Measurement for improvement: a survey of current practice in Australian public hospitals

Objective:
To identify patient safety measurement tools in use in Australian public hospitals and to determine barriers to their use.

Design:
Structured survey, conducted between 4 March and 19 May 2005, designed to identify tools, and to assess current use of, levels of satisfaction with, and barriers to use of tools for measuring the domains and subdomains of: organisational capacity to provide safe health care; patient safety incidents; and clinical performance.

Participants and setting:
Hospital executives, managers and clinicians from a nationwide random sample of Australian public hospitals stratified by state and hospital peer grouping.

Main outcome measures:
Tools used by hospitals within the three domains and their subdomains; patient safety tools and processes identified by individuals at these hospitals; satisfaction with the tools; and barriers to their use.

Results:
Eighty-two of 167 invited hospitals (49%) responded. The survey ascertained a comprehensive list of patient safety measurement tools that are in current use for measuring all patient safety domains. Overall, there was a focus on use of processes rather than quantitative measurement tools. Approximately half the 182 individual respondents from participating hospitals reported satisfaction with existing tools. The main reported barriers were lack of integrated supportive systems, resource constraints and inadequate access to robust measurement tools validated in the Australian context. Measurement of organisational capacity was reported by 50 (61%), of patient safety incidents by 81 (99%) and of clinical performance by 81 (99%).

Conclusion:
Australian public hospitals are measuring the safety of their health care, with some variation in measurement of patient safety domains and their subdomains. Improved access to robust tools may support future standardisation of measurement for improvement.

Integral approach and numerical improvement to calculate the carbon concentration profiles in carburising process

In the present work, the carbon diffusion in steel, where the carbon diffusivity varies with the carbon content, was solved with the integral methods under the third boundary condition. The variation of carbon diffusivity in steel with the carbon content was described with two different functions ie. linear dependence and exponential dependence. The integral approximation for both cases was improved with the numerical computation to more accurately predict the carbon profiles. The integral solution is more accurate than the formulation based on the assumption of a constant diffusivity or those based on the assumption of a constant diffusivity and/or constant carbon content at part surface. It is also more easily used in practice than the numerical method to describe the carburising process and predict the carbon content at steel surface and carbon profiles in treated layer.

Improvement in mechanical properties of aluminum polypropylene composite fiber

Aluminum particles (Al) were added to polypropylene (PP) in the presence of poly ethylene glycol (PEG) and polypropylene-graft-maleic anhydride to produce composites. The composites were then melt-spun into a mono filament and tested for tensile properties, diameter evenness and morphology. Melt rheological properties of Al/PP composites were studied in linear viscoelastic response regions. It was observed that level of dispersion of aluminum particles within a polypropylene composite fiber could be improved by incorporating polyethylene glycol. The improvement of dispersion led to an improvement in the fibers mechanical properties through a reduction of the coefficient of variation of fiber diameter.

Casting yield improvement in graphite iron castings

A well designed runner and feeding system should produce castings with minimal defects and low pour weight. This thesis investigates how the filling regime and solidification of the mould influences defects in the castings produced from that mould. Design guidelines to reduce such defects are proposed and tested. An existing shrinkage fault in a Grey Iron disc brake casting is simulated using a commercial finite-difference computer program. Three criteria are used to predict the defect and the effect of changes to the feeder geometry. Critical Fraction Solidification analysis is used to determine whether the feeder remains in liquid contact with the casting during solidification and this approach is shown to correctly predict the presence or absence of porosity* The feeder block is extended below the ingate of the casting to improve liquid contact between the casting and feeder without significantly increasing the feeder mass. Plant trials confirm the change to the feeder eliminates the porosity defect. The runner system and mould venting for a thin walled Ductile Iron casting are investigated. Trials show that by setting the total mould vent area to be greater than the net ingate area of the castings, the cold-shut frequency is halved. A method for runner system design based on peak linear flow velocity in the runner during mould filling is proposed. A new pressurised runner system produces castings with significantly fewer defects and reduced pour weight when runner areas are designed to maintain peak velocity below 1 m/s. Peak velocity and magnesium levels are demonstrated to be critical factors in the elimination of cold-shut defects. A pressurised runner system is also shown to isolate inclusion defects from castings more effectively than an unpressurised system. From this work, a technique is proposed which allows the yield of an existing runner and feeder system for iron castings to be improved with confidence in the results.

Raising 'standards' in schools : considerations in the first stage of an improvement intervention

This article discusses the initial phase of a government-funded intervention to raise school achievement in a cluster of schools with below average standardised test results. Five schools - four primary schools and one secondary school - in the far outer reaches of Melbourne achieved lower standardised test scores in literacy and numeracy than the state average. Two departmental strategies were in place before my involvement the appointment of a coaching teacher in each school, and funding for a four day intensive residential professional learning workshop for these coaching teachers, to be held at the beginning of the 2009 school year. lt was at this stage that I became involved in what was planned to be an ongoing research program to record, monitor and evaluate the success of the intervention.

Measuring quality of life in alcohol and other drug users - the need for improvement

Objective : The use of Quality of Life (QoL) -related measures in Alcohol and Other Drug-related research has increased dramatically over the past decade. However, there remains a great deal of confusion about which type of QoL measure is most valid, what each constrict actually measures and the ethicality of the process of QoL measurement and its subsequent transfer to monetary value. This is particularly important in regard to subsequent resource allocation on the basis of Quality Adjusted Life Years (QALYs). We aim to review the logic of current QoL -related measurement and determine the most conceptually valid way of measuring QoL.

Methods : This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQoL) and the measurement of subjective well-being.

Results : We argue that there are serious logical and methodological issues concerning HRQoL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood.

Conclusions : It is recommended that HRQoL measurement be abandoned in favour of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

Living improvement : a case study of a secondary school in England

Schools in England are being urged to personalize the curriculum and make school experiences more responsive to all students. We report on an evaluation project which investigated innovation in teaching and learning in a successful secondary school in the north of England. Data were gathered from a sample of teaching staff, a questionnaire to all students, lesson and meeting observations, and meetings with the governing body and parents: the student-guided evaluation canvassed recent and planned changes to the structure and experience of teaching and learning. This article illuminates how one school is breaking the ‘traditional schooling rules’ that limit improvement and how in doing so it is developing new insights about the nature and process of improvement. We show how staff and students have been engaged in the change process, and focus in particular on analysing the interplay between improvement as a plan, a practice and a lived experience.

From quality assurance to process improvement : an action research project

This action research project was undertaken at the Casino & District Memorial Hospital in northern N.S.W. during 1995 & 1996. The purpose was to utilise the Action Research frameork to enable the participants to improve their problem solving skills in relation to quality improvement strategies within the Nursing Division.

Frame rate improvement for the VFX1 headset in virtual reality applications

Concentrates on reducing the processing time to enhance the visual component of the experience in virtual reality. Investigates the use of two co-processing cards, each with their own microprocessor providing parallel processing to the host computer. Concludes that the frame rates of a single computer running the virtual reality system could be improved by up to 35% by the use of parallel processing.