Chapter 2
Factors influencing the application and diffusion of CQI in health care
Contents
Introduction
The dynamic character of CQI
A CQI case study
The current state of CQI in healthcare
CQI and the science of innovation
The business case for CQI
Factors affecting successful CQI application
Introduction
CQI is utilized across health care sectors (including primary and preventative care) as well as across geographic and economic boundaries
The need for CQI is increasing
One reason: the safety and quality of care has shown little improvement over the last decade despite best efforts of clinicians, managers, researchers, and involvement of public
This lecture will review a number of factors and processes have been shown to facilitate or impede the implementation of CQI in health care
The Dynamic Character of CQI
CQI methodology is constantly being refined and tested: it is an evolutionary quality improvement mechanism
This is because in response to new challenges, CQI applications develop via continuous, ongoing learning and sharing among disciplines about ways to use CQI philosophies, processes and tools in a variety of settings
The Surgical Safety Checklist:
a CQI Success Story
Checklist CQI methodology orginated in aviation
2001 utilised by Pronovost (2006) in Intensive Care Units as a way of reducing central line infections
Surgical Safety Checklist (SSC) developed by Gawande (2009) is disseminated by WHO across the world
The Surgical Safety Checklist:
a CQI Success Story
Development of SSC depended upon:
Effective leadership
Interdisciplinary teamwork
Use of a PDSA improvement cycle to test, learn and improve
Engagement of a broad range of expertise to improve safety on a global scale
The Surgical Safety Checklist:
a CQI success story
Results vary but after the introduction of the SSC:
Haynes et al. (2009) demonstrated a reduction in complication rates from 11.0% at baseline to 7.0% plus, and a reduction in death rates from 1.5% to 0.8% in eight hospitals in eight cities
The SURPASS group study of six hospitals in the Netherlands, showed a statistically significant decrease in the proportion of patients with one or more complications, from 15.4% to 10.6% (de Vries et al. 2010).
So if Checklists are Successful …
Why aren’t more healthcare providers using CQI tools and processes?
Why is the gap between knowledge and practice so large?
Why don’t clinical systems incorporate the findings of clinical science or copy the “best known” practices reliably, quickly, and even gratefully into their daily work simply as a matter of course?
Limitations of Checklists
May be too simple a tool and what is required is more complex system solutions to quality and safety issues (Bosk et al. 2009).
Problems with checklists are indicative of broader CQI and quality improvement issues in healthcare including:
Process vs. outcome;
Cost vs. benefit vs. value;
Minimum standards required to define evidence for change;
How to balanc ...
The document discusses challenges in transforming healthcare systems and applying systems engineering approaches. It notes that while the US leads in medical advances, gaps remain in translating research into practice. Systems transformation requires integrating changes across multiple levels, sustaining gains over time, and spreading successful redesigns. Implementation science provides frameworks to study how research gets applied in real-world settings. Strategies include incorporating user needs, using data for decision making, and taking account of past implementation studies to promote evidence-based quality improvement.
April 2012 Volume 19 Number 1 NURSING MANAGEMENT32Feat.docxrossskuddershamus
April 2012 | Volume 19 | Number 1 NURSING MANAGEMENT32
Feature Feature
EstimatEs of the number of americans who
die annually from preventable medical errors are
astonishingly high, with studies citing figures of
between 44,000 and 98,000 (american Hospital
association 1999, Kohn et al 2000). as a result,
Us consumer and regulatory bodies have dedicated
considerable human and financial resources
to ameliorating the problem by setting standards
to promote and ensure safety and to mitigate errors.
the Us healthcare industry has, in addition,
entered an era of transparency, with publicly
reported quality and patient safety data, and is
no longer reimbursed for costs associated with
certain preventable or hospital-acquired conditions.
in the coming years, through provisions
made by the Centers for medicare and medicaid
services (Cms) and the recently enacted Patient
Protection and affordable Care act, Us hospitals
will be under pressure to address safety and
quality issues. Reimbursement for hospital care
will diminish and fines will be imposed for not
meeting specified, predetermined quality indicators
(Cromwell et al 2011).
a major movement to encourage institutions
to shift towards a non-punitive and fair culture
of safety and zero errors is gathering momentum.
it is led by several national organisations that
include the Committee on Quality of Health
Care in america/institute of medicine of the
National academies, the institute for Healthcare
improvement and the Us Department of Health and
Human services agency for Healthcare Research
and Quality.
Central to this movement is the incorporation
of strategies developed in the aviation industry,
which include using checklists to foster and ensure
safe practice.
Numerous examples illustrate the success of
checklists in preventing individual episodes of
harm and even fatalities, such as the World Health
organization’s surgical safety Checklist (2009) and
the Checklist manifesto (Gawande 2009). However,
healthcare providers, and nurses in particular,
must be encouraged to look not only at how
checklists are increasingly used in daily practice,
but also how they present a subtle yet requisite
context for ethical decision making. failure to
examine the ethical dimension of such routine
activities may perpetuate rather than prevent unsafe
practices or errors occurring.
Nursing documentation
Documentation is a significant component of
nurses’ daily practice and serves as ‘one important
mechanism used to evaluate care performance
conducted by the caregiver serving as the centre of
nursing activities’ (Cheevakasemsook et al 2006).
Ethics of everyday decision making
Gina Kearney and Sue Penque discuss the responsibility of staff
to document care accurately. Using the example of checklists,
they show how simple omissions can put patient safety at risk
abstract
Evidence suggests that checklists can prevent
episodes of patient harm and they ar.
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
Leading change in healthcare- thesis_Mulondo_160601jerry mulondo
This document summarizes Jerry Mulondo's master's thesis which explored leadership approaches associated with positive change in healthcare. The thesis used narrative analysis of interviews with 19 physician leaders in Sweden. Five major themes were identified: an evidence-informed and problem-focused approach; driving goals from the front; leaders as facilitators; vision guiding leadership; and principles guiding leadership. These themes were linked to leadership theories. The study found that leadership development programs should draw from various leadership theories and develop capabilities for data-informed change processes. Further research is needed on physician leadership and the factors affecting leadership style choices in different healthcare settings.
HS410 Unit 6 Quality Management - DiscussionDiscussionThi.docxAlysonDuongtw
HS410 Unit 6: Quality Management - Discussion
Discussion
This is a graded Discussion
. Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.
Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:
1.
What are the steps in the quality improvement model and how is benchmarking involved?
2. What are the stages in which data quality errors found in a health record most commonly occur?
3. What is the definition of risk management?
4. What are the parts of an effective risk management program?
5. What is utilization review and why is it important in healthcare?
6. What is the process of utilization review?
Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.
NO PHARGIARISM PLEASE!
This is the Chapter reading for this assignment:
Read Chapter 7 in
Today’s Health Information Management
.
INTRODUCTION
Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient's family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.
This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.
In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY
Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of.
This document discusses clinical governance and clinical audits. It begins by defining clinical governance as a framework that holds healthcare organizations accountable for continuously improving quality and standards of care. It then discusses how clinical audits are used to review healthcare practices and identify areas for improvement. The document presents a case study of a clinical audit examining compliance with guidelines for preventing surgical site infections (SSIs). The audit found high rates of compliance, though one patient did develop an SSI. An action plan is proposed to implement a new protocol aimed at further reducing SSIs. Barriers to clinical audits like lack of resources and solutions are also discussed.
This document discusses the need for quality improvement in the US healthcare system. It notes that while the US leads in medical innovation, care is often fragmented and inconsistent. Several organizations have found issues with the accessibility and quality of care received. The objectives of proposed changes are to prioritize patient safety and deliver the highest quality care nationwide through better education and training. The rationale includes reports that many Americans don't receive recommended care, quality varies greatly between groups, and 30% of healthcare spending has no benefit to patients. Literature supports that most medical errors stem from flawed systems and processes, not individuals, highlighting the need for quality and safety improvements.
This document summarizes the current status of research on the digital transformation of healthcare through health information technology (HIT). It finds that while HIT has potential to improve quality and reduce costs, evidence of its actual impacts is mixed. Research has focused on HIT adoption issues and its effects on performance, but results are equivocal, finding both positive, negative, and no effects. The document identifies important areas for further research, including HIT design/implementation, quantifying HIT impacts, and extending the traditional realm of HIT.
The document discusses challenges in transforming healthcare systems and applying systems engineering approaches. It notes that while the US leads in medical advances, gaps remain in translating research into practice. Systems transformation requires integrating changes across multiple levels, sustaining gains over time, and spreading successful redesigns. Implementation science provides frameworks to study how research gets applied in real-world settings. Strategies include incorporating user needs, using data for decision making, and taking account of past implementation studies to promote evidence-based quality improvement.
April 2012 Volume 19 Number 1 NURSING MANAGEMENT32Feat.docxrossskuddershamus
April 2012 | Volume 19 | Number 1 NURSING MANAGEMENT32
Feature Feature
EstimatEs of the number of americans who
die annually from preventable medical errors are
astonishingly high, with studies citing figures of
between 44,000 and 98,000 (american Hospital
association 1999, Kohn et al 2000). as a result,
Us consumer and regulatory bodies have dedicated
considerable human and financial resources
to ameliorating the problem by setting standards
to promote and ensure safety and to mitigate errors.
the Us healthcare industry has, in addition,
entered an era of transparency, with publicly
reported quality and patient safety data, and is
no longer reimbursed for costs associated with
certain preventable or hospital-acquired conditions.
in the coming years, through provisions
made by the Centers for medicare and medicaid
services (Cms) and the recently enacted Patient
Protection and affordable Care act, Us hospitals
will be under pressure to address safety and
quality issues. Reimbursement for hospital care
will diminish and fines will be imposed for not
meeting specified, predetermined quality indicators
(Cromwell et al 2011).
a major movement to encourage institutions
to shift towards a non-punitive and fair culture
of safety and zero errors is gathering momentum.
it is led by several national organisations that
include the Committee on Quality of Health
Care in america/institute of medicine of the
National academies, the institute for Healthcare
improvement and the Us Department of Health and
Human services agency for Healthcare Research
and Quality.
Central to this movement is the incorporation
of strategies developed in the aviation industry,
which include using checklists to foster and ensure
safe practice.
Numerous examples illustrate the success of
checklists in preventing individual episodes of
harm and even fatalities, such as the World Health
organization’s surgical safety Checklist (2009) and
the Checklist manifesto (Gawande 2009). However,
healthcare providers, and nurses in particular,
must be encouraged to look not only at how
checklists are increasingly used in daily practice,
but also how they present a subtle yet requisite
context for ethical decision making. failure to
examine the ethical dimension of such routine
activities may perpetuate rather than prevent unsafe
practices or errors occurring.
Nursing documentation
Documentation is a significant component of
nurses’ daily practice and serves as ‘one important
mechanism used to evaluate care performance
conducted by the caregiver serving as the centre of
nursing activities’ (Cheevakasemsook et al 2006).
Ethics of everyday decision making
Gina Kearney and Sue Penque discuss the responsibility of staff
to document care accurately. Using the example of checklists,
they show how simple omissions can put patient safety at risk
abstract
Evidence suggests that checklists can prevent
episodes of patient harm and they ar.
This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.
Leading change in healthcare- thesis_Mulondo_160601jerry mulondo
This document summarizes Jerry Mulondo's master's thesis which explored leadership approaches associated with positive change in healthcare. The thesis used narrative analysis of interviews with 19 physician leaders in Sweden. Five major themes were identified: an evidence-informed and problem-focused approach; driving goals from the front; leaders as facilitators; vision guiding leadership; and principles guiding leadership. These themes were linked to leadership theories. The study found that leadership development programs should draw from various leadership theories and develop capabilities for data-informed change processes. Further research is needed on physician leadership and the factors affecting leadership style choices in different healthcare settings.
HS410 Unit 6 Quality Management - DiscussionDiscussionThi.docxAlysonDuongtw
HS410 Unit 6: Quality Management - Discussion
Discussion
This is a graded Discussion
. Please refer to the Discussion Board Grading Rubric in Course Home / Grading Rubrics.
Respond to all of the following questions and be sure to respond to two of your other classmates’ postings:
1.
What are the steps in the quality improvement model and how is benchmarking involved?
2. What are the stages in which data quality errors found in a health record most commonly occur?
3. What is the definition of risk management?
4. What are the parts of an effective risk management program?
5. What is utilization review and why is it important in healthcare?
6. What is the process of utilization review?
Please paper should be 400-500 words and in an essay format, strictly on topic, original with real scholar references to support your answers.
NO PHARGIARISM PLEASE!
This is the Chapter reading for this assignment:
Read Chapter 7 in
Today’s Health Information Management
.
INTRODUCTION
Quality health care “means doing the right thing at the right time, in the right way, for the right person, and getting the best possible results.”1 The term quality, by definition, can mean excellence, status, or grade; thus, it can be measured and quantified. The patient, and perhaps the patient's family, may interpret quality health care differently from the way that health care providers interpret it. Therefore, it is important to determine—if possible—what is “right” and what is “wrong” with regard to quality health care. The study and analysis of health care are important to maintain a level of quality that is satisfactory to all parties involved. As a result of the current focus on patient safety, and in an attempt to reduce deaths and complications, providing the best quality health care while maintaining cost controls has become a challenge to all involved. Current quality initiatives are multifaceted and include government-directed, private sectorsupported, and consumer-driven projects.
This chapter explores the historical development of health care quality including a review of the important pioneers and the tools they developed. Their work has been studied, refined, and widely used in a variety of applications related to performance-improvement activities. Risk management is discussed, with emphasis on the importance of coordination with quality activities. The evolution of utilization management is also reviewed, with a focus on its relationship to quality management.
In addition, this chapter explores current trends in data collection and storage, and their application to improvements in quality care and patient safety. Current events are identified that influence and provide direction to legislative support and funding. This chapter also provides multiple tips and tools for both personal and institutional use.
DATA QUALITY
Data quality refers to the high grade, superiority, or excellence of data. Data quality is intertwined with the concept of.
This document discusses clinical governance and clinical audits. It begins by defining clinical governance as a framework that holds healthcare organizations accountable for continuously improving quality and standards of care. It then discusses how clinical audits are used to review healthcare practices and identify areas for improvement. The document presents a case study of a clinical audit examining compliance with guidelines for preventing surgical site infections (SSIs). The audit found high rates of compliance, though one patient did develop an SSI. An action plan is proposed to implement a new protocol aimed at further reducing SSIs. Barriers to clinical audits like lack of resources and solutions are also discussed.
