

Management effectiveness influences the overall performance of an organization. This may be shown by achieving organizational goals and employee satisfaction even when change occurs. Organizational changes may involve changes in an organization’s structure and strategy that may be planned in advance or may be implemented because of a sudden shift in the environment. Alongside dealing with these distractions, change management helps an organization to implement strategies for inducing change, controlling change, and helping employees to adapt to change. The organization understudy is the Department of Trade and Industry Laguna Provincial Office (DTI Laguna). This study describes organizational resilience and change management as inputs to management effectiveness. More specifically, it determines the assessment in organizational resilience in terms of capital resilience, strategic resilience, cultural resilience, relationship resilience, and learning resilience and the assessment in change management in terms of project management and corporate culture. Likewise, it determines if there is a significant relationship between assessment in organizational resilience and change management. Moreover, it proposes an action plan based on significant findings as inputs to management effectiveness. The study uses a quantitative method of research to gather information on organizational resilience and change management. The entire population of the organization understudy is small; thus, the participants of the study are all 62 employees of DTI Laguna, including the management and support staff. The data gathering instrument is divided into three major parts (profile of the respondents, a questionnaire on organizational resilience using a 4-point Likert scale, and a questionnaire on change management using a 4-point Likert scale) and is tested for reliability using Cronbach’s alpha. An online survey tool (Google Forms) is used to gather the information. The results are analyzed by a trained statistician using Statistical Package for the Social Sciences tool for frequency distribution and percentages, weighted mean, and ANOVA. Based from the results, the employees agree on the assessment in organizational resilience in terms of capital resilience, strategic resilience, cultural resilience, and learning resilience. Employees strongly agree on the assessment in organizational resilience in terms of relationship resilience. There is a significant difference between assessment in organizational resilience in terms of strategic resilience, cultural resilience, relationship resilience, and learning resilience when grouped to length of service. There is a significant difference between assessment in organizational resilience in terms of capital resilience, strategic resilience, cultural resilience, and learning resilience when grouped to monthly income. Moreover, based from the results, employees agree on the assessment in change management in terms of project management and corporate culture. Corporate culture was ranked first. There is a significant difference between assessment in change management in terms of project management and corporate culture when grouped to length of service and monthly income. There is a significant relationship between assessment in organizational resilience in terms of capital resilience, strategic resilience, cultural resilience, relationship resilience, and learning resilience and assessment in change management in terms of project management and corporate culture. The researcher recommends that the Office of the Provincial Director may want to increase connections with employees by devising online bulletin boards wherein employees’ thoughts (pulse survey perhaps) may be posted. Also, they may want to organize an in-house “mentor me” program wherein an open communication may be facilitated between the management and the employees. The quality management team may want to revisit the implementation of monthly staff meeting and quarterly management reviews to maintain management effectiveness. The Administrative and Finance Management Unit may want to further improve the level of trust of employees to the management by devising an online shared portal of status of funds that is to be updated from time to time. Future researchers may do a similar study or may use other variables not included in this study. More so, they may want to compare two or more government agencies to know if they will come up with the same results.

Confronting challenges of school-based management in a developing country

School-Based Management (SBM) has served as a key reform program, concretizing decentralization in the basic education sector in different parts of the world, including the Philippines. The study used qualitative research methods, including key informant interviews and focus groups of faculty and administrators, to explore the challenges of SBM in the area of curriculum and learning in a public secondary school. Results revealed that poor foundation of basic knowledge, inadequate school facilities and instructional materials, non-observance of time on task policy, students' misbehaviour and poor academic interest, low parental support, as well as errors in learners' materials were among the challenges being confronted by English, Science, and Mathematics (ENSCIMA) teachers that affect the successful implementation of the curriculum and learning. The study recommended different strategies, which include benchmarking activities through school-to-school partnerships, immersion activities, organization of a quality management team, remedial and intervention sessions, additional School Learning Action Cell (SLAC) and In-Service Training (INSET) sessions, student orientation, parents' summit, for a symposium, and write-shop. These activities, if collaboratively undertaken by various stakeholders, will help address the challenges that would result in efficient SBM, leading to a successful and quality education in the country.

