Ventilator-associated pneumonia (VAP) is a healthcare-associated infection (HAI), or more specifically, a healthcare-associated pneumonia (HAP) that can lead to significant morbidity and mortality in hospitalized patients that are being mechanically ventilated. There are established evidence-based guidelines in existence designed to reduce or eliminate VAP from occurring and when properly maintained have been shown to reduce the incidence of VAP. Nurses are at the frontline adhering to the VAP protocol through its integration into their workflow. It is yet unknown what elements of the protocol and workflow contribute to a successful VAP reduction in occurrence and increased patient safety. This program evaluation project, guided by an adapted Systems Engineering Initiative for Patient Safety (SEIPS) model, takes a human-factors approach towards answering these questions. It specifically examines the VAP protocol in a large urban southwestern teaching hospital to evaluate program effectiveness using a human factors approach. Building on the work of Carayon, et al. (2006) and Jansson et al. (2013), I present the findings from this program evaluation project using an adapted SEIPS model that sought to evaluate the VAP prevention program from a human factors perspective addressing the following aims: Aim 1. Determine the effectiveness of using the adapted SEIPS model to evaluate a VAP quality improvement (QI) project; Aim 2. Evaluate a VAP QI program taking a human factors approach; and Aim 3. Using the adapted SEIPS model, identify elements of the VAP bundle that nurses perceive as strength and weaknesses. The project was completed with the following findings: Based on this work the adapted SEIPS model demonstrates usefulness for evaluating QI projects. It would be interesting to continue this work with QI projects to see how well it performs.

Background and Objectives: Tennessee has low breastfeeding rates and has identified opportunities for improvement to enhance maternity practices to support breastfeeding mothers. We sought a 10% relative increase in the aggregate Joint Commission measure of breastfeeding exclusivity at discharge (TJC PC-05) by focusing on high-reliability (≥90%) implementation of processes that promote breastfeeding in the delivery setting. Methods: A statewide, multidisciplinary development team reviewed evidence from the WHO-UNICEF “Ten Steps to Successful Breastfeeding” to create a consensus toolkit of process indicators aligned with the Ten Steps. Hospitals submitted monthly TJC PC-05 data for 6 months while studying local implementation of the Ten Steps to identify improvement opportunities, and for an additional 11 months while conducting tests of change to improve Ten Steps implementation using Plan-Do-Study-Act cycles, local process audits, and control charts. Data were aggregated at the state level and presented at 12 monthly webinars, 3 regional learning sessions, and 1 statewide meeting where teams shared their local data and implementation experiences. Results: Thirteen hospitals accounting for 47% of live births in Tennessee submitted data on 31,183 mother–infant dyads from August 1, 2012, to December 31, 2013. Aggregate monthly mean PC-05 demonstrated “special cause” improvement increasing from 37.1% to 41.2%, an 11.1% relative increase. Five hospitals reported implementation of ≥5 of the Ten Steps and two hospitals reported ≥90% reliability on ≥5 of the Ten Steps using locally designed process audits. Conclusion: Using large-scale improvement methodology, a successful statewide collaborative led to >10% relative increase in breastfeeding exclusivity at discharge in participating Tennessee hospitals. Further opportunities for improvement in implementing breastfeeding supportive practices were identified.

Health care providers gather and track quality patient indicator scores to monitor patients' safety and outcomes and decrease the number of adverse events. Nursing leaders implemented a Quality Workbook Committee (QWC) within a hospital setting to improve patient outcomes and the facility's reported scores for nurse-sensitive patient indicators. The practice-focused question for this quality improvement evaluation project examined whether the implementation of the QWC improved nurse-sensitive patient indicator scores. Watson's theory of human caring was used to evaluate the gap in practice, and Rosswurm and Larabee's model for evidence-based practice change provided guidance for planning the project. Sources of evidence were 2017 end-of-year organization report cards. The 4 specific areas chosen for evaluation were: patient falls, hospital-acquired pressure ulcers, pain reassessment scores, and medication scanning rates. Results from an analysis of variance showed improvements in 3 of the 4-nurse-sensitive patient indicator scores. Hospital-acquired pressure ulcers decreased by 13 pressure ulcers, pain reassessment rates increased by 18.42%, and medication scanning scores increased by 4.03%. However, patient falls increased by 15, suggesting the need for further evaluation measures. Project findings may help nursing leaders to improve nurse-sensitive patient indicator scores and promote social change by reducing hospital adverse events, length of hospitalization stays, and wasted healthcare resources.

