Continuous Quality Improvement System Research Articles

Пути совершенствования внутреннего контроля качества и безопасности медицинской деятельности: как использовать результаты контроля в сфере обязательного медицинского страхования.

R e l e v a n c e . Currently, the issues of ensuring the quality and safety of medical activities are one of the priority areas in healthcare management. The legislation of the Russian Federation has determined the organization and conduct of internal quality control and safety of medical activities as a licensing requirement. Identified inconsistencies/violations in the provision of medical care are one of the elements of risk management and should be used to improve the efficiency of medical organizations. T h e p u r p o s e of the study is to develop management practices to improve the quality and safety of medical activities using the results of external audits in the field of compulsory health insurance. M a t e r i a l s a n d m e t h o d s . The analysis of modern requirements of normative legal acts of quality control and safety of medical activity has been carried out, the main tools used in conducting external audits in the system of compulsory medical insurance have been systematized. R e s u l t s . The modern architecture of quality control and safety of medical activities includes 5 levels of control. The tools for monitoring the quality of medical care for identifying violations, applying financial sanctions to a medical organization are described. In order to improve the quality and safety of medical activities, the development of corrective measures and various management practices is recommended. C o n c l u s i o n s . The results of external audits are an important element of the modern model of quality management and safety of medical activities, which should be integrated into the work of a medical organization of any profile for use in a system of continuous quality improvement.

Implementing Lean Six Sigma Concepts in Audiology Practices

Implementing Lean Six Sigma Concepts in Audiology Practices

A Validity Framework for Effective Analysis and Interpretation of Milestones Data.

A Validity Framework for Effective Analysis and Interpretation of Milestones Data.

An automated continuous quality improvement framework for failing student outcomes based on mathematics weaknesses

In this paper, we present a detailed action plan under continuous quality improvement (CQI) exercise of outcomes based education framework related to Mathematics concerns highlighted by the Electrical Engineering (EE) Department. Failing and low performed student learning outcomes (SOs) and course learning outcomes (COs) in range of core EE courses were observed to be linked with weak Mathematics basis of students. This feedback was achieved through an automated CQI system in EvalTools under Faculty Class Assessment Report (FCAR) tab, where each instructor is required to make reflections about failing as well as low performed SOs and COs. Feedback was reviewed comprehensively, and mathematical concepts which significantly affect the performance of students in the core EE courses were derived. Moreover, a high level of Mathematics pre-requisite covering required mathematical concepts is identified for the range of core EE courses. Consequently, well-defined tasks were assigned to continuously evaluate and monitor improvement in required Mathematics concepts to ensure SOs and COs achieved in core EE courses. Results are given to exhibit the effectiveness of continuous improvement management system (CIMS).

Re-engaging students in medical school accreditation: the independent student analysis action (ISA2) approach

This article was migrated. The article was marked as recommended. Background: Student satisfaction with key aspects of a medical school program plays a major role in an institution's accreditation in the United States (US). There is limited evidence regarding how to best engage students in responding to areas of lower student satisfaction that are identified through the national Liaison Committee on Medication Education (LCME) accreditation self-study process. Methods: We present a student-led innovation to promote greater levels of student engagement throughout Harvard Medical School's re-accreditation experience, which we refer to as the Independent Student Analysis Action (ISA2) process. This innovation built directly upon the Independent Student Analysis (ISA) survey, which is expected by the LCME for accreditation. The ISA2 process allowed medical student leaders to leverage ISA results to identify 11 priority areas that had relatively lower levels of satisfaction and subsequently coordinate focused, time-limited ISA2 working groups to address these problematic areas. These working groups then presented their solutions to the student body, and a follow-up survey gauged satisfaction with these areas in light of the changes made. Results: The ISA2 process engaged over 110 students, faculty, and staff. The majority of the student body completed the follow-up survey, which demonstrated higher levels of satisfaction with these previously problematic areas as identified in the original ISA survey. Further, 96% of students reported being satisfied with the ISA2 process as a mechanism for utilizing student feedback in the ISA to create meaningful institutional changes. Conclusions: The ISA2 served as a powerful convening mechanism for engaging a large number of students in our institution's re-accreditation efforts. Other medical schools looking to involve students in their continuous quality improvement systems and accreditation experience may benefit from reviewing and customizing this model to their institution's needs.

