The mission statement sets the direction and priority for developing and implementing the quality plan. It clearly states the nature of the organization’s commitment to quality and should then be tied to the organizational operations through programs, projects, actions and rewards/recognition.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
Due to the near-universal desire for safe and good quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process. Healthcare is a vital and emotive issue—its importance pervades all aspects of societies, and it has medical, social,political, ethical, business, and financial ramifications.
An introductory overview of the basic concepts of Healthcare Quality, a starter for beginners.
Prepared in 2014 for the new staff of the Quality Management Department in King Saud University Medical City in Riyadh as a part of their capacity building plan.
Acknowledgments:
*Dr. Magdy Gamal Yousef, MBBCh, MS, CPHQ - for his contribution in the scientific content
**Ms. Maram Baksh, MS, CPHQ - for the design of the full HCQ capacity building plan in KSUMC
Due to the near-universal desire for safe and good quality healthcare, there is a growing interest in international healthcare accreditation. Providing healthcare, especially of an adequate standard, is a complex and challenging process. Healthcare is a vital and emotive issue—its importance pervades all aspects of societies, and it has medical, social,political, ethical, business, and financial ramifications.
effective risk management systems can best be achieved in an atmosphere of trust.
Successful risk management provides assurance that the organisation’s objectives will be
achieved within an acceptable degree of residual risk.13 It also creates an environment in which
quality improvement occurs as the natural consequence of the identification, assessment and
elimination or minimisation of risk. Risk management can therefore also be considered as an
aspect of the organisation’s ongoing continuous quality improvement program.
“I solemnly pledge myself to consecrate my life to service of humanity.” This is the first sentence a doctor utters while taking an oath when s/he enters into the medical profession. They are considered as God by people despite knowing the fact that they are human, as the profession gives ‘hope’ to live to a patient and his family. But due to the increasing number of medico legal issues in the country, there is a serious concern about the doctor-patient relationship. To raise awareness among the patients about their rights and responsibilities as patients and to build up a strong, safe and healthy doctor patient relationship, the Dr. Anamika Ray Memorial Trust observes June 25 as Patients’ Rights Day under the “STOP MEDICAL TERRORISM” movement for better and transparent healthcare services in India.
The Trust, in consultation with a panel of medical professionals of national and international repute, drafted the Patients’ Rights in 10 points and the responsibilities in another 10 points. The Rights and Responsibilities of the patients available at http://smt.armt.in in many Indian languages. It's a two page document. The Trust requests everyone to support the cause by downloading the document in their preferred language, printing it out and distributing it among patients in any hospital in India. The Trust believes that this initiative may save hundreds of lives and will be a great contribution for better and more transparent healthcare services in India.
The rights mentioned in the draft include the right to get the best possible medical care without discrimination; right to prompt, life-saving treatment; right to take part in all decisions relating to one’s health care; right to privacy; right to know the identity and role of people involved in treatment; right to dignity and to have caregivers’ respect; right to appropriate assessment and management of pain; right to receive visitors; right to refuse treatment and to leave the medical centre; and right to get necessary information related to the line of treatment as well as all health records.
The responsibilities mentioned in the draft include the responsibility to refrain from misbehaving and misconduct towards any medical service providers; responsibility to refrain from physical assault of any healthcare personnel or damage to property; responsibility to be truthful; responsibility to provide complete and accurate medical history; responsibility to cooperate with the agreed line of treatment; responsibility to meet the financial obligations; responsibility to refrain from initiating, participating or supporting fraudulent and illegal health care practices; responsibility to report illegal or unethical behaviour; responsibility to get a post-mortem done and responsibility to discuss end of life decisions.
effective risk management systems can best be achieved in an atmosphere of trust.
Successful risk management provides assurance that the organisation’s objectives will be
achieved within an acceptable degree of residual risk.13 It also creates an environment in which
quality improvement occurs as the natural consequence of the identification, assessment and
elimination or minimisation of risk. Risk management can therefore also be considered as an
aspect of the organisation’s ongoing continuous quality improvement program.
