Background Mentorship is used to ease entry to practice for new nursing graduates. However, little is known about the process of pairing with experienced nurses. The aim of this dissertation is to explore mentorship pairing processes for new nursing graduates and experienced nurses. Methods 1. A quality improvement project was conducted using organizational data to describe the impact of the New Graduate Guarantee program at The Ottawa Hospital from 2013 to 2018 on new graduate nurses and organizational outcomes. 2. An interpretive descriptive study was conducted to develop an in-depth understanding of mentorship pairing practices specific to nursing occurring in a clinical setting that will ultimately inform future mentorship pairing practices. 3. A systematic review was conducted to determine the effect of mentorship pairing processes on the mentoring relationship and outcomes at the level of the new nursing graduate, mentor and organization. Findings 1. From 2013 to 2017, 66 nurses were hired directly into operational vacancies and 579 new graduate nurses were paired with a mentor in the New Graduate Guarantee program. The two-year turnover rate for new graduates who participated in the New Graduate Guarantee program (21.5%, N=92/427) was lower than new graduate turnover rates reported in the literature. 2. Interviews with 13 new graduate nurses and 12 mentors revealed a lack of awareness of current nursing mentorship pairing processes. Six nurse leaders described pairing processes using third party pairing. Participants suggested preparation, socialization and self-selection are key components to consider for future practice. 3. Of 2583 citations screened, no studies evaluated the nursing mentorship pairing process. Research is required to determine effective mentorship pairing processes in nursing. Conclusion Although 579 nurses were hired through the New Graduate Guarantee nursing mentorship program, the 13 new graduates and 12 mentors interviewed were unaware of the process used for pairing. Furthermore, no studies have evaluated mentorship pairing processes. Ninety percent of new graduates hired participated in the New Graduate Guarantee program. Future research is required to trial pairing processes proposed by nurse leaders, new graduates and experienced nurses and to develop and validate tools to evaluate the outcomes of these pairings.

Clinical documentation is at the center of a patient's medical record; this record contains all the information applicable to the care a patient receives in the hospital. The practice problem addressed in this project was the lack of clear, consistent, accurate, and complete patient medical records in a pediatric hospital. Although the occurrence of incomplete medical records has been a known issue for the project hospital, the issue was further intensified following the implementation of the 10th revision of International Classification of Diseases (ICD-10) standard for documentation, which resulted in gaps in provider documentation that needed to be filled. Based on this, the researcher recommended a quality improvement project and worked with a multidisciplinary team from the hospital to develop an evidence-based documentation guideline that incorporated ICD-10 standard for documenting pediatric diagnoses. Using data generated from the guideline, an artificial intelligence (AI) was developed in the form of best practice advisory alerts to engage providers at the point of documentation as well as augment provider efforts. Rosswurm and Larrabee's conceptual framework and Kotter's 8-step change model was used to develop the guideline and design the project. A descriptive data analysis using sample T-test significance indicated that financial reimbursement decreased by 25%, while case denials increased by 28% after ICD-10 implementation. This project promotes positive social change by improving safety, quality, and accountability at the project hospital.

Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at a large hospital in the northwestern United States. The model of improvement was used as a framework for the QI initiative and this evaluation project. The practice-focused question asked in this project was: Did NTSV cesarean birth rates change after implementation of an evidenced-based standardized labor management bundle? Archived data were collected on cesarean birth rates for 3 time periods: prebaseline, 1 year postimplementation, and 2 years postimplementation. Chi-squareï? tests compared the differences between observed and expected results of data following implementation of labor management bundles. Results show no statistically significant difference between the pre- and post- implementation periods in the NTSV laboring population. Results suggest use of labor management practice bundles alone may not lead to expected outcomes improvements and that operationalization of such practices are sensitive to institutional and/or patient population contexts. This project may serve to promote positive social change by framing evidence-based practice as a process that must attend to contextual considerations.

