An examination of factors influencing effective and continuous improvement of Indonesian contractors' quality management systems

This paper presents the results of a pilot study examining the factors that impact most on the effective implementation of, and improvement to, Quality Mangement Sytems (QMSs) amongst Indonesian construction companies. Nine critical factors were identified from an extensive literature review, and a survey was conducted of 23 respondents from three specific groups (Quality Managers, Project Managers, and Site Engineers) undertaking work in the Indonesian infrastructure construction sector. The data has been analyzed initially using simple descriptive techniques. This study reveals that different groups within the sector have different opinions of the factors regardless of the degree of importance of each factor. However, the evaluation of construction project success and the incentive schemes for high performance staff, are the two factors that were considered very important by most of the respondents in all three groups. In terms of their assessment of tools for measuring contractor’s performance, additional QMS guidelines, techniques related to QMS practice provided by the Government, and benchmarking, a clear majority in each group regarded their usefulness as ‘of some importance’.

Revisiting the conceptualization and measurement of service quality

Since the 1980s, industries and researchers have sought to better understand the quality of services due to the rise in their importance (Brogowicz, Delene and Lyth 1990). More recent developments with online services, coupled with growing recognition of service quality (SQ) as a key contributor to national economies and as an increasingly important competitive differentiator, amplify the need to revisit our understanding of SQ and its measurement. Although ‘SQ’ can be broadly defined as “a global overarching judgment or attitude relating to the overall excellence or superiority of a service” (Parasuraman, Berry and Zeithaml 1988), the term has many interpretations. There has been considerable progress on how to measure SQ perceptions, but little consensus has been achieved on what should be measured. There is agreement that SQ is multi-dimensional, but little agreement as to the nature or content of these dimensions (Brady and Cronin 2001). For example, within the banking sector, there exist multiple SQ models, each consisting of varying dimensions. The existence of multiple conceptions and the lack of a unifying theory bring the credibility of existing conceptions into question, and beg the question of whether it is possible at some higher level to define SQ broadly such that it spans all service types and industries. This research aims to explore the viability of a universal conception of SQ, primarily through a careful re-visitation of the services and SQ literature. The study analyses the strengths and weaknesses of the highly regarded and widely used global SQ model (SERVQUAL) which reflects a single-level approach to SQ measurement. The SERVQUAL model states that customers evaluate SQ (of each service encounter) based on five dimensions namely reliability, assurance, tangibles, empathy and responsibility. SERVQUAL, however, failed to address what needs to be reliable, assured, tangible, empathetic and responsible. This research also addresses a more recent global SQ model from Brady and Cronin (2001); the B&C (2001) model, that has potential to be the successor of SERVQUAL in that it encompasses other global SQ models and addresses the ‘what’ questions that SERVQUAL didn’t. The B&C (2001) model conceives SQ as being multidimensional and multi-level; this hierarchical approach to SQ measurement better reflecting human perceptions. In-line with the initial intention of SERVQUAL, which was developed to be generalizable across industries and service types, this research aims to develop a conceptual understanding of SQ, via literature and reflection, that encompasses the content/nature of factors related to SQ; and addresses the benefits and weaknesses of various SQ measurement approaches (i.e. disconfirmation versus perceptions-only). Such understanding of SQ seeks to transcend industries and service types with the intention of extending our knowledge of SQ and assisting practitioners in understanding and evaluating SQ. The candidate’s research has been conducted within, and seeks to contribute to, the ‘IS-Impact’ research track of the IT Professional Services (ITPS) Research Program at QUT. The vision of the track is “to develop the most widely employed model for benchmarking Information Systems in organizations for the joint benefit of research and practice.” The ‘IS-Impact’ research track has developed an Information Systems (IS) success measurement model, the IS-Impact Model (Gable, Sedera and Chan 2008), which seeks to fulfill the track’s vision. Results of this study will help future researchers in the ‘IS-Impact’ research track address questions such as: • Is SQ an antecedent or consequence of the IS-Impact model or both? • Has SQ already been addressed by existing measures of the IS-Impact model? • Is SQ a separate, new dimension of the IS-Impact model? • Is SQ an alternative conception of the IS? Results from the candidate’s research suggest that SQ dimensions can be classified at a higher level which is encompassed by the B&C (2001) model’s 3 primary dimensions (interaction, physical environment and outcome). The candidate also notes that it might be viable to re-word the ‘physical environment quality’ primary dimension to ‘environment quality’ so as to better encompass both physical and virtual scenarios (E.g: web sites). The candidate does not rule out the global feasibility of the B&C (2001) model’s nine sub-dimensions, however, acknowledges that more work has to be done to better define the sub-dimensions. The candidate observes that the ‘expertise’, ‘design’ and ‘valence’ sub-dimensions are supportive representations of the ‘interaction’, physical environment’ and ‘outcome’ primary dimensions respectively. The latter statement suggests that customers evaluate each primary dimension (or each higher level of SQ classification) namely ‘interaction’, physical environment’ and ‘outcome’ based on the ‘expertise’, ‘design’ and ‘valence’ sub-dimensions respectively. The ability to classify SQ dimensions at a higher level coupled with support for the measures that make up this higher level, leads the candidate to propose the B&C (2001) model as a unifying theory that acts as a starting point to measuring SQ and the SQ of IS. The candidate also notes, in parallel with the continuing validation and generalization of the IS-Impact model, that there is value in alternatively conceptualizing the IS as a ‘service’ and ultimately triangulating measures of IS SQ with the IS-Impact model. These further efforts are beyond the scope of the candidate’s study. Results from the candidate’s research also suggest that both the disconfirmation and perceptions-only approaches have their merits and the choice of approach would depend on the objective(s) of the study. Should the objective(s) be an overall evaluation of SQ, the perceptions-only approached is more appropriate as this approach is more straightforward and reduces administrative overheads in the process. However, should the objective(s) be to identify SQ gaps (shortfalls), the (measured) disconfirmation approach is more appropriate as this approach has the ability to identify areas that need improvement.

Adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines

Adjuvant use of nutritional and herbal medicines has potential to increase the efficacy of synthetic pharmaceuticals, and perhaps also decrease their side-effects by allowing lower doses to be prescribed. We evaluated current evidence for adjuvant use of nutritional and herbal medicines with antidepressants, mood stabilizers and benzodiazepines; and explored novel future areas of research. The paper also critiques current evidence for co-administration of St. John’s wort with synthetic antidepressants. We performed a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane database, China National Knowledge Infrastructure and the Chinese Science Citation Database. Search results were supplemented by a review of reference lists and a forward search using the Web of Science. Where possible we calculated effect sizes. Encouraging evidence exists for the use of omega-3 fatty acids, SAMe, folic acid and l-tryptophan adjuvantly with antidepressants to enhance response and improve efficacy. Various nutrients also have emerging evidence as effective adjuncts with antipsychotics and mood stabilizers. While some evidence supports nutritional adjuvancy with various psychopharmacotherapies, adjuvant use of herbal therapies has not been sufficiently studied to warrant standard clinical application. This remains a promising area of research via robust, safety-conscious studies.

Student perceptions of the quality of property education in Australia : 1994 – 2009

Using the Graduate Careers Australia’s Course Experience Questionnaire (CEQ), the students’ perceptions of the quality of property education in Australia is assessed over 1994-2009. Analyses are presented for the major property universities in Australia regarding good teaching and overall satisfaction, as well as the property discipline benchmarked against the property-related disciplines of accounting, building, business, economics, law and planning. The link between good teaching and overall satisfaction, and the delivery of added value by property programs are also assessed. Changes over this 16-year period are highlighted in terms of student perceptions of the quality of property education in Australia.