“I solemnly pledge myself to consecrate my life to service of humanity.” This is the first sentence a doctor utters while taking an oath when s/he enters into the medical profession. They are considered as God by people despite knowing the fact that they are human, as the profession gives ‘hope’ to live to a patient and his family. But due to the increasing number of medico legal issues in the country, there is a serious concern about the doctor-patient relationship. To raise awareness among the patients about their rights and responsibilities as patients and to build up a strong, safe and healthy doctor patient relationship, the Dr. Anamika Ray Memorial Trust observes June 25 as Patients’ Rights Day under the “STOP MEDICAL TERRORISM” movement for better and transparent healthcare services in India.
The Trust, in consultation with a panel of medical professionals of national and international repute, drafted the Patients’ Rights in 10 points and the responsibilities in another 10 points. The Rights and Responsibilities of the patients available at http://smt.armt.in in many Indian languages. It's a two page document. The Trust requests everyone to support the cause by downloading the document in their preferred language, printing it out and distributing it among patients in any hospital in India. The Trust believes that this initiative may save hundreds of lives and will be a great contribution for better and more transparent healthcare services in India.
The rights mentioned in the draft include the right to get the best possible medical care without discrimination; right to prompt, life-saving treatment; right to take part in all decisions relating to one’s health care; right to privacy; right to know the identity and role of people involved in treatment; right to dignity and to have caregivers’ respect; right to appropriate assessment and management of pain; right to receive visitors; right to refuse treatment and to leave the medical centre; and right to get necessary information related to the line of treatment as well as all health records.
The responsibilities mentioned in the draft include the responsibility to refrain from misbehaving and misconduct towards any medical service providers; responsibility to refrain from physical assault of any healthcare personnel or damage to property; responsibility to be truthful; responsibility to provide complete and accurate medical history; responsibility to cooperate with the agreed line of treatment; responsibility to meet the financial obligations; responsibility to refrain from initiating, participating or supporting fraudulent and illegal health care practices; responsibility to report illegal or unethical behaviour; responsibility to get a post-mortem done and responsibility to discuss end of life decisions.
The Joint Commission is a Chicago-based organization which accredits 15,000 hospitals in the United States. The Joint Commission International (JCI) is its subsidiary which accredits hospitals outside the U.S. As the medical travel trend grows, JCI accreditation is becoming an important benchmark for quality standards.
Eat less, live longer cutting back on food can help repair the body by Dr.Ma...Healthcare consultant
Eating less can boost healthier ageing by protecting the body’s cells from harmful deterioration and the risk of cancer.
Scientists know an extreme diet does not appeal to many people but say their discovery could lead to ways of mimicking its effects and pave the way for an “anti-ageing pill.
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
Quality Improvement In Healthcare: Where Is The Best Place To Start?Health Catalyst
One of the biggest challenges providers face in their quality improvement efforts is knowing where to get started. In my experience, one of the best ways to overcome that “where do we begin?” factor is by using data from an enterprise data warehouse to look for high-cost areas where there are large variations in how health care is delivered. Variation found through the KPA is an indicator of opportunity. The more avoidable variation that is reflected in a particular care process, the more opportunity there is to reduce that variation and standardize the process. Suppose after performing a KPA you discover three areas of opportunity. How do you determine which one to pursue, especially if it’s your first journey into process improvement? The most obvious answer would seem to be the one with the largest potential ROI. That may not always be the best course to pursue, however. You will also want to take into consideration the readiness/openness to change in each of those areas.
This PPT is mainly oriented to the Final yr MBBS students who are preparing for their Final exams. The Audit cycle has taken up from Bailey & Love - 24th edition.
MEDICAL AUDIT
Evaluation of data, documents, and resources to check performance of systems meets specified standards
PRESCRIPTION MONITORING, ADR, DRUG RELATED PROBLEMS, staff safety, data,defining standards,
collecting data,
identifying areas for improvement,
making necessary changes
back round to defining new standards.
