O crescimento do número de laboratórios acreditados na ISO 17025:2005, ocasionou, por consequência, um aumento na demanda de diversos serviços relacionados a manutenção destes tipos de sistema. Um Item de grande importância da norma ressalta a importância da garantia da qualidade de resultados de ensaio, uma maneira de se verificar isto é através da participação em um tipo de ensaio interlaboratorial conhecido como programa de ensaio de proficiência ou EP. Este tipo de serviços apresentou um crescimento considerável em sua demanda, especialmente no território nacional, devido a um requisito do próprio INMETRO presente na NIT DICLA-026, o qual exige que um laboratório participe de um EP para que o mesmo se torne elegível a obter a sua acreditação em ISO 17025:2005. Com o aumento em sua demanda, surge o interesse por parte dos provedores de ensaios de proficiência de otimizar seus processos sem que os requisitos da qualidade sejam comprometidos. Uma maneira de se atingir este objetivo é através da modernização de seus sistemas de armazenamento de informação e cálculos para um sistema computadorizado. Entretanto o mercado não apresenta ferramentas especialmente desenvolvidas para esta finalidade, e as utilizadas para isto não apresentam todas as características exigidas pelas normas ISO 17025:2005 e ISO 17043:2011 e, para serem utilizadas neste tipo de ambiente, exigem longos processos de avaliação e validação dos sistemas atuais. Em muitos casos o usuário é forçado a utilizar múltiplos softwares ao longo do processo, tornando todo o processo ainda mais passível de erros e, em casos extremos, gerando erros na apresentação de resultados finais. Portanto, surge a necessidade do desenvolvimento de uma ferramenta computacional especializada e desenvolvida com o foco neste tipo especifico de laboratório, atendendo aos requisitos normativos e trazendo características úteis para uma melhor otimização do processo. / The growth in the number of laboratories certified in the ISO 17025:2005 triggered, therefore, an increase in the demand for several services related to the maintenance of these kinds of systems. One very important topic in the standard emphasizes on the importance of the assurance of the quality of the result obtained, which may be verified by participating in a type of interlaboratory tests known as proficiency testing programs or PT. These types of services have grown considerably in demand., especially in the national territory, due to a requirement of INMETRO present on the standard NIT DICLA-026, which demands that laboratories take place on EP to become eligible for an accreditation in ISO 17025:2005. With its increase in demand, it becomes more interesting for proficiency test providers to optimize their systems all the while without compromising their quality, one of the ways of achieving this objective is through and upgrade on their information storage systems and calculation systems to a computerized one. However, the market does not feature specialized tools developed for this specific task, and the ones being used for this goal do not feature all of the characteristics required by the ISO 17025:2005 and ISO 17043:2011 standards, and, therefore, require a long process of evaluation and validation for being used in this type of environment. In a lot of cases its also common that the enterprise is forced to use multiple software\'s throughout the process, making the entire process more susceptible to mistakes and in extreme cases even generating mistakes that might be present on the end results sent to the client. Therefore, the necessity of developing a specialized computer tool arises, one developed focused specifically on these types of laboratories, complying with every requirement made by the standard and bringing with it useful features for a better optimization of the process.

