scholarly journals Strength in unity: the power of redesign to align the hospital team

2014 ◽  
Vol 38 (3) ◽  
pp. 271 ◽  
Author(s):  
Anthony Bell ◽  
Alastair Cochrane ◽  
Sally Courtice ◽  
Kathy Flanigan ◽  
Mandeep Mathur ◽  
...  
Keyword(s):  
Resistance To Change ◽  
Hospital Staff ◽  
Baseline Data ◽  
Clinical Group ◽  
Efficient Manner ◽  
Patient Journey ◽  
Communication Plan ◽  
Inpatient Episode ◽  
Starting Point ◽  
Hospital Team

Objective The aim of Queen Elizabeth II Jubilee Hospital (QEII) redesign project (QEII United) was to enhance timely access to an inpatient bed and maximise opportunities to value add during the inpatient episode of care. Methods A tripartite relationship between the hospital team, system manager and external consultants. The team, QEII United, was formed to ‘diagnose, solve and implement’ change under the unifying metaphorical banner of a football team. A marketing strategy and communication plan targeted the key ‘players’ and outlined the ‘game plan’. Baseline data were collected, analysed and reported in keeping with key aims. Strategies for systems improvement implementation were attached to key performance indicators (KPIs). Results Thematic KPIs were developed to embed internal process change to reflect the contributions made towards the National Emergency Access Target (NEAT) at each stage of the patient journey. As such, access block of under 20%, morning discharge rates of 50% before midday, reduced length of stay for selected elective orthopaedic and general medical diagnostic related groupings (DRGs; i.e. relative stay index ≤1) and hospital in the home (HITH) utilisation rates 1.5% of all admissions were all met. Key to sustainability was the transfer of clinical redesign skills to hospital staff and the fostering of emergent ground up leadership. Conclusions QEII United’s success has been underpinned by the development of themed solution areas developed by the hospital staff themselves. Robust baseline data analysis used in combination with nationally available benchmarking data provided a quantitative starting point for the work. The collaborative elements of the program re-energised the hospital team, who were kept informed by targeted communications, to establish quick wins and build trust and momentum for the more challenging areas. What is known about the topic? Clinical redesign is now commonly used to understand, define and improve those clinical processes that underpin the patient journey across the continuum of care. Different industry models exist and have been extended for use in healthcare settings to involve, engage and educate staff with the primary focus of providing the best possible patient care, in an effective and efficient manner. What does this paper add? The clinical redesign process outlined in this paper is instructive in its use of the metaphorical team. Team philosophy, composition and functionality was built up using the vernacular of a football competition. In this way, organisational learning and capability building occurred within empowered local action teams, across the ‘season’ to effect changes at all points of the patient journey. What are the implications for practitioners? The implications for practitioners are to fully understand the breadth of issues before deciding upon focus areas for improvement. Resistance to change is inevitable and there are a number of ways to mitigate this and create a sense of purpose within the broader clinical group by structuring teams across traditional reporting lines. Collaboration is crucial in keeping lines of communication open and the use of data and patient feedback is very instructive.

scholarly journals The DWQ-EMR Embedded Tool to Enhance the Family Physician-Caregiver Connection: A Pilot Case Study

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 29
Author(s):  
Kristina Marie Kokorelias ◽  
Einat Danieli ◽  
Sheila Dunn ◽  
Sid Feldman ◽  
David Patrick Ryan ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Best Practice ◽  
Data Gathering ◽  
Family Physicians ◽  
Efficient Manner ◽  
Efficient Access ◽  
Increased Risk ◽  
Starting Point ◽  
To Receive

The number of family caregivers to individuals with dementia is increasing. Family physicians are often the first point of access to the health care system for individuals with dementia and their caregivers. Caregivers are at an increased risk of developing negative physical, cognitive and affective health problems themselves. Caregivers also describe having unmet needs to help them sustain care in the community. Family physicians are in a unique position to help support caregivers and individuals with dementia, but often struggle with keeping up with best practice dementia service knowledge. The Dementia Wellness Questionnaire was designed to serve as a starting point for discussions between caregivers and family physicians by empowering caregivers to communicate their needs and concerns and to enhance family physicians’ access to specific dementia support information. The DWQ aims to alert physicians of caregiver and patient needs. This pilot study aimed to explore the experiences of physicians and caregivers of people using the Questionnaire in two family medicine clinics in Ontario, Canada. Interviews with physicians and caregivers collected data on their experiences using the DWQ following a 10-month data gathering period. Data was analyzed using content analysis. Results indicated that family physicians may have an improved efficacy in managing dementia by having dementia care case specific guidelines integrated within electronic medical records. By having time-efficient access to tailored supports, family physicians can better address the needs of the caregiver–patient dyad and help support family caregivers in their caregiving role. Caregivers expressed that the Questionnaire helped them remember concerns to bring up with physicians, in order to receive help in a more efficient manner.

