Continuous Quality Improvement Tools Research Articles

Development of manufacturing engineering program of Bulacan State University using employability tracer study

<span lang="EN-US">Tracer study is one of the continuous quality improvement tools for curriculum development. The graduates are invited to answer the tracer form to determine their employability. Since the Manufacturing Engineering program in Bulacan State University (BuLSU) is the youngest engineering program, there is minimal data on graduates available, especially on the details of their first jobs, such as the first job related to the program, time taken to land their first job, gross monthly salary, and learning competencies. The demographic profile of the manufacturing engineering graduates from 2015 to 2019 is preserved and remains strictly confidential for the safety of their identification. Correspondingly, the study applied a cross-sectional retrospective survey method. Moreover, 67.41% of manufacturing engineering graduates responded. The employment rate of manufacturing engineering graduates was 93.38%, whereas regular or permanent in their current employment was 84.40%. Furthermore, data show that they are employed within less than a month, 50.97% of responses. Lastly, the primary learning competency that manufacturing engineering graduates consider is critical thinking skills, with a response rate of 86.11%, followed by problem-solving skills, with 81.94% responses, while third was communication skills, with a rate of 78.08%. Ultimately, the recommendations for further curriculum and program improvement are exhibited.</span>

Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya

BackgroundChildren and adolescents living with HIV have poorer rates of HIV testing, treatment, and virologic suppression than adults. Strategies that use a systems approach to optimize these multiple, linked steps simultaneously are critical to close these gaps.MethodsThe Systems Analysis and Improvement Approach (SAIA) was adapted and piloted for the pediatric and adolescent HIV care and treatment cascade (SAIA-PEDS) at 6 facilities in Kenya. SAIA-PEDS includes three tools: continuous quality improvement (CQI), flow mapping, and pediatric cascade analysis (PedCAT). A predominately qualitative evaluation utilizing focus group discussions (N = 6) and in-depth interviews (N = 19) was conducted with healthcare workers after implementation to identify determinants of implementation. Data collection and analysis were grounded in the Consolidated Framework for Implementation Research (CFIR).ResultsOverall, the adapted SAIA-PEDS strategy was acceptable, and the three tools complemented one another and provided a relative advantage over existing processes. The flow mapping and CQI tools were compatible with existing workflows and resonated with team priorities and goals while providing a structure for group problem solving that transcended a single department’s focus. The PedCAT was overly complex, making it difficult to use. Leadership and hierarchy were complex determinants. All teams reported supportive leadership, with some describing in detail how their leadership was engaged and enthusiastic about the SAIA-PEDS process, by providing recognition, time, and resources. Hierarchy was similarly complex: in some facilities, leadership stifled rapid innovation by insisting on approving each change, while at other facilities, leadership had strong and supportive oversight of processes, checking on the progress frequently and empowering teams to test innovative ideas.ConclusionCQI and flow mapping were core components of SAIA-PEDS, with high acceptability and consistent use, but the PedCAT was too complex. Leadership and hierarchy had a nuanced role in implementation. Future SAIA-PEDS testing should address PedCAT complexity and further explore the modifiability of leadership engagement to maximize implementation.

A retrospective analysis of near-miss incidents at a tertiary care teaching hospital in Riyadh, KSA

ObjectiveThis study seeks to establish an error-free reporting system that enhances patient safety and organisational culture. It investigates the prevalence of near-miss incident reporting systems by healthcare professionals in the General Surgery Department. MethodsThis retrospective observational study was conducted at a tertiary care teaching hospital in Riyadh, KSA. A sample of 253 medical records, ranging from January 2018 to December 2020, belonging to secondary patients was obtained using the near-miss Datix reporting and occurrence variance reporting system. The demographic variable data of registered patients were based on their age group (18–80 years), length of stay, date of admission, medication prescribed for more than four days, and whether they underwent surgical interventions. The cases were documented after the occurrence of a near-miss incident using a convenience sampling technique. ResultsIn terms of prevalence in the near-miss main categories, medical errors were 248 (98.2%), workplace violations were two (0.80%), and others was one (0.40%). The number of incidence in the subcategories were: prescribing, 227 (89.7%); dispensing, 16 (6.30%) wrong dose/strength, 118 (46.6%), male, 123 (48.6%), and female, 130 (51.4%). The mean age and S.D. of patients was 1.94 ± 0.88 years and the demographic nationality as 1.16 ± 0.37. The one-sample t-test value for the main categories was −235 (p-value < 0.001). ConclusionNear-misses are recognised as essential targets for continuous quality improvement tools to mitigate preoperative incidents in hospitals. These findings can benefit the advancement of techniques for improving guidelines related to compliance and effective communication to improve the preoperative safety of patients.