The adoption of advanced quality practices and its impact on manufacturers

Presently, the manufacturing sector faces unprecedented levels of competition in both the domestic and international markets. This competition is mainly as a result of rapidly expanding international trade, gradual removal of protection, substantial reforms in labour markets and industrial relations, rapid technological changes and discerning customers. Intense global competition requires manufacturers to deliver products with higher quality in a shorter time. Simultaneously, owing to new technological innovations, the complexity of the products is increasing. In Australia, the impact of this intense competition and structural changes appear to be having negative effects on the manufacturing sector. This paper discusses the quality and reliability (Q & R) practices and associated drawbacks of Australian manufacturers and presents the findings of an investigation of the challenges Australian manufacturers are currently facing. The results reported in the paper are based on the data collected from a survey using the standard questionnaire. The study was driven by a conceptual model, which relates advanced quality practices to manufacturing performance and manufacturing difficulties.Evidence indicates that Q & R is the main competitive factor for Australian manufacturers. Design capability and on time delivery (OTD) came second. Results show that Australian manufacturers in general are facing some manufacturing difficulties. The relationship between advanced quality practices and company performance and manufacturing difficulties are explored. It is found that the companies who have more emphasis on advanced quality practices have fewer problems in manufacturing practices. Moreover, companies who have actively implemented the advanced quality practices have managed to improve the quality of the product continuously. The results validate the proposed hypothesis and lend credence to current thinking that improvement in Q & R is a vital tool for competitive advantage.

Quality delivery of mobile video : in-depth understanding of user requirements

The increase of powerful mobile devices has accelerated the demand for mobile videos. Previous studies in mobile video have focused on understanding of mobile video usage, improvement of video quality, and user interface design in video browsing. However, research focusing on a deep understanding of users’ needs for a pleasing quality delivery of mobile video is lacking. In particular, what quality-delivery mode users prefer and what information relevant to video quality they need requires attention. This paper presents a qualitative interview study with 38 participants to gain an insight into three aspects: influencing factors of user-desired video quality, user-preferred quality-delivery modes, and user-required interaction information of mobile video. The results show that user requirements for video quality are related to personal preference, technology background and video viewing experience, and the preferred quality-delivery mode and interactive mode are diverse. These complex user requirements call for flexible and personalised quality delivery and interaction of mobile video.

The effect of exercise on sleep quality in heart failure

Purpose The primary objective of this study was to examine the effect of exercise on subjective sleep quality in heart failure patients. Methods This study used a randomised, controlled trial design with blinded end-point analysis. Participants were randomly assigned to a 12-week programme of education and self-management support (control) or to the same programme with the addition of a tailored physical activity programme designed and supervised by an exercise specialist (intervention). The intervention consisted of 1 hour of aerobic and resistance exercise twice a week. Participants included 108 patients referred to three hospital heart failure services in Queensland, Australia. Results Patients who participated in supervised exercise classes showed significant improvement in subjective sleep quality, sleep latency, sleep disturbance and global sleep quality scores after 12 weeks of supervised hospital based exercise. Secondary analysis showed that improvements in sleep quality were correlated with improvements in geriatric depression score (p=0.00) and exercise performance (p=0.03). General linear models were used to examine whether the changes in sleep quality following intervention occurred independently of changes in depression, exercise performance and weight. Separate models adjusting for each covariate were performed. Results suggest that exercise significantly improved sleep quality independent of changes in depression, exercise performance and weight. Conclusion This study supports the hypothesis that a 12 week program of aerobic and resistance exercise improves subjective sleep quality in patients with heart failure. This is the first randomised controlled trial to examine the role of exercise in the improvement of sleep quality for patients with this disease. While this study establishes exercise as a therapy for poor sleep quality, further research is needed to investigate exercise as a treatment for other parameters of sleep in this population. Study investigators plan to undertake a more in-depth examination within the next 12 months

Appraisal of the quality of care of older people with cognitive impairment presenting to emergency departments

