It is imperative to have quality assurance processes in place in division training to provide quality training to enable members of the South African Police Service (SAPS) to provide quality services to communities within their area of jurisdiction. The aim of the study was to determine the presence of and the need for implementation of effective quality assurance processes in education and training in the South African Police Service (SAPS). The concepts quality and quality assurance were explained in the literature review. Questionnaires were completed by the trainers in the South African Police Service (SAPS) at various training centers in the Northern Cape Province. The researcher advocates to promote and enhance quality assurance in education and training programmes in the South African Police Service (SAPS). Therefore, it is recommended that quality assurance programmes be introduced based on total quality management system for continuous improvement which can provide any training programme with a set of “tools” to meet and exceed the present needs and expectations of the adult learners in the South African Police Service (SAPS) context. / Teacher Education / M. Ed. (Education Management)

The purpose of the study is to explore the current policy and practice of the national and institutional QA system in public HEIs in Ethiopia in order to determine how the quality of teaching and learning might have been enhanced through the QA system. Two organisational theories – contingency and neo-institutional theory – provide a theoretical lens to explain how internal and external organisational environments affect the implementation of QA in the HEIs. The mixed-methods research approach was used in the study, including document analysis, semi-structured interviews and questionnaires. Three public universities were chosen as data source. At macro level, the HERQA was also included to examine the effect of the institutional environments on internal quality assurance practices. The findings revealed that there is little evidence of self-initiated quality enhancement activities in the public HEIs. They do not have adequate structures, systems, and written policies to assure quality. The quality assurance efforts were implemented without a clear sense of direction and purposes and therefore lacked effective coordination. The self-evaluations were symbolically took place at the higher levels of the universities and that the results of the evaluations were rarely used in a structured way in improvement of teaching-learning, faculty decision-making and planning processes. It is far from clear that whether the internal quality assurance contributed to the teaching and learning or transformed the student learning experience. It can be concluded that the HERQA’s quality assurance policy and practices seems to be de-coupled from internal initiatives to improve quality in the higher education institutions. It is recommended that HEIs should develop QA policy, mobilise resources for institutional quality improvement, establish full-fledged QA structures at all levels, and furnish the structures with necessary human resources. The HEIs should initiate and undertake effective self-assessment of their activities, own it and work towards achieving their own stated objectives. It is important that the HERQA should develop accreditation procedures, particularly at programme level, for the public HEIs. The HERQA should consider playing more active roles in communicating with HEIs regularly about QA; pay more attention to a follow-up of the audits, the punctual development and delivery of the SEDs. The HERQA should be more independent, have more autonomy and sufficient resources to become a viable professional agency informing the HE sector on the quality of its performance. / Educational Leadership and Management / D. Ed. (Education Management)