Slide deck from 2008 Symposium "Developing an Expert-System for Health Promotion: An Experimental E-Learning Platform" from the APA-NIOSH International Conference on Work, Stress, and Health
Competency Validation: An Advisory Board ApproachAPI Healthcare
Over the past decade competency has gone from buzzword to requirement in healthcare. The Joint Commission, along with federal and state regulatory agencies, has increasingly focused on staff competency with each coming year. Why this focus on competency?
Purpose of the Call:
•Recap of aggregated MedRec audit month data that identifies potential opportunities for improvement
•Review quality improvement concepts as it relates to measuring for quality improvement
•Hear how Horizon Health team (NB) is using their data to improve MedRec processes
•Receive a tutorial on how to access your MedRec Quality Score run charts in Patient Safety Metrics.
WATCH: http://bit.ly/1EVcREL
The clinicalaudit.ie website is dedicated to improving patient care standards by providing information for anyone interested in clinical audit. Please download a copy of this PDF for offline viewing.
M Heenan_PhD Dissertation Lecture_eHealth Lecture_Engaging Leaders in KPI Sel...Mike Heenan
Presentation of the proliferation of measurement in health care and how organizations should redesign indicator selection processes to engage and motivate managers to improve performance. Presentation to eHealth students based on 2023 PhD dissertation.
Similar to How to Implement Quality in Health Care Organizations. (20)
In India, Young Graduates Struggle by Dr. Mahboob Khan to Get Jobs.pdfHealthcare consultant
In the world’s most populous country, tens of thousands of graduates and postgraduates, many with professional degrees, such as engineering, spend years studying at the tutoring centers that have mushroomed in Indian cities, hoping to qualify for a highly sought-after government job. The chances are slim. Less than one-half of 1% of the more than 1 million who take the exam each year pass.
The middle class in India is growing unexpectedly, however they're still dealing with demanding situations in accessing excellent and low-priced healthcare. This is because of a number of of factors, such as inefficient healthcare gadget, high price of healthcare, and lack of know-how.
Chat GPT for Doctors -Revolutionizing Healthcare Communication by Dr.Mahboob.pdfHealthcare consultant
Learn how Chat GPT for doctors can revolutionize healthcare communication by improving efficiency and accuracy of patient-provider interaction.
In recent years, there has been a growing interest in the potential of artificial intelligence (AI) to transform healthcare. One area that has received particular attention is communication between patients and healthcare providers. The emergence of chatbots powered by AI has provided a new tool for improving the efficiency and effectiveness of healthcare communication. One of the most promising applications of AI-powered chatbots is Chat GPT for doctors.
As an expert in hospital management and administration i have written this book -Hospital Management is a new theory in management faculty. Earlier a senior doctor used to perform the role of a hospital manager. However, nowadays everything demands a specialist. Almost all the things related to hospital have changed. Many categories concerning medical sciences and hospital have altered totally. There are various types of hospitals today, including ordinary hospitals, specialty hospitals and super specialty hospitals. The categories are regarding to the types of facilities they offer to the people.
Steve Jobs logged off too soon. He was a serial innovator whose illness cost the world a bright talent who was also a great company leader. I hope that the music from the hymns of praise sung to him in his waning days is playing on his iPod as he ascends into the firmament of the greatest American business leaders. If there were a Nobel prize for business, surely he would have won it. He did what he set out to do and more. He saw the potential for computing power for the masses, useful and accessible to everyone. In a phrase that drove the early Apple, he created bicycles for the mind.
“He is a charismatic leader who inspires people to follow him. A strategic thinker who can master the details. A tireless worker with incredible focus and problem-solving skills. He is well-liked by his employees but is also able
to make and execute unpopular decisions. Above all, he is an exceptional communicator who can convey a vision to any audience, from Wall Street to
the most junior employee.”
