This study examined a first grade, general education teacher's changing practices related to reading intervention for struggling readers as she worked with a group of university researchers to develop and implement a first grade reading instruction model. This study also investigated the following research questions: What changes in a first grade, general education teacher’s reading instructional practices occurred because of a year long university-teacher collaborative relationship in implementing evidence-based reading instruction for struggling students? What were the facilitators and barriers for implementing evidence-based reading practices for struggling readers? Analyses of classroom observations, teacher interviews, intervention validity checklists (IVC's), observations, support team meeting notes, research team meeting notes, field notes, and other forms of documentation provided a view into the process of change of one teacher. / text

A segurança do paciente tem sido considerada uma prioridade para a qualidade da assistência em saúde no mundo inteiro. Considerando que o paciente está continuamente exposto a riscos, eventos adversos e danos, as Infecções Relacionadas à Assistência à Saúde (IRAS) ganham destaque, seja pela sua incidência ou pelos danos que podem provocar. Dentre eles, a Pneumonia Associada à Ventilação Mecânica (PAV) acomete pacientes em Unidades de Terapia Intensiva (UTI) e causa inúmeros prejuízos ao paciente e às instituições. Este estudo teve como objetivo elaborar e implementar um protocolo de prevenção de PAV em uma UTI de um hospital do interior do Estado de Minas Gerais. Trata-se de uma pesquisa de intervenção em enfermagem, na qual foi utilizado o Modelo de Melhoria e o Ciclo PDSA, sendo realizado em quatro etapas: Etapa 1 - Coleta de informações e planejamento de ações (Plan); Etapa 2 - Desenho e implementação das intervenções (Do); Etapa 3: Análise dos resultados (Study); Etapa 4: Análise final dos resultados e proposição de ações corretivas (Act). Os resultados mostraram que as discussões com os enfermeiros possibilitaram a identificação de fatores associados à ocorrência de PAV na unidade e, posteriormente, a implementação das seguintes ações: realização de higiene oral com clorexidina, interrupção diária da sedação do paciente, posicionamento adequado do circuito de ventilação mecânica, elevação da cabeceira da cama em 30-45°, realização de tratamento profilático de tromboembolismo e a profilaxia de úlcera péptica, além de melhorar a higiene das mãos na unidade. A adesão dos profissionais quanto à realização destas ações aumentou após a terceira avaliação e foi verificada melhor comunicação entre as equipes de saúde após a implementação do protocolo. Conclui-se que os dados obtidos no presente estudo apontaram que o ciclo de melhoria realizado foi válido para promover a elaboração e a implementação de medidas de prevenção de PAV na UTI. Considera-se essencial, entretanto, a sistematização das avaliações na instituição por meio da adoção contínua de ciclos de melhoria, promovendo mudanças na cultura da organização e nas práticas de saúde e melhorando a qualidade do cuidado prestado ao paciente. / Patient safety has been considered a priority for the quality of health care worldwide. Considering that the patient is continually exposed to risks, adverse events and damages, Health Care-related Infections gain prominence, either because of their incidence or the damage they can cause. Among them, Ventilator-Associated Pneumonia (VAP) affects patients in Intensive Care Units (ICU) and causes numerous damages to patients and institutions. The purpose of this study was to elaborate and implement a protocol for the prevention of VAP in an ICU of a hospital in the interior of the State of Minas Gerais. It is a nursing intervention research, in which the Improvement Model and the PDSA Cycle were used, being carried out in four stages: Step 1 -Data collection and planning of actions (Plan); Step 2 - Design and implementation of interventions (Do); Step 3: Analysis of results; Step 4: Final analysis of results and proposition of corrective actions (Act). The results showed that the discussions with the nurses enabled the identification of factors associated with the occurrence of VAP in the ICU and, later, the implementation of the following actions: oral hygiene with chlorhexidine, daily interruption of patient sedation, adequate positioning of the circuit mechanical ventilation, elevation of the the bed by 30-45 °, prophylactic treatment of thromboembolism and prophylaxis of peptic ulcer, in addition to improving hand hygiene in the unit. The adherence of the professionals regarding the accomplishment of these actions increased after the third evaluation and it was verified a better communication between the health teams after the implementation of the protocol. It is concluded that the data obtained in the present study pointed out that the improvement cycle was valid to promote the elaboration and implementation of measures to prevent VAP in the ICU. It is considered essential, however, to systematize evaluations in the institution through the continuous adoption of improvement cycles, promoting changes in the organization\'s culture and health practices and improving the quality of care provided to the patient.