Introdução: As infecções primárias da corrente sanguínea associadas ao cateter venoso central (IPCS) são um grande problema nas unidades de terapia intensiva (UTI) pediátricas e neonatais em todo o mundo. Evidências sugerem que a prevenção das IPCSs é crucial para o atendimento seguro ao paciente. Uma percentagem significativa (65-70%) das IPCSs são evitáveis utilizando as estratégias baseadas em evidências, incluindo os bundles. Estas medidas têm um papel bem estabelecido em pacientes adultos.O objetivo deste estudo foi avaliar, a partir de uma ampla revisão sistemática da literatura, o benefício da implementação do bundle do cateter central na prevenção das IPCSs em pacientes pediátricos e neonatais internados em UTI. Métodos: Foram pesquisadas as bases de dados Cochrane Library, Medline, Latin American and Caribbean Health Science Literature (LILACS), Centre for Reviews and Dissemination (CRD), Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), além de busca manual e literatura cinzenta entre 1 de janeiro de 2005 até 31 de dezembro de 2015. Não houve restrição dos estudos com relação ao idioma, a data ou status de publicação. Para avaliar o benefício do bundle do cateter central, foram selecionados estudos envolvendo pelo menos dois componentes (higiene de mãos, precauções de barreira máxima, antissepsia da pele, seleção adequada do sítio do cateter, revisão diária da necessidade do cateter) como medida preventiva para pacientes com cateter venoso central (CVC). O desfecho foi o número de IPCSs por 1000 cateteres-dias antes e depois da implementação do bundle. Resultados: Foram identificados inicialmente 6369 estudos, após a exclusão dos títulos duplicados e os inelegíveis, 31 estudos preencheram os critérios de elegibilidade. Os estudos foram heterogêneos tanto na composição do bundle quanto na estratégia de implementação. A mediana da densidade de incidência de IPCS foi de 5.9 por 1000 cateteres-dias (2.6-23.1) nas unidades de terapia intensiva pediátricas (UTIP) e 4.9 por 1000 cateteres-dias (2.0-24.1) nas unidades de terapia intensiva neonatais (UTIN). Após a implementação do bundle do cateter central, a densidade de incidência de IPCS variou de 0 a 14.9 por 1000 cateteres-dias (mediana de 2.1) nas UTIPs e 0.3 a 13.9 (mediana de 2.8) nas UTINs. Conclusões: As IPCSs continuam sendo um problema significativo em unidades de terapia intensiva pediátricas e neonatais, mas a implementação do bundle do cateter central pode reduzir significativamente as taxas dessas infecções. Intervenções assistenciais com as melhores práticas baseadas em evidência permitem uma redução substancial das IPCSs pela promoção de grupos ou bundles de procedimentos e tecnologias, e pela utilização de uma estratégia multimodal para a educação, formação, implementação e divulgação. / Background: Central-line-associated bloodstream infections (CLABSIs) are a major problem in neonatal and pediatric intensive care units (ICUs) worldwide. Evidence suggests that CLABSI prevention is crucial for safe patient care. A significant percentage of CLABSIs (65- 70%) are preventable using evidenced-based guidelines. Strategies to prevent these infections have included a myriad of different preventive maneuvers gathered as “bundles”. These measures have a well established role in the adult ICU setting. We aimed to assess the benefit of the implementation of central-line bundles to prevent CLABSIs in neonatal and pediatric ICU patients, populations where their actual efficacy is yet to be proven. Methods: We searched Cochrane Library, Medline, Latin American and Caribbean Health Science Literature (LILACS), Centre for Reviews and Dissemination (CRD), Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), manual search and gray literature to identify studies reporting the implementation of central-line bundles in pediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 2005, and December 21, 2015, without language restriction. To evaluate the benefit of the central line bundle were selected studies involving at least two components (hand hygiene, maximal barrier precautions, skin antisepsis, optimal catheter site selection and daily review of line necessity) as a preventive measure to patients with central venous catheter (CVC). The outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Results: We initially identified 6369 records, and after excluding duplicates and those ineligible, 31 studies met the eligibility criteria. The studies reviewed were quite heterogeneous both in bundle composition and implementation strategy. Median CLABSIs incidence were 5.9 per 1000 catheter-days (range 2.6–23.1) on PICUs and 4.9 per 1000 catheter-days (range 2.0–24.1) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 14.9 per 1000 catheter-days (median 2.1) on PICUs and 0.3 to 14.9 (median 2.8) on NICUs. Conclusions: CLABSIs remain a significant problem in neonatal and pediatric critical care units, but implementation of catheter care bundles can significantly reduce rates of these infections. Best practice interventions allow substantial CLABSI reduction by promotion of groups or bundles of procedures and technology, and by use of a multimodal strategy for education, training, implementation, and dissemination.

