Healthcare Improvement Scotland aims to continuously improve healthcare quality and safety in Scotland. It runs national improvement programs focused on areas like patient safety, healthcare associated infections, and person-centered care. Through measurement and data collection, the Scottish Patient Safety Program has demonstrated significant reductions in infection rates, improved compliance with best practices, and decreased mortality and length of stay in critical care units. The goal is to spread effective improvement strategies nationwide to benefit all Scottish patients.
Forming part of the Yoma Central project, the Peninsula Residences Yangon is a collection of luxury private homes for sale that blends heritage and modern design with the Peninsula brand’s refined elegance. The Peninsula Residences Yangon which comprises 112 units offers the choice of two-bedroom, three-bedroom, four-bedroom, and penthouse serviced residences across its 26 floors together with a unique menu of dedicated facilities and amenities.
Basic information on various methods of cooking and the advantages are described in details. classification of cooking methods are explained and the various medium of cooking are covered.
TMK.edu Traditional Media Buying Presentation: August 2015The Media Kitchen
Presented by Ludmila Palasin: August 12, 2015
This presentation provides a recap of our suite of research tools to be sure that everyone knows what is available. But there is a lot more out there – a lot of it for free. This presentation will go into depth on what these are and how to access and use them.
Presented by Bruce Harwood: July 2016
Have you heard about traditional media but aren't quite sure what it is?
This session on how to plan and buy traditional media will give you some context on why advertisers use it and how you should think about it.
As each medium is different in its own way and we will explore the nuances of each and how they are adapting in today's digital landscape.
Forming part of the Yoma Central project, the Peninsula Residences Yangon is a collection of luxury private homes for sale that blends heritage and modern design with the Peninsula brand’s refined elegance. The Peninsula Residences Yangon which comprises 112 units offers the choice of two-bedroom, three-bedroom, four-bedroom, and penthouse serviced residences across its 26 floors together with a unique menu of dedicated facilities and amenities.
Basic information on various methods of cooking and the advantages are described in details. classification of cooking methods are explained and the various medium of cooking are covered.
TMK.edu Traditional Media Buying Presentation: August 2015The Media Kitchen
Presented by Ludmila Palasin: August 12, 2015
This presentation provides a recap of our suite of research tools to be sure that everyone knows what is available. But there is a lot more out there – a lot of it for free. This presentation will go into depth on what these are and how to access and use them.
Presented by Bruce Harwood: July 2016
Have you heard about traditional media but aren't quite sure what it is?
This session on how to plan and buy traditional media will give you some context on why advertisers use it and how you should think about it.
As each medium is different in its own way and we will explore the nuances of each and how they are adapting in today's digital landscape.
An information piece I created for Integrity Health Coaching Centers. A booklet with recipes, tips and a place for you to log your food and plan your meals! You can find a print out version here:
http://www.integrityfit.com/Something-New-Made-Especially-For-You--1-4207.html
No "20/20 hindsight" jokes.
Just clear, concise suggestions, axioms and guidance for any business and brand's success in 2020 and beyond.
Share all you like.
Root cause analysis is an approach for identifying the underlying causes of an incident so that the most effective solutions can be identified and implemented. It’s typically used when something goes badly, but can also be used when something goes well. Within an organization, problem solving, incident investigation, and root cause analysis are all fundamentally connected by three basic questions:
What’s the problem?
Why did it happen?
What will be done to prevent it from happening again?
Presentation of the workshop 'Making Astronomy Accessible for All' at Universe Awareness 2015 International Workshop by Amelia Ortiz, Lina Canas, and Thilina Heenatigala.
An information piece I created for Integrity Health Coaching Centers. A booklet with recipes, tips and a place for you to log your food and plan your meals! You can find a print out version here:
http://www.integrityfit.com/Something-New-Made-Especially-For-You--1-4207.html
No "20/20 hindsight" jokes.
Just clear, concise suggestions, axioms and guidance for any business and brand's success in 2020 and beyond.
Share all you like.
Root cause analysis is an approach for identifying the underlying causes of an incident so that the most effective solutions can be identified and implemented. It’s typically used when something goes badly, but can also be used when something goes well. Within an organization, problem solving, incident investigation, and root cause analysis are all fundamentally connected by three basic questions:
What’s the problem?
Why did it happen?
What will be done to prevent it from happening again?
