Effective & Efficient Implementation of OBE Framework within Constrained Pakistani Environment to Attain Desired Learning Outcomes

Outcome-based-education (OBE) is an educational theory that bases each part of an educational system around goals (outcomes). Pakistan Engineering Council (PEC) introduced the OBE in Pakistani engineering higher-education-institutions (HEIs),from 2018, in the replacement of previously followed Syllabus& Curriculum based education system. Key to success of OBE System is its continuous-quality-improvement (CQI) mechanism. The CQI mechanism design should be based on accurate assessment process and flawless evaluation of OBE System parameters; otherwise the OBE System’s benefits cannot be achieved. However, some HEIs have not devised an effective CQI mechanism and they still using classical procedures and academic tools in implementation of the OBE Framework, which cannot give desired results from the new System. This paper presents that; instead of presently employed loose-control, a modified stringent control strategy for academic activity and employment of latest technology, can make the CQI mechanism, more effective and efficient. This paper therefore presents a two-fold contribution. At first, the implementation problems of the OBE System are critically analyzed. Secondly, few modifications in the existing approaches have been introduced to achieve the desired results from the recently adopted OBE system.

A systematic review on the effectiveness of clinician directed interventions to improve compliance to post polypectomy surveillance guidelines

Introduction Clinical practice guidelines recommend periodic colonoscopy surveillance following colorectal adenoma excision. Inappropriate use of post polypectomy surveillance is common and lead to improper resource utilisation.The aim of this review is to identify structured interventions which can affect post polypectomy surveillance practices and to evaluate the effectiveness of these various interventions in improving clinician adherence to post polypectomy surveillance guidelines. Methods A computerised search was performed to identify relevant studies between 1997 to November 2020. Two investigators identified eligible studies and extracted data independently. The quality of the included studies was assessed by the Newcastle-Ottawa risk of assessment scoring system. Results The search identified 5602 citations. Forty-one articles were retrieved for full text analysis and seven studies met the inclusion criteria. Compliance to PPS guidelines were higher following interventions which included medical education, specialist nurse coordinators facilitation, continuous quality improvement and clinical decision support systems. Conclusion This study demonstrates that medical education, specialist nurse coordinators, continuous quality improvement and clinical decision support systems are effective in improving clinicians’ compliance to post polypectomy surveillance guidelines and is associated with reduction in over- and underutilisation of colonoscopy surveillance resources.

The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Quasi-Experimental Difference-in-Differences Design

BackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative network, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality improvement and staff education to participating hospitals. The primary outcome of the evaluation was all-cause risk-adjusted hospital mortality among cases with sepsis per hospital. Sepsis was identified by ICD-10 codes in claims data for sepsis with organ dysfunction or septic shock according to the sepsis-1 definition. To evaluate the effect of the GQNS, the change in outcomes from a retrospective baseline (January 2014 – March 2016) to the intervention phase (April 2016 – June 2018) was compared between the hospitals in the GQNS and the national German diagnosis-related-groups statistics. Tests were conducted by interrupted time-series analyses using hierarchical models. Implementation processes and barriers were assessed by a survey of local leaders of quality improvement teams in autumn 2018.ResultsSeventy-four hospitals participated, of which 17 were university hospitals and 18 were tertiary care facilities. Observed mortality was 43.5% during baseline period and 42.7% during intervention period. Interrupted time-series analyses did not show effects on course or level of risk-adjusted mortality of cases with sepsis compared to the national DRG-statistics after the beginning of the intervention period (p=0.632, and p=0.512, respectively). There were also no significant effects in the subgroups of patients with septic shock or ventilation >24h or subgroups of hospitals. Surveys among 48 local quality improvement leaders revealed that most hospitals did not succeed in implementing a continuous quality improvement program or relevant measures to improve early recognition and treatment of sepsis. Barriers perceived most commonly were lack of time (77.6%), staff shortage (59.2%), and lack of participation of relevant departments (38.8%).ConclusionsAs long as hospital-wide sepsis quality improvement efforts will not become a high priority for the hospital leadership by assuring adequate resources and involvement of all pertinent stakeholders, voluntary initiatives to improve the quality of sepsis care will remain prone to failure.

Using Data to Support Networks’ Theory of Change

Funders, communities, and network leaders all recognize the value of data. This chapter argues that effective data-use practices should be used to support the theory of change that networks employ. It prescribes program evaluation for project-based social impact and continuous quality improvement for learning-based models. It suggests public opinion polling and power mapping for policy-based mechanisms. For catalyst-based social impact, it advocates for gathering implementation fidelity data. Finally, it suggests using data to identify gaps in service and leaky pipelines for systems alignment-based mechanisms. It also includes instructions for using data for network management and community empowerment. The chapter uses examples of best practices from case studies. It also includes a tool for assessing how project-based networks are using data and instructions for using pivot tables for systems alignment.

School Re-Entry of Adolescent Patients Discharged from Psychiatric Hospital: One Step in Continuous Quality Improvement

Objective: School re-entry following hospitalization for psychiatric care has been reported as difficult for many adolescent patients. Continuous quality improvement initiatives may improve programming to enhance school re-entry experiences. The purpose of this study was to explore the school re-entry perspectives of the youth discharged from a psychiatric inpatient unit after implementing programs that patients previously identified as needed. Methods: A survey was administered to the youth about one month after discharge to gather their perspective of their school re-entry, along with self-rated resilience and stress. Results: Twenty-six youth (23%) participated in the post-discharge survey who reported a mean age of 15.6 years (SD 1.0), 77% identified as female, 13 (50%) provided very positive re-entry comments, eight (31%) reported moderately positive experiences, and five (19%) reported a very poor school re-entry. Mean perceived resilience (4.01, SD 0.6) and stress (3.42, SD 0.8) scores suggest youth thought they had good resilience and moderate stress. Conclusions: Most youth reported a good school re-entry. Considerable concerns remain for the 19% who reported a poor school re-entry who may benefit from specialized outpatient or day programming post-discharge before attempting a return to school. Future directions for research are provided.