Patient outcomes are influenced by the quality of care that the workforce renders. The registered nurse, as designated process-owner of the “Back to basics” quality improvement (QI) initiative, plays a vital role, being responsible for providing compassionate patient-centred care to alleviate suffering and restore health. The aim of the study was to gain an in-depth understanding of how nurses perceive their roles, responsibilities and challenges in delivering basic nursing care, linked to the organisational “Back to basics” QI initiative. A qualitative study with an explorative descriptive contextual design was utilised. Registered nurses with a direct patient care involvement in the general nursing discipline of a private hospital group participated in focus-group interviews. Data were analysed using Creswell’s data-analysis cycle. Findings were that patient care coordination involves an assessment-delegation-supervision triad. However, meeting stakeholder expectations, management and administrative responsibilities, remove the registered nurse from direct patient care. Time constraints affect physical bedside availability to model the exemplary knowledge, skills and attitudes underlying quality basic nursing care delivery. Reduced opportunities to model quality basic nursing care at the bedside affect patients’ care expectations, resulting in complaints related to basic nursing care omissions. Participants felt that they needed more clarification on the “Back to basics” QI initiative, and more in-service training. The many broad-ranging recommendations include in-service training that empowers registered nurses with the competencies to deal with role and task balance in the face of the diverse and complex demands of the modern healthcare arena. / Health Studies / M.A. (Health Studies)

abstract: Mobile applications (Apps) markets with App stores have introduced a new approach to define and sell software applications with access to a large body of heterogeneous consumer population. Several distinctive features of mobile App store markets including – (a) highly heterogeneous consumer preferences and values, (b) high consumer cognitive burden of searching a large selection of similar Apps, and (c) continuously updateable product features and price – present a unique opportunity for IS researchers to investigate theoretically motivated research questions in this area. The aim of this dissertation research is to investigate the key determinants of mobile Apps success in App store markets. The dissertation is organized into three distinct and related studies. First, using the key tenets of product portfolio management theory and theory of economies of scope, this study empirically investigates how sellers’ App portfolio strategies are associated with sales performance over time. Second, the sale performance impacts of App product cues, generated from App product descriptions and offered from market formats, are examined using the theories of market signaling and cue utilization. Third, the role of App updates in stimulating consumer demands in the presence of strong ranking effects is appraised. The findings of this dissertation work highlight the impacts of sellers’ App assortment, strategic product description formulation, and long-term App management with price/feature updates on success in App market. The dissertation studies make key contributions to the IS literature by highlighting three key managerially and theoretically important findings related to mobile Apps: (1) diversification across selling categories is a key driver of high survival probability in the top charts, (2) product cues strategically presented in the descriptions have complementary relationships with market cues in influencing App sales, and (3) continuous quality improvements have long-term effects on App success in the presence of strong ranking effects. / Dissertation/Thesis / Doctoral Dissertation Business Administration 2015

Orientador: Ademir Jose Petenate / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica / Made available in DSpace on 2018-08-06T21:18:10Z (GMT). No. of bitstreams: 1 Isaac_MassimoJorge_M.pdf: 398681 bytes, checksum: e045c1be6f79b4340534fe3642f04a5e (MD5) Previous issue date: 2006 / Resumo: Este trabalho tem como objetivo demonstrar a aplicação de um processo de melhoria em uma empresa de adesivos, através da diversificação mercadológica e com indicadores de desempenho e mensuração dos objetivos almejados, pelo método do Balanced Scorecard. Os resultados obtidos demonstraram que a organização evoluiu do estágio de eminente inviabilidade econômica para um patamar de viabilidade e lucratividade / Abstract: This resource paper was developed in order to purpose an application of an improvement process in a Printer Company of Stickers, trough a marketing diversification and measurement of the results by The Balanced Scorecard. The achieve results demonstrate that the company became profitable and economically viable / Mestrado / Gestão da Qualidade Total / Mestre em Engenharia Mecânica