Presentation of the workshop 'Making Astronomy Accessible for All' at Universe Awareness 2015 International Workshop by Amelia Ortiz, Lina Canas, and Thilina Heenatigala.
We are engaged in an exponentially growing cyber war that we are visibly losing. Within the next 3 years it has been estimated that the global cost will equal, or overtake, the UK GDP, and it is clear that our defences are inadequate and often ineffective. Malware and ransomer-ware continue to extort more money, and cause damage and inconvenience to individuals, organisations and society, whilst hacker groups, criminals and rogue states continue to innovate and maintain their advantage. At the same time, our defences are subverted and rendered ineffective as we operate in a reactive and prescriptive, after the fact, mode with no foresight or anticipation.
In any war it is essential to know and understand as much about the enemy as possible, it is also necessary to establish the truth and validity of any situation or development. Doing this in the cyber domain is orders of magnitude more difficult than the real world, but some of the relevant tools are now available or at an advanced stage of development. For example; fully automated fact checkers and truth engines have been demonstrated, whilst situational awareness technologies are commercially available. However, what is missing is some level of context assessment on a continual basis. Without this we will continue to be ‘blind-sided’ by the actions and developments of the attackers as they maintain their element of surprise along every line of innovation.
What do we need? In short ; a Context Engine that continually monitors networks, servers, routers, machines, devices and people for anomalous behaviours that flag pending attacks as behavioural deviations that are generally easy to detect. In the case of attacker groups we have observed precursor events and trends in network activity days ahead of some big offensive. However, this requires a shift in the defenders thinking and operations away for the reactive and short term, to the long term continual monitoring, data collection and analysis in order to establish threat assessments on a real time.
The behavioural analysis of people, networks and ITC, is at the core of our ‘Context Engine’ solution which completes the triangle of: Truth; Situation; Context Awareness to provide defenders with a fuller and transformative picture. Most of the known precursor elements of this undertaken have been studied in some depth, with some behavioural elements identified on real networks and some physical situations. The unknown can only add more accuracy!
Wama Technology is a leading website development and mobile app development company who aim at solving parental issues and make the life of parents much easier and smoother. Wama Technology has 7+ of experience in parents app development and aims at teaming up with companies who have the same objective.
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Wama Technology is a leading mobile application and website development company that has made over 150+ projects. Wama Technology is the best company to choose from for making the perfect mobile applications. Wama Technology has expert knowledge in notes apps and can deliver the best app for your business and create the next big thing in an online.
Allora USA is a privately held manufacturer of custom sinks and faucets. We use the best materials and workmanship in every product we offer. We are committed to providing the highest level of professionalism and customer service. We strive to achieve a long-term relationship with our clients by delivering high-quality, cost-effective products.
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p a m p h l e t s . T r a d i t i o n a l l y , o n e o f t h e
m o r e c h a l l e n g i n g a s p e c t s o f o r g a n i z i n g
i n t e r n a t i o n a l t e r r o r i s t a c t i v i t i e s i s
r o o t e d i n f i n a n c i a l t r a n s a c t i o n s . T h e
t r a n s f e r o f m o n e y a r o u n d t h e w o r l d
h a s , i n t h e l a s t d e c a d e , f u n d a m e n t a l l y
c h a n g e d t h e w a y t e r r o r i s t o r g a n i z a t i o n s
r a i s e m o n e y t o s u p p o r t t h e i r a c t i v i t i e s .
D i g i t a l c u r r e n c i e s l i k e e - g o l d , B i t c o i n ,
P e e r c o i n , a n d D o d g e c o i n p r o v i d e
c o m p l e x y e t e f f i c i e n t m e c h a n i s m s f o r
t h e t r a n s f e r o f f u n d s , a s w e l l a s t h e
d e c e n t r a l i z e d c o l l e c t i o n o f d o n a t i o n s
i n a m o r e a n o n y m o u s m a n n e r t h a n
c o n v e n t i o n a l b a n k i n g t r a n s a c t i o n s .
