Metodologia para aplicação de reuso e reengenharia nos softwares de aquisição e redução de dados de um túnel de vento

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Nonlinear constrained and saturated control of power electronics and electromechanical systems

Power electronic converters are extensively adopted for the solution of timely issues, such as power quality improvement in industrial plants, energy management in hybrid electrical systems, and control of electrical generators for renewables. Beside nonlinearity, this systems are typically characterized by hard constraints on the control inputs, and sometimes the state variables. In this respect, control laws able to handle input saturation are crucial to formally characterize the systems stability and performance properties. From a practical viewpoint, a proper saturation management allows to extend the systems transient and steady-state operating ranges, improving their reliability and availability. The main topic of this thesis concern saturated control methodologies, based on modern approaches, applied to power electronics and electromechanical systems. The pursued objective is to provide formal results under any saturation scenario, overcoming the drawbacks of the classic solution commonly applied to cope with saturation of power converters, and enhancing performance. For this purpose two main approaches are exploited and extended to deal with power electronic applications: modern anti-windup strategies, providing formal results and systematic design rules for the anti-windup compensator, devoted to handle control saturation, and “one step” saturated feedback design techniques, relying on a suitable characterization of the saturation nonlinearity and less conservative extensions of standard absolute stability theory results. The first part of the thesis is devoted to present and develop a novel general anti-windup scheme, which is then specifically applied to a class of power converters adopted for power quality enhancement in industrial plants. In the second part a polytopic differential inclusion representation of saturation nonlinearity is presented and extended to deal with a class of multiple input power converters, used to manage hybrid electrical energy sources. The third part regards adaptive observers design for robust estimation of the parameters required for high performance control of power systems.

Effect of X-ray tube parameters, iodine concentration, and patient size on image quality in pulmonary computed tomography angiography: a chest-phantom-study

OBJECTIVES: The aim of this phantom study was to evaluate the contrast-to-noise ratio (CNR) in pulmonary computed tomography (CT)-angiography for 300 and 400 mg iodine/mL contrast media using variable x-ray tube parameters and patient sizes. We also analyzed the possible strategies of dose reduction in patients with different sizes. MATERIALS AND METHODS: The segmental pulmonary arteries were simulated by plastic tubes filled with 1:30 diluted solutions of 300 and 400 mg iodine/mL contrast media in a chest phantom mimicking thick, intermediate, and thin patients. Volume scanning was done with a CT scanner at 80, 100, 120, and 140 kVp. Tube current-time products (mAs) varied between 50 and 120% of the optimal value given by the built-in automatic dose optimization protocol. Attenuation values and CNR for both contrast media were evaluated and compared with the volume CT dose index (CTDI(vol)). Figure of merit, calculated as CNR/CTDIvol, was used to quantify image quality improvement per exposure risk to the patient. RESULTS: Attenuation of iodinated contrast media increased both with decreasing tube voltage and patient size. A CTDIvol reduction by 44% was achieved in the thin phantom with the use of 80 instead of 140 kVp without deterioration of CNR. Figure of merit correlated with kVp in the thin phantom (r = -0.897 to -0.999; P < 0.05) but not in the intermediate and thick phantoms (P = 0.09-0.71), reflecting a decreasing benefit of tube voltage reduction on image quality as the thickness of the phantom increased. Compared with the 300 mg iodine/mL concentration, the same CNR for 400 mg iodine/mL contrast medium was achieved at a lower CTDIvol by 18 to 40%, depending on phantom size and applied tube voltage. CONCLUSIONS: Low kVp protocols for pulmonary embolism are potentially advantageous especially in thin and, to a lesser extent, in intermediate patients. Thin patients profit from low voltage protocols preserving a good CNR at a lower exposure. The use of 80 kVp in obese patients may be problematic because of the limitation of the tube current available, reduced CNR, and high skin dose. The high CNR of the 400 mg iodine/mL contrast medium together with lower tube energy and/or current can be used for exposure reduction.

