Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

Purpose – The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A&E) unit of a Maltese hospital. Design/methodology/approach – The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients’ requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A&E unit of the hospital. Findings – The major and related problems being faced by the hospital under study were overcrowding at A&E and shortage of beds, respectively. The combined framework ensures better A&E services and patient flow. QFD identifies and analyses the issues and challenges of A&E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A&E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A&E unit. Practical/implications – The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Originality/value – Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A&E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

The experiences of con sultations on oral anticoagula-tion for AF:the importance of qualitative research incardiovascular sciences

Objectives: Multiple-perspective qualitative designs can aid researchersto develop a more multifaceted account of a phenomenon and as aform of triangulation of data. Two interlinking studies aimed toexplore patients’ and physicians’ experiences of atrial fibrillation (AF)and warfarin.Methods: Audio-recorded semistructured individual interviews wereused. Study 1: Three AF patient subgroups were interviewed (n = 11);accepted, refused, or discontinued warfarin. Study 2: Four physiciansubgroups (n = 16): consultant cardiologists, consultant general physi-cians, general practitioners, and cardiology registrars. Data was ana-lyzed using interpretative phenomenological analysis, a qualitativemethodology.Results: Study 1: Three overarching themes comprised patients’ experi-ences: the initial consultation, life after the consultation, and patients’reflections. Patients commented on the reassurance experienced duringthe consultation, but they perceived the decision-making processmostly led by the physician. Lack of education and take-home materi-als during the initial consultation were highlighted. Patients’ uptake ofinformation was influenced by past experiences and knowledge ofstroke and/or bleeding. Study 2: Two overarching themes covered phy-sicians’ experiences: communicating information and challenges withwarfarin prescription for AF. Physicians’ approach to the consultationstyle shifted through a continuum of compliance-adherence-concor-dance during the consultation. Time and the perceived patient trust inthem as the expert led to physicians to adopt a paternalistic approach.Guideline adherence and the need to adopt a multidisciplinaryapproach were pointed out as current challenges.Conclusion: There is a need to target patients’ and physicians’ abilityto communicate with each other in a comprehensible way. This projecthas illustrated the benefit of using a qualitative approach to under-stand the lived experience of the physician–patient consultation.Disclosure of Interest: None declare

Environmental Management Accounting - Estimating the Benefit Side

The presentation focuses on estimating benefits of environmental projects and achievements like image improvement, gaining an environmental award, profit from environmentally benign products, risk reduction benefits, etc. The paper integrates the results and experience gained in three different fields: EMA, evaluation of natural resources and working as a consultant

Development and Application of a Methodology to Identify Projects of Energy Community Interest

Projects of Energy Community Interest” (PECIs) is a label attached to those projects which have the highest positive impact in the largest possible number of Contracting Parties. The assessment of one hundred projects submitted as candidates, and final selection of 35 PECIs was achieved in a collaborative process undertaken by the same Task Force that contributed to the preparation of the Energy Strategy. Chaired by the European Commission, the Task Force was facilitated by the Energy Community Secretariat and benefited from technical assistance of a Consultant sponsored from the Energy Community budget.

Cuba’s Role in Venezuela’s Control of the Internet and Online Social Networks

The arrival of Cuba’s Information Technology (IT) and Communications Minister Ramiro Valdés to Venezuela in the Spring of 2010 to serve as a ‘consultant’ to the Venezuelan government awakened a new reality in that country. Rampant with deep economic troubles, escalating crime, a murder rate that has doubled since Chávez took over in 1999, and an opposition movement led by university students and other activists who use the Internet as their primary weapon, Venezuela has resorted to Cuba for help. In a country where in large part traditional media outlets have been censored or are government-controlled, the Internet and its online social networks have become the place to obtain, as well as disseminate, unfiltered information. As such, Internet growth and use of its social networks has skyrocketed in Venezuela, making it one of Latin America’s highest Web users. Because of its increased use to spark political debate among Venezuelans and publish information that differs with the official government line, Chávez has embarked on an initiative to bring the Internet to the poor and others who would otherwise not have access, by establishing government-sponsored Internet Info Centers throughout the country, to disseminate information to his followers. With the help of Cuban advisors, who for years have been a part of Venezuela’s defense, education, and health care initiatives, Chávez has apparently taken to adapting Cuba’s methodology for the control of information. He has begun to take special steps toward also controlling the type of information flowing through the country’s online social networks, considering the implementation of a government-controlled single Internet access point in Venezuela. Simultaneously, in adapting to Venezuela’s Internet reality, Chávez has engaged online by creating his own Twitter account in an attempt to influence public opinion, primarily of those who browse the Web. With a rapidly growing following that may soon reach one million subscribers, Chávez claims to have set up his own online trench to wage cyber space battle.

Take the "Con" Out of Consulting in the Food Service Industry

Consultants can help a food service operator with almost any problem which needs solving. Howeve6 the manager must "manage" the consultant. The author offers a design for planning for hiring and evaluating the work of anyone given the job of analyzing existing systems and diagnosing problems.

Toward A Better Understanding of the Evolution of Hotel Development: A Discussion of Product-specific Lodging Demand

In his essay - Toward a Better Understanding of the Evolution of Hotel Development: A Discussion of Product-Specific Lodging Demand - by John A. Carnella, Consultant, Laventhol & Horwath, cpas, New York, Carnella initially describes his piece by stating: “The diversified hotel product in the united states lodging market has Resulted in latent room-night demand, or supply-driven demand resulting from the introduction of a lodging product which caters to a specific set of hotel patrons. The subject has become significant as the lodging market has moved toward segmentation with regard to guest room offerings. The author proposes that latent demand is a tangible, measurable phenomenon best understood in light of the history of the guest room product from its infancy to its present state.” The article opens with an ephemeral depiction of hotel development in the United States, both pre’ and post World War II. To put it succinctly, the author wants you to know that the advent of the inter-state highway system changed the complexion of the hotel industry in the U.S. “Two essential ingredients were necessary for the next phase of hotel development in this country. First was the establishment of the magnificently intricate infrastructure which facilitated motor vehicle transportation in and around the then 48 states of the nation,” says Carnella. “The second event…was the introduction of affordable highway travel. Carnella goes on to say that the next – big thing – in hotel evolution was the introduction of affordable air travel. “With the airways filled with potential lodging guests, developers moved next to erect a new genre of hotel, the airport hotel,” Carnella advances his picture. Growth progressed with the arrival of the suburban hotel concept, which wasn’t fueled by developments in transportation, but by changes in people’s living habits, i.e. suburban affiliations as opposed to urban and city population aggregates. The author explores the distinctions between full-service and limited service lodging operations. “The market of interest with consideration to the extended-stay facility is one dominated by corporate office parks,” Carnella proceeds. These evolutional states speak to latent demand, and even further to segmentation of the market. “Latent demand… is a product-generated phenomenon in which the number of potential hotel guests increases as the direct result of the