There isn t a unique development process suitable for all software projects. Standards and quality models such as ISO/IEC 15504, MPS.BR, CMM and CMMI, recommend the process tailoring to satisfy specific project features. However process tailoring is a complex task because it requires knowledge and expertise of who performs. The incomplete or duplicate process elements selection can generate ambiguities which may disturb the project progress and generate distrust in relation to the tailored process. This dissertation presents a systematic strategy to completeness and internal consistency validation of the elements that are part of the tailored process, call fragments. The aim is to contribute to improving the software development process quality and help the process engineer on the process tailoring task, providing complete and consistent process elements which are prioritized according to the project features. To support the proposed strategy have benn developed: i) ontology to similarity recognition among process; ii) a metamodel for process tailoring; iii) a web toll for complete and consistent process definition. The proposed strategy facilitates the work of the engineer showing which elements are adequate (complete and consistent) to be part of the tailored process and enables the elimination of inconsistences lead to improving the process. / Não existe um modelo de processo de desenvolvimento único para ser adotado para todos os projetos de software. Normas e modelos de qualidade como a norma ISO/IEC 15504, MPS.BR, CMM e o CMMI preconizam que a adaptação de processos seja realizada para satisfazer às necessidades específicas dos projetos. Entretanto, a atividade de adaptar um processo de software é considerada uma tarefa complexa, exigindo conhecimento e experiência de quem a realiza. A seleção de elementos de processo incompletos, ou duplicados podem gerar ambiguidades que podem comprometer o andamento do projeto e gerar desconfiança para com o processo adaptado. Esta dissertação apresenta uma estratégia sistemática para validação da completude e consistência interna dos elementos formadores do processo adaptado, neste trabalho chamados fragmentos. O objetivo é contribuir para a melhoria da qualidade dos processos de desenvolvimento de software adaptados e auxiliar o engenheiro de processos na tarefa de adaptação de processos, fornecendo elementos de processo completos, consistentes e priorizados de acordo com as características do projeto. Para apoiar a proposta, foram desenvolvidas: i) uma ontologia para reconhecimento da similaridade em processos; ii) um metamodelo para adaptação de processos e iii) uma ferramenta web para definição de processos completos e consistentes. A estratégia proposta facilita o trabalho do engenheiro de processos informando para este quais elementos são adequados (completos e consistentes), e possibilita a eliminação de inconsistências levando a melhoria do processo.

Made available in DSpace on 2016-06-02T19:50:28Z (GMT). No. of bitstreams: 1 TeseABS.pdf: 2232752 bytes, checksum: a1757428e1651e0e6c2121d798b0d831 (MD5) Previous issue date: 2006-02-09 / With the growth of customer demand level, at last two decades it appeared quality improvement approach focusing customer satisfaction as the way to the organizations improve the efficiency and effectiveness of their processes. Though this, to get their aim, it was necessary broke some paradigms; to stimulate creativity; to innovate; to intensify the effort to reduce processes variation; and above all to assume customer satisfaction in all operations as a priority. Six Sigma approach has been solidifying as an efficient alternative to organizational growth on the strength of quality levels elevation. But, how can we define Six Sigma? Making a theoretical and conceptual research several definitions founded in literature were rescued and examined with purpose to compose a broader definition which translates better Six Sigma meaning. About structure of Six Sigma Quality Program (PQSS), this thesis became as a link between theory and practice when it aided others theories to Six Sigma context and when it used empirical subsidies to identify and evaluate the essential components to structure the PQSS. The empirical subsidies were obtained from qualitative research (case studies) involving four Brazilian subsidiaries of American multinational