Management of fever and neutropenia in paediatric cancer patients: room for improvement?

PURPOSE OF REVIEW Fever and neutropenia is the most common complication in the treatment of childhood cancer. This review will summarize recent publications that focus on improving the management of this condition as well as those that seek to optimize translational research efforts. RECENT FINDINGS A number of clinical decision rules are available to assist in the identification of low-risk fever and neutropenia however few have undergone external validation and formal impact analysis. Emerging evidence suggests acute fever and neutropenia management strategies should include time to antibiotic recommendations, and quality improvement initiatives have focused on eliminating barriers to early antibiotic administration. Despite reported increases in antimicrobial resistance, few studies have focused on the prediction, prevention, and optimal treatment of these infections and the effect on risk stratification remains unknown. A consensus guideline for paediatric fever and neutropenia research is now available and may help reduce some of the heterogeneity between studies that have previously limited the translation of evidence into clinical practice. SUMMARY Risk stratification is recommended for children with cancer and fever and neutropenia. Further research is required to quantify the overall impact of this approach and to refine exactly which children will benefit from early antibiotic administration as well as modifications to empiric regimens to cover antibiotic-resistant organisms.

Health information exchange: Using metrics to address quality of care and return on investment

Health Information Exchange (HIE) will play a key part in our nation’s effort to improve healthcare. The evidence of HIEs transformational role in healthcare delivery systems is quite limited. The lack of such evidence led us to explore what exists in the healthcare industry that may provide evidence of effectiveness and efficiency of HIEs. The objective of the study was to find out how many fully functional HIEs are using any measurements or metrics to gauge impact of HIE on quality improvement (QI) and on return on investment (ROI).^ A web-based survey was used to determine the number of operational HIEs using metrics for QI and ROI. Our study highlights the fact that only 50 percent of the HIEs who responded use or plan to use metrics. However, 95 percent of the respondents believed HIEs improve quality of care while only 56 percent believed HIE showed positive ROI. Although operational HIEs present numerous opportunities to demonstrate the business model for improving health care quality, evidence to document the impact of HIEs is lacking. ^

The role of a nursing home administrator's education in influencing quality of care in US nursing homes

Nursing home literature links poor management practices to poor quality of care and resident outcomes. Since Nursing Home Administrators (NHAs) require an array of skills to perform their role, it is important to explore what makes a NHA effective. This research fills a gap in the literature and provides a possible option to improve the quality of care in nursing homes. Purpose of the study. The study examines whether NHAs with advanced education (defined as a Masters degree or more) are associated with better quality of care in licensed nursing homes (NHs). Design and Methods. Data was derived from the CDC’s 2004 National Nursing Home Survey, which is a representative sample of NHs across the US. A Donabedian- inspired structure-process-outcomes study model was created to explain how education relates to quality of care. Quality of care was defined as onsite oral care, employee influenza vaccination rates and staff recognition programs. Statistical analyses included multivariate logistic regression; covariates included facility-level variables used in similar peer-reviewed research but also included select measures from the Area Resource File to control for county-level factors. Results. Descriptive and analytical analyses confirm that NHAs with a Bachelor’s degree, Associate degree or high school diploma perform less well than NHAs with a Masters degree or more. NHAs with advanced education are more likely to have onsite dental care and recognition programs for staff than NHAs with a Bachelor’s degree (or less). Also NHAs with less than graduate education are more likely to provide off-site dental care. Employee vaccination rates are not impacted by education. Adding certification, tenure or years of experience to a NHA with advanced education gives them an advantage. In fact, certification and experience alone do not have a positive relationship to care indicators; however adding these to advanced education produces a significant result. Implications. This research provides preliminary evidence that advanced education for the NHA is associated with better quality of care. If future research can confirm these findings, there is merit in revisiting the qualifications. Education can be a legitimate option to support quality improvement efforts in US nursing homes. ^