La maîtrise de la résistance bactérienne passe par une amélioration de la prescription des anti-infectieux en pathologie humaine. L'objectif de ce travail était de mettre au point et d'évaluer l'impact d'une intervention destinée à améliorer la qualité de l'antibiothérapie, en ciblant en priorité les prescriptions hospitalières. Nous avons voulu utiliser des stratégies dérivées des sciences sociales et de l'industrie, notamment les techniques d'amélioration continue de la qualité, pour changer le comportement des prescripteurs. Nous avons ensuite ciblé une étape-clé de la prescription antibiotique, i.e. la réévaluation des antibiothérapies probabilistes 24-96 heures après leur initiation, que nous avons sélectionnée à l'issue d'une revue de la littérature et d'une analyse quantitative par questionnaire des perceptions, attitudes et connaissances des prescripteurs ; le questionnaire permettait également d'approcher les barrières locales à cette intervention. Puis nous avons mis au point des indicateurs de processus permettant de mesurer cette réévaluation des antibiothérapies. Enfin, nous avons étudié l'impact sur la qualité de l'antibiothérapie d'une intervention utilisant une stratégie d'audit et de retour d'information, visant à améliorer la documentation de la réévaluation des antibiothérapies par des médecins non-infectiologues dans deux services. En conclusion, les stratégies d'amélioration continue de la qualité s'avèrent utiles pour promouvoir le bon usage des anti-infectieux. / Antibiotic stewardship is essential to curb bacterial resistance in humans. Our aim was to design an intervention to improve the quality of prescription of antibiotics, focusing on the inpatient setting. We used strategies derived from the social sciences and the industry, particularly continuous quality improvement techniques, to lead the doctors to change their behaviour. We focused on a key process of antibiotic prescribing, i.e. reassessment of antibiotic therapies 24-96 hours after their start ; we selected this process based on a review of the literature and on the results of a survey designed to assess the perceptions, attitudes and knowledge of the prescribers. This survey also enabled us to approach potential barriers to the intervention. We designed then a set of process measures of quality of care in the reassessment of inpatient empirical antibiotic prescriptions. Finally, we assessed the impact of an intervention designed to improve the documentation of the reassessment of inpatient empiric antibiotic prescriptions on the quality of these prescriptions ; this intervention was conducted on two wards and targeted non-infectious diseases specialists, using an audit and feedback approach. In conclusion, continuous quality improvement strategies are a valuable tool to improve antibiotic use.

Magister Public Health - MPH / Introduction Mother to Child Transmission is a significant route of HIV infection in children and in South Africa (SA) the median HIV prevalence rate among pregnant women is 30, 2% and in the Western Cape Province (WCP) it is 18, 2%. lthough Prevention of Mother to Child Transmission (PMTCT) programmes are now available at 100% of all health care facilities and 95% of women attend antenatal care, these programmes are complex and outcome data reveals fluctuations in transmission rates as well as pockets of high transmission within well performing sub-districts. The careful management of programme processes thus requires more than coverage and outcome data. It also requires a clear picture of process indicators related to access to PMTCT services, the quality and continuity of care within the PMTCT programme and integration of PMTCT service into the comprehensive package of health care services. Aims and objectives To develop a tool that will measure the quality of care of HIV exposed infants in the PMTCT programme at primary care setting in Cape Town, by engaging local programme managers in a participatory process to develop a tool that is locally applicable and relevant, and captures local management expertise. To identify the evaluation omains, to develop a set of indicators for each domain and to pilot the tool to assess its feasibility and usefulness of the data generated.