The objective of this study was to examine the use of frequent, anonymous student course surveys as a tool in supporting continuous quality improvement (CQI) principles in online instruction. The study used a qualitative, multiple-case design involving four separate online courses. Analysis methods included pattern matching/explanation building, time series analysis, and thematic analysis. Findings suggested that instructors used student feedback to make course changes that alleviated technical difficulties, added and clarified content, and contributed to future course changes. Students and instructors responded positively to the opportunity to give and receive anonymous feedback and felt that it helped improve the course. It is uncertain, however, whether using CQI principles had an impact on end-of-semester teacher course quality ratings. An important finding from the research is that students like to be asked to help improve their learning experience, as long as the instructor listens and responds to their feedback. Evaluation is a valuable component of instructional design theories, which are based on the philosophy that the best designs result from an iterative process. Using a synergistic CQI approach, this study indicates that it is possible for changes to be made more quickly to a course when students are involved in the process. The combination of frequent student feedback with a willing and experienced instructor who can make expert course revision decisions allows the process of course improvement to be enhanced.

Export of heat treated steel goods has an important impact on the Swedish economy which brings performance demands and expectations on production to keep a competitive market position. Sustainability and efficiency are two important aspects in meeting these demands. This thesis studies how a data driven approach can be used to increase efficiency in manufacturing of rods produced for the mining industry.  The purpose of this thesis is to use a machine learning model suitable for classifying quality results for heat treated steel rods. This is done by comparing nine algorithms with the objective to tune and deploy the model best fitted while gaining insights in variables that have an impact on the quality output.  This thesis outset is a heat treatment process at Epirocs facility in Fagersta. Interviews are conducted to gain domain knowledge about important features and an AI pipeline is implemented to demonstrate its suitability for predicting quality given production and weather data in the form of time series and product-unique data points.  The result of the study shows that the machine learning algorithm random forest is indicated as most suitable among the analyzed. The study also shows that an AI pipeline with streaming data can be designed and efficiently implemented for quality improvement. Through this work, the authors have proved that machine learning can be used to improve the heat treatment process of rods, but the model still has room for improvement in feature selection and availability of larger and more detailed data at the facility.

Sammanfattning Internationell forskning visar behov av att studera och utvärdera evidensbaserade palliativa vårdplaner för patienter i livets slutskede. I Sverige behövs en ökad kunskap om vården och hur man kan ta reda på varje persons individuella behov och önskemål. Att bidra till välbefinnande, samt till god lindring av smärta och andra besvär, är de insatser som är mest betydelsefulla för svårt sjuka patienter som befinner sig i livets slutskede. I föreliggande text redovisas förbättringsarbete på ett kommunalt korttidsboende vars syfte var att förbättra livskvaliteten för patienter i livets slutskede, genom att införa Nationell palliativ vårdplan (NVP). Här presenteras också en studie vars syfte var att klarlägga chefernas uppfattningar och erfarenheter vid införandet av NVP. Förbättringsarbetet följde Nolans förbättringsmodell med PDSA-cykler utifrån kartläggning av det kliniska mikrosystemet på korttidsboendet. Studien är en kvalitativ intervjustudie där intervjuer har genomförts och analyserats med innehållsanalys. De genomförda åtgärderna i förbättringsarbetet resulterade i mätbara förbättringar. Andelen aktuella patienter för vilka det gjordes skattning av symtom och smärta och strukturerad bedömning av välbefinnande, ångest och oro, som registrerades i NVP uppnådde målet på 95%. Data från studien visar hur ledare agerar och deras erfarenhet av hur man introducerar och använder NVP. Cheferna/ledarna har agerat med intresse, engagemang och använt sig av kunskapsstödet. Deras upplevelser av införandet har varit positiva och de har lagt vikt på deras behov av att få stöd som chef/ ledare vid införandet. Förbättringsarbetet med att införa NVP var framgångsrikt och bidrog till ökad livskvalitet för korttidsboendets patienter i livets slutskede. PDSA-cykler med styrdiagram var en värdefull metod för uppföljning av förbättringsarbetet. Mätningarna visade att de planerade insatserna gav önskvärda effekter trots att det SMART: a målet inte uppnåddes helt. Studien visade att cheferna upplevt motivation, gett och fått stöd samt att de visat engagemang och intresse vid införandet av NVP. / Summary International studies show a need to study and evaluate evidence-based end-of-life care plans and studies need to include more symptom controls of patients, patient’s well-being, and satisfaction. In the short-term unit there was a need for a more structured documentation-tool designed to meet patients in the end of their life. S-PCG is designed for this intention. The purpose was to improve the quality of life for patients in the short- term unit who are in the last days of their life. The main structure of the improvement initiative was Nolan´s model change and PDSA. The study was based on a qualitative interview study. The interviews were analyzed by content analysis. The results of the implemented measures show measurable improvements. 95% of all measurements regarding symptom assessment, pain assessment and continuous assessment based on well-being, anxiety and concern were registered in S-PCG. Data from the study shows knowledge among leaders acting and their experience how to introduce and use S-PCG. The conclusion of the improvement initiative with the introduction of S-PCG has proven to be successful, which has contributed to an increased quality of life for patients in the end of their life. PDSA-cycles and control charts proved to be a valuable method for following up the improvement initiative. The study showed that motivation, support and committed managers / leaders were successful factors that was the most important, during the improvement initiative.