Quality assessment in radiation oncology

Oncologic specialty societies and multidisciplinary collaborative groups have dedicated considerable effort to developing evidence-based quality indicators (QIs) to facilitate quality improvement, accreditation, benchmarking, reimbursement, maintenance of certification, and regulatory reporting. In particular, radiation oncology as a field has a long history of organized quality assessment efforts, and continues to work toward developing consensus quality standards in the face of continually evolving technologies and standards of care. The present report provides a comprehensive review of the current state of quality assessment in radiation oncology, with an emphasis on recent quality improvement efforts. Specifically, this report aims to highlight implications of the healthcare quality movement for radiation oncology and review existing efforts to define and measure quality in the field, with particular focus on dimensions of quality that are specific to radiation oncology within the "big picture" of oncologic quality improvement efforts.^

Product quality and intra-industry trade

In this study, we argue that the conventional intra-industry trade (IIT) index does not address the quality issue directly and propose a methodology to make full use of unit-price gap information to deduce quality differences between simultaneously exported and imported products. By applying this measure to German trade data at the eight-digit level, we study the quality improvement of Chinese export goods in its IIT with Germany. We compare the case of China with those of Eastern European countries, which are also major trading partners of Germany. Our results show that the unit-value difference in IIT between Germany and Eastern European countries is clearly narrowing. However, China's export prices to Germany are much lower than Germany's export prices to China, and this gap has not narrowed over the last 23 years. This is at odds with the common perception that China's product quality has improved, as documented by Rodrik (2006) and Schott (2008). Our results support Xu (2010), which argued that incorporating the quality aspect of the exported goods weakens or even eliminates the evidence of the sophistication of Chinese export goods in Rodrik (2006).

Optimizing rabbit production under heat stress: cage density and cage size during fattening, and breeding system and water quality on rabbit does