companies. After to analyze the empirical evidences, it was possible to formalize a set of arguments to purpose a Reference Model to structure the PQSS. This model is sustained by the followings components: strategic orientation; statistical thinking; performance measurement; Six Sigma methodology; and people graduation and qualification. To evaluate the Reference Model it was developed a quantitative research based in Green belts, Black belts and Master Black belts information. Statistical results showed that each one of these components has a meaningful relevance to compose the minimal structure to the PQSS. As principal conclusions this thesis highlights: (1) the PQSS as an integrator program of strategic and operational objectives; (2) strategic orientation and alignment are fundamental to define Six Sigma projects; (3) the use of performance measures increases the potential of Six Sigma projects; (4) its not clear for many specialists that statistical thinking is a background to PQSS; (5) Six Sigma projects are catalysts of a system which uses these projects to reflect it strategic orientation and customer focus importance to get measurable results; and (6) the Reference Model can be valid and can be utilized to structure or re-structure the PQSS implementation. / Com o aumento do nível de exigências dos clientes, as iniciativas de melhoria da qualidade que surgiram nas últimas duas décadas focaram fortemente a satisfação do cliente como o caminho para as organizações aumentarem a eficiência e a eficácia de seus processos produtivos. Todavia, para trilharem este caminho, foi necessário quebrar paradigmas; estimular a criatividade; inovar; intensificar o esforço em reduzir a variação dos processos; e, sobretudo, priorizar a satisfação dos clientes em todas as operações. O Seis Sigma é uma abordagem que vêm se consolidando como uma forma eficiente de crescimento organizacional, decorrente da elevação dos níveis de qualidade. Mas, afinal, como Seis Sigma é definido? Por meio de uma pesquisa teórico-conceitual, diversas definições encontradas na literatura foram resgatadas e analisadas visando compor uma definição mais ampla, e que traduza melhor a abrangência do Seis Sigma. No tocante ao Programa de Qualidade Seis Sigma (PQSS), esta tese trouxe um enlace de teoria e prática ao incorporar outras teorias ao contexto do Seis Sigma, e ao agregar subsídios empíricos para identificar e avaliar componentes que são essenciais para estruturar o PQSS. Estes subsídios decorreram de uma pesquisa com abordagem qualitativa realizada com quatro subsidiárias brasileiras de empresas multinacionais americanas (estudo de casos). Após análise das evidências empíricas foi possível formalizar um conjunto de argumentos que levaram a proposição de um Modelo de Referência para estruturar o PQSS, o qual é sustentado basicamente pelos seguintes componentes essenciais: orientação estratégica; pensamento estatístico; medição de desempenho; metodologia Seis Sigma; e capacitação/especialização das pessoas. Uma avaliação preliminar do Modelo de Referência é apresentada logo após o modelo ter sido proposto e detalhado. Esta avaliação foi realizada com base em uma pesquisa empírica com abordagem quantitativa que envolveu Green belts, Black belts e Master black belts. Realizada a análise estatística, os resultados obtidos revela ram, entre outros pontos, que cada um dos componentes considerados no Modelo de Referência possui uma relevância significativa para estruturar o PQSS. Como conclusões a tese destaca que: (1) o PQSS é um programa integrador dos objetivos estratégicos e operacionais que facilita o direcionamento e a implementação dos projetos Seis Sigma; (2) a orientação estratégica e o alinhamento são priorizados na definição dos projetos Seis Sigma; (3) o uso de indicadores de desempenho aumenta o potencial dos projetos Seis Sigma; (4) ainda não há uma compreensão de que o pensamento estatístico consiste num pano de fundo para o PQSS; (5) os projetos Seis Sigma são catalisadores de um sistema que reflete, por meio destes, a visão estratégica e a importância do foco no cliente para se conseguir resultados mensuráveis que impactam em uma ou mais dimensões do sistema de medição do desempenho organizacional; e (6) há evidências de que o Modelo de Referência pode ser válido, o que permite que ele seja utilizado para estruturar ou re-estruturar o PQSS.

