Background: Low performance rate of comprehensive diabetic foot examinations (CDFEs) causing health care disparity. Objective: Increasing performance of CDFEs at Phoenix Indian Medical Center, an Indian Health Service (IHS) facility. Design: Before-after design, convenience sample. Setting: An IHS adult ambulatory care clinic in urban Phoenix, Arizona. Target: Four primary care providers (PCPs).Interventions: Utilizing the PDSA framework, a multidisciplinary group of clinical staff developed a process to increase the performance rate of CDFEs. Brainstorming, use of the Ishikawa diagram, and root cause analysis led to identification of factors contributing to low rates of CDFEs in the clinic. The QI intervention addressed multiple aspects of activities related to the CDFE performance, including pre-visit planning, enhanced communication, making equipment for CDFEs accessible to healthcare providers, and requesting patients to remove shoes and socks. Measurement: Weekly performance rate of CDFEs. Results: The results, analyzed with a run chart, showed an upward trend in performance for some providers. The median aggregate performance rates for pre and post intervention were 82.6% and 80.2%, respectively. Limitations: This study should be replicated over a longer time frame with more participants. Two significant weaknesses were identified in this study. The required provider de-identification prevented provider feedback. The data collection method provided CDFE performance data based on provider empanelment. This method of data collection reflects composite team care rather than specific provider behaviors. Conclusions: This multidisciplinary approach to improving the performance rates of CDFEs showed an upward trend for some providers but was not statistically significant. Post intervention CDFE performance rates were not improved. Significance: This study highlights the role of the doctorally prepared advanced practice nurse (DNP) in designing, facilitating and evaluating a practice change project to address the rate of provider performance of CDFE for their AI/NA patients. An exemplar, this QI intervention can be replicated for quality improvement initiatives targeting improved healthcare outcomes, crucial to the national effort of addressing healthcare disparities.

This study focuses on valuation of natural resources and particularly valuation of the quality of a natural resource. The aim is to value an improvement of water quality, measured as sight depth, in the bay Himmerfjärden in the Stockholm archipelago. It is desirable to attain a value of a one metre sight depth improvement in Himmerfjärden and to analyse how a sight depth improvement affects the demand for travelling to Himmerfjärden. A condtional logit model is applied to obtain these values from survey data. The benefits of a one metre sight depth improvement in Himmerfjärden, will yield 162 260-1 599 420 SEK per year, adjusted to the price level of 2007. The estimated value depends on how travel time is treated and whether a commute variable is included or not. Furthermore will a one per cent sight depth improvement in Himmerfjärden increase the demand for travelling to Himmerfjärden with approximately 0.13-0.18 trips on a given choice occasion. These results indicate that there are values attained to the quality of a natural resource.

No description available.