This thesis is anchored in improvement science, the research field of improvement. Improvement science describes and explores improvement in real-life contexts and “system of profound knowledge” (Deming, 2000) is a cornerstone. Performance measures, including their variation over time, are fundamental in the research and evaluation of outcomes of continuous quality improvement efforts (CQI efforts). However, the strong emphasis on operationalisations and measurements risks overshadowing other kinds of outcomes to which CQI efforts can lead. Research has shown that it is advantageous that those performing change have some kind of “sharedness”, e.g. shared cognitions, understanding, knowledge, interpretations or frame of reference. Despite the diversity of concepts and scientific studies, “sharedness” is mainly described as a prerequisite for change. This thesis addresses the call to broaden the scientific approach in improvement science and to take advantage of knowledge developed since Deming's time. It has a point of departure in the presumption that CQI efforts also lead to intangible outcomes; qualitative effects that are not easily captured with traditional performance measures. The concept “Expressions of shared interpretations” is used to study “sharedness” as intangible outcomes. The overall aim with this thesis is to explore Expressions of shared interpretations as intangible outcomes of CQI efforts from the perspective of clinical microsystems and healthcare professionals. The specific aims are to examine and establish how Expressions of shared interpretations develop, influence CQI efforts and change over time. Using a qualitative approach, this thesis comprises four papers, based on three studies. The empirical context is healthcare and welfare organizations providing care: hospital clinics in county councils/regions and nursing homes in municipalities. The studies include time periods from one to three and a half years, totalling six years. Expressions of shared interpretations inherently mean that the methods for data analysis need to be based on commonalities or patterns in the data. In this thesis three methods are used: qualitative content analysis, thematic analysis and directed content analysis. To examine time-related changes, year-to-year comparative analyses of themes and categories are done. To explore Expressions of shared interpretations, different theoretical frameworks are used: team cognitions (Paper 1), sensemaking theory (Paper 2), cognitive shifts (Paper 3) and programme theories (Paper 4). A directed content analysis is applied in a meta-analysis of the results presented in the four papers. The results indicate that Expressions of shared interpretations develop as intangible outcomes of CQI efforts and a general programme theory of CQI efforts in health- and elderly care is developed, illuminating how Expressions of shared interpretations change and influence CQI efforts. The general programme theory incorporates the PDSA cycle and describes the complex, interconnected and continuous development of Expressions of shared interpretations. It also illuminates how Expressions of shared interpretations provide change performers with momentum to engage in forthcoming PDSA cycles and how sensemaking is a central activity. CQI efforts in health- and elderly care are characterised by a “just get on with it” attitude, while in this thesis, thoughtfulness is emphasized. Existing improvement tools support collaboration, creativity and analysis of critical aspects of the operations, yet none of the improvement tools help change performers gain understanding of the CQI effort as such. To address this, this thesis suggests that change performers complement the use of improvement tools with an inquiring mind, that they collaborate in thoughtful dialogues and that leaders function as inquirers. To support this posture, the widely used Model for improvement is complemented with a fourth question: What are our assumptions? The question pinpoints the need to be thoughtful in every step of the CQI effort, not just in the analysis of the problem at hand.

Medical devices are used to diagnose, treat, or prevent a disease or abnormal physical condition without any chemical action in the body. They can also result in unintended incidents and other errors. This thesis was divided into three chapters: i) a systematic review on the recognition, reporting and resolution of incidents related to medical devices and other health technologies; ii) telephone interviews with physicians and registered nurses (RNs) to solicit information on the resolution, reporting and resolution of medical device-related incidents based on their professional experience; and iii) a case study to review the continuous quality improvement (CQI) data retrieved from the wireless smart infusion pump system at The Ottawa Hospital (TOH) and to propose a CQI data analysis process. The systematic review included 30 studies on factors that influence the recognition, reporting and resolution of incidents in hospitals and interventions to improve patient safety. Central themes that emerged for incident reporting were personal attitudes, awareness and perception of incident reporting systems, organizational culture, and feedback to healthcare professionals. In our telephone interviews, physicians and RNs attributed incident recognition to devices not operating based on the manufacturer’s instructions, and to the hospital staff’s knowledge of and professional experience with the use of the medical device, and clinical manifestations of patients. Suggestions to improve medical device safety surveillance centered on education and training to ensure that the staff is able to use the medical device properly and know what would be considered an error, and how to report these errors. The results of the systematic review and interviews helped to inform the design of a medical device surveillance framework in a hospital setting. Our case study assessed the Dose Error Reduction Software compliance and frequency of soft and hard limit alerts with wireless smart infusion pump systems over a one year period. A CQI data analysis process to monitor the performance of wireless smart infusion pumps is proposed. The findings of this doctoral thesis can contribute to the development of a medical device surveillance system that would help to improve health care delivery and patient safety in a health care institution.