This final column of the series is focused on how school and district teams can continue the forward motion toward positive student outcomes using data via continuous improvement cycles. We draw on the work of technical assistance providers and researchers from the National Implementation Research Network (NIRN; https://nirn.fpg.unc.edu) and the Center on Positive Behavioral Interventions and Supports (PBIS; https://www.pbis.org/). The key takeaway of this series is to describe how implementation of EBPs in schools can be enhanced when implementation teams “invest in the systems to support their implementation” (Kittelman et al., 2020, p. 96).

Personcentrerad omsorg är en del av värdegrunden inom svensk äldreomsorg och har visat sig ha positiva effekter på de boendes välbefinnande och bibehållandet av förmågor. Syftet med förbättringsarbetet: Med stöd av förbättringsmetoder erbjuda de boende en mer personcentrerad omvårdnad genom ett systematiskt och kontinuerligt arbete med individuellt anpassade sociala aktiviteter och reminiscens. Syftet med studien av förbättringsarbetet var att beskriva omsorgspersonalens upplevelser av lärande och förbättringar både i sin arbetssituation och för de boende. Förbättringsarbetets metod mätningar och förbättringsverktyg. Förbättringsidén utgörs av tydliga rutiner för arbetsdagen och för morgonmötet, där individuellt anpassade aktiviteter skall vara inplanerade och genomföras minst en (1) ggr/vecka för varje boende. Studiens metod: Kvalitativ innehållsanalys av skriftliga svar på öppna frågor. Resultat: Vid mätperiodens slut syns en tydlig uppåtgående trend. Dock hade inte ett stabilt resultat med 1 aktivitet/vecka och boende uppnåtts. Alla avdelningar hade nya rutiner för dagen på plats samt en struktur för dagsplaneringen. Det mätinstrument som utvecklats under arbetet används systematiskt som både mät- och planeringsverktyg. Som en del i arbetet har bland annant Reminiscenslådor och Aktivitetsskåp utvecklats på boendet. Studien visade tydliga förbättringar i de boendes välbefinnande. De uppfattas som lugnare, mindre stressade och de uttrycker mindre ensamhet och oro. Omvårdnadspersonalen beskriver också tydliga förbättringar i sin arbetsmiljö, de känner sig mer tillfredsställda då de kan arbeta mer personcentrerat och de upplever bättre teamarbete och mer ordning och reda och struktur med de nya rutinerna på plats. Slutsats: Systematiskt arbete med rutiner kan frigöra tid till att arbeta mer personcentrerat och med att individanpassa de sociala aktiviteter som erbjuds de boende. Tydliga mandat, stöd från ledning samt tydlig coaching av medarbetarna är avgörande faktorer för att lyckas med förändringsarbetet. / Introduction: A quality improvement project was started to provide person-centered care through personalized social activities. The specific aim was to systematically offer residients person-centered care through personalized social activities minimum once a week. The aim of the study was to describe staff's views on learning and improvements both for the residents an in their work situation. Method: The improvement model was used throughout the improvement project. A tool to measure the number of activities in a simple and illustrative way was developed. The case study was conducted through open questions that the staff answered in writing. The material was then analyzed using qualitative content analysis. Results: The results have been going up consistently throughout the whole measuring period. All three sections at the nursing home have implemented new routines and structure for planning the day. The instrument to measure the number of social activities called "Blomman" is now also functioning as a planning tool. Boxes for Reminiscence and lockers with items and various tools for social activities have been installed. The quality improvement gave improvements in the wellbeing of the residents. The staff describes residents as calmer, less stressed and that they express less loneliness. The staff also desbride that they have gotten to know the residents better. The results also show that staff is more satisfied by providingt person-centered care. They work better as a team and have more order and structure and results show a general improvement in the work environment. Conclusion: Implementing routines and structure for planning can be a way of getting more time for the staff to provide more person-centered care. This can be done by individualizing social activities so that they correspond to the residents' needs and interests. To be successful it is essential to have support from the management for a project like this and to be able to support the staff throughout the change process.