scholarly journals The impact of the Emergency Department target upon the discharge decision for people who self-harm

2019 ◽  
Vol 19 (2) ◽  
pp. 89-97
Author(s):  
Michael Brian Haslam ◽  
Emma S. Jones
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Wait Time ◽  
Adverse Outcomes ◽  
Patient Journey ◽  
Content Type ◽  
Target Time ◽  
Starting Point ◽  
Self Harm ◽  
The Impact

Purpose The purpose of this paper is to consider the influence of the Emergency Department (ED) target wait time upon the discharge decision in ED, specifically for patients who have self-harmed. Pressures to discharge patients to avoid breaching the 4-h target wait time, potentially increase the risk of adverse responses from clinicians. For the patient who has self-harmed, such interactions may be experienced as invalidating and may result in adverse outcomes. Design/methodology/approach Secondary data analysis was applied to the retrospective referral data of a Mental Health Liaison Team (MHLT), collected over a period of 11 months from a single hospital in the North of England. In total, 734 episodes of care were referred to the team from ED, where the primary presentation was recorded as self-harm. Findings Over half of patients referred to the MHLT from ED having self-harmed were seen after already breaching the target and the potential for a more restrictive outcome reduced. Of those patients seen within 4 h, the potential for a more restrictive treatment option was increased. Practical implications Recommendations to improve the patient journey for those who have self-harmed include mental health triage and treatment in clinical areas outside of the target. Social implications This study challenges the concept of the target as being realistic and attainable for patients who have self-harmed. Originality/value This exploratory study provides a starting point from which to explore the impact of the target time upon discharge decisions and clinical outcomes specifically for those who have self-harmed.

scholarly journals Prevalence of brucellosis in ruminants in Bangladesh

2011 ◽  
Vol 56 (No. 8) ◽  
pp. 379-385 ◽  
Author(s):  
MS Rahman ◽  
MO Faruk ◽  
M. Her ◽  
JY Kim ◽  
SI Kang ◽  
...  
Keyword(s):  
Baseline Data ◽  
Sheep And Goats ◽  
Livestock Species ◽  
Starting Point ◽  
Sera Samples ◽  
Epidemiological Information ◽  
Structured Questionnaire

The prevalence of brucellosis was determined in the ruminants (buffaloes, cattle, sheep and goats) of five different districts viz. Bagerhat, Bogra, Gaibangha, Mymensingh and Sirajgonj of Bangladesh. A total of 550 sera samples of 105 buffaloes, 188 cattle, 127 goats and 130 sheep were screened by RBT and were further confirmed with I-ELISA. A structured questionnaire was used to collect epidemiological information on the animals. The overall serological prevalence derived from the samples was 2.87% in buffaloes, 2.66% in cattle, 3.15% in goats, and 2.31% in sheep. The prevalence was relatively higher in females than that in males in cattle, goats and sheep but, an insignificantly higher prevalence was observed in males than that in females in the case of buffalo. A significant association was found between abortion or age and occurrence of brucellosis (P < 0.01). The results of the study provide (a) a comparison of the prevalence of brucellosis in different livestock species in Bangladesh, (b) constitute baseline data for further study of Brucella infections, and (c) are a starting point for the control of brucellosis.

Advanced Modeling with the MATLAB Reservoir Simulation Toolbox

2021 ◽  
Keyword(s):  
Oil Recovery ◽  
Reservoir Simulation ◽  
Geothermal Energy ◽  
Unconventional Reservoirs ◽  
Flow In Porous Media ◽  
Simulation Methods ◽  
Efficient Manner ◽  
Advanced Students ◽  
Starting Point

Many leading experts contribute to this follow-up to An Introduction to Reservoir Simulation using MATLAB/GNU Octave: User Guide for the MATLAB Reservoir Simulation Toolbox (MRST). It introduces more advanced functionality that has been recently added to the open-source MRST software. It is however a self-contained introduction to a variety of modern numerical methods for simulating multiphase flow in porous media, with applications to geothermal energy, chemical enhanced oil recovery (EOR), flow in fractured and unconventional reservoirs, and in the unsaturated zone. The reader will learn how to implement new models and algorithms in a robust, efficient manner. A large number of numerical examples are included, all fully equipped with code and data so that the reader can reproduce the results and use them as a starting point for their own work. Like the original textbook, this book will prove invaluable for researchers, professionals and advanced students using reservoir simulation methods.

