The document discusses initiatives in New Zealand to enhance child health and wellbeing. It focuses on three key areas: improved quality, safety and experience of care; improved health and equity for all populations; and best value for public health resources. Specific quality initiatives discussed include increasing immunization rates, the B4School check, reducing rheumatic fever, and quality improvement for screening programs. Metrics are provided tracking progress on immunization coverage goals and disparities reduction.
1) Columbus MSA employment increased sharply during Q1 2012, gaining 9,400 jobs. Healthcare employment enjoyed particularly strong growth, adding 2,700 jobs.
2) Manufacturing lost 3,300 jobs during the quarter, suggesting improving efficiency rather than weakness in the sector itself.
3) The Columbus region unemployment rate rose to 7.0% in March from 6.8% due to an increase in the number of active job seekers despite a decline later in the quarter.
The document discusses the economic recovery of Southern Nevada from the recession. It provides data on housing prices, job growth, unemployment rates, consumer confidence and other economic indicators from 2001 to 2011. While some indicators like housing prices and unemployment have improved from their lowest points, the recovery has been slow and the region still faces challenges in achieving stronger and sustained job and income growth.
The document discusses how inequality threatens economic recovery from the global recession in three main ways:
1) The recovery has been uneven, with slowing growth lowering incomes and demand around the world.
2) Recovery remains slow in advanced economies, while emerging economies face tightening limits to growth from rising commodity prices and stagnant domestic demand.
3) Structural changes in labor markets from the downturn have exacerbated inequality and made policy interventions like hiring incentives or job training less effective. Coordinated fiscal stimulus focused on income support could still help spur a more equitable recovery.
The document analyzes Corinthian Colleges Inc (COCO), a for-profit education company. It finds that:
1) COCO has experienced strong recent growth in profits, enrollment, and margins due to the countercyclical nature of its industry during the economic recession.
2) However, this growth trajectory is unsustainable as economic conditions improve. Enrollment growth is expected to slow by half towards the long-term average.
3) Margins are also expected to decline from recent highs as marketing expenditures and bad debt expenses increase from current low levels, posing risks to COCO's stock price target of $14.01.
Odds of investing in indian equity marketgautambhupal
The document analyzes Indian equity market returns over various time periods from 1 month to 10 years, finding that the probability of earning returns higher than inflation increases the longer the investment horizon. It also shows that investing when the price-earnings ratio is below the long-term average of 16.9 improves the odds of earning higher returns compared to investing irrespective of the PE level. In summary, the data demonstrates that Indian equities become a more favorable investment the longer the time horizon and when investing during periods of lower valuations.
The document discusses achieving emotional wellbeing for looked after children. It finds that looked after children are approximately four times more likely to have mental health issues than other children. It identifies five priorities for improving support: embedding wellbeing throughout the system, taking a proactive approach, giving children voice, supporting relationships, and aiding care leavers' needs. Analysis suggests that lack of support for wellbeing could be more costly than preventing placement breakdowns through specialist help. The report calls for a whole system focus on children's wellbeing across social care and health.
This document summarizes macroeconomic convergence issues for Botswana within the context of deepening integration in the Southern African Development Community (SADC) region. It finds that while Botswana is meeting most primary convergence targets, there are concerns about long-term growth prospects and weaknesses in data quality. Key recommendations include focusing policies more on efficiency, productivity and competitiveness to address challenges like a potentially overvalued exchange rate. Regional integration could benefit Botswana through trade in services and facilitation, but a SADC monetary union may be too distant given current economic dissimilarities across countries.
The document provides information on the Irongate Global Strategy Fund Limited, a fund of hedge funds. It seeks capital preservation, appreciation and superior risk-adjusted returns with low correlation to traditional markets. The fund invests with experienced managers employing strategies like macro, long/short equities, emerging markets, fixed income arbitrage, and more. Performance figures for 2004-2008 are provided showing the fund outperforming benchmarks like the MSCI World Index and HFRI Fund of Funds Composite Index over various periods.
1) Columbus MSA employment increased sharply during Q1 2012, gaining 9,400 jobs. Healthcare employment enjoyed particularly strong growth, adding 2,700 jobs.
2) Manufacturing lost 3,300 jobs during the quarter, suggesting improving efficiency rather than weakness in the sector itself.
