BACKGROUND: Adolescent idiopathic scoliosis (AIS) surgery is the most common reason for elective pediatric orthopaedic surgery. Minimization of adverse events is an important goal. Institute of Medicine (IOM) outlined 6 facets of healthcare quality improvement within the acronym STEEEP. Two of these facets, Safety and Timeliness for AIS surgery in Canada, are examined in this thesis. METHODS: A three - part study, using clinical records at the largest Canadian pediatric hospital and CIHI national administrative data, determined i) the relationship between surgical wait times and rates of adverse events, along with determination of an empirically derived access target, ii) accuracy of ICD-10 coding of surgical AIS cases along with an optimal search strategy to identify surgical AIS cases, and iii) the volume – outcome relationships for scoliosis surgery using hierarchical and conventional single level multi-variate regression analysis. RESULTS: Access target of 3 months minimized the adverse events related to waiting. Optimal search strategy for AIS surgical cases using ICD-10 coding required combination of codes as each code in isolation was inaccurate due to limitations in coding definitions. There was no significant volume – outcome relationship using appropriate modeling strategies. CONCLUSIONS: Ensuring timeliness of surgical treatment of less than 3 months is important in surgical cases of AIS given the potential for curve progression in higher risk individuals who are skeletally immature with large magnitude curves at time of surgical consent. At the administrative database level, knowledge of coding accuracy and optimal search strategies are needed to capture a complete cohort for analysis. In AIS, several ICD-10 codes need to be combined. AIS surgery cases captured through this optimal search strategy, revealed no significant volume-outcome relationships with appropriate modeling. Based on these results, minimum volume thresholds and regionalization of care for AIS surgery does not appear to be justified. However, a larger sample size was needed to determine whether there was a clinically significant difference in wound infection and blood transfusion rates. Furthermore, clinical variables, not part of an administrative database such as curve pattern were not included.

The use of formative assessment in the classroom is becoming a more widely used practice and acceptable way to support students’ learning. There are several different strands to the formative concept of assessment for learning as opposed to assessment of learning. This research project looks at one strand of formative assessment, namely, the use of wait-time in the classroom. Three wait-time strategies were investigated and examples of their use are provided in an upper primary situation with three students of lower ability and challenging behaviours. Findings from this brief study show no conclusive evidence to support either the widely recognised use of increased wait-time to support a learner’s needs or the opposing view that brief wait-time, when used with students with behavioural issues, might increase academic responses and improve on-task behaviours. The use of one of the strategies, that of ‘talking partners’, demonstrated a slight increase in academic responses with members of the focus group. This research project, together with limitations and further research suggestions, is discussed.

This is a mixed-methods study investigating parental satisfaction and wait times as parents inquire about an autism spectrum disorder diagnosis for their child in a Northern Ontario community. Satisfaction and wait times of those diagnosed with an autism spectrum disorder (ASD) by a single practitioner were compared to satisfaction and wait times of those diagnosed by the multidisciplinary assessment team in the Sudbury/Manitoulin region (the Autism Diagnostic Team; ADT). No significant differences were noted between groups on satisfaction or wait times. However, ADT group received much more consistent service, with less variation in wait times between clients, and more consistent provision of comprehensive services prior to the diagnostic meeting. Points of interest are noted for practitioners including increased wait times for parents of children with milder forms of ASD and for girls. No differences in wait time or satisfaction were noted between language groups. Content analysis of the qualitative interviews representing mainly single practitioners saw the emergence of themes including difficulty activating the assessment process, concerns regarding the wait, and appointment demands. The importance of professional expertise, empathy, and respectful communication also emerged. Parents felt the experience was deeply distressing and they often experienced abandonment following the diagnostic process. Additionally, parents whose children did not receive a diagnosis often felt confusion about what to do next. Reducing wait times, increasing professional expertise, completing comprehensive assessments, and using truly interdisciplinary teams should continue to be the focus of service improvements that may translate into improved satisfaction.

In a commercial Internet environment, the quality of service experienced by a user is critical to competitive advantage and business survivability. The availability and response time of a distributed software service are central components of the overall quality of service provided to users. Traditionally availability is a measure of service down time. Traditionally availability measures the probability that the service will be live and is expressed in terms of failure occurrence and repair or recovery time. Response time is a measure of the time taken from when the service request is made, to when service provision occurs for the user. Deteriorating response time is also a valuable indicator to denial of service attacks which continue to pose a significant threat to service availability. The concept of the service cluster is increasingly being deployed to improve service availability and response time. Cluster processor replication increases service availability. Cluster dispatching of service requests across the replicated cluster processors increases service scalability and therefore response time. This thesis commences with a review of the research and current technology in the area of distributed software service availability. The review aims to identify any deficiencies within that area and propose critical features that mitigate those deficiencies. The three critical features proposed are in relation to user wait time, cluster dispatching, and the trust-based filtering of service requests. The user wait time proposal is that the availability of a distributed service should reflect both liveness probability level and probabalistic user access time of the service. The cluster dispatching proposal is that dispatching processing overhead is a function of the number of Internet Protocol (IP) datagrams/Transport Control Protocol (TCP) segments that are received by the dispatcher in respect of each service request. Consequently the number of IP datagrams/TCP segments should be minimised ideally so that for each incoming service request there is one IP datagram/TCP segment. The trust-based filtering proposal is that the level of trust in respect of each service request should be identified by the service as this is critical in mitigating distributed denial of service attacks - and therefore maximising the availability of the service A conceptual availability model which supports the three critical features within an Internet clustered service environment is then described. The conceptual model proposes an expanded availability definition and then describes the realization of this definition via additional capabilities positioned within the Transport layer of the Internet communication environment. The additional capabilities of this model also facilitate the minimization of cluster dispatcher processing load and the identification by the cluster dispatcher of request trust level. The model is then implemented within the Linux kernel. The implementation involves the addition of several options to the existing TCP specification and also the addition of several functions to the existing Socket API. The implementation is subsequently evaluated in a dispatcher-based clustered service environment.