Some of the lower vibrations, as you can see on the chart are anger, grief, shame, fear. Some of the higher vibrations are love, joy, appreciation and excitement.
Going to higher vibrations means more energy ,lower vibration is easily achieved and is default in everyone of us and is easily aggravated by gravity.
thats why anger, grief,shame and fear are more common than love ,joy appreciation and excitement.
Hospitals profitability can be increased by boosting patient satisfaction, reducing readmissions and understanding revenue cycle performance.
In this period of healthcare reform, numerous organizations continue to change their business practices so they can obtain more hospital profitability while also delivering quality care. Healthcare expenditures are expected to reach $4.4 trillion by 2022, and this high level of spending activity has hospitals currently under a lot of pressure to reduce costs.
Development of the digital economy started way before COVID-19. The exact date of the beginning may be defined in different ways, depending on different definitions of “digital economy.” The popularly understood “digital economy” phenomenon began when T-Mall was set up in 2003 and when Alipay came online in 2004. While the digital technology brings about the fourth industrial revolution, just like the steam engine, electrical machines, and computers, respectively.
Strategy is not complex. But it is hard. It’s hard because it forces people and organizations to make
specific choices about their future—something that doesn’t happen in most companies. Dr .Mahboob
Khan
Couch potatoes as they are called are the ones who stick on to their sofas just watching the idiot box that has caused many such unwarranted developments in health.
Probably a long vacation could be a precipitating factor for inactivity while the unexpected strife in the country’s developments has brought with it some unexpected holidays. This is the time when children tend to relax but when they cross the line the human body becomes mentally and physically inactive.
While Metaverse is evolving, it holds new potential in healthcare that combines the technologies like Artificial Intelligence, Virtual Reality, Augmented Reality, Internet of Medical Devices, Web 3.0, intelligent cloud, edge and quantum computing along with robotics to provide new directions to healthcare.
Robotic Process Automation in Healthcare-An Urgency! By.Dr.Mahboob KhanHealthcare consultant
More and more industries are adopting RPA because RPA exceeds adopters’ expectations not only when it comes to the rapid rate of ROI(Return on Investment) increase, but also when it comes to facilitating compliance (92%), improved quality and accuracy (90%), or improved productivity (86%).
As per a study conducted by McKinsey, the healthcare sector had a 36% technical potential for automation. It also stated robotic process automation as one of the emerging technologies that will reshape healthcare and create between $350 billion and $410 billion in annual value by 2025.
Apply This to Your Life
We know this is boring, but you know you need to do it!
Clear an hour in your schedule somewhere in the next week, and set your filing system up!
Many inventions originated in wealthy countries and these were responsible to produce global public goods and medical goods.In which everyone got benefitted even developing and poor countries too.This transfer of knowledge is now compromised by the extension of intellectual property rights and held by high-income countries.
Precision medicine will drive new standards of care in post COVID -19 world. In simplest terms precision medicine is the right test for the right patient and at the right time. A physician must choose from an array of complicated tests that are appropriate for a diagnosis and creation of a treatment plan for their patient in a timely manner.
Ways That Quantum Technology Could transform Health Care. By.Dr.Mahboob KhanHealthcare consultant
You probably don’t grasp the finer points of how quantum mechanics works, but scientists are using its tricky rules to make medicine faster, less painful, and more personalized.
How is COVID-19 Reshaping the role of Institutional strategy? By.Dr.Mahboob KhanHealthcare consultant
While workers around the globe are keeping essential services running, it is imperative for business leaders, particularly senior strategy executives, to reflect on the lasting implications of COVID-19 and what they can do to best position their people, their businesses, and society to recover and thrive in the long term. Five key shifts can help chief strategy officers (CSOs) successfully guide their organizations through the pandemic.
