With the rapid growth in the hospitality industry, its owners and managers are also facing serious challenges. The industry is becoming more and more competitive. Managers are pressed to find the balance between cutting cost to increase profit and improving the quality of the service/product to increase the value their customers’ experience. Customers are nowadays more aware of the quality of the service or the product provided to them and more than ever before, hospitality owners and managers need to focus on improving their quality. The main objective of the research was to establish whether the implementation of selected Six Sigma principles would result in a measurable improvement in the quality of a hospitality establishment. An analysis was done based on three different feedback systems, some Sig Sigma-inspired changes were made and a post-measurement was done to establish the effect of the changes. The study concluded that the implementation of selective Six Sigma principles, can improve the quality of services and products in hospitality establishments, as well as reducing their process waste in such establishments. / MBA, North-West University, Potchefstroom Campus, 2015

With the rapid growth in the hospitality industry, its owners and managers are also facing serious challenges. The industry is becoming more and more competitive. Managers are pressed to find the balance between cutting cost to increase profit and improving the quality of the service/product to increase the value their customers’ experience. Customers are nowadays more aware of the quality of the service or the product provided to them and more than ever before, hospitality owners and managers need to focus on improving their quality. The main objective of the research was to establish whether the implementation of selected Six Sigma principles would result in a measurable improvement in the quality of a hospitality establishment. An analysis was done based on three different feedback systems, some Sig Sigma-inspired changes were made and a post-measurement was done to establish the effect of the changes. The study concluded that the implementation of selective Six Sigma principles, can improve the quality of services and products in hospitality establishments, as well as reducing their process waste in such establishments. / MBA, North-West University, Potchefstroom Campus, 2015

Healthcare is facing great challenges and psychiatric care is no exception. Extensive attempts to improve quality are made. It is essential to use methods that enable learning from experience, to improve performance. The core feature of Statistical Process Control (SPC), the control charts, are in use in various settings to enable learning and to support quality improvement work, but its use in psychiatric settings are scarce. This master´s thesis explores the usefulness of control charts, in quality improvement work. This was done in a case study at a department of psychosis by addressing two questions related to: a) control chart’s contribution to knowledge on if, when, where and how changes occur, and 2) how usefulness of control charts is perceived at the department. Control charts were applied to important variables and development officer’s and manager’s thoughts on usefulness were analysed using pattern matching. The use of charts shows shifts and differences between wards related to ongoing improvement projects. There is a readiness to start using control charts. The perceived usefulness matches the benefits and challenges identified in literature. Control charts as a tool supporting continuous improvement work in a psychiatric context, has a great potential still awaiting its use.

Bakgrund: Hälso- och sjukvårdens svårigheter att erbjuda hög tillgänglighet till läkare uppmuntrar till överföring av arbetsuppgifter från läkare till sjuksköterskor. Tidigare studier visar att kvalitet, leverans och effektivitet använts för utvärdering av sjuksköterskemottagning. Utvärderingen ges ett mer balanserat perspektiv om även arbetsmiljön följs upp. För att förbättra tillgänglighet och arbetsmiljö införde Hudkliniken i Östergötland sjuksköterskemottagningar för olika diagnosgrupper.   Syfte: Syftet med förbättringsarbetet var att införa sjuksköterskemottagningar för att öka tillgängligheten och samtidigt förbättra kvaliteten, leveransen, effektiviteten och arbetsmiljön. Syftet med studien var att ta tillvara erfarenheter av förändringsarbetet.   Metod: Arbetsgrupper utvecklade och testade sjuksköterskemottagningar i liten skala. Etablerad förbättringsmetodik användes som metodstöd. Mått på kvalitet, leverans, effektivitet och arbetsmiljö definierades. En fallstudie genomfördes för att studera förbättringsarbetet. Individuella intervjuer och fokusgruppsintervjuer genomfördes. Data analyserades via kvalitativ innehållsanalys.   Resultat: Tillgängligheten till återbesök förbättrades delvis. Kvaliteten och effektiviteten förbättrades. Patienterna kunde delvis erbjudas besök när behovet var aktuellt. Sjuksköterskornas ökade kontakt med patienterna förbättrade arbetsmiljön samtidigt som det ökade antalet arbetsuppgifter ökade stressen. Utveckling av flera parallella sjuksköterskemottagningar gav effekt på verksamheten i sin helhet.   Slutsats: Sjuksköterskemottagning kan förbättra tillgängligheten. Erfarenheterna av förändringsarbetet föranleder ytterligare förändring av arbetsinnehållet och arbetsorganisationen. Kvalitet, leverans, effektivitet och arbetsmiljö var värdefulla mått för uppföljning av resultatet. / “Our wishes and their needs” Nurse-led clinics to increase access to healthcare A study of implementing nurse-led clinics at a Dermatology Department   Background: The demand for timely access to healthcare service encourage task shifting from physicians to nurses. Previous studies of task-shifting evaluated quality, delivery and efficiency. Including the work environment in the evaluation can make it more balanced. In order to improve access and the working environment, the Department of Dermatology in Östergötland Region introduced nurse-led clinics for some groups of patients.   Purpose: The purpose of the improvement work was to introduce nurse-led clinics to increase access and improve quality, delivery, efficiency and working environment. The purpose of the study of the improvement work was to identify the experience of the change process.   Methods: Working groups developed and tested nurse-led clinics on a small scale, using common improvement methodology. Measures of quality, delivery, efficiency and the working environment were defined. A case study of the improvement work was conducted. Interviews, individual and focus group, were used to gather data. The data was analyzed via qualitative content analysis.   Results: Access to return visits was partly improved and patients were partly offered appointments right when they needed them. The increased contact between nurses and patients was seen as an improvement to the work environment although the number of tasks also increased nurses stress levels. The simultaneous implementation of several nurse-led clinics affected the clinic as a whole.   Conclusion: Nurse-led clinics can improve patient access. As a result of the improvement work, the tasks and organization within the clinic require additional review. Measures of quality, delivery, efficiency and working environment were useful for performance evaluation.