The globalized world has increased people’s awareness, which has resulted in a higher demand for better quality as well as shorter led times, without increasing the selling price. The fact that companies are actively working with streamlining processes of the existing business can therefore be seen as crucial for its future existence. In this study, a decision support model for the initial part of streamlining projects for warehouses has been developed. The model is based on key theories and methods of efficiency and warehouse layouts. This constitutes the theoretical foundation, for which the six areas of the model were designed. The model is based on a process- and rating structure, in which the six areas were broken down to 12 matrices and 1 summary. In each matrix, the solution methods are rated based on their individual properties against crucial parameters. As support for the model, complementary questions for each area have been developed, to give the user good opportunities to gather necessary information and data. By answering the questions and studying the matrices, the user has a good foundation to select the alternatives that fits the company’s needs. By doing this, the user will be able in a timely manner to identify the most relevant opportunities, and thus also discard those who do not possess the requested features or properties. This study has resulted in a model whose strength lies in its ability to allow companies, at an earlier stage, to allocate resources to the solutions that are relevant and therefore should be examined more closely. This based on the company's situation, goals and needs.

La industria de plásticos se encuentra en un crecimiento progresivo a comparación de otros sectores, ya que la gran mayoría de las empresas tienen procesos automatizados. Es por esto que las empresas del sector se vuelven más competitivas cada día. Esta investigación se realiza en una empresa peruana en la que se detecta como problema principal la alta tasa de productos defectuosos, que impacta a su vez negativamente en un 4.37% del costo fabricación. Por ello y en base a diversos estudios sobre la implementación de herramientas y metodologías de solución y mejora, se propone la implementación de un modelo basado en la filosofía Lean Manufacturing con el método Taguchi para la reducción de estos, obteniendo como resultado un decremento del 60.41% en la tasa de defectos. Si bien el objetivo del proyecto es posicionar la empresa dentro del porcentaje estándar, se logra estar por debajo de este. / The plastics industry is in progressive growth compared to other sectors since the vast majority of companies have automated processes. This is why the companies in the sector become more competitive every day. This investigation is carried out in a Peruvian company in which the high rate of defective products is detected as the main problem, which in turn negatively impacts 4.37% of the manufacturing cost. For this reason and based on various studies on the implementation of tools and methodologies for solution and improvement, the implementation of a model based on the Lean Manufacturing philosophy with the Taguchi method is proposed to reduce these, resulting in a decrease of 60.41 % in defect rate. Although the objective of the project is to position the company within the standard percentage, it is possible to be below this. / Trabajo de investigación

Testförbättringsmodeller har utvecklats och blivit fler sedan 90-talet. Dessa modeller strävar efter att ge team och organisationer struktur inom testarbete. TMM, som är en av de äldsta testförbättingsmodellerna, togs fram i början av 90-talet och har sedan gett inspiration till flera testförbättringsmodeller med mognadsnivåer. Två av dem är TMMi och TIM. Modellerna, som båda ursprungligen är bearbetningar av TMM, har olika strukturer när det kommer till hur olika delar av testfunktionen förbättras. I en fallstudie har TMMi och TIM jämförts mot varandra för att få fram skillnaderna i modellerna samt rekommendationer hos ett team som arbetar med flera konsultuppdrag. TIM utvärderas även om hur aktuell den är i ett agilt konsultföretag.Enkät och intervju användes för att samla in data och modellerna användes för att generera rekommendationer till teamet.Det framkommer att TIM kan appliceras på en agil konsultverksamhet, främst för att TIM lägger fram vad som ska göras och det agila arbetssättet lägger fram hur det ska göras.Den främsta skillnaden som upptäcktes mellan TIM och TMMi ligger i deras struktur gällande mognadsnivåer. TIM uppmuntrar till en balanserad förbättring genom individuell bedömning av testprocessområden (KPA), så att det studerade teamet har en bättre förståelse för vilka av de som främst behöver förbättras, till skillnad från TMMi som är striktare vid sin bedömning.TIM i förhållande till TMMi har rekommendationer som riktar sig till enskilda testare på en lägre mognadsnivå, vilket påverkar graden av självständighet för testning. TMMi:s rekommendationer betonar att röktester bör utföras av teamet i större utsträckning än vad som sker för tillfället. / Test improvement models have evolved and become more common since the 1990s. These