Retaining Healthcare Quality During COVID-19 and Future of Care Delivery. By....Healthcare consultant
With the onset of COVID-19, healthcare delivery organizations around the world were collectively faced with one primary challenge: How to effectively deliver quality healthcare to all patients, regardless of the entry point into the system, while protecting the well-being of non-COVID-19 patients and the healthcare workforce.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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!
How to Implement Quality in Health Care Organizations.
1. Measuring & Understanding Quality
Improvement in Healthcare
Mahboob ali khan, MHA / CPHQ,
Consultant Quality - Operations
Continental Hospitals
Hyderabad, India
2. Continuing the Journey
1) Research Questions
• Experience in Healthcare Operations
2) Theory / Models
•Search and Study
•Develop Questions and Hypotheses
3) Develop / Test
•Develop 2 into something that can
help answer 1
4) Examine Results
• How does 3 answer 1
Focus
Oral Exam
Defense
3. Initial Research Questions
Developed from 8 years of frustration in healthcare
management knowing that I wasn’t equipped to
provide appropriate support to clinicians
What I Could Provide What I Needed to Provide
Leadership
Understanding of Healthcare
Financial Direction
Strategic Direction
Management Capabilities
A More Balanced Approach to
Managing
Assessment
Data Management
Study Design
4. Initial Research Questions
How do I know something works?
Continued requests for equipment, supplies and
instruments
Do patients get better?
The End of Medicine
Is there one way to do a procedure that is
better than another?
Significant variation in preference cards
How do I measure quality?
5. Defining Quality
IOM – The degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional knowledge.
Donabedian - The systematic measurement and
evaluation of the predetermined outcomes of a
process, and the subsequent use of information
to improve the process based on expectations
of the customer.
6. Theories / Models – Oral Exam
Ernest Amory Codman
end results idea – 1920s
Florence Nightingale (late 1800s) and Walter Shewhart
(1920s)
Statistical Process Control
Edwards Deming, Joseph Juran and Kauru Ishikawa
Continuous Quality Improvement (CQI)
Avedis Donabedian
structure – process – outcome
Implicit vs. explicit criteria
Everett Rogers
Dissemination of Innovation
Don Berwick, Paul Batalden, Brent James and Steve
Shortell
Recent literature
7. Structure – Process - Outcome
Quality of healthcare can be assessed on the basis of
structure, process (how care is delivered), and outcome
(mortality, functional status, quality of life, and patient
satisfaction)
good measures of the first two are those that have a clear
relationship to the third
structure must proceed process which must proceed outcome
Structure Definition
Something arranged in a definite pattern of organization
Organization of parts as dominated by the general
character of the whole
8. Implementing CQI is Largely Structure
Medical Scott CQI
Outcomes
Organization Division of labor HR / Training
Specialty Mix Coordination Customer Focus
Resources Training/Experience Planning
Work Load Power Process
Access Resources Innovation
Buildings Supplier Partner
Information Information
Leadership Leadership
Policies/Procedures
Tasks
9. Structural Dimensions of CQI
Implementation
Strategic Cultural Technical Organiz. Result
No Yes Yes Yes No significant results
on anything important
Yes No Yes Yes Small, temporary
effects
Yes Yes No Yes Frustration & False
starts
Yes Yes Yes No Inability to capture the
learning & diffusion
Yes Yes Yes Yes Lasting process
change
Adapted from Shortell et al. 1996
10. Translating Theory To Research –
Putting Shape to my Frustrations
1. The healthcare system is broken
The IOM reports
2. Appropriate structure – “the forgotten, but important
component of the quality triad” – is wrongly assumed
as present
JCAHO
3. CQI, if implemented properly, can be the appropriate
structure
Managerial Philosophy
4. Healthcare providers are are finding it difficult to
implement CQI
Problem Solving Methodology
11. Research Question
Why haven’t healthcare organizations
been able to use CQI to differentiate
themselves in terms of quality?