In the planning and delivery of services the voice and choice of consumers have appeared as the foremost key factors. For a large number of organisations the received feedback from customers about the quality of services, which are the criteria and indication of their level of satisfaction play a crucial role in the improvement of quality. Although across developed western communities, the importance of customers’ views has gained acceptance, few studies have been dedicated to the exploration of the voice of the residents in care homes. The review of the literature regarding residents’ satisfaction and quality in care homes revealed that the voices of residents in care homes are usually not heard or are absent. Moreover, the adoption of quality improvement tools in health care has lagged behind that in other industries and there is generally a failure to use an appropriate methodology in care homes, one based on residents’ voice, for improving quality. As a result, the main aim of this research is to investigate residents’ voice regarding improving their satisfaction in care homes. Further, the researcher seeks to obtain data by using an appropriate methodology to assist care home managers in enhancing the quality of the services they offer by assigning weights to quality indicators pertaining to improving quality and residents’ levels of satisfaction. For this purpose, this research employs both qualitative and quantitative approaches to develop a research process entailing: (1) a comprehensive literature review to recognise the phenomenon; (2) interviews with fifteen older people who lived in three different care homes in order to discover the most important residents’ needs and requirements in such homes; (3) a resident survey with one hundred and two residents in thirty five care homes. These were conducted to assess their preferences for the importance of demanded qualities; their satisfaction with provided services and the attributes of each demanded quality based on the Kano model, in order to identify the priority of improvement. Next, (4) there was the development of the House of Quality (HoQ) to optimize quality to assure residents’ satisfaction; and finally, (5) an evaluation study was conducted with thirteen service providers, in order to assess the accuracy and appropriateness of the methodology. This research has contributed towards a better understanding of the residents’ voice, and applying it for enhancing quality and residents’ satisfaction in care homes. For the first time residents’ requirements are prioritised and classified in this context through accurate methods. Moreover, an understanding of the attributes of care home residents’ needs in relation to a Kano model has been elicited. The novelty of this proposed methodology is in utilising the Quality Function Deployment (QFD) in care homes to translate the voice of residents’ regarding their requirements into service planning. The research methodology and results facilitate care home managers with a hierarchy for improvement planning at both service and executive management levels.

<p>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.</p>

Continuous Quality Improvement (CQI) is a set of constructs, principles, and tools aimed at continually improving organizational processes. While thousands of organizations worldwide have adopted CQI, there are still many gaps in our knowledge of how to get the most out of CQI efforts. This paper addresses several of these gaps, including the limitations of existing CQI theory and the inconsistencies regarding the implementation of CQI at team and departmental levels. After discussing the basic principles of CQI, a framework for understanding and utilizing CQI is offered. Then, the results of 102 interviews, conducted with team leaders and department heads in a large hospital in the Southwestern United States, are presented. These results suggest that CQI team effectiveness is most influenced by goal specificity, team composition, and team leader training in statistical process control (SPC). Other factors, including team leader attitude toward CQI and team CQI skills, were also related to CQI team effectiveness. Departmental results were less clear. Only department head attitude toward CQI was significantly correlated with departmental CQI implementation. Potential meanings and implications of these findings are discussed, suggestions for implementing CQI in teams and departments are offered, and directions for future research are provided.