T h e r e i s s u f f i c i e n t e v i d e n c e t o s u g g e s t
t h a t t e r r o r i s t s a r e c o n s i d e r i n g a n d ,
i n l i m i t e d i n s t a n c e s , u s i n g d i g i t a l
c u r r e n c i e s s u c h a s B i t c o i n t o f i n a n c e
a c t i v i t i e s . 1 W h i l e t h e s e t o o l s h a v e
g a i n e d i n p o p u l a r i t y , i n r e c e n t y e a r s
t h e i r e x p a n s i o n i n t o v a r i o u s t e r r o r i s t
o r g a n i z a t i o n s h a s b e e n s l o w a n d
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s a m e t e c h n o l o g i e s .
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“ t e r r o r i s t o r g a n i z a t i o n ” d o e s n o t i n c l u d e
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u t i l i z a t i o n o f t h e s e t e c h n o l o g i e s . H e r e ,
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t h e s c o p e o f t h e a n a l y s i s t o a s p e c i f i c
c o m m u n i t y o f a c t o r s a n d a c k n o w l e d g e s
t h a t t h e u s e o f t h e s e t e c h n o l o g i e s h a s
1 This has been witnessed by tracking conversations of
jihadists within various internet chat rooms and forums.
Financing Terror Bit by Bit
By Aaron Brantly
Content.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
Dr. Frances Elliot
1. T h e S c o t t is h A p p r o a c h t o
R e f o r m in g H e a lt h c a r e – Q u a lit y ,
E f f ic ie n c y a n d P r o d u c t iv it y
National Healthcare Conference, 22 March 2012
Frances Elliot | Chief Executive
2. T H E P R E S E N T A T IO N
T h e S c o t t is h n a t io n a l c o n t e x t f o r
q u a lit y in h e a lt h c a r e
M y o r g a n is a t io n
O u r a c t iv it y
W h a t c a n y o u le a r n ?
3. N H S S C O T L A N•D5.1 million population
• One integrated NHS system
• £10.3 billion
• Integrated health and social care
• 14 territorial boards
• Special boards
– Healthcare Improvement Scotland
– NHS Education for Scotland
– NHS Health Scotland
– NHS National Services Scotland
– Scottish Ambulance Service
– State Hospital
– Golden Jubilee National Hospital
– NHS 24
5. Q U A L IT Y A M B IT IO N S
M u t u a lly b e n e f ic ia l p a r t n e r s h ip s b e t w e e n
p a t ie n t s , t h e ir f a m ilie s a n d t h o s e d e liv e r in g
h e a lt h c a r e s e r v ic e s w h ic h r e s p e c t in d iv id u a l
n e e d s a n d v a lu e s a n d w h ic h d e m o n s t r a t e
c o m p a s s io n , c o n t in u it y , c le a r c o m m u n ic a t io n
a n d s h a r e d d e c is io n -m a k in g .
T h e r e w ill b e n o a v o id a b le in ju r y o r h a r m t o
p e o p le f r o m h e a lt h c a r e t h e y r e c e iv e , a n d a n
a p p r o p r ia t e , c le a n a n d s a f e e n v ir o n m e n t w ill
b e p r o v id e d f o r t h e d e liv e r y o f h e a lt h c a r e
s e r v ic e s a t a ll t im e s .
T h e m o s t a p p r o p r ia t e t r e a t m e n t s ,
in t e r v e n t io n s , s u p p o r t a n d s e r v ic e s w ill b e
p r o v id e d a t t h e r ig h t t im e t o e v e r y o n e w h o
6. Q U A L IT Y A N D E F F IC IE N C Y –
G E T T IN G T H E B A L A N C E
R IG H T
7. N A T IO N A L P E R F O R M A N C E
F R A M E W O R K 2 0 11
8. Q U A L IT Y O U T C O M E IN D IC A T O R S
e a lt h c a r e n d e r 7 5 m o r t a lit y
e x p e r ie n c e ra te
ta ff e ng a g e m e nt
a t i e n t /u s e r
a n d p o t e n t ia l
re p o rte d o u tc o me
me a s ure s
e a lt h c a r e
a s s o c ia t e d
in f e c t io n e lf -a s s e s s e d
g e n e r a l h e a lt h
me rg e nc y
a d m is s io n e r c e n t a g e o f t im e
r a t e /b e d d a y s in la s t 6 m o n t h s
o f lif e s p e n t a t
9. TR A N S P A R E N C Y
e f in it io n o f t r a n s p a r e n t : a llo w in g
lig h t t o p a s s t h r o u g h s o t h a t o b je c t s
b e h in d c a n b e e a s ily s e e n ; e a s ily
u n d e r s t o o d ; o f s u c h a k in d t h a t t h e
t r u t h b e h in d it is e a s ily p e r c e iv e d ;
c le a r a n d u n m is t a k e a b le
f t e n d e s c r ib e d in t e r m s o f h o w
in d iv id u a ls b e h a v e a n d
o r g a n is a t io n s f u n c t io n e . g . w it h
c a n d o u r , in t e g r it y , h o n e s t y , e t h ic s ,
c la r it y , f u ll d is c lo s u r e , le g a l
10. H E A L T H C A R E IM P R O V E M E N T
S C O TL A N D
S e t u p b y a n A c t o f S c o t t is h
P a r l i a m e n t o n 1 A p r i l 2 0 11.
