The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study

BACKGROUND: Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST). METHODS: In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression. RESULTS: In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST. CONCLUSIONS: The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

Service employee behaviour : the role of compliance and risk taking

This paper looks at the decision-making process that determines the amount of effort frontline service employees will expend in delivering a service in a business-to-business context. Using theories in behavioural economics and interactional and social psychology, the paper develops and presents a model of employee decision-making. Managerial implications, which have the potential to enhance the marketing of business-to-business services and directions for future research in this area, are indicated.

A requirements framework for semantic business process modelling

The emergence of semantic technologies to deal with the underlying meaning of things, instead of a purely syntactical representation, has led to new developments in various fields, including business process modeling. Inspired by artificial intelligence research, technologies for semantic Web services have been proposed and extended to process modeling. However, the applicablility of semantic Web services for semantic business processes is limited because business processes encompass wider requirements of business than Web services. In particular, processes are concerned with the composition of tasks, that is, in which order activities are carried out, regardless of their implementation details; resources assigned to carry out tasks, such as machinery, people, and goods; data exchange; and security and compliance concerns.

The GST Compliance Costs Of Nonprofit Organisations

On 2 December 1998, the Federal Government tabled their policy paper entitled Regulation Impact Statement for the Introduction of a Goods and Services Tax (RIS) in the House of Representatives. The Federal Government predicted that total gross GST compliance costs to Australian businesses in the first year of implementation would be approximately $1,912 million (or $1,195 per firm). Furthermore, it is estimated that the recurrent net compliance costs will be much lower at $131 per firm. Whilst the government made brief references to charitable organisations in their analysis, it stated that the compliance costs faced by nonprofits would, in substance, be no different to the compliance costs faced by businesses or government departments. This paper examines the RIS process in relation to nonprofit organisations in the context of recent taxation legislation affecting nonprofit organisations. It argues that the assumption that nonprofit compliance costs are similar to government and business costs is flawed and makes a case for the RIS process to be reformed to include more appropriate assessments of the impact of legislation on nonprofit enterprises.

Automated support for versioning compliance checking between workflow management and product lifecycle management (in Chinese)

With the development of enterprise informatisation, Product Lifecycle Management (PLM) systems have been widely deployed and applied in enterprises. This paper analyzes the requirement that conducting version operations on business objects as specified in process models should be compliant with the versioning policies imposed by product lifecycles. This leads to the introduction of the concept of versioning compliance, and the approach of compliance checking that we proposed in our earlier work, which comprises both syntactical compatibility and behavioural compatibility checking. The paper then focuses on the tool implementation for providing automated support to the versioning compliance checking. An empirical evaluation of the tool was also performed with industrial partners using the well-known questionnaire-based method. The evaluation and feedback from practitioners further evidence the practical significance of this research question in the PLM field and demonstrate that the proposed solution with its automated tool support possesses a high application potential.

Effects of average speed enforcement on speed compliance and crashes : a review of the literature

Average speed enforcement is a relatively new approach gaining popularity throughout Europe and Australia. This paper reviews the evidence regarding the impact of this approach on vehicle speeds, crashes rates and a number of additional road safety and public health outcomes. The economic and practical viability of the approach as a road safety countermeasure is also explored. A literature review, with an international scope, of both published and grey literature was conducted. There is a growing body of evidence to suggest a number of road safety benefits associated with average speed enforcement, including high rates of compliance with speed limits, reductions in average and 85th percentile speeds and reduced speed variability between vehicles. Moreover, the approach has been demonstrated to be particularly effective in reducing excessive speeding behaviour. Reductions in crash rates have also been reported in association with average speed enforcement, particularly in relation to fatal and serious injury crashes. In addition, the approach has been shown to improve traffic flow, reduce vehicle emissions and has also been associated with high levels of public acceptance. Average speed enforcement offers a greater network-wide approach to managing speeds that reduces the impact of time and distance halo effects associated with other automated speed enforcement approaches. Although comparatively expensive it represents a highly reliable approach to speed enforcement that produces considerable returns on investment through reduced social and economic costs associated with crashes.

How to guarantee compliance between workflows and product lifecycles?