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Syfte – Syftet med detta projekt att kartlägga och skapa förslag på förbättring av lagerläggningen vid torrvarulagret på företaget för att minska kostnader och öka effektiviteten. 1. Hur kan artiklar prioriteras för optimal lagerhållning? 2. Hur kan företaget upprätthålla god lagerhållning på lång sikt? 3. Hur kan en förbättrad lagerhållning bidra till företagets lönsamhet Metod – Undersökningen har baserats på kombination av personliga observationer, en dokumentstudie för att samla information gällande företagets omsättning, marginaler och svinn för de olika varugrupperna samt en enkätstudie som syftar till att samla information angående personalens syn på lagerhanteringen och vilket framtida läge som bör uppnås. Resultat – Observationerna visar att personalen inte fullt ut följer de instruktioner som finns angående var varor skall ställas på lagret. Det visar sig att på grund av mängden varor på lagret är detta inte möjligt. Observationerna visar även att många produkter som lagras inte direkt skapar värde i form av försäljning och tar upp värdefullt lagerutrymme som skulle kunna användas till andra produkter. Varor tenderar att placeras i hörnet av lagret vilket blockerar framkomligheten för två ställageplatser. Av enkätsvaren visar det sig att personalen på arbetsplatsen har delade uppfattningar om hur arbetet på lagret fungerar. Det visar sig att många i personalen håller med om att pallar ofta behöver flyttas för att komma åt bakomliggande varor. Resultatet från enkäterna visar att många medarbetare anser att varor inte ställs på rätt plats. Det visar sig att en stor del av medarbetarna inte vet att det finns nedskrivna bestämmelser om hur lagerarbetet skall skötas. Slutsatser – Produkter kan delvis prioriteras baserat på ABC-analysen men inte fullt ut enligt den teoretiska modellen. Företaget bör behålla principerna för ställagelagring eftersom denna metod anpassas bra för den typen av lager som företaget har men faller på grund av att dessa principer inte följs. Familjegruppsprincipen kan användas för att prioritera varor i större volymer på enhetliga pallar vid de angivna ställageplatserna. 5S kan hjälpa företaget att få koll på onödiga produkter på lagret genom att sortera ut och strukturera var sak på sin plats. Genom att göra detta med kontinuitet kan företaget hålla en bättre lagernivå och därmed hålla lagret under kontroll under tider då lagret blir pressat. Strukturerade rutiner och visuell styrning kan hjälpa erfarna och nya medarbetare att lätt förstå vad som behöver göras och hur detta skall genomföras. PDSA-cykeln kan användas för att kontinuerligt utveckla och förbättra processerna för lagerhållningen vid arbetsplatsen. Genom att skapa struktur, en städad arbetsplats och tydliga rutiner kan företaget skapa en bättre överblick av lagret. Denna överblick skapar möjlighet att se varugrupper eller produkter som är i riskzonen för att gå sönder eller passera utgångsdatum. Detta bidrar till att minska svinnet på arbetsplatsen vilket i sin tur leder till potentiell ekonomisk vinning under lång sikt. Långa ledtider är något företaget drabbas av på grund av den bristande framkomligheten på lagret. Med ett strukturerat lager minskar ledtider vilket ger personalen mer tid att lägga på värdeskapande aktiviteter. Onödiga rörelser för personalen är vanligt förkommande då varor flyttas och omplaceras på lagret för att komma åt andra varor. Detta agerar som ett slöseri av personalens tid. Väntan förekommer som ett resultat av den bristande framkomligheten vilket påverkar ledtider och effektiviteten på arbetsplatsen. / Purpose - The purpose of this project is to map and make suggestions for quality improvements for warehousing at the company with focus on increasing effectiveness and lowering the cost. 1.How can articles get prioritized for optimal warehousing? 