D.Phil.

This study investigated the current practices of quality assurance systems in Ethiopia at national and institutional levels in the light of government’s intended policies and the policies that are being implemented in HEIs. In addition, the study intended to compare the practices of public and private HEIs. It focused on quality assurance in degree-granting public and accredited private higher education institutionsin Ethiopia. For this study, I employed a mixed approach (qualitative as a main and quantitative as a subsidiary approach), combining a comparative case study and a survey to investigate the practices of QA systems in HEIs. Data was gathered from the National QA agency, degree-granting public universities, and accredited private university colleges. In addition, HERQA experts, academic vice presidents, QA directors, research and publication directors, college deans, internal quality reviewers and senior academic staff were involved in the study. Semi-structured interviews with key informants, documentary evidence, and a survey questionnaire form the main evidence base. Content analysis and descriptive statistics were used to analyze the qualitative and quantitative data respectively. Although the study found structured QA processes at national and institutional levels, these were very recent in public HEIs, whereas and a quality culture had been developed in private HEIs. Self-evaluation and external quality audits are common methodologies used by both private and public HEIs. In addition, accreditation is another QA mechanism used by national quality assurance agencies to accredit private HEIs. This study confirmed that there was no QA policy at national and institutional levels to direct QA activities at all levels. This had a negative impact on the effective implementation of the system. Standards could be useful because they provide an institution with a clear idea of an ‘ideal’ end point, something towards which to strive. HEIs should develop their own quality principles and quality indicators for each key area of quality; however, the quality managers of both private and public HEIs did not understand the meaning of quality standards or quality indicators. There was a significant difference between public and private HEIs in the implementation of internal QA systems and their commitment to implementing them. Private HEIs’ top managers were more committed than those of public HEIs. The impact of QA systems on core activities of the institutions also varied from private and public HEIs. / Educational Studies / D. Ed. (Comparative Education)

An Investigational Project Report Submitted to the Faculty of Engineering, University of the W'itwatersrand for the Degree of Master of Science in Engineering. / This investigational project is concerned with quality management in the process plant manufacturing industry. Process plant manufacture can be defined as the design, manufacture and installation of pressure vessels, pipework, heat exchangers, storage vessels, etc., for the power generation, chemical and oil processing industries, food and beverage, metals producing and mining practices for similar quality assurance (Q.A.) and quality control (O.C.) practices to be employed. (Abbreviation abstract) / Andrew Chakane 2018