scholarly journals Improving quality of psychiatry training in Northern Ireland through the introduction of postgraduate education fellows

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S127-S127
Author(s):  
Catherine Boucher ◽  
Roisin Connolly ◽  
Michael Doris ◽  
Colin Gorman ◽  
Michael McMorran ◽  
...  
Keyword(s):  
Northern Ireland ◽  
Royal College ◽  
Postgraduate Education ◽  
Training Programme ◽  
Baseline Data ◽  
Pass Rate ◽  
Simulated Patients ◽  
Teaching Programme ◽  
Psychiatry Education ◽  
Starting Point

AimsTo improve postgraduate psychiatry education and training in Northern Ireland.BackgroundHistorically within Northern Ireland there has been a postgraduate Member of the Royal College of Psychiatrists (MRCPsych) teaching programme delivered to core trainees in preparation for MRCPsych examinations. There has been no official teaching programme for higher trainees. Northern Ireland Medical and Dental Training Agency (NIMDTA), in collaboration with the Royal College of Psychiatrists in Northern Ireland and all five Trusts developed the novel idea of introducing Postgraduate Education Fellows, to oversee and improve core training, and to develop a bespoke higher training programme.The Postgraduate Education Fellows met to collate information from various sources in relation to issues within the current teaching programme and address these along with the development of new initiatives. The fellows further act as a point of contact for all trainees within their Trust to provide advice and support with education if needed.MethodOne higher trainee was appointed to the role of Postgraduate Education Fellow in each Trust within the NIMDTA deanery for a term of 1 year.The starting point was delivering the pre-established teaching timetable and gaining feedback from core trainees to identify areas for improvement. The next phase involved piloting traditional and contemporary methods of feedback. A further development was designing a mock paper A delivered under exam conditions. Two mock Clinical Assessment of Skills and Competencies (CASC) exams were organised under exam conditions, offering other trainees the opportunity to act as simulated patients and examiners.The third aspect of this role involved creating a programme of higher trainee seminars. Baseline data were collated and identified key areas that higher trainees felt they needed further training and guidance in.ResultUsing baseline data on the current teaching programme and from higher trainees as well as incorporating quality improvement methodology, we have been making small changes to each aspect of the teaching programme and evaluating the changes made. The feedback from trainees has been positive as evidenced by quantitative and qualitative feedback. 8 candidates sat our first mock CASC with a 100% pass rate in their MRCPsych CASC examination. There has been a positive response to the higher trainee seminar programme.ConclusionThis programme has produced good outcomes to date and sets foundations for the future development of post graduate psychiatry education in Northern Ireland.

scholarly journals Upscaling, Obduracy, and Underground Parking in Maastricht (1965-Present): Is There a Way Out?

2020 ◽  
pp. 009614422090906
Author(s):  
Jelena Stanković ◽  
Marc Dijk ◽  
Anique Hommels
Keyword(s):  
Inner City ◽  
Resistance To Change ◽  
Decision Making Process ◽  
Cultural Meanings ◽  
Sustainable Mobility ◽  
Parking Garage ◽  
Car Use ◽  
Starting Point ◽  
History Of ◽  
Dutch City

This article reconstructs the history of underground parking in the Dutch city of Maastricht by connecting the model of obduracy (i.e., “resistance to change”) with the concept of upscaling, which offers new insights in historic urban transitions. We discuss how the decision-making process about the building of the first underground parking garage (Vrijthof) in the late 1960s was a starting point of a growing obduracy of the urban practice of car use and parking in the inner city of Maastricht. We argue that this obduracy can be explained by the growing interconnections between the cultural meanings of historic squares and urban car use, expertise of urban planners, traffic experts and parking operators, parking and traffic policies and regulations, and underground parking infrastructures. Ironically, the expansion of underground parking in Maastricht can be seen as a pivotal part of the successful upscaling and increasing obduracy of car mobility in this town, but at the same time significantly affects the upscaling of local sustainable mobility innovations forty years later and beyond.