T w o k e y f u n c t io n s :
E n h a n c in g a n d p r o t e c t in g t h e
s a f e t y a n d w e llb e in g o f a ll p e r s o n s
w h o u s e s e r v ic e s p r o v id e d u n d e r
t h e n a t io n a l h e a lt h s e r v ic e a n d
in d e p e n d e n t h e a lt h c a r e s e r v ic e s .
U n iq u e ly in t h e U n it e d K in g d o m w e
f u lf il b o t h a n im p r o v e m e n t a n d
s c r u t in y r o le w it h r e g a r d t o h e a lt h
s e r v ic e s .
11. V IS IO N
T o d e liv e r e x c e lle n c e in
im p r o v in g t h e q u a lit y o f
t h e c a r e a n d e x p e r ie n c e
o f e v e r y p e r s o n in
S c o t la n d e v e r y t im e t h e y
a c c e s s h e a lt h c a r e .
12. IN T E G R A T E D C YC L E O F
IM P R O V E M E N T
13. IM P R O V E M E N T
T h e c o m b in e d a n d u n c e a s in g e f f o r t s
o f e v e r y o n e – h e a lt h c a r e
p r o f e s s io n a ls , p a t ie n t s a n d t h e ir
f a m ilie s , r e s e a r c h e r s , p a y e r s ,
p la n n e r s , a d m in is t r a t o r s , e d u c a t o r s
– t o m a k e c h a n g e s t h a t w ill le a d t o
b e t t e r p a t ie n t o u t c o m e , b e t t e r
s ys te m p e r fo r m a n c e , a n d b e tte r
p r o f e s s io n a l d e v e lo p m e n t . ”
a t a l d e n P , Da v id o f f F . Qu a l . S a f .
14. IM P R O V E M E N T
W e r u n t h e S c o t t is h P a t ie n t S a f e t y
P r o g r a m m e , a P a e d ia t r ic S a f e t y P a t ie n t
P r o g r a m m e a n d a r e d e v e lo p in g n e w
n a t io n a l p r o g r a m m e s f o r p r im a r y c a r e ,
m e n t a l h e a lt h , m a t e r n it y s e r v ic e s a n d
p e rs o n c e ntre d c a re
W e a ls o h a v e a n u m b e r o f o t h e r
im p r o v e m e n t p r o g r a m m e s , f o r e x a m p le
H e a lt h c a r e A s s o c ia t e d In f e c t io n ( H A I) ,
c a r d io v a s c u la r d is e a s e , n e u r o lo g ic a l
c o n d it io n s
T h e S c o t t is h Q u a lit y Im p r o v e m e n t H u b
W e s u p p o r t n a t io n a l in it ia t iv e s s u c h a s
16. S IX Q U E S T IO N S F O R
H E A L T H C A R E P R O V ID E R S
D o e s e v e r y o n e in t h e s y s t e m k n o w
w h a t w e a r e t r y in g t o a c h ie v e ?
A r e w e p r io r it is in g t h e im p r o v e m e n t s
lik e ly t o h a v e t h e b ig g e s t im p a c t o n
t h e a im a n d s t o p p in g t h o s e t h a t h a v e
lit t le im p a c t ?
Is e v e r y o n e c le a r a b o u t t h e m e a n s o f
s e c u r in g im p r o v e m e n t s t o w a r d s o u r
a im ?
A r e w e a b le t o m e a s u r e a n d r e p o r t
p r o g r e s s o n o u r a im ?
