scholarly journals Improving Compliance of Physicians in Reporting and Documenting Critical Alerts in a Cancer Hospital

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Wania Imtiaz ◽  
Khawaja Shehryar Nasir ◽  
Fareeha Kanwal ◽  
Sheeba Saqib ◽  
Haroon Hafeez
Keyword(s):  
Compliance Rate ◽  
Effect Analysis ◽  
Continuous Quality ◽  
Continued Education ◽  
Fishbone Diagram ◽  
Life Threatening ◽  
Cause And Effect Analysis ◽  
Chart Audits ◽  
And Training ◽  
Electronic Hospital

Introduction: A critical result of an investigation is considered a representation of a pathophysiological state deemed to be high-risk or life-threatening for the patient. Therefore, such results should be addressed in an appropriate and timely manner. Unfortunately, routine closed-chart audits suggested that the compliance of physicians in documenting critical alerts in patient notes was poor. This prompted the hospital to conduct a continuous quality improvement (CQI) project to improve the physicians' compliance. Materials and Methods: A cause-and-effect analysis was conducted using a fishbone diagram to identify the reasons for poor compliance. Based on the analysis, several modifications were made, including, but not limited to, hospital-wide educational sessions on the standard operating procedures of receiving and documenting critical alerts for the physicians, daily audit of critical alerts to review the appropriateness of documentation, and introduction of a new module in the hospital electronic medical record to acknowledge and document receiving critical alerts. Results: Before implementing the strategies to improve physicians' documentation compliance, the average compliance rate was 57 % in April 2020, and the median compliance rate was 52 % (January 2020 - April 2020). However, afterwards, within a couple of months of implementing changes, the average compliance rate increased to 88 %. This improvement was sustained for the next eight months (median of 89 %). Conclusion: This study found that CQI approach can be used to improve the compliance of the physicians for appropriately and timely documenting critical alerts, in this case, by continued education and training process and incorporating changes into the electronic hospital information system.

How to Improve Remanufacturing?—A Systematic Analysis of Practices and Theories

2018 ◽  
Vol 141 (2) ◽  
Author(s):  
Tomohiko Sakao ◽  
Erik Sundin
Keyword(s):  
Customer Value ◽  
Success Factors ◽  
Theory And Practice ◽  
Systematic Analysis ◽  
Effect Analysis ◽  
Product Service ◽  
Fishbone Diagram ◽  
Cause And Effect Analysis ◽  
The Right ◽  
A Company

Remanufacturing has gained attention from industry, but the literature lacks the scientific comprehension to realize efficient remanufacturing. This hinders a company from commencing or improving remanufacturing efficiently. To fill this gap, the paper proposes a set of practical success factors for remanufacturing. To do so, it analyzes remanufacturing practices in industry through interviews with staff from remanufacturing companies with long experience. The practical success factors are found to be (1) addressing product and component value, (2) having a customer-oriented operation, (3) having an efficient core acquisition, (4) obtaining the correct information, and (5) having the right staff competence. Next, the paper further analyzes remanufacturing processes theoretically with both cause and effect analysis and means-ends analysis. Since the factors show that, among other things, the product/service system (PSS) is highly relevant to remanufacturing in multiple ways, theories on the PSS are partly utilized. As a result, the distinctive nature of remanufacturing underlying in the processes is found to have high variability, high uncertainty and, thus, also complexity. The obtained insights from practice and theory are found to support each other. In addition, a fishbone diagram for remanufacturing is proposed based on the analysis, including seven m's, adding two new m's (marketing and maintenance) on top of the traditional five m's (measurement, material, human, method, and machine) in order to improve customer value. The major contribution of the paper lies in its insights, which are grounded in both theory and practice.

Construction projects delay mitigation using integrated balanced scorecard and quality function deployment

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Murat Gunduz ◽  
Nasser H. Al-Naimi
Keyword(s):  
Balanced Scorecard ◽  
Quality Function Deployment ◽  
Construction Projects ◽  
Related Factors ◽  
Effect Analysis ◽  
Content Type ◽  
Financial Perspective ◽  
Fishbone Diagram ◽  
Cause And Effect Analysis ◽  
Construction Delay