Exploring the value of the learners' perception of teaching effectiveness in informing faculty development needs: A mixed-methods study.

This article was migrated. The article was marked as recommended. The evaluation of a faculty development intervention needs to start at the outset, and not as an afterthought. Moreover, it is important to evaluate the degree to which the predefined impact is attained as a result to the learning and development opportunity. This calls for the engagement of the ultimate receivers: the students, who are well-positioned to identify gaps in the teaching performance of their own instructors. Accordingly, this mixed-methods study aims at shedding light on a Continuous Quality Improvement system where feedback from undergraduate and postgraduate students is assembled to pinpoint faculty development needs, based on which professional development opportunities are devised. Data was extracted from an annual survey that evaluates the students' satisfaction. Qualitative data was thematically analysed, and quantitative data was analysed using SPSS. The qualitative analysis resulted in six categories of recommendations, that were fit into two themes: dynamic between the instructors and students, and organization and delivery of the program. As for the quantitative analysis, the students indicated opportunities for improvement in the following two areas: student academic advising process (55.17%), and communication between instructors and students (50.59%). The study concluded that there is added value in capturing and effectively assembling the learners' perception of faculty performance. It raises the reliability of the implemented evaluation framework, and has the potential of improving the rigor of faculty development initiatives.

Laboratory Quality Management System and Quality Indicators Implementation Status as Perceived by Laboratory Professionals in Preparation for the Accreditation Process from Selected Government Hospitals of Ethiopia.

The aim was to produce quality results that clinical laboratories need to implement and maintain continuous quality improvement systems. In recent years, health organizations have increasingly prioritized the quality of laboratory services by implementing quality management systems (QMSs) and building quality improvement activities. Efforts to strengthen laboratory systems in the African region have received increased attention in recent years. Assessing the implementation levels of laboratory quality management system components is important to identify the gaps that need further improvements. A cross-sectional study design was used between March and May 2017 in selected government hospitals of Ethiopia, and sample size was determined using a finite population formula, and a proportional sampling technique was employed; a sample size of 184 (62%) was calculated from 295 laboratory professionals. All respondents were informed about the laboratory's experience in the quality management system implementation; of those, only 138 (79%) engaged in the implementation process. From the 18 selected laboratory quality management components, 5 were observed to have the list implementation status, which are: (1) Performance of internal quality control for all tests, (2) Development and communication of a quality manual for all tests, (3) Adequacy of storage space for the supplies, (4) Development of an action plan based on internal audit, and (5) monitoring of environmental conditions. Running quality controls for all types of tests became a headache in almost all laboratories. From 12 selected quality indicators studied in this research, the 5 indicators with either poor or very poor performance outcome were: control of documents 136 (77.7%), control of records 123 (70.3%), development of manuals and policies 122 (69.7%), development of process and procedures 120 (68.6%), and internal communication 114 (65.1%). This research indicated the top 3 LQMS components with either poor or very poor implementation status: (1) Performance of internal quality controls for all tests, (2) Development and communication of quality manuals for all tests, (3) Adequacy of storage space for the supplies. Of the quality indicators studied, control of documents was perceived to have poor performance outcome by 136 (77.7%) of study participants.

A Study on the CQI System for the Quality Management of Competency-Based Education