Os aceleradores lineares representam a mais importante, prática e versátil produtores de raios-X de alta energia em radioterapia. O comportamento funcional destes equipamentos pode variar devido a defeitos eletrônicos, falhas de componentes ou rupturas mecânicas, ou então podem variar devido ao deterioramento e envelhecimento de seus componentes. A manutenção da qualidade dos tratamentos depende essencialmente da estabilidade dos aceleradores e do controle de qualidade das instituições para monitorar desvios nos parâmetros do feixe. O objetivo deste trabalho consiste em avaliar e analisar a estabilidade do fator de calibração dos aceleradores lineares, bem como os demais parâmetros dosimétricos normalmente incluídos em um programa de controle de qualidade em radioterapia. A média dos fatores de calibração dos aceleradores para o período de aproximadamente quatro anos para os Clinacs 600C e 6EX foram (0,998 ± 0,012) e (0,996 ± 0,014), respectivamente. Para o Clinac 2100CD de 6 MV e 15 MV foi (1,008 ± 0,009) e (1,006 ± 0,010), respectivamente, em um período de aproximadamente quatro anos. Através de análises estatísticas nos três aceleradores lineares verificou-se que os coeficientes de variação dos fatores de calibração apresentaram valores inferiores a 2% o que mostra uma homogeneidade nos dados. Através do cálculo da distribuição normal dos fatores de calibração, verificou-se que para os Clinacs 600C e 2100CD, é esperada uma probabilidade de que em mais de 90% dos casos os valores estejam dentro dos limites aceitáveis segundo o protocolo TG-142, enquanto que para o Clinac 6EX é esperado em torno de 85% uma vez que esse acelerador apresentou diversas trocas de componentes. Os valores do TPR20,10 dos três aceleradores são praticamente constantes e dentro dos limites aceitáveis segundo o protocolo TG-142. Pode-se concluir que um estudo detalhado dos dados do fator de calibração dos aceleradores e do TPR20,10 a partir de um ponto de vista quantitativo, é extremamente útil em um programa de garantia de qualidade. / The linear accelerators represent the most important, practical and versatile source of ionizing radiation in radiotherapy. These functional characteristics influence the geometric and dosimetric accuracy of therapeutic doses applied to patients. The performance of this equipment may vary due to electronic defects, component failures or mechanical breakdowns, or may vary due to the deterioration and aging of components. Maintaining the quality of care depends on the stability of the accelerators and quality control of the institutions to monitor deviations in the parameters of the beam. The aim of this study is to assess and analyze the stability of the calibration factor of linear accelerators, as well as the other dosimetric parameters normally included in a program of quality control in radiotherapy. The average calibration factors of the accelerators for the period of approximately four years for the Clinac 600C and Clinac 6EX were (0,998 ± 0,012) and (0,996 ± 0,014), respectively. For the Clinac 2100CD 6 MV and 15 MV was (1,008 ± 0,009) and (1,006 ± 0,010), respectively, in a period of approximately four years. Statistical analysis of the three linear accelerators was found that the coefficient of variation of calibration factors had values below 2% which shows a consistency in the data. By calculating the normal distribution of calibration factors, we found that for the Clinac 600C and Clinac 2100CD, is an expected probability that more than 90% of cases the values are within acceptable limits according to the TG-142, while for the Clinac 6EX is expected around 85% since this had several exchanges of accelerator components. The values of TPR20,10 of three accelerators are practically constant and within acceptable limits according to the TG-142. It can be concluded that a detailed study of data from the calibration factor of the accelerators and TPR20,10 from a quantitative point of view, is extremely useful in a quality assurance program.

In 2004, the Saudi Higher Education Supreme Council (HESC) established the National Commission for Academic Accreditation and Assessment (NCAAA). According to the Secretary General of the NCAAA, introducing this system at the national level was essential for economic and social development in Saudi Arabia. The emergence of the NCAAA represents the central focus of this thesis, specifically in relation to the NCAAA’s role in improving the educational process in Saudi higher education institutions (HEIs). The overarching objective was to explore and describe the present engagement within Saudi higher education with the recommendations made by the NCAAA directed towards the enhancement of the quality of student learning, with the intention of identifying whether the attributes of the Saudi higher education system were consistent with these recommendations. This overarching objective was further divided into the following three more specific objectives: a) To explore administrators’ (i.e. faculty deans’) perceptions of the extent to which the recommendations made by the NCAAA have been adopted in two public Saudi universities. b) To explore teachers’ perceptions of their practice, considering comparisons between the two institutions. c) To explore the students’ experiences, again considering comparisons between the two institutions. The above objectives drove the data collection process, and these data constituted the empirical base of the study. The research was conducted in two public universities located in two geographically distinct provinces of Saudi Arabia. Data were collected from three groups of stakeholders, including senior administrators, teachers and students. This was done by means of individual interviews with 11 senior administrators and the collection of survey data from 78 teachers and 430 students, who were recruited from 11 faculties across the two institutions. Semi-structured interviews with senior administrators focused on their personal views and opinions of the educational process with respect to student learning, in order to identify the extent to which their faculty/unit was engaged with the NCAAA recommendations. The questions in the teacher and student surveys were derived from the recommendations published by the NCAAA with regard to the improvement of the educational process, and focused on their teaching practice and learning experiences respectively. The qualitative analysis of the administrators’ data suggested some differences in terms of how the two institutions engaged with the NCAAA’s recommendations and thus I adopted a comparative approach to the analysis of the teachers’ and students’ responses. A factor analysis was carried out to further clarify the themes present in the surveys from the perspectives of both teachers and students, and descriptive analyses were then used to explore the extent of resonance with the recommendations of the NCAAA. Inferential statistics were applied to investigate any differences between the two institutions against the outlined themes. The administrators’ responses at both institutions indicated that there was room for improvement in adopting the NCAAA’s recommendations. While the perceptions of teachers at both institutions seemed to suggest compliance with these recommendations, the statements of the students were more congruent with those of the administrators. The findings of the study indicate that there is yet some way to go towards the realisation of the aspirations of the NCAAA. They further suggest the desirability of a greater degree of student involvement in the evaluation of the quality of the educational process. Finally, the transformation of a series of recommendations for quality enhancement into a culture of quality within an individual institution is a process that can be expected to take some time. The study, while indicating a degree of commitment to, and espousal of, the recommendations of the NCAAA, suggests that there is some considerable way to go before this will be seen to impact directly and significantly on the student experience.