Product Lifecycle Management (PLM) systems are widely used in the manufacturing industry. A core feature of such systems is to provide support for versioning of product data. As workflow functionality is increasingly used in PLM systems, the possibility emerges that the versioning transitions for product objects as encapsulated in process models do not comply with the valid version control policies mandated in the objects’ actual lifecycles. In this paper we propose a solution to tackle the (non-)compliance issues between processes and object version control policies. We formally define the notion of compliance between these two artifacts in product lifecycle management and then develop a compliance checking method which employs a well-established workflow analysis technique. This forms the basis of a tool which offers automated support to the proposed approach. By applying the approach to a collection of real-life specifications in a main PLM system, we demonstrate the practical applicability of our solution to the field.

Regulatory compliance as a means to achieve environmental sustainability at some large coastal developments in Queensland

The growing public concern about the complexity, cost and uncertain efficacy of the statuary environmental impact assessment process applying to large-scale projects in Queensland is reviewed. This is based on field data gathered over the past six years sat large-scale marina developments that access major environmental reserves along the coast. An ecological design proposal to broaden the process consisted with both government aspirations and regional ecological parameters - termed Regional Landscape Strategies - would allow the existing Environmental Impact Asessment to be modified alone potentially more practicable and effective lines.

Vertical alignment of process models – how can we get there?

There is a wide variety of drivers for business process modelling initiatives, reaching from business evolution and process optimisation over compliance checking and process certification to process enactment. That, in turn, results in models that differ in content due to serving different purposes. In particular, processes are modelled on different abstraction levels and assume different perspectives. Vertical alignment of process models aims at handling these deviations. While the advantages of such an alignment for inter-model analysis and change propagation are out of question, a number of challenges has still to be addressed. In this paper, we discuss three main challenges for vertical alignment in detail. Against this background, the potential application of techniques from the field of process integration is critically assessed. Based thereon, we identify specific research questions that guide the design of a framework for model alignment.

A Tobit model for analyzing speed limit compliance in work zones

Poor compliance with speed limits is a serious safety concern in work zones. Most studies of work zone speeds have focused on descriptive analyses and statistical testing without systematically capturing the effects of vehicle and traffic characteristics. Consequently, little is known about how the characteristics of surrounding traffic and platoons influence speeds. This paper develops a Tobit regression technique for innovatively modeling the probability and the magnitude of non-compliance with speed limits at various locations in work zones. Speed data is transformed into two groups—continuous for non-compliant and left-censored for compliant drivers—to model in a Tobit model framework. The modeling technique is illustrated using speed data from three long-term highway work zones in Queensland, Australia. Consistent and plausible model estimates across the three work zones support the appropriateness and validity of the technique. The results show that the probability and magnitude of speeding was higher for leaders of platoons with larger front gaps, during late afternoon and early morning, when traffic volumes were higher, and when higher proportions of surrounding vehicles were non-compliant. Light vehicles and their followers were also more likely to speed than others. Speeding was more common and greater in magnitude upstream than in the activity area, with higher compliance rates close to the end of the activity area and close to stop/slow traffic controllers. The modeling technique and results have great potential to assist in deployment of appropriate countermeasures by better identifying the traffic characteristics associated with speeding and the locations of lower compliance.

The desirability of depoliticization: Compliance in the international climate regime

The Kyoto Protocol is remarkable among global multilateral environmental agreements for its efforts to depoliticize compliance. However, attempts to create autonomous, arm’s length and rule-based compliance processes with extensive reliance on putatively neutral experts were only partially realized in practice in the first commitment period from 2008 to 2012. In particular, the procedurally constrained facilitative powers vested in the Facilitative Branch were circumvented, and expert review teams (ERTs) assumed pivotal roles in compliance facilitation. The ad hoc diplomatic and facilitative practices engaged in by these small teams of technical experts raise questions about the reliability and consistency of the compliance process. For the future operation of the Kyoto compliance system, it is suggested that ERTs should be confined to more technical and procedural roles, in line with their expertise. There would then be greater scope for the Facilitative Branch to assume a more comprehensive facilitative role, safeguarded by due process guarantees, in accordance with its mandate. However, if – as appears likely – the future compliance trajectories under the United Nations Framework Convention on Climate Change will include a significant role for ERTs without oversight by the Compliance Committee, it is important to develop appropriate procedural safeguards that reflect and shape the various technical and political roles these teams currently play.