S128: CONTINUOUS QUALITY IMPROVEMENT IN PAEDIATRIC SICKLE CELL DISEASE

Background: Sickle cell disease (SCD) is characterised by severe episodic pain requiring prompt and effective analgesia. However, SCD patients frequently experience poor quality of care due to lack of awareness of the condition among non- specialist staff, pre-conceived biases and unfounded allegation of drug-seeking behaviour. Several reports and surveys using Patient Reported Experience Measure (PREM) tools indicate widespread prevalence of ineffective pain relief in emergency department(ED), poor access to psychological therapies and poor funding for service development. Aims: To use a validated PREM tool to survey patients or carers of sickle cell disease within the paediatric service of a Specialist Haemoglobinopathy Team. To use an established Continuous Quality Improvement (CQI) methodology (5-D’s-define, describe, design, deliver, digest) to ensure sustained improvement in patient- reported areas of service deficit. Methods: The PREM survey was conducted as part of a network- wide initiative in 2018. The survey responses were analysed and problem scores created for specialist care, emergency care, ward-based care, information and support. These problem areas were categorised into domains where further improvement action was needed. CQI tools were used to map the patient journey within Emergency Department (ED) when presenting with pain followed by thematic analysis to identify potential improvements in the patient journey. Results: The PREM survey analysis identified three domains for improvement: Domain A: To improve the effectiveness of pain relief and quality of empathic and informed care to paediatric sickle cell patients and their families in ED. We developed multi-disciplinary teaching videos with patient involvement and patient information material based on ED/pain/sickle staff feedback. Excellent engagement from all staff groups obtained. Patient involvement in ED teaching video was well received. Thematic analysis of ED process mapping highlighted need for sustained staff education and re-writing ED pain protocol to align with current practice. Pre-conceived biases were identified among staff with respect to attributing drug-seeking behaviour to patients during severe sickle cell pain. Domain B: To improve the information presented to children regarding SCD and the care services available in our trust We developed child friendly Information leaflets targeting primary school age and secondary school age readers Domain C: To improve the availability of, and access to, mental health services for paediatric SCD patients. We developed virtual parent support groups and psychological health screening for adolescent patients in clinics. We organised a ‘Tree of Life’ (ToL) patient empowerment workshop. The parent support groups were well attended. Plans are in place to continue ToL workshops and support groups on a regular basis. Future work: A rapid improvement workshop is being planned to engage a wider multi-disciplinary team to engender a culture of empathy in line with our trust values. Further input from workshop is expected to identify and implement sustainable goals. We plan to undertake a repeat PREM survey following the end of this CQI project to understand the impact and the implemented improvements.

A scoping review to inform the use of continuous quality improvement in Australian Aboriginal oral health care

Objective The need to improve existing services to Aboriginal communities is prioritised by Australia's National Oral Health Plan. Although only an emerging area in dentistry, continuous quality improvement (CQI) approaches have positively impacted the delivery of primary health services to Aboriginal communities. This scoping review maps the applicability of CQI strategies to Aboriginal Australian oral healthcare services. Methods A scoping review was conducted and studies that reported using CQI approaches to improve existing oral health services or quality of care deemed relevant to Aboriginal Australian communities were included. Results A total of 73 articles were retrieved and eight articles were included in the final synthesis. Several CQI tools were identified, including: plan-do-study-act cycles, dental quality alliance measures, prioritisation matrices, causal mapping and the use of collective impact methodology. Conclusion Data exploring CQI in the context of Aboriginal oral health is scarce. The plan-do-study-act cycle and its variations show potential applicability to Aboriginal oral health care. However, for CQI approaches to be adequately implemented, the prevailing model of dental care requires a paradigm shift from quality assurance to quality improvement, acknowledging the impact of structural and process elements on care.

