Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument

Background
Multi attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument.

Methods
The AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements.

Results and Discussion
The resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model.

Conclusions
The AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.

Improve construction knowledge management system by using the soft system methodology

The construction industry has a poor record in the management of its knowledge and results into huge wastage of resources and detrimental effect to quality. Research has shown that data and information management system plus knowledge management are a critical part of today's project management practice for construction projects. Few people will deny that 'quality information' and 'useful knowledge' are extremely important to any decision-making. However, the current processes of handling information and knowledge in the construction industry and increasingly costly. One of the major reasons is the nature of this industry is not conducive to good knowledge management and the traditional data/information systems used in the industry has long been critisized. It is very common that information is often duplicated, inconsistent and not current. In turn, making knowledge becomes difficult to manage properly. Project managers have in the past found it very difficult to source and analyse data in order to make sound decisions. This paper is part of a doctoral research project which summarizes three exploratory surveys; namely ERP system, Partnering strategy and Leadership impact of a knowledge management system in a construction company. Those findings are described by using the Soft Systems Methodology (SSM) which later becomes the basis for actions research. SSM is useful to reveal complexities of the knowledge management situations that occur in construction industry. The first stage was to conduct interviews of the different practices in knowledge and reporting process. Then, the SSM rich picture was developed to present the problematic areas including difficulties in inputting data to enable the knowledge platform in place. The research then develops root definition and CATWOE, and a conceptual model was formed. Interviewees were conducted with structured questions to identify prioritized actions and activities that can be undertaken to improve and manage the knowledge platform.

Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

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.

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.

How does organizational culture affect IS effectiveness : a culture-information system fit framework

Previous research has examined the impact of organizational culture(OC) on the implementation of many information systems. However, there is a lack of overall picture on how OC affects the effectiveness of different information systems differently. Based on the Competing Value Framework, this paper proposes a comprehensive framework to explain how the fit between organizational culture and types of IS results in different types of IS effectiveness. This framework can be used by managers to create a proper organizational culture that is compatible with the use of specific information systems.

A framework for environmental management system adoption and maintenance : an Australian perspective

Purpose – The purpose of this paper is to present a framework for environmental management system (EMS) adoption which can be used by managers to enable them to achieve a faster, smoother, effective and sustainable EMS implementation. This is termed by the authors as “successful” EMS implementation.
Design/methodology/approach – The framework presented is based on an extensive field study conducted in Australia that included a questionnaire survey and in-depth interviews conducted with practitioners, the results of which have been reported in this and other journals.
Findings – The framework presented covers three distinct phases, namely development, certification and maintenance and continuous improvement. Preliminary assessment of this framework by a group of Australian experts that included four senior managers, one academic and one consultant suggests that this framework is a useful tool for implementing an effective EMS.
Practical implications – Each of the three phases of the framework provides a step-by-step approach and a sequential map towards a successful EMS implementation.
Originality/value – The framework has been developed from extensive fieldwork and has been validated by a group of “experts” which comprised of four industry practitioners, one management academic, and one EMS consultant. The framework provides a detailed understanding of the steps involved in the implementation, certification, and maintenance of EMS.

Integrated management system:the experiences of three Australian organisations

Purpose – Management systems and standards have become a key part of the organisation's lifeline and a prerequisite for survival in the twenty-first century. Systems for quality environmental and occupational health and safety (OHS) now form the three main pillars of the organisation, the fourth one being financial accounting. In light of the increasing pressure and demands from different stakeholders, it is becoming necessary for organisations to adopt the different systems/standards. However, to achieve the benefits from the implementation and subsequently maintenance of these systems it is only a practical and logical step that the existing management systems/standards be integrated into a single system.

Design/methodology/approach – This paper presents the experiences of three Australian-based organisations that have successfully undertaken the integration of their management systems/standards. Data for this paper were collected through in-depth interviews conducted with the managers responsible for quality, environment and OHS systems.

Findings – The interviews revealed a number of quantifiable and unquantifiable benefits experienced by the companies from operating one integrated system, such as saving of dollars, better utilisation of resources and improved communication across the organisation, to name a few. However, for the benefits to be realized it is essential that organisations are aware of the challenges and obstacles accompanying integration of systems/standards. If these challenges are not addressed early in the process they can delay the completion of the integration process.

Originality/value – Recommendations for other organisations contemplating integrating their management system include: obtaining commitment from the top management; having adequate resources to integrate the systems; having communication and training across the organisation in aspects of integration; and, last but not the least, having integrated audits. Implementation of these recommendations may vary from one organisation to another; however, it would result in lesser resistance for the organisations following them.

Committing to quality learning through adaptive online assessment

With advances in computer-based technologies and the emergence of e-learning, there are unprecedented opportunities to reconsider assessment of learning (and, axiomatically, of teaching) and how this can be undertaken. One approach is adaptive assessment. Although it has existed in the tertiary environment since the time of the oral examination, advanced technologies allow much fuller exploitation of the possibilities inherent in a dynamic system of testing that responds to the user. Having described the characteristics of adaptive assessment, this paper considers how it can achieve significant pedagogical aims within the sector. The paper differentiates between adaptive assessment to assist learning and adaptive assessment to assess achievement. How adaptive assessment can be put in place and salient issues, such as security and system integrity, when such assessment is used for credit, are then discussed. The paper concludes that the capability exists but it has yet to be exploited within higher education as a viable approach to assessment and as a contributor to quality learning.

Analysis of stamping production data with view towards quality management

A quality analysis trial was undertaken at Ford Geelong Stamping Plant on a press line that was fitted with standard press sensors to measure press and binder force over the stamping cycle for each panel. The quality of randomly sampled panels was measured by obtaining the panel thicknesses at five points, for 135 panels in total. These points were chosen such that they exhibited different forming modes. This paper analyses the input force data and the output quality data from the trial to determine any potential relationships. The analysis of the production data was performed using statistical correlation techniques to determine initial potential relationships between input and output variables. An Active Shape Model was used to extract features when identifying the major sources of variation within the input data. However, the initial analysis of the data elicited no direct relationship between the input variables measured and the panel thicknesses. This result is significant as the data collected is from a standard sensor configuration found in many press lines through-out the world. The reason for the lack of a direct relationship is believed to come from the lack of sensitivity in the force measurements which are not able to identify small changes in the process, whereas gross geometric variations have in previous studies shown an obvious relationship with changes in the force press profile. This means that existing force sensors require augmentation by additional sensors if a detailed automatic quality control system for the press lines based on input sensors alone.

Has quality management run its course? Views from the field

The aim of this paper is to assess and reflect on, through the perspectives of Australian Quality practitioners, the current status of quality management; whether there had been any significant and recent shift in their roles and responsibilities; and if there had been any improvement in the extent to which their development and training needs were being fulfilled. This paper sets out to identify the roles, responsibilities, and training and development needs of Australian quality managers and what impact these may be having on the current 'quality agenda' of organisations in Australia. In light of these findings this paper focuses on the HR people aspects of QM implementation (e.g. development of a quality culture; learning, training and development; leadership and management commitment and support) and the significance of these aspects for sustainable QM implementation. Recent literature On QM implementation and the findings of three previously conducted surveys (Waddell 1998; Waddell and Mallen 2001; and Stewart and Waddell 2003) have been integrated with the findings of this research.