Using knowledge management to drive performance

Organisations are gathering ever more information, but are less good at analysing it and utilising the resultant knowledge for improved performance. Here Paul Collier, co-author of research on the subject, discusses how finance can help improve matters.

Survey of General Optical Council disciplinary and fitness to practise hearings:2001-2011

The aim of this survey was to review 187 transcripts from the United Kingdom’s General Optical Council (GOC) Disciplinary and Fitness To Practise (FTP) Committee hearings from 2001 to 2011 in order to identify common themes and thereby help practitioners to avoid the more frequently occurring pitfalls that were recorded during this period. The study covered changes in GOC FTP regulations in 2005, which involved a change from a disciplinary to a fitness to practise process. The number of cases was very small compared to the total number of optometrist and dispensing optician registrants, which was 13709 in 2001-02 rising to 18582 in 2010-11. The main findings indicated that between 2001 and 2011 there was a three times greater likelihood that male registrants versus female registrants would be brought in front of a GOC Disciplinary or FTP Committee. In terms of erasures from the GOC registers between 2001 and 2011, male registrants were also more likely to be erased than females. The male: female split for erasures between 2001 and 2011 was five: one, increasing to seven: one when considering the situation post the 2005 GOC FTP rule change. Of the cases brought before the Disciplinary and FTP Committees between 2001 and 2011, it was noted that cases implicating theft and fraud were most frequent representing 27% of hearings examined (17% involving NHS fraud and 10% theft or fraud from an employer). The examination of transcripts revealed other hearings were more complex. These hearings often had a primary reason for the investigation that highlighted further secondary concerns that also required investigation.

The framework of the virtual laser tracker - A systematic approach to the assessment of error sources and uncertainty in laser tracker measurement

Laser trackers have been widely used in many industries to meet increasingly high accuracy requirements. In laser tracker measurement, it is complex and difficult to perform an accurate error analysis and uncertainty evaluation. This paper firstly reviews the working principle of single beam laser trackers and state-of- The- Art of key technologies from both industrial and academic efforts, followed by a comprehensive analysis of uncertainty sources. A generic laser tracker modelling method is formulated and the framework of the virtual tracker is proposed. The VLS can be used for measurement planning, measurement accuracy optimization and uncertainty evaluation. The completed virtual laser tracking system should take all the uncertainty sources affecting coordinate measurement into consideration and establish an uncertainty model which will behave in an identical way to the real system. © Springer-Verlag Berlin Heidelberg 2010.

Assessing visual fields for driving in patients with paracentral scotomata

Background: The binocular Esterman visual field test (EVFT) is the current visual field test for driving in the UK. Merging of monocular field tests (Integrated Visual Field, IVF) has been proposed as an alternative for glaucoma patients. Aims: To examine the level of agreement between the EVFT and IVF for patients with binocular paracentral scotomata, caused by either ophthalmological or neurological conditions, and to compare outcomes with useful field of view (UFOV) performance, a test of visual attention thought to be important in driving. Methods: 60 patients with binocular paracentral scotomata but normal visual acuity (VA) were recruited prospectively. Subjects completed and were classified as “pass” or “fail” for the EVFT, IVF and UFOV. Results: Good agreement occurred between the EVFT and IVF in classifying subjects as “pass” or “fail” (kappa?=?0.84). Classifications disagreed for four subjects with paracentral scotomata of neurological origin (three “passed” IVF yet “failed” EVFT). Mean UFOV scores did not differ between those who “passed” and those who “failed” both visual field tests (p?=?0.11). Agreement between the visual field tests and UFOV was limited (EVFT kappa?=?0.22, IVF kappa 0.32). Conclusions: Although the IVF and EVFT agree well in classifying visual fields with regard to legal fitness to drive in the UK, the IVF “passes” some individuals currently classed as unfit to drive due to paracentral scotomata of non-glaucomatous origin. The suitability of the UFOV for assessing crash risk in those with visual field loss is questionable.

Adherence to antiepileptic medicines in children:a multiple-methods assessment involving dried blood spot sampling

Purpose - To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods. Methods - A total of 100 children with epilepsy (≤17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (≥9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children. Key Findings - The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.37–15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95% CI 1.16–11.41). Significance - This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.