The quality continuum: perceptions of institutional accreditation

PurposeAcademics and administrators frequently lament the bureaucracy in higher education, which diverts attention from teaching and research. Heightened monitoring of institutions as a result of dominant neoliberal ideologies shapes perceptions of accreditation as a bureaucratic burden rather than a value-added tool for continuous quality improvement. This paper aims to identify factors that positively and negatively impact a culture of quality in North American accredited postsecondary institutions to address issues of equity and inform policy changes that are relevant to community needs.Design/methodology/approachAcademics’ and administrators’ perceptions of accreditation processes are explored through an interpretivist mixed-methods study that combined focus group and survey results from over 200 participants representative of four-year private and four- and two-year public institutions and tribal colleges in North America.FindingsFindings suggest that a utilitarian and exclusionary mindset perpetuated by neoliberal logics restricts participatory decision-making processes in postsecondary institutions. Furthermore, the research identified a noticeable gap between those who are invited to participate in accreditation processes and those who contribute to decision-making. This lack of inclusive governance inhibits the ability of institutions to respond appropriately to the needs of its community.Originality/valueThe scope of the study and prioritization of qualitative data offers a comprehensive picture of academics’ and administrators’ perceptions and positions them as the experts in their own learning and development. Through participant narratives, strategies for increasing the value of quality assurance processes are illuminated. As a result, the study participants become the change agents who provide the solutions for ameliorating academics’ and administrators’ resistance to quality assurance.

The Continuous Learning Cycle: A Multi-phase Post-occupancy Evaluation (POE) of Decentralized Nursing Unit Design.

This study aims to demonstrate how multiphase postoccupancy evaluation (POE) research was integrated into multiple projects to develop a continuous learning cycle. Despite the well-recognized importance of POE, few studies have reported how knowledge from POE is applied in new designs. This study is developed as a multiphase POE that spanned 3 years and across three units. Phase I POE compared an existing unit (Unit A) in Hospital A and a new Unit B in Hospital B that has implemented innovative design features such as decentralized nurse stations. The idea was to understand the challenges of the existing facility in Hospital A and gather lessons learned from the new design in Unit B to inform the design of the Hospital A expansion (Unit C). After the new expansion was occupied, the Phase II POE was conducted using the same set of POE tools in both Unit C and Unit A. The POE applied the following methods: (1) patient room evaluations using the Center for Health Design standardized POE tools, (2) space syntax analysis of visibility, and (3) a pre- and postmove analysis of Press Ganey data. The results demonstrated that by incorporating lessons learned from the Phase I POE, Unit C has further improvement on patient room design ratings, improved patient satisfaction, and better visibility among nurse work areas compared to Unit A and Unit B. The multiphase, multisite POE with standardized tools has demonstrated its value as an important tool for continuous design quality improvement.

Quality Indicators for Avalanche Victim Management and Rescue.

Decisions in the management and rescue of avalanche victims are complex and must be made in difficult, sometimes dangerous, environments. Our goal was to identify indicators for quality measurement in the management and rescue of avalanche victims. The International Commission for Mountain Emergency Medicine (ICAR MedCom) convened a group of internal and external experts. We used brainstorming and a five-round modified nominal group technique to identify the most relevant quality indicators (QIs) according to the National Quality Forum Measure Evaluation Criteria. Using a consensus process, we identified a set of 23 QIs to measure the quality of the management and rescue of avalanche victims. These QIs may be a valuable tool for continuous quality improvement. They allow objective feedback to rescuers regarding clinical performance and identify areas that should be the foci of further quality improvement efforts in avalanche rescue.

Achieving Continuous Improvement in CSSD Management through Performance Measurements using User Satisfaction Surveys and Interventions.

The objective of the study was to achieve continuous improvement in Central Sterile Supply Department (CSSD) management through performance measurements using user satisfaction surveys and interventions. A brainstorming session was conducted with the multidisciplinary process improvement team in 2012 on the reasons for dissatisfaction with CSSD services. A baseline survey questionnaire was prepared to assess levels of dissatisfaction for key indicators and to establish target benchmarks for improvement. Charge nurses in the wards were chosen as respondents. The report was presented by the Quality Management Cell (QMC) to the steering committee in the presence of the CSSD managers. Solutions and support were offered to the team for improvement. Similar surveys were conducted in 2014, 2016, 2017, 2018, and 2019 to understand the impact of the changes implemented. The overall satisfaction of the respondents with the CSSD services increased from 54% in 2012 to 89% in 2019, which is statistically significant (95% Cl: -0.56 to -0.25) with p-value < 0.001. This exercise helped to build a strong team and create a culture of openness in the CSSD. Improvement measures were data driven and other departments like Radiology and Laundry were motivated to embrace the idea of understanding their user perceptions. This study demonstrates the effectiveness of internal user satisfaction surveys as a valuable tool for continuous quality improvement. This exercise proved beyond doubt that regular monitoring improves quality of services.

