While the amount of textual data available to us is constantly increasing, managing the texts by human effort is clearly inadequate for the volume and complexity of the information involved. Consequently, requirement for automated extraction of useful knowledge from huge amounts of textual data to assist human analysis is apparent. Text mining (TM) is mostly an automated technique that aims to discover knowledge from textual data. In this thesis, the notion of text mining, its techniques, applications are presented. In particular, the study provides the definition and overview of concepts in text categorization. This would include document representation models, weighting schemes, feature selection methods, feature extraction, performance measure and machine learning techniques. The thesis details the functionality of text mining as a quality improvement tool. It carries out an extensive survey of text mining applications within service sector and manufacturing industry. It presents two broad experimental studies tackling the potential use of text mining for the hotel industry (the comment card analysis), and in automobile manufacturer (miles per gallon analysis). Keywords: Text Mining, Text Categorization, Quality Improvement, Service Sector, Manufacturing Industry.

Today great efforts are made to record and reduce waiting times in cancer care. Long and variable turnaround times (TATs) delay the start of treatment and waiting contributes to mental anguish. The purposes of the QI intervention were to establish an effective and streamlined histopathology process with shorter TATs, to extend customer collaboration and to build knowledge of internal processes in order to lay the foundation for a learning environment. The goal was to raise the proportion of reported tissue samples from 50% to 90% within a 15 day period, ending 31th December 2014. The study of the QI intervention intended to identify factors that affect the introduction of novel working methods. Both quantitative and qualitative methods were used to achieve the goals. Improvement knowledge was combined with lean-inspired methods, and two focus groups were arranged in which data were analysed using qualitative content analysis. The goal to report 90% of tissue samples within 15 days was not achieved for all sample types, but improved TATs were clearly noted. Customer collaboration and visualisation of the processes had a positive effect on staff. The study resulted in six key factors important working with QI interventions; competence, compliance, feedback, interaction, patient- and customer focus and resources. Having motivated and dedicated staff is a key success factor for improvement work, in contrast to a lack of resources, and people that oppose change. To achieve future ambitious goals requires continuous improvement initiatives that involve optimisation of both human resources and equipment. / Stort fokus riktas idag på att kartlägga och reducera väntetider inom cancervården. För långa och variabla svarstider fördröjer behandlingsstart och väntan innebär dessutom psykiskt lidande. Syftet med förbättringsarbetet var att etablera en effektiv och stabil patologiprocess med kortare svarstider, utöka kundsamverkan samt bygga kunskap om interna processer för att lägga grunden till en lärandemiljö. Målet var att senast den 31 december 2014 höja andelen besvarade vävnadsprover från 50 % till 90 % inom 15 dagar. Studien av förbättringsarbetet syftade till att identifiera faktorer som påverkar införandet av nya arbetssätt. Såväl kvantitativa som kvalitativa metoder användes för att uppnå målen; förbättringskunskap kombinerades med lean-inspirerade metoder och två fokusgrupper där data analyserades med kvalitativ innehållsanalys. Målet att höja andelen vävnadsprover som besvarades inom 15 dagar på 90 % uppnåddes inte för samtliga provtyper, men tydligt förbättrade svarstider noterades. Kundsamverkan och visualisering av processerna hade en positiv effekt på personalen. Studien resulterade i sex viktiga faktorer; kompetens, inställning, återkoppling/feedback, interaktion, patient- och kundfokus och resurser. Motiverad och engagerad personal är nyckelframgångsfaktorer i förbättringsarbeten i motsats till resursbrist och människor som motsätter sig förändring. För att på sikt uppnå högt uppsatta mål krävs fortsatta förbättringsinitiativ som involverar optimering av både personalresurser och instrumentering.