Artificial intelligence products reshape accounting: time to re-train

2020 ◽  
Vol 34 (6) ◽  
pp. 41-43 ◽  
Author(s):  
Kathie J. Shaffer ◽  
Carol J. Gaumer ◽  
Kiersten P. Bradley
Keyword(s):  
Artificial Intelligence ◽  
Service Sector ◽  
New Technologies ◽  
Resistance To Change ◽  
Workforce Training ◽  
Accounting Education ◽  
Added Value ◽  
Accounting Profession ◽  
Efficient Manner ◽  
Content Type

Purpose Managers are expected to increase productivity in the most cost-efficient manner, using all available resources and, “work smarter.” As technology improves, there is greater incentive for managers to invest in options where automation becomes less expensive than the high cost of human capital. When repetitive tasks can be accurately duplicated through automation, the decision becomes a fait accompli. Advances in artificial intelligence (AI) or synthetic intelligence that simulates human intellectual function has significant impact potential in the service sector. This paper examines productivity efficiencies sought through artificial intelligence and the need for re-training, specifically in the accounting profession. Design/methodology/approach This is a conceptual paper for practitioners without research methodology. Findings The accounting profession 10 years from now will look noticeably different than it does now. The accountants, who embrace the new technologies, like artificial intelligence, will survive and even thrive by becoming more specialized. This will require training and, in some instances, re-training. Organizations must be willing to absorb those development costs. I hope that new graduates will enter the profession with updated skills providing added value for organizations and employers who started into the profession many years ago. The biggest challenge may lie in the re-training of accountants who have been in practice for many years and managing the resistance to change. Employers must first set the example by accepting the inevitable and then encourage and support employees to improve and update their skills. Additionally, they will have to coach employees through the changes with reassurance that those who embrace the change will experience less chance of job elimination. Embracing the available technology will enable firms to serve clients more efficiently and effectively by providing up to date business solutions regardless of the services being offered. Research limitations/implications There is no empirical research in this paper. It is a conceptual piece looking at the changing organization in accounting, specifically due to artificial intelligence. Practical implications Accounting firms that focus on basic accounting functions should find new services to offer. The same clients can be served, but at a higher-level. Accountants will offer more value to clients by detecting patterns and trends when more time can be devoted to analysis. Helping clients beyond the preparation of documents requires that accountants understand the current market conditions and potential effects of inflation and, engage in more critical thinking while at the same time be able to teach clients and help them understand at the higher level. Just as accountants’ responsibilities and duties will be transformed through the integration of AI, accounting education must be altered. Social implications Implications related to the workplace are only discussed in this paper. Originality/value It is not completely original. It is a compilation of research that is out there as a means to address critical workforce training needs in accounting as technology moves forward.

scholarly journals From 'to cure' to 'to care' in Oncology Toward shared Evidence based practice

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Rubba ◽  
E Paparo ◽  
F Capuano ◽  
E Montella ◽  
I G Continisio ◽  
...  
Keyword(s):  
Social Life ◽  
Life Experience ◽  
Health Workers ◽  
Hospital Staff ◽  
Breast Cancers ◽  
Word Cloud ◽  
Care Givers ◽  
Starting Point ◽  
The Relationship

Abstract Aims Oncological disease need a system of care involving hospital staff and informal caregivers. Care-givers are subjected to stressful factors (burden) with repercussions on psycho-physical balance. The project, carried out together with the ONLUS Travel Companions Association and the Multidisciplinary Oncological Groups (GOM) of Brain and Breast Cancers, intends to offer supportive training experiences for care-givers and health workers, offering emotional and practical preparation for the treatments that they will find themselves providing the cancer relative by helping to improve the quality of care and the relationship between the subjects. The professionals participating in the project (doctors, nurses) take part in a training held by professionals from the Association. The care givers, divided into groups, carry out a CBI test (Caregiver Burden Inventory) and training meetings on medical, psychological and social assistance issues. After 3 months from the end of the course, the care-giver carries out the interview with the psychologist and recompiles the CBI. Furthermore, on 30 selected patients of Breast Cancers, GOM, an emotional evaluation questionnaire of their life experience was administered with respect to the stages of the disease pathway. Results The answers were then analyzed by the word cloud method and summarized in a synthetic map for each question. The most used words to describe the mood during the illness are 'anger, pain, anguish and worry'; while waiting before the visit they are 'long, exhausting, anxious'; towards the doctor 'availability, humanity, kindness, friendliness, professionalism'; with regard to 'excellent, availability' assistance; about social life during the 'unchanged, serene' illness; towards the return home 'joy'. Conclusions The project is a starting point towards a continuous and progressive humanization of the integrated pathways from 'to cure' to 'to care' in oncology. Key messages Patients are positively affected from shared initiatives. Word cloud may resume patients moods and thei main issues concerninthe path.

