Which diagrams and when? Health workers' choice and usage of different diagram types for service improvement

Diagrammatic representations, such as process mapping and care pathways, have been often used for service evaluation and improvement in healthcare. While a broad range of diagrammatic representations exist, their application in healthcare has been very limited. There is a lack of understanding about how and which diagrams could be usable and useful to health workers. In this study, ten mental health workers were asked to discuss positive and negative issues around their service delivery using one or two diagrams of their choice out of seven different diagrams representing their service: care pathway diagram; organisation diagram; communication diagram; service blueprint; patient state transition diagram; free form diagram; geographic map. Their interactions with diagrams were video-taped for analysis. The patient state transition diagram was the most popular choice in spite of relatively low previous familiarity. The overall findings provided insight into a better use of diagrams in healthcare. © 2012 Springer-Verlag.

Getting to zero: evidence-based healthcare risk management is key.

In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.

Performance and power dissipation comparisons between 28 Gb/s NRZ, PAM, CAP and optical OFDM systems for data communication applications

Theoretical investigations have been carried out to analyze and compare the link power budget and power dissipation of non-return-to-zero (NRZ), pulse amplitude modulation-4 (PAM-4), carrierless amplitude and phase modulation-16 (CAP-16) and 16-quadrature amplitude modulation-orthogonal frequency division multiplexing (16-QAM-OFDM) systems for data center interconnect scenarios. It is shown that for multimode fiber (MMF) links, NRZ modulation schemes with electronic equalization offer the best link power budget margins with the least power dissipation for short transmission distances up to 200 m; while OOFDM is the only scheme which can support a distance of 300 m albeit with power dissipation as high as 4 times that of NRZ. For short single mode fiber (SMF) links, all the modulation schemes offer similar link power budget margins for fiber lengths up to 15 km, but NRZ and PAM-4 are preferable due to their system simplicity and low power consumption. For lengths of up to 30 km, CAP-16 and OOFDM are required although the schemes consume 2 and 4 times as much power respectively compared to that of NRZ. OOFDM alone allows link operation up to 35 km distances. © 1983-2012 IEEE.

State estimation over a communication network: Measurement or estimate communication?

In this paper we consider the problem of state estimation over a communication network. Using estimation quality as a metric, two communication schemes are studied and compared. In scheme one, each sensor node communicates its measurement data to the remote estimator, while in scheme two, each sensor node communicates its local state estimate to the remote estimator. We show that with perfect communication link, if the sensor has unlimited computation capability, the two schemes produce the same estimate at the estimator, and if the sensor has limited computation capability, scheme one is always better than scheme two. On the other hand, when data packet drops occur over the communication link, we show that if the sensor has unlimited computation capability, scheme two always outperforms scheme one, and if the sensor has limited computation capability, we show that in general there exists a critical packet arrival rate, above which scheme one outperforms scheme two. Simulations are provided to demonstrate the two schemes under various circumstances. © South China University of Technology and Academy of Mathematics and Systems Science, CAS and Springer-Verlag Berlin Heidelberg 2010.

Dynamic programming solutions for decentralized state-feedback LQG problems with communication delays

This paper presents explicit solutions for a class of decentralized LQG problems in which players communicate their states with delays. A method for decomposing the Bellman equation into a hierarchy of independent subproblems is introduced. Using this decomposition, all of the gains for the optimal controller are computed from the solution of a single algebraic Riccati equation. © 2012 AACC American Automatic Control Council).

On the structure of state-feedback LQG controllers for distributed systems with communication delays

This paper presents explicit solutions for a few distributed LQG problems in which players communicate their states with delays. The resulting control structure is reminiscent of a simple management hierarchy, in which a top level input is modified by newer, more localized information as it gets passed down the chain of command. It is hoped that the controller forms arising through optimization may lend insight into the control strategies of biological and social systems with communication delays. © 2011 IEEE.

How can online schedules improve communication and estimation tradeoff?

We consider remote state estimation and investigate the tradeoff between the sensor-to-estimator communication rate and the remote estimation quality. It is well known that if the communication rate is one, e.g., the sensor communicates with the remote estimator at each time, then the remote estimation quality is the best. It degrades when the communication rate drops. We present one optimal offline schedule and two online schedules and show that the two online schedules provide better tradeoff between the communication rate and the estimation quality than the optimal offline schedule. Simulation examples demonstrate that significant communication savings can be achieved under the two online schedules which only introduce small increment of the estimation errors. © 1991-2012 IEEE.

Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups.

To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation.

Healthcare human reliability analysis - By heart

As part of the investigations into a surgical incident involving the accidental retention inside a patient's venous system of a guide wire for central venous catheterisation (CVC), the Human Error Assessment and Reduction Technique (HEART) was used to examine the potential for further occurrences. It was found to be time-efficient and to yield plausible probabilities of human error, although its use in healthcare has challenges, suggesting adaptation would be beneficial.

Stabilization of planar collective motion with limited communication

This paper proposes a design methodology to stabilize relative equilibria in a model of identical, steered particles moving in the plane at unit speed. Relative equilibria either correspond to parallel motion of all particles with fixed relative spacing or to circular motion of all particles around the same circle. Particles exchange relative information according to a communication graph that can be undirected or directed and time-invariant or time-varying. The emphasis of this paper is to show how previous results assuming all-to-all communication can be extended to a general communication framework. © 2008 IEEE.

Stabilization of planar collective motion: All-to-all communication

This paper proposes a design methodology to stabilize isolated relative equilibria in a model of all-to-all coupled identical particles moving in the plane at unit speed. Isolated relative equilibria correspond to either parallel motion of all particles with fixed relative spacing or to circular motion of all particles with fixed relative phases. The stabilizing feedbacks derive from Lyapunov functions that prove exponential stability and suggest almost global convergence properties. The results of the paper provide a low-order parametric family of stabilizable collectives that offer a set of primitives for the design of higher-level tasks at the group level. © 2007 IEEE.