The medical records of 273 patients 75 years and older were reviewed to evaluate quality of emergency department (ED) care through the use of quality indicators. One hundred fifty records contained evidence of an attempt to carry out a cognitive assessment. Documented evidence of cognitive impairment (CI) was reported in 54 cases. Of these patients, 30 had no documented evidence of an acute change in cognitive function from baseline; of 26 patients discharged home with preexisting CI (i.e., no acute change from baseline), 15 had no documented evidence of previous consideration of this issue by a health care provider; and 12 of 21 discharged patients who screened positive for cognitive issues for the first time were not referred for outpatient evaluation. These findings suggest that the majority of older adults in the ED are not receiving a formal cognitive assessment, and more than half with CI do not receive quality of care according to the quality indicators for geriatric emergency care. Recommendations for improvement are discussed.

Genetic improvement of giant freshwater prawn in Vietnam

The giant freshwater prawn (Macrobrachium rosenbergii) or GFP is one of the most important freshwater crustacean species in the inland aquaculture sector of many tropical and subtropical countries. Since the 1990’s, there has been rapid global expansion of freshwater prawn farming, especially in Asian countries, with an average annual rate of increase of 48% between 1999 and 2001 (New, 2005). In Vietnam, GFP is cultured in a variety of culture systems, typically in integrated or rotational rice-prawn culture (Phuong et al., 2006) and has become one of the most common farmed aquatic species in the country, due to its ability to grow rapidly and to attract high market price and high demand. Despite potential for expanded production, sustainability of freshwater prawn farming in the region is currently threatened by low production efficiency and vulnerability of farmed stocks to disease. Commercial large scale and small scale GFP farms in Vietnam have experienced relatively low stock productivity, large size and weight variation, a low proportion of edible meat (large head to body ratio), scarcity of good quality seed stock. The current situation highlights the need for a systematic stock improvement program for GFP in Vietnam aimed at improving economically important traits in this species. This study reports on the breeding program for fast growth employing combined (between and within) family selection in giant freshwater prawn in Vietnam. The base population was synthesized using a complete diallel cross including 9 crosses from two local stocks (DN and MK strains) and a third exotic stock (Malaysian strain - MY). In the next three selection generations, matings were conducted between genetically unrelated brood stock to produce full-sib and (paternal) half-sib families. All families were produced and reared separately until juveniles in each family were tagged as a batch using visible implant elastomer (VIE) at a body size of approximately 2 g. After tags were verified, 60 to 120 juveniles chosen randomly from each family were released into two common earthen ponds of 3,500 m2 pond for a grow-out period of 16 to 18 weeks. Selection applied at harvest on body weight was a combined (between and within) family selection approach. 81, 89, 96 and 114 families were produced for the Selection line in the F0, F1, F2 and F3 generations, respectively. In addition to the Selection line, 17 to 42 families were produced for the Control group in each generation. Results reported here are based on a data set consisting of 18,387 body and 1,730 carcass records, as well as full pedigree information collected over four generations. Variance and covariance components were estimated by restricted maximum likelihood fitting a multi-trait animal model. Experiments assessed performance of VIE tags in juvenile GFP of different size classes and individuals tagged with different numbers of tags showed that juvenile GFP at 2 g were of suitable size for VIE tags with no negative effects evident on growth or survival. Tag retention rates were above 97.8% and tag readability rates were 100% with a correct assignment rate of 95% through to mature animal size of up to 170 g. Across generations, estimates of heritability for body traits (body weight, body length, cephalothorax length, abdominal length, cephalothorax width and abdominal width) and carcass weight traits (abdominal weight, skeleton-off weight and telson-off weight) were moderate and ranged from 0.14 to 0.19 and 0.17 to 0.21, respectively. Body trait heritabilities estimated for females were significantly higher than for males whereas carcass weight trait heritabilities estimated for females and males were not significantly different (P > 0.05). Maternal and common environmental effects for body traits accounted for 4 to 5% of the total variance and were greater in females (7 to 10%) than in males (4 to 5%). Genetic correlations among body traits were generally high in both sexes. Genetic correlations between body and carcass weight traits were also high in the mixed sexes. Average selection response (% per generation) for body weight (transformed to square root) estimated as the difference between the Selection and the Control group was 7.4% calculated from least squares means (LSMs), 7.0% from estimated breeding values (EBVs) and 4.4% calculated from EBVs between two consecutive generations. Favourable correlated selection responses (estimated from LSMs) were detected for other body traits (12.1%, 14.5%, 10.4%, 15.5% and 13.3% for body length, cephalothorax length, abdominal length, cephalothorax width and abdominal width, respectively) over three selection generations. Data in the second selection generation showed positive correlated responses for carcass weight traits (8.8%, 8.6% and 8.8% for abdominal weight, skeleton-off weight and telson-off weight, respectively). Data in the third selection generation showed that heritability for body traits were moderate and ranged from 0.06 to 0.11 and 0.11 to 0.22 at weeks 10 and 18, respectively. Body trait heritabilities estimated at week 10 were not significantly lower than at week 18. Genetic correlations between body traits within age and genetic correlations for body traits between ages were generally high. Overall our results suggest that growth rate responds well to the application of family selection and carcass weight traits can also be improved in parallel, using this approach. Moreover, selection for high growth rate in GFP can be undertaken successfully before full market size has been reached. The outcome of this study was production of an improved culture strain of GFP for the Vietnamese culture industry that will be trialed in real farm production environments to confirm the genetic gains identified in the experimental stock improvement program.