Nenhuma medição é realizada com perfeição absoluta, uma vez que todos os valores encontrados são aproximações do valor real e todas as medidas, independente de sua finalidade ou qualidade, possuem uma incerteza. A incerteza de medição é um parâmetro associado ao resultado, que caracteriza a dispersão em torno dos seus valores. O conceito de incerteza de medição já é adotado em laboratórios de calibração e também muito aplicado na área de engenharia; no entanto em análises toxicológicas esta abordagem ainda é recente e há poucos relatos na literatura científica. Portanto, este trabalho teve como objetivo o estudo da incerteza de medição em análises toxicológicas confirmatórias de substâncias psicoativas - anfetaminas (anfetamina e metanfetamina), ácido 11-nor-Δ9-tetraidrocanabinol carboxílico (THC-COOH) e benzoilecgonina - em urina, detectados pela técnica de cromatografia em fase gasosa acoplada à espectrometria de massas (GC-MS). A microextração em fase líquida (LPME) mostrou-se eficaz na determinação de THC-COOH, e após a completa validação, o método desenvolvido foi aplicado na quantificação de amostras de urina de referência provenientes do National Institute of Standards and Technology (NIST) dos Estados Unidos da América (SRM1507b - NIST). As principais contribuições para a incerteza do método foram a concentração do analito, a acurácia, seguidos da precisão e do volume de amostra. A incerteza combinada obtida foi equivalente a 8%. A LPME também apresentou-se eficiente para a extração das anfetaminas e a incerteza combinada obtida por este método foi 2,1%. No método de detecção de benzoilecgonina, a principal fonte de incerteza foi a acurácia do método e o resultado da incerteza combinada da análise de uma urina de referência (SRM1508a - NIST) foi 4,8%. Todos os valores de incerteza de medição encontrados em nosso estudo estão de acordo com as normas e referências internacionais e também são condizentes com os valores estipulados pela NIST nos laudos de análise das amostras de referência. / Neither measurement is made with absolute perfection, once all the values are approximations of the actual value and all measures, independent of its purpose or quality, have an uncertainty. Measurement uncertainty is a parameter associated with the result, which characterizes the dispersion around their values. The concept of measurement uncertainty is already used in calibration laboratories and also widely applied in engineering, however, in toxicological analysis, this approach is recent and there are few reports in the scientific literature. Therefore, this work aimed to study the measurement uncertainty in confirmatory toxicological analysis of psychoactive drugs - amphetamines (amphetamine and methamphetamine), acid 11-nor-Δ9-tetrahydrocannabinol carboxylic acid (THC - COOH) and benzoylecgonine - in urine detected by the technique of gas chromatography-mass spectrometry (GC- MS). The liquid phase microextraction (LPME) was effective in the determination of THC-COOH, and after complete validation, the method was applied to the quantification of urine samples of reference from the National Institute of Standards and Technology (NIST) of United States of America (SRM1507b - NIST). The main contributions to the uncertainty of the method were the analyte concentration, accuracy, followed by the precision and the sample volume. The combined uncertainty obtained was equivalent to 8%. The LPME also presented efficient for the extraction of amphetamine and combined uncertainty obtained by this method was 2.1%. In the method of detection of benzoylecgonine, the main source of uncertainty was the accuracy of the method and the result of the combined uncertainty of the analysis of a urine reference (SRM1508a - NIST) was 4.8%. All values of measurement uncertainty found in our study are in accordance with international standards and references and are also consistent with the values stipulated by certificate of analysis of NIST reference samples.

L'assurance qualité est une discipline récente dans le domaine médical, d'autant plus en odontologie. Sa mise en oeuvre passe dans notre discipline essentiellement par l'application de règles d'exigences vis-à-vis des dispositifs médicaux utilisés au sein des cabinets dentaires. Les implants, les piliers, les prothèses implantaires mais également les guides chirurgicaux sont des exemples appliqués au domaine implantaire. Cette technique chirurgico-prothétique se doit d'être exécutée dans les meilleurs conditions avec une exigence optimale : chaque acte pouvant avoir des conséquences sur le patient et/ou l'avenir du traitement. Afin de répondre aux exigences d'assurance qualité du traitement implantaire, il semble que les guides chirurgicaux statiques puissent être un moyen afin d'améliorer le placement implantaire impactant donc la qualité de la thérapeutique mise en place. Dans un premier temps, les notions d'assurance qualité et des dispositifs médicaux sont remis en lumière, notamment au travers du filtre de l'implantologie orale. Ensuite, la qualité du traitement implantaire est discutée : des bases historiques jusqu'aux connaissances d'aujourd'hui. Il est important de maitriser l'évolution de cette technique et des outils associées afin de comprendre et donc d'utiliser les outils diagnostics et thérapeutiques à notre disposition aujourd'hui. Le dernier temps de ce travail constitue l'évaluation des outils actuels en implantologie (CFAO, stéréolithographie, chirurgie guide statique, informatique) au travers d'une étude sur sujets anatomiques. Cette étude évalue la précision du positionnement implantaire avec des guides dits conventionnels et des guides de chirurgie guidée statique. Cette précision est évaluée par comparaison des images préalables de planification et des examens