Validating the organizational climate measure:links to managerial practices, productivity and innovation

This paper describes the development and validation of a multidimensional measure of organizational climate, the Organizational Climate Measure (OCM), based upon Quinn and Rohrbaugh's Competing Values model. A sample of 6869 employees across 55 manufacturing organizations completed the questionnaire. The 17 scales contained within the measure had acceptable levels of reliability and were factorially distinct. Concurrent validity was measured by correlating employees' ratings with managers' and interviewers' descriptions of managerial practices and organizational characteristics. Predictive validity was established using measures of productivity and innovation. The OCM also discriminated effectively between organizations, demonstrating good discriminant validity. The measure offers researchers a relatively comprehensive and flexible approach to the assessment of organizational members' experience and promises applied and theoretical benefits. Copyright © 2005 John Wiley & Sons, Ltd.

Magnetic drive system for a new centrifugal rotary blood pump

The purpose of this investigation was to design a novel magnetic drive and bearing system for a new centrifugal rotary blood pump (CRBP). The drive system consists of two components: (i) permanent magnets within the impeller of the CRBP; and (ii) the driving electromagnets. Orientation of the magnets varies from axial through to 60° included out-lean (conical configuration). Permanent magnets replace the electromagnet drive to allow easier characterization. The performance characteristics tested were the axial force of attraction between the stator and rotor at angles of rotational alignment, Ø, and the corresponding torque at those angles. The drive components were tested for various magnetic cone angles, ?. The test was repeated for three backing conditions: (i) non-backed; (ii) steel-cupped; and (iii) steel plate back-iron, performed on an Instron tensile testing machine. Experimental results were expanded upon through finite element and boundary element analysis (BEM). The force/torque characteristics were maximal for a 12-magnet configuration at 0° cone angle with steel-back iron (axial force = 60 N, torque = 0.375 Nm). BEM showed how introducing a cone angle increases the radial restoring force threefold while not compromising axial bearing force. Magnets in the drive system may be orientated not only to provide adequate coupling to drive the CRBP, but to provide significant axial and radial bearing forces capable of withstanding over 100 m/s2 shock excitation on the impeller. Although the 12 magnet 0° (?) configuration yielded the greatest force/torque characteristic, this was seen as potentially unattractive as this magnetic cone angle yielded poor radial restoring force characteristics.

Intern pharmacists as change agents to improve the practice of nonprescription medication supply: provision of salbutamol to patients with asthma

BACKGROUND: Earlier work established an evidence practice gap during provision of nonprescription salbutamol (albuterol). Pharmacist interns are hypothesized to be in a position to improve professional practice in the community pharmacy setting. OBJECTIVE: To explore the potential of intern pharmacists to improve the professional practice of community pharmacy staff in the provision of nonprescription salbutamol. METHODS: Intern pharmacists (n = 157) delivered an asthma intervention in 136 pharmacies consisting of an educational activity to pharmacy staff and a health promotion campaign to consumers. Post-intervention, simulated patients presented to 100 intervention and 100 control community pharmacies with a request for salbutamol. The appropriate outcome was medical referral for poor asthma control and correction of poor inhaler technique. Incidence and quantity of patient assessment and counseling provided during the visit were also assessed. Logistic regression was used to determine the predictors of medical referral. RESULTS: A doubling in the rate of medical referral was seen in the intervention group (19% vs 40%; p = 0.001). Assessment of reliever use frequency was the main predictor of medical referral (OR = 22.7; 95% CI 9.06 to 56.9). Correction of poor inhaler technique did not improve; however, a reduction in salbutamol supplied without patient assessment (23% vs 8%; p = 0.009) or counseling (75% vs 48%; p < 0.001) was noted. CONCLUSIONS: A doubling in the rate of medical referral showed a clear improvement in professional practice during the provision of nonprescription salbutamol. The improved patient outcome in the intervention group was due to increased assessment of reliever use frequency. Identification of poor inhaler technique remained near zero in both groups, which suggests that intern pharmacists were able to improve the current practice of community pharmacies yet were unable to establish a new practice behavior. This study provides evidence that intern pharmacists can act as change agents to improve pharmacy practice.

Measuring the assessment and counselling provided with the supply of non-prescription asthma reliever medication: a simulated patient study

BACKGROUND: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking. OBJECTIVE: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. METHODS: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. RESULTS: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02). CONCLUSIONS: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.