Introduction: with the expanded application of ERP system, business process model-ing, as an essential part of the ERP system implementation, has already attracted in-creasingly attention from the organizations. However, even though with the great signif-icance, there is no specific guideline to indicate the key factors of a business process modeling within the ERP system implementation context, especially from the supplier, customer and consultancy point of view. Accordingly, the authors are interested in the following two research questions:1. What are the factors that ERP customer. Supplier and consultancy focused on when they do business process modeling for an ERP implementation?2. How these factors are ranked and viewed by ERP customers, suppliers and con-sultants?Purpose: This study is an exploratory study aiming at identifying improvement factors for business process modeling within the context of ERP system implementation. addi-tionally, the authors seek to identify the diverse attitudes from the parties involved in the process of ERP implantation, that are supplier, customer and consultancy, towards the significance level of the improvement factors.Method: This research has adopted an inductive approach due to the nature of its re-search questions. Besides, data has been collected through six interviews in in total. And each supplier, consultancy, customer party has been conducted two interviews respec-tively. The six interview companies are with different cultural background. Additionally, secondary data from books, magazines are obtained through documentation as well.Conclusion: The thesis main results show that there are five improvement factors con-cerning the business process modeling within ERP system implementation, involving correctness, clarity, resource efficiency, cultural specification and relevance. Based upon the suppliers, consultancies and customers points of view, correctness, clarity and cul-tural specification can be categorized into basic factors and resource efficiency, rele-vance are grouped as optional factors. Furthermore, from the customers perspective, correctness and clarity ranks at the top two places among those five factors, while con-sultants focus on correctness and resource efficiency first. Besides, suppliers regard cor-rectness as the most fundamental improvement factors for business process modeling.

A decade of heightened awareness concerning safety issues in healthcare since the Institute of Medicine’s awakening call has resulted in a string of counteroffensive measures. The pace of improvement has been slow and not altogether clear. Rates of patient harm are in general now measured by voluntary reporting and indicator measurements. The use of triggers or clues in random nurse-based reviews to enable identification of patient harm is a more effective method for measuring the overall rate of harm in a health care organisation. Measured actual overall rates of patient harm, their variations and patterns during delivery in the south-east health-care region of Sweden are not previously known. Measurement is important to patient safety improvement, as a foundation for accountability, effort selection and keeping track of results. The patient’s voice must also be much clearer in quality and safety improvement efforts in healthcare. The Institute of Healthcare Improvements Global Trigger Tool for measuring adverse events was used to review 1137 deliveries during 2011 in the seven departments (10% of all cases). Mother and new-born were both evaluated. Thirty eight patient harm events per 1000 patient days were identified, correlating to 13% of admissions. Presupposed rates among staff were double this value. Current patient safety indicators are half this value. One third of patient harm events at birth affected the new-born. Twenty different categories of harm were found. This study shows significantly higher rates of patient harm than previously reported. The nurse reviewers defined the method as valuable and a useful method for measuring harm at delivery. Limitations at this stage are no observed changes in health care delivery or clinical outcomes and that value assessment is based entirely on the judgement of the data-abstractors.