Background and Rationale: The increasing prevalence of type 2 diabetes, particularly in rural communities, is a major problem facing our nation. Many patients are in poor compliance with ADA guidelines for diabetes management. In addition, patients with diabetes in rural communities often face challenges that can impede management initiatives by health care providers (Utz, 2008). Quality care must be achieved to reduce the likelihood of costly, life-altering, and potentially fatal complications (American Diabetes Association, 2008). To manage chronic diseases effectively and prevent secondary complications, an organized quality review process within the practice setting should be in place to address quality indicators in an ordered and timely manner. Purpose and Aims: The purpose of this project was to develop a quality improvement initiative (electronic diabetes education flow sheet - DEFS) associated with managing type 2 diabetes in a rural, nurse practitioner-managed clinic. The specific objectives were 1) to evaluate the extent to which select type 2 diabetes quality indicators are met; 2) to develop, implement, and evaluate a diabetes education process for a rural, nurse practitioner-managed clinic; and 3) to implement a QI framework clinic personnel can use for future QI initiatives. Methods: The Plan-Do-Study-Act (PDSA) cycle was the framework used to implement the QI initiative. Process and outcome measures were collected for baseline data and the DEFS was developed. Routine evaluation by the QI committee ensured appropriate utilization of the DEFS. Patients receiving initial diabetes education were interviewed to understand their perspective of the education experience. For eight weeks, process data was reviewed to ensure improvements in diabetes education. Results: Data analysis of process measures showed inconsistent documentation of selected quality indicators. Outcome measures were controlled 62% to 70% of the time. Clinical staff successfully integrated the DEFS into patient education and expanded its use to ensure compliance. Limited numbers of patient volunteers prohibited analyzing patient feedback on the education process. Significance: This project demonstrated how QI initiatives can bring about positive changes in patient management. Based on this demonstration of how the PDSA cycle can be used to address clinical concerns, other rural nurse-managed clinics might use a similar method to implement QI initiatives to ensure quality healthcare.

There has been an ongoing debate on quality and what constitutes quality improvement in healthcare for several decades. Several authors identify that defining quality is an important part of that debate, yet recognise that quality is defined differently by different interests (Caper, 1988; Harteloh, 2003). Harteloh's distinction between quality as a property (a descriptive approach) and quality as a category of judgment (a prescriptive approach) has influenced the conception of quality as a property of participation emerging in this research. This is in stark contrast to the wide spread prescriptive approach set out in published accounts of quality and quality improvement. In the mainstream management literature, conventionally organisations are understood as systems and this conceptualisation underpins many published considerations of quality. In this way of thinking, those involved in leading quality improvement are thought to operate as autonomous individuals who design improvement tools and control improvements according to plans. It is taken for granted that it is possible for a powerful individual to step out of the organisational system and treat it as an object for manipulation and change, following the diagnosis of problem areas and gaps. Yet at other times that autonomous individual becomes part of the system and is subject to manipulation and change by others. As with much of the literature of change management, this approach sets "thought" before "action". In other words, "thought" is understood as the formulation of a plan and "action" is the implementation of that plan. In this thesis, it is my contention that this way of thinking leads to a privileging of the more mechanical and cybernetic elements of quality improvement - such as tools and techniques of waste elimination and fault detection, and, of particular interest in this thesis, the use of national targets in the public sector. My research is underpinned by a complex responsive processes perspective (Stacey, Griffin and Shaw, 2000). Central to this theory of human interaction is the importance of understanding everyday experience from the perspective of inquiring into “…just what is it that we are doing in our groups or in our organisations that leads to emergent patterns that are our experience…” (Stacey, 2003c: 32). In this thesis, I take up a key question raised by Stacey (2006) concerning how those working in the public sector institutions are operationalising central government governance requirements. I explore my experience of working locally with nationally determined performance targets for access to emergency care. I argue for consideration of quality improvement as a cult value along the lines defined by Mead (1923). In conceptualising quality improvement in this way, my inquiry focuses on what happens as we try to make sense of the ways in which our daily activities are being influenced by competing ideologies, by power relations that are played out, and by the enabling and constraining aspects of going on together in patterns of conversation. These are the complex social processes of working with targets I refer to in the title of this thesis. It is my contention that this perspective draws attention to quality as a property of our own participation as managers, rather than the more usual exhortations to look for the next tool for instilling quality into the organisation. As such, I argue that this research makes an important contribution to the ongoing debate on quality, as well as managerial practice. I propose that the participative and socially reflexive nature of the qualitative methodology involved provides a practical example of Mode 2 research, addressing what MacLean, MacIntosh and Grant (2002) identify as a current gap in the literature. Finally, I posit a potential contribution to policy making seeking to address a growing recognition from some policy makers regarding what is now being seen as an increasing problematic reliance on traditional, modernist assumptions of programmatic change.

Objective. Analyze quality improvement (QI) education across US pharmacy programs. Methods. This was a two stage cross-sectional study that inspected each accredited school website for published QI curriculum or related content, and e-mailed a questionnaire to each school asking about QI curriculum or content. T-test and chi square were used for analysis with an alpha a priori set at .05. Results. Sixty responses (47% response rate) revealed the least-covered QI topics: quality dashboards /sentinel systems (30%); six-sigma or other QI methodologies (45%); safety and quality measures (57%); Medicare Star measures and payment incentives (58%); and how to implement changes to improve quality (60%). More private institutions covered Adverse Drug Events than public institutions and required a dedicated QI class; however, required QI projects were more often reported by public institutions. Conclusion. Despite the need for pharmacists to understand QI, it is not covered well in school curricula.