Digitized by Kansas Correctional Industries

Os aceleradores lineares representam a mais importante, prática e versátil produtores de raios-X de alta energia em radioterapia. O comportamento funcional destes equipamentos pode variar devido a defeitos eletrônicos, falhas de componentes ou rupturas mecânicas, ou então podem variar devido ao deterioramento e envelhecimento de seus componentes. A manutenção da qualidade dos tratamentos depende essencialmente da estabilidade dos aceleradores e do controle de qualidade das instituições para monitorar desvios nos parâmetros do feixe. O objetivo deste trabalho consiste em avaliar e analisar a estabilidade do fator de calibração dos aceleradores lineares, bem como os demais parâmetros dosimétricos normalmente incluídos em um programa de controle de qualidade em radioterapia. A média dos fatores de calibração dos aceleradores para o período de aproximadamente quatro anos para os Clinacs 600C e 6EX foram (0,998 ± 0,012) e (0,996 ± 0,014), respectivamente. Para o Clinac 2100CD de 6 MV e 15 MV foi (1,008 ± 0,009) e (1,006 ± 0,010), respectivamente, em um período de aproximadamente quatro anos. Através de análises estatísticas nos três aceleradores lineares verificou-se que os coeficientes de variação dos fatores de calibração apresentaram valores inferiores a 2% o que mostra uma homogeneidade nos dados. Através do cálculo da distribuição normal dos fatores de calibração, verificou-se que para os Clinacs 600C e 2100CD, é esperada uma probabilidade de que em mais de 90% dos casos os valores estejam dentro dos limites aceitáveis segundo o protocolo TG-142, enquanto que para o Clinac 6EX é esperado em torno de 85% uma vez que esse acelerador apresentou diversas trocas de componentes. Os valores do TPR20,10 dos três aceleradores são praticamente constantes e dentro dos limites aceitáveis segundo o protocolo TG-142. Pode-se concluir que um estudo detalhado dos dados do fator de calibração dos aceleradores e do TPR20,10 a partir de um ponto de vista quantitativo, é extremamente útil em um programa de garantia de qualidade. / The linear accelerators represent the most important, practical and versatile source of ionizing radiation in radiotherapy. These functional characteristics influence the geometric and dosimetric accuracy of therapeutic doses applied to patients. The performance of this equipment may vary due to electronic defects, component failures or mechanical breakdowns, or may vary due to the deterioration and aging of components. Maintaining the quality of care depends on the stability of the accelerators and quality control of the institutions to monitor deviations in the parameters of the beam. The aim of this study is to assess and analyze the stability of the calibration factor of linear accelerators, as well as the other dosimetric parameters normally included in a program of quality control in radiotherapy. The average calibration factors of the accelerators for the period of approximately four years for the Clinac 600C and Clinac 6EX were (0,998 ± 0,012) and (0,996 ± 0,014), respectively. For the Clinac 2100CD 6 MV and 15 MV was (1,008 ± 0,009) and (1,006 ± 0,010), respectively, in a period of approximately four years. Statistical analysis of the three linear accelerators was found that the coefficient of variation of calibration factors had values below 2% which shows a consistency in the data. By calculating the normal distribution of calibration factors, we found that for the Clinac 600C and Clinac 2100CD, is an expected probability that more than 90% of cases the values are within acceptable limits according to the TG-142, while for the Clinac 6EX is expected around 85% since this had several exchanges of accelerator components. The values of TPR20,10 of three accelerators are practically constant and within acceptable limits according to the TG-142. It can be concluded that a detailed study of data from the calibration factor of the accelerators and TPR20,10 from a quantitative point of view, is extremely useful in a quality assurance program.