Bakgrund: Högre grad av automation i lager har blivit en viktig och tilltagande trend. Lager är en viktig komponent i de flesta flöden och essentiellt i strävandet av önskade servicenivåer då de ofta verkar i det avslutande stadiet i flöden där ordern förbereds och levereras till kund. Den ständigt växande konkurrensen på marknaden har dock lett till att lagerverksamheter ständigt måste arbeta med kontinuerlig förbättring. Genom eliminering av icke värdeskapande moment skapas förutsättningar för att uppnå effektivare lager och överlag en högre kvalitet i lagerverksamheten. Kvaliteten som erbjuds samt kvalitetens betydelse för kunden är det som utgör den totala kvalitetsnivån, eventuella avvikelser från denna nivå betraktas som brister. Syfte: Syftet med studien är att genom kartläggning beskriva hur påfyllnads- och plockprocessen på den automatiserade delen av Staples lager utförs. Vidare ämnar studien identifiera kvalitetsbrister som uppstår i påfyllnadsprocessen och plockprocessen. Dessutom ämnar studien undersöka de bakomliggande orsakerna för kvalitetsbristerna och ge förslag avseende hur påfyllnads- och plockprocessen kan förbättras. Metod: Studien är en kvaliativ fallstudie på Staples. Datainsamlingen utfördes genom semi-struktuerade intervjuer, direkta observartioner och fokusgrupper. Inledningsvis utfördes processkartläggning för påfyllnads- och plockprocessen, varpå kvalitetsbrister i de båda processerna identifierades. Därefter utarbetades orsakerna bakom kvalitetsbristerna och förbättringsförslag presenterades. Slutsatser: Ett flertal kvalitetsbrister i påfyllnads- och plockprocessen identifierades. Samtliga identifierade kvalitetsbrister kunde härledas till de tre främst förekommande kvalitetsbristerna Staples tillämpar på lagret: Saknas i kolli, Felplock: artikel eller antal och Dålig nedpackning. Bakomliggande orsaker till dessa var avvikande arbetssätt på ZtZ, att produkter faller ur kartong eller skadas på transportbandet och fellevererat till I-iiiPoint. Dessutom var brister i kvalitetsarbetet orsakade av högt produktivitetsfokus, otydliga orsakskoder och bristfällig kostnadsmedvetenhet avseende bristande kvalitet förekommande i alla tre. Genom att faställa mål för kvalitetsförbättring, grundade i identifierade kvalitetsbrister och personalens kompetenser ökar möjligheten för att de ska realiseras och förankras bättre hos personal. För att uppnå kvalitetsförbättring bör ledarskap som uttrycker betydelsen av kvalitet i såväl anvisningar som handling fastställas. Genom utbildning kan personalens förståelse öka avseende deras påverkan på kvalitet och koppling mellan olika aktiviteter och resultera i ökat kvalitetsansvar. För att upprättahålla kvalitetsförbättring är det viktigt att arbetsrutiner standardiseras samt investeringar på lagret införs.

The quality of care for Swedish patients with acute myocardial infarction (AMI) is continuously increasing. Nevertheless, a great potential for improvement still exists. The aim of the present study was to design and implement a systematic quality improvement (QI) collaborative in the area of AMI care, and to validate its usefulness primarily by analyzing its effect on hospital adherence to national guidelines. Also, the impact on patient morbidity and mortality was to be evaluated. The intervention was based on proven QI methodologies, as well as interactive use of a web-based quality registry with enhanced, powerful feedback functions. 19 hospitals in the intervention group were matched to 19 similar control hospitals. In comparison with the control group, the intervention group showed significantly higher post-interventional improvements in 4 out of 5 analyzed quality indicators (significance shown for ACE-inhibitors, Clopidogrel, Heparin/LMWH, Coronary angiography, no significance for Lipid-lowering therapy). From baseline to the post-intervention measurement, the intervention hospitals showed significantly lower all-cause mortality and cardiovascular re-admission rates (events per 100 patient-years; -2,82, 95% CI -5,26 to -0,39; -9,31, 95% CI -15,48 to -3,14, respectively). No significant improvements were seen in the control group. The improved guideline adherence rates in the intervention hospitals were sustained for all indicators but one (ACE-inhibitors), this during a follow-up measurement three months after study support withdrawal. No effects were seen on any indicators other than those primarily targeted. In conclusion, by combining a systematic QI collaborative with the utilization of a national quality registry, significant improvements in quality of care for patients with AMI can be achieved.

Thesis (M.S. in environmental engineering)--Washington State University, December 2008. / Title from PDF title page (viewed on Apr. 2, 2009). "Department of Civil and Environmental Engineering." Includes bibliographical references.

OBJECTIVE: This study investigated how upper limb post-operative patients defined quality care. We specifically assessed the following three aims: (1) determining patient expectations following upper limb surgery, (2) identifying patient recognized barriers to receiving quality care, and (3) analyzing patient identified areas of improvement in patient education. METHOD: In total, 52 patients, aged 19 – 89 years (mean age: 48 years) who received upper limb surgery were surveyed with an open-ended questionnaire during their six to eight week post-operative visit at Stanford Medicine Outpatient Center in Redwood City or Stanford Orthopaedic Surgery Clinic in Los Gatos. Responses were electronically transcribed to REDcap, Research Electronic Data Capture System, for analysis of responses to demographic questions. Open-ended questions were evaluated by thematic analysis until data saturation was reached. RESULTS: Thematic analysis of open-ended responses revealed three main themes: (1) Pain, (2) Function; and (3) Patient Unpreparedness. Both pain and function involved pre- and post-operative factors. Of our three identified themes, elimination of pain and regaining function were the two main health-outcomes that upper limb patients identified as successful treatments of their condition. Patient unpreparedness was recognized as a main barrier in patients receiving quality care and an important area to improve patient education about their problem and treatment. CONCLUSION: By understanding the desired health outcomes and limitations in achieving those outcomes for post-operative upper limb patients, we can improve how medical care is practiced. Our results highlighted that both process and outcome domains of care are important elements in patients’ definition of quality care when seeking medical treatment for their upper limb problems. Specifically, patients identified that elimination of pain and regaining function were important health outcomes during their care. In order to achieve those desired health-outcomes, we recognized that improvements need to be made with regard to patient education about their health condition and treatment process, in order to foster better physician-patient communication. Overall, our findings support the need for continued focus on patient-centered care to ensure the delivery of quality healthcare to all patients.