Answer: Accountability & Assessment
12. Accountability
Individual motivation has not been successful
Midnight at the Waldorf-Astoria
Rhetoric, not Reality (The Halothane Study)
Large scale environmental change is needed
Environment, Organization, Micro-System, Pt
Current Motivators that may force change
Patient Safety – Medical Errors
“report cards” - PA, NY and CA
Increase in Costs and Premiums
Increase in the use of Alternative Medicine
Variation in processes
Increase in litigation
13. Assessment Issues & Research Questions
1. Low CQI knowledge level of senior leadership
Do step by step instructions exist that assists researchers in studying CQI,
and healthcare leaders in implementing CQI?
2. Implementing only a subset of the CQI domains
Does a comprehensive survey and scale of CQI implementation exist?
3. Poor measurement strategies
Are psychometrics examined appropriately in measuring CQI implementation?
4. Rhetoric does not equal the reality
Does a measure exist that can be used to develop a quick snapshot of CQI
implementation efforts in a hospital and is there a corresponding descriptive
scale?
14. Step 1: Search the Literature
Does a comprehensive, valid and easy to administer
measurement tool exist that provides organization leaders
with a descriptive scale and instructions for next steps?
Methods -
Used Ovid databases with a focus on business,
psychology, sociology and healthcare
Keywords: measurement quality, continuous quality
improvement, total quality management,
implementation
Scrolled through quickly at least 10,000 references
most focused on implementing only a few domains of CQI
Articles not deleted included: Measuring Quality;
Domains and Implementation of Quality
15. Quality Overload
Using Medline through PubMed
from 1995 to the present / English only
‘quality improvement’ = 8,848
‘continuous quality improvement’ = 1,100
‘quality’ in title = 17,466
‘quality improvement measure’ in title = 3
from 2000 to present / English only
‘quality improvement’ in title = 350
50 usable, 30 ‘easily findable’, 15 good, 1
measurement
16. Worldwide Measurement for QA/QI Structure
AWARDS - too time intensive, gold standard domains
The Malcolm Baldrige Award
Leadership, HR/Training, Process, Business Results, Customer
Focus, Information Systems, Planning, Partnership
EFQM
US State-Based Awards
ACCREDITATION & CERTIFICATION - questions on
validity and too time intensive
JCAHO
IS0 9002 - 2000
Inspection, Contract, Public Responsibility, Innovation, Product
Control, Servicing
SURVEY INSTRUMENTS
17. Survey Instruments
Eleven worldwide surveys examining CQI as a
managerial philosophy were analyzed (Tables - pges
1 & 2)
8 from the US, 1 from Canada, the Netherlands, and
Australia
5 were specific to healthcare, including the ‘gold standard’
from Shortell et al.
Most examined psychometrics while very few provided a
scale
The shortest (22 questions) was also the least
comprehensive
The Baldrige Domains dominated
18. Survey Instruments
Weaknesses of the current surveys included:
Relatively few domains other than the Baldrige were
even mentioned
The most comprehensive surveys are much too long
(depth vs. breadth)
Strong potential for respondent bias if survey is only
given to one level employee in an organization
Very few surveys provided a scale
Published in the International Journal for Quality in
Health Care 2001: Volume 13, Number 3: pp 197-207
19. Step 2: Develop and test a comprehensive and
concise measure of CQI implementation
Initial Survey
14 domains (Baldrige, EFQM, ISO) and 70 items, with
each domain containing at least 4 items
All but a very few items were from the 11 surveys
analyzed in Step 1
Items were chosen by the researchers using a
subjective analysis and whether or not the question
could be answered using a 5 point Likert scale
20. Content Validity
The benefits of a content validity study for this study
True experts in the field of CQI
Past measures have gone through psychometric testing
Excellent method of data reduction
Methods
Statistical method described in Grant & Davis (1997) and
Lynn (1986)
1. Panel of Experts
All either attend an invite only CQI symposium sponsored by
Dartmouth, have recently taught CQI at a Masters level or are
positional leaders of QI efforts in a healthcare organization
Best to have between 7 and 10 - this study had 7 from the
US and 1 from England
21. Content Validity
Methods (cont.)
