The importance of respecting accreditation indicators to improve quality of care

Issue The health and social-care facilities (HSF) of the Lombardy Region provide services specifically conceived for fragile populations, including elderly, disabled, addicts etc. Through its Accreditation Units, the Agency for Health Protection (ATS) in the Metropolitan City of Milan is responsible for overseeing authorization and accreditation indicators of HSFs in all afferent districts. Assessed requirements include the qualitative standard (presence of mandatory professional figures) and the quantitative standard (guaranteed weekly minimum time of care per patient) of operating staff, based on current legislation. Description of the problem These standards are evaluated at site-inspection by examining staff qualifications and by matching staff working hours to actual daily presence of patients, randomly selecting a recent past week. The resulting standards may thus not be fully representative of the whole year. In 2019, the Health and Social-care facilities Accreditation Unit of ATS began a retrospective quali-quantitative analysis of health service staffing data for 2017 and 2018. Data were extrapolated from two main databases: “Scheda Struttura”, a data collection tool regarding work hours, qualifications, waiting lists etc. compiled yearly by HSF managers; and economic data detailing reimbursements by the regional health service, based on effective daily presence of patients at the HSF. Results Preliminary results relating to 2017 showed that around 4% of HSFs do not guarantee qualitative staffing standards, and almost 30% do not guarantee quantitative staffing standards throughout the year. Lessons The proposed tool is useful for emphasizing potentially critical situations and may help define the annual inspection schedule with the aim of continuously improving quality of care among regional HSFs. Key messages Data management tools can help local health authorities monitor and identify facilities at risk of falling below the defined standards of care. Qualitative and quantitative analysis of health service staffing is useful for emphasizing potentially critical situations and may help define the annual inspection schedule.

Conversation-Based School Building Inspection Support System

A conversation-based system is proposed for supporting assessors in performing existing school building inspections. School building safety is a pressing issue; however, some difficulties in the overall process require solutions or improvements, including the complexity of building inspection tasks, the restrictions posed by the paperwork process, and the ineffectiveness of the management of existing school building inspections. In this study, we developed a conversation-based building inspection support system to reduce such problems, with the proposed system notifying and guiding assessors to complete building inspections, combined with a dashboard for managers to consume reports to determine whether further assessments or retrofits are required. The process of school building inspections was digitalized, with a chatbot implemented that features notifications either according to a routine inspection schedule or postseismic events, a conversation-based interface for guiding nonprofessional assessors, the integration of intuitive activation of inspections after receiving notifications, the use of multimedia to show damage directly without the possibility of mistakes, and data visualization for supporting managerial decision-making to enhance the quality and accuracy of budget allocation.

OPTIMUM INSPECTION INTERVAL FOR TANKER IN UNIFIED INSPECTION REGIME

Inspections on board tankers contribute to the prevention of accidents, which can have a significant impact to humans and environment. Therefore a high amount of tanker inspections is performed by various stakeholders. This practice could be made more efficient by introducing unified inspection regime, which covers existing areas of inspection, eliminates overlapping and has the potential to improve safety. In this paper an important aspect in defining inspection regime, inspection interval, is determined considering contradictory goals: lowering the costs of inspection and increasing useful service life of tanker structure and equipment, without compromising safety. A probabilistic approach has been applied to establish inspection schedule, which fulfils a range of requirements. Due to the many varieties of tanker types, their conditions, range of size and age span, the paper focuses on the 10 years AFRAMAX tanker. Results indicate that optimal inspection interval in the unified inspection regime for that tanker should be 3 months. Using modified input parameters, similar approach could be used for other tanker types.

Impact of In-Service Inspection on the Reliability of Small Piping

This chapter describes the cracking of stainless steel piping under Inter-granular Stress Corrosion Cracking (IGSCC) conditions using probabilistic fracture mechanics that predict the impact of in-service inspection (ISI) programs on the reliability of specific nuclear piping systems that have failed in service. The IGSCC is characterized by a single damage parameter, which depends on residual stresses, environmental conditions, and the degree of sensitization. The Probability of Detection (POD) curves and the benefits of in-service inspection in order to reduce the probability of the leak for nuclear piping systems subjected to IGSCC were discussed. The results show that an effective ISI requires a suitable combination of crack detection and inspection schedule. An augmented inspection schedule is recurred for piping with fast-growing crack to ensure that the inspection is done before the cracks reach critical sizes and that the use of a better inspection procedure can be more effective than a tenfold increase in the number of inspections of inferior quality.

Value of rescheduling of rail inspection

A regular rail inspection schedule has been proposed to minimise any detrimental financial cost incurred due to operations under harsh environments. Missing opportunities to detect a defective rail could ultimately lead to its breaking, which would magnify the repair (as well as maintenance) cost by approximately 30–35% per rail-mile. However, the performance of a pre-planned inspection schedule may be affected by disruptions in one or more element(s) of inspection such as machine/vehicle breakdown or track unavailability, which are usually unpredictable events. As part of the justification for the need to manage a disrupted inspection schedule, this paper proposes a methodology that highlights the value of rescheduling. An extensive literature search was undertaken on the rescheduling framework in order to determine the appropriate policies, strategies and methods for rail inspection. As a result, the value of rescheduling is formulated as the ratio of rescheduling cost to a change in the value of risk from a missed opportunity to repair a defective rail, i.e. late defect detection. This numerical formula demonstrates how the proposed methodology is useful for filtering out a rescheduling strategy that has (negative) value when dealing with a disrupted rail inspection schedule. The discussion portrays several potential aspects to feasibly extend the proposed methodology on a large scale of rail network.