The aim of this work was to evaluate different management strategies to optimize rabbit production under chronic heat stress. To achieve it, three trials were conducted. In the first trial, to find the optimal cage density in tropical very dry forest condition, were measured growth performance, mortality rate, injured animals and carcass performance over an initial population of 300 cross-breed rabbits of New Zealand, California, Butterfly, Dutch and Satin, weaned at 30 days (535 ± 8 g, standard error). Treatments evaluated were: 6, 12, 18 and 24 rabbits/m2 (3, 6, 9 and 12 rabbits/cage, respectively, each cage of 0.5 m2). The maximal temperature-humidity index indicated a severe heat stress from weaning to 2.2 kg body weight (experimental time). At the end of experimental period 10, 20, 30 and 30 rabbits from the treatments of 6, 12, 18 and 24 rabbits/m2, respectively, were slaughtered and carcass performance recorded. Average daily gain and feed intake decreased by 0.31 ± 0.070 and 1.20 ± 0.25 g, respectively, per each unit that the density increased at the beginning of the experiment (P = 0.001). It increased the length of the fattening period by 0.91 ± 0.16 d (P = 0.001) per each unit of increment of density. However, rabbit production (kg/m2) increased linear and quadratically with the density (P < 0.008). Animals housed at the highest density compared to the lower one tended to show a higher incidence of ringworm (68.9 vs 39.4%; P = 0.075), injured animals (16.8 vs 3.03%; P = 0.12) and mortality (20.5 vs 9.63%; P = 0.043). The proportion of scapular fat (P = 0.042) increased linearly with increasing levels of density. Increasing density reduced linearly dorsal length (P = 0.001), and reduced linear and quadratically drip loss percentage (P = 0.097 and 0.018, respectively). In the second trial, 46 nulliparous rabbit does (23 clipped and 23 unclipped) with a BW of 3.67 ± 0.05 kg (s.e.) were used to evaluate heat stress and circadian rhythms comparing unclipped and clipped rabbit does, and to study if a more extensive breeding system increase litters performance at weaning without impairing rabbit doe performance,. Rectal temperature, feed and water 4 intake were recorded for 24 h. Rabbit does were mated 7 d after circadian measurements, and randomly assigned to two breeding systems. Control (C): mated at 14 d after parturition + litter weaned at 35 d of age. Extensive (E): mate at 21 after parturition + litter weaned at 42 d of age. The first three cycles were evaluated concerning to rabbit doe and litter performance. Two hundred twenty eight weaned rabbits, were divided into two cage sizes: 0.5 and 0.25 m2 with same density (16 rabbit/m2) and growing performance was recorded. Farm and rectal temperatures were minimal and feed and water intake maximal during the night (P < 0.001). Unclipped rabbit does showed higher rectal temperature (P = 0.045) and lower feed intake respect to clipped does (P = 0.019) which suggest a lower heat stress in the latter. Kits weaned per litter was reduced by 33% (P=0.038) in C group. This reduction was more important in the 2nd and 3rd cycles compared to the first (P ≤ 0.054). Rabbit doe feed efficiency tended to decrease in E respect C group (P = 0.093), whereas it was impaired from the first to the third cycle by 48% (P = 0.014). Growing rabbits from the E group were heavier at weaning (by 38%. P < 0.001), showed a higher feed intake (+7.4%) and lower feed efficiency (-8.4%) throughout the fattening period (P ≤ 0.056) respect to C group. Cage size had minor influence in growing performance. In the third trial, forty five non pregnant and non lactating rabbit does (21 nulliparous and 24 multiparous) were assigned randomly to farm water and to potable water to study if a water quality improvement can affect positively rabbit doe response to heat stress during pregnancy and lactation. A transponder was implanted in each animal to record subcutaneous temperature at 07:30 and 14:30 h. Experimental period extended from pregnancy (with no lactation) to the next lactation (until day 28). Body temperature and milk production were recorded daily, and body condition, feed and water intake weekly. Water quality did not affect any trait (P ≥ 0.15). Pregnant rabbit does were classified as does that weaned (W: 47%), not weaned (NW: 44%) or those pregnant that did not deliver (NB: 9%). Body temperature and feed intake decreased during pregnancy (P ≤ 0.031), but water intake remained constant. In this period body temperature decreased with metabolic weight (P ≤ 0.009). In W and NW does, 5 from mating to birth energy and protein balance impaired (P≤0.011). Body temperature of W does tended to be the lowest (P ≤ 0.090). Pregnancy length and total number of kits born tended to be longer and higher in NW than in W does (P = 0.10 and 0.053, respectively). Kit mortality at birth and from birth to 14 d of lactation was high, being worse for NW than for W does (97 vs. 40%; P<0.001). Body temperature during lactation was maximal at day 12, and milk production increased it (P ≤ 0.025). . In conclusion, in our heat stress conditions densities higher than 18 rabbits/m2 (34 kg/m2) at the end of fattening, are not recommended despite cage size, gestation and lactation productivity impaired not only when lactation is extended and along successive reproductive cycles but also due to a reduced embryo/kit survival and finally water quality improvement did not attenuate negative effect of heat stress. RESUMEN El propósito de éste trabajo fue evaluar diferentes estrategias de manejo para optimizar la producción de conejos bajo estrés térmico. Para lo cual se desarrollaron tres experimentos. En el primer experimento, para encontrar el número óptimo de gazapos por m2 de jaula durante el cebo en condiciones de bosque muy seco tropical, se estudiaron los rendimientos durante el cebo, mortalidad, animales lesionados y rendimiento de la canal sobre una población inicial