Thực trạng hài lòng người bệnh đến khám chữa bệnh ngoại trú tại khoa Khám bệnh bệnh viện Phú Nhuận 6 tháng đầu năm 2020

Introduction: The study aims to assess the of out-patient’ssatisfaction at the Department of Examination in the Department of Examination, Phu Nhuan district Hospital in the first six month of 2020. Method: Cross-sectional study applying mix method. Secondary data of patient’s satisfaction in the first six month of 2020. Qualitative study applied in-depth interviews with hospital leaders, hospital quality management team staff, and patients. Quantitative data was analysed and compared with the patient’s satisfaction standards of the Vietnamese Ministry of Health. Qualitative data was coded and interpreted by themes. Results: The majority of people who went to outpatient care at the Faculty of Examination were satisfied with the hospital (90.63%, the mean score of service quality is 4.63). The highest mean score belongs to the dimesion of Behavior, professional capacity of health workers and results of service provision. The lowest mean score belongs to the dimension of infrastructure, facilities and instrument. The mean score between of service quality among the patients using health insurance and not using health insurance has a negligible difference. Recommendations: Phu Nhuan Hospital needs to upgrade and expand the facilities and infrastructure in order to improve patient’s confidence and satisfaction. Keywords: satisfaction, outpatient care, Phu Nhuan Hospital, Ho Chi Minh City

Knowledge Promotes Quality Management: A Case Study of Quality Problem-Solving in Two Automotive Plants

Quality management is a vital link to ensure product quality in the automobile production process. This paper investigates problem-solving of two automotive plants and explores the factors that influence the quality improvement in the organisation. The case studies analyse the status quo and problems in the quality management organisation, problem-solving process, and team, as well as quality management information system with particular emphasis on how each plant uses data, information, and knowledge to solve quality problems from the perspective of knowledge management. The result shows that there is a lack of utilisation of data, information, and knowledge in problem-solving. Based on the analysis result and the demands of plants for improving the efficiency and effectiveness of problem-solving, we propose a knowledge management based intelligent problem-solving system (IPSS). At the same time, a five-tier environment construction for the successful implementation of IPSS is proposed. The main shortcomings identified are common to many other plants and companies worldwide. The suggestions and proposals put forward are of great significance for manufacturing enterprises to improve the efficiency and effectiveness of quality problem-solving.

Time Reduction of New Patient Consultation at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital

Objective. To decrease the total time spent of new patients on a General Clinic consult at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital. Methods. A time quality management team was formed. The description of the process of a General Clinic new patient consult was elucidated and was consolidated in a data collection form. Convenience sampling of the population was done. The collection and analysis of the data were done with institution of interventions to address the factors causing the prolonged consultation visit; then, pre-intervention analysis, post-intervention analysis and comparison were done. Results. Thirty-five new patients were tracked prior to and after intervention. Among the identified causes for prolonged new patient consult were delay in temporary chart, front of chart and blue card issuance, insufficient examination tools and resident dedicated to the General Clinic, unnecessary examination and patient not being around when called. Most causes were addressed. A mean decrease of 68±112 minutes or approximately 18% in total time stay was noted. Conclusion. This study showed that the total consultation time of a new patient in General Clinic decreased. This was achieved with the help of most of the personnel involved in the system after identifying factors causing the prolonged consultation visit and instituting interventions to address these identified factors. The improvement in health service delivery was taken as a step by step process. A preliminary step was demonstrated in this paper for future interventions for better service delivery.

Ações para reduzir o risco de infecções relacionados à assistência à saúde

Identificar as ações realizadas pela equipe de SCIH e Gestão da Qualidade para alcançar a meta redução do risco de infecções relacionadas à assistência à saúde. Pesquisa qualitativa, exploratória e descritiva, realizada em duas instituições hospitalares. Houve triangulação de dados com entrevistas, observação e análise documental. Para a análise dos dados utilizou-se a análise de conteúdo. As ações mais realizadas foram educação permanente, identificação e correções de problemas em procedimentos, busca ativa, vigilância e higienização das mãos. Foi possível identificar a ocorrência de eventos adversos. A comunicação e os problemas estruturais aparecem como dificultadores no alcance da meta. As ações identificadas foram práticas tradicionais e muitas vezes ineficientes. A prevenção e o controle de infecções ainda são desafios para as instituições de saúde. Há necessidade de adoção de estratégias inovadoras para alcançar a meta de redução do risco de infecção relacionada à assistência à saúde.

Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safety.

ObjectiveThis study aimed to determine if introducing nontechnical skills to surgical trainees during surgical education can reduce the operation time and contribute to patient safety.DesignQuality improvement initiatives using the KAIZEN as a problem-solving method.SettingDepartment of surgery in a referral and educational hospital.ParticipantsSurgical team and quality management team.InterventionThe KAIZEN was used as a problem-solving method between 2015 and 2018 to reduce the operation time. First, baseline measurement was performed to understand the current situations in our department. To achieve continuous improvement, periodical feedback of the current status was obtained from all staff. Bundles, including nontechnical skills, were established. Briefing and debriefing were performed by the surgical team.Main Outcome MeasuresExcessively long operation rates with a standard procedure.ResultsWe included 1573 operations in this initiative. Excessively long operation rates were reduced in all types of surgeries, from 27.1% to 15.2% for herniorrhaphy (P = 0.005), 58.3–40.0% for gastrectomy (P = 0.03), 50.0–4.1% for total gastrectomy (P = 0.12), 65.6–45.0% for colectomy (P = 0.004), 67.8–43.2% for high anterior resection (P = 0.02) and 69.6–47.9% for low anterior resection (P = 0.03). The adherence to briefing and debriefing were improved, and majority of the surgeons favored the bundle elements.ConclusionsThe KAIZEN initiative was effective in clinical healthcare settings. In the event of scaling-up this initiative, the educational program for physicians should include project management strategies and leadership skills.

Obtaining BMT Programmatic Feedback for Performance and Quality Improvements

Over the last year, the Medical City Dallas Blood and Marrow Transplant (BMT) Program quality management team implemented a formal process to solicit feedback from the processing facility, collection facility, and the clinical programs within the BMT Program. The information received is used to improve interactions and processes, as well as meeting and/or exceeding Foundation for the Accreditation of Cellular Therapy (FACT) requirements. <b>Background:</b> Feedback is one of the most powerful influences for learning and achieving process improvements, but its impact can be positive, negative, or neutral. The 7^th edition <i>FACT-JACIE International Standards</i> requires that the Quality Management Plan include, or summarize and reference, policies and procedures for obtaining feedback from associated Clinical, Collection and Processing Facilities. Figure 1, "Feedback Flow between Program Facilities", illustrates the flow of feedback between facilities. <b>Method:</b> To facilitate the collection of data, an electronic survey instrument was used to expedite survey completion. Over a 10-month period, the Quality Manager, assisted by the program's BMT Secretary, sent out bi-weekly feedback surveys and to each facility. If facility staff did not return surveys, reminders were sent again after 3 days and then again after 10 business days (refer to figure 2. "Survey Questions and # of Returns"). Returned surveys are then analyzed. Results and any concerns are presented during the program's quarterly quality meetings for review and endorsement of performance improvement plans. <b>Analysis:</b> To date, the responses have been approximately 90% positive; the other 10% suggested that professional communication could be improved (refer to Figure 3. "Example Feedback"). Some survey respondents remarked that fear of retaliation arising from negative comments prevented them from responding honestly and openly. <b>Results:</b> The survey process has been well received, providing actionable feedback. The evidence confirms that the type of feedback, and the way it is delivered, can be perceived as positive or negative. As one outcome of the survey process, documents are now placed on a shared drive folder so that staff who need them can access them directly. This has improved information flow and communication within the team. The Program is investigating opportunities to improve interpersonal communication approaches in order to improve "sense of team". From the perspective of this program, in addition to surpassing FACT requirements, this initiative provides ways in which feedback can be used to improve communications and streamline processes between facilities.