This document discusses the need for quality improvement in the US healthcare system. It notes that while the US leads in medical innovation, care is often fragmented and inconsistent. Several organizations have found issues with the accessibility and quality of care received. The objectives of proposed changes are to prioritize patient safety and deliver the highest quality care nationwide through better education and training. The rationale includes reports that many Americans don't receive recommended care, quality varies greatly between groups, and 30% of healthcare spending has no benefit to patients. Literature supports that most medical errors stem from flawed systems and processes, not individuals, highlighting the need for quality and safety improvements.
This document summarizes the current status of research on the digital transformation of healthcare through health information technology (HIT). It finds that while HIT has potential to improve quality and reduce costs, evidence of its actual impacts is mixed. Research has focused on HIT adoption issues and its effects on performance, but results are equivocal, finding both positive, negative, and no effects. The document identifies important areas for further research, including HIT design/implementation, quantifying HIT impacts, and extending the traditional realm of HIT.
Medical Simulation 2.0: Improving value-based healthcare deliveryYue Dong
This document provides an overview of medical simulation and its applications in healthcare delivery. It discusses how simulation can be used as a tool to systematically analyze complex healthcare systems and processes, identify bottlenecks, and test interventions to optimize quality and safety. Specific applications mentioned include using simulation to study workflows like sepsis care, test user interfaces on clinical tasks and performance, and evaluate new system designs before implementation. The goal is to move from traditional education-focused "Simulation 1.0" to a more integrated "Simulation 2.0" approach that leverages simulation throughout healthcare systems and daily practices.
RESEARCH ARTICLE Open AccessAn organizational perspective .docxronak56
RESEARCH ARTICLE Open Access
An organizational perspective on the long-
term sustainability of a nursing best
practice guidelines program: a case study
Andrea R. Fleiszer1*, Sonia E. Semenic1,2, Judith A. Ritchie1, Marie-Claire Richer1,2 and Jean-Louis Denis3
Abstract
Background: Many healthcare innovations are not sustained over the long term, wasting costly implementation
efforts and often desperately-needed initial improvements. Although there have been advances in knowledge
about innovation implementation, there has been considerably less attention focused on understanding what
happens following the early stages of change. Research is needed to determine how to improve the ‘staying
power’ of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in
nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was
sustained over a long-term period in an acute healthcare centre.
Methods: We conducted a qualitative descriptive case study to examine the program’s sustainability at the nursing
department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada.
The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three
BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following
program initiation through 14 key informant interviews, document reviews, and observations. We developed a
framework for the sustainability of healthcare innovations to guide data collection and content analysis.
Results: Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization,
and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These
factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing
program sustainability and characteristics of program sustainability accounted for how the program had been
sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership
actions and both institutionalization and development; and a reflection-and-course-correction strategy and
development.
Conclusions: Study findings indicate that the successful initial implementation of an organizational program does not
automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of
committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders
should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or
program benefits. The development of an organizational program may be necessary for its long-term survival.
Keywords: Sustainability, Program, Organizational change, Innovation, Cl ...
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
The National Academies Health and Medicine DivisionAbout U.docxdennisa15
The National Academies
Health and Medicine Division
About UsPublicationsActivitiesMeetings
Announcement
Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
Best Practices of Total Quality ManagementImplementation in .docxikirkton
Best Practices of Total Quality Management
Implementation in Health Care Settings
FAISAL TALIB
Mechanical Engineering Section, University Polytechnic, Faculty of Engineering and
Technology, Aligarh Muslim University, Aligarh, India
ZILLUR RAHMAN and MOHAMMED AZAM
Department of Management Studies, Indian Institute of Technology Roorkee,
Roorkee, India
Due to the growing prominence of total quality management
(TQM) in health care, the present study was conducted to identify
the set of TQM practices for its successful implementation in
healthcare institutions through a systematic review of literature.
A research strategy was performed on the selected papers published
between 1995 and 2009. An appropriate database was chosen and
15 peer-reviewed research papers were identified through a
screening process and were finally reviewed for this study. Eight
supporting TQM practices, such as top-management commitment,
teamwork and participation, process management, customer focus
and satisfaction, resource management, organization behavior
and culture, continuous improvement, and training and educa-
tion were identified as best practices for TQM implementation in
any health care setting. The article concludes with a set of recom-
mendations for the future researchers to discuss, develop, and work
upon in order to achieve better precision and generalizations.
KEYWORDS health care institutions, total quality management,
TQM implementation, TQM practices
Address correspondence to Faisal Talib, Assistant Professor, Mechanical Engineering
Section, University Polytechnic, Faculty of Engineering and Technology, Aligarh Muslim
University, Aligarh-202002, Uttar Pradesh, India. E-mail: [email protected]
Health Marketing Quarterly, 28:232–252, 2011
Copyright # Taylor & Francis Group, LLC
ISSN: 0735-9683 print=1545-0864 online
DOI: 10.1080/07359683.2011.595643
232
INTRODUCTION
The health care and medical services are growing immensely due to a high
influx of the private sector, changing disease patterns, medical tourism,
and demographic variations. Development of new and advanced techniques,
increased awareness on patient’s safety, intensity of competition in health
care market, and new generation of purchasers and providers have forced
the health care institutions to improve the efficiency and introduce a
consumer culture in their institutions for effective cost and quality of care
(Mosadegh Rad, 2005; Lee, Ng, & Zhang, 2002; Short, 1995). Quality of care
is the vital issue for every health care institution and there is an immediate
need for health care reforms in order to address and resolve the problems
associated with quality of care, as well as patient preferences, safety, and
choice (Koeck, 1997). Another critical issue is the consistently increasing
operating costs of health care institutions. Rising health care expenditures
have created serious financial burdens for the ex-chequer (government
department in charge of national revenue or national ...
Overcoming Challenges in implementation of Quality Process in Healthcare By D...Healthcare consultant
Research has shown that 95 percent of diets fail over the long term. Oddly enough, various studies show that 60 to 80 percent of major change initiatives also fail. In both cases, it is certainly not for lack of good intentions. For a person who has been on a successful diet, it is frustrating to see those pounds sneak back on. And it is just as frustrating for an organization which has implemented a major improvement initiative to have costs, errors or inefficiencies creep in again. This is the short-term-gain, long-term-wane syndrome.
BioMed CentralBMC Health Services ResearchssOpen AcceDebChantellPantoja184
BioMed CentralBMC Health Services Research
ss
Open AcceDebate
From theory to practice: improving the impact of health services
research
Kevin Brazil*1, Elizabeth Ozer2, Michelle M Cloutier3, Robert Levine4 and
Daniel Stryer5
Address: 1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University and St. Joseph's Health System
Research Network, Hamilton, ON, Canada, 2Department of Pediatrics/Adolescent Medicine, University of California, San Francisco, CA, USA,
3Department of Pediatrics, University of Connecticut Health Center and Connecticut. Children's Medical Center, Hartford, CT, USA,
4Occupational and Preventive Medicine, Meharry Medical College, Nashville, TN, USA and 5Center for Outcomes and Effectiveness Research,
Agency for Healthcare Research and Quality, Rockville, MD, USA
Email: Kevin Brazil* - [email protected]; Elizabeth Ozer - [email protected]; Michelle M Cloutier - [email protected];
Robert Levine - [email protected]; Daniel Stryer - [email protected]
* Corresponding author
Abstract
Background: While significant strides have been made in health research, the incorporation of
research evidence into healthcare decision-making has been marginal. The purpose of this paper is
to provide an overview of how the utility of health services research can be improved through the
use of theory. Integrating theory into health services research can improve research methodology
and encourage stronger collaboration with decision-makers.
Discussion: Recognizing the importance of theory calls for new expectations in the practice of
health services research. These include: the formation of interdisciplinary research teams;
broadening the training for those who will practice health services research; and supportive
organizational conditions that promote collaboration between researchers and decision makers.
Further, funding bodies can provide a significant role in guiding and supporting the use of theory in
the practice of health services research.
Summary: Institutions and researchers should incorporate the use of theory if health services
research is to fulfill its potential for improving the delivery of health care.
Background
While significant strides have been made in medical
research over the past several decades, many research
results considered important by researchers and expert
committees are not being used by health care practition-
ers. While the value of health services research must be
judged by its validity, its utility cannot be taken for
granted. There has been an assumption that when
research information is available it will be accessed,
appraised and then applied [1]. However, knowledge of a
research-based recommendation is by itself insufficient to
ensure its adoption. While the value of research evidence
as a basis for decision making in health care is well estab-
lished, the incorporation of such evidence into decision-
making remains inconsistent [2].
The gap betw ...
Factors Influencing the Realization of Quality Improvement in Healthcare Disc...sdfghj21
Factors Influencing the Realization of Quality Improvement in Healthcare Discussion
This document discusses several factors that have influenced quality improvement in healthcare, including:
1) Historical, social, political, and economic trends over the last century such as rising costs, an aging population, and legislation like the Affordable Care Act.
2) Reports from the Institute of Medicine in the 1990s and 2000s that helped establish a framework for improving safety and quality in the 21st century healthcare system.
3) Initiatives from organizations like the Joint Commission and Agency for Healthcare Research and Quality that have aimed to decrease errors, establish standards, and improve outcomes.
Why Clinical Leaders Must Climb Mountains?Mutaz Shegewi
This document discusses the importance of clinical leadership and provides examples of how clinical leadership has enabled improvements in healthcare systems. It argues that clinical leadership is essential for facilitating significant change in healthcare as clinicians are able to block or support changes. The document outlines Don Berwick's 11 aims for improving healthcare and provides two case studies on how Kaiser Permanente and the Veterans Health Administration developed clinical leadership to improve outcomes. It also discusses frameworks for developing clinical leadership competencies and insights from interviews with Libyan healthcare professionals on the challenges and preferences for clinical leadership in Libya.
Grantham University Wk 11 Evidence Based Nursing Practice Discussion Question...write4
The document discusses evidence-based practice and the importance of integrating different types of evidence beyond just scientific research. It argues that evidence-based practice requires the expert judgment and knowledge of experienced clinicians, not just research evidence. True evidence-based practice considers both research findings as well as clinical expertise and patient preferences. The Iowa Model of evidence-based practice is presented as a framework to guide the implementation of evidence into clinical practice through identifying problems or knowledge triggers, forming teams, reviewing and critiquing research, and piloting changes.
Grantham University Wk 11 Evidence Based Nursing Practice Discussion Question...write31
The document discusses evidence-based practice and the importance of integrating different types of evidence beyond just scientific research. It argues that evidence-based practice requires the expert judgment and knowledge of experienced clinicians, not just research evidence. True evidence-based practice involves synthesizing knowledge from various sources, including research findings as well as clinical expertise. The Iowa Model of evidence-based practice is presented as a framework to help implement changes based on the best available evidence.
Section #2To be completed by Learner2.1 ProjectWrite app.docxkenjordan97598
The document summarizes an action research project that aims to explore leadership effectiveness issues created by healthcare reform. The project will qualitatively analyze case studies of leadership at Michael E. DeBakey VA Medical Center to assess the current leadership model and provide a new model incorporating shared leadership. If successful, the new model could enhance patient and employee outcomes at the medical center and beyond by improving workforce engagement in a dynamic healthcare environment.
Improving practice through evidence not only helps lower healthcare improve.docxwrite4
- Improving healthcare practices through evidence-based research can help lower costs, improve outcomes and safety, and increase job satisfaction for medical professionals.
- It is important to disseminate information about evidence-based practices in order to advance the healthcare system, though it often takes years for research results to be implemented in practice.
- Strategies for disseminating evidence-based practice information include unit-level education, posters, and champions to help reinforce positive results.
Surrogate endpoints in global health research: still searching for killer app...SystemOne
1. The document discusses the use of surrogate endpoints in global health research instead of long-term clinical outcomes. It provides examples where interventions improved surrogate endpoints but did not improve mortality, such as a TB diagnostic test and a WHO childbirth checklist in India.
2. It argues that surrogate endpoints alone are not sufficient and global health interventions need to strengthen entire health systems to improve outcomes. Researchers should map how an intervention fits in the care pathway and evaluate multiple endpoints along the pathway.
3. The authors propose using implementation research to understand how interventions can be optimized depending on context and to lower unrealistic expectations of what innovations can achieve when introduced into suboptimal systems.
Achieving Health Care Reform in the United States Toward a Whole-System Und...Suzanne Simmons
The document discusses health care reform in the United States and proposes a system dynamics approach. It provides context on the types of reforms attempted, including expanding access, containing costs, improving quality, and protecting health. Past reforms have been piecemeal and failed to address the full scope of problems or satisfy all stakeholders. The authors develop causal loop diagrams to explain the development and problems of the US health care system, assess past reform efforts, and consider future reform possibilities through a system dynamics lens.
This document discusses clinical audit, which seeks to improve patient care through systematic review of care against criteria and implementing changes where needed. It defines audit and outlines the audit cycle of selecting a topic, identifying standards, collecting data on performance, implementing changes if needed, and monitoring further to ensure improvement. The document provides examples of what can be audited, such as structure, processes of care, or outcomes. It emphasizes that audit criteria should be evidence-based and measurable. The goal of audit is to continuously improve quality of care.
This document outlines concepts related to health care quality assessment. It describes key definitions, such as quality referring to services that increase health outcomes and are consistent with current knowledge. It also discusses perspectives on quality from practitioners, patients, and communities. Additionally, the document outlines different levels of quality analysis from national policies to individual care provision and lists examples of common quality indicators assessed in the US, such as patient satisfaction, mortality rates, and adherence to treatment protocols.
Reflection Journal 10Assessment DescriptionStudents are requir.docxcargillfilberto
Reflection Journal 10
Assessment Description
Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:
Please focus on the topic: Fall Prevention in Outpatient Radiology Clinic
New practice approaches
Intra-professional collaboration
Healthcare delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
2.6: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
3.2: Utilize patient care technology and information management systems.
4.2: Preserve the integrity and human dignity in the care of all patients.
5.5: Provide culturally sensitive care.