BackgroundIn this study, we describe a Quality Improvement (QI) intervention in three radiology departments within the Swedish health care system, with a special focus on access and methodology. AimThe goals for the QI-intervention were to implement best practice for patients with suspected colon cancer, and reduce the Turn Around Time (TAT).The aim of the study was to identify relevant factors for successful QI in order to further develop the organisation to create a system of continuous QI (CQI) for the radiological service. MethodsInitially, a multiprofessional QI-team was formed. To identify waste and areas for improvement, process mapping and lead time analysis were conducted during a collaborative learning approach. A focus group interview was carried out with the participants in the QI-intervention and the local managers, and a qualitative content analysis of the focus group transcript was performed. ResultsBest practise was gradually introduced, and overall access was improved, but TAT was not changed. Four key factors for CQI were revealed; Communication, Engagement, Context, and Patient- and Customer focus. Moreover, the impact of providing useful and reliable measurements to the frontline staff was found to be high DiscussionThe lack of decreased TAT indicates that further redesign of the radiology process is needed. As the impact of measurements was considered high, an improved system for obtaining and providing useful information to all parts in the organization is essential. Moreover, the infrastructure for CQI needs to be developed further, e.g. by clarifying roles, educating in improvement knowledge, and developing multiprofessional meetings. Finally, motivating and engaging staff is crucial to improve healthcare. It is important with a deeper understanding what triggers this, patient centeredness could be one.

Title: The implementation of a football certification system - Overcoming barriers and fulfilling success factors associated with the implementation process    Level: Final assignment for Master Degree in Business Administration   Authors: Robert Carlsson & Emil Ring   Supervisor: Jonas Kågström   Date: 2012 – 05   Aim: The aim of this study is to investigate which factors that influence the implementation process regarding a football quality certification system and especially the certification system in Swedish elite football clubs. We will further look into which factors that are perceived as success factors and which factors that are perceived as barriers.   Method: Our study has the starting point from a previous study made by Carlsson (2011), where barriers and success factors in the implementing phase of the Swedish football certification process was investigated. In this study we wish to develop our understanding of different clubs’ experiences of the certification process, we have therefore used a qualitative approach where we have interviewed four clubs’ playing in Allsvenskan (first division in Sweden).   Result & Conclusions: We can conclude that even though the work with the certification system is fairly new for the Swedish elite football clubs, it appears as they have a satisfying insight into the organizational demands’ of the certification system.   One significant success factor identified in the study is the clubs’ attitude towards the system, where positive attitude overcomes the experienced difficulties associated with the process. Other importing factors that have a major impact of the overall result of the process is having the right prerequisites in terms of staff, time and documentation before implementing the certification system in the club.   Contribution of the thesis: This study has contributed to provide an extensive framework of the possible affecting factors when implementing a football specific quality certification system. Further contribution is the identification of two affecting factors not mentioned in the theoretical framework, communication in the establishing phase and geographical location.   Key words: Football certification system, quality improvement, success factors, barriers, implementation process

Abstract Bachelor’s degree thesis in Business Administration School of Economics and Management, University of Växjö, FEN 330, Spring 2006 Authors: Malin Jansson and Mirja Wynn-Williams Supervisor: Stig Malm How does Good Laboratory Practice improve quality? Background: The quality systems that steer manufacturing of pharmaceutical products from the testing phase to commercial manufacturing are the national and international regulatory frameworks and legislation. Good Laboratory Practice (GLP) is a quality system concerned with the organizational process and the conditions under which non-clinical health and environmental safety studies are planned, performed, monitored, recorded, archived and reported. In Sweden the Medical Products Agency monitors and regulates compliance with the principles of Good Laboratory Practice. Aim: The aim of our thesis is to explore the reasons why companies/laboratories adopt Good Laboratory Practice. We shall do this by identifying the advantages and disadvantages of adopting GLP principles for companies/laboratories, and how quality is improved by adopting GLP principles. We have summarized our aim in one principal question: How does Good Laboratory Practice function as a tool for quality improvement? Limitations: We will focus on GLP, and this thesis will not consider other Good Practice procedures such as Good Manufacturing Practice or Good Clinical Practice. Only laboratories in Sweden monitored by the Medical Products Agency are targeted in the empirical part of this work. Method: Literature research and interviews with GLP contact persons listed by MPA. Results and conclusions: Though costumers’ needs and legislation seem to be the motivations for companies deciding to comply with GLP, quality improvement seems to be the biggest advantage of validation. Proposal for further research: Do laboratory assistants and technical employees differ from management in their experience and views on GLP?