본 연구에서는 역량기반 교육의 질 관리의 일환으로 D대학에서 실행되고 있는 교과목 CQI 시스템의 체계와 구성요소, 평가기준 및 활용에 대해 살펴보았다. D대학에서는 역량기반 교육계획-교육과정-교육결과의 질 관리 체계를 통해 전반적인 개선점을 도출하고, 이를 차기 강의에 반영할 수 있도록 CQI 환류시스템을 구성하였다. 또한, ‘개선실적 중심’의 평가기준을 마련함으로써 교육의 질 관리를 강화하였으며, 평가의 결과는 우수교원 시상 및 교원업적평가에 반영함으로써 교원들의 참여를 제고하였다. 이러한 결과에 비추어 대학교육의 질 관리를 위한 CQI 시스템 구축 및 운영에 있어 제언을 한다면, 먼저 교수자의 자기성찰과 학생들의 강의평가 결과를 토대로 지속적인 강의의 개선이 이루어지도록 순환적인 체계로 구성되어야 할 것이다. 다음으로 각 대학의 실정에 적합한 CQI를 개발하도록 노력하여야 한다. 이에 교과교육 및 교육과정이 실제 수업에서 어떻게 계획, 실행되고 있는지를 분석하고 수업실행결과인 학습자의 학습성과 평가결과 등이 포함된 종합적인 분석결과를 바탕으로 다시 교과교육과 교육과정 개선에 환류되어 교수자의 교수역량 및 학습자의 학습능력을 지속적으로 향상시킬 수 있는 접근방안을 찾도록 한다. 이상의 결과는 대학교육의 질 관리를 위한 CQI 시스템을 개발하여 적용하고자 할 때 CQI 구성항목 및 평가기준 등의 수립에 있어 실제적인 도움을 줄 수 있을 것이다. 그러나 본 연구의 대학사례가 한정적이므로 추후 다양한 사례의 연구가 이루어 질 필요가 있다.In this study, we examined the system, components, evaluation criteria, and application of the Continuous Quality Improvement(CQI) system in a particular subject, which was carried out at D university as part of the quality management of competency-based education. D University has developed a CQI feedback system that can improve the quality of the educational plan, competency-based curriculum, and educational outcomes; the results of the feedback could be reflected in the next lecture. In addition, to improve the quality of education through evaluation criteria based on “improvement performance”, the results of the evaluation were reflected in the results of the best teachers professors and teacher’s achievement evaluations. The results of this study can be useful for establishing CQI configuration items and evaluation criteria when developing and applying CQI for quality management of university education. However, As this study was limited to retain additional case studies need to be conducted.

‘At the grass roots level it’s about sitting down and talking’: exploring quality improvement through case studies with high-improving Aboriginal and Torres Strait Islander primary healthcare services

ObjectivesImproving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a...

Aligning Professional Development to Continuous Quality Improvement: A Case Study of Los Angeles Unified School District’s Beyond the Bell Branch

Abstract There is a strong, empirical link between facets of afterschool program quality and a range of positive youth outcomes. However, implementing quality programs that are more likely to produce positive youth development require a high-level of knowledge and expertise among program staff. Training staff on the critical components of high-quality programming requires approaches that are systematic, ongoing, data-driven, inclusive of all staff, embedded into their organizational roles, and supported by organizational leadership. We present a case study of preliminary continuous quality improvement (CQI) system at the Beyond the Bell (BTB) Branch of the Los Angeles Unified School District. We discuss the components of a CQI system (i.e., strategic planning, development of tools, staff development and data use) as well as reflect on important organizational factors that promote CQI. Keywords: after school programming, program quality, professional development, continuous quality improvement ----- Bibl iography: Berryl, Tiffany/Sloper, Michelle/Pickar, Hannah/Talbot, Harry: Aligning Professional Development to Continuous Quality Improvement: A Case Study of Los Angeles Unified School District’s Beyond the Bell Branch, IJREE, Vol. 4, Issue 1-2016, pp. 65-84. https://doi.org/10.3224/ijree.v4i1.24776

Effectiveness of Five-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience.

