Striving for Performance Excellence: Ten Years’ Experience & Impact of Accreditation on Quality, Safety, and Overall Performance in King Saud University Medical City (KSUMC) – A Mixed-Methods Study

BackgroundThe Kingdom of Saudi Arabia (KSA) has undergone a healthcare system transformation to improve healthcare delivery and quality and central to this is the accreditation for healthcare facilities. Hospitals in KSA have relied on international accreditation bodies and are now shifting to national accreditation boards. The objective of this paper is to assess long-term effects of national and international accreditation through measuring staff perception after ten years of participation in multiple accreditation surveys.MethodsThis mixed-methods study was conducted at the King Saud University Medical City. The quantitative tool was adapted from previous studies and was made available in both English and Arabic. Respondents were asked to evaluate their involvement in accreditation and hospital readiness for another accreditation survey using 11 subscales. ANOVA was used to evaluate differences in mean scores based on level of participation in accreditation surveys. A qualitative interview tool was also used to elicit input from key stakeholders, senior leaders, and managers from the university hospitals. ResultsA total of 630 respondents completed the survey. The subscale on Patient Safety scored highest with an average and those measuring Accreditation Impact, Quality Impact and Quality Management closely followed. ANOVA results showed a significantly increasing mean score with increasing involvement of respondents in accreditation with highest scores observed for the first accreditation survey. Linear regression results showed increases in selected outcomes when with increasing subscale scores for patient satisfaction, management and leadership and others. Findings from the qualitative component showed that accreditation supported improved and sustained quality of care. Despite some differences and challenges in implementing both international and national accreditation standards, there were areas of complementarity which supported quality improvement. Respondents also noted improvements in patient outcomes as a result of participation in accreditation.ConclusionThis study is the first to examine the long-term impact of accreditation over an extended period in KSA. The long-term assessment of accreditation conducted in this study revealed that staff perception about performance was highest during the first cycle and consistently decreased with consequent surveys. The slight and incremental decrease in scale scores reveal that the benefits of accreditation were retained.

Transformational Change in maternity services in England: a longitudinal qualitative study of a national transformation programme ‘Early Adopter’

Background Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding ‘what works’ in large system transformation. Methods A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper. Results Alignment of transformation work with Best et al’s rules for ‘what works’ in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new ‘system’ limiting system leaders’ power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change. Conclusions Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established.

Experiences and Lessons from Agri-Food System Transformation for Sustainable Food Security: A Review of China’s Practices

Food system transformation has been a widely discussed topic in international society over time. For the last few decades, China has made remarkable achievements in food production and has contributed greatly to the reduction in global hunger and poverty. Examining experiences and lessons from China’s food security practices over the years is helpful to promote a national food system transformation for China, as well as other developing countries. This study systematically reviews the literature on Chinese food security studies, with the aim of assessing China’s food security achievements and examining the remaining and emerging issues in the pursuit of food system transformation. The results show that China has continuously promoted food system transformation in land consolidation, agri-food production technologies, management and organization modes, food reserves, trade governance, and food consumption. These transformations ensure not only food availability, timeliness, and nutrition, but also in terms of the ecological, social, and economic sustainability, feasibility, and justice of food security. However, China is also confronting new challenges in food security, for example, malnutrition, environmental unsustainability, and reductions in diversified agri-food. In the future, China is expected to be committed to promoting healthy diets, sustainable agricultural production, climate change mitigation, and the reduction of food waste and loss to enhance its agri-food system’s resilience.