<p>Abstract</p><p>Bachelor’s degree thesis in Business Administration</p><p>School of Economics and Management, University of Växjö, FEN 330, Spring 2006</p><p>Authors: Malin Jansson and Mirja Wynn-Williams</p><p>Supervisor: Stig Malm</p><p>How does Good Laboratory Practice improve quality?</p><p>Background: The quality systems that steer manufacturing of pharmaceutical products from the testing phase to commercial manufacturing are the national and international regulatory frameworks and legislation. Good Laboratory Practice (GLP) is a quality system concerned with the organizational process and the conditions under which non-clinical health and environmental safety studies are planned, performed, monitored, recorded, archived and reported. In Sweden the Medical Products Agency monitors and regulates compliance with the principles of Good Laboratory Practice.</p><p>Aim: The aim of our thesis is to explore the reasons why companies/laboratories adopt Good Laboratory Practice. We shall do this by identifying the advantages and disadvantages of adopting GLP principles for companies/laboratories, and how quality is improved by adopting GLP principles. We have summarized our aim in one principal question: How does Good Laboratory Practice function as a tool for quality improvement?</p><p>Limitations: We will focus on GLP, and this thesis will not consider other Good Practice procedures such as Good Manufacturing Practice or Good Clinical Practice. Only laboratories in Sweden monitored by the Medical Products Agency are targeted in the empirical part of this work.</p><p>Method: Literature research and interviews with GLP contact persons listed by MPA.</p><p>Results and conclusions: Though costumers’ needs and legislation seem to be the motivations for companies deciding to comply with GLP, quality improvement seems to be the biggest advantage of validation.</p><p>Proposal for further research: Do laboratory assistants and technical employees differ from management in their experience and views on GLP?</p>

Background: Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid analgesia. Failure to recognize and respond to OIRD may result in respiratory arrest, anoxic brain injury, and death. Measuring end-tidal carbon dioxide through the use of capnography has been shown to detect early signs of OIRD. Early detection of OIRD facilitates the timely rescue of patients on medical-surgical units where critical patient events are less likely to be witnessed. Purpose: The goal of this quality improvement project was to enhance patient safety by decreasing the incidence of OIRD. The aim was to design, implement, and evaluate a multifaceted intervention to improve patient monitoring for OIRD on medical-surgical units through the use of capnography. The intervention included an updated nursing protocol, an electronic order trigger, improved access to capnography monitors, and education to nurses about OIRD and the use of capnography. Methods: The project was conducted over twelve months on ten medical-surgical units at a 489-bed academic medical center in Southern Arizona. Outcomes were measured using pre- and post-intervention point prevalence surveys. Indicators included the number of patients being monitored with capnography and the number of cases of OIRD. A survey of medical-surgical RNs was also conducted to gather their perceptions on the ease of use and effectiveness of capnography. Results: Twelve months after introducing the intervention, there was a statistically significant increase in monitoring frequency, with 2.56 times more patients at high risk for OIRD being monitored with capnography than at baseline (p = .006). Of the 167 RNs surveyed during this project, 99% perceived the portable capnography monitors as easy to use and interpret. However, 71% reported systems issues in obtaining the monitoring equipment, and 65% reported problems with patient adherence. Preliminary data suggest that the incidence of OIRD decreased after one year, although not by a statistically significant amount (p = .876). Implications for Practice: The intervention succeeded in increasing the number of high-risk patients being monitored with capnography, though the increased monitoring did not improve patient outcomes. The RN survey highlighted areas in need of further improvement, such as the supply of monitors and patient education.