models strive to give teams and organizations structure in their testing work. TMM, one of the oldest models, was developed in the early 90's and has since provided inspiration for several test improvement models with maturity levels thereafter. Two of them are TMMi and TIM. Both models, which are further worked on from TMM originally, have two different structures when it comes to how different parts of the test function are improved. In a case study, TMMi and TIM have been compared against each other to identify the differences in the models and recommendations from a team working on several consulting assignments. TIM is also evaluated on how current it is in an agile consulting company. The questionnaire and interview were used to collect data and the models were used to generate recommendations for the team. It appears that TIM can be applied to an agile consulting business, mainly because TIM focuses on what to do and the agile methodology focuses on how to do it. The main difference found between TIM and TMMi lies in their structure regarding maturity levels. TIM encourages balanced improvement through separate assessment of key process areas (KPA), so that the studied team has a better understanding of which of them needs to be improved primarily, unlike TMMi, which is stricter in its assessment. TIM in relation to TMMi has recommendations aimed at individual testers at a lower maturity level, which affects the degree of independence for testing. TMMi's recommendations emphasize that smoke tests should be performed by the team to a greater extent than is currently happening.

Studies have shown that it is necessary for manufacturing industries, in order to stay competitive and increase the profitability, to work with optimizations and continuous improvements of processes. Existing models and philosophies aiming for this, such as PDCA (Plan Do Check Act), IDEA (Investigate Design Execute Adjust), DMAIC (Define Measure Analyze Improve Control), and Lean Production, are either ambiguous or only focusing on one specific area or field. Due to this it is not suitable to apply these singly at a cutting station because root causes to problems can derive from many different factors. The purpose of this thesis has been to develop a model, with the advantage of having a clear and structured approach, and still considering all affecting factors of the cutting station. This leads to a better chance of finding the actual root causes, consequently maximizing the profits gained from the improvement solutions suggested. The model has been applied and tested on a case company and it has been proven to be suitable to use when optimizing a cutting station. Eight alternatives for possible improvements were found, where five of these were estimated to generate more than 800 000 SEK in cost savings each year. For the other three there were no estimations done due to the large extent of the suggestions, but it is believed that these will have an even larger impact on the profitability than the other alternatives. The results found will provide a solid foundation for the company in order to achieve the best possible outcome, when completing the rest of the model. The model has been developed for cutting stations but with small modifications it can be applied on any other production station in a plant. / Studier har visat att det är nödvändigt för tillverkande industrier, för att kunna bibehålla en hög konkurrenskraft och en ökad vinst, att arbeta med optimeringar och ständiga förbättringar av processer. Existerande modeller och filosofier som har detta som mål, såsom PDCA (Plan Do Check Act), IDEA (Investigate Design Execute Adjust), DMAIC (Define Measure Analyze Improve Control), och Lean Production, kan vara otydliga eller fokuserar endast på ett specifikt område eller fält. På grund av detta är det inte passande att applicera dessa individuellt på en skärande bearbetningsstation, då felorsaker kan härstamma från många olika faktorer. Syftet i detta examensarbete har varit att utveckla en modell som har fördelen att ha ett tydligt och strukturerat tillvägagångssätt, men fortfarande ta hänsyn till alla påverkande faktorer i den skärande bearbetningsstationen. Detta medför en större chans till att hitta den verkliga felorsaken, därmed också maximera den tjänade vinsten från förbättringslösningarna som föreslagits. Modellen har blivit applicerad och testad på ett fallföretag samt blivit bevisad att vara passande att använda vid optimeringar av skärande bearbetningsstationer. Åtta alternativ för möjliga förbättringar har hittats, varav fem av dessa var estimerade att generera mer än 800 000 kr i kostnadsbesparingar varje år. På de andra tre alternativen var inga estimeringar utförda på grund av storleken på förslagen, men dessa tros ha en ännu större inverkan på vinsten jämfört med de andra alternativen. Dessa resultat tillhandahåller företaget med en solid grund att stå på, för att kunna uppnå bästa möjliga utfall när resten av modellen slutförs. Modellen har utvecklats för skärande bearbetningsstationer men kan, med mindre modifikationer, även appliceras på vilken produktionsstation som helst på en fabrik.