Inledning En välsmakande och hygieniskt säker mat är viktig för patientens medicinska behandling och välbefinnande. Det ligger i sakens natur att man som patient ofta är svag eller nedsatt och därmed extra känslig för infektioner. Livsmedelshygien är på ett sjukhus en fråga om patientsäkerhet med temperaturen som den enskilt viktigaste faktorn. Brickdukning har som system för att distribuera maten inom ett sjukhus många fördelar men en nackdel är svårigheten att upprätthålla rätt temperatur. Mätningar på det studerade sjukhuset visade stora variationer och betydande avvikelser från tillåtna temperaturer, varför ett förbättringsprojekt genomfördes för att förbättra och stabilisera temperaturerna. Syfte Förbättringsarbetet studerades med syfte att beskriva de fenomen som den involverade personalen upplevt vara betydelsefulla för förbättringsarbetets resultat och hur patienternas upplevelse av maten förändrades under tiden för förbättringsarbetet. Syftet med förbättringsarbetet var att uppnå en stabil process med korrekta temperaturer. Metod Förbättringsarbetet genomfördes med PDSA-modellen som övergripande teori och metod. Studien utfördes som en deskriptiv fallstudie med induktiv ansats med deduktiva inslag. Fokusgruppsintervju och enkäter användes för datainsamling. Kvalitativ innehållsanalys och deskriptiv statistik användes som metoder vid analys. Resultat Förbättringsarbetet resulterade i betydande temperaturförbättringar, en stabil process med eftersträvade målvärden uppnåddes. Dock förändrades inriktning och mål för förbättringen under projekttiden, de ursprungliga målen uppnåddes ej till fullo. Förbättringarna minskade risken för matförgiftning bland patienterna. Studien visade att fenomen som i hög grad ligger inom mikrosystemets inflytande varit betydelsefulla. Dessa sammanfattades i fyra kategorier: Resursanvändning, Interaktion och kommunikation, Förändringsförmåga samt Delaktighet/engagemang. Slutsats Ett sjukhus med brickdukningssystem kan uppnå betydande förbättringar i mattemperaturen med hjälp av strukturerat förbättringsarbete. Förändringens resultat påverkades främst av fenomen som finns beskrivna i litteraturen sedan tidigare. Framtida studier kan med fördel kombinera induktiva, kvalitativa ansatser med deduktiva jämförelser med fenomen som finns beskrivna i litteraturen. / Introduction Tasty and hygienically safe food is essential to the treatment and comfort of the patient. Patients are commonly weak or impaired and more vulnerable to infections. Food hygiene is a matter of patient safety in hospitals where food temperature is the single most important factor. Meal tray as food distribution system in hospitals offers many advantages but one disadvantage is its ability to maintain proper temperature of the food. Measurements at the studied hospital display substantial variations and significant deviations from acceptable temperatures. Hence, an improvement project was completed in order to improve and stabilize temperatures. Purpose The improvement project was studied in order to describe what phenomena was important to the success for the improvement, according to staff involved and also how patients experience of the food. The aim of the improvement project was to achieve a stable process with proper food temperatures. Methods The quality improvement completed with the PDSA improvement model as overarching theory and method The study was conducted as a descriptive case study with an inductive approach and deductive ingredients. Focus group interview and questionnaires was used for data collection. Qualitative content analysis an descriptive statistics was used for analysis of data. Results The improvement project resulted in substantially temperature improvement, a stable process with desired temperatures was achieved. Yet the focus and the aims for the improvement were adjusted under the project period, the original aims were not achieved completely. The improved temperatures decreased the risk for patients getting infected with food poisoning. The study displayed phenomena that to a great extent are within the influence of the microsystem, as important for the success of the improvement. These where summarized in four categories: Utilization of resources, Interaction and communication, Improvement capability and Participation/involvement. Conclusions A hospital with meal tray distribution system can achieve substantial improvements in food temperature using structured improvement methods. The results of the changes were mainly affected by phenomena that already are described in the quality improvement litterature. Future studies may combine inductive, qualitative approaches with deductive comparisons to phenomena described in literature.

The level of increased central government that we have experienced during the last decades in school, for the purpose of increasing equality and to adapt the Swedish school to a certain international standard, clearly shows that increased control scarcely leads to improvement. The aim of this paper is to examine whether teachers believe that national tests contribute to equivalent assessment and increased goal attainment. Furthermore the teachers’ attitude towards and work with national tests is described. The paper is written from a school improvement perspective, where good examples from current research on what creates increased quality in school meaning increased goal attainment and equivalent assessment are related to research on school effectiveness and increased testing in schools. The study builds upon a quantitative survey among teachers in upper primary - and secondary school in a medium-sized municipality in Sweden. The result shows that the teachers have a somewhat more positive than negative attitude towards national tests, as a whole. The teachers use the tests in their instruction and they are a part of their planning. The advantages mentioned are the possibilities of showing off good examples, making the curriculum concrete, prepare the students for the test and get guidelines and support in assessment and grading. The teachers in the survey don’t consider the tests giving a full image of the abilities of a student nor do they consider the tests themselves relevant for the student’s learning. The result also shows a certain variation in the attitude of the teachers. Teachers, who have worked the longest period of time, more than 20 years, are those with the best attitude towards the test and their ability to contribute to increased goal attainment and equivalent assessment. Teachers who have worked the shortest period of time are the most skeptical to the positive effects of the tests. The teachers generally consider the tests contributing to equivalent assessment to some degree, but have the least positive stance toward the ability of the tests leading to improved quality meaning increased learning and goal attainment.