Svensk hälso- och sjukvård är av god kvalitet men det finns också utmaningar. Forskningen identifierar utmaningar med tillgänglighet och personcentrering och det finns brist på personal. Framöver kommer det bli färre som ska försörja fler och finansieringen av hälso- och sjukvården kan påverkas. Samtidigt är utvecklingstakten snabb, speciellt när det gäller digitalisering och medicinteknik. Dagens styrning har fått kritik för att inte ta tillvara den kompetens och engagemang som finns. För att klara av vårdens utmaningar och ta vara på möjligheterna behöver styrningen fokusera på lärande och utveckling med fokus på de professionella drivkrafterna. Syftet med denna studie var att utforska drivkrafterna bakom framgångsrikt kvalitetsarbete samt identifiera metoder att förstärka dessa i avtalsutformning och uppföljning. Sex ledare för barn- och ungdomsmedicinska mottagningar i Region Stockholm intervjuades. Resultatet visade att drivkrafter till förbättringsarbete var kopplade till ledarskapet, det dagliga arbetet och individuella drivkrafter. När det gäller hur styrningen kan ta till vara och förstärka dessa drivkrafter var det kopplat till dialog, frihet och begränsningar, stöd, arbetsmiljön, ekonomi och faktorer kopplade till relationen till beställarorganisationen. Rekommendationer utifrån forskning var att styrningen bör kommunicera en tydlig riktning som inkluderar personcentrering och systemsyn samt använda sig av dialoger som fokuserar på lärande och utveckling. Personer som kan ha nytta av denna studie är individer som i sitt arbete gör upphandlingar och uppföljning av hälso- och sjukvård, kvalitetsansvariga och ledare. / Swedish health care is of good quality, but there are also challenges. Research identifies challenges with accessibility, person-centeredness and a lack of health care workers. In the future, there will be fewer who must provide for more and it might influence financing of health care. At the same time, the pace of development is rapid, especially when it comes to digitalization and medical technology. Today's governance has received criticism for not taking advantage of the skills and commitment that exist. To meet the challenges of healthcare, governance must focus on learning and development with a focus on the professional driving forces. The purpose of this study was to explore the driving forces behind successful quality improvement (QI) and identify methods to strengthen these in contract design and follow-up. Six leaders for paediatrics and adolescent medicine clinics in the Stockholm Region were interviewed. The results show that driving forces for QI are linked to leadership, daily work and individual driving forces. The study shows that the driving forces are linked with dialogue, freedom and restrictions, support, the work environment, finances and factors linked to the relationship with the contract organization. Research recommends that governance should focus on communicating a clear direction that includes person-centeredness and a systems perspective, and dialogues that focus on learning and development. Those who can benefit from this study is those who do procurement and follow-up of health care services, quality managers and leaders. / <p>2021-06-06</p>

This study aims to review thirteen coastal restoration projects considering the various ecosystem services provided by restoration and estimates the economic value of one of the ecosystem services of restoration. These ecosystem services include water quality improvement, fish and benthic species productivity, shoreline stabilization, oyster abundance, and marsh growth. The projects represent a set of large-scale projects within Alabama and Mississippi, with construction and monitoring costs ranging from $2.3 million to $50 million per project. To determine the economic value of one of the ecosystem services of coastal restoration projects, I used the meta-analysis method to estimate the willingness to pay (WTP) for coastal water quality improvements. The estimated function from the meta-analysis is applied to parameters specific to the study area. The WTP for improved coastal water quality, from a baseline of fishable but likely to degrade, to an improved fishing catch rate, is $203 per household annually among residents of Alabama and Mississippi.