The impact of continuous quality improvement on coverage of antenatal HIV care tests in rural South Africa: Results of a stepped-wedge cluster-randomised controlled implementation trial.

Evidence for the effectiveness of continuous quality improvement (CQI) in resource-poor settings is very limited. We aimed to establish the effects of CQI on quality of antenatal HIV care in primary care clinics in rural South Africa. We conducted a stepped-wedge cluster-randomised controlled trial (RCT) comparing CQI to usual standard of antenatal care (ANC) in 7 nurse-led, public-sector primary care clinics-combined into 6 clusters-over 8 steps and 19 months. Clusters randomly switched from comparator to intervention on pre-specified dates until all had rolled over to the CQI intervention. Investigators and clusters were blinded to randomisation until 2 weeks prior to each step. The intervention was delivered by trained CQI mentors and included standard CQI tools (process maps, fishbone diagrams, run charts, Plan-Do-Study-Act [PDSA] cycles, and action learning sessions). CQI mentors worked with health workers, including nurses and HIV lay counsellors. The mentors used the standard CQI tools flexibly, tailored to local clinic needs. Health workers were the direct recipients of the intervention, whereas the ultimate beneficiaries were pregnant women attending ANC. Our 2 registered primary endpoints were viral load (VL) monitoring (which is critical for elimination of mother-to-child transmission of HIV [eMTCT] and the health of pregnant women living with HIV) and repeat HIV testing (which is necessary to identify and treat women who seroconvert during pregnancy). All pregnant women who attended their first antenatal visit at one of the 7 study clinics and were ≥18 years old at delivery were eligible for endpoint assessment. We performed intention-to-treat (ITT) analyses using modified Poisson generalised linear mixed effects models. We estimated effect sizes with time-step fixed effects and clinic random effects (Model 1). In separate models, we added a nested random clinic-time step interaction term (Model 2) or individual random effects (Model 3). Between 15 July 2015 and 30 January 2017, 2,160 participants with 13,212 ANC visits (intervention n = 6,877, control n = 6,335) were eligible for ITT analysis. No adverse events were reported. Median age at first booking was 25 years (interquartile range [IQR] 21 to 30), and median parity was 1 (IQR 0 to 2). HIV prevalence was 47% (95% CI 42% to 53%). In Model 1, CQI significantly increased VL monitoring (relative risk [RR] 1.38, 95% CI 1.21 to 1.57, p < 0.001) but did not improve repeat HIV testing (RR 1.00, 95% CI 0.88 to 1.13, p = 0.958). These results remained essentially the same in both Model 2 and Model 3. Limitations of our study include that we did not establish impact beyond the duration of the relatively short study period of 19 months, and that transition steps may have been too short to achieve the full potential impact of the CQI intervention. We found that CQI can be effective at increasing quality of primary care in rural Africa. Policy makers should consider CQI as a routine intervention to boost quality of primary care in rural African communities. Implementation research should accompany future CQI use to elucidate mechanisms of action and to identify factors supporting long-term success. This trial is registered at ClinicalTrials.gov under registration number NCT02626351.

Evolution of the performance of Latin America Reference Laboratories in the detection of mechanisms of antimicrobial resistanceEvolução do desempenho dos Laboratórios de Referência na América Latina na detecção de mecanismos de resistência antimicrobiana

