Using the quality improvement (QI) tool Failure Modes and Effects Analysis (FMEA) to examine implementation barriers to common workflows in integrated pediatric care.

2020 ◽  
Vol 8 (3) ◽  
pp. 257-267
Author(s):  
Mahader Tamene ◽  
Anita Morris ◽  
Emily Feinberg ◽  
Megan H. Bair-Merritt
Keyword(s):  
Quality Improvement ◽  
Failure Modes ◽  
Pediatric Care ◽  
Implementation Barriers ◽  
Tool Failure

scholarly journals Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

2015 ◽  
Vol 95 (4) ◽  
pp. 588-599 ◽  
Author(s):  
Joel M. Stevans ◽  
Christopher G. Bise ◽  
John C. McGee ◽  
Debora L. Miller ◽  
Paul Rockar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Case Report ◽  
Physical Therapy ◽  
Care Quality ◽  
Routine Practice ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Improvement Program ◽  
Improvement Project ◽  
Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care—Pediatrician Perspectives

2021 ◽  
pp. 1-8
Author(s):  
Kim D. Lu ◽  
Dan Cooper ◽  
Raluca Dubrowski ◽  
Melanie Barwick ◽  
Shlomit Radom-Aizik
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Barriers And Facilitators ◽  
Pediatric Care ◽  
Team Approach ◽  
Implementation Barriers ◽  
Primary Care Clinics ◽  
Exercise Medicine ◽  
Practice Variability ◽  
Facilitators And Barriers

Purpose: Despite the known health benefits of physical activity (PA), few primary care pediatricians discuss, evaluate, or prescribe PA for children. The goal of this study was to examine pediatricians’ thoughts and practices related to child PA and the perceived facilitators and barriers to implementing PA evaluation and prescription in pediatric primary care clinics. Methods: The Consolidated Framework for Implementation Research was used to explore implementation barriers and facilitators. A mixed-method design combined questionnaires and focus groups with 27 pediatricians. Results: Despite the pediatricians’ beliefs that PA is important for patients, there was wide practice variability in their approaches to discussing PA. Several perceived barriers to implementing PA evaluation and prescription were identified, including lack of knowledge and training, managing time for PA with multiple demands, the need for a team approach and simple PA tools and resources, support for patient tailoring of PA messaging, and a need for PA best practice champions. Conclusion: The identified barriers to implementing evidence in PA suggest several directions for improvement, including a care-team approach; quick, inexpensive, and simple PA tools; community PA partnerships; PA training in medical education; evidence-based strategies; and PA directories for families. These efforts could facilitate the implementation of PA best practices in pediatrics.

Tool Pre-Failure Monitoring in Intermittent Cutting Operations

2016 ◽  
Author(s):  
M. Hassan ◽  
A. Sadek ◽  
A. Damir ◽  
M. H. Attia ◽  
V. Thomson
Keyword(s):  
Tool Wear ◽  
Failure Modes ◽  
Impact Load ◽  
Research Work ◽  
Unstable Crack ◽  
Tool Failure ◽  
Milling Operations ◽  
High Feed ◽  
Rough Milling ◽  
Intermittent Cutting

Tool failure remains one of the most challenging phenomena in machining that affects the productivity and product quality, and hence the cost. In high feed rough milling operations of hard-to-cut materials, chipping and breakage have been observed as the dominant failure modes of the end mill cutters. Most of the work in the open literature is focusing on either detecting the complete tool breakage after it takes place or detecting the progressive tool wear. Detecting the abrupt/sudden tool failure due to tool chipping before it takes place, which is essential to avoid any damage to the machined part, has not been addressed. Therefore, the main objective of this research work is to investigate the ability of using the process monitoring signals in order to detect the tool pre-failure and failure by chipping/breakage in intermittent cutting operations. A method was devised to induce impact load on the cutting tool tip to study the features of signals collected by various sensors due to unstable crack propagation and chipping, while ensuring minimal tool wear effect. The acoustic emission (AE) signal features were able to successfully capture tool pre-failure, while other signals could detect the failure occurrence only.