2.How can the company maintain optimal warehousing in the long run? 3.How can optimized warehousing contribute to the company's profitability? Method - The study is based on a combination of personal observation, a document study used to gather information regarding the company's revenue, margins and waste for the different article groups. An inquiry was made with the purpose to gather information regarding the staff´s view of present warehouse logistics and future goals. Results - The observations show that the staff doesn't follow the guidelines regarding positioning of the articles in the warehouse. This is not possible with the amount of products in stock. The observations show that there are some products in the warehouse that do not directly contribute to the revenue of the company and therefore taking up space from products that do contribute to the revenue. Some articles are placed in the corner of the warehouse which limits access to two parts of the shelving system at the same time. The results from the inquiry show that the staff have mixed opinions regarding how well the warehouse runs. Most of the staff recognize the problem of having to move articles before reaching the wanted item. The inquiry show that a lot of the staff members does not follow the rules regarding placement of articles in the warehouse and most don't know if there are any written rules regarding this. Conclusions - Products can partially be prioritized based on the ABC-model but not to the full extent. The company should follow the principles of the shelving system since this is already implemented but is not used to the full extent. The family group principle can be used to prioritize products and sort them in different groups based on their attributes. 5S can help the company to identify unnecessary products and sort and mark everything in the warehouse. This identification leads to the possibility to lower and keep reasonable stock volume and keep control even though a big delivery is due. Structured routines and visual leadership may help both veteran and new workers in the work with the warehouse. The PDSA-cycle can be used to continuously improve and perfect processes for stock management at the store. Through designing a structure, a clean workplace and clear routines is it possible for the company to maintain a clear overview of the warehouse. This overview makes it possible to spot product groups that are in the danger zone for breaking or passing the expiration date. This will contribute to lowering the waste for the company which leads towards a potential financial gain over a longer period of time. With a more organized warehouse does the staff get more time to focus on value gaining tasks. Unnecessary movement for the staff is common due to the need to move products before work can be done. This is recognized as a waste of the staff's time and therefore a waste of resources. Waiting i common which is present due to products blocking the passage ways, this does lengthen lead times and decreases the effectiveness at the warehouse.

Purpose: The purpose of this project is to increase the number of open patient appointments by implementing a validated process in which stabilized behavioral health patients are repatriated to primary care. Currently, there is an increased demand for behavioral health services and decreased supply of behavioral health clinicians at the Nashville Veterans Affairs Medical Center (VAMC). Aims: This project aims to teach behavioral health providers how to identify appropriate patients and complete successful discharges while helping primary care providers integrate the repatriation process into their workflow. Without the proposed intervention, veterans initiating behavioral health services in the catchment area will continue to experience delays. Methods: The Knowledge to Action Framework is being used to adapt the process to the local context. All behavioral health and primary care clinicians at the Nashville VAMC are included in project knowledge dissemination. Data is collected by tracking the behavioral health discharge note within the site. The number of discharge notes per month will be analyzed by comparing the number of discharge notes from previous years to those after project implementation. Results: Results are ongoing, however preliminary results from January and February of 2022 look promising with a total of 35 discharge notes, compared to the six discharge notes from the same months in 2019, 11 in 2020, and 15 in 2021. Conclusion: Preliminary results are encouraging, as the number of successful discharges has significantly increased. This allows for more veterans with mental health needs to be served at the Nashville VAMC.