3) The Columbus region unemployment rate rose to 7.0% in March from 6.8% due to an increase in the number of active job seekers despite a decline later in the quarter.
The document discusses the economic recovery of Southern Nevada from the recession. It provides data on housing prices, job growth, unemployment rates, consumer confidence and other economic indicators from 2001 to 2011. While some indicators like housing prices and unemployment have improved from their lowest points, the recovery has been slow and the region still faces challenges in achieving stronger and sustained job and income growth.
The document discusses how inequality threatens economic recovery from the global recession in three main ways:
1) The recovery has been uneven, with slowing growth lowering incomes and demand around the world.
2) Recovery remains slow in advanced economies, while emerging economies face tightening limits to growth from rising commodity prices and stagnant domestic demand.
3) Structural changes in labor markets from the downturn have exacerbated inequality and made policy interventions like hiring incentives or job training less effective. Coordinated fiscal stimulus focused on income support could still help spur a more equitable recovery.
The document analyzes Corinthian Colleges Inc (COCO), a for-profit education company. It finds that:
1) COCO has experienced strong recent growth in profits, enrollment, and margins due to the countercyclical nature of its industry during the economic recession.
2) However, this growth trajectory is unsustainable as economic conditions improve. Enrollment growth is expected to slow by half towards the long-term average.
3) Margins are also expected to decline from recent highs as marketing expenditures and bad debt expenses increase from current low levels, posing risks to COCO's stock price target of $14.01.
Odds of investing in indian equity marketgautambhupal
The document analyzes Indian equity market returns over various time periods from 1 month to 10 years, finding that the probability of earning returns higher than inflation increases the longer the investment horizon. It also shows that investing when the price-earnings ratio is below the long-term average of 16.9 improves the odds of earning higher returns compared to investing irrespective of the PE level. In summary, the data demonstrates that Indian equities become a more favorable investment the longer the time horizon and when investing during periods of lower valuations.
The document discusses achieving emotional wellbeing for looked after children. It finds that looked after children are approximately four times more likely to have mental health issues than other children. It identifies five priorities for improving support: embedding wellbeing throughout the system, taking a proactive approach, giving children voice, supporting relationships, and aiding care leavers' needs. Analysis suggests that lack of support for wellbeing could be more costly than preventing placement breakdowns through specialist help. The report calls for a whole system focus on children's wellbeing across social care and health.
This document summarizes macroeconomic convergence issues for Botswana within the context of deepening integration in the Southern African Development Community (SADC) region. It finds that while Botswana is meeting most primary convergence targets, there are concerns about long-term growth prospects and weaknesses in data quality. Key recommendations include focusing policies more on efficiency, productivity and competitiveness to address challenges like a potentially overvalued exchange rate. Regional integration could benefit Botswana through trade in services and facilitation, but a SADC monetary union may be too distant given current economic dissimilarities across countries.
The document provides information on the Irongate Global Strategy Fund Limited, a fund of hedge funds. It seeks capital preservation, appreciation and superior risk-adjusted returns with low correlation to traditional markets. The fund invests with experienced managers employing strategies like macro, long/short equities, emerging markets, fixed income arbitrage, and more. Performance figures for 2004-2008 are provided showing the fund outperforming benchmarks like the MSCI World Index and HFRI Fund of Funds Composite Index over various periods.
Stora Enso Fourth Quarter and Full Year Results 2012Stora Enso
Stora Enso reported financial results for Q4 and full year 2012. Key highlights include:
- Operational EBIT improved in Q4 year-over-year due to lower costs. Cash flow from operations remained strong.
- Printing and Reading operational EBITDA improved year-over-year and quarter-over-quarter despite capacity reductions.
- Building and Living showed improvement is needed, and plans were announced to streamline operations and reduce costs.
- Strategic investments in Montes del Plata, Ostroleka and Skoghall are progressing as planned.
Telecom versus Online - Worlds in collisionireijjhhjhut
Telecom operators face slowing growth in voice, internet, and broadband revenues. New services like IPTV are not expected to significantly improve revenue growth. Online players are successfully capturing consumer attention with communication and content services launched at a rapid pace. Innovative business models from new players also challenge telecoms' fee-based revenue structures. To compete, telecoms will need to revisit their innovation strategies and address challenges in driving internal innovation and benefiting from external innovation like that of acquired start-ups.