2. Scoring Grid (See Sample Grid - pge 3)
Each expert was emailed the scoring grid with
definitions and instructions.
Is the item clear and understandable?
4 point scale
Does the item represent CQI?
4 point scale
Match the item with a domain.
1 through 14 representing each domain & 15 representing
unable to classify
22. Content Validity
Methods (cont.)
3. Indices
Inter-rater agreement (IR) = # of raters who scored an
item as high / total # of raters
high defined as a 1 or 2 on both 4 point scales
acceptable IR > / = .70
Content Validity Index (CVI) = # of items where all
experts rated high / # of items
acceptable CVI > / = .80
Domain congruence = % of time where experts chose
the same domain as the investigators
23. Content Validity Results
After 4 analysis iterations where poorly rated items
were deleted, the questionnaire included:
22 items
8 domains
Clarity IR of .91 (range of .85 - 1)
Representativeness IR of .93 (range of .87 - 1)
Clarity CVI of .73 using Lynn’s (1986) method
Representativeness CVI of .91 using Lynn’s (1986)
method
Overall, the experts chose the same domain as the
investigators in the original measure 76% of the time
24. Content Validity Results
Investigators added 6 items to ensure that every
domain except for Supplier Partnership contained 3
items
Investigators changed some wording to increase
clarity
Final survey was sent back to experts for comments
Other Results
The scoring grid took a lot longer to complete than originally
thought
The leadership domain had the highest rate of agreement
QI must be differentiated from QA
Baldrige criteria dominate
25. Step 3: Develop a corresponding scale of
CQI implementation
A 5 level corresponding scale (pge 4) was developed by
the investigators from:
Roger’s Diffusion of Innovations
agenda setting, matching, redefining / restructuring, confirmation,
clarifying, routinizing
Deming’s Continuous Quality Improvement
match domains with appropriate level
Samsa & Matchar
CQI as a problem solving methodology vs. a managerial
philosophy
Characteristics:
CQI is a developmental process
Time is important
Scale provides focus for future quality initiatives
26. Steps 2 & 3 - Content Validity and Scale
Published and Voted Best Student-Led Paper in
the 2002 Business and Health Administration
Proceedings,pges 198-204
Will be further published in Either Quality in
Health Care or Hospital Topics
27. Step 4: Is the survey and scale easy to use
and are the results practical?
Pilot Study
Worked with the Missouri Hospital Association for contacts.
83 Missouri hospitals eligible (above 40 beds), 40 participated
5 responses from each hospital: CEO/COO, Director of
Quality, a non-salaried MD, and 2 managers
Survey and results disseminated via email
Hypotheses based on Paper 1 Weaknesses
1. There will be measurable differences between and
within hospitals.
2. The survey will have high known-groups validity.
3. The items and domains will differentiate between levels
as hypothesized by the conceptual scale.