The healthcare industry, and more specifically the nursing home sector, is changing operations and services due to a healthcare mandates and enactment of the 2010 Affordable Care Act. Such changes are termed quality assurance performance improvements (QAPI), to receive government subsidies and indemnification compensations. The purpose of this single case study was to explore effective strategies implemented by 4 healthcare leaders to comply with QAPI regulations. Total quality management theory was the conceptual framework used in this study. Data were collected through semistructured, open-ended, face-to-face interviews with 4 participants who serve in a management capacity at an organization located in northwest Missouri. Member checking was used to strengthen the credibility and trustworthiness of the interpretation of the participants' responses. The emergent themes from the study were (a) quality planning using systematic and strategic approaches, (b) quality control using business instruments and tools to measure performance and progress, (c) quality assurance through internal and external systematic analysis, and (d) quality improvements using an integrated systems approach. The implications for positive social change include the potential optimization of care provided to consumers in nursing homes by identifying best practices and strategies healthcare and business professionals have used to modify their business processes and operations.

A series of on-farm quality assurance schemes for red meat producers across Australia were developed in the late 1990s in response to increasing global demands for greater accountability within the whole food. The Cattlecare and Flockcare schemes were introduced in 1996 and 1998, respectively, to provide mechanisms for producers to demonstrate that their livestock were free of potential chemical residues, and that they had taken measures to prevent injury or stress to livestock. These schemes were independently audited codes of practice. After several years there was some dissatisfaction with the levels of adoption of these schemes, especially Flockcare. By 2001 just over 5% of all cattle producers and just over 1% of all sheep producers had implemented on-farm quality assurance. This covered nearly 16% of all cattle and 2% of all sheep in Australia, indicating that the larger than average producers were implementing quality assurance. Based on previous studies and anecdotal evidence that there were few current benefits for producers, the aims of this study were to identify the reasons for slow uptake and to quantify factors affecting implementation of on-farm quality assurance in the red meat industry. Surveys of "adopters" and "nou-adopters" of these schemes were developed and implemented in 2000 and 2001. Producers were approached initially by phone and given the options of completing the survey over the phone, by mail or by fax. / Three hundred and forty-seven Cattlecare producers (9% of all certified Cattlecare producers) and 142 Flockcare producers (22% of certified Flockcare producers) across Australia were initially approached. A total of 382 adopter surveys were completed. The level of interest from adopters was remarkable, with a 75% completion rate from telephone approaches and only 9 direct refusals. These producers had over 1.3 million cattle and 0.9 million sheep covered by quality assurance schemes. This represented 5% of the total cattle population (27% of certified cattle) and less than 1% of all sheep (26% of certified sheep) in Australia at that time. There was an extremely large variation in the size of properties surveyed, which reflected the structure of the industry. The producers were asked about what motivated them to implement quality assurance, what were the problems, where could it be improved, how much time and money had they invested specifically into implementing quality assurance, what benefits had they gained (financial and other), how it had changed their management or product offered for sale, and their opinion on various issues associated with quality assurance and food safety. In addition 133 non-adopter surveys were also completed to provide a control data set. These producers had over 0.12 million cattle and 0.48 million sheep on their properties. In general, it was much harder to persuade these producers to participate. It was estimated that about 60% of producers approached refused to participate. These producers were asked similar questions; except that they were asked to estimate (if they could) how much time and money it would take to implement quality assurance. Unfortunately, most of these producers were uninterested or knew little about quality assurance and were reluctant to estimate these values, so the data for these producers was very limited. / Analysis of the adopter data indicated the adoption rates between regions and schemes were significantly different. A benefit cost analysis was completed for the adopters based on estimated time and money invested into quality assurance and the tangible benefits gained from selling certified animals. The resulting net benefits were calculated as annual equivalent annuities. Only about 30% of adopters had gained any tangible benefit, and only half of these (15% of the total analysed producers) had a positive net benefit, and these were all cattle producers. Description of time, effort and money spend by adopting producers was most representative using median values due to the extreme data from some producers. Overall, implementation took a median of 13 days in the initial year and 6 days in subsequent years per property, and the median cost was $1,200 in the initial year and $500 in subsequent years. This investment of time and money equated to a median cost of $875 per year. The median net financial loss per year from adopting quality assurance was $660 per property or $2 per 100 DSE of livestock managed. Producers indicated that they were implementing quality assurance to gain financial and market benefits; but, with only 15% of producers gaining a positive net benefit, some producers were disappointed with the schemes. However they did report improvements in product (15% of producers) or management practices (90% had at least one). / Improvements in product included livestock were free from chemical residues, cattle were dehorned and yards had been improved so bruising was reduced. Improvements in management practices included improved record keeping, chemical control and livestock handling. While producers mostly believed it was the right thing to do for the industry, they indicated that they would need to be rewarded for their efforts at some stage. Adopters and non-adopters had different motives for implementing quality assurance. Peer pressure, market advantage and increased returns (27%, 26% and 18% of producers, respectively) were cited as the three major prompts for adopters. All the other categories of reasons for adoption were not business-based, but more emotional. Non-adopters, however, cited increased returns, market advantage and supply chain pressure (44%, 7% and 6%, respectively) as possible prompts to implement quality assurance. Difficulties in adoption actually experienced by adopters were also different to the difficulties anticipated by non-adopters. Paperwork, actually getting to implementing it and the extra time demands (19%, 13% and 12%, respectively) were the major difficulties for adopters, while time, in costs and paperwork (19%, 16% and 12%, respectively) were the anticipated difficulties for non-adopters. / Twenty-four percent of adopters had not had any difficulties, while 16% of non- adopters anticipated no difficulties. Simplification of initial paperwork, increased demand for quality assured livestock and a need to promote the schemes and the associated benefits to producers were the three highest ranking categories of suggested improvements by adopters. Non-adopters indicated similar issues but in a different order - a need to promote the schemes and the associated benefits to producers, simplification of initial paperwork and the process of implementation. Grouping producers based on inputs, attitudes, investment or any combination of these indicators failed to provide a statistically significant prediction of the net benefit or loss for a new adopter. The only way to identify or predict which producers would gain a positive net benefit was to focus on the methods of selling livestock. Selling direct to processors either over the hook, with forward contracts or privately appeared to be the only way to gain financial benefits from implementing quality assurance on-farm.