Enligt nuvarande biobankslag i Sverige ska handläggningen av patienternas biobankssamtycken ske omedelbart och utan onödig tidsfördröjning. Det är utifrån patientsäkerhetsperspektiv, viktigt att ha uppdaterade biobankssamtycken i laboratorieinformationssystemet eftersom korrekt uppdaterade samtycken är avgörande för leverans av säker vård. Tidigare behövde den berörda biobankverksamheten i genomsnitt 77 arbetsdagar för att handlägga en inkommen nej-talong, vilket var alldeles för lång tid. Det här förbättringsarbetet görs i syfte att tidseffektivisera processen för biobankssamtycke vid berörd biobankverksamhet i Region Stockholm. Nolans förbättringsmodell, Service Blueprint, 5 P´s analys och PDSA-hjulen användes som metod i det här förbättringsarbetet. Med hjälp av de införda förändringsidéerna under förbättringsarbetet minskades antalet handläggningsdagar för nej-talonger från 77 till 42 arbetsdagar på den berörda biobankverksamheten. Detta är en minskning med 35 arbetsdagar. Det här förbättringsarbetet resulterade i en mer tidseffektiviserad process för biobankssamtycke och en ny nationell rekommendation gällande antal handläggningsdagar för nej-talonger.  Studien av förbättringsarbetet syftade till att öka förståelsen om personalens erfarenheter av att genomföra förbättringsarbete med processen för biobankssamtycke. Studien genomfördes som en kvalitativ fallstudie med induktiv ansats. Kvalitativ datainsamling utfördes i form av åtta samtalsintervjuer. Studien visade att det fanns två viktiga faktorer som enligt berörd personal ledde till ökad teameffektivitet och tidseffektivisering av processen: systematisering av processen för biobankssamtycke och motivationsdrivande faktorer. Förändrat arbetssätt, ökade personalresurser och utvecklade kommunikationskanaler bidrog till skapandet av en systematisk process vilket underlättade genomförandet av förbättringsarbetet och tidseffektiviserade processen. Motivationsdrivande faktorer som påverkade teameffektivitet under förbättringsarbetets gång var gruppstöd, agilt arbetssätt och visuell utvärdering av förbättringsarbetet. / According to the current Biobanking Act in Sweden, processing of patients' biobanking consent must occur immediately without unnecessary time delay. From a patient safety perspective, it’s important to have updated consents in laboratory information systems because correctly updated consents are critical to the delivery of safe care. Previously, biobank organization where study was conducted needed an average of 77 working days to process an incoming biobanking consent, which was overly long. The aim of improvement work is to make the process for biobanking consent more time-efficient in one biobank organization in the Region of Stockholm. Nolan’s improvement model, Service Blueprint, 5 P's analysis and the PDSA-cycles were used as methods for this improvement work. With the help of five improvement interventions the number of processing days for biobanking consents was reduced from 77 to 42 working days which is a reduction of 35 days. This improvement work resulted in a more time-efficient process and a new recommendation regarding the number of processing days for biobanking consent.  The study of the improvement work aimed to increase the understanding of the staff's experiences regarding improvement work with the process for biobanking consent. The study was conducted as qualitative case study with an inductive approach. Qualitative data collection was carried out in the form of eight interviews. The study showed that the following factors led to increased team effectiveness and time efficiency of the process: systematization of the biobank consent process and motivational factors. Changed work methods, increased personnel resources, and developed communication channels contributed to the creation of the systematic process, which facilitated the implementation of the improvement work and made the process time efficient. Motivational factors that influenced team effectiveness under improvement work were group support, agile working methods and visual evaluation of improvement work.

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