Background: Pelvic organ prolapse (POP) can be treated surgically or, more conservatively, with use of a pessary. Objective: To determine if the population of women treated for POP with the use of a pessary in one Nurse Practitioner's (NP) practice demonstrated health outcomes as better, same, or needing improvement through use of a data-based practice model from encounter data extracted from the electronic health record (EHR).Design: The project design was a quality improvement (QI) project, descriptive in nature. One Plan Do Study Act (PDSA) cycle was conducted for this QI project. Setting: NP managed specialty clinic in urban Southwestern Arizona that provides services to women with POP. Patients: Ten randomly selected women who had been treated conservatively for POP with use of a pessary were identified as two subpopulations and evaluated: women who received professional management of the pessary and women who were patient managed. Intervention: The intervention was the development of a data-based practice model, using patient profile data elements derived from the documented EHR encounters of the 10 women. Measurements: Twelve scales were developed to evaluate the patient profile data elements, generating numeric scores for each encounter. Two Decision Rules were then used to evaluate numeric scores by encounter, creating primary and secondary health outcomes. Limitations: Two limitations were identified. The QI project was limited by the small sample size of 10 patients. This is however, true to PDSA guidelines that recommend small scale cycles. The data were limited as only documented data were used. Conclusions: In general, the expected outcome was the outcome observed; the provider was unaware of any women in this QI Project who were not successfully treated with use of a pessary for treatment of POP. The value of this data-based practice model is that outcomes can be aggregated across populations rather than relying on recall of individual outcomes and therefore has potential to be used regularly and systematically as a quality feedback loop, as well as on a larger scale in future PDSA cycles to determine other outcomes beyond a single provider in this or other similar clinical populations.

Medicaid provides coverage to approximately 60 million individuals and is the largest single payer of healthcare for children. Given this scope of the program and the concentration of low-income and minority recipients, improvements to the quality of care delivered to Medicaid members represents a significant opportunity to reduce health care disparities and improve the overall delivery and quality of healthcare within the U.S. The current study sought to evaluate the various approaches that state Medicaid agencies are taking to assess and improve the quality of care to their managed care enrollees and the degree to which they have implemented recommendations of various policy experts. A survey was distributed to the Medicaid Directors of all 50 states. A total of 23 states with risk based managed care programs responded, representing 62% of the states that have managed care programs. The results indicated that nearly all states are utilizing standard performance measures as one method to assess quality, with virtually all relying on HEDIS measures for this purpose. Additional strategies that are being used include public reporting of quality data and the use of pay-for-performance incentives; few states are currently focusing on health information technology. Recommendations are made for steps that the Medicaid program could take at both the state and federal level to further develop quality improvement programs.

Darbe analizuojama paslaugų ir jų kokybės sampratos, pristatomas tyrimas, kurio rezultate įvertinamas studentų požiūris į administratorių teikiamas paslaugas bei jų kokybę. Paslaugų teikimas studentams, tai – viena iš svarbiausių universiteto administracijos darbuotojų veiklos funkcijų. Paslaugos kokybę daugelis vartotojų suvokia kaip poreikių patenkinimą ir reikalavimų atitikimą. Teikiant paslaugas svarbiausia vartotojų poreikių patenkinimas ir teikiamos paslaugos kokybė. Baigiamojo darbo tikslas atlikti paslaugų kokybės ypatumų mokslinės literatūros analizę, nustatyti studentų požiūrį į administratorių teikiamų paslaugų kokybę ir pateikti pasiūlymus VDU EVF administratorių teikiamų paslaugų kokybės gerinimui. Siekiant įgyvendinti nustatytą darbo tikslą, teorinėje darbo dalyje pateikiami paslaugų kokybės vertinimo kriterijai, aptariami paslaugų kokybės matavimo modeliai. Antroje darbo dalyje pateikiami pagal Servqual metodiką atlikto tyrimo rezultatai. Trečioje, projektinėje darbo dalyje, pateikiami siūlymai VDU EVF administratorių teikiamų paslaugų kokybės gerinimui. / The diploma paper deals with service quality concepts and presents the research, which analyzes the university students’ attitude towards administrative assistants’ services and their quality. Services for students are one of the most important university administrative personnel’s functions. Many customers perceive service quality as satisfaction of their needs and meeting of their requirements. Satisfaction of customer needs and service quality are the core elements in the service sector. The aim of the diploma paper is to present the scientific literature analysis on service quality peculiarities, to set the students’ attitude towards the administrative assistants’ service quality and to give suggestions how to improve their service quality at the Faculty of Economics and Management of Vytautas Magnus University. In order to achieve the set aim of the paper the author in the theoretical part has distinguished the assessment criteria for service quality as well as has highlighted the service quality evaluation models. The second part of the paper analyzes the research results based on Servqual method. The third part gives suggestions how to improve the administrative assistants’ service quality at the Faculty of Economics and Management of VMU.

