Towards development of a quality cost model for automotive stamping

The current work used discrete event simulation techniques to model the economics of quality within an actual automotive stamping plant. Automotive stamping is a complex, capital intensive process requiring part-specific tooling and specialised machinery. Quality control and quality improvement is difficult in the stamping environment due to the general lack of process understanding and the large number to interacting variables. These factors have prevented the widespread use of statistical process control. In this work, a model of the quality control techniques used at the Ford Geelong Stamping plant is developed and indirectly validated against results from production. To date, most discrete event models are of systems where the quality control process is clearly defined by the rules of statistical process control. However, the quality control technique used within the stamping plant is for the operator to perform a 100% visual inspection while unloading the finished panels. In the developed model, control is enacted after a cumulative count of defective items is observed, thereby approximating the operator who allows a number of defective panels to accumulate before resetting the line. Analysis of this model found that the cost sensitivity to inspection error is dependent upon the level of control and that the level of control determines line utilisation. Additional analysis of this model demonstrated that additional inspection processes would lead to more stable cost structures but these structures many not necessarily be lower cost. The model was subsequently applied to investigate the economics of quality improvement. The quality problem of panel blemishes, induced by slivers (small metal fragments), was chosen as a case stuffy. Errors of 20-30% were observed during direct validation of the cost model and it was concluded that the use of discrete event simulation models for applications requiring high accuracy would not be possible unless the production system was of low complexity. However, the model could be used to evaluate the sensitivity of input factors and investigating the effects of a number of potential improvement opportunities. Therefore, the research concluded that it is possible to use discrete event simulation to determine the quality economics of an actual stamping plant. However, limitations imposed by inability of the model to consider a number of external factors, such as continuous improvement, operator working conditions or wear and the lack of reliable quality data, result in low cost accuracy. Despite this, it still can be demonstrated that discrete event simulation has significant benefits over the alternate modelling methods.

Public reporting of nursing home quality of care : Lessons from the United States experience for Canadian policy discussion

While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy.

Acceptability, impact and sustainability of the national pilot quality assurance system for self management programs

Chronic condition self-management education and training interventions such as the Stanford Self Management Programs (SMP) have the capacity to improve health and quality of life of people with chronic conditions whilst reducing the use of health services. This is in line with the outcomes from the recent Council of Australian Governments’ meeting where it was indicated that self-management will be a centrepiece in forthcoming chronic disease initiatives.
Aim: report on a large national pilot quality assurance program involving the implementation and of an evaluation and quality monitoring system for SMPs including the provision of structured feedback to courses course leaders and service providers. During 2005/06 the quality assurance program was implemented at 11 diverse organisations across Australia. The program involved assisting organisations apply the 42-item Health Education Impact Questionnaire (HEIQ), a chronic disease health education outcome measure, and then observe and evaluate the value and impact of the quality program. Interviews with course leaders (n=60) and course participants (n=35) have elicited views about course quality and feedback processes.
Results: The evaluation revealed enablers and barriers to effective implementation and sustainability. Important enablers were:
- Course Leaders and organisations valued an Australia-wide system that provided feedback on course
quality and the impact on participants.
- Course Leaders were strongly personally motivated to respond appropriately to HEI-Q course
report feedback.
- Completing the questionnaire provided participants with the opportunity to reflect on issues that
emerge in the course content and reflect on their progression at the end of the SSMP.
Sustainability issues included:
- Organisations and course leaders require support, training and flexibility on how to administer and
manage the use of the HEI-Q.
- Availability of administrative resources in organisations to support the quality assurance activities.
- The requirement that course leaders are trained in interpreting HEI-Q course report data.
A quality improvement framework was developed which identified the actions required of key stakeholders to
support effective implementation.
Discussion: With the increasing endorsement of SMP across sectors it is important that course quality is known, is acceptable, and is communicated to stakeholders to inform and engender confidence in the SSMP. To effectively implement and sustain a quality improvement program for SMP, the processes and tools for measuring outcomes need to be responsive, flexible and easily integrated into the organisation and delivery of programs.

Evaluation of individual program plan content and quality in a Victorian residential service

The study assesses the quality and content of Individual Program Plans for 284 Victorian adults with profound intellectual disabilities living in one residential service. A checklist was developed for improving plan quality, and measurement difficulties with checklists discussed. Recommends that a quality improvement process be implemented.

The resident assessment instrument-minimum data set 2.0 quality indicators : a systematic review

Background
The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs).

Methods
We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included.

Results
The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n=13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others.

Conclusion
Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.