20XXKRONA HOSPITAL OPERATING BUDGET FOR 20XXRevenuesInpatient $ 25,000,000Outpatient15,000,000Emergency Room10,000,000Laboratory5,000,000Pharmacy1,500,000Home Health and Hospice1,500,000Ambulance Services950,000Substance Abuse250,000Other850,000Subtotal$ 60,050,000Less Chartiy Care18,000,000Net Revenues$ 42,050,000ExpensesPayroll (including nursing salaries)$ 12,500,000Benefits3,000,000Contract Labor100,000Insurance300,000General Services (laundary, security, etc)3,000,000Depreciation 1,500,000Interest Expense300,000Professional Services10,000,000Total Operating Expenses$ 30,700,000Net Income$ 11,350,000
Sheet2
Sheet3
Benchmark - Capstone Project Change Proposal
Mananita Gerochi-Caparas
Grand Canyon University
NRS-493-O503 Professional Capstone and Practicum
Davida Murphy Smith
October 23, 2022
Benchmark - Capstone Project Change Proposal
Background
Falling incidences are prevalent among older patients. In so.
Examine how nature is discussed throughout The Open Boat.” Loo.docxcravennichole326
Examine how nature is discussed throughout “The Open Boat.” Look at the literary critical piece by Anthony Channell Hilfer. Once you have established your own ideas, consider how Hilfer discusses nature in the short story and analyze the following questions: What does nature mean to the men aboard the boat? or Do their perceptions of nature shift throughout the story? Why or why not?
Do their perceptions of nature shift throughout the story? Why or why not?
Write down a loose response about what I think of the question and what I remember of the story.
ICE method.
I introduce the citation
C the citation itself
E explain its meaning to your argument.
The scenes shift with no discernable rhyme or reason. Crane invites every reader in. Critic Anthony Channell Hilfer disagrees with point, saying, “Crane’s image is an accusation of the putative picturesque spectators” (Hilfer 254). Hilfer’s challenge goes against what Crane is trying to do, by making nature a copilot through the reading.
3. Nature as Protagonist in “The Open Boat”
Anthony Channell Hilfer
Texas Studies in Literature and Language, Volume 54, Number 2, Summer
2012, pp. 248-257 (Article)
Published by University of Texas Press
DOI:
For additional information about this article
[ Access provided at 9 Apr 2020 17:36 GMT from Marymount University & (Viva) ]
https://doi.org/10.1353/tsl.2012.0012
https://muse.jhu.edu/article/476402
https://doi.org/10.1353/tsl.2012.0012
https://muse.jhu.edu/article/476402
Anthony Channell Hilfer248
3. Nature as Protagonist in “The Open Boat”
The bottom of the sea is cruel.
—Hart Crane, “Voyages”
As many critics have argued, questions of perspective and epistemology are
central to Stephen Crane’s “The Open Boat” (Kent; Hutchinson). The story’s
first sentence famously clues us to this: “None of them knew the color of
the sky” (68). But behind the uncertainties of perspective is a determinable
ontology, a presence, or rather, I shall argue, a sort of presence, the existence
of which implies a rectified aesthetic response. This response emerges, how-
ever, from negations, denials, and occultations: what is not seen, who is not
there, and what does not happen.3 Here again, when we look at nature we
behold things that are not there and miss “the nothing that is.”
Fully as much as Stevens in “The Snow Man,” Crane is concerned
with certain conventions of representation: personification, the pictur-
esque, the American sublime, and the melodramatic, which although it
does not inform “The Snow Man” is played on in Stevens’s “The Ameri-
can Sublime.” Crane’s story is intertextual with nature poetry, sentimental
poetry, hymns, and landscape art, as well as with Darwinism, theological
clichés, and, less obviously, theological actualities. For the most part these
conventions add up to what the Stevens poem declares is “not there.” To
get to “the nothing that is” we must first traverse this ocean of error. Doing
so helps keep our p.
Examine All Children Can Learn. Then, search the web for effec.docxcravennichole326
Examine
"All Children Can Learn"
. Then, search the web for effective, evidence-based differentiated strategies that are engaging, motivating, and address the needs of individual learners.
First, provide five evidence-based strategies:
Two instructional strategies (i.e., graphic organizers),
Two instructional tools (e.g., technology tool, device or iPad App, Web Quests, etc.),
One activity (e.g., Think-Pair-Share).
Second, for the two instructional strategies you listed explain how you can alter each to address the classroom needs you designed in Weeks One and Two and how the modification is relevant to the theory of differentiation.
.
More Related Content
Similar to Chapter 2Factors influencing the application and diffusion of .docx
Medical Simulation 2.0: Improving value-based healthcare deliveryYue Dong
This document provides an overview of medical simulation and its applications in healthcare delivery. It discusses how simulation can be used as a tool to systematically analyze complex healthcare systems and processes, identify bottlenecks, and test interventions to optimize quality and safety. Specific applications mentioned include using simulation to study workflows like sepsis care, test user interfaces on clinical tasks and performance, and evaluate new system designs before implementation. The goal is to move from traditional education-focused "Simulation 1.0" to a more integrated "Simulation 2.0" approach that leverages simulation throughout healthcare systems and daily practices.
RESEARCH ARTICLE Open AccessAn organizational perspective .docxronak56
RESEARCH ARTICLE Open Access
An organizational perspective on the long-
term sustainability of a nursing best
practice guidelines program: a case study
Andrea R. Fleiszer1*, Sonia E. Semenic1,2, Judith A. Ritchie1, Marie-Claire Richer1,2 and Jean-Louis Denis3
Abstract
Background: Many healthcare innovations are not sustained over the long term, wasting costly implementation
efforts and often desperately-needed initial improvements. Although there have been advances in knowledge
about innovation implementation, there has been considerably less attention focused on understanding what
happens following the early stages of change. Research is needed to determine how to improve the ‘staying
power’ of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in
nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was
sustained over a long-term period in an acute healthcare centre.
Methods: We conducted a qualitative descriptive case study to examine the program’s sustainability at the nursing
department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada.
The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three
BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following
program initiation through 14 key informant interviews, document reviews, and observations. We developed a
framework for the sustainability of healthcare innovations to guide data collection and content analysis.
Results: Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization,
and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These
factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing
program sustainability and characteristics of program sustainability accounted for how the program had been
sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership
actions and both institutionalization and development; and a reflection-and-course-correction strategy and
development.
Conclusions: Study findings indicate that the successful initial implementation of an organizational program does not
automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of
committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders
should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or
program benefits. The development of an organizational program may be necessary for its long-term survival.
Keywords: Sustainability, Program, Organizational change, Innovation, Cl ...
Reply1
Re: Topic 1 DQ 2
Topic 1 DQ 2
The inclusion of evidence-based practice provides nurses with the scientific research and experience to make a comprehensive decision. The practice enables the nurses to re-evaluate the risks and only adopt the best mechanism to ensure an improved patient outcome. Patients are also able to receive the best available outcomes. It is very advisable to move the nursing practice to be evidence-based to ensure that there is patient-centered care that is safe, inclusive, and effective. However, there have been barriers towards this progress since only 15% of U.S practice is evidence-based. One of the barriers which have led to lagging behind in adopting evidence-based practice is nurse shortage. Evidence-based practice requires massive documentation and research together with increased testing and experience. This requires a large human resource which is not available due to nurse shortage across the united states (Stavor et al., 2017). This has acted as a barrier towards the goal of moving practice to evidence-based. The government should employ more nurses and also dedicate some of the workforces specifically to matters to do with shifting traditional caregiving to EBP.
The second barrier is unsupportive administration. Research indicates that over 70% of nurses know about evidence-based practice, but the barriers to the practice in a clinical setting make it hard for them to adopt it. To move practice to EBP requires active collaboration from all stakeholders and more so from the administration of the healthcare setting. However, most administrations have been termed as unsupportive for the move due to the challenges of resources involved in the move. EPB presents a huge cost in the beginning due to its data requirements. However, it is able to reduce the cost of healthcare by 35% after its implementation. Lack of support from the management makes it hard to move nursing practice to EBP in a clinical setting since it’s a collaborative activity that requires dedicated and goal-oriented leadership (Duncombe, 2018). Policies and regulations should be created which force the push to enable the administration of various healthcare to have no otherwise but to comply in the shift.
References
Stavor, D. C., Zedreck-Gonzalez, J., & Hoffmann, R. L. (2017). Improving the use of evidence-based practice and research utilization through the identification of barriers to implementation in a critical access hospital.
JONA: The Journal of Nursing Administration
,
47
(1), 56-61.
Duncombe, D. C. (2018). A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice.
Journal of Clinical Nursing
,
27
(5-6), 1216-1226.
Reply 2
aur
1 posts
Re: Topic 1 DQ 2
As unprecedented development in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented c.
The National Academies Health and Medicine DivisionAbout U.docxdennisa15
The National Academies
Health and Medicine Division
About UsPublicationsActivitiesMeetings
Announcement
Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
Best Practices of Total Quality ManagementImplementation in .docxikirkton
Best Practices of Total Quality Management
Implementation in Health Care Settings
FAISAL TALIB
Mechanical Engineering Section, University Polytechnic, Faculty of Engineering and
Technology, Aligarh Muslim University, Aligarh, India
ZILLUR RAHMAN and MOHAMMED AZAM
Department of Management Studies, Indian Institute of Technology Roorkee,
Roorkee, India
Due to the growing prominence of total quality management
(TQM) in health care, the present study was conducted to identify
the set of TQM practices for its successful implementation in
healthcare institutions through a systematic review of literature.
A research strategy was performed on the selected papers published
between 1995 and 2009. An appropriate database was chosen and
15 peer-reviewed research papers were identified through a
screening process and were finally reviewed for this study. Eight
supporting TQM practices, such as top-management commitment,
teamwork and participation, process management, customer focus
and satisfaction, resource management, organization behavior
and culture, continuous improvement, and training and educa-
tion were identified as best practices for TQM implementation in
any health care setting. The article concludes with a set of recom-
mendations for the future researchers to discuss, develop, and work
upon in order to achieve better precision and generalizations.
KEYWORDS health care institutions, total quality management,
TQM implementation, TQM practices
Address correspondence to Faisal Talib, Assistant Professor, Mechanical Engineering
Section, University Polytechnic, Faculty of Engineering and Technology, Aligarh Muslim
University, Aligarh-202002, Uttar Pradesh, India. E-mail: [email protected]
Health Marketing Quarterly, 28:232–252, 2011
Copyright # Taylor & Francis Group, LLC
ISSN: 0735-9683 print=1545-0864 online
DOI: 10.1080/07359683.2011.595643
232
INTRODUCTION
The health care and medical services are growing immensely due to a high
influx of the private sector, changing disease patterns, medical tourism,
and demographic variations. Development of new and advanced techniques,
increased awareness on patient’s safety, intensity of competition in health
care market, and new generation of purchasers and providers have forced
the health care institutions to improve the efficiency and introduce a
consumer culture in their institutions for effective cost and quality of care
(Mosadegh Rad, 2005; Lee, Ng, & Zhang, 2002; Short, 1995). Quality of care
is the vital issue for every health care institution and there is an immediate
need for health care reforms in order to address and resolve the problems
associated with quality of care, as well as patient preferences, safety, and
choice (Koeck, 1997). Another critical issue is the consistently increasing
operating costs of health care institutions. Rising health care expenditures
have created serious financial burdens for the ex-chequer (government
department in charge of national revenue or national ...
Overcoming Challenges in implementation of Quality Process in Healthcare By D...Healthcare consultant
Research has shown that 95 percent of diets fail over the long term. Oddly enough, various studies show that 60 to 80 percent of major change initiatives also fail. In both cases, it is certainly not for lack of good intentions. For a person who has been on a successful diet, it is frustrating to see those pounds sneak back on. And it is just as frustrating for an organization which has implemented a major improvement initiative to have costs, errors or inefficiencies creep in again. This is the short-term-gain, long-term-wane syndrome.
BioMed CentralBMC Health Services ResearchssOpen AcceDebChantellPantoja184
BioMed CentralBMC Health Services Research
ss
Open AcceDebate
From theory to practice: improving the impact of health services
research
Kevin Brazil*1, Elizabeth Ozer2, Michelle M Cloutier3, Robert Levine4 and
Daniel Stryer5
Address: 1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University and St. Joseph's Health System
Research Network, Hamilton, ON, Canada, 2Department of Pediatrics/Adolescent Medicine, University of California, San Francisco, CA, USA,
3Department of Pediatrics, University of Connecticut Health Center and Connecticut. Children's Medical Center, Hartford, CT, USA,
4Occupational and Preventive Medicine, Meharry Medical College, Nashville, TN, USA and 5Center for Outcomes and Effectiveness Research,
Agency for Healthcare Research and Quality, Rockville, MD, USA
Email: Kevin Brazil* - [email protected]; Elizabeth Ozer - [email protected]; Michelle M Cloutier - [email protected];
Robert Levine - [email protected]; Daniel Stryer - [email protected]
* Corresponding author
Abstract
Background: While significant strides have been made in health research, the incorporation of
research evidence into healthcare decision-making has been marginal. The purpose of this paper is
to provide an overview of how the utility of health services research can be improved through the
use of theory. Integrating theory into health services research can improve research methodology
and encourage stronger collaboration with decision-makers.
Discussion: Recognizing the importance of theory calls for new expectations in the practice of
health services research. These include: the formation of interdisciplinary research teams;
broadening the training for those who will practice health services research; and supportive
organizational conditions that promote collaboration between researchers and decision makers.
Further, funding bodies can provide a significant role in guiding and supporting the use of theory in
the practice of health services research.
Summary: Institutions and researchers should incorporate the use of theory if health services
research is to fulfill its potential for improving the delivery of health care.
Background
While significant strides have been made in medical
research over the past several decades, many research
results considered important by researchers and expert
committees are not being used by health care practition-
ers. While the value of health services research must be
judged by its validity, its utility cannot be taken for
granted. There has been an assumption that when
research information is available it will be accessed,
appraised and then applied [1]. However, knowledge of a
research-based recommendation is by itself insufficient to
ensure its adoption. While the value of research evidence
as a basis for decision making in health care is well estab-
lished, the incorporation of such evidence into decision-
making remains inconsistent [2].
The gap betw ...
Factors Influencing the Realization of Quality Improvement in Healthcare Disc...sdfghj21
Factors Influencing the Realization of Quality Improvement in Healthcare Discussion
This document discusses several factors that have influenced quality improvement in healthcare, including:
1) Historical, social, political, and economic trends over the last century such as rising costs, an aging population, and legislation like the Affordable Care Act.
2) Reports from the Institute of Medicine in the 1990s and 2000s that helped establish a framework for improving safety and quality in the 21st century healthcare system.