Background:Triage for patients’ prioritization in the emergency department is a suitable solution to decrease overcrowding. Different methods are used for prioritization that needs effectiveness evaluation.Objectives:The aim of this study was to assess the effectiveness of the emergency severity index (ESI) 5-level triage system in contrast with spot check triage.Patients and Methods:Data for this quasi-experimental study were extracted using a form to review 770 records of patients referred to emergency department of Imam Khomeini hospital (in Sari, north of Iran) during two separated periods each for four months; the first from 20th March to 19th July 2010 and the other from 21 March to 20 July 2011. The method used in the first time was spot check triage and the second one ESI triage. Data were processed with descriptive statistics and analyzed using independent samples t-test (CI = 95%).Results:Increase from 6.46 to 8.92 minutes in the average time from patient arrival to being visited by a physician (P < 0.001) and increase in average time from physician visit to receive the first nursing care from 7.68 to 15.89 minutes were significant (P < 0.001). The average waiting time for laboratory services was significantly decreased from 112.3 to 84.1 (P = 0.033). Increase in the average waiting time for radiology, decrease in average waiting time for sonography, average length of stay in the emergency department, and number of patients per emergency bed were not significant.Conclusions:Between the two systems of triage, ESI was more effective than the spot check and in the spatial and temporal domain of research, was a successful method in improving some indicators of emergency and improving the performance indices. Hospital managers by implementation of ESI system can take a step toward new health policies and improve the processes as key tools of continuous quality improvement system.

Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services.

BackgroundManagement of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia.MethodsRetrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI.ResultsA total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change.ConclusionsWell-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.

A model for the continuous quality improvement of the Sing With Us choir leaders

Abstract Sing With Us is a network of fifteen research-led community choirs run weekly by the cancer charity Tenovus Cancer Care, as a form of support for people affected by cancer in Wales. This article discusses a model created by Tenovus Cancer Care to train and develop their team of eight community Choir Leaders (CLs). It explores the theoretical frameworks and methodology through which a system of continuous quality improvement has been developed for them, and looks specifically at the initial results of a first team assessment. This article will explore the idea that by professionalizing and valuing the roles of the CLs and the work they do, this will create a positive impact in the service that is provided. It will suggest that by implementing a process to ensure a quality leadership in a community choir setting, choristers will be more likely to have a richer experience on which they place high value and will be engaged for longer.

Corporate social responsibility of hotels in Serbia as an element of total quality management

Many companies have realized that economic and financial crisis is not a short-term phenomenon, but rather a long-term trend. This finding has caused the creation of a strategy for overcoming the difficult business conditions. In the beginning, that was the outsourcing of production and services, followed by downsizing and business processes reengineering. Since quality has emerged as a key factor for ensuring the long-term competitiveness, Total Quality Management (TQM) has become a modern system of continuous quality improvement for all company activities. Corporate social responsibility (CSR) is one of the dimensions of total quality management which is increasingly gaining importance during the economic crisis when customers' trust plays an important role in making purchasing decisions. Due to complex expectations of guests, hotel companies see TQM, and especially CSR as a vital component of competitiveness. The purpose of this article is to highlight the extent of CSR use in the Serbian hotel industry as well as benefits gained by the implementation of this approach, including employee satisfaction, customer satisfaction, public opinion, revenue increase, cost savings, and others.

The impact of national culture on total quality management effects

Total quality management is a holistic business philosophy of striving for continuous quality improvement of all processes in the company. Unlike traditional management, where decisions are made at the top of the organizational pyramid and orders transmited from the top-down, total quality management emphasizes the involvement of all employees in the process of establishing a system of continuous quality improvement. This is achieved by encouraging employees to make proposals, taking responsibility and making decisions. The effects of the implementation of total quality management is significantly conditioned by the national cultural environment in which the company operates. The aim of this paper was to present the way in which national culture affects the efficiency of the implementation of total quality management and to propose guidelines for improving such efficiency.

De ontwikkeling van kwaliteitssystemen in Nederlandse ziekenhuizen tussen 1995 en 2011

This study describes the development of quality systems in Dutch hospitals between 1995 and 2011. To measure the development stage of quality systems, a structured questionnaire was sent to the Board of Directors of all Dutch hospitals in 1995, 2000, 2005, 2007 and 2011. The results of this study show that the development stage of quality systems in Dutch hospitals increased between 1995-2011. In 1995, 52% of the participating hospitals were in the preparation stage of development. In 2011, 53% of the participating hospitals already possessed all the necessary elements of a quality system and another 45% had integrated these elements into a system of continuous quality improvement. Although the development of quality systems increased, this development did not follow the same pattern in the different elements of the quality system. Furthermore, quality systems of larger hospitals were significantly further developed. Future research should focus on further explanations of differences in quality management development stages between hosptitals and the effectiveness of these systems in terms of quality of care.