Study on Cutting Performance of the Alumina Based Nanocomposite Ceramic Tool

2014 ◽  
Vol 941-944 ◽  
pp. 1917-1921
Author(s):  
Qi Fen Zhou ◽  
Peng Zhou ◽  
Hai Ying Zhang
Keyword(s):  
Tool Wear ◽  
Failure Modes ◽  
Cutting Tool ◽  
Cutting Speed ◽  
Cutting Performance ◽  
Crater Wear ◽  
Tool Failure ◽  
Ceramic Tools ◽  
Ceramic Cutting Tool ◽  
Adhesion Wear

In this paper, the oxide nanometer composite cutting performance of ceramic tools cutting cast iron were studied. And the tool failure modes were mainly analyzed. Through the study found that, with the increase of tool wear with cutting speed, failure forms mainly adhesion wear. When the cutting speed is low, the knife before the crater wear become the main form of ceramic cutting tool wear, boundary wear and the surface of the knife after wear is also very serious. And in the process of cutting, the collapse edge can also occur now; With the increase of cutting speed, collapse become the main failure forms of cutter blade.

Fracture and Wear as Factors Affecting Stochastic Tool-Life Models and Machining Economics

1977 ◽  
Vol 99 (1) ◽  
pp. 281-286 ◽  
Author(s):  
S. Rossetto ◽  
R. Levi
Keyword(s):  
Failure Modes ◽  
Probabilistic Approach ◽  
Cutting Tools ◽  
Distribution Functions ◽  
Profit Rate ◽  
Tool Failure ◽  
Factors Affecting ◽  
Machining Economics ◽  
Fracture Processes ◽  
Production Conditions

Under production conditions cutting tools often fail under several failure modes, the occurrence of a single one only for a given operation being rather exceptional. In light of this observation a stochastic model is developed, considering as causes of tool failure both wear and fracture processes. Machining economics are then analyzed with a probabilistic approach, deriving distribution functions of profit rate.

Modified Early Warning System: Quality Improvement with the Help of Healthcare Failure Modes and Effect Analysis

2020 ◽  
Vol 98 (3) ◽  
pp. 108-117
Author(s):  
Salam Ahmad Samim ◽  
Ankit Singh ◽  
Priya Ravi
Keyword(s):  
Quality Improvement ◽  
Early Warning ◽  
Early Warning System ◽  
Failure Modes ◽  
Warning System ◽  
System Quality ◽  
Effect Analysis

Thermal Behavior and Tool Failures on Rotary Cutting of Difficult-to-Cut Materials Utilizing Multi Tasking Lathe

2010 ◽  
Vol 447-448 ◽  
pp. 806-810 ◽  
Author(s):  
Hiromasa Yamamoto ◽  
Kentaro Satake ◽  
Hiroyuki Sasahara ◽  
Toru Narita ◽  
Masaomi Tsutsumi ◽  
...  
Keyword(s):  
Failure Modes ◽  
Single Point ◽  
Cutting Speed ◽  
Tool Failure ◽  
Average Temperature ◽  
Rotary Cutting ◽  
The Difference ◽  
Coated Carbide ◽  
Coated Carbide Tools ◽  
Cutting Speeds

In rotary cutting difficult-to-cut materials, less tool wear is observed at higher cutting speeds, contrary to the case of conventional single-point turning. In order to examine this characteristic feature of rotary cutting, this study focuses on the effects of cutting speed and tool peripheral speed on tool failure. Dry rotary cutting tests of stainless steel SUS304 were carried out using coated carbide tools. Cutting speeds were set at 100 m/min, the speed typically recommended for conventional turning, and 500 m/min. At 100 m/min, adhesions and subsequent chippings were observed on the cutting edges. Meanwhile, at 500 m/min the higher average temperature at the tool-workpiece contact area caused small wear spots, rather than adhesions at the optimized tool speed. Hence, for rotary cutting, a higher cutting speed is more effective in terms of both achieving several-times-higher productivity and reducing the amount of tool failure due to the difference of tool failure modes.