Waste to power

ABSTRACT: There has been a growing trend towards the use of biomass as a primary energy source, which now contributes over 54% of the European pulp and paper industry energy needs [1]. The remaining part comes from natural gas, which to a large extent serves as the major source of energy for numerous recovered fiber paper mills located in regions with limited available forest resources. The cost of producing electricity to drive paper machinery and generate heat for steam is increasing as world demand for fossil fuels increases. Additionally, recovered fiber paper mills are also significant producers of fibrous sludge and reject waste material that can contain high amounts of useful energy. Currently, a majority of these waste fractions is disposed of by landspreading, incineration, or landfill. Paper mills must also pay a gate fee to process their waste streams in this way and the result of this is a further increase in operating costs. This work has developed methods to utilize the waste fractions produced at recovered fiber paper mills for the onsite production of combined heat and power (CHP) using advanced thermal conversion methods (pyrolysis and gasification) that are well suited to relatively small scales of throughput. The electrical power created would either be used onsite to power the paper making process or alternatively exported to the national grid, and the surplus heat created could also be used onsite or exported to a local customer. The focus of this paper is to give a general overview of the project progress so far and will present the experimental results of the most successful thermal conversion trials carried out by this work to date. Application: The research provides both paper mills and energy providers with methodologies to condition their waste materials for conversion into useful energy. The research also opens up new markets for gasifier and pyrolysis equipment manufacturers and suppliers.

Survey and applications of standardized energy metrics to mobile networks

The energy consumption and the energy efficiency have become very important issue in optimizing the current as well as in designing the future telecommunications networks. The energy and power metrics are being introduced in order to enable assessment and comparison of the energy consumption and power efficiency of the telecommunications networks and other transmission equipment. The standardization of the energy and power metrics is a significant ongoing activity aiming to define the baseline energy and power metrics for the telecommunications systems. This article provides an up-to-date overview of the energy and power metrics being proposed by the various standardization bodies and subsequently adopted worldwide by the equipment manufacturers and the network operators. © Institut Télécom and Springer-Verlag 2012.and Springer-Verlag 2012.

Fuzzy assessment of performance of a decision making units using DEA:a non-radical approach

Data Envelopment Analysis (DEA) is recognized as a modern approach to the assessment of performance of a set of homogeneous Decision Making Units (DMUs) that use similar sources to produce similar outputs. While DEA commonly is used with precise data, recently several approaches are introduced for evaluating DMUs with uncertain data. In the existing approaches many information on uncertainties are lost. For example in the defuzzification, the a-level and fuzzy ranking approaches are not considered. In the tolerance approach the inequality or equality signs are fuzzified but the fuzzy coefficients (inputs and outputs) are not treated directly. The purpose of this paper is to develop a new model to evaluate DMUs under uncertainty using Fuzzy DEA and to include a-level to the model under fuzzy environment. An example is given to illustrate this method in details.

Transfer of patients from health care centres to special care services:analysis of travel distances in Nordic countries

Objectives: This paper highlights the importance of analysing patient transportation in Nordic circumpolar areas. The research questions we asked are as follows: How many Finnish patients have been transferred to special care intra-country and inter-country in 2009? Does it make any difference to health care policymakers if patients are transferred inter-country? Study design: We analysed the differences in distances from health care centres to special care services within Finland, Sweden and Norway and considered the health care policy implica tions. Methods: An analysis of the time required to drive between service providers using the "Google distance meter" (http://maps.google.com/); conducting interviews with key Finnish stakeholders; and undertaking a quantitative analyses of referral data from the Lapland Hospital District. Results: Finnish patients are generally not transferred for health care services across national borders even if the distances are shorter. Conclusion: Finnish patients have limited access to health care services in circumpolar are as across the Nordic countries for 2 reasons. First, health professionals in Norway and Sweden do not speak Finnish, which presents a language problem. Second, The Social Insurance Institution of Finland does not cover the expenditures of travel or the costs of medicine. In addition, it seems that in circumpolar areas the density of Finnish service providers is greater than Swedish ones, causing many Swedish citizens to transfer to Finnish health care providers every year. However, future research is needed to determine the precise reasons for this.

Examining the relationship between risk assessment and risk management in mental health

Risk assessment is crucial for developing risk management plans to prevent or minimize mental health patients' risks that will impede their recovery. Risk assessments and risk management plans should be closely linked. Their content and the extent to which they are linked within one Trust is explored. There is a great deal of variability in the amount and detail of risk information collected by nurses and how this is used to develop risk management plans. Keeping risk assessment information in one place rather than scattered throughout patient records is important for ensuring it can be accessed easily and linked properly to risk management plans. Strengthening the link between risk assessment and management will help ensure interventions and care is tailored to the specific needs of individual patients, thus promoting their safety and well-being. Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others. © 2011 Blackwell Publishing.