Outsourcing Deal Activity – September 2012Everest Group
Transaction Intelligence (TI) Monthly report for September, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in September 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
The document discusses a presentation on borderless higher education. It covers topics like the growing demand for higher education globally, the rise of open universities and distance learning, increasing internet usage worldwide, and the need for institutions to improve flexibility, internationalization, and cost-cutting through new technologies and collaboration. Borders in higher education are blurring with changes in time, space, geography and levels of learning.
Ted Hart 11 Am June 15 2009 Digital Leap Success OnlineDigital Leap
Ted Hart presented on strategies for online fundraising and social networking. He discussed how online giving has grown significantly in recent years. He emphasized building relationships with donors through communication and focusing on their needs. Hart also covered using social networking sites like Facebook and LinkedIn to engage supporters and recruit volunteers. People-to-people fundraising was highlighted as an approach that combines social networking with fundraising inspired by charities.
Transaction Intelligence (TI) Monthly report for June, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in June 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
Transaction Intelligence (TI) Monthly report for March, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in March 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
Pakistan has a population of 165 million people and experienced strong economic growth of 7% annually from 2003-2007. However, inflation has increased to over 20% and political tensions remain. Telenor Pakistan entered the market in 2004 and has seen much higher subscriber and revenue growth than initially projected, reaching 14.6 million subscribers and an ARPU of 269 PKR in 2007. However, challenges remain from high inflation and uncertain economic policies. Telenor has invested heavily in building its network and distribution channels in Pakistan.
Transaction Intelligence (TI) Monthly report for April, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in April 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
Aquent/AMA Webcast: Planning for Mobile Marketing Success Through Smart StaffingAquent
The document discusses planning for mobile marketing success through smart staffing. It summarizes findings from a study on how companies are adjusting their staffing to support growing mobile programs. The study found a mismatch between current hiring practices and organizational needs for mobile marketing. During the webcast, Melissa Parrish from Forrester Research will present key findings from the study and provide recommendations on planning for mobile marketing success through smarter staffing.
Tim Pulido, President & CEO with 30 years of restaurant industry experience, presents his outlook for 2012 and the brand strategies necessary to win in the New Normal.
Next generation Waterside Convention 10-2012 AmundiMarnix van Eerde
This document discusses improving equity exposure through asymmetrical strategies. It notes that average stock market returns have declined since 2000 while volatility has increased, presenting challenges. It then outlines Amundi's approaches for navigating volatile markets, moving from minimum risk to total risk strategies including minimum variance, risk parity, and directional asymmetric funds. These strategies aim to reduce downside risk while enhancing risk-adjusted returns through asymmetrical participation in market movements. Performance simulations show these approaches outperforming a traditional market-cap weighted benchmark since their inceptions.
This document discusses the use of multiple data sources to inform instruction and principal evaluation. It provides an overview of Criterion 3 which focuses on recognizing and seeking out various data sources, analyzing and interpreting data to guide school improvement efforts, and assisting staff to use data to modify teaching and learning. Specific data on demographic changes and performance at Everett High School is presented, including comparisons to other high performing schools and longitudinal staff perception surveys. Resistance to change and accountability is also examined.
S&P Capital IQ Market Outlook 2012; Tech & O&G sector outlooksAhmad Halim
The document provides an outlook and analysis of global markets and economies from S&P Capital IQ. It summarizes that markets rallied in recent months due to positive actions by central banks and signs of improvement. However, risks remain for the US, Eurozone, and China. The US is expected to see slow growth, while the Eurozone may face a shallow recession in the first half of 2012 and debt issues remain an overhang. China's growth is projected to slow slightly but avoid recession lows.
C. describe a time when you took a great risk. what was the outcome.Ricardo Ocampo
I invested all my savings and convinced my parents to invest in Ecopetrol's IPO on the Colombian Stock Exchange in 2007 despite only having 5 months of work experience. This was risky as we had no stock market investing experience and commodity prices could fall. However, my research found Ecopetrol was undervalued and local IPOs typically saw high returns. After a year and a half, I sold the stocks for a 94% return, doubling my savings and allowing me to pay for an MBA program.