Introdução: As infecções primárias da corrente sanguínea associadas ao cateter venoso central (IPCS) são um grande problema nas unidades de terapia intensiva (UTI) pediátricas e neonatais em todo o mundo. Evidências sugerem que a prevenção das IPCSs é crucial para o atendimento seguro ao paciente. Uma percentagem significativa (65-70%) das IPCSs são evitáveis utilizando as estratégias baseadas em evidências, incluindo os bundles. Estas medidas têm um papel bem estabelecido em pacientes adultos.O objetivo deste estudo foi avaliar, a partir de uma ampla revisão sistemática da literatura, o benefício da implementação do bundle do cateter central na prevenção das IPCSs em pacientes pediátricos e neonatais internados em UTI. Métodos: Foram pesquisadas as bases de dados Cochrane Library, Medline, Latin American and Caribbean Health Science Literature (LILACS), Centre for Reviews and Dissemination (CRD), Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), além de busca manual e literatura cinzenta entre 1 de janeiro de 2005 até 31 de dezembro de 2015. Não houve restrição dos estudos com relação ao idioma, a data ou status de publicação. Para avaliar o benefício do bundle do cateter central, foram selecionados estudos envolvendo pelo menos dois componentes (higiene de mãos, precauções de barreira máxima, antissepsia da pele, seleção adequada do sítio do cateter, revisão diária da necessidade do cateter) como medida preventiva para pacientes com cateter venoso central (CVC). O desfecho foi o número de IPCSs por 1000 cateteres-dias antes e depois da implementação do bundle. Resultados: Foram identificados inicialmente 6369 estudos, após a exclusão dos títulos duplicados e os inelegíveis, 31 estudos preencheram os critérios de elegibilidade. Os estudos foram heterogêneos tanto na composição do bundle quanto na estratégia de implementação. A mediana da densidade de incidência de IPCS foi de 5.9 por 1000 cateteres-dias (2.6-23.1) nas unidades de terapia intensiva pediátricas (UTIP) e 4.9 por 1000 cateteres-dias (2.0-24.1) nas unidades de terapia intensiva neonatais (UTIN). Após a implementação do bundle do cateter central, a densidade de incidência de IPCS variou de 0 a 14.9 por 1000 cateteres-dias (mediana de 2.1) nas UTIPs e 0.3 a 13.9 (mediana de 2.8) nas UTINs. Conclusões: As IPCSs continuam sendo um problema significativo em unidades de terapia intensiva pediátricas e neonatais, mas a implementação do bundle do cateter central pode reduzir significativamente as taxas dessas infecções. Intervenções assistenciais com as melhores práticas baseadas em evidência permitem uma redução substancial das IPCSs pela promoção de grupos ou bundles de procedimentos e tecnologias, e pela utilização de uma estratégia multimodal para a educação, formação, implementação e divulgação. / Background: Central-line-associated bloodstream infections (CLABSIs) are a major problem in neonatal and pediatric intensive care units (ICUs) worldwide. Evidence suggests that CLABSI prevention is crucial for safe patient care. A significant percentage of CLABSIs (65- 70%) are preventable using evidenced-based guidelines. Strategies to prevent these infections have included a myriad of different preventive maneuvers gathered as “bundles”. These measures have a well established role in the adult ICU setting. We aimed to assess the benefit of the implementation of central-line bundles to prevent CLABSIs in neonatal and pediatric ICU patients, populations where their actual efficacy is yet to be proven. Methods: We searched Cochrane Library, Medline, Latin American and Caribbean Health Science Literature (LILACS), Centre for Reviews and Dissemination (CRD), Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), manual search and gray literature to identify studies reporting the implementation of central-line bundles in pediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 2005, and December 21, 2015, without language restriction. To evaluate the benefit of the central line bundle were selected studies involving at least two components (hand hygiene, maximal barrier precautions, skin antisepsis, optimal catheter site selection and daily review of line necessity) as a preventive measure to patients with central venous catheter (CVC). The outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Results: We initially identified 6369 records, and after excluding duplicates and those ineligible, 31 studies met the eligibility criteria. The studies reviewed were quite heterogeneous both in bundle composition and implementation strategy. Median CLABSIs incidence were 5.9 per 1000 catheter-days (range 2.6–23.1) on PICUs and 4.9 per 1000 catheter-days (range 2.0–24.1) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 14.9 per 1000 catheter-days (median 2.1) on PICUs and 0.3 to 14.9 (median 2.8) on NICUs. Conclusions: CLABSIs remain a significant problem in neonatal and pediatric critical care units, but implementation of catheter care bundles can significantly reduce rates of these infections. Best practice interventions allow substantial CLABSI reduction by promotion of groups or bundles of procedures and technology, and by use of a multimodal strategy for education, training, implementation, and dissemination.