de 300 conejos mestizos de Nueva Zelanda, California, Mariposa, Holandés y Satin, destetados a los 30 días de edad (535 ± 8g, error estándar). Los tratamientos evaluados fueron: 6, 12, 18 y 24 conejos/m2 (3, 6, 9 y 12 conejos/jaula, respectivamente, en jaulas de 0.5 m2). Durante el período experimental (destete a 2.2 kg de peso vivo), se observaron valores de THI correspondientes con un estrés térmico severo (THI max. De 31 a 35). Al final del período experimental, 10, 20, 30, y 30 conejos de los tratamientos con densidades de 6, 12, 18 y 24 conejos/m2, respectivamente, fueron sacrificados y su canal fue valorada. El promedio de la ganancia diaria y el consumo de alimento disminuyeron en 0.31 ± 0.070 y 1.20 ± 0.25 g, respectivamente, por cada unidad de incremento en la densidad al inicio del experimento (P=0.001). Esto alargó el período de engorde en 0.91 ± 0.16 d (P=0.001) por cada unidad de incremento de la densidad. Sin embargo, la producción de conejos (kg/m2) aumentó lineal y cuadráticamente con la densidad (P<0.008). Los animales alojados en las mayores densidades en comparación con el resto tendieron a mostrar una mayore incidencia de tiña (68.9 vs 39.4%; P=0.075), de cantidad de animales heridos (16.8 vs 3.03%; P=0.12), así como de mortalidad (20.5 vs 9.63%; P=0.043). El aumento en la densidad aumentó linealmente la proporción de grasa escapular (P=0.042) y redujo linealmente la longitud dorsal (P=0.001), y lineal y cuadráticamente el porcentaje de pérdida por goteo (P=0.018). En el segundo experimento, 46 conejas nulliparas (23 rasuradas y 23 no rasuradas) con un peso vivo de 3.67 ± 0.05 kg (e.e.) fueron usadas para evaluar el estrés 8 térmico y los ritmos circadianos comparando conejas rasuradas o no, y estudiar si un sistema de crianza más extensivo mejora el desempeño de la camada al destete sin perjudicar la productividad de la coneja. Durante 24 h se midió la temperatura rectal, consumo de alimento y de agua. Las conejas fueron montadas 7 días después, y distribuidas en dos sistemas de crianza. El control (C): monta a 14 días posparto y destete a 35 d de edad. El extensivo (E): monta a 21 días posparto y destete a 42 d de edad. Se controló la productividad de la coneja y la camada durante los tres primeros ciclos. Doscientos veintiocho gazapos fueron distribuidos en dos tamaños de jaulas (0.5 y 0.25 m2) con la misma densidad (16 conejos/m2) y se controlaron sus rendimientos productivos. Durante la noche se observaron los valores mínimos para la temperatura ambiental y rectal, y los máximos para consumo de alimento y agua (P< 0.001). Las conejas no rasuradas mostraron mayor temperatura rectal (P=0.045) y menores valores de consumo de alimento con respecto a las conejas rasuradas (P=0.019), lo que sugiere un menor estrés térmico en las últimas. El número de gazapos destetados por camada se redujo en 33% (P=0.038) en el grupo C. Este comportamiento se acentuó en el 2do y 3er ciclo en comparación con el primero (P≤0.054). La eficiencia alimenticia de las conejas tendió a disminuir en el grupo E con respecto al grupo C (P=0.093), dicha tendencia se acentúa del primer al tercer ciclo en un 48% (P=0.014). Los gazapos en fase de crecimiento provenientes del grupo E fueron más pesados al momento del destete (en 38% P<0.001), mostrando un mayor consumo de alimento (+7.4%) y menor eficiencia alimenticia (-8.4%) a lo largo del engorde (P≤0.056) con respecto al grupo C. El tamaño de la jaula tuvo una mínima influencia en el comportamiento durante el crecimiento de éstos gazapos. En el tercer experimento, cuarenta y cinco conejas no gestantes ni lactantes (21 nulíparas y 24 multíparas) se les asignó al azar agua dos tipos de agua: común de la granja y agua potable, con el fin de estudiar si una mejora en la calidad del agua puede afectar positivamente la respuesta de la coneja al estrés térmico durante la gestación y la lactancia. Se les implantó un transponder para registrar la temperatura subcutánea a las 7:30 y a las 14:30 h. El período experimental se extendió desde la gestación (sin 9 lactancia) hasta la lactanción consecutiva (hasta los 28 días). La temperatura corporal y la producción de leche se controlaron diariamente, y la condición corporal, consumo de agua y alimento, semanalmente. La calidad del agua no afectó a ninguna variable (P≥0.15). Las conejas preñadas fueron clasificadas como conejas que destetaron (W: 47%), que no destetaron (NW:44%) o aquellas que no parieron (NB: 9%). La temperatura corporal y consumo de alimento disminuyeron durante la gestación (P≤0.031), mientras que el consumo de agua se mantuvo constante. La temperatura corporal descendió con el peso metabólico durante la gestación (P≤0.009). El balance de energía y proteína disminuyó desde la monta al parto para las conejas W y NW (P≤0.011). Durante la gestación la temperatura corporal tendió a ser menor en las conejas W (P≤0.090). La longitud de la gestación y el número total de gazapos nacidos tendieron a ser mayores en conejas NW que en conejas W (P=0.10 y 0.053, respectivamente). La mortalidad de los gazapos al parto y del parto a los 14 días de lactancia fue alta, siendo peor para las conejas NW que para las W (97 vs 40%; P<0.001). Durante la lactancia la temperatura corporal alcanzó su valor máximo para el día 12, y la producción de leche indujo un incremento en la misma (P≤0.025). En conclusión, en nuestras condiciones de estrés térmico y sin importar el tamaño de la jaula, no se recomiendan densidades mayores a 18 conejos/m2 (34 kg/m2) al final del engorde. La productividad de la gestación y la lactancia disminuyen cuando la lactancia es mayor y se suceden varios ciclos reproductivos seguidos. Esto se debe al efecto negativo del estrés térmico sobre la vitalidad y supervivencia del embrión/gazapo. La mejora de la calidad del agua atenuó el efecto negativo del estrés térmico. Las conejas más productoras parece que son aquéllas que consiguen manejar mejor el estrés térmico.