tridimensionnels post-opératoires / The quality assurance is a recent discipline in the medical domain, all the more in odontology. Its implementation passes in our discipline essentially by the application of rules of requirements towards medical devices used within dental surgeries. Implants, abutments, implant’s prosthesis but also the surgical guides are examples applied to the domain. This surgico-prosthetic technique owes be executed in the best conditions with an optimal requirement: every act which can have consequences on the patient and/or the future of the treatment. To meet the requirements of quality assurance of the treatment, it seems that the static surgical guides can be a way to improve the placement of implants thus impacting on the quality of the organized therapeutics. At first, the notions of quality assurance and medical devices are handed in light, in particular through the filter of the oral implantology. Then, the quality of the treatment is discussed: historic bases until the knowledge of today. It is important to master the evolution of this technique and tools associated to understand and thus use tools diagnoses and therapeutic at our disposal today. The last time of this work establishes) the evaluation of the current tools implantologie (CAD-CAM, stereolithography, surgery guides static, IT) through a study on anatomical subjects. This study estimates the precision of the implant’s positioning with conventional said guides and guides of static guided surgery. This precision is estimated by comparison of the preliminary images of planning and the post operative threedimensional examinations

The purpose of this dissertation is to examine the organizational and environmental correlates of hospital EMR use and to examine the relationship between hospital EMR use and performance. Using a theoretical framework that combines resource dependence theory with Donabedian's structure, process, outcome model, a conceptual model is created. To test the hypotheses of this model, logistic regression and Data Envelopment Analysis (DEA) are used. The data included in this analysis come from the AHA, HIMSS, CMS, ARF, and HQA. In the analysis of hospitals correlates of EMR use, three hypotheses were supported, and one was partially supported. Hospital system affiliation, bed size, and environmental uncertainty were found to be positively associated with hospital EMR use. Hospital rurality was found to be associated with EMR use for all categories except one; at every other level of rurality, as the hospital moves on a continuum from least rural to most urban, the likelihood of hospital EMR use also increases. Hospital EMR use was not found to be associated with teaching status, environmental munificence, competition, operating margin, ownership, or public payer mix. In the hospital performance analyses, one hypothesis was supported, and one was partially supported. Regarding quality, hospitals with EMRs were found to provide higher quality than those without EMRs. In efficiency performance, only small hospitals with EMRs were found to be more efficient than hospitals without EMRs. No support was found that hospitals with EMRs improve their efficiency over time more than hospitals without EMRs. Hospital EMR use does vary by certain organizational and environmental characteristics. For this reason, hospitals and policy makers must take action that enables and encourages all hospitals to implement and use EMRs because some hospitals do not have the motivation or resources to begin using EMRs on their own. Hospital EMR use is positively associated with high quality care, thus justifying the practice. Hospital efficiency was not found to be associated with EMR use in medium or large hospitals, but it was found to be associated with EMR use in small hospitals. Interestingly, larger hospitals are more likely to use EMRs than small hospitals. It is possible that the efficiency gains of EMR use in hospitals will not be realized until a standardized, fully interoperable system is developed, allowing health care provides to quickly and easily share the medical charts of their patients.

Clinicians rely heavily on accurate laboratory results to diagnose and treat their patients. Laboratory errors can occur in any area of total testing phases, but more than half of the errors occur in the preanalytical phase. Framed by the total quality management theory, the purpose of this multiple case study was to explore medical laboratory managers' strategies to reduce preanalytical errors. A purposive sample of 2 organizations with laboratories in southern California participated in semistructured face-to-face interviews. Company A had 2 participants and 3 participants participated in the study from Company B. Each participant had at least 5 years of laboratory experience, with a minimum of 2 years of management experience in preanalytical testing, and had completed one project to minimize laboratory errors. Thematic analysis exposed 5 main themes: quality improvement, recognition, reward, and empowerment, education and training, communication, and patient satisfaction. The participants highlighted the need for organizations to concentrate on quality management to achieve patient satisfaction. To achieve quality services, medical laboratory managers noted the importance of employee engagement, education and training, and communication as successful strategies to mitigate preanalytical errors. The recommendation for action is for laboratory leaders to review and apply effective strategies exposed by the data in this study to reduce preanalytical errors in their medical laboratory. Positive implications of this study include reduction of preanalytical errors, increased operational cost, and improved patient experience.