Submitted by Celso Magalhaes (celsomagalhaes@ufrrj.br) on 2017-07-10T13:42:06Z No. of bitstreams: 1 2016 - Emilio Possidente Daher.pdf: 6377828 bytes, checksum: 1b72ec0c17b9c0829e7a5c7abb93866c (MD5) / Made available in DSpace on 2017-07-10T13:42:06Z (GMT). No. of bitstreams: 1 2016 - Emilio Possidente Daher.pdf: 6377828 bytes, checksum: 1b72ec0c17b9c0829e7a5c7abb93866c (MD5) Previous issue date: 2016-01-22 / The objective of this research is to show the contribution of Process Management in the improvements implemented in selected critical processes linked to the Administrative Support Services Sector of the Instituto National de C?ncer Jos? Alencar Gomes da Silva (INCA). Its research topic Process Management and, as a thematic issue, and Analysis Management Process Improvement and inspection services contracts. For this purpose the theorist referencial emphasizes the concepts of Process Management, Administrative Management and Contracts Management and Quality Management. The methodology used in this study was the method of action research, using to collect data to literature, documentary and field research through semi-structured interviews. Involving those responsible for activities related to the investigated processes was established a focus group, making it possible to obtain as a result the diagnosis of the current situation of selected critical processes, draw your business process diagrams (BPD), identify problems, prioritize the resolution and develop an action plan with the implementation of new (BPD) of these processes. It stands out as key benefits: more transparency, fluency and rationality in the process execution, enabling the achievement of improvements in quality and productivity in accountability and management of public resources. / O objetivo desta pesquisa ? apresentar a contribui??o da Gest?o de Processos nas melhorias implementadas nos processos cr?ticos selecionados vinculados ao setor de Servi?o de Apoio administrativo do Instituto Nacional de C?ncer Jos? Alencar Gomes da Silva (INCA). Tem como tema de pesquisa a Gest?o de Processos e, como tem?tica, a An?lise e Melhoria de Processos da Gest?o e fiscaliza??o de contratos de servi?os. Para tal, o referencial te?rico privilegia os conceitos da Gest?o de Processos, Gest?o de Contratos Administrativos e Gest?o da Qualidade. A metodologia aplicada neste trabalho foi o m?todo de pesquisa-a??o, utilizando-se para a coleta de dados a pesquisa bibliogr?fica, documental e de campo por meio de entrevistas semiestruturadas. Com a participa??o dos respons?veis pelas atividades relacionadas aos processos pesquisados foi constitu?do um grupo focal, viabilizando obter como resultados o diagn?stico das situa??es atuais dos processos cr?ticos selecionados, desenhar seus diagramas de processos de neg?cios (DPN), identificar os problemas, priorizar a resolu??o e desenvolver um plano de a??o com a implanta??o de novos (DPN) destes processos. Destacam-se como principais benef?cios: mais transpar?ncia, flu?ncia e racionalidade na execu??o do processo, possibilitando a obten??o de melhorias na qualidade e produtividade na presta??o de contas e na gest?o dos recursos p?blicos.

Inom specialiserad barnsjukvård finns behov av säkerhetsstrategier utvecklade för komplexa adaptiva system. Tillvägagångssätt från ”Resilience Engineering” kan användas när säkerhetsstrategier utvecklas, men erfarenheten av detta är begränsad inom sjukvården. Masterarbetet genomfördes för att utforska hur ett förbättringsarbete kring att utveckla och använda instrumentet ”Resilient Assessment Grid”, RAG, kunde stödja medarbetarnas förutsättningar att arbeta på ett resilient sätt. Förbättringsarbetet genomfördes enligt Nolans förbättringsmodell. Studien var en fallstudie med kvalitativ ansats på en vårdavdelning inom specialiserad barnsjukvård. Studieresultatet visade att arbetet med att utveckla och använda RAG kunde stödja medarbetarnas förutsättningar att arbeta på ett resilient sätt genom att de fick tillgång till ett sätt att mäta förutsättningar för resiliens och genomföra strategiska förbättringsinterventioner. Medvetenheten och kunskapen om patientsäkerhet och resiliens ökade, vilket har lett till en ökad förståelse för verksamheten, och för vad som är viktigt för god patientsäkerhet. Vi har hittills inte kunnat påvisa förbättrade förutsättningar för resiliens genom att använda instrumentet RAG. Innan längre tid förflutit och ytterligare RAG-mätningar gjorts kan vi varken påvisa eller utesluta att förutsättningarna kommer förbättras. Erfarenheterna från masterarbetet kan nyttjas i kommande initiativ, inom komplexa adaptiva system i hälso- och sjukvården, som syftar till att förbättra förutsättningarna för resiliens. / This master´s thesis explores how an improvement work of developing and using the “Resilience Assessment Grid”, RAG, can support the potential for resilient performance on a paediatric ward, in light of the need