Evaluation on implementation of quality management system in vocational high schools with CIPP approach

This study aims to find out: (1) the results of implementing ISO 9001: 2008 Quality Management System in terms of context, (2) input, (3) process, (4) and product in Vocational Schools in Bali. This research is an evaluation research with the Context Input Process Product model. The place for this research is SMKN 1 Kuta Selatan and SMKN 3 Singaraja. The research subjects were principals, vice principals, representative quality management teams, teachers, and students. The instrument of data collection is a questionnaire with scale 2. Data analysis techniques with percentage techniques. The results of the study can be seen: (1) the implemantation of ISO 9001: 2008 QMS in Vocational High Schools in Bali in terms of context is categorized as “very good”, (2) in terms of inputs included in the” very good “category, (3) in terms of the process is included in the “very good” category, (4) and in terms of the products included in the “very good” category.

96 Kuala Lumpur Hospital Fall Preventive Measures, for a Better Tommorow

Abstract Introduction Hospital Kuala Lumpur is the largest tertiary hospital under the MoH. Inpatient falls is a setback in every health institution with ramifications to the patient’s well-being and the health organization image. Methodology This is a retrospective, cross-sectional and descriptive report conducted from January 2014 till December 2018. Data collected from submitted IR forms. Results 942 cases of falls were reported last 5 years with an exponential increase from 63 cases in 2014 to 386 cases in 2018. 81% (758) falls involved medical-based divisions, 17% (163) falls involved surgical based division and 2.2% (21) falls involved allied health. 59% (556) involving male patient and 41% (386) involving female patients. Prevailing age groups are from 61 to 70 y.o with 28.2% (266) falls. Highest number of falls is observed during night shift 40.6% (382) falls. 58.3% (549) patients escaped with no injuries, however, 3.5% (33) falls sustained severe injuries requiring prolonged stay and treatment. Discussion Highest falls were reported at Department of Internal Medicine 60% (564) falls, followed by Department of Orthopaedics 8.8% (83) and 2.6% (24) falls reported at Department of Rehabilitative Medicine in the last 5 years. The embodiment of FIT team was inevitable with the increase in falls at HKL whereby they assume the responsibility in designing fall prevention and awareness program in HKL. The FIT Team represents a multi-disciplinary team consisting of doctors, nurses, and allied health supports. The FIT team has conducted multiple sessions of “Training of Trainers” empowering health staff in improving patient safety. Quality Management team educates health staff on accurate reporting using the IR form and conducts regular audits at wards, concerning patient safety. The collaboration of this both entities have created an immense awareness in regards to patient safety, hence spike in numbers of notification. Thus, patient safety is the epitome and cornerstone of all health institution.

Quality management of helicopter rescue transportation for critical patients

Objective To explore the quality management of critical patients in the process of medical helicopter rescue and transshipment. Methods After receiving the rescue and transshipment task for 10 critically ill patients, the Emergency Department quickly established the rescue quality management team under the direction of the dean: with helicopter on-site rescue and transshipment team, in-hospital pick-up and transshipment team, logistic support team and coordination command group; full medical security assessment: to prepare all emergency supplies, drugs, instruments and equipment in a predictable manner, and all within the effective period, completed. The success rate is 100%. The formulation of rescue plan: formulating individualized emergency plan, pre-examination and triage evaluation plan, transporting and implementing process plan; unblocked green channel: setting up rescue room as rescue preparation area; radiology department, laboratory department, pharmacy, B-ultrasound room, electrocardiogram room, emergency transfer elevator, medical housekeeper and other departments ensure the green channel unblocked, safety logistic support team dedicated personnel management. To manage the area from apron to emergency hall and rescue room, smooth transit routes, and prepare for emergency treatment in emergency intensive care unit and specialized intensive care unit. Specialized organizations are responsible for: Department directors, head nurses and quality control team leaders to organize and coordinate quality management work. Results All 10 critically ill patients were safely and smoothly transported to hospital for emergency treatment without any adverse events. Six patients received emergency intensive care, three orthopaedic care, one hand-foot surgery care, and 10 critically ill patients were discharged from hospital in time and safely through various specialties. Conclusion The successful rescue and safe transshipment of 10 critically ill patients reflects the good beginning of the development of medical helicopter rescue in our province, and forms a complete, organized, targeted, planned and implemented team rescue system, which greatly improves the quality management level of medical helicopter rescue and transshipment. Key words: Helicopter rescue transfer; Quality management