Syfte: Digitalisering av byggbranschen har ökat succesivt de senaste åren i takt med att nya effektiva BIM-verktyg lanseras på marknaden. Med ny teknik effektiviseras föråldrade metoder och kvalitetssäkringen förbättras. BIM som verktyg i produktionsstadiet är ej lika utpräglat som i andra skeden av ett byggprojekt. VVSproduktion överlag präglas av föråldrade metoder och en förnyelse av detta skede ligger i tiden då nya effektiva verktyg utvecklas. BIM360 Build är ett verktyg som är framtaget för att effektivisera byggproduktion. Målet med studien är att genom granskning av utvalda funktioner av BIM360 Build, ge förslag på hur verktyget kan förbättra kvalitetssäkringen, samt att ta fram implementeringsstrategier för verktyget inom VVS-produktion. Metod: Rapporten är en kvalitativ studie med underlag av befintlig forskning inom ämnet. Metoder för insamlad empiri är semistrukturerade intervjuer som utförts på Skanska Sverige AB och Assemblin Ventilation AB samt en dokumentanalys av BIM360 Build. Resultat: Intervjuer på värdföretaget Assemblin Ventilation AB ger en bra inblick i hur ett nationellt stort företag inom ventilationsproduktion arbetar idag. Intervjuer med byggjätten Skanska Sverige AB ger en inblick i hur BIM360 BUILD används efter implementering. Med insamlad empiri kan frågeställningarna besvaras, analyseras och det står klart att BIM-verktyget kan effektivisera många problemområden inom produktionen för Assemblin Vent AB. För en implementering ska lyckas krävs tydliga riktlinjer och strategier från företagsledningen. Konsekvenser: Issues, Cheklist, Equipment och Task är funktioner i BIM360 Build som är ett effektivt verktyg för att öka kvalitetssäkringen inom VVS-produktion. För att säkerställa en effektiv implementering krävs implementeringsstrategier: • Om digitala verktyg som BIM360 Build ska få genomslag krävs det konkreta underlag för att programvaran har fungerat tidigare. • Någon form av expert/support av programmen bör finnas tillgänglig inom organisationen för att underlätta för den äldre generationen. • All personal som ska använda BIM360 Build bör få utbildning om programvaran för att undvika en lång inlärnings- och implementeringsprocess. • En BIM-samordnare bör anställas för att underlätta samordningen i den egna organisationen samt samordningen mellan andra entreprenörer. Begränsningar: Rapporten avgränsas till de fyra funktionerna Issues, Checklist, Euqipment och Task, vilket hanterar avvikelser, egenkontroller, material och delegering av arbetsmoment ute i byggproduktion. Rapporten avgränsar sig till ventilationsbranschen men författarna har förhoppning att resultatet kan generaliseras till övriga installationsgrenar. Nyckelord: kvalitetssäkring, BIM360 Build, implementering, VVS-produktion, digitalisering / Purpose: Digitization of the construction industry has increased successively in recent years as new efficient BIM tools are launched in the market. New technology improves the use of outdated methods and improves quality assurance. BIM as a tool in the production stage is not as pronounced as in the other stages of a construction project. HVAC production, in general, is characterized by outdated methods and a renewal of this stage lies in the time when new efficient tools arrive. BIM360 BUILD is a tool that is designed to make building production more efficient. The aim of the report is to examine the tool BIM360 BUILD and then find out how this tool can increase the quality assurance for HVAC production and to develop implementation strategies. Method: The report is a qualitative study based on existing research within the subject. Methods for collected empirical data are semi-structured interviews conducted at Skanska Sweden AB and Assemblin Ventilation AB and a document analysis of BIM360 Build. Findings: Interviews at the host company Assemblin Ventilation AB provide a good insight into how a nationally large company in ventilation production works today. Interviews with the building giant Skanska Sweden AB gives an insight into how BIM360 BUILD is used after implementation. With collected empirical data, the issues can be analysed, and the BIM tool can streamline many problem areas in the company's production. For an implementation, clear guidelines and strategies are required from management. Implications: Issues, Checklist, Equipment and Task are functions of BIM360 Build which is an effective tool for increasing the quality assurance in HVAC production. Implementation strategies are required to ensure effective implementation: • If digital tools such as BIM360 Build are to be impacted, the proof is required that the software has worked before. • Some form of expert/support of the program should be available within the organization to make it easier for the older generation. • All staff who will use the BIM360 Build should be trained on the software to avoid a lingering learning and implementation process. • A BIM coordinator should be hired to facilitate coordination in their own organization and the coordination between other contractors. Limitations: The report is delimited to the four functions Issues, Checklist, Equipment and Task, which handle deviations, self-checks, materials and delegation of work elements in construction production. The report is limited to the ventilation industry, but the authors hope that the result can be generalized to other installation branches. Keywords: quality assurance, BIM360 Build, implementation, HVAC production, digitization.