RESUMENObjetivo.El objetivo es presentar los resultados del Programa Latinoamericano de Aseguramiento de la Calidad en Bacteriología y Resistencia a los Antimicrobianos (LA-EQAS) entre 2000 y 2018 y la evolución en la detección de mecanismos de resistencia de impacto clínico.Métodos.Los Laboratorios Nacionales de Referencia (LNR) participantes recibieron 25 encuestas con 10 cepas cada una, representando un total de 86 especies bacterianas y 40 mecanismos de resistencia. Para evaluar el desempeño de los LNR, se analizaron cinco indicadores: identificación bacteriana, interpretación de las pruebas de sensibilidad, rangos de las zonas de inhibición aceptables, mecanismo de resistencia inferido, y tiempo de demora en la respuesta.Resultados.La concordancia media fue 82,6% (rango: 74-95%) en la identificación bacteriana, 93,3% (85-98%) en la interpretación de las pruebas de sensibilidad, 84,6% (70-94%) en las zonas de inhibición, 82,5% (73-96%) en el mecanismo de resistencia inferido, y la demora en la respuesta, 34 días. Se observó una mejora en la detección de mecanismos de relevancia clínica como resistencia a meticilina, macrólidos y glucopéptidos en cocos gram positivos, y betalactamasas de espectro extendido, AmpC plasmídico y carbapenemasas en bacilos gram negativos.Conclusiones.El LA-EQAS es una excelente herramienta para la mejora continua de la calidad en el diagnóstico de las infecciones por microorganismos multirresistentes en los LNR de América Latina.

Case-mix adjusted postanaesthesia care unit length of stay and business intelligence dashboards for feedback to anaesthetists

BackgroundDespite advances in business intelligence software and evidence that feedback to doctors can improve outcomes, objective feedback regarding patient outcomes for individual anaesthetists is hampered by lack of useful benchmarks. We aimed to address this issue by producing case-mix and risk-adjusted postanaesthesia care unit (PACU) length of stay (LOS) benchmarks for integration into modern reporting tools. MethodsWe extended existing hospital information systems to calculate predicted PACU LOS using a neural network trained on patient age, surgery duration, sex, operating specialty, urgency, weekday, and insurance status (n=100 511). We then calculated the difference between observed mean and predicted PACU LOS for individual doctors, and compared the results with and without case-mix adjustment. We report practical implications of using visual analytics dashboards displaying the difference between observed and predicted PACU LOS to provide feedback to anaesthetic doctors. ResultsThe neural network accounted for over half of observed variation in individual doctors' mean PACU LOS (mean predicted and mean actual LOS Spearman's r2=0.57). Account for case-mix reduced apparent spread, with 80% of individual doctors falling in a band of 4.3 min after case-mix adjusting, compared with a range of 24 min without adjustment. Case-mix adjusting also identified different individual doctors as outliers (Weighted Cohen's kappa [κ]=0.27). Finally, we demonstrated that we were able to integrate the adjusted metrics into routine reporting tools. ConclusionWith caution, case-mix adjustment of anaesthetic outcome measures such as PACU LOS potentially provides a useful continuous quality improvement tool. Unadjusted outcome measures are imprecise at best and misleading at worst.

MATLAB-based project assessment in process modelling unit: A case study from Swinburne University of Technology Sarawak Campus

MATLAB has become one of the most widely used mathematical simulation software for process modelling and simulation globally. Integrating MATLAB learning into third year undergraduate Process Modelling unit nonetheless can be quite challenging given the students’ lack of prior programming knowledge and skills. Following a “Constructive Alignment” concept, a group-based MATLAB Project assessment has been developed here that shifts the focus from ‘what the teacher does’ to ‘what the students do’ to encourage them actively and independently learn MATLAB as they do the project. The students’ learning achievements in the Project are assessed through their group reports and presentations. Detailed marking rubrics are introduced for the reports evaluation while the individual group members’ learning achievements can be differentiated during the presentations.The observed trend and comments in the 2017–2019 student feedback surveys on the unit indicate that the implementation of the MATLAB Project has enhanced the students’ learning of the mathematical modelling principles and theories and that the self-directed or discovery learning methods adopted in this Project has encouraged them to discover process modelling for themselves via experimentation and exploration – relative to before the Project was introduced. This work also demonstrates the potential to use the students’ unit learning outcome (ULO) attainment data as a tool for continuous quality improvement, i.e., to determine what aspects should be modified or improved in the next year unit delivery to address the changes observed in the current year ULO attainment with respect to the previous years’ ULOs attainments.

Measuring the continuous quality improvement orientation of medical education programs.