PurposeDelays occur mostly in the construction process of many projects, which can have a consequent effect on the overall performance of the project in areas such as profitability, efficiency and safety. This study aims to suggest a structure that can be applied to manage construction projects effectively and, thus, to reduce delays. The integrated balanced scorecard (BSC) and quality function deployment (QFD) framework proposed in the present study enabled the identification and ranking of the objectives of the financial perspective and the enablers of construction delay mitigation. This will help construction industry professionals prioritize the enabling factors that influence the financial perspective, thereby helping them focus on the achievement of the most important ones which subsequently results in efficiency. Consequently, more tasks are accomplished with the use of less time and resources as the actions tend to be more narrowly focused on the achievement of the most important factors such as client and contractor-related factors, as opposed to the low-value adding factors.Design/methodology/approachA literature review was conducted to determine the essential factors that would help resolve or reduce delays. A total of 41 mitigation factors (seven financial objectives and 36 enabler objectives) were identified and categorized into four BSC perspectives: financial, client, contractor and project management team, and innovation and learning. Two management tools, the BSC and QFD, were used to develop the system based on the mitigation factors defined.FindingsThe results of this study show that the most significant factors affecting the achievement of the financial objectives of the project are mainly customer-related factors, accompanied by factors related to contractors and project management teams. With the fishbone diagram and cause and effect analysis, the proposed BSC and QFD system provides a long-term approach for all stakeholders to help professionals in the construction industry prioritize and reduce delays more effectively. Moreover, the findings of the present study highlight the utility of the integrated BSC and QFD framework in quantifying the strengths of association of different objectives of the financial perspective and the enablers of construction delay mitigation.Originality/valueThe contribution of this paper to the body of knowledge is the proposed integrated structure for BSC and QFD that can serve as a comprehensive and structural approach to rating the essential enabling delay mitigation factors based on the magnitude of their effects on the financial performance of the project. The proposed framework can be considered a novel tool since this is the first integrated BSC and QFD framework for construction delay mitigation. Finally, the proposed BSC and QFD framework, along with the fishbone diagram and cause and effect analysis, provides a long-term strategy for all stakeholders to mitigate delays. Thus, the proposed integrated BSC and QFD framework can serve as a systematic and structural approach for measuring the strength of influence of the enablers of delay mitigation against the financial perspective.

scholarly journals IDENTIFIKASI RISIKO PADA OKRA MENGGUNAKAN FAILURE MODE AND EFFECT ANALYSIS (FMEA) DI PT. MITRATANI DUA TUJUH DI KABUPATEN JEMBER

2019 ◽  
Vol 13 (01) ◽  
pp. 25
Author(s):  
Ida Bagus Suryaningrat ◽  
Wiwik Febriyanti ◽  
Winda Amilia
Keyword(s):  
Failure Mode ◽  
Critical Value ◽  
Agricultural Product ◽  
Effect Analysis ◽  
Post Harvest ◽  
Age Factor ◽  
Fishbone Diagram ◽  
Main Factors ◽  
Post Harvest Loss ◽  
And Training

Post-harvest is an activity processed from harvesting to becoming a product. Post-harvest handling aims to maintain the quality and minimize the loss of the agricultural product. Post-harvest loss of okra is the reduction of the okra harvest amount from picking up to transporting process. Many factors can cause the post-harvest loss of okra. This study aimed to determine the causal sources of the okra loss. This study used FMEA and fishbone diagram. Fishbone diagram was used to identify the causes of the okra loss in a fishbone skeleton. FMEA was used to give the value on the causes of the okra loss by assessing the severity, occurrence and detection to get the RPN value. The RPN value was used to rank the potential causes of the loss. From the result of the study, it was found that there were 4 main factors causing the okra loss which had the RPN value above the RPN critical value. It were lack of picker accuracy and training or counseling, handling pets and diseases, and age factor of picker. Keywords: fishbone diagram, FMEA, okra, post-harvest loss

Behavioral Emergencies and Crises

2010 ◽  
pp. 739-762
Author(s):  
Phillip M. Kleespies ◽  
Justin M. Hill
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
High Risk ◽  
Work Environment ◽  
Emotional Impact ◽  
High Risk Patients ◽  
Risk Patients ◽  
Life Threatening ◽  
Behavioral Emergencies ◽  
And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

Chart Audit of Spiritual Care Documentation: Continuous Quality Improvement

2020 ◽  
Vol 74 (4) ◽  
pp. 280-289
Author(s):  
Vivian B. Stang ◽  
Mary Jane Beavis ◽  
Geneviève Côté
Keyword(s):  
Quality Improvement ◽  
Electronic Health Record ◽  
Acute Care ◽  
Continuous Quality Improvement ◽  
Spiritual Care ◽  
Health Record ◽  
Chart Audit ◽  
Continuous Quality ◽  
And Performance ◽  
Chart Audits

Eight spiritual care practitioners at an acute care teaching hospital undertook a systematic chart audit of their documentation practices in the patient electronic health record. The purpose was to evaluate their practices using the standards of their professional association and regulatory college. A preliminary “mock audit” was essential for the overall success of the audit. Plans for ongoing chart audits will lead to continuous quality improvement. A limitation was that their manager acted as both improvement coach and performance evaluator.

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