3) Initiatives from organizations like the Joint Commission and Agency for Healthcare Research and Quality that have aimed to decrease errors, establish standards, and improve outcomes.
Why Clinical Leaders Must Climb Mountains?Mutaz Shegewi
This document discusses the importance of clinical leadership and provides examples of how clinical leadership has enabled improvements in healthcare systems. It argues that clinical leadership is essential for facilitating significant change in healthcare as clinicians are able to block or support changes. The document outlines Don Berwick's 11 aims for improving healthcare and provides two case studies on how Kaiser Permanente and the Veterans Health Administration developed clinical leadership to improve outcomes. It also discusses frameworks for developing clinical leadership competencies and insights from interviews with Libyan healthcare professionals on the challenges and preferences for clinical leadership in Libya.
Grantham University Wk 11 Evidence Based Nursing Practice Discussion Question...write4
The document discusses evidence-based practice and the importance of integrating different types of evidence beyond just scientific research. It argues that evidence-based practice requires the expert judgment and knowledge of experienced clinicians, not just research evidence. True evidence-based practice considers both research findings as well as clinical expertise and patient preferences. The Iowa Model of evidence-based practice is presented as a framework to guide the implementation of evidence into clinical practice through identifying problems or knowledge triggers, forming teams, reviewing and critiquing research, and piloting changes.
Grantham University Wk 11 Evidence Based Nursing Practice Discussion Question...write31
The document discusses evidence-based practice and the importance of integrating different types of evidence beyond just scientific research. It argues that evidence-based practice requires the expert judgment and knowledge of experienced clinicians, not just research evidence. True evidence-based practice involves synthesizing knowledge from various sources, including research findings as well as clinical expertise. The Iowa Model of evidence-based practice is presented as a framework to help implement changes based on the best available evidence.
Section #2To be completed by Learner2.1 ProjectWrite app.docxkenjordan97598
The document summarizes an action research project that aims to explore leadership effectiveness issues created by healthcare reform. The project will qualitatively analyze case studies of leadership at Michael E. DeBakey VA Medical Center to assess the current leadership model and provide a new model incorporating shared leadership. If successful, the new model could enhance patient and employee outcomes at the medical center and beyond by improving workforce engagement in a dynamic healthcare environment.
Improving practice through evidence not only helps lower healthcare improve.docxwrite4
- Improving healthcare practices through evidence-based research can help lower costs, improve outcomes and safety, and increase job satisfaction for medical professionals.
- It is important to disseminate information about evidence-based practices in order to advance the healthcare system, though it often takes years for research results to be implemented in practice.
- Strategies for disseminating evidence-based practice information include unit-level education, posters, and champions to help reinforce positive results.
Surrogate endpoints in global health research: still searching for killer app...SystemOne
1. The document discusses the use of surrogate endpoints in global health research instead of long-term clinical outcomes. It provides examples where interventions improved surrogate endpoints but did not improve mortality, such as a TB diagnostic test and a WHO childbirth checklist in India.
2. It argues that surrogate endpoints alone are not sufficient and global health interventions need to strengthen entire health systems to improve outcomes. Researchers should map how an intervention fits in the care pathway and evaluate multiple endpoints along the pathway.
3. The authors propose using implementation research to understand how interventions can be optimized depending on context and to lower unrealistic expectations of what innovations can achieve when introduced into suboptimal systems.
Achieving Health Care Reform in the United States Toward a Whole-System Und...Suzanne Simmons
The document discusses health care reform in the United States and proposes a system dynamics approach. It provides context on the types of reforms attempted, including expanding access, containing costs, improving quality, and protecting health. Past reforms have been piecemeal and failed to address the full scope of problems or satisfy all stakeholders. The authors develop causal loop diagrams to explain the development and problems of the US health care system, assess past reform efforts, and consider future reform possibilities through a system dynamics lens.
This document discusses clinical audit, which seeks to improve patient care through systematic review of care against criteria and implementing changes where needed. It defines audit and outlines the audit cycle of selecting a topic, identifying standards, collecting data on performance, implementing changes if needed, and monitoring further to ensure improvement. The document provides examples of what can be audited, such as structure, processes of care, or outcomes. It emphasizes that audit criteria should be evidence-based and measurable. The goal of audit is to continuously improve quality of care.
This document outlines concepts related to health care quality assessment. It describes key definitions, such as quality referring to services that increase health outcomes and are consistent with current knowledge. It also discusses perspectives on quality from practitioners, patients, and communities. Additionally, the document outlines different levels of quality analysis from national policies to individual care provision and lists examples of common quality indicators assessed in the US, such as patient satisfaction, mortality rates, and adherence to treatment protocols.
Reflection Journal 10Assessment DescriptionStudents are requir.docxcargillfilberto
Reflection Journal 10
Assessment Description
Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:
Please focus on the topic: Fall Prevention in Outpatient Radiology Clinic
New practice approaches
Intra-professional collaboration
Healthcare delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
2.6: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
3.2: Utilize patient care technology and information management systems.
4.2: Preserve the integrity and human dignity in the care of all patients.
5.5: Provide culturally sensitive care.
20XXKRONA HOSPITAL OPERATING BUDGET FOR 20XXRevenuesInpatient $ 25,000,000Outpatient15,000,000Emergency Room10,000,000Laboratory5,000,000Pharmacy1,500,000Home Health and Hospice1,500,000Ambulance Services950,000Substance Abuse250,000Other850,000Subtotal$ 60,050,000Less Chartiy Care18,000,000Net Revenues$ 42,050,000ExpensesPayroll (including nursing salaries)$ 12,500,000Benefits3,000,000Contract Labor100,000Insurance300,000General Services (laundary, security, etc)3,000,000Depreciation 1,500,000Interest Expense300,000Professional Services10,000,000Total Operating Expenses$ 30,700,000Net Income$ 11,350,000
Sheet2
Sheet3
Benchmark - Capstone Project Change Proposal
Mananita Gerochi-Caparas
Grand Canyon University
NRS-493-O503 Professional Capstone and Practicum
Davida Murphy Smith
October 23, 2022
Benchmark - Capstone Project Change Proposal
Background
Falling incidences are prevalent among older patients. In so.
Similar to Chapter 2Factors influencing the application and diffusion of .docx (20)
Examine how nature is discussed throughout The Open Boat.” Loo.docxcravennichole326
Examine how nature is discussed throughout “The Open Boat.” Look at the literary critical piece by Anthony Channell Hilfer. Once you have established your own ideas, consider how Hilfer discusses nature in the short story and analyze the following questions: What does nature mean to the men aboard the boat? or Do their perceptions of nature shift throughout the story? Why or why not?
Do their perceptions of nature shift throughout the story? Why or why not?
Write down a loose response about what I think of the question and what I remember of the story.
ICE method.
I introduce the citation
C the citation itself
E explain its meaning to your argument.
The scenes shift with no discernable rhyme or reason. Crane invites every reader in. Critic Anthony Channell Hilfer disagrees with point, saying, “Crane’s image is an accusation of the putative picturesque spectators” (Hilfer 254). Hilfer’s challenge goes against what Crane is trying to do, by making nature a copilot through the reading.
3. Nature as Protagonist in “The Open Boat”
Anthony Channell Hilfer
Texas Studies in Literature and Language, Volume 54, Number 2, Summer
2012, pp. 248-257 (Article)
Published by University of Texas Press
DOI:
For additional information about this article
[ Access provided at 9 Apr 2020 17:36 GMT from Marymount University & (Viva) ]
https://doi.org/10.1353/tsl.2012.0012
https://muse.jhu.edu/article/476402
https://doi.org/10.1353/tsl.2012.0012
https://muse.jhu.edu/article/476402
Anthony Channell Hilfer248
3. Nature as Protagonist in “The Open Boat”
The bottom of the sea is cruel.
—Hart Crane, “Voyages”
As many critics have argued, questions of perspective and epistemology are
central to Stephen Crane’s “The Open Boat” (Kent; Hutchinson). The story’s
first sentence famously clues us to this: “None of them knew the color of
the sky” (68). But behind the uncertainties of perspective is a determinable
ontology, a presence, or rather, I shall argue, a sort of presence, the existence
of which implies a rectified aesthetic response. This response emerges, how-
ever, from negations, denials, and occultations: what is not seen, who is not
there, and what does not happen.3 Here again, when we look at nature we
behold things that are not there and miss “the nothing that is.”
Fully as much as Stevens in “The Snow Man,” Crane is concerned
with certain conventions of representation: personification, the pictur-
esque, the American sublime, and the melodramatic, which although it
does not inform “The Snow Man” is played on in Stevens’s “The Ameri-
can Sublime.” Crane’s story is intertextual with nature poetry, sentimental
poetry, hymns, and landscape art, as well as with Darwinism, theological
clichés, and, less obviously, theological actualities. For the most part these
conventions add up to what the Stevens poem declares is “not there.” To
get to “the nothing that is” we must first traverse this ocean of error. Doing
so helps keep our p.
Examine All Children Can Learn. Then, search the web for effec.docxcravennichole326
Examine
"All Children Can Learn"
. Then, search the web for effective, evidence-based differentiated strategies that are engaging, motivating, and address the needs of individual learners.
First, provide five evidence-based strategies:
Two instructional strategies (i.e., graphic organizers),
Two instructional tools (e.g., technology tool, device or iPad App, Web Quests, etc.),
One activity (e.g., Think-Pair-Share).
Second, for the two instructional strategies you listed explain how you can alter each to address the classroom needs you designed in Weeks One and Two and how the modification is relevant to the theory of differentiation.
.
Examine each of these items, which are available on the internet .docxcravennichole326
Examine each of these items, which are available on the internet:
1) for music, listen to the first movement of J.S. Bach's MAGNIFICAT; this is the High Baroque era. If you can find a performance with Sir John Eliot Gardiner and his Monteverdi Choir and the English Baroque soloists, go for it.
2) For art, find Giovanni Bellini's ST. FRANCIS IN THE DESERT; you might want to read up on the background of this wonderful painting. Not only St. Francis, but what else do you notice i the painting?
3) For architecture, look at the church at Melk Abbey, Austria; BE SURE to look at the interior shots. Again,
this is high Baroque--but in post-Reformation Catholicism, it had a political aim, too; can you figure it out?
After you have analyzed these, telling what you think the artists/musicians valued and were trying to express, tell me what
YOU think about them! Remember, if you read up on these items, LIST THE WORKS YOU CONSULTED! That way, you avoid plagiarism.
write a 1-page paper on each of these three, telling 1) where they found this value, 2) why it was important “back then,” and 3) is it still around today.
.
Examine a web browser interface and describe the various forms .docxcravennichole326
Examine a web browser interface and describe the various forms of analogy and composite interface metaphors that have been used in its design. What familiar knowledge has been combined with new functionality? need a couple of paragraphs.. and one reference
need this in the next 4 hours..
.
Examine a scenario that includes an inter-group conflict. In this sc.docxcravennichole326
Examine a scenario that includes an inter-group conflict. In this scenario, you are recognized as an authority in cross-cultural psychology and asked to serve as a consultant to help resolve the conflict. You will be asked to write up your recommendations in a 6-page paper not including your title and reference page.
Darley, J.M. & Latané, B. (1968). Bystander interview in emergencies: Diffusion of responsibility.
Journal of Personality and Social Psychology, 8
(4), 377-383.
Scenario: Culture, Psychology, and Community
Imagine an international organization has approached you to help resolve an inter-group conflict. You are an authority in cross-cultural psychology and have been asked to serve as a consultant based on a recent violent conflict involving a refugee community in your town and a local community organization. In the days, weeks, and months leading up to the violent conflict, there were incidents of discrimination and debates regarding the different views and practices people held about work, family, schools, and religious practice. Among the controversies has been the role of women’s participation in political, educational, and community groups
.
Part 1: Developing an Understanding
(2 pages)
Based on the scenario, explain how you can help integrate the two diverse communities so that there is increased understanding and appreciation of each group by the other group. (
Note
: Make sure to include in your explanation the different views and practices of cultural groups as well as the role of women.)
Based on your knowledge of culture and psychology, provide three possible suggestions/solutions that will help the community as a whole. In your suggestions make sure to include an explanation regarding group think and individualism vs. collectivism.
Part 2: Socio-Emotional, Cognitive, and Behavioral Aspects
(2 pages)
Based on your explanations in Part 1, how do your suggestions/solutions impact the socio-emotional, cognitive, and behavior aspects of the scenario and why?
Part 3: Gender, Cultural Values and Dimensions, and Group Dynamics
(2 pages)
Explain the impact of gender, cultural values and dimensions, and group dynamics in the scenario.
Further explain any implications that may arise from when working between and within groups.
Support your Assignment by citing all resources in APA style, including those in the Learning Resources.
.
Examine a current law, or a bill proposing a law, that has to do wit.docxcravennichole326
Examine a current law, or a bill proposing a law, that has to do with technology and criminal activity. The law can be at the state or federal level. Identify the law or bill, where it comes from, and its purpose or intent. Next, identify positive outcomes if the law is successful. Finally, identify at least two unintended consequences that the law could bring about. . . DUE 4/18, 2021
.
Exam IT 505Multiple Choice (20 questions , 2 points each)Pleas.docxcravennichole326
Exam IT 505
Multiple Choice (20 questions , 2 points each)
Please Submit a word document of your exam. Please DO NOT repeat the questions. Only submit your answers for example 1.A, 2. B……Ect
1. Which of the following is NOT one of the typical characteristics of back-end networks?
A. high data rate B. high-speed interface
C. distributed access D. extended distance
2. Problems with using a single Local Area Network (LAN) to interconnect devices
on a premise include:
A. insufficient reliability, limited capacity, and inappropriate network
interconnection devices
B. insufficient reliability, limited capacity, and limited distances
C. insufficient reliability, limited distances, and inappropriate network
interconnection devices
D. limited distances, limited capacity, and inappropriate network
interconnection devices
3. Which of following is NOT one of the designs that determines data rate and
distance?
A. the number of senders B. the number of receivers
C. transmission impairment D. bandwidth
4. The fact that signal strength falls off with distance is called ________________.
A. bandwidth B. attenuation
C. resistance D. propagation
5. Which of the following is NOT one of the distinguishing characteristics for optical
fiber cables compared with twisted pair or coaxial cables?
A. greater capacity B. lower attenuation
C. electromagnetic isolation D. heavier weight
6.________ is a set of function and call programs that allow clients and servers to intercommunicate.