Development of a quality infrastructure for a 135-site statewide network of community oncologists.

74 Background: The delivery of patient centered, high-value care requires a formal system of continuous quality improvement. In order to bring metrics to the site and physician level the need to revamp our program for 364 physicians was apparent The starting point was 4 physician-led network wide quality committees. Methods: In 2010, the position of Director of Quality Programs was created to assist in the development of a quality infrastructure for a statewide network of community oncologists. Beginning in January 2011 meetings were held with the management team of each site for education on national quality initiatives and the IOM 6 aims for improvement in healthcare. The discussion also included review of quality metrics set forth by ASCO’s QOPI, evidence-based pathway reporting, variance reporting on patient safety and employee safety, and processes to improve patient satisfaction. Each site then identified their team members, physician champion, and frequency of committee meetings. An action plan format was provided with discussion on components of the plan and the reporting structure to the physician-lead quality oversight committees. Results: The network currently has 38 quality committees serving 84 sites of service. Within a year’s time pathways assessable data improved from 84% to 90%, pathways adherence improved from 60% to 68%, and exception documentation rose from 14% to 25%. Variance reporting increased 35% and a network Patient Satisfaction Survey was created and administered with 10 surveys per physician collected and tabulated for baseline data. The survey process was reviewed and refined and will now be administered twice yearly at each site. Documentation of hospice referrals and follow-up processes on deceased patient information are key initiatives at each site. Conclusions: Development of a robust quality infrastructure at the site level can increase adherence to quality measures by identifying common barriers to improvement, sharing of best practices, and supporting the delivery of patient-centered, value-based care.

Veterinary education: a basis for good governance leading to effective Veterinary Services

Veterinary education serves as the foundation on which a country can build effective Veterinary Services (VS). In addition, an appropriately well-educated animal health workforce will be better poised to actively participate in and advance good governance practices. Good governance, in turn, will lead to improved animal and veterinary public heath infrastructures and help advance economic development across the globe. A crucial first step in establishing a strong educational foundation is to define minimum competencies for both public- and private-practice veterinarians to perform veterinary service tasks. Defining minimum competencies will also assist veterinary education establishments (VEEs) in developing and implementing curricula to allow graduates to achieve those competencies. Incorporating veterinary educational prerequisites and requirements into governance documents that regulate VS will help to ensure that those who deliver VS have an adequate knowledge and skills base to do so. Public-private partnerships may be particularly effective in designing and implementing curricula that address defined minimum competencies and assure the quality of VEEs. Through these partnerships, a system of continuous quality improvement is established that embodies the qualities essential to good governance practices. Such practices will ultimately strengthen national VS, better protect animal and public health, and ensure food security.

Abstract 19: Targeted Education Can Change Paramedics' Attitudes to CPR

Objectives: One reason for sub-standard CPR quality may be linked to long-held beliefs and lack of knowledge. We wanted to study if targeted education could change these attitudes among paramedics. Methods: Ambulance New Brunswick introduced a continuous quality improvement system (CQI) for out-of-hospital cardiac arrest in 2008 based on CPR-performance recordings. Shortly after this, all paramedics were invited to answer a survey, to study the attitudes and knowledge towards CPR. Learning objectives were constructed from the survey to address attitudes and lack of knowledge, and were used in the following training sessions. The survey was repeated in 2011 to evaluate the effect training had on attitudes. Respondents graded statements on a five-point Likert scale from strongly agree to strongly disagree. Chi-square tests with continuity correction (SPSS v16) were used to test for changes in proportions between the combined agree and disagree answers. Results: Of 761 invited paramedics, 288 answered in 2008; in 2011 233 of 967 answered. Learning objectives on three subjects were identified: importance of compression depth, confidence in the importance of pre-hospital cardiac arrest care and acceptance of CQI system. A positive change was seen for all three learning objectives, see table 1. Conclusion: It is possible to change long-held beliefs and attitudes towards CPR trough targeted education.

Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members

IntroductionThe objectives of the Breakthrough Series Collaborative are to close the gap between what we know and what we do, and to contribute to continuous quality improvement (CQI) of healthcare...