This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers??? value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers??? value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation.

The thesis aims to improve treatment dose accuracy in brachytherapy using a high dose rate (HDR) Ir-192 stepping source and in external beam therapy using intensity modulated radiation therapy (IMRT). For HDR brachytherapy, this has been achieved by investigating dose errors in the near field and the transit dose of the HDR brachytherapy stepping source. For IMRT, this study investigates the volume effect of detectors in the dosimetry of small fields, and the clinical implementation and dosimetric verification of a 6MV photon beam for IMRT. For the study of dose errors in the near field of an HDR brachytherapy stepping source, the dose rate at point P at 0.25 cm in water from the transverse bisector of a straight catheter was calculated with Monte Carlo code MCNP 4.A. The Monte Carlo (MC) results were used to compare with the results calculated with the Nucletron Brachytherapy Planning System (BPS) formalism. Using the MC calculated radial dose function and anisotropy function with the BPS formalism, 1% dose calculation accuracy can be achieved even in the near field with negligible extra demand on computation time. A video method was used to analyse the entrance, exit and the inter-dwell transit speed of the HDR stepping source for different path lengths and step sizes ranging from 2.5 mm to 995 mm. The transit speeds were found to be ranging from 54 to 467 mm/s. The results also show that the manufacturer has attempted to compensate for the effects of inter-dwell transit dose by reducing the actual dwell time of the source. A well-type chamber was used to determine the transit doses. Most of the measured dose differences between stationary and stationary plus inter-dwell source movement were within 2%. The small-field dosimetry study investigates the effect of detector size in the dosimetry of small fields and steep dose gradients with a particular emphasis on IMRT measurements. Due to the finite size of the detector, local discrepancies of more than 10 % are found between calculated cross profiles of intensity modulated beams and intensity modulated profiles measured with film. A method to correct for the spatial response of finite sized detectors and to obtain the

<p>The aims of intrapartal care are a healthy mother and child and a positive birth experience for the woman. The aims should be achieved using the least possible number of interventions that is compatible with safety. The overall aim of this thesis was to develop an instrument based on the WHO’s recommendations for care in normal birth, to describe documented intrapartal care in a pre- and post-test following a quality improvement program and to elucidate women’s perceptions of received intrapartal care. The Delphi method was used to develop the instrument. Birth records were scrutinized in the pre-test (n=212) as well in the post-test (n=240). Women’s (n=138) perceptions were collected with a questionnaire.</p><p>An instrument with 69 questions and 24 follow-up questions was developed. The results from the pre-test showed that WHO’s recommendations were only partly followed. Intrapartal care for women at low-risk was similar to care for women at high-risk. Areas for improvement were identified and a quality improvement program was carried out during a two-year period. The post-test showed that the intrapartal care changed towards more adherence to WHO’s recommendations, especially for areas where guidelines were written and for women at low-risk. No statistically significant differences were found for the number of spontaneous vaginal deliveries, mother and child at low-risk after birth, active labour longer than 12 hours or second stage longer than one hour. The result from the women’s questionnaire showed that they to a great extent received care which encompassed practices that are demonstrably useful and should be encouraged. The women’s perceptions were that all received care was of great subjective importance.