Transforming adaptive management in knowledge-intensive enterprises

The article considers the aspects of transforming the adaptive management of knowledge-intensive enterprises under highly volatile institutional conditions in the current technological order. The initial scientific hypothesis was that the quality and efficiency of enterprises in the medium and long term is a consequence of management system transformation, as a result of using a wide range of digital technologies in the process of implementating preventive management measures aimed at maintaining a certain level of correspondence between the digital environment and the internal capacity of the management system.The structural aspects of the concept of adaptive transformation of the management system of knowledge-intensive enterprises in a highly variable digital environment have been analysed. An algorithm that represents a complete independent system has been proposed in which the order and levels of interconnection between individual subsystems and elements have been determined, with the adaptive transformation process itself as the central link, which is supported by a complex of different subsystems. A methodological approach for implementating a multicomponent process of adaptive management system development has been presented, detailing the various methodological recommendations and developments. The methodological techniques used for the indicative assessment of the level of efficiency of the management system of knowledge-intensive enterprises have been outlined.An independent and unified digital management environment for knowledge-intensive enterprises enables real-time analysis of business processes in order to make timely, high-quality and effective decisions in the following key areas: investment and financial activities; enterprise knowledge and personnel management; production and technical management; logistics, operations and disposal. The article offers methodological recommendations on the reengineering of business processes in knowledge-intensive enterprises in a new technological mode.

Smart Grid Implementation of the Industrial Sector

In the development of smart grid solutions, the contribution of industrial consumers is prime essential to ensure the energy system transformation. The present article introduces a covenant with the implementation of an economic dispatch (ED) in the electrical framework with the smart grid. The proposed ED strategy is comprised of two steps; the first step includes the swarm optimization technique of energy ED with the net loss of the power system and the second step consists of an ED that considers the cutoff points of system security. The prime goal of the second step is to minimize the net loss and the foundation development of the generator cost function. The test framework is comprised of four generators with one battery storage apparatus that considers the energy demand. The ED will perform for 24 hours. The test results show that the two-step ED technique not only reduces system losses but also the fuel consumption of the system as well. This article gives ideas to the industrial consumers to implement a smart grid in the industrial sector.

Transforming the German Food System – How to Make Start-ups Great!

The food system represents a key industry for Europe and particularly Germany. However, it is also the single most significant contributor to climate and environmental change. A food system transformation is necessary to overcome the system's major and constantly increasing challenges in the upcoming decades. One possible facilitator for this transformation are radical and disrup-tive innovations that start-ups develop. There are many challenges for start-ups in general and food start-ups in particular. Various support opportunities and resources are crucial to ensure the success of food start-ups. One aim of this study is to identify how the success of start-ups in the food system can be supported and further strengthened by players in the innovation ecosystem in Germany. There is still room for improvement and collaboration toward a thriving innovation ecosystem. A successful innovation ecosystem is characterised by a well-organised, collaborative, and supportive environment with a vivid exchange between the members in the ecosystem. The interviewees confirmed this, and although the different actors are already cooperating, there is still room for improvement. The most common recommendation for improving cooperation is learning from other countries and bringing the best to Germany.

Rozwój instytucji wznowienia postępowania administracyjnego: od totalitaryzmu do demokracji

The purpose of the paper is to present the evolution of the legal shape the institution of resuming administrative proceedings has undergone, starting from the classic regulation in the second decade of the 20th century, through the Polish People’s Republic period, to the present day. The main function of the discussed procedural institution is to verify the final resolution of an individual case if the already completed procedure was affected by what qualified as procedural defect. The resumption of administrative proceedings in the present formula, mainly regulated by the Code of Administrative Procedure, was shaped mainly during the totalitarian rule of the Polish United Workers’ Party of the PRL period. As a consequence, the way the discussed procedural institution formed was influenced by such circumstances as: the one-party system, the lack of social consultations before its passing, or the imposition of the communist ideology adopted in advance, affecting the legal understanding of individual premises for the resumption of proceedings. Due to the lack of administrative judiciary until 1980, which could independently control the public administration activities in the context of correctly interpreting and applying the provisions on resuming administrative proceedings, it was entirely dominated by the communist authorities. Importantly, the administrative law system during the existence of the so-called Polish People’s Republic — which was de facto a non-sovereign state strongly influenced by the Soviet Union — made it impossible for individual legal institutions, including the institution of resuming administrative proceedings, to settle into social and economic realities naturally and free from extra-legal influences. Establishing the administrative judiciary in the form of the Supreme Administrative Court on September 1, 1980 was the first announcement of the system transformation planned for the Polish Republic and democratic changes that were to affect the resumption of administrative proceedings institution by introducing an independent control of its application and interpretation. Due to the changes initiated in 1980 and continued in 1989, 1997, and 2002, the institution of resuming administrative proceedings was separated from political influence and totalitarian values in favor of a democratic state ruled by law.