A. IaaS B. SQL C. API D. Middleware
7. A computer that houses information for manipulation by networked clients is a __________.
A. server B. minicomputer C. PaaS D. broker
8. ________ is software that improves connectivity between a client application and a server.
A. SQL B. API C. Middleware D. SAP
9. The inability of frame relay to do hop by hop error control is offset by:
A. its gigabit speeds B. its high overhead
C. the extensive use of in-band signaling D. the increasing reliability of networks
10. All Frame Relay nodes contain which of the following protocols?
A. LAPB B. LAPD
C. LAPF Core D. LAPF Control
11. The technique employed by Frame Relay is called __________.
A. inband signaling B. outband signaling
C. common channel signaling D. open shortest path first routing
12. In ATM, the basic transmission unit is the ________.
A. frame B. cell
C. packet D. segment
13. When using ATM, which of the following is NOT one of the advantages for the
use of virtual paths?
A. less work is needed to set a virtual path
B. the network architecture is simplified
C.
EXAM
Estructura 8.1 - Miniprueba A
Verbos
Complete the chart with the correct verb forms.
infinitivo
seguir
(1) [removed]
yo
(2) [removed]
morí
tú
seguiste
(3) [removed]
nosotras
seguimos
(4) [removed]
ellos
(5) [removed]
murieron
Completar
Fill in the blanks with the correct preterite forms of the verbs in parentheses.
Diego y Javier [removed] (conseguir) un mapa.
Esta mañana usted [removed] (despedirse) de los estudiantes.
Tú [removed] (sentirse) mal ayer.
La semana pasada yo no [removed] (dormir) bien.
Amparo [removed] (preferir) comer en casa.
Oraciones
Write sentences using the information provided. Use the preterite and make any necessary changes.
Modelo
Edgar / preferir / pollo asado
Edgar prefirió el pollo asado.
Álvaro y yo / servir / los entremeses
[removed]
¿quién / repetir / las instrucciones?
[removed]
ayer / yo / despedirse / de / mis sobrinos
[removed]
ustedes / dormirse / a las diez
[removed]
La cena
Fill in the blanks with the preterite form of the appropriate verbs from the list. Four verbs will not be used.
abrir
conseguir
escoger
leer
mirar
pedir
preferir
probar
repetir
sentirse
servir
vestirse
Anoche Jorge, Iván y yo salimos a cenar a Mi Tierra, un restaurante guatemalteco. Nosotros
(1) [removed]
este lugar porque Jorge
(2) [removed]
una reseña (
review
) en Internet que decía (
said
) que la comida es auténtica y muy sabrosa. No es un restaurante elegante; entonces nosotros
(3) [removed]
de bluejeans. De verdad, en Mi Tierra mis amigos y yo
(4) [removed]
como (
like
) en casa. El camarero que nos
(5) [removed]
fue muy amable. Para empezar, Jorge e Iván
(6) [removed]
tamales, pero yo
(7) [removed]
esperar el plato principal: carne de res con arroz y frijoles. Comimos tanto (
so much
) que no
(8) [removed]
nada de postre (
dessert
). ¡Fue una cena deliciosa!
.
Examine current practice guidelines related to suicide screeni.docxcravennichole326
Examine current practice guidelines related to suicide screening and prevention and how they could pertain to John.
Choose two of the following questions to answer as part of your initial post.
What events in John's life created a "downward spiral" into homelessness and hopelessness? Which events were related to social needs, mental health needs, and medical needs, and which could health care have addressed?
What were some of the barriers John faced in accessing medical care and mental health care?
How does homelessness and mental illness intersect? Do you believe homelessness may develop because of a mental health issue, or do you believe those who become homeless eventually sink into psychological despair?
The tipping point for many people who live at the margins of society may be things that could have been managed given the right support. How can your role as an APRN help identify, alleviate, or support those who are in need like John?
In your own experience, have you encountered a homeless individual? What was that like? Do you recall what you were thinking?
Please include at least three scholarly sources within your initial post.
Rubric:
Discussion Question Rubric
Note:
Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.
Discussion Question Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsQuality of Initial PostProvides clear examples supported by course content and references.
Cites three or more references, using at least one new scholarly resource that was not provided in the course materials.
All instruction requirements noted.
40 points
Components are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints.
Meets all requirements within the discussion instructions.
Cites two references.
35 points
Components are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development.
Is missing one component/requirement of the discussion instructions.
Cites one reference, or references do not clearly support content.
Most instruction requirements are noted.
31 points
Absent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial.
Demonstrates incomplete understandin.
Examine Case Study Pakistani Woman with Delusional Thought Processe.docxcravennichole326
Examine Case Study: Pakistani Woman with Delusional Thought Processes.
You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so.
She currently weighs .
Examination of Modern LeadershipModule 1 Leadership History, F.docxcravennichole326
Examination of Modern Leadership
Module 1: Leadership: History, Fundamentals, and the Modern Context
Module 1 content establishes the context for the entire course dedicated to the examination of modern and postmodern leadership. The introduction of critical theory and its use in ORG561 provides a framework for investigation. The context of social, economic, political, and technological environments informs an exploration of modern and postmodern leadership approaches. Emphasis on leader self-awareness sets the stage for reflection, introspection, and personal leadership development.
Learning Outcomes
1. Compare and contrast historical leadership concepts against modern and postmodern organization needs.
2. Analyze leadership approaches using a critical framework.
3. Construct a personal leadership biography.
For Your Success & Readings
A key to success in ORG561 is to start early, build, reflect, reinforce, build, reflect, and reinforce.
Begin each week’s study by reading and comprehending the learning outcomes. Learning outcomes are always revealed in assignments, discussions, and lectures. Likewise, learning outcomes are reflected in rubrics, which are used as objective measures for scoring and grading. Establish the learning outcomes as your checklist for success.
In Module 1 criticaltheory is introduced through the readings, lecture, discussion, and Critical Thinking Assignment. The critical approach provides new frameworks on which to research leadership. You may not be familiar with critical inquiry, so seize the opportunity to advance your analytic skills. You are expected to use one or more critical frames in each module of this course. Take the time this week to fully understand the reasoning and context of critical theory.
Studying the history of leadership requires reading publications from earlier eras. Notice that some of the required and recommended readings for Module 1 are not current publications, but these contribute to understanding the earlier periods of organization and leadership study.
Postmodern leadership literature expounds on the notion that self-awareness is a critical component required to lead. In ORG561, the thread of self-examination is woven throughout the course. You will have opportunities to move beyond reflection to develop a better understanding of personal assumptions and biases, skills and competencies, and professional development plans, all related to leadership. Embrace the opportunity!
Required
· Introduction and Chapters 1 & 2 in Leadership: A Critical Text
· Axley, S. R. (1990). The practical qualities of effective leaders. Industrial Management, 32(5), 29-31.
· Brocato, B., Jelen, J., Schmidt, T., & Gold, S. (2011). Leadership conceptual ambiguities.Journal of Leadership Studies, 5(1), 35-50. doi:10.1002/jls.20203
· Gandolfi, F., & Stone, S. (2016). Clarifying leadership: High-impact leaders in a time of leadership crisis. Revista De Management Comparat International, 17(3), 212-224.
· Blom, M. .
Examine current international OB issues that challenge organizat.docxcravennichole326
Examine current international OB issues that challenge organizational leaders to resolve critical issues involving cross-cultural communication, negotiation, leadership, motivation, decision-making, among others.
(1) identify the key organizational behavior issues facing management,
(2) what impact the international environment has on these issues,
(3) strategies management should use to overcome these issues,
(4) how these strategies will impact the overall organizational operations, and
(5) identify the potential costs and risks to the organizations of implementing the newly developed strategies.
Offer a set of recommendations, which must be derived from both data and theory. Teams must include aspects of global leadership, global motivation and global team-management in their work.
APA format, Times New Roman (12), 20-25 pages, No plagiarism.
.
Executive Program Practical Connection Assignment .docxcravennichole326
Executive Program Practical Connection Assignment
Component Proficient (15 to 20 points) Competent (8 to 14 points) Novice (1 to 7 points) Score
Assignment
Requirements
Student completed all required
portions of the assignment
Completed portions of the
assignment
Did not complete the required
assignment.
Writing Skills,
Grammar, and APA
Formatting
Assignment strongly demonstrates
graduate-level proficiency in
organization, grammar, and style.
Assignment is well written, and ideas
are well developed and explained.
Demonstrates strong writing skills.
Student paid close attention to spelling
and punctuation. Sentences and
paragraphs are grammatically correct.
Proper use of APA formatting. Properly
and explicitly cited outside resources.
Reference list matches citations.
Assignment demonstrates graduate-
level proficiency in organization,
grammar, and style.
Assignment is effectively
communicated, but some sections
lacking clarity. Student paid some
attention to spelling and
punctuation, but there are errors
within the writing. Needs attention
to proper writing skills.
Use of APA formatting and citations
of outside resources, but has a few
instances in which proper citations
are missing.
Assignment does not demonstrate
graduate-level proficiency in
organization, grammar, and style.
Assignment is poorly written and
confusing. Ideas are not
communicated effectively. Student
paid no attention to spelling and
punctuation. Demonstrates poor
writing skills.
The assignment lacks the use of APA
formatting and does not provide
proper citations or includes no
citations.
Maintains
purpose/focus
Submission is well organized and has a
tight and cohesive focus that is
integrated throughout the document
Submissions has an organizational
structure and the focus is clear
throughout.
Submission lacks focus or contains
major drifts in focus
Understanding of
Course Content
Student demonstrates understand of
course content and knowledge.
Student demonstrates some
understanding of course content
and knowledge.
Student does not demonstrate
understanding of course content and
knowledge.
Work Environment
Application
Student strongly demonstrates the
practical application, or ability to apply,
of course objectives within a work
environment.
Student demonstrates some
practical application, or ability to
apply, of course objectives within a
work environment.
Student does not demonstrate the
practical application, or ability to
apply, of course objectives within a
work environment.
Executive Program Practical Connection Assignment
At UC, it is a priority that students are provided with strong educational programs and courses that
allow them to be servant-leaders in their disciplines and communities, linking research with practice and
kn.
Executive Program Practical Connection Assignment Component .docxcravennichole326
Executive Program Practical Connection Assignment
Component
Proficient (15 to 20 points)
Competent (8 to 14 points)
Novice (1 to 7 points)
Score
Assignment Requirements
Student completed all required portions of the assignment
Completed portions of the assignment
Did not complete the required assignment.
Writing Skills, Grammar, and APA Formatting
Assignment strongly demonstrates graduate-level proficiency in organization, grammar, and style.
Assignment is well written, and ideas are well developed and explained. Demonstrates strong writing skills. Student paid close attention to spelling and punctuation. Sentences and paragraphs are grammatically correct.
Proper use of APA formatting. Properly and explicitly cited outside resources. Reference list matches citations.
Assignment demonstrates graduate-level proficiency in organization, grammar, and style.
Assignment is effectively communicated, but some sections lacking clarity. Student paid some attention to spelling and punctuation, but there are errors within the writing. Needs attention to proper writing skills.
Use of APA formatting and citations of outside resources, but has a few instances in which proper citations are missing.
Assignment does not demonstrate graduate-level proficiency in organization, grammar, and style.
Assignment is poorly written and confusing. Ideas are not communicated effectively. Student paid no attention to spelling and punctuation. Demonstrates poor writing skills.
The assignment lacks the use of APA formatting and does not provide proper citations or includes no citations.
Maintains purpose/focus
Submission is well organized and has a tight and cohesive focus that is integrated throughout the document
Submissions has an organizational structure and the focus is clear throughout.
Submission lacks focus or contains major drifts in focus
Understanding of Course Content
Student demonstrates understand of course content and knowledge.
Student demonstrates some understanding of course content and knowledge.
Student does not demonstrate understanding of course content and knowledge.
Work Environment Application
Student strongly demonstrates the practical application, or ability to apply, of course objectives within a work environment.
Student demonstrates some practical application, or ability to apply, of course objectives within a work environment.
Student does not demonstrate the practical application, or ability to apply, of course objectives within a work environment.
.
Executive Program Group Project Assignment Component Profi.docxcravennichole326
Executive Program Group Project Assignment
Component
Proficient (15 to 20 points)
Competent (8 to 14 points)
Novice (1 to 7 points)
Score
Assignment Requirements
Student completed all required portions of the assignment
Completed portions of the assignment
Did not complete the required assignment.
Writing Skills, Grammar, and APA Formatting
Assignment strongly demonstrates graduate-level proficiency in organization, grammar, and style.
Assignment is well written, and ideas are well developed and explained. Demonstrates strong writing skills. Student paid close attention to spelling and punctuation. Sentences and paragraphs are grammatically correct.
Proper use of APA formatting. Properly and explicitly cited outside resources. Reference list matches citations.
Assignment demonstrates graduate-level proficiency in organization, grammar, and style.
Assignment is effectively communicated, but some sections lacking clarity. Student paid some attention to spelling and punctuation, but there are errors within the writing. Needs attention to proper writing skills.
Use of APA formatting and citations of outside resources, but has a few instances in which proper citations are missing.
Assignment does not demonstrate graduate-level proficiency in organization, grammar, and style.
Assignment is poorly written and confusing. Ideas are not communicated effectively. Student paid no attention to spelling and punctuation. Demonstrates poor writing skills.
The assignment lacks the use of APA formatting and does not provide proper citations or includes no citations.
Maintains purpose/focus
Submission is well organized and has a tight and cohesive focus that is integrated throughout the document
Submissions has an organizational structure and the focus is clear throughout.
Submission lacks focus or contains major drifts in focus
Understanding of Course Content
Student demonstrates understand of course content and knowledge.
Student demonstrates some understanding of course content and knowledge.
Student does not demonstrate understanding of course content and knowledge.
Work Environment Application
Student strongly demonstrates the practical application, or ability to apply, of course objectives within a work environment.
Student demonstrates some practical application, or ability to apply, of course objectives within a work environment.
Student does not demonstrate the practical application, or ability to apply, of course objectives within a work environment.
Criteria Excellent Satisfactory Less than Satisfactory Not Completed
Log
Completion
4 points
Food logs are
complete with detailed
food/beverage items
3 points
Food logs are
complete but lack
some detail on
food/beverage items
(3 pts)
2 points
Food logs are
complete are missing
substantial detail on
food/beverage items
0 points
Student did not
complete this
component of the
project.
/ 4
Por.