A process mining-based investigation of adverse events in care processes

This paper proposes the Clinical Pathway Analysis Method (CPAM) approach that enables the extraction of valuable organisational and medical information on past clinical pathway executions from the event logs of healthcare information systems. The method deals with the complexity of real-world clinical pathways by introducing a perspective-based segmentation of the date-stamped event log. CPAM enables the clinical pathway analyst to effectively and efficiently acquire a profound insight into the clinical pathways. By comparing the specific medical conditions of patients with the factors used for characterising the different clinical pathway variants, the medical expert can identify the best therapeutic option. Process mining-based analytics enables the acquisition of valuable insights into clinical pathways, based on the complete audit traces of previous clinical pathway instances. Additionally, the methodology is suited to assess guideline compliance and analyse adverse events. Finally, the methodology provides support for eliciting tacit knowledge and providing treatment selection assistance.

The process for implementation of a Quality Management System within a multi-functional cereal laboratory

The intent of this study was to design, document and implement a Quality Management System (QMS) into a laboratory that incorporated both research and development (R&D) and routine analytical activities. In addition, it was necessary for the QMS to be easily and efficiently maintained to: (a) provide documented evidence that would validate the system's compliance with a certifiable standard, (b) fit the purpose of the laboratory, (c) accommodate prevailing government policies and standards, and (d) promote positive outcomes for the laboratory through documentation and verification of the procedures and methodologies implemented. Initially, a matrix was developed that documented the standards' requirements and the necessary steps to be made to meet those requirements. The matrix provided a check mechanism on the progression of the system's development. In addition, it was later utilised in the Quality Manual as a reference tool for the location of full procedures documented elsewhere in the system. The necessary documentation to build and monitor the system consisted of a series of manuals along with forms that provided auditable evidence of the workings of the QMS. Quality Management (QM), in one form or another, has been in existence since the early 1900's. However, the question still remains: is it a good thing or just a bugbear? Many of the older style systems failed because they were designed by non-users, fiercely regulatory, restrictive and generally deemed to be an imposition. It is now considered important to foster a sense of ownership of the system by the people who use the system. The system's design must be tailored to best fit the purpose of the operations of the facility if maximum benefits to the organisation are to be gained.

A method and tool for 'cradle to grave' embodied carbon and energy impacts of UK buildings in compliance with the new TC350 standards

As operational impacts from buildings are reduced, embodied impacts are increasing. However, the latter are seldom calculated in the UK; when they are, they tend to be calculated after the building has been constructed, or are underestimated by considering only the initial materials stage. In 2010, the UK Government recommended that a standard methodology for calculating embodied impacts of buildings be developed for early stage design decisions. This was followed in 2011-12 by the publication of the European TC350 standards defining the 'cradle to grave' impact of buildings and products through a process Life Cycle Analysis. This paper describes a new whole life embodied carbon and energy of buildings (ECEB) tool, designed as a usable empirical-based approach for early stage design decisions for UK buildings. The tool complies where possible with the TC350 standards. Initial results for a simple masonry construction dwelling are given in terms of the percentage contribution of each life cycle stage. The main difficulty in obtaining these results is found to be the lack of data, and the paper suggests that the construction and manufacturing industries now have a responsibility to develop new data in order to support this task. © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

Revisioning assessment through a children’s rights approach: implications for policy, process and practice

The linkage between the impact of assessment and compliance with children’s rights is a connection, which although seemingly obvious, is nonetheless rarely made, particularly by governments, which, as signatories to the relevant human rights treaties, have the primary responsibility for ensuring that educational practice is compatible with international children’s rights standards. While some jurisdictions are explicit about an adherence to children’s rights frameworks in general policy documentation, such a commitment rarely features when the focus is on assessment and testing. Thus, in spite of significant public and academic attention given to the consequences of assessment for children and governments committed to working within children’s rights standards, the two are rarely considered together. This paper examines the implications for the policy, process and practice of assessment in light of international human rights standards. Three key children’s rights principles and standards are used as a critical lens to examine assessment policy and practice: (1) best interests; (2) non-discrimination; and (3) participation. The paper seeks new insights into the complexities of assessment practice from the critical perspective of children’s rights and argues that such standards not only provide a convenient benchmark for developing, implementing and evaluating assessment practices, but also acknowledge the significance of assessment in the delivery of children’s rights to, in and through education more generally.