There is a growing interest in applying continuous quality improvement (CQI) methodologies and tools to medical education contexts. One such tool, the "Are We Making Progress" questionnaire from the Malcolm Baldrige National Quality Award framework, adequately captures the dimensions critical for performance excellence and allows organizations to assess their performance and identify areas for improvement. Its results have been widely validated in business, education, and health care and might be applicable in medical education contexts. The measurement properties of the questionnaire data were analyzed using Rasch modeling to determine if validity evidence, based on Messick's framework, supports the interpretation of results in medical education contexts. Rasch modeling was performed since the questionnaire uses Likert-type scales whose estimates might not be amenable to parametric statistical analyses. Leaders and teachers at 16 of the 17 Canadian medical schools were invited in 2015-2016 to complete the 40-item questionnaire. Data were analyzed using the ConQuest Rasch calibration program, rating scale model. 491 faculty members from 11 (69 percent) schools participated. A seven-dimensional, four-point response scale model better fit the data. Overall data fit to model requirements supported the use of person measures with parametric statistics. The structural, content, generalizability, and substantive validity evidence supported the interpretation of results in medical education contexts. For the first time, the Baldrige questionnaire results were validated in medical education contexts. Medical education leaders are encouraged to serially use this questionnaire to measure progress on their school's CQI focus.

Syphilis testing performance in Aboriginal primary health care: exploring impact of continuous quality improvement over time.

Data from 110 primary healthcare clinics participating in two or more continuous quality improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic's STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.

Using Continuous Quality Improvement Tools to Promote Tobacco Cessation Among Primary Caregivers in a Home Visiting Program in Alabama.

Alabama's Maternal, Infant, and Early Childhood Home Visiting-funded program was one of 10 state teams accepted to participate in the first wave of the Federal Home Visiting Program State and Territory Continuous Quality Improvement Practicum. This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners. The Alabama team tracked CQI data weekly for the duration of the practicum using an annotated run chart. Participants included 20 identified tobacco users in 2 participating LIAs. This article highlights specific CQI tools to achieve the project aim. On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim; these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Moving beyond hand hygiene monitoring as a marker of infection prevention performance: Development of a tailored infection control continuous quality improvement tool

Infection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool. The Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery. Barriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace. The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system. Hand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.

How Faculty Recognized for Teaching Excellence Interpret and Respond to Student Ratings of Teaching

Objective. To determine how experienced pharmacy educators who have been recognized for teaching excellence interpret and respond to end-of-course student ratings of their teaching. Methods. An expert sampling technique was used to identify pharmacy faculty members who had been recognized by the American Association of Colleges of Pharmacy (AACP) for teaching excellence as potential participants in the study. Sixteen of these faculty members were independently identified by two or more of the researchers as trusted candidates for the study, and 10 of these were randomly selected and invited to be interviewed via a web-conferencing platform. The interviews were transcribed and thematic analysis was used to identify overall themes. Results. Nine pharmacy faculty members representing both practice-based (n=5) and non-practice (n=4) backgrounds participated in the interviews. The three primary themes that emerged from the interviews regarding approach to interpreting student evaluations of instruction were "Use to improve," "Trends," and "Value input." The four primary themes that emerged regarding advice for new instructors were "Use to improve," "Reflect," "Do not take personally," and "Themes." Conclusion. The faculty participants recognized for teaching excellence were consistent in their attitudes of valuing student feedback and using it as a tool for continuous quality improvement. While recognizing the limitations of student ratings of teaching, the participants used them as part of a reflective and holistic approach to teaching. These teaching experts provided valuable insight for new instructors, such as do not compromise instruction and do not take student ratings personally.

Qualitative perspectives on the sustainability of sexual health continuous quality improvement in clinics serving remote Aboriginal communities in Australia

ObjectivesTo examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia.DesignQualitative study.SettingPrimary health care services serving remote Aboriginal...

Kaizen a Tool for Continuous Quality Improvement in Indian Manufacturing Organization

Kaizen is a practice of continuous improvements in manufacturing, assembly, quality and engineering. In this paper author have discussed the problems faced by a leading automobile manufacturing organization on quality of interior parts of the automobile like plastics and rubber. During study author used a new technique called “Global Customer Audit” which is basically a vehicle audit from final customer point of view for interior parts of automobiles. During this audit, author has observed various defects and by using different quality control tools like pareto charts, histograms, check sheets and arranged defects according to their intensity or magnitude of occurrence i.e. finding useful one from trivial many. In this paper, the author found the root cause of defects by using different quality control tools. Kaizen is done to remove these defects and continuously improve products and production processes. Kaizen helps in making manufacturing process leaner, simple and fitter. The main purpose of this paper is to discuss the concept of Kaizen, its application in case organization for solving problems raising big quality concerns on a day to day bases.