Executive Practical Connection Activityit is a priority that stu.docxcravennichole326
Executive Practical Connection Activity
it is a priority that students are provided with strong educational programs and courses that allow them to be servant-leaders in their disciplines and communities, linking research with practice and knowledge with ethical decision-making. This assignment is a written assignment where students will demonstrate how this course research has connected and put into practice within their own career.
Assignment:
Provide a reflection of at least 500 words (or 2 pages double spaced) of how the knowledge, skills, or theories of this course have been applied, or could be applied, in a practical manner to your current work environment. If you are not currently working, share times when you have or could observe these theories and knowledge could be applied to an employment opportunity in your field of study.
Requirements:
· Provide a 500 word (or 2 pages double spaced) minimum reflection.
· Use of proper APA formatting and citations. If supporting evidence from outside resources is used those must be properly cited.
· Share a personal connection that identifies specific knowledge and theories from this course.
· Demonstrate a connection to your current work environment. If you are not employed, demonstrate a connection to your desired work environment.
· You should NOT, provide an overview of the assignments assigned in the course. The assignment asks that you reflect how the knowledge and skills obtained through meeting course objectives were applied or could be applied in the workplace.
MY ROLE: BIGDATA/KAFKA ADMIN
Need Plagiarism report for this Assignement.
****Directions
Choose from one of the following tweets and answer the 4 questions, Include at least one scholarly source***** The link is included in each tweet for more information.
1. Identify a healthcare issue within your community and explain the issue to your class colleagues. (You may use the same issue you identified in Week 2, but please expand your responses to address this week's focus).
2. Describe the type of healthcare policy you would advocate for in an effort to change this issue.
3. What type of campaign would you need to launch in order to gather a network of support?
4. Compose a Tweet that describes what you have shared with your class colleagues. Remember, Twitter only allows for 140 characters so you will need to be concise.
1. NR708HealthPol Retweeted
Tara Heagele, PhD, RN, PCCN, EMT@TaraHeagele
#NurseTwitter Hurricane season starts today! Helping Vulnerable People Before Disasters Strike | Campaign for Action https://campaignforaction.org/helping-vulnerable-people-before-disasters-strike/#.XtUB00-UAZ4.twitter …
Helping Vulnerable People Before Disasters Strike | Campaign for Action
Floods, tornadoes, heat waves, blizzards, earthquakes, and hurricanes threaten the health and well-being of millions of people each year
campaignforaction.org
13h
·
·
2. NR708HealthPol Retweeted
Diana Mason@djmasonrn
By @AmyAnderso.
Executive FunctionThe Search for an Integrated AccountMari.docxcravennichole326
Executive Function
The Search for an Integrated Account
Marie T. Banich
Department of Psychology & Neuroscience, and Institute of Cognitive Science, University of Colorado at Boulder;
Department of Psychiatry, University of Colorado Denver
ABSTRACT—In general, executive function can be thought
of as the set of abilities required to effortfully guide be-
havior toward a goal, especially in nonroutine situations.
Psychologists are interested in expanding the under-
standing of executive function because it is thought to be a
key process in intelligent behavior, it is compromised in a
variety of psychiatric and neurological disorders, it varies
across the life span, and it affects performance in compli-
cated environments, such as the cockpits of advanced
aircraft. This article provides a brief introduction to the
concept of executive function and discusses how it is
assessed and the conditions under which it is compromised.
A short overview of the diverse theoretical viewpoints re-
garding its psychological and biological underpinnings is
also provided. The article concludes with a consideration
of how a multilevel approach may provide a more inte-
grated account of executive function than has been previ-
ously available.
KEYWORDS—executive function; frontal lobe; prefrontal
cortex; inhibition; task switching; working memory; atten-
tion; top-down control
Like other psychological constructs, such as memory, executive
function is multidimensional. As such, there exists a variety of
models that provide varying viewpoints as to its basic component
processes. Nonetheless, common across most of them is the idea
that executive function is a process used to effortfully guide
behavior toward a goal, especially in nonroutine situations.
Various functions or abilities are thought to fall under the rubric
of executive function. These include prioritizing and sequencing
behavior, inhibiting familiar or stereotyped behaviors, creating
and maintaining an idea of what task or information is most
relevant for current purposes (often referred to as an attentional
or mental set), providing resistance to information that is dis-
tracting or task irrelevant, switching between task goals, uti-
lizing relevant information in support of decision making,
categorizing or otherwise abstracting common elements across
items, and handling novel information or situations. As can be
seen from this list, the functions that fall under the category of
executive function are indeed wide ranging.
ASSESSING EXECUTIVE FUNCTION
The very nature of executive function makes it difficult to
measure in the clinic or the laboratory; it involves an individual
guiding his or her behavior, especially in novel, unstructured,
and nonroutine situations that require some degree of judgment.
In contrast, standard testing situations are structured—partic-
ipants are explicitly told what the task is, given rules for per-
forming the task, and provide.
Executive Compensation and IncentivesMartin J. ConyonEx.docxcravennichole326
Executive Compensation and Incentives
Martin J. Conyon*
Executive Overview
The objective of a properly designed executive compensation package is to attract, retain, and motivate
CEOs and senior management. The standard economic approach for understanding executive pay is the
principal-agent model. This paper documents the changes in executive pay and incentives in U.S. firms
between 1993 and 2003. We consider reasons for these transformations, including agency theory, changes
in the managerial labor markets, shifts in firm strategy, and theories concerning managerial power. We show that
boards and compensation committees have become more independent over time. In addition, we demonstrate
that compensation committees containing affiliated directors do not set greater pay or fewer incentives.
Introduction
E
xecutive compensation is a complex and con-
troversial subject. For many years, academics,
policymakers, and the media have drawn atten-
tion to the high levels of pay awarded to U.S.
chief executive officers (CEOs), questioning
whether they are consistent with shareholder in-
terests.1 Some academics have further argued that
flaws in CEO pay arrangements and deviations
from shareholders’ interests are widespread and
considerable.2 For example, Lucian Bebchuk and
Jesse Fried provide a lucid account of the mana-
gerial power view and accompanying evidence.3
Marianne Bertrand and Sendhil Mullainathan too
provide an analysis of the ‘skimming view’ of CEO
pay.4 In contrast, John Core et al. present an
economic contracting approach to executive pay
and incentives, assessing whether CEOs receive
inefficient pay without performance.5 In this pa-
per, we show what has happened to CEO pay in
the United States. We do not claim to distinguish
between the contracting and managerial power
views of executive pay. Instead, we document the
pattern of executive pay and incentives in the
United States, investigating whether this pattern
is consistent with economic theory.
The Context: Who Sets Executive Pay?
B
efore examining the empirical evidence pre-
sented in this paper, it is important to consider
the pay-setting process and who sets executive
pay. The standard economic theory of executive
compensation is the principal-agent model.6 The
theory maintains that firms seek to design the most
efficient compensation packages possible in order to
attract, retain, and motivate CEOs, executives, and
managers.7 In the agency model, shareholders set
pay. In practice, however, the compensation com-
mittee of the board determines pay on behalf of
shareholders. A principal (shareholder) designs a
contract and makes an offer to an agent (CEO/
manager). Executive compensation ameliorates a
moral hazard problem (i.e., manager opportunism)
arising from low firm ownership. By using stock
options, restricted stock, and long-term contracts,
shareholders motivate the CEO to maximize firm
value. In other words, shareholders try to design
optimal compensation packages .
Executing the StrategyLearning ObjectivesAfter reading.docxcravennichole326
Executing the Strategy
Learning Objectives
After reading this chapter, you should be able to:
• Distinguish good operational plans from weak ones.
• Detail the value of tracking progress on all operational plans.
• Discuss why emergent strategies occur and how they might affect an organization’s
current strategy.
• Implement the ten basic steps of a generic strategic formulation process.
• Manage, improve, and evaluate an existing strategic management process.
Chapter 9
Neil Webb/Ikon Images/Getty Images
spa81202_09_c09.indd 247 1/16/14 10:08 AM
CHAPTER 9Section 9.1 Managing Operational Plans
Implementing a strategy (see Figure 1.1) in the real world is not a leisurely swim across
a calm pond on a sunny day, but rather like crossing from one bank of a raging river to
the other, encountering hidden eddies, fog, driving rain, lightning, and riptides along the
way. While it is not impossible to reach the other bank (the goal), the task often becomes
one of overcoming obstacles and making constant adjustments without losing sight of the
goal. Implementation is like that. Even the most brilliant strategy is worthless if it cannot
be implemented.
This chapter focuses on strategy execution and its difficulties. Part of the chapter is devoted
to assessing, improving, and managing the strategy formulation process itself.
9.1 Managing Operational Plans
The process for obtaining board approval of operational plans is covered in this chapter.
Exactly what is it that gets approved? An operational plan is a document that specifies the
projects or tasks that must be accomplished to achieve particular operational objectives.
Many of these plans will contain activities that are ongoing. Some will include plans for
enhanced or new services. Details specified in operational plans include the names of those
who will be involved and the indi-
vidual responsible for each one, what
equipment will be needed, when each
will start and end, and the estimated
costs for each activity. Given the level
of detail required, it should come as
no surprise that an operational plan
for a large functional unit, such as the
nursing department in a hospital, can
run to many pages, as there are lots of
activities to be detailed. Operational
plans for small HSOs such as physi-
cian clinics and community health
centers may be just a few pages long
unless new strategic initiatives are to
be undertaken.
It takes contributions from everyone
who will be involved in that HSO’s
operations to create such plans. They
will make sure that continuing cur-
rent operations are included in the plans, which is easily done. What adds a level of com-
plexity and difficulty is incorporating additional tasks demanded by a change in strategy.
Consider the following scenarios, which illustrate the difficulty in creating operational
plans that involve more than simply repeating what was done the previous year:
Javier Larrea/age fotostock/Getty Ima.
Executing Strategies in a Global Environment Examining the Case of .docxcravennichole326
Executing Strategies in a Global Environment: Examining the Case of Federal Express 5-7 pages
Requirements:
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ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Chapter 2Factors influencing the application and diffusion of .docx
1. Chapter 2
Factors influencing the application and diffusion of CQI in
health care
Contents
Introduction
The dynamic character of CQI
A CQI case study
The current state of CQI in healthcare
CQI and the science of innovation
The business case for CQI
Factors affecting successful CQI application
Introduction
CQI is utilized across health care sectors (including primary and
preventative care) as well as across geographic and economic
boundaries
The need for CQI is increasing
One reason: the safety and quality of care has shown little
improvement over the last decade despite best efforts of
clinicians, managers, researchers, and involvement of public
This lecture will review a number of factors and processes have
been shown to facilitate or impede the implementation of CQI in
health care
The Dynamic Character of CQI
CQI methodology is constantly being refined and tested: it is an
2. evolutionary quality improvement mechanism
This is because in response to new challenges, CQI applications
develop via continuous, ongoing learning and sharing among
disciplines about ways to use CQI philosophies, processes and
tools in a variety of settings
The Surgical Safety Checklist:
a CQI Success Story
Checklist CQI methodology orginated in aviation
2001 utilised by Pronovost (2006) in Intensive Care Units as a
way of reducing central line infections
Surgical Safety Checklist (SSC) developed by Gawande (2009)
is disseminated by WHO across the world
The Surgical Safety Checklist:
a CQI Success Story
Development of SSC depended upon:
Effective leadership
Interdisciplinary teamwork
Use of a PDSA improvement cycle to test, learn and improve
Engagement of a broad range of expertise to improve safety on
a global scale
The Surgical Safety Checklist:
a CQI success story
Results vary but after the introduction of the SSC:
Haynes et al. (2009) demonstrated a reduction in complication
rates from 11.0% at baseline to 7.0% plus, and a reduction in
death rates from 1.5% to 0.8% in eight hospitals in eight cities
The SURPASS group study of six hospitals in the Netherlands,
showed a statistically significant decrease in the proportion of
patients with one or more complications, from 15.4% to 10.6%
(de Vries et al. 2010).
3. So if Checklists are Successful …
Why aren’t more healthcare providers using CQI tools and
processes?
Why is the gap between knowledge and practice so large?
Why don’t clinical systems incorporate the findings of clinical
science or copy the “best known” practices reliably, quickly,
and even gratefully into their daily work simply as a matter of
course?
Limitations of Checklists
May be too simple a tool and what is required is more complex
system solutions to quality and safety issues (Bosk et al.
2009).
Problems with checklists are indicative of broader CQI and
quality improvement issues in healthcare including:
Process vs. outcome;
Cost vs. benefit vs. value;
Minimum standards required to define evidence for change;
How to balance difference of opinions about findings;
Ways of influencing practitioners to adopt new ideas;
Diffusion of innovation in health care.
Discussion Questions
What is the current state of quality in health care?
What are the problems regarding implementation of CQI in
health care?
Given the widespread application of CQI, what factors that
contribute to the implementation of CQI across industries and
settings?
What are the factors that have influenced the rate of diffusion
4. and spread of CQI in health care?
The Current State of CQI in Healthcare
• A decade after the Institute of Medicine To Err is Human
(2000) and Crossing the Quality Chasm (2001) and despite best
efforts, improvement in quality and safety remains limited
The ability of the patient safety movement to close the gap in
errors and adverse events was rated as “C+” in 2005, and as a
“B-” in 2009 (Wachter 2009)
A recent review of patient “harms” from 2002 to 2007 in over
2,300 admissions in 10 hospitals in North Carolina showed little
improvement in error rates despite high levels of engagement in
safety efforts (Landrigan et el. 2010)
Discussion Question
Do you agree with the following quotation?