The survey found that employees generally had positive views of ABC in most areas. Job satisfaction, cooperation, communication, and management received favorable ratings from over 70% of respondents. Areas needing some improvement included working conditions, personal opportunities, and compensation/benefits, which were viewed favorably by 61%, 51%, and 42% respectively. The survey also identified supervision and compensation as areas with the highest percentages of unfavorable views at 11% and 22%. Overall, the results indicate that while employees are generally satisfied, ABC could enhance working conditions, career development opportunities, and compensation.
Retail's rocky ride following the slump in consumer confidence as the banking crisis unwound. What is the future for high streets? How can retailers and town centre managers rise to the challenge?
The document reports on the results of an advertising campaign by Wickes in two regions of the UK.
1) The Central region saw the highest uplift in spontaneous brand awareness and advertising recall compared to the other region.
2) Residents in the Central region also reported more positive shifts in their perceptions of characteristics describing the Wickes brand after the campaign, such as trustworthy and valuable, compared to the other region.
Sample Line Chart - need line colours and markers lockedMary Ferguson
The document shows percentage values across 10 categories from March 2010 to June 2012. Category performance varied over time, with some categories ranging from 80% to 10% and others showing different trends up and down across the periods. Overall the graph provides a comparison of category performance metrics over multiple periods.
Two-Scheme Grading Management and Student Profiling SystemRix Morales
The document provides an overview of the grading systems used in the Philippines and the school being studied. It discusses the K-12 grading program implemented by the Department of Education which uses letter grades instead of numbers for grades 1-10. It also reviews literature on subject rubrics which outline the assessment criteria and weightings for different subjects. Finally, it compares the point scale used by the University of Santo Tomas to the letter grade scale used by the International School of Manila.
A presentation given by David Fitzsimons in the 'Delivering Safety & Quality: The Health Reform Agenda stream at the CHA Conference 2012, The Journey, in October.
Presented by Mr David Fitzsimons, Clinical Specialist Speech Pathologist from the Children's Hospital at Westmead, at the CHA Conference on 24 October 2012
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Stora Enso reported financial results for Q4 and full year 2012. Key highlights include:
- Operational EBIT improved in Q4 year-over-year due to lower costs. Cash flow from operations remained strong.
- Printing and Reading operational EBITDA improved year-over-year and quarter-over-quarter despite capacity reductions.
- Building and Living showed improvement is needed, and plans were announced to streamline operations and reduce costs.
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Telecom operators face slowing growth in voice, internet, and broadband revenues. New services like IPTV are not expected to significantly improve revenue growth. Online players are successfully capturing consumer attention with communication and content services launched at a rapid pace. Innovative business models from new players also challenge telecoms' fee-based revenue structures. To compete, telecoms will need to revisit their innovation strategies and address challenges in driving internal innovation and benefiting from external innovation like that of acquired start-ups.
Outsourcing Deal Activity – September 2012Everest Group
Transaction Intelligence (TI) Monthly report for September, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in September 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
The document discusses a presentation on borderless higher education. It covers topics like the growing demand for higher education globally, the rise of open universities and distance learning, increasing internet usage worldwide, and the need for institutions to improve flexibility, internationalization, and cost-cutting through new technologies and collaboration. Borders in higher education are blurring with changes in time, space, geography and levels of learning.
Ted Hart 11 Am June 15 2009 Digital Leap Success OnlineDigital Leap
Ted Hart presented on strategies for online fundraising and social networking. He discussed how online giving has grown significantly in recent years. He emphasized building relationships with donors through communication and focusing on their needs. Hart also covered using social networking sites like Facebook and LinkedIn to engage supporters and recruit volunteers. People-to-people fundraising was highlighted as an approach that combines social networking with fundraising inspired by charities.
Transaction Intelligence (TI) Monthly report for June, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in June 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
Transaction Intelligence (TI) Monthly report for March, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in March 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
Pakistan has a population of 165 million people and experienced strong economic growth of 7% annually from 2003-2007. However, inflation has increased to over 20% and political tensions remain. Telenor Pakistan entered the market in 2004 and has seen much higher subscriber and revenue growth than initially projected, reaching 14.6 million subscribers and an ARPU of 269 PKR in 2007. However, challenges remain from high inflation and uncertain economic policies. Telenor has invested heavily in building its network and distribution channels in Pakistan.