This qualitative, descriptive study explored physiotherapists' experience of participating in peer review in public and private health services in New Zealand. Peer review is a professional activity where one health practitioner evaluates the practice of another. Accordingly, much professional effort has been expended on developing peer review systems and implementing review processes, yet the benefits of peer review are uncertain. A changing legislative environment where producing evidence of ongoing professional development is required, has provided impetus for this study given the limited research to support the use of peer review in this context. While the literature identifies competing focuses on professional development and accountability, there is lack of clarity about which model of peer review is being implemented in this country and which might serve the profession better. This study is a first step in clarifying the issues by identifying the personal, professional and organisational factors that influence health professionals' participation in peer review. The methodology consisted of a qualitative descriptive approach situated within a post positivist paradigm. Seven physiotherapists working in the New Zealand health system who had participated in a peer review process within the last 3 years participated in this study. Semi structured interviews were conducted, guided by broad questions relating to central themes identified during an extensive literature review. Interviews were then audio taped and transcribed verbatim to form the data. Transcripts were analysed by assigning content labels to units of text that seemed to encapsulate one complete thought or idea. The labelled groups were analysed into sub themes. Finally, the general themes that arose were described. Findings indicate that while peer review systems have been developed and are carried out as prescribed, therapists lack clarity about the intended outcomes. While recognising the benefits of receiving feedback on practice, many manage the review process to maintain positive working relationships and ensure their practice is favourably reviewed. The strategies they employ and the consequences of managing peer review in these ways are described. Current peer review processes in New Zealand do not provide reliable information about competence to practice. Neither do they fully achieve their potential as a professional development tool. Therefore, the professional emphasis and effort on peer review needs to be revisited. The findings highlight the need for consultation amongst individual physiotherapists, physiotherapy managers, physiotherapy professional organisations, and the registration board, to negotiate whether regulatory or professional development needs will drive peer review processes in New Zealand in the future.