28. Pilot Study Methods
Known Groups Validity
Examined the relationship between the survey and:
state quality team winners >/= Level 2
state quality organization winners >/= Level 3
national quality award finalists >/= Level 3
subjective quality assessment at 10 of the 40 hospitals
question 1 (pge 5) asking the participants to categorize
their quality structure
Reliability
Cronbach’s Alpha for each domain, each title, and the
overall measure
29. Pilot Study Methods
Between Hospital Variation
One-way ANOVA & Bonferroni
by size, region and ownership model
Within Hospital Variation
Repeated Measures ANOVA & Bonferroni
by title
Item and Domain Analysis
ANOVA & Bonferroni
determine which items and which domains discriminate
well between different levels of the scale
30. Pilot Study Hospital Total Level
N = 40 (min of 90, max of 130)
16
14
12
10
8
6
4
2
0
Level 1
(</= 100)
Level 2
(101-110)
Level 3
(111-120)
Level 4
(121-130)
Level 5
(131-140)
# of hospitals
31. Pilot Study Results
Sample Characteristics (pge 6)
40 hospitals are significantly larger and more likely to be
for profit and part of a system
Of the 200 returned surveys, there was less than 5%
missing values and ‘I don’t know / NA’
Known Groups Validity
2 of the 12 did not score as hypothesized
hospitals were not significantly different than others
4 of 9 (44%) similar for the subjective assessment
40% agreement for question 1 assessment
32. Pilot Study Results
Reliability
Cronbach’s Alpha ranged from .54 (HR/Training) to
.84 (Innovation) for the domains
Information .69; Process, Planning .77; Customer .78;
Leadership .83
Cronbach’s Alpha ranged from .88 (Director
/Manager and QI Director) to .92 (MDs) for different
groups
Cronbach’s Alpha was .94 for the overall measure
33. Pilot Study Results
Between Hospital Variation
Region was only attribute that was significant
Within Hospital Variation
Senior Executives significantly lower than QI Directors
QI Directors significantly higher than Managers /
Directors
MDs significantly higher than Managers/ Directors
supports surveying more than one level employee
34. Pilot Study Results
Item and Domain Analysis (pge 7)
Of the 28 items, 4 did not show good differentiation
between any of the levels
these should be either reworded or changed
Leadership showed significant differentiation between
all levels studied
Planning showed significant differentiation between 2 of
the 5 levels
35. Pilot Study Results
Quality Improvement Scale
Level Components after Domain Analysis
1. Quality Assurance
2. QI Low High Focus – Leadership ( visibility) ; Customer Focus
M edium Focus – I nnovation
3. QI Medium High Focus – Process; HR / Training; Planning
M edium Focus – Leadership ( support)
4. QI High M edium Focus – I nformation; Supplier Partnership
Low Focus – Leadership ( consistency) ; Planning
5.QI - Absorbed
36. Findings
The survey is easy to administer
The survey provides a reliable and valid snapshot of
CQI implementation in a healthcare organization
No known group exists
The scale is a practical method of providing hospital
leaders with a roadmap for CQI implementation
Leadership is the most important component of
implementing CQI
Submitted to Health Services Research
37. A Likely Future Scenario
1. Patient Safety provides accountability to analyze
quality and outcomes
2. Healthcare leaders see CQI as a methodology to
improve patient outcomes
3. Hospitals use the survey and scale to help
assess & implement CQI appropriately, which in
turn eliminates structure issues discussed
4. Because of this, hospitals can effectively assess
their processes and improve their outcomes
38. Future Research Questions
Can a clearer snapshot of CQI implementation emerge using
line worker responses, and senior leadership interviews?
Administered the survey to a 40 random line workers at 10
hospitals
Initial results include:
50% return rate
high number of ‘I don’t know / NA’ responses
all hospitals overall employee score < 100 (Quality Assurance)
Senior hospital leadership meetings to discuss quality
structure
Initial results include:
low knowledge of ‘quality’ among the senior leaders
structures developed with little statistical or facilitation resources
39. Future Questions
Does a higher level of CQI implementation lead to better
financial, quality and safety outcomes? If not, why?
Develop and Find Financial, Operational and HR
Effectiveness and Efficiency Measures
Counte & Glandon, 1995
Build one, clean database with CQI implementation
scores and measures
Analyze to assess relationships
40. Future Questions
Is CQI, as its described in the literature, an effective
method for improving quality outcomes?
Change the four items that did not differentiate well
1. How many multi-disciplinary teams currently work to improve the
processes of care in your organization? (Process)
more statistics, less teams
• Human Factors Research
• Toyota
• Six Sigma
2. Do people in your organization know who their customers are?
(Customer Focus)
not clear
3. Are employees in this organization encouraged to try new and
better ways of doing things? (Innovation)
4. Is creativity actively encouraged in this organization? (Innovation)
healthcare has typically not been innovative and so these questions
may need to be more specific