In 2011 the University of Kentucky opened the first two inpatient floors of its new hospital. With an estimated cost of over $872 million, the new facility represents a major investment in the future of healthcare in Kentucky. This facility is outfitted with many features that were not present in the old hospital, with the expectation that they would improve the quality and efficiency of patient care. After one year of occupancy, hospital administration questioned the effectiveness of some features. Through focus groups of key stakeholders, surveys of frontline staff, and direct observational data, this dissertation evaluates the effectiveness of two such features, namely the ceiling-based patient lifts and the placement of large team meeting spaces on every unit, while also describing methods that can improve the overall state of quality improvement research in healthcare.

När en ny produkt lanseras på marknaden uppkommer det med stor sannolikhet brister som intetidigare upptäckts. Syftet med denna studie är att skapa en arbetsmodell för hur medelstora företagska hantera kvalitetsavvikelser som uppkommer inom produktion. För att skapa en realistisk modellför hur dessa kvalitetsavvikelser skall hanteras, baseras detta examensarbete på en fallstudie utfördpå ett tillverkande företag vid namn AQ ParkoPrint AB som är beläget i Gävle. Följande forskningsfrågor har besvarats för att understödja det huvudsakliga syftet: • Vilka kvalitetsavvikelser kan uppkomma inom medelstora företag? • Hur kan dessa kvalitetsavvikelser hanteras samt om möjligt reduceras? Metoderna som använts i studien är intervjuer och observationer. Fem intervjuer och tvåobservationer utfördes på AQ ParkoPrint AB. Den arbetsmodell som skapats kallas förfemstegsmodellen och innebär att processen för att hantera kvalitetsavvikelser delats upp i fem steg:dokumentera, utred, illustrera, forma åtgärdsförslag och genomför. Femstegsmodellen är utformadför medelstora tillverkande företag och inriktad på att skapa ett arbetssätt för systematiskt arbetemed hantering samt om möjligt reducering av kvalitetsbrister. Dessa steg är flexibla på det viset attvarje företag utformar egna åtgärdshanteringar och använder femstegsmodellen som grundstruktur idet fullständiga kvalitetsarbetet.Med hjälp av den utvecklade femstegsmodellen kan medelstora företag hantera och reducera sinakvalitetsbrister. Arbetsmodellen i sig kräver inga kostsamma verktyg utan det som styr kostnadernaär omfattningen av det arbete som läggs på samtliga steg.I denna studie presenteras även frågeställningar som företag kan arbeta utifrån för att reducerakvalitetsbrister som kan härledas till underleverantörer. Fallstudien påvisar att de kvalitetsavvikelsersom uppkommer troligtvis kan härledas till underleverantörerna. / When a new product is launched, product defects in various processes and process steps willprobably appear that were not previously known or detected. The purpose of this study is to create aworking model for how middle-sized companies should manage to handle defects in quality thatwill appear in manufacturing productions. To be able to create a realistic model, this thesis will bebased on a case study of a manufacturing company by the name of AQ ParkoPrint AB, located in Gävle, Sweden. The following research questions are answered in order to support the main purpose: • What defects in quality occur most often in middle-sized manufacturing companies? • How can these defects in quality be managed, and if possible, be reduced? The methods used in this study are interviews and observations. Five interviews and twoobservations were performed on AQ ParkoPrint AB. The working model that was created wasnamed “Five-step-model” and involves the process of managing defects in quality divided into fivesteps: document, investigate, illustrate, propose action and implement. The “Five-step model” isdesigned for middle-sized manufacturing companies focused on creating a way to worksystematically with how to managing quality defects and how to reduce them if possible. The stepsin this model are flexible because every single company should be able to customize each step tosuit their company needs, and only use the “Five-step model” that is created in this study as thebasic structure of the quality work. The case study shows that the suppliers are the majorcontributors of causing quality defects. Middle-sized companies can use the developed five stepmodel to handle and reduce their quality defects. The “Five-step model” itself requires no expensivetools. It is the extent of the work in every specific step that determines the costs.This study also presents some question formulations that companies can use to reduce their qualitydefects that can be traced back to the subcontractors.