Patienter som vårdats på en intensivvårdsavdelning (IVA) och tillfrisknat efter kritisk sjukdom löper stor risk för komplikationer efter att de flyttats till annan vårdavdelning för fortsatt vård. Oförutsedda komplikationer kan ibland leda det till att patienten återinläggs på IVA. Tidig identifiering och nära samarbete mellan IVA och vårdavdelning kring vanliga komplikationer skulle kunna förbättra förutsättningar för effektiv rehabilitering för den enskilda patienten.   Syftet med förbättringsarbetet var att underlätta patientens rehabilitering genom att tillgodose dennes behov av information och specifika rehabiliteringsinsatser som är vanliga efter intensivvård. återhämtning efter intensivvård samt minska risken för återinläggning.    Under förbättringsarbetet infördes ett screeningsinstrument för att tidigt kunna fånga patientens behov av stöd. Förbättringsarbetet utgick från Nolans förbättringsmodell. Resultatet av förbättringsarbetet visar på att det finns behov av tidigare uppföljning av intensivvårdspatienten för att förbättra och stötta patienten i sin återhämtning. Screeningsinstrumentet bidrog till att de patienter som är i behov av stöd fångades upp.    Kunskap om utmaningar och framgångsfaktorer under förbättringsarbete kan bidra till en större förståelse för förbättringskunskapens betydelse vid utveckling av vården. Syftet med studien var att belysa intensivvårdspersonalens erfarenheter av förbättringsarbete inom post-intensivvård.   En kvalitativ studie genomfördes med två fokusgruppsintervjuer bestående av vårdpersonal från en IVA-avdelning. Under intervjuerna fångades vårdpersonalens upplevelse av förbättringsarbete. De transkriberade intervjuerna analyserades med en kvalitativ innehållsanalys. I resultatet av studien framkom både utmaningar och framgångsfaktorer i tre kategorier: ”Skapa mening och förståelse för nytt arbetssätt”, ”Proaktivt arbete med patientfokus” samt ”Förändringströtthet och brist på tid”.   Tidigare uppföljning är en viktig del i patientens återhämtning efter IVA-vård för att förebygga senkomplikationer. Studien visar att tydlig information kring interventioner bidrar till ökad förståelse för förändringsprocessen och skapar drivkraft i förbättringsarbetet. / Patients who recovers from severe illness entails an increased risk of complications when being transferred from intensive care unit (ICU) to ward. Unforeseen complications can sometimes lead to ICU re-admissions. Early identification of common complications and close collaboration between ICU and ward can improve the chances of a successful recovery for the patient.   The purpose of the improvement work was to facilitate the patient's recovery after intensive care and to reduce the risk of readmission. rehabilitation by meeting his or her need for information and specific rehabilitation interventions that are common after intensive care.   During the improvement work, a screening instrument predicting high risk-individuals was introduced to capture the patient's need for support at an early stage. The improvement work was based on Nolan's improvement model. The results of the improvement work showed that there is a need for earlier follow-up of the ICU-patient to improve and support patients in their recovery. The screening instrument helped to catch the patients in need of support.   Knowledge of challenges and success factors during improvement work can contribute to a greater understanding of the importance of improvement knowledge in the developement of care. The purpose of the study was to illuminate intensive care staff's experiences of improvement work in post-intensive care.   A qualitative study was conducted with two focus group interviews consisting of care staff from an ICU department. During the interviews, the care staff's experience of improvement work was captured. The transcribed interviews were analyzed with a qualitative content analysis. Focus group interviews with staff resulted in three categories: "Creat meaning and understanding for a new way of working", "Proactive work with a patient focus" and "Change fatigue and lack of time".  Previous follow-up is an important part of the patient's recovery to detect late complications. The study result concludes that clear information according to interventions during improvement work contributes to increased understanding for the improvement process and creates motivation and drive in the improvement work.