Transaction Intelligence (TI) Monthly report for April, 2012. This report provides a brief overview of the overall outsourcing market activity for the month and includes the following:
• Trailing three-month average of outsourcing deals
• Split of outsourcing deals by function and industry vertical
• Geographical split and analysis of the level of deal activity
• Key outsourcing deals signed in April 2012
We would be happy to receive your feedback on this report and/or on the TI offering.
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Tim Pulido, President & CEO with 30 years of restaurant industry experience, presents his outlook for 2012 and the brand strategies necessary to win in the New Normal.
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This document discusses the use of multiple data sources to inform instruction and principal evaluation. It provides an overview of Criterion 3 which focuses on recognizing and seeking out various data sources, analyzing and interpreting data to guide school improvement efforts, and assisting staff to use data to modify teaching and learning. Specific data on demographic changes and performance at Everett High School is presented, including comparisons to other high performing schools and longitudinal staff perception surveys. Resistance to change and accountability is also examined.
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The document provides an outlook and analysis of global markets and economies from S&P Capital IQ. It summarizes that markets rallied in recent months due to positive actions by central banks and signs of improvement. However, risks remain for the US, Eurozone, and China. The US is expected to see slow growth, while the Eurozone may face a shallow recession in the first half of 2012 and debt issues remain an overhang. China's growth is projected to slow slightly but avoid recession lows.
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2. Quality Improvement cycles
Act Plan
Quality
improvement
actions
Check Do
Small
Maintaining the gains with steps of
Standards and Quality
Assurance continuous
improvement
3. Well-child/Tamariki Ora
Draft Quality framework
Health Quality and Safety Commission
adapted the IHI Triple Aim for NZ.
The three dimensions in the New
Zealand adapted model are:
• improved quality, safety and experience
of care
• improved health and equity for all
populations
• best value for public health system
resources.
The three sides of the WCTO triangle
are:
• improved safety and quality experience
of child, family/and community
• improved health and equity across
populations
• best value for health system resource
4. Quality initiatives in Child health in
New Zealand
Well-child/Tamariki Ora quality framework
• Immunisation coverage target
• B4School check quality initiative
• Reducing rheumatic fever
• Children’s Commissioners Compass
• Development of clinical networks
• QI for maternal and newborn screening
• Maternity quality initiative
6. Improved health and equity across
populations
• To improve
immunisation
coverage at 2 years
to 95% by July 2012
• To reduce ethnic and
socio-demographic
disparities in
coverage
7. The 2 year immunisation target
100%
Coverage at 2 by Socioeconomic quintile
95%
90%
85%
3% difference
Total %
Coverage (%)
80%
Dep 1-2 %
75% Dep 3-4 %
Dep 5-6 %
70%
Dep 7-8 %
65% 10% difference
Dep 9-10 %
Dep Unavailable %
60%
55%
50%
Sep-2011
Jun-2007
Jun-2008
Jun-2009
Jun-2010
Jun-2012
Dec-2010
Sep-2007
Dec-2007
Sep-2008
Dec-2008
Sep-2009
Dec-2009
Sep-2010
Mar-2008
Mar-2009
Mar-2010
Jun-2011
Mar-2012
Dec-2011
Mar-2011
11. The B4 School Check is a universal-offer
Well-Child check
It aims to identify and
address any
health, behavioural, social,
or developmental
concerns which could
affect a child’s ability to
get the most benefit from
school.