The effect of exercise training on sleep quality in heart failure

Background: Heart failure is a serious condition estimated to affect 1.5-2.0% of the Australian population with a point prevalence of approximately 1% in people aged 50-59 years, 10% in people aged 65 years or more and over 50% in people aged 85 years or over (National Heart Foundation of Australian and the Cardiac Society of Australia and New Zealand, 2006). Sleep disturbances are a common complaint of persons with heart failure. Disturbances of sleep can worsen heart failure symptoms, impair independence, reduce quality of life and lead to increased health care utilisation in patients with heart failure. Previous studies have identified exercise as a possible treatment for poor sleep in patients without cardiac disease however there is limited evidence of the effect of this form of treatment in heart failure. Aim: The primary objective of this study was to examine the effect of a supervised, hospital-based exercise training programme on subjective sleep quality in heart failure patients. Secondary objectives were to examine the association between changes in sleep quality and changes in depression, exercise performance and body mass index. Methods: The sample for the study was recruited from metropolitan and regional heart failure services across Brisbane, Queensland. Patients with a recent heart failure related hospital admission who met study inclusion criteria were recruited. Participants were screened by specialist heart failure exercise staff at each site to ensure exercise safety prior to study enrolment. Demographic data, medical history, medications, Pittsburgh Sleep Quality Index score, Geriatric Depression Score, exercise performance (six minute walk test), weight and height were collected at Baseline. Pittsburgh Sleep Quality Index score, Geriatric Depression Score, exercise performance and weight were repeated at 3 months. One hundred and six patients admitted to hospital with heart failure were randomly allocated to a 3-month disease-based management programme of education and self-management support including standard exercise advice (Control) or to the same disease management programme as the Control group with the addition of a tailored physical activity program (Intervention). The intervention consisted of 1 hour of aerobic and resistance exercise twice a week. Programs were designed and supervised by an exercise specialist. The main outcome measure was achievement of a clinically significant change (.3 points) in global Pittsburgh Sleep Quality score. Results: Intervention group participants reported significantly greater clinical improvement in global sleep quality than Control (p=0.016). These patients also exhibited significant improvements in component sleep disturbance (p=0.004), component sleep quality (p=0.015) and global sleep quality (p=0.032) after 3 months of supervised exercise intervention. Improvements in sleep quality correlated with improvements in depression (p<0.001) and six minute walk distance (p=0.04). When study results were examined categorically, with subjects classified as either "poor" or "good" sleepers, subjects in the Control group were significantly more likely to report "poor" sleep at 3 months (p=0.039) while Intervention participants were likely to report "good" sleep at this time (p=0.08). Conclusion: Three months of supervised, hospital based, aerobic and resistance exercise training improved subjective sleep quality in patients with heart failure. This is the first randomised controlled trial to examine the role of aerobic and resistance exercise training in the improvement of sleep quality for patients with this disease. While this study establishes exercise as a therapy for poor sleep quality, further research is needed to investigate the effect of exercise training on objective parameters of sleep in this population.