Emergency surgeries are serviced by three main forms of capacity: dedicated operating room time reserved for emergency surgeries, alternative (on call) capacity, and lastly, canceling of elective surgeries. The objective of this research is to model capacity implications of meeting wait time targets for multiple priority levels in the context of emergency surgeries. Initial attempts to solve the capacity evaluation problem were made using a non-linear optimisation model, however, this model was intractable. A simulation model was then used to examine the trade-off between additional dedicated operating room capacity (and consequent idle capacity) versus increased re-scheduling of elective surgeries while keeping reserved time for emergency surgeries low. Considered performance measures include utilization of operating room time, elective re-scheduling, and wait times by priority class. Finally, the instantaneous utilization of different types of downstream beds is determined to aid in capacity planning. The greatest number of patients seen within their respective wait time targets is achieved by a combination of additional on call capacity and a variation of the rule allowing low priority patients to utilize on call capacity. This also maintains lower cancelations of elective surgeries than the current situation. Although simulation does not provide an optimum solution it enables a comparison of different scenarios. This simulation model can determine appropriate capacity levels for servicing emergency patients of different priorities with different wait time targets.

The purpose of this research was to develop an algorithm that could predict ramp meter wait time at metered freeway on-ramps throughout the state of Utah using existing loop detector systems on the ramps. The loop detectors provided data in 60-second increments that include volume, occupancy, and the metering rate. Using these data sources, several ramp meter queue length algorithms were applied; these predicted queue lengths were then converted into wait times by using the metering rate provided by the detector data. A conservation model and several variations of a Kalman filter model generated predicted queue lengths and wait times that were compared to the observed queue lengths. The Vigos model—the model that yielded the best results—provided wait time estimates that were generally within approximately 45 seconds of the observed wait time. This model is simple to implement and can be automated for the Utah Department of Transportation (UDOT) to provide wait time estimates at any metered on-ramp throughout the state.

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This study aimed at investigating the effect of an extended teacher wait time on student participation in primary school context. The main purpose of the study was to inquire whether primary level students would participate in the lesson more when they are given extended wait time after questions than those lessons in which they received average wait time. Students&rsquo / attitudes towards receiving extended wait time and teachers&rsquo / opinions about and experiences in applying it were also explored. For this purpose, two fifth grade classes at ihsan Dogramaci Foundation Bilkent Primary School participated in the study. Pre-test and post-test results and first part of the teacher and student questionnaires provided the quantitative data of the study. The qualitative data came from the second part of the questionnaires that were given to the teachers and the students. The analysis of the quantitative data indicated that students who received extended wait time participated in the lesson more than the students who received average wait time. Analysis of the results of student questionnaire indicated that the students were aware of the positive outcomes of being allowed extended wait time. The results of the teacher questionnaire showed that although extending wait time strategy and its outcomes are known by the teachers, it is not widely used in the classrooms.

Long wait times are a global issue in the healthcare sector, particularly in Canada. Despite numerous research findings on wait time management, the issue persists. This is partly because for a given hospital, the data required to conduct wait times analysis is currently scattered across various information systems. Moreover, such data is usually not accurate (because of possible human errors), imprecise and late. The whole situation contributes to the current state of wait times. This thesis proposes a location-aware business process management system for real-time care process monitoring. More precisely, the system enables an improved visibility of process execution by gathering, as processes execute, accurate and granular process information including wait time measurements. The major contributions of this thesis include an architecture for the system, a prototype taking advantages of commercial real-time location system combined with a business process management system to accurately measure wait times, as well as a case study based on a real cardiology process from an Ontario hospital.

Title: Artificial Intelligence in Customer Interactions: A Study on Customers' Perceptionsregarding IVR Services in the Banking Industry Purpose: The purpose of this paper was to explore consumer perspectives on automated IVRcustomer services. Design/methodology/approach: This research paper was conducted qualitatively, where theresearchers developed a framework and a suggested model based on existing research andcollected primary data from eight interviews with open-ended questions. The collected datawas coded so that the researchers could spot patterns in the responses which were thendiscussed in relation to previous studies. Based on the results of the data analysis thedeveloped model was also discussed and revised. Findings: The findings of this study suggest that consumers are skeptical towards IVRtelephone customer service and believe that the service quality would be lower than regulartelephone service. The findings do however show that consumers are willing to try to adjust tonew technology as long as there are alternatives if they are not satisfied. Research implications: Managers should focus on delivering quality service to all of theirconsumers and therefore need to consider how well their services can fulfill the needs of theirconsumers. If the quality of the technology cannot provide the service that is expected there isstill a need for regular telephone customer service or else the company might suffer in thelong run. Originality/value: This study is, to the best of our knowledge, the first to explore the topic ofcustomers perceptions of AI in customer service. Keywords: IVR, AI, Customer Service, Banking, Customer Satisfaction, Wait time, TAM,Technology Acceptance Model, Sweden