12. 10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
0.0%
10.0%
30.0%
50.0%
70.0%
90.0%
20.0%
40.0%
60.0%
80.0%
0.0%
Auckland Auckland
Bay of Plenty Bay of Plenty
Canterbury Canterbury
Capital and… Capital and Coast
Counties … Counties Manukau
Hawkes Bay Hawkes Bay
Hutt Hutt
Lakes Lakes
Midcentral Midcentral
Nelson… Nelson…
Northland Northland
Otago Otago
South… South Canterbury
Southland Southland
Tairawhiti Tairawhiti
% of PEDS Pathway A referred
Taranaki Taranaki
Waikato Waikato
% of Decay Level 2 - 6 referred
Wairarapa Wairarapa
Waitemata Waitemata
West Coast West Coast
Whanganui Whanganui
% of Extreme Obese Referred
100.0%
120.0%
20.0%
40.0%
60.0%
0.0%
80.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
0.0%
Auckland
Bay of Plenty Auckland
Canterbury Bay of Plenty
Capital and… Canterbury
Counties… Capital and…
Hawkes Bay Counties…
Hutt Hawkes Bay
Lakes Hutt
Lakes
Midcentral
When we started
Midcentral
Nelson…
Nelson…
Northland
Northland
Otago Otago
South… South…
Southland Southland
Extreme Obese that are referred
Tairawhiti Tairawhiti
Taranaki Taranaki
Waikato
% of Abnormal SDQ scores referred
Waikato
Wairarapa Wairarapa
Waitemata Waitemata
West Coast
West Coast
Whanganui
Whanganui
13. The quality letter.
• A Quality Improvement
process for the 4 year old
check.
• Shared with providers and
DHB management
• An opportunity to provide
up to date information
and share good practice
• Provision of benchmarking
information
14. Quality improvement in action
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
01-July-2011 01-January-2012 01-April-2012 01-July-2012
Lift the Lip % of 2-6 referred % of BMI>=21 referred
PEDS % of pathway A referred SDQ-P abnormal that were referred
15. Improved safety and quality experience
for child, family and community
Improving community
involvement and parent
satisfaction with the
B4School check
16. Improved safety and quality experience
for child, family and community
We developed a
relationship with
Richard Taylor of
Weta workshop
to promote the
B4School checks
using the Wot-
Wots.
17. Improved safety and quality experience
for child, family and community
Validation of the Strengths
and Difficulties
Questionnaire
18. SDQ validation
• The SDQ is a behavioural and emotional
screen used in many countries and translated
into over 30 languages
• Parents and early childhood teachers have
told us that they were uncertain about he
screen because it had not been tested on
New Zealand children
• Ministry of Health has contracted Auckland
University of Technology to validate the SDQ
on New Zealand children
19. Conclusion
• Reframing difficult problems within a QI
perspective can lead to rapid gains
• A Quality Framework will ensure that all
aspects of quality are considered and
addressed
• Once you have had success, your learning
is generalisable to other areas
• Improving quality doesn’t always save
money, but it can increase efficiency
Editor's Notes
Quality improvement is a cyclical or iterative process. The Archetypal CQI cycle was described by Deming – Plan Do Check ActIt requires a series of conscious actions which improve quality by first setting standards which act as an agreed baseline or a “chock” for the quality cycle. This is complemented by continuous activity which identifies opportunities for improvement, and puts in place agreed actions, monitors results and restarts the cycle.However there are three fundamentals1 – Know where you are heading2 - Know how you are going to get here3 - Know when to stop
However one of the essentials is knowhing what you want your quality improvement activity to cover. It’s essential to have a clear concept of the outcomes you want, and ensure that all aspects of quality are addressed. The Triple Aim model addresses the range of quality domains curently consisered important in the provision of healthcare. In the context of child health these are Improved safety and quality experience of child, family/and community, Improved health and equity across populations and Best value for health system resource
The WCTO qi
As you can see we have increased coverage and reduced inequalities since the target initiative commended in 2007. We have had a threefold reduction in inequalities and an almost 20% increase in coverage. Children from both the lowest and highest quintile now have identical coverage of 94%.We did this through a systematic approach which involved being clear about the evidence, agreeing a national plan of action, monitoring results using our NIR, and revising the plan if results were not as we expected.
The basis of this is getting best efficiency. For immunisation this is maximising coverage within existing funding. No new money went into the increasing immunisation programme, apart from some infrastructure enhancements – NIR and training for staff, and the payments ($21 per vaccination given) for the additional coverage which is undertaken on a fee for service basis.
The B4 School Check is a Universal offer Well child check which aims to identify and address any health, behavioural, social, or developmental concerns which could affect a child’s ability to get the most benefit from school, such as a hearing problem or communication difficulty.The Check is highly manualised, has it’s own dedicated information system, and is delivered in a range of settings by trained nurses, mainly practice nurses, public health and well child nurses.It is the eighth core contact of the Well Child Tamariki Ora Schedule of services.The value for money for this check is maximised by ensuring optimal referral rates for any issues found.
The B4school check efficiency gains revolved aroungmaximising referrals for children with significant issues identified at the check. We also need to measure and analyse outcomes as referrals are only a proxy for outcomes.