Development and use of risk adjusted statistical process control tools for the monitoring and improvement of clinical outcomes in interventional cardiology

This thesis explored the development of statistical methods to support the monitoring and improvement in quality of treatment delivered to patients undergoing coronary angioplasty procedures. To achieve this goal, a suite of outcome measures was identified to characterise performance of the service, statistical tools were developed to monitor the various indicators and measures to strengthen governance processes were implemented and validated. Although this work focused on pursuit of these aims in the context of a an angioplasty service located at a single clinical site, development of the tools and techniques was undertaken mindful of the potential application to other clinical specialties and a wider, potentially national, scope.

Validating a novel, low cost, automated malnutrition screening system as a predictor of nutritional risk in the Oncology Day Care Unit

Background Cancer-related malnutrition is associated with increased morbidity, poorer tolerance of treatment, decreased quality of life, increased hospital admissions, and increased health care costs (Isenring et al., 2013). This study’s aim was to determine whether a novel, automated screening system was a useful tool for nutrition screening when compared against a full nutrition assessment using the Patient-Generated Subjective Global Assessment (PG-SGA) tool. Methods A single site, observational, cross-sectional study was conducted in an outpatient oncology day care unit within a Queensland tertiary facility, with three hundred outpatients (51.7% male, mean age 58.6 ± 13.3 years). Eligibility criteria: ≥18 years, receiving anticancer treatment, able to provide written consent. Patients completed the Malnutrition Screening Tool (MST). Nutritional status was assessed using the PG-SGA. Data for the automated screening system was extracted from the pharmacy software program Charm. This included body mass index (BMI) and weight records dating back up to six months. Results The prevalence of malnutrition was 17%. Any weight loss over three to six weeks prior to the most recent weight record as identified by the automated screening system relative to malnutrition resulted in 56.52% sensitivity, 35.43% specificity, 13.68% positive predictive value, 81.82% negative predictive value. MST score 2 or greater was a stronger predictor of nutritional risk relative to PG-SGA classified malnutrition (70.59% sensitivity, 69.48% specificity, 32.14% positive predictive value, 92.02% negative predictive value). Conclusions Both the automated screening system and the MST fell short of the accepted professional standard for sensitivity (80%) or specificity (60%) when compared to the PG-SGA. However, although the MST remains a better predictor of malnutrition in this setting, uptake of this tool in the Oncology Day Care Unit remains challenging.

Elements of Better Assessment for the Improvement of Learning

Building a community of shared practice at the classroom level calls for clarity about the important assessment capabilities and dispositions of teachers, especially when teachers are expected to take a direct focus on learning. In this chapter, we present new ways of thinking about teachers’ assessment literacies, offering a formulation of better assessment for the improvement of learning, including three elements, namely (i) assessment criteria and standards; (ii) the teacher’s professional judgment; and (iii) social moderation. The potential of the first element lies in teachers’ classroom practices that deliberately embed assessment criteria and standards in pedagogy in productive ways. The second element involves the engagement of teachers and students in judgment practice, that develops the understanding that judgment involves more than the application of explicit or stated criteria. More fundamental is the matter of how teachers bring to bear stated features of quality and other intellectual and experiential resources in arriving at judgment. That is to say, they range across and orient to explicit (stated), tacit (unstated) and meta-criteria in judgment making. These insights have direct relevance to teachers’ efforts to develop students’ own evaluative experience, especially as this involves students working with stated features of quality for self-assessment and peer-assessment purposes. Further, practices for social moderation are discussed, giving examples of good practice in moderation, how teachers experience moderation and the potential benefits of various types.