scholarly journals Demystifying Unexpected Silicon Responses through User-Defined Fault Models (UDFM) and Failure Analysis

2021 ◽  
Author(s):  
Subhadip Kundu ◽  
Gaurav Bhargava ◽  
Lesly Endrinal ◽  
Lavakumar Ranganathan
Keyword(s):  
Failure Analysis ◽  
Fault Model ◽  
Test Design ◽  
Fault Models ◽  
Critical Test ◽  
Efficient Manner ◽  
Starting Point ◽  
A Cell ◽  
Diagnosis Algorithm ◽  
Transition Delay

Abstract Failure Analysis (FA) plays an important role during silicon development and yield ramp up, helping identify critical test, design marginality and process issues in a timely and efficient manner. FA techniques typically rely on diagnosis callouts as a starting point for debug. Diagnostic algorithms rely on the error logs collected on production patterns which are generated to detect Stuck-at Faults (SAF) and Transition Delay Faults (TDF). Typically, SAF patterns screen out the static defects and TDF patterns test for transient fails. But often, we see cases where a SAF pattern shmoo is clean but the TDF pattern shmoo is a gross failure indicating a cell-internal static defect missed by the traditional SAF patterns. In this work, we will present our own developed User-Defined Fault Model, which targets cell-internal faults to explain unexpected silicon observations. An added advantage of the work can be seen in improving diagnosis results on the error logs collected using these targeted UDFM patterns. Since UDFM utilizes targeted fault excitation, the diagnosis algorithm results in better callouts. In this paper, we will also propose a custom diagnosis flow using our in-house UDFM to achieve better resolution. Three FA case studies will be presented to showcase the usefulness and effectivity of the proposed methods.

scholarly journals Hand Hygiene In and Out: Compliance and Sustainability Are Possible: 90/90 Program in a Mexican Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s241-s242
Author(s):  
Roxana Trejo González ◽  
Miguel Ángel García Salcido ◽  
Diana Palami Antunez ◽  
Reyna Yacaman Handal
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Staff ◽  
Positive Influence ◽  
Health Providers ◽  
Starting Point ◽  
Hygiene Compliance

Background: The American British Cowdray Medical Center I.A.P., also known as ABC Medical Center, is a highly specialized hospital and private assistance institution located in Mexico City. The ABC Medical Center implemented hand hygiene policies since around 2009, when Mexico committed to patient security. However, hand hygiene compliance remained low. Methods: The objective of the Hand Hygiene 90/90 program was to increase hand hygiene compliance through an integral strategy including a multidisciplinary team with leaders from different areas (nursing, physicians, human resources, quality, and educators). It was named 90/90 because it aimed to accomplish a 90% hand hygiene compliance among all health providers and hospital staff in 90 days (October 1–December 29) upon entering and exiting patient rooms (ie, In & Out). The Hand Hygiene 90/90 program led by the epidemiology area consisted of 5 specific components: management, supplies, education, monitoring, and social marketing (Fig. 1). For a period of 90 days, several permanent actions were implemented; they had a positive influence on the expected outcome (Fig. 2). Results: The starting point at the ABC Medical Center upon launching the program was 70% compliance. With the Hand Hygiene 90/90 program, the first steady change was observed at the end of November 2012 (ie, the sixth measurement point). An 88% compliance was achieved, all compliance was >50% from this point on. The highest compliance was achieved among health providers (doctors and nurses), followed by administrative staff. At the end of December 2012, 91% compliance was achieved by all health providers and hospital staff. Sustainability has been possible over the years through ongoing hand hygiene campaigns. In the 5 years following the implementation of the program, hand hygiene compliance remained mostly below the 90% standard (Fig. 3). Conclusions: An intervention for continuous improvement and hand hygiene compliance using the WHO 5 Moments was implemented throughout 2018, (in addition to the In & Out program). This intervention also incorporated elements of the WHO Multimodal Strategy 1 to develop a comprehensive hand hygiene program together with new indicators. The ABC Medical Center, with the support and leadership of the Ministry of Health, aims to become an example of institutions that achieve national and international benchmarks in the implementation of patient safety programs that are not only successful but also sustainable.Funding: NoneDisclosures: None

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