for new safety strategies developed for complex adaptive systems. A qualitative case study of the improvement work was conducted. The improvement work was done according to the Model for Improvement. The work of developing and using RAG for measuring and managing resilient performance, supported the employees' potential for resilient performance by helping them in implementing strategic improvement interventions. The awareness and knowledge of patient safety and resilience increased, which led to increased understanding of the system and the needs of the system in terms of patient safety. We have not been able to show that the potential for resilient performance has improved by using RAG for measurement. We can neither demonstrate nor exclude that the potential will improve before further measurements have been made. Experience from the present study can be used in future interventions of improving the potential for resilient performance and patient safety in a complex adaptive system in the health care setting.

The first cycle of quality assurance (QA) was conceptualised and developed between 2001 and 2004 as reflected in the policy documents of the Higher Education Quality Committee (HEQC). The HEQC as the national QA agency was created as the permanent sub-committee of the Council on Higher Education (CHE) to take care of the QA responsibility in 2001. The national QA agency had to operate within the divisions created in higher education under apartheid, which often created perceptions based on prejudice about the distribution of quality. The South African higher education landscape has been exposed to the first cycle of the Higher Education Quality Committee QA cycle during which conducted 34 institutional audits, accredited approximately 5000 new programmes, subjected 85 programmes to national reviews, trained approximately 550 institutional auditors and 1500 programme evaluators and conducted many workshops and training opportunities for higher education institutions (HEIs). The main aim posed by this study was to determine the response of HEIs to the recommendations in the HEQC audit reports. The sub-questions of the research are (i) What process was followed to develop the quality improvement plan? (ii) Who were the role-players in the development of the quality improvement plan? (iii) What influenced their actions in the development of the quality improvement plan? (iv) What value did the quality improvement plan development have for the institution? (v) How does the quality improvement plan fit into the comprehensive quality management system of the institution? To answer the research questions, interviews were carried out on six participants. The findings were that the primary research question has been addressed conclusively by the three institutions through the experience of participants. The responses indicate how they have embraced improvement at the respective institutions which in turn have grown as a result of the HEQC audit process. The conclusion was an in depth response to the recommendations in the audit reports, illustrating ownership of quality improvement plan processes within the institutions. From the results of the secondary research questions it is concluded that the participants’ responses provided the richness of the quality improvement plan process in the audit process. The responses reflected and confirmed the processes followed in developing the quality improvement plans and the role and influence of role- players in the quality improvement plan process. The responses reflected the value of this process and revealed how it had been incorporated into the comprehensive annual planning processes of the institutions. The study concludes that the participating institutions responded differently and effectively to the recommendations in the HEQC audit reports, with the improvement reflected in the manner and approach institutions displayed when responding to recommendations, reflecting systematic processes. Copyright / Dissertation (MEd)--University of Pretoria, 2012. / Science, Mathematics and Technology Education / unrestricted

The master thesis is focused on mapping of all the processes that customer goes through before achieving the skiing activity in ski resort Špindlerův Mlýn, currently operated by MELIDA, a.s. In the theoretical part services specifications, Six Sigma methodology and Key Performance Indicators basics are briefly described. The practical part consists of introduction of the ski area, measuring and mapping processes in combination with weak points identification. In order to eliminate weak points previously identified, the process of getting feedbacks from customers was introduced. As a result of this process, actions to eliminate the weak spots, were proposed and will be implemented. In order to maintain the appropriate structure of the thesis, Six Sigma methodology procedures and instruments, were used.