Discovering the value that the library can contribute to quality teaching and learning through student evaluation data

Large surveys of library user service quality perception are common. However, student evaluation of teaching (SET) data often show a disparity between ratings of library service quality and library resource quality. In this situation, perhaps SET data can also provide insights into what contributes to the perception of library resource quality, and hence identify leverage points for quality improvement interventions. This paper documents an analysis of available Deakin University SET data relating to student interaction with, and evaluation of, library resources. It highlights significant correlations associated with library-related SET items, and from them infers actions that the library could undertake to improve the value and perception of the quality of library resources. The following results were observed. High ratings for library resources were likely to be associated with high general ratings of teaching and unit quality. Postgraduate coursework students rated library resources significantly higher than students in the first three years of undergraduate programs. Students in one faculty (Health) rated library resources significantly higher than students in all other faculties. There was a strong correlation observed in Australasian Survey of Student Engagement data for both 2009 and 2010 between the two items “Used library resources on campus or online” and “Worked on an essay or assignment that required integrating ideas or information from various sources”. These findings suggest the following conclusions. Well-planned learning environments are likely to integrate meaningful student interaction with the library. Initiatives to improve the value and perception of the quality of library resources should be focussed on the specific characteristics and needs of particular student cohorts to have maximum impact. More sophisticated assessment tasks that require students to interact with the library have the potential to result in higher student ratings of the value of library resources.

Perceptions of quality in higher education : a comparative study of Turkish and Australian business academics

Finding a common definition of ‘quality’ in studies of quality and quality improvement in higher education institutions is very important. This study identifies the views of a key stakeholder group, academics, with reference to their beliefs (what is currently occurring) and their attitudes (what ought to be occurring) in relation to quality in their departments. The focus of this paper is on the collection of data from 64 business administration academics in Turkish universities. Face-to-face interviews were conducted using an instrument titled ‘Quality in Accounting Education Survey’. The questionnaire was developed by Watty and is based on the conceptions of quality framework, developed by Harvey and Green. The results are compared with the beliefs and attitudes of Australian accounting academics as reported in an earlier paper by Watty. The findings show that academics from Turkey adopt the perspective of quality as excellent or élitist, both in their beliefs (current situation perception) and in their attitudes (desired situation perception). This compares with the findings that Australian academics’ attitudes reflect a quality perspective as fitness for purpose in the current situation and beliefs that reflect a transformational quality perspective as the desired situation (what ought to be).

Assessing data quality issues in the Emergency Department through data and process mapping

Data and information quality is a well-established research topic and gradually appears on the decision-makers' top concern lists. Many studies have been conducted on how to investigate the generic data/information quality issues and factors by providing a high-level abstract framework or model. Based on these previous studies, this study tries to discuss the actual data quality issues with the operation-level and middle-level managers emerged during the emergency department data collection and reporting processes. By conduct data quality issues and business processes mapping, possible data quality issues are summarised under the well-known TOP model and the recommendations of data quality improvement are suggested.)

Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Aim.  The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme – the Heart Failure Intervention Score – to facilitate quality improvement and programme auditing.

Background.  The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta-analyses. However, meta-analyses did not determine individual interventions in a programme that resulted in beneficial patient outcomes.

Design.  A prospective cross-sectional survey design.

Method.  All chronic heart failure management programmes in Australia (n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions.

Results.  Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 individual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median = 178, interquartile range 176–195) was used to divide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community-based programmes (38%) and programmes in small community hospitals (10%).

Conclusion.  The Heart Failure Intervention Score provides a potential evidence-based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes.

Interprofessional interactions influence nurses' adoption of handover improvement

Aim: The purpose of this study was to explore clinician experiences of adopting quality improvement tools to standardise interprofessional (anaesthetist-to-nurse) handover communication when patients arrive in the post-anaesthetic care unit (PACU). Method: In this study, factors that impacted PACU nurses' adoption of the quality improvement tools were explored using pre- and postimplementation, semi-structured focus group interviews. Interview data was analysed using the PARiHS¹ (context, evidence and facilitation) framework as a deductive analysis tool. Results: PACU nurses recognised that PACU handover from anaesthetists to PACU nurses was suboptimal and described the tools as useful for their practice. However, PACU nurses frequently cited fear of anaesthetists' reactions as reasons not to insist on the use of the handover improvement tools. PACU nurses at Hospital 2 identified lacking "authority" (Hospital 2 FG 2) in the OR as hindering their willingness to use the tools against these behaviours. In comparison, visible support from leadership at Hospital 1 was described as encouraging nurses to be "assertive" (Hospital 1 FG 2) and take charge of their patients' care. Conclusion: PACU nurses perceived the handover tools were useful and helped them identify gaps in handover practice; however, PACU nurses described difficult relationships as hindering communication effectiveness and discouraging their adoption of the tools. However, strong leadership and organisational support of change emerged as essential to mitigate the effects of these difficult relationships.

Systematic review and quality appraisal of economic evaluation publications in dentistry

Economic evaluation (EE) studies have been undertaken in dentistry since the late 20th century because economic data provide additional information to policy makers to develop guidelines and set future direction for oral health services. The objectives of this study were to assess the methodological quality of EEs in oral health. Electronic searching of Ovid MEDLINE, the Cochrane Library, and the NHS Economic Evaluation Database from 1975 to 2013 were undertaken to identify publications that include costs and outcomes in dentistry. Relevant reference lists were also searched for additional studies. Studies were retrieved and reviewed independently for inclusion by 3 authors. Furthermore, to appraise the EE methods, 1 author applied the Drummond 10-item (13-criteria) checklist tool to each study. Of the 114 publications identified, 79 studies were considered full EE and 35 partial. Twenty-eight studies (30%) were published between the years 2011 and 2013. Sixty-four (53%) studies focused on dental caries prevention or treatment. Median appraisal scores calculated for full and partial EE studies were 11 and 9 out of 13, respectively. Quality assessment scores showed that the quality of partial EE studies published after 2000 significantly improved (P = 0.02) compared to those published before 2000. Significant quality improvement was not found in full EE studies. Common methodological limitations were identified: absence of sensitivity analysis, discounting, and insufficient information on how costs and outcomes were measured and valued. EE studies in dentistry increased over the last 40 y in both quantity and quality, but a number of publications failed to satisfy some components of standard EE research methods, such as sensitivity analysis and discounting.