Bakgrund: Omkring 10-15 % av befolkningen, oftast i arbetsför ålder, riskerar att någon gång drabbas av njursten. Nationella riktlinjer för njurstensbehandling saknas, men studier stödjer behandling inom 48 timmar för snabb symtomlindring och minskade besvär för patienten. Inom studerad verksamhet var tiden från diagnos till behandling lång och återinläggningarna var många, varför ett förbättringsarbete initierades. Syfte: Syftet med förbättringsarbetet var att halvera tiden från diagnos till behandling för patienter med akut behandlingskrävande uretärsten, samt minska negativa effekter relaterade till obehandlad uretärsten. Vidare syftade studien av förbättringsarbetet till att beskriva ett tvärprofessionellt teams erfarenheter av aktuellt förbättringsarbete gällande patienter med uretärsten. Metod: Ett tvärprofessionellt team bedrev förbättringsarbetet med stöd av Nolans modell för förbättringsarbete, vilket studerades genom en deskriptiv fallstudie med induktiv ansats. Effekterna av förbättringsarbetet utvärderades med Statistical Process Control (SPC). Vidare studerades teamets erfarenheter genom gruppintervjuer, och skriftliga berättelser vars data analyserades och sammanställdes genom kvalitativ innehållsanalys. Resultat: Målet med behandlingstiden uppnåddes inte, men positiva effekter för patienterna uppmättes. ESWL-behandling inom 48 timmar minskade tiden från diagnos till sista behandling. Planering, samarbete, information var nödvändigt för att lyckas med ett förbättringsarbete, men i kontexten fanns motsättningar, vilket försvårade arbetet, så som hög arbetsbelastning och bristande rutiner. Vidare beskrevs en bristande helhetssyn inom verksamheterna kring patienter med njursten, vilket ledde till varierande drivkrafter hos medarbetarna. Slutsatser: ESWL inom 48 timmar förkortade tiden från diagnos till behandling, även hos de patienter som behövde ombehandlas. Utmaningarna i ett förbättringsarbete finns inom olika nivåer, inom en komplex organisation. Riktlinjer och en gemensam målsättning är viktigt för att erbjuda patienterna ändamålsriktig vård i rätt tid. Kommunikation är grundläggande för att lyckas med ett förbättringsarbete. / Background: About 10-15% of the population, mostly at working age, has the risk that at some point be affected by kidney stones. There is a lack of national guidelines for kidney stone treatment, but several studies suggest treatment to start within 48 hours for rapid symptom relief and reduced discomfort for the patient. Within the studied context, the time from diagnosis to final treatment was too long, and the readmission rate was high, why a quality improvement project was initiated. Purpose: The aim of the Quality Improvement project was to halve the time from diagnosis to final treatment for the patients suffering from urethral calculi, and to reduce negative impacts related to an untreated urethral stone. Furthermore the aim of the study was to describe a multi-professional teams’ experiences of actual Quality improvement project. Method: Nolans model for Improvement was used by the team. The effects of the quality improvement were evaluated with Statistical Process Control (SPC). A case study with inductive approach was used. The teams’ experiences was studied through group interviews, and written stories and the data were conducted through qualitative content analysis Results: The goal considering time to final treatment was not achieved, but positive effects for the patients were noted. Extracorporeal Shock Wave Lithotripsy (ESWL) treatment within 48 hours reduced the time from diagnosis to final treatment. Planning, cooperation and communication was the key factors for success for quality improvement. Several barriers was identified in the context, such as; high work load and indistinct routines, which complicated their work. Furthermore a lack of holistic view, considering patients with kidney stone was described, which led to a variation in the driving forces among the employees. Conclusions: ESWL in 48 hours shortened the time from diagnose to final treatment, even if a retreatment was necessary. In a complex organization, the challenges conducting a quality improvement project is on several levels. Well known guidelines and a shared goal for the entire process are important to be able to offer patients appropriate care at the right time.  Communication is fundamental to achieve success.