Resolving Pediatric Preventive Care Gaps Through Hospital Inreach

PEDIATRICS ◽  
2021 ◽  
Author(s):  
John F. Morehous ◽  
Cynthia White ◽  
William B. Brinkman ◽  
Dominick J. DeBlasio ◽  
Allison Reyner ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Health Care System ◽  
Preventive Care ◽  
Failure Modes ◽  
Hospital Medicine ◽  
Primary Care Settings ◽  
Care Gaps ◽  
Care System

OBJECTIVES: Panel management processes have been used to help improve population-level care and outreach to patients outside the health care system. Opportunities to resolve gaps in preventive care are often missed when patients present outside of primary care settings but still within the larger health care system. We hypothesized that we could design a process of “inreach” capable of resolving care gaps traditionally addressed solely in primary care settings. Our aim was to identify and resolve gaps in vaccinations and screening for lead exposure for children within our primary care registry aged 2 to 66 months who were admitted to the hospital. We sought to increase care gaps closed from 12% to 50%. METHODS: We formed a multidisciplinary team composed of primary care and hospital medicine physicians, nursing leadership, and quality improvement experts within the Division of General and Community Pediatrics. The team identified a smart aim, mapped the process, predicted failure modes, and developed a key driver diagram. We identified, tested, and implemented multiple interventions related to role assignment, identification of admitted patients with care gaps, and communication with the inpatient teams. RESULTS: After increasing the reliability of our process to identify and contact the hospital medicine team caring for patients who needed action to 88%, we observed an increase in the preventive care gaps closed from 12% to 41%. CONCLUSIONS: A process to help improve preventive care for children can be successfully implemented by using quality improvement methodologies outside of the traditional domains of primary care.

Effect of tool wear on chip formation during dry machining of Ti-6Al-4V alloy, part 2: Effect of tool failure modes

2015 ◽  
Vol 231 (9) ◽  
pp. 1575-1586 ◽  
Author(s):  
Shoujin Sun ◽  
Milan Brandt ◽  
Matthew S Dargusch
Keyword(s):  
Plastic Deformation ◽  
Tool Wear ◽  
Failure Modes ◽  
Flank Wear ◽  
Cutting Tools ◽  
Cutting Edge ◽  
Machined Surface ◽  
Tool Failure ◽  
Geometric Ratio ◽  
Cutting Speeds

Variation in the geometric and surface features of segmented chips with an increase in the volume of material removed and tool wear has been investigated at cutting speeds of 150 and 220 m/min at which the cutting tools fail due to gradual flank wear and plastic deformation of the cutting edge, respectively. Among the investigated geometric variables of the segmented chips, slipping angle, undeformed surface length, segment spacing, degree of segmentation and chip width showed the different variation trends with an increase in the volume of material removed or flank wear width, and achieved different values when tool failed at different cutting speeds. However, the chip geometric ratio showed a similar variation trend with an increase in the volume of material removed and flank wear width, and achieved the similar value at the end of tool lives at cutting speeds of both 150 and 220 m/min regardless of the different tool failure modes. Plastic deformation of the tool cutting edge results in severe damage on the machined surface of the chip and significant compression deformation on the undeformed surface of the chip.

Study on damage behavior of carbide tool for milling difficult-to-machine material

2018 ◽  
Vol 233 (2) ◽  
pp. 735-747
Author(s):  
Yao-Nan Cheng ◽  
Wan-Ying Nie ◽  
Rui Guan ◽  
Wei-Kun Jia ◽  
Fu-gang Yan
Keyword(s):  
Failure Modes ◽  
Impact Load ◽  
Impact Damage ◽  
High Plasticity ◽  
Carbide Tool ◽  
Machine Material ◽  
Tool Failure ◽  
Damage Behavior ◽  
Tool Damage ◽  
The Impact

Water chamber head is an important component of nuclear power unit, and the main material is 508 III steel of difficult-to-machine material, which has the characteristics of high hardness, high strength, high plasticity and high profile shrinkage, etc. During the milling process, the tool is subjected to the cyclic impact load, which make cutting force and cutting heat change violent and occurrence of tool damage failure accelerate. In this paper, the damage behavior of carbide tool for milling difficult-to-machine material is studied first, and then field experiment was carried out on 508 III steel material, tool failure modes were analyzed, which include impact damage and fatigue fracture, and the failure theory and the crack propagation of carbide material were investigated in the process of tool damage. Then, the impact damage model of carbide tool is established based on the classical strength theory, and the critical condition of impact damage is determined according to simulation analysis. Finally, the theoretical model of carbide tool fatigue life is established and the tool fatigue limit is analyzed. Theoretical basis and technical support are provided for the tool failure mechanisms analysis, life prediction, parameter optimization, tool design and development aspects during the study.

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