</p><p>The instrument developed from WHO’s recommendations can be used to examine intrapartal care. Midwives should carry out a risk assessment on the woman’s arrival at the maternity unit and plan the care together with the woman and significant others. Midwives’ documentation needs to change to incorporate interpersonal aspects. Women’s faith in intrapartal care shows the importance of continuous education for midwives in evidence-based care for normal birth. National evidence-based guidelines for intrapartal care need to be developed.</p> / <p>Målet med förlossningsvården är en frisk mor och ett friskt barn samt en för kvinnan positiv upplevelse av förlossningen. Dessa mål skall eftersträvas med minsta möjliga ingrepp i förlossningens förlopp men med bibehållen säkerhet för mor och barn. Det övergripande syftet med denna avhandling var att, utifrån WHO:s rekommendationer avseende vård vid normal förlossning, utveckla ett instrument för att kartlägga barnmorskors dokumenterade förlossningsvård före och efter ett kvalitetsutvecklingsprogram samt belysa kvinnors uppfattningar av förlossningsvård.</p><p>Instrumentutvecklingen genomfördes med Delfimetoden. Förlossningsjournaler granskades vid såväl föremätning (n= 212) som eftermätning (n=240). Kvinnors (n=138) uppfattningar insamlades med en enkät.</p><p>Ett instrument omfattande 69 frågor och 24 uppföljningsfrågor utvecklades. Resultatet av föremätningen visar att WHO:s rekommendationer bara delvis följdes. Vården skilde sig i liten utsträckning för kvinnor med låg- respektive högrisk. Förbättringsområden identifierades och ett kvalitetsutvecklingsprogram genomfördes under en tvåårsperiod. Eftermätningen visar att vården förändrades i riktning mot WHO:s rekommendationer, särskilt för de områden där riktlinjer utvecklats samt för kvinnor i lågriskgruppen. Inga statistiskt signifikanta skillnader noterades beträffande antalet spontana förlossningar, antalet mödrar och barn som var lågrisk efter förlossningen, antalet aktiva förlossningar över 12 timmar och antalet förlossningar med utdrivningsskede över 1 timma. Enkätstudien till kvinnorna visar att de i stor utsträckning erhöll vård enligt den praxis som är bra och bör uppmuntras. Kvinnorna uppfattade genomgående att erhållen vård var av stor subjektiv betydelse.</p><p>Instrumentet med utgångspunkt från WHO:s rekommendationer kan användas vid kartläggning av förlossningsvård. Barnmorskor bör göra en riskbedömning vid kvinnans ankomst till förlossningen och planera vården tillsammans med kvinnan och anhöriga utifrån denna. Barnmorskors dokumentation behöver förändras för att såväl omfatta medicinsk-tekniska som mellanmänskliga aspekter. Kvinnors tillit till förlossningsvården visar på vikten av att barnmorskor erhåller kontinuerlig fortbildning i evidensbaserad vård avseende normal förlossning. Evidensbaserade nationella riktlinjer för vård vid förlossning behöver utvecklas.</p>

Engineering education reform has been a topic of discussion for the last twenty years. The concern has only intensified in recent years as stakeholders strive to improve quality in engineering education. Today, stakeholders are recognizing that one of the keys to successful engineering education reform is in taking a systems view of higher education. Academic departments within the higher education system are organized around academic disciplines for the purpose of creating, transferring, and applying knowledge in three principal areas: teaching, research and service. This study addresses the need for quality improvement in the engineering higher education system by first completing a literature review in order to identify recurring themes on the issue. A proposed systems view is presented. The thesis builds a case for viewing students as the primary stakeholder based on stakeholder theory concepts. The application of a systems view is then used to identify the impacts of the recurring issues on the identified stakeholders of the system. Recommendations are made to address the system’s issues.