D o w e k n o w h o w a n d w h e r e t o d e p lo y
r e s o u r c e s w h e n im p r o v e m e n t is
s lo w e r t h a n r e q u ir e d ?
D o w e h a v e a w a y o f t e s t in g a n d
in n o v a t in g a n d t h e n s p r e a d in g n e w
le a r n in g ?
17. T H E C O S T O F Q U A L IT Y
H a v in g t o r e d o o p e r a t io n s a n d
in t e r v e n t io n s
R e a d m is s io n s – in it ia l p r o b le m n o t
f ix e d
H e a lt h c a r e a s s o c ia t e d in f e c t io n
D e la y e d d is c h a r g e s
P o o r c o m m u n ic a t io n
D r u g in t e r a c t io n s a n d r e a c t io n s
P o o r p a t ie n t f lo w a lo n g c a r e
p a th w a ys
C o m p la in t s a n d lit ig a t io n .
18. TR U S T
T r u s t a n d t r a n s p a r e n c y a r e a lw a y s
lin k e d
T h e u n im p e d e d f lo w o f in f o r m a t io n is
e s s e n t ia l f o r h e a lt h y r e la t io n s h ip s
a n d f o r o r g a n is a t io n a l h e a lt h
Ib s e n d e f in e s “ v it a l lie s ” a s t h e
o p e r a t iv e f ic t io n s t h a t c o v e r a
m o r e d is t u r b in g t r u t h in t r o u b le d
f a m ilie s
In o r g a n is a t io n s t h e y p la y a r o le in
a t t e m p t in g t o k e e p e m b a r r a s s in g
t r u t h s f r o m s u r f a c in g .
19. S C O T T IS H P A T IE N T
S A F E TY P R O G R A M M E
20. S P S P WO R K S TR E A M S
C r it ic a l C a r e
– Ventilator acquired pneumonia bundle, central line bundle
G e ne ra l Wa rd
– Early rescue
– Communication
M e d ic in e s M a n a g e m e n t
– Medicines reconciliation
P e r io p e r a t iv e
– Surgical pause, surgical checklist
– Infection prevention/control, prevention of venous
thromboembolism
L e a d e r s h ip
– Safety walkrounds
– Executive leadership, board patient safety profile
22. T o e n d o f 2 0 11:
• 61% reduction in Ventilator Associated Pneumonia rate
• 70% reduction in Central Line Bloodstream Infection rate
• There were 14 central line infections in intensive care units in Scotland in 2011
• There were zero central line infections in intensive care units in March, June and
December 2011
• 19% improvement in compliance with critical care multidisciplinary rounds and
daily goals
• 24% improvement in critical care mortality
• 0.5 day reduction in ICU length of stay
• 90% reduction in ward C. difficile rate
• 40% reduction in ward Staph aureus bacteraemia rate
• 20% improvement in compliance with surgical briefing
• 18% improvement in medicines reconciliation
H S M R – u p t o e n d o f S e p t e m b e r 2 0 11 i m p r o v e d b y
9 .3 %
23. VA P R A TE
( P E R T H O U S A N D V E N T IL A T O R D A YS )
20
18 61% reduction
16
14
12 9.11
10
8 3.54
6
4
2
0
10
08
11
09
8
1
0
9
8
1
9
0
8
0
1
9
l-0
l-1
l-0
l-1
r- 0
r- 1
r- 0
r- 1
-0
-0
-1
-1
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
O
O
O
O
24. 75
80
85
90
95
100
Jun-08
Aug-08
Oct-08
85%
Dec-08
Feb-09
Apr-09
Jun-09
Aug-09
Oct-09
Dec-09
Feb-10
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
V A P B U N D L E C O M P L IA N C E
Feb-11
Apr-11
Jun-11
7% improvement
Aug-11
92%
Oct-11
Dec-11
25. (
0.5
1.5
2.5
3.5
0
1
2
3
4
Jan-08
Mar-08
May-08
Jul-08
Sep-08 2.8
Nov-08
Jan-09
Mar-09
May-09
Jul-09
Sep-09
Nov-09
Jan-10
C E N T R A L L IN E
Mar-10
May-10