Emission inventories and modeling requirements for the development of air quality plans. Application to Madrid (Spain)

Modeling is an essential tool for the development of atmospheric emission abatement measures and air quality plans. Most often these plans are related to urban environments with high emission density and population exposure. However, air quality modeling in urban areas is a rather challenging task. As environmental standards become more stringent (e.g. European Directive 2008/50/EC), more reliable and sophisticated modeling tools are needed to simulate measures and plans that may effectively tackle air quality exceedances, common in large urban areas across Europe, particularly for NO2. This also implies that emission inventories must satisfy a number of conditions such as consistency across the spatial scales involved in the analysis, consistency with the emission inventories used for regulatory purposes and versatility to match the requirements of different air quality and emission projection models. This study reports the modeling activities carried out in Madrid (Spain) highlighting the atmospheric emission inventory development and preparation as an illustrative example of the combination of models and data needed to develop a consistent air quality plan at urban level. These included a series of source apportionment studies to define contributions from the international, national, regional and local sources in order to understand to what extent local authorities can enforce meaningful abatement measures. Moreover, source apportionment studies were conducted in order to define contributions from different sectors and to understand the maximum feasible air quality improvement that can be achieved by reducing emissions from those sectors, thus targeting emission reduction policies to the most relevant activities. Finally, an emission scenario reflecting the effect of such policies was developed and the associated air quality was modeled.