“U.S. health care is broken. Although other industries have
transformed themselves using tools such as standardization of
value-generating processes performance measurement and
transparent reporting of quality, the application of these tools to
health care is controversial, evoking fears of “cookbook
medicine,” loss of professional autonomy, a misinformed focus
on the wrong care or a loss of individual attention and the
personal touch in care delivery…Our current health care system
is essentially a cottage industry of nonintegrated, dedicated
artisans who eschew standardization….Growing evidence
highlights the dangers of continuing to operate in a cottage-
industry mode. Fragmentation of care has led to suboptimal
performance.” (Swenson et al. 2010, p. e12(1))
5. The Current State of CQI in Healthcare
Two key issues have been associated with the lack of
improvement in the quality and safety of care in the U.S.:
Complexity and cost
These are same key factors in the recent debate about health
reform in the United States
Complexity of U.S. Healthcare
The complexity of the healthcare system is both a challenge and
a source of ideas for how to make improvements (Plsek &
Greenhalgh 2001)
Health care is described as a complex adaptive system (Rouse
2008)
This has implications for how to improve the system of
healthcare:
Health care can only be designed to a certain extent
Cannot be designed around minimizing costs
Requires a focus on maximizing value
There is a need to be proactive - designing the system required,
rather than continuing to let it evolve
Therefore leadership is critical and
There need to be incentives for improvement
Cost of U.S. Healthcare
The U.S. Healthcare system is much more expensive, but not
significantly better than other healthcare systems around the
world (Leonhardt 2009)
The U.S. spends more per capita for health care than any other
country, yet ranks 27th in infant mortality, 27th in life
expectancy, with Americans less satisfied with their care
6. than the English, Canadians or Germans (Berwick 2003)
CQI and the Science of Innovation
There are no simple answers about how to move CQI
innovations into the mainstream of health care more quickly and
efficiently
A common element to all complex systems is the difficulty
surrounding diffusion of innovation
Diffusion theory provides one way of understanding the barriers
and facilitators of CQI in healthcare
CQI and the Science of Innovation
Complexity must be considered in understanding healthcare
innovation
Innovation may not be able to be managed, but organizational
conditions can be designed and controlled in a way that
“enhance the possibility of innovation occurring and spreading”
(Greenhalgh et al. 2005, p.80)
Factors which facilitate these conditions include:
Leadership
The creation of a receptive and even enthusiastic culture (e.g.
the development of quality improvement collaboratives).
CQI and the Science of Innovation
The speed and overall adoption of any change is influenced by
the characteristics of the change and how it is perceived by
those responsible for implementation
Characteristics affecting change include:
Relative advantage
Compatibility
Simplicity
7. Trialability
Observability (Rogers 1995)
In the SSC example, compatibility (how closely do the change
ideas align with the existing culture and environment) and
trialability (the evidence base for whether the change can be
adapted and tested in the new environments in which they are
being spread) were most pertinent.
CQI and the Science of Innovation
Berwick (2003) identified 7 rules for dissemination of
innovation in health care:
Find sound innovations
Find and support innovators
Invest in early adopters
Make early adopter activity observable
Trust and enable reinvention
Create slack for change
Lead by example
8. CQI and the Science of Innovation
Fundamental levers of CQI include:
Reinvention
Trust
Leadership
CQI and the Science of Innovation
CQI cannot be a top-down mandate
It must be part of the vision of an organization and accepted by
all who must implement CQI - requiring trust at all levels
Trust comes from leadership and teamwork and Deming’s
concept of “constancy of purpose.”
Top leadership must be involved and support and communicate
the vision for innovation and change
The participation, buy-in and support from opinion leaders at all
levels within an organization are critical for successful
implementation, and the process to reinvention.
One size will not fit all. As described by Berwick (2003,
p.1974) “To work, changes must be not only adopted locally,
but also locally adapted.” Berwick asserts that for this to
happen requires reinvention. “Reinvention is a form of learning,
and, in its own way, it is an act of both creativity and courage.
Leaders who want to foster innovation … should showcase and
celebrate individuals who take ideas from elsewhere and adapt
them to make them their own”(Berwick, 2003, p.1974).
CQI and the Science of Innovation
9. CQI and the Science of Innovation
Checklist example cited at the beginning of this chapter is a
clear illustration of this process of reinvention and leadership.
adapted from the airline and other industries
Health care is complex and requires diligence to spread the
improvement process.
Equally complex quality improvement strategies are required,
slow adaptation
- Simple PDSA cycles, have enjoyed broad success.
Review of a study by Foy et al. (2002) by Greenhalgh et al
a prospective study of the attributes of 42 clinical practice
recommendations in gynecology.
Examples of progress in specific segments of health care
models that can be considered to increase diffusion of CQI
ideas.
Social marketing
Discussion Question
“Reinvention is a form of learning, and, in its own way, it is an
act of both creativity and courage. Leaders who want to foster
innovation … should showcase and celebrate individuals who
take ideas from elsewhere and adapt them to make them their
own”(Berwick, 2003, p.1974).
Do you agree?
The Business Case for CQI
A business case for a health care improvement intervention
exists if the entity that invests in the intervention realizes a
financial return on its investment in a reasonable time frame,
using a reasonable rate of discounting. This may be realized as
10. “bankable dollars” (profit), a reduction in losses for a given
program or population, or avoided costs
A business case may also exist if the investing entity believes
that a positive indirect impact on organization function and
sustainability will accrue within a reasonable time frame. (p.
18)
The Business Case for CQI
The economic case for an innovation includes the returns to all
the actors, not just the individual investing business unit
The social case involves measuring benefits, but not requiring
positive returns on the investment
The social case has been overriding consideration in the battle
to control medical variation and medical errors (McGlynn et al.
2003)
Economics alone does not provide an argument strongly for or
against the use of CQI, but does add to the complexity of the
wider and more rapid implementation of CQI in health care.
The Business Case for CQI
The business case for CQI faces the same negative factors as the
business case for other preventive health care measures:
all or part of the benefits accruing to other business units or
patients, and delayed impacts that get discounted heavily in the
reckoning.(Leatherman et al. 2003)
The regulatory arguments for quality improvement efforts are
usually justified on the basis of social and economic benefits
such as lives saved and overall cost reductions, but are not
necessarily profitable to the investor.
Factors Associated with Successful CQI Applications
Motivational factors
Regulatory agencies and accreditation
11. Transformational leadership, teamwork and a culture of
excellence
1. Motivational factors
Intrinsic motivation
CQI as job enrichment
Capturing the intellectual capital of the workforce
capitalizing on professional and specialist knowledge of
workers
Reducing managerial overhead
unique implications for healthcare setting
Lateral linkages
interdisciplinary care, interdependence and effective teamwork
2. Regulatory Agencies and Accreditation
Regulatory mechanisms such as accreditation are key factors
that have led to greater diffusion of CQI
The Joint Commission (TJC) and the Centers for Medicare and
Medicaid Services (CMS) have led to the implementation of a
series of initiatives that require hospitals to report on quality
measures
Quality Improvement Organizations (QIOs) report extensive
CQI activities and findings associated with these activities
Joint Commission has noted the use of robust, evidence based
measures, linking process performance and patient outcomes
(Chassin,et al. 2010) in the acute sector, but identified more
work was required in measurements of quality in ambulatory
care
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Transformational leadership is distinguished by its reliance on
vision
12. A culture of excellence of excellence in CQI has been defined
as a culture in which “a commitment to safety permeates all
levels of the organization from frontline personnel to executive
management” (AHRQ 2010)
A culture of excellence is one that ensures excellence and high
quality at every customer interface, in which a commitment to
the highest quality and CQI is shared by all in the organization
Figure 2.1:
Factors Influencing Successful CQI Implementation
Leadership
Vision
Constancy
of
Purpose
Culture of Excellence
Statistical Thinking
Empowerment
Teamwork
Motivation
CQI
Communication/Feedback
Systems Thinking
Customer Focus
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Underlying the creation of a culture of excellence is a need for
systems view which emphasizes the importance of:
adding value
13. leadership rather than management
influence rather than power and
the alignment of incentives focused on quality not quantity of
services (Rouse 2008).
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Customer Focus
Emphasizing the importance of both internal and external
customers
Systems Thinking
Optimizing the system as a whole and thereby creating synergy
(Deming 1986; Kelly 2007)
Statistical Thinking
Understanding causes of variation, learning from measurement,
and using data to make decisions (Balestracci 2009)
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Teamwork
Teams of peers working together to ensure empowerment and
motivation, ensuring alignment of the organization, the team
and the individual around the CQI vision
Communication and Feedback
Open channels of communication and feedback to make
adjustments as needed, including feedback which is fact based
and given with true concern for individuals’ organizational
success (Balestracci 2009).
Leadership and Diffusion
Innovativeness is seen as critically dependent on good
leadership
14. Organizational leadership is also critical to the development of
a culture that fosters innovation (Greenhalgh et al. 2005).
Discussion Question
“Leaders within organizations are critical firstly in
creating a cultural context that fosters innovation and
secondly, establishing organizational strategy, structure and
systems that facilitate innovation”
(Greenhalgh et al. 2005, p. 69)
Leadership and Diffusion
Three types of leaders: opinion leaders, champions, and
boundary spanners can contribute to the diffusion of innovation
across an organization
Each of these types of leaders is found in the adoption of
quality improvement initiatives in health care and often these
various types of leaders are found in combination.
Opinion leaders
At all levels of the organization
Influence on the beliefs and actions of their colleagues
Influence can be either positive or negative in regard to
embracing innovation
Opinion leaders
May be experts, respected for formal academic authority in
regard to an innovation
Their support represents a form of evidenced based knowledge
May also be peers, respected for their know-how and
understanding of the realities of clinical practice (Greenhalgh et
al. 2005).
Leadership and Diffusion
15. Leadership and Diffusion
Champions
Persistently support new ideas
May come from the top management of or within organizations,
including technical or business experts
Include team and project leaders and others who have
persistence to fight both resistance and/or indifference to
promote the acceptance of a new idea or to achieve project
goals (Greenhalgh et al. 2005).
Leadership and Diffusion
Boundary spanners
Are a combination of these various types of leaders of
innovation
Are distinguished by the fact that they have influence across
organizational and other boundaries (Greenhalgh et al. 2005;
Kaluzny 1974)
Play an important role in multi-organizational innovations and
quality improvement initiatives (ie quality improvement
collaboratives)
Teamwork
Teams play a major role in all of health care
Teamwork is one of the most important components of all
successful CQI initiatives
Team building centers on the ability to create teams of
empowered and motivated people who are leaders themselves
and who will take the lead as necessary to foster change,
innovation and improvement
The link between leadership and teamwork is the glue which
holds CQI together – with leadership exhibited as called for at
all levels within a team
“There is no substitute for teamwork and good leaders of
16. teams to bring consistency of effort along with knowledge”
(Deming 1986, p.19).
Teamwork
Inherent in teamwork involves:
A high level of empowerment of team members which in turn
leads to high levels of motivation
Empowerment implies that levels of authority match levels of
responsibility, and training
Training is critical to the success of leaders, and the training of
future leaders is one of the most important responsibilities of a
leader (Tichy 1997).
Results in all members of the team being able to make
suggestions and interventions can be made to allow
improvements and prevent problems or errors(Berwick, 2010)
Teamwork
Improved motivation is the result of empowerment, and both
will interact to lead to higher quality
But both require a culture of trust
Deming’s point number eight is:
“Drive out fear. No one can put in his best performance unless
he feels secure…Secure means without fear, not afraid to
express ideas, not afraid to ask questions” (Deming 1986, p.59).
Kotter’s change model
Kotter’s work has been used to define a culture of change,
including the role of vision and leadership
Eight-stage change model which describes “how to” rather than
“what is” major organizational change
Provides guidance on traditional errors to avoid
There is a clear overlap between Kotter’s model and the factors
17. defined in the figure describing the culture of excellence
Common elements include:
Empowerment
Communication
feedback loops to produce more change
the central role of vision and anchoring change in the culture.
Table 2-1:
Kotter’s Eight-Stage Process of Creating Major Change
1. Establishing a Sense of Urgency
2. Creating the Guiding Coalition
3. Developing a Vision and Strategy
4. Communicating the Change Vision
5. Empowering Broad-Based Action
6. Generating Short-Term Wins
7. Consolidating Gains and Producing More Change
Anchoring New Approaches in the Culture
Source: Adapted from John Kotter, Leading Change
Conclusion
The factors that are associated with successful CQI applications
can be clearly identified
These include leadership and team work and their role in
developing a shared vision leading to a culture of excellence
which embraces CQI
CQI leaders are individuals who lead by example, teach others,
and continue to develop and expand both the philosophy and
processes of CQI
Despite the spread of CQI its further adoption in health care
continues to meet challenges, including the lack of substantial
progress in improving quality of health care and most important
18. reducing harm to patients (Landrigan et al. 2010; Wachter
2009)
Factors that influence the adoption of CQI include complexity,
which can inhibit further adoption and the slowing down of
progress after the impact of early adopters has waned
Conclusion
Chapter 2
Factors influencing the application and diffusion of CQI in
health care
Contents
Introduction
The dynamic character of CQI
A CQI case study
The current state of CQI in healthcare
CQI and the science of innovation
The business case for CQI
Factors affecting successful CQI application
Introduction
CQI is utilized across health care sectors (including primary and
preventative care) as well as across geographic and economic
boundaries
The need for CQI is increasing
One reason: the safety and quality of care has shown little
19. improvement over the last decade despite best efforts of
clinicians, managers, researchers, and involvement of public
This lecture will review a number of factors and processes have
been shown to facilitate or impede the implementation of CQI in
health care
The Dynamic Character of CQI
CQI methodology is constantly being refined and tested: it is an
evolutionary quality improvement mechanism
This is because in response to new challenges, CQI applications
develop via continuous, ongoing learning and sharing among
disciplines about ways to use CQI philosophies, processes and
tools in a variety of settings
The Surgical Safety Checklist:
a CQI Success Story
Checklist CQI methodology orginated in aviation
2001 utilised by Pronovost (2006) in Intensive Care Units as a
way of reducing central line infections
Surgical Safety Checklist (SSC) developed by Gawande (2009)
is disseminated by WHO across the world
The Surgical Safety Checklist:
a CQI Success Story
Development of SSC depended upon:
Effective leadership
Interdisciplinary teamwork
Use of a PDSA improvement cycle to test, learn and improve
Engagement of a broad range of expertise to improve safety on
a global scale
The Surgical Safety Checklist:
20. a CQI success story
Results vary but after the introduction of the SSC:
Haynes et al. (2009) demonstrated a reduction in complication
rates from 11.0% at baseline to 7.0% plus, and a reduction in
death rates from 1.5% to 0.8% in eight hospitals in eight cities
The SURPASS group study of six hospitals in the Netherlands,
showed a statistically significant decrease in the proportion of
patients with one or more complications, from 15.4% to 10.6%
(de Vries et al. 2010).
So if Checklists are Successful …
Why aren’t more healthcare providers using CQI tools and
processes?
Why is the gap between knowledge and practice so large?
Why don’t clinical systems incorporate the findings of clinical
science or copy the “best known” practices reliably, quickly,
and even gratefully into their daily work simply as a matter of
course?
Limitations of Checklists
May be too simple a tool and what is required is more complex
system solutions to quality and safety issues (Bosk et al.
2009).
Problems with checklists are indicative of broader CQI and
quality improvement issues in healthcare including:
Process vs. outcome;
Cost vs. benefit vs. value;
Minimum standards required to define evidence for change;
How to balance difference of opinions about findings;
Ways of influencing practitioners to adopt new ideas;
Diffusion of innovation in health care.
21. Discussion Questions
What is the current state of quality in health care?
What are the problems regarding implementation of CQI in
health care?
Given the widespread application of CQI, what factors that
contribute to the implementation of CQI across industries and
settings?
What are the factors that have influenced the rate of diffusion
and spread of CQI in health care?
The Current State of CQI in Healthcare
• A decade after the Institute of Medicine To Err is Human
(2000) and Crossing the Quality Chasm (2001) and despite best
efforts, improvement in quality and safety remains limited
The ability of the patient safety movement to close the gap in
errors and adverse events was rated as “C+” in 2005, and as a
“B-” in 2009 (Wachter 2009)
A recent review of patient “harms” from 2002 to 2007 in over
2,300 admissions in 10 hospitals in North Carolina showed little
improvement in error rates despite high levels of engagement in
safety efforts (Landrigan et el. 2010)
Discussion Question
Do you agree with the following quotation?
“U.S. health care is broken. Although other industries have
transformed themselves using tools such as standardization of
value-generating processes performance measurement and
transparent reporting of quality, the application of these tools to
health care is controversial, evoking fears of “cookbook
medicine,” loss of professional autonomy, a misinformed focus
on the wrong care or a loss of individual attention and the
22. personal touch in care delivery…Our current health care system
is essentially a cottage industry of nonintegrated, dedicated
artisans who eschew standardization….Growing evidence
highlights the dangers of continuing to operate in a cottage-
industry mode. Fragmentation of care has led to suboptimal
performance.” (Swenson et al. 2010, p. e12(1))
The Current State of CQI in Healthcare
Two key issues have been associated with the lack of
improvement in the quality and safety of care in the U.S.:
Complexity and cost
These are same key factors in the recent debate about health
reform in the United States
Complexity of U.S. Healthcare
The complexity of the healthcare system is both a challenge and
a source of ideas for how to make improvements (Plsek &
Greenhalgh 2001)
Health care is described as a complex adaptive system (Rouse
2008)
This has implications for how to improve the system of
healthcare:
Health care can only be designed to a certain extent
Cannot be designed around minimizing costs
Requires a focus on maximizing value
There is a need to be proactive - designing the system required,
rather than continuing to let it evolve
Therefore leadership is critical and
There need to be incentives for improvement
23. Cost of U.S. Healthcare
The U.S. Healthcare system is much more expensive, but not
significantly better than other healthcare systems around the
world (Leonhardt 2009)
The U.S. spends more per capita for health care than any other
country, yet ranks 27th in infant mortality, 27th in life
expectancy, with Americans less satisfied with their care
than the English, Canadians or Germans (Berwick 2003)
CQI and the Science of Innovation
There are no simple answers about how to move CQI
innovations into the mainstream of health care more quickly and
efficiently
A common element to all complex systems is the difficulty
surrounding diffusion of innovation
Diffusion theory provides one way of understanding the barriers
and facilitators of CQI in healthcare
CQI and the Science of Innovation
Complexity must be considered in understanding healthcare
innovation
Innovation may not be able to be managed, but organizational
conditions can be designed and controlled in a way that
“enhance the possibility of innovation occurring and spreading”
(Greenhalgh et al. 2005, p.80)
Factors which facilitate these conditions include:
Leadership
The creation of a receptive and even enthusiastic culture (e.g.
the development of quality improvement collaboratives).
24. CQI and the Science of Innovation
The speed and overall adoption of any change is influenced by
the characteristics of the change and how it is perceived by
those responsible for implementation
Characteristics affecting change include:
Relative advantage
Compatibility
Simplicity
Trialability
Observability (Rogers 1995)
In the SSC example, compatibility (how closely do the change
ideas align with the existing culture and environment) and
trialability (the evidence base for whether the change can be
adapted and tested in the new environments in which they are
being spread) were most pertinent.
CQI and the Science of Innovation
Berwick (2003) identified 7 rules for dissemination of
innovation in health care:
Find sound innovations
Find and support innovators
Invest in early adopters
Make early adopter activity observable
25. Trust and enable reinvention
Create slack for change
Lead by example
CQI and the Science of Innovation
Fundamental levers of CQI include:
Reinvention
Trust
Leadership
CQI and the Science of Innovation
CQI cannot be a top-down mandate
It must be part of the vision of an organization and accepted by
all who must implement CQI - requiring trust at all levels
Trust comes from leadership and teamwork and Deming’s
concept of “constancy of purpose.”
Top leadership must be involved and support and communicate
the vision for innovation and change
The participation, buy-in and support from opinion leaders at all
levels within an organization are critical for successful
implementation, and the process to reinvention.
26. One size will not fit all. As described by Berwick (2003,
p.1974) “To work, changes must be not only adopted locally,
but also locally adapted.” Berwick asserts that for this to
happen requires reinvention. “Reinvention is a form of learning,
and, in its own way, it is an act of both creativity and courage.
Leaders who want to foster innovation … should showcase and
celebrate individuals who take ideas from elsewhere and adapt
them to make them their own”(Berwick, 2003, p.1974).
CQI and the Science of Innovation
CQI and the Science of Innovation
Checklist example cited at the beginning of this chapter is a
clear illustration of this process of reinvention and leadership.
adapted from the airline and other industries
Health care is complex and requires diligence to spread the
improvement process.
Equally complex quality improvement strategies are required,
slow adaptation
- Simple PDSA cycles, have enjoyed broad success.
Review of a study by Foy et al. (2002) by Greenhalgh et al
a prospective study of the attributes of 42 clinical practice
recommendations in gynecology.
Examples of progress in specific segments of health care
models that can be considered to increase diffusion of CQI
ideas.
Social marketing
Discussion Question
“Reinvention is a form of learning, and, in its own way, it is an
act of both creativity and courage. Leaders who want to foster
innovation … should showcase and celebrate individuals who
take ideas from elsewhere and adapt them to make them their
own”(Berwick, 2003, p.1974).
27. Do you agree?
The Business Case for CQI
A business case for a health care improvement intervention
exists if the entity that invests in the intervention realizes a
financial return on its investment in a reasonable time frame,
using a reasonable rate of discounting. This may be realized as
“bankable dollars” (profit), a reduction in losses for a given
program or population, or avoided costs
A business case may also exist if the investing entity believes
that a positive indirect impact on organization function and
sustainability will accrue within a reasonable time frame. (p.
18)
The Business Case for CQI
The economic case for an innovation includes the returns to all
the actors, not just the individual investing business unit
The social case involves measuring benefits, but not requiring
positive returns on the investment
The social case has been overriding consideration in the battle
to control medical variation and medical errors (McGlynn et al.
2003)
Economics alone does not provide an argument strongly for or
against the use of CQI, but does add to the complexity of the
wider and more rapid implementation of CQI in health care.
The Business Case for CQI
The business case for CQI faces the same negative factors as the
business case for other preventive health care measures:
all or part of the benefits accruing to other business units or
patients, and delayed impacts that get discounted heavily in the
reckoning.(Leatherman et al. 2003)
28. The regulatory arguments for quality improvement efforts are
usually justified on the basis of social and economic benefits
such as lives saved and overall cost reductions, but are not
necessarily profitable to the investor.
Factors Associated with Successful CQI Applications
Motivational factors
Regulatory agencies and accreditation
Transformational leadership, teamwork and a culture of
excellence
1. Motivational factors
Intrinsic motivation
CQI as job enrichment
Capturing the intellectual capital of the workforce
capitalizing on professional and specialist knowledge of
workers
Reducing managerial overhead
unique implications for healthcare setting
Lateral linkages
interdisciplinary care, interdependence and effective teamwork
2. Regulatory Agencies and Accreditation
Regulatory mechanisms such as accreditation are key factors
that have led to greater diffusion of CQI
The Joint Commission (TJC) and the Centers for Medicare and
Medicaid Services (CMS) have led to the implementation of a
series of initiatives that require hospitals to report on quality
measures
Quality Improvement Organizations (QIOs) report extensive
CQI activities and findings associated with these activities
Joint Commission has noted the use of robust, evidence based
measures, linking process performance and patient outcomes
29. (Chassin,et al. 2010) in the acute sector, but identified more
work was required in measurements of quality in ambulatory
care
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Transformational leadership is distinguished by its reliance on
vision
A culture of excellence of excellence in CQI has been defined
as a culture in which “a commitment to safety permeates all
levels of the organization from frontline personnel to executive
management” (AHRQ 2010)
A culture of excellence is one that ensures excellence and high
quality at every customer interface, in which a commitment to
the highest quality and CQI is shared by all in the organization
Figure 2.1:
Factors Influencing Successful CQI Implementation
Leadership
Vision
Constancy
of
Purpose
Culture of Excellence
Statistical Thinking
Empowerment
Teamwork
Motivation
CQI
Communication/Feedback
30. Systems Thinking
Customer Focus
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Underlying the creation of a culture of excellence is a need for
systems view which emphasizes the importance of:
adding value
leadership rather than management
influence rather than power and
the alignment of incentives focused on quality not quantity of
services (Rouse 2008).
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Customer Focus
Emphasizing the importance of both internal and external
customers
Systems Thinking
Optimizing the system as a whole and thereby creating synergy
(Deming 1986; Kelly 2007)
Statistical Thinking
Understanding causes of variation, learning from measurement,
and using data to make decisions (Balestracci 2009)
3. Transformational Leadership, Teamwork, and a Culture of
Excellence
Teamwork
Teams of peers working together to ensure empowerment and
motivation, ensuring alignment of the organization, the team
and the individual around the CQI vision
Communication and Feedback
Open channels of communication and feedback to make
31. adjustments as needed, including feedback which is fact based
and given with true concern for individuals’ organizational
success (Balestracci 2009).
Leadership and Diffusion
Innovativeness is seen as critically dependent on good
leadership
Organizational leadership is also critical to the development of
a culture that fosters innovation (Greenhalgh et al. 2005).
Discussion Question
“Leaders within organizations are critical firstly in
creating a cultural context that fosters innovation and
secondly, establishing organizational strategy, structure and
systems that facilitate innovation”
(Greenhalgh et al. 2005, p. 69)
Leadership and Diffusion
Three types of leaders: opinion leaders, champions, and
boundary spanners can contribute to the diffusion of innovation
across an organization
Each of these types of leaders is found in the adoption of
quality improvement initiatives in health care and often these
various types of leaders are found in combination.
Opinion leaders
At all levels of the organization
Influence on the beliefs and actions of their colleagues
Influence can be either positive or negative in regard to
embracing innovation
Opinion leaders
32. May be experts, respected for formal academic authority in
regard to an innovation
Their support represents a form of evidenced based knowledge
May also be peers, respected for their know-how and
understanding of the realities of clinical practice (Greenhalgh et
al. 2005).
Leadership and Diffusion
Leadership and Diffusion
Champions
Persistently support new ideas
May come from the top management of or within organizations,
including technical or business experts
Include team and project leaders and others who have
persistence to fight both resistance and/or indifference to
promote the acceptance of a new idea or to achieve project
goals (Greenhalgh et al. 2005).
Leadership and Diffusion
Boundary spanners
Are a combination of these various types of leaders of
innovation
Are distinguished by the fact that they have influence across
organizational and other boundaries (Greenhalgh et al. 2005;
Kaluzny 1974)
Play an important role in multi-organizational innovations and
quality improvement initiatives (ie quality improvement
collaboratives)
Teamwork
Teams play a major role in all of health care
Teamwork is one of the most important components of all
33. successful CQI initiatives
Team building centers on the ability to create teams of
empowered and motivated people who are leaders themselves
and who will take the lead as necessary to foster change,
innovation and improvement
The link between leadership and teamwork is the glue which
holds CQI together – with leadership exhibited as called for at
all levels within a team
“There is no substitute for teamwork and good leaders of
teams to bring consistency of effort along with knowledge”
(Deming 1986, p.19).
Teamwork
Inherent in teamwork involves:
A high level of empowerment of team members which in turn
leads to high levels of motivation
Empowerment implies that levels of authority match levels of
responsibility, and training
Training is critical to the success of leaders, and the training of
future leaders is one of the most important responsibilities of a
leader (Tichy 1997).
Results in all members of the team being able to make
suggestions and interventions can be made to allow
improvements and prevent problems or errors(Berwick, 2010)
Teamwork
Improved motivation is the result of empowerment, and both
will interact to lead to higher quality
But both require a culture of trust
Deming’s point number eight is:
“Drive out fear. No one can put in his best performance unless
he feels secure…Secure means without fear, not afraid to
express ideas, not afraid to ask questions” (Deming 1986, p.59).
34. Kotter’s change model
Kotter’s work has been used to define a culture of change,
including the role of vision and leadership
Eight-stage change model which describes “how to” rather than
“what is” major organizational change
Provides guidance on traditional errors to avoid
There is a clear overlap between Kotter’s model and the factors
defined in the figure describing the culture of excellence
Common elements include:
Empowerment
Communication
feedback loops to produce more change
the central role of vision and anchoring change in the culture.
Table 2-1:
Kotter’s Eight-Stage Process of Creating Major Change
1. Establishing a Sense of Urgency
2. Creating the Guiding Coalition
3. Developing a Vision and Strategy
4. Communicating the Change Vision
5. Empowering Broad-Based Action
6. Generating Short-Term Wins
7. Consolidating Gains and Producing More Change
Anchoring New Approaches in the Culture
Source: Adapted from John Kotter, Leading Change
Conclusion
The factors that are associated with successful CQI applications
can be clearly identified
These include leadership and team work and their role in
developing a shared vision leading to a culture of excellence
35. which embraces CQI
CQI leaders are individuals who lead by example, teach others,
and continue to develop and expand both the philosophy and
processes of CQI
Despite the spread of CQI its further adoption in health care
continues to meet challenges, including the lack of substantial
progress in improving quality of health care and most important
reducing harm to patients (Landrigan et al. 2010; Wachter
2009)
Factors that influence the adoption of CQI include complexity,
which can inhibit further adoption and the slowing down of
progress after the impact of early adopters has waned
Conclusion