IN F E C T IO N R A T E
Jul-10
P E R T H O U S A N D L IN E D A YS )
Sep-10
Nov-10
Jan-11
70% reduction
Mar-11
0.84
May-11
Jul-11
Sep-11
Nov-11
26. Ja
80
85
90
95
100
n-
08
Ap
r- 0
8
Ju
l-0
8
89%
O
ct
-0
8
Ja
n-
09
Ap
r- 0
9
Ju
C O M P L IA N C E
l-0
9
O
ct
-0
9
Ja
n-
10
Ap
r- 1
0
Ju
l-1
0
O
C E N T R A L L IN E B U N D L E
ct
-1
0
Ja
n-
11
Ap
r- 1
1
Ju
l-1
1
O
ct
5% improvement
-1
94%
1
27. % C O M P L IA N C E W IT H
M U L T I-D IS C IP L IN A R Y
R O U N D S A N D D A improvement
100
19% I L Y
G OALS
95
90 93%
85
80 74%
75
70
65
60
Nov-09
Nov-11
Nov-08
Nov-10
Jan-09
Jul-10
Jan-11
Jul-08
Jul-09
Jul-11
Jan-10
May-11
Mar-10
Sep-10
Mar-11
Sep-09
Sep-08
Mar-09
May-09
May-10
Sep-11
28. Ja
10
12
14
16
18
20
22
24
26
28
30
n-
08
Ap
r- 0
8
Ju
l-0
8
O
ct
-0
8
18.2%
Ja
n-
09
Ap
r- 0
9
Ju
l-0
9
O
ct
-0
9
Ja
n-
% IC U M O R T A L IT Y
10
Ap
r- 1
0
Ju
l-1
0
O
ct
-1
0
Ja
n-
11
Ap
r- 1
1
Ju
l-1
1
O
ct
24% improvement
-1
1
13.9%
29. Ja
3
3.5
4
4.5
5
5.5
6
n-
08
Ap
r- 0
8
Ju
l-0
8
O
4.8
ct
-0
8
Ja
n-
09
Ap
r- 0
9
Ju
l-0
9
O
ct
-0
9
Ja
n-
10
Ap
r- 1
0
Ju
l-1
0
O
ct
-1
0
Ja
n-
11
Ap
r- 1
1
Ju
l-1
1
4.3
O
IC U A V E R A G E L E N G T H O F S T A Y
ct
-1
1
½ day improvement
30. G E N E R A L WA R D
C . D IF F IC IL E R A T E
( P E R T H O U S A N D P A T IE N T D A YS )
2.5 1.15 90% reduction
2
1.5
1 0.12
0.5
0
10
08
11
09
8
1
0
9
8
1
9
0
8
0
1
9
l-0
l-1
l-0
l-1
r- 0
r- 1
r- 0
r- 1
-0
-0
-1
-1
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
O
O
O
O
31. G E N E R A L WA R D S A B
R A TE
0.6P
( E R T H O U S A N D O C C U P IE D B E D
0.35
0.5 A Y S )
D 40% reduction
0.4
0.3
0.21
0.2
0.1
0
11
10
08
09
12
8
9
0
1
8
9
0
1
9
0
1
8
l-1
l-1
l-0
l-0
r- 0
r- 0
r- 1
r- 1
-0
-0
-1
-1
n-
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
Ja
O
O
O
O
32. 84
86
88
90
92
94
96
98
Jul-08
Sep-08
E WS
Nov-08
92%
Jan-09
Mar-09
May-09
Jul-09
Sep-09
Nov-09
Jan-10
Mar-10
P E R C E N TA G E
May-10
Jul-10
Sep-10
Nov-10
Jan-11
C O M P L IA N C E W IT H
Mar-11
May-11
Jul-11
95%
Sep-11
Nov-11
Jan-12
33. P E R C E N TA G E
C O M P L IA N C E W IT H
S U R G IC A L B R IE F IN G
100
95
94%
90
85
80
75 20% improvement
70
65
74%
60
55
50
09
08
11
10
9
8
0
1
0
8
1
9
8
9
1
0
l-0
l-1
l-1
l-0
r- 0
r- 1
r- 0
r- 1
-0
-1
-0
-1
n-
n-
n-
n-
ct
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
O
O
O
O
34. P E R C E N T A G E C O M P L IA N C E W IT H
P E R I-O P B R IE F IN G S
95%
92%
35. P E R C E N TA G E
C O M P L IA N C E W IT H
M E D I C I N E S 18% improvement 82%
100
R E C O N C IL IA T IO N
95
90
85
80 64%
75
70
65
60
55
50
11
10
08
09
08
09
10
11
08
11
09
10
0
8
9
1
-1
-0
-0
-1
v-
v-
v-
v-
b-
b-
b-
b-
g-
g-
g-
g-
ay
ay
ay
ay
No
No
No
No
Fe
Fe
Fe
Fe
Au
Au
Au
Au
M
M
M
M
36. TH E N E W TR A N S P A R E N C Y
n e v e r y d a y lif e w e liv e in a g lo b a lly
n e t w o r k e d s o c ie t y
h e m o b ile p h o n e e q u ip p e d w it h a
c a m e ra , a nd C C TV, m e a ns tha t e a c h
o f u s is , m o r e o r le s s , a lw a y s u n d e r
s c r u t in y a n d o n d is p la y
h is n e w , in v o lu n t a r y t r a n s p a r e n c y
r e c o g n is e s t h a t t h e r e is n o s u c h
t h in g a s s e c r e c y
37. R E C O M M E N D E D R E A D IN G
FOR B OARD MEMB ERS
How well does your organisation
measure up in terms of
transparency?