Making it easy to do the right thing in healthcare: Advancing improvement science education through accredited pan European higher education modules

Background: Numerous international policy drivers espouse the need to improve healthcare. The application of Improvement Science has the potential to restore the balance of healthcare and transform it to a more person-centred and quality improvement focussed system. However there is currently no accredited Improvement Science education offered routinely to healthcare students. This means that there are a huge number of healthcare professionals who do not have the conceptual or experiential skills to apply Improvement Science in everyday practise. Methods: This article describes how seven European Higher Education Institutions (HEIs) worked together to develop four evidence informed accredited inter-professional Improvement Science modules for under and postgraduate healthcare students. It outlines the way in which a Policy Delphi, a narrative literature review, a review of the competency and capability requirements for healthcare professionals to practise Improvement Science, and a mapping of current Improvement Science education informed the content of the modules. Results: A contemporary consensus definition of Healthcare Improvement Science was developed. The four Improvement Science modules that have been designed are outlined. A framework to evaluate the impact modules have in practise has been developed and piloted. Conclusion: The authors argue that there is a clear need to advance healthcare Improvement Science education through incorporating evidence based accredited modules into healthcare professional education. They suggest that if Improvement Science education, that incorporates work based learning, becomes a staple part of the curricula in inter-professional education then it has real promise to improve the delivery, quality and design of healthcare.

Data quality initiatives - striving for continuous improvements

Although managers consider accurate, timely, and relevant information as critical to the quality of their decisions, evidence of large variations in data quality abounds. Over a period of twelve months, the action research project reported herein attempted to investigate and track data quality initiatives undertaken by the participating organisation. The investigation focused on two types of errors: transaction input errors and processing errors. Whenever the action research initiative identified non-trivial errors, the participating organisation introduced actions to correct the errors and prevent similar errors in the future. Data quality metrics were taken quarterly to measure improvements resulting from the activities undertaken during the action research project. The action research project results indicated that for a mission-critical database to ensure and maintain data quality, commitment to continuous data quality improvement is necessary. Also, communication among all stakeholders is required to ensure common understanding of data quality improvement goals. The action research project found that to further substantially improve data quality, structural changes within the organisation and to the information systems are sometimes necessary. The major goal of the action research study is to increase the level of data quality awareness within all organisations and to motivate them to examine the importance of achieving and maintaining high-quality data.

Managing healthcare quality using combined SWOT and the analytic process

Improving healthcare quality is a growing need of any society. Although various quality improvement projects are routinely deployed by the healthcare professional, they are characterised by a fragmented approach, i.e. they are not linked with the strategic intent of the organisation. This study introduces a framework which integrates all quality improvement projects with the strategic intent of the organisation. It first derives the strengths, weaknesses, opportunities and threats (SWOT) matrix of the system with the involvement of the concerned stakeholders (clinical professional), which helps identify a few projects, the implementation of which ensures achievement of desired quality. The projects are then prioritised using the analytic hierarchy process with the involvement of the concerned stakeholders (clinical professionals) and implemented in order to improve system performance. The effectiveness of the method has been demonstrated using a case study in the intensive care unit of Queen Elizabeth Hospital in Bridgetown, Barbados.

Managing healthcare quality in project management framework

Healthcare professionals routinely deploy various quality management tools and techniques in order to improve performance of healthcare delivery. However, they are characterised by fragmented approach i.e., they are not linked with the strategic intent of the organisation. This study introduces a holistic quality improvement method, which integrates all quality improvement projects with the strategic intent of the healthcare organisations. It first identifies a healthcare system and its environment. The Strengths, Weaknesses, Opportunities and Threats (SWOT) of the system are then derived with the involvement of the concerned stakeholders. This leads to developing the strategies in order to satisfy customers in line with the organisation's competitive position. These strategies help identify a few projects, the implementation of which ensures achievement of desired quality. The projects are then prioritised with the involvement of the concerned stakeholders and implemented in order to improve the system performance. The effectiveness of the method has been demonstrated using a case study of an intensive care unit at the Eric Williams Medical Sciences Complex Hospital in Trinidad. Copyright © 2007 Inderscience Enterprises Ltd.

Managing healthcare quality using logical framework analysis

Purpose - The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance. Design/methodology/approach - This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps - problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case-study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended. Practical implications - The proposed model can be implemented in hospital-based healthcare services in order to improve performance. It may also be applied to other services. Originality/value - Quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services. © Emerald Group Publishing Limited.