Building equitable staff-parent communication in early childhood settings : an Australian case study

International research has consistently found that good staff-parent relationships in early childhood centers benefit children, staff, and parents. Given these findings, the Australian federal government's Quality Improvement and Accreditation Scheme (QIAS) requires centers to involve parents in their programs. However, international research has also found that early childhood staff are anxious about their relationships with parents. This article describes a study in which early childhood staff in Australia were asked about their experiences with parent involvement. It draws on those interviews to consider communication strategies to create equitable relationships between staff and parents.

Degradation of VOCs by phototcatalytic oxidation reactor using TiO2 pellets

Volatile Organic Compounds (VOCs) are air pollutants that come from burning fossil fuels and industrial emissions. They have potentially adverse health effects being carcinogenic and highly persistent in the environment. The use of photocatalytic oxidation to remove VOCs has the potential to be applied in indoor air quality improvement and industrial emission control. A fixed bed photocatalytic reactor was designed and built. UV black light lamps were installed in the reactor to provide a source of UV radiation. A non-film titania media as pellets were placed on the three fixed beds within the reactor. Toluene and acetone were used as indicators of VOCs during the experiment. With a flow rate of 12.75l/min, the oxidation efficiencies were obtained at four different concentrations of acetone laden gas streams ranging from 40ppm to 250ppm. It was found that the lower the acetone concentration of the untreated inlet gas, the higher the oxidation efficiency. The oxidation efficiency was in the range of 40–70% for various concentrations of untreated gases. Two concentrations of toluene laden gas stream were also tested using the same reactor. The oxidation efficiencies were found as 50% for 120ppm toluene gas and 45% for 300ppm toluene gas. It was found that the times required for toluene to reach oxidization equilibrium have been halved than for acetone gas stream. Other parameters such as flow rate and UV intensity were also altered to see their effects on the oxidation efficiency. A full spectrum scan was carried out using a Bio-rad Infrared spectrometer. It was found that the main components of the treated gas stream from the outlet of the reactor were CO2 and water along with small amount of untreated acetone. The suspected intermediates of aliphatic hydrocarbons and CO were found in very minimal amounts or undetectable. The research experiments supported that the TiO2 pellets can work effectively in a fixed bed photocatalytic reactor and achieve significant oxidation efficiencies for degradation of toluene and acetone as indicators of VOCs.

Designing contemporary learning environments for excellence in public relations

Universities are striving to enhance the quality of the educational experience in the professions in response to external and internal pressures. The professional field of public relations (PR) is not immune to these forces. Previously, enhancements were often pursued through particular initiatives relating to curriculum, pedagogical or assessment redesign at the unit level. While such initiatives are valuable we argue for a strategic, integrated, programmatic approach. This requires the design of learning environments, with integrated virtual and physical dimensions, based on a relevant and meaningful curriculum, and student-centred approaches to learning. These learning environments enable quality learning in fields like public relations with diverse student cohorts studying on- and off-campus. The challenges involved in designing what we term ‘contemporary learning environments’ are illuminated through a case study of Deakin University’s Public Relations Program. Over the last three years redesigning PR online has led to changed curriculum, and pedagogical and assessment practices. We conclude by suggesting that a commitment to continuous quality improvement will be required to ensure the program’s learning environment remains relevant to the needs of students studying in the field.

20 years on - have student evaluations made a difference?

This paper poses the question, what impact have student evaluations (SE’s) of teaching had on the improvement in teaching in Australian tertiary education. The paper proposes to assess the effectiveness of SE’s through an investigations of the ways in which have been used in Australian tertiary education over the last 20 years or so. Three approaches are discussed: a) quality assurance - student evaluations used to ensure the quality of the learning environment in which learning takes place; b) quality improvement - student evaluations used as a diagnostic tool for individual teaching staff; and c) student feedback – student evaluations used to provide prospective and current students with information to help inform their choices and expectations. The discussions reviews some of the research and known practise in Australian universities. It concludes that SE’s have had a profound impact on pedagological understandings of tertiary education by placing the student at centre stage of teaching and learning. However it suggests that we do not know how SE’s have impacted on teaching effectiveness and improvement. The paper concludes by recommending further research to define critical success factors, a better understanding of how to make the student feedback and evaluation tools and mechanisms more approachable and meaningful for students, and an assessment of the ‘survey industry’ as a sustainable enterprise.