An empirical case study about what preschool teachers perceive as meaningful methods regarding the "Quality indicator for the preschool", which is a tool to systematize teachersassessment and progression when working with quality improvement. Swedish law states that the preschool must accomplish a systematic quality improvement. According to my experience, preschool teachers and principals find this aim more or less difficult, more or less meaningful. This is a mandatory part of the curriculum and therefor the preschool needs to make efforts in securing quality. I want to highlight constructive strategies so that preschool teachers perceive working with quality improvement as meaningful. The study is based on qualitative methods and I have interviewedfour experienced preschool teachers. They have been asked about their experience of working with "Quality Indicator forPreschool", as part of working systematically with quality, their way of working and their thoughts on the possible improvements. The theoretical frameworks chosen for analysis are postmodernism, social constructivism and social semiotics. The concepts meaningful and meaningfullness as well as quality are definedin more detail as of how they are used within this context. The result shows that the preschool teachers find "Quality Indicator for Preschool" meaningful because it widens their perspective of their pedagogical work and what can be improved. On the other hand, there are differences in their working methods and approaches. In order for their work to be meaningful, an understanding of how to interpret teaching in relation to the preschool curriculum using documentation and discussion becomes vital. Results also show the importance of the principal implementing structures, participating in work and keeping constructive conversations with the preschool teachers

Abstract For the past few years, electronics manufacturing may have been the victim of its own success. Unlike in heavier industries, rationalization is a concept that was unknown in the sector until only a few years ago and even now, many companies are struggling with cost-cutting measures. Production systems in electronics manufacturing need to be highly flexible because of a varying and evolving environment. Therefore real-time process control and, possibly as a result, production optimization are extremely challenging areas. Traditional approaches often do not work due to a lack of robustness or reliability. For this reason, a new generation of decision support systems is needed in response to some specific problems. The thesis addresses topics such as design of intelligent interfaces for knowledge acquisition and elicitation, use of that knowledge for improved data analysis and diagnostics, real-time feedback control, self-tuning capabilities, and evaluation of optimization methods in discrete processes. Topics covered therefore include the whole scope of a decision support system, from its design through to the evaluation of its performance as well as interaction capabilities as a vehicle for sharing information. The aim of this research is to streamline the development of a new generation of decision support systems by providing tools and methods for a better integration of knowledge in an evolving environment. The main interest lies not only in improved data analysis, but also in better formalization and use of diagnosis. Case studies presented in this thesis demonstrate the practical feasibility of such an approach.

To constantly work with quality improvement is important to maintain a high standard of care. Tanzania is one of many countries facing challenges within the health sector due to constrained resources. Exploring the nurses’ perspective of working with quality improvement  gives a glimpse of the current situation in the Tanzanian health sector. The purpose of this study is to analyse the nurses’ experiences of working with quality improvement. For this study interviews have been conducted and then analysed through a qualitative content inductive analysis. The result showed the nurses’ experiences of obstacles and possibilities when developing the quality of care. Main categories were lack of economy, resources and staff, feeling empowered and healthy team dynamics among colleagues. During the study the authors encountered several obstacles that limited the study. An ethical approval was required, thus only six participants partook in this study. Lack of economy resulted in the biggest obstacle towards improvement as this limited investing in possible assets. The effects of good collaboration between colleagues are shown in many studies to be beneficial for the working atmosphere, which was also found in this study.