Do you have a mechanism to
encourage difficult conversations
in your senior management team,
in governance committees and at
the board level?
How do your staff raise sensitive
and difficult issues?
What support do they receive
when they do?
38. KEY MES S AGE
D o n o t b e c o n t e n t w it h
m e d io c r it y .
D o y o u r jo b s o w e ll t h a t n o b o d y
c o u ld d o it b e t t e r . ”
a r t in L u t h e r K in g
39. U S E F U L W E B S IT E S
w w w . h e a lt h c a r e im p r o v e m e n t s c o t la n d . o
w w w . s c o t la n d p e r f o r m s . c o m
w w w . s c o t t is h p a t ie n t s a f e t y . p r o g r a m m e .
Editor's Notes
I quote from the Cabinet Secretary’s opening remarks in the foreward - “The ultimate aim of our Quality Strategy is to deliver the highest quality healthcare services to people in Scotland and through this to ensure that NHSScotland is recognised by the people of Scotland as amongst the best in the world.“ What will make Scotland a world leader will be the combined effect of millions of individual care encounters that are consistently person-centred, clinically effective and safe, for every person, all the time. People in Scotland have told us that they need and want the following things from the NHS and we have built this strategy around these priorities: ●Caring and compassionate staff and services; ●Clear communication and explanation about conditions and treatment; ●Effective collaboration between clinicians, patients and others; ●A clean and safe care environment; ● Continuity of care; and ● Clinical excellence. Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times. The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
The six healthcare Quality Outcomes are: · Everyone gets the best start in life, and is able to live a longer, healthier life · People are able to live well at home or in the community · Healthcare is safe for every person, every time · Everyone has a positive experience of healthcare · Staff feel supported and engaged · The best use is made of available resources
This is in line with the Scottish Government’s Healthcare Quality Strategy published in May 2010.
Improvement is everybody's business.
Work on maternity services is likely to expand to neonates and further consideration of supporting the SG drive to support early years of children's development. The Scottish Quality Improvement Hub is a collaboration between a number of national health boards and Scottish Government to build capacity and capability for improvement science in Scotland. It will use an educational framework for improvement to support this activity.
At a recent conference in November 2011 for Scottish Public Sector leaders we were urged to consider these 6 questions in all of our work.
Goleman speaks of transparency and creating a culture of candour as the free flow of information within an organisation and between the organisation and its many stakeholders, including the public. Ibsen coined the term “vital lies” for the operative fictions that cover a more disturbing truth in troubled families. A vital lie masks a truth that is too threatening, dangerous or painful to be spoken aloud. The vital lie preserves the surface harmony of the family but at great cost. Problems that are not acknowledged rarely get better on their own. “ Vital lies” play a role in keeping essential truths from surfacing, first in families and later in businesses and other organisations. Self deception can skew decision making.
This year we are adding work on early recognition and treatment of sepsis and prevention of venous thromboembolism in medical wards and emergency medicine.
At a recent conference on quality and safety in healthcare, one speaker described a future scenario where regulators could request CCTV coverage of clinical areas to check that what is being claimed by organisations is actually the reality of what goes on behind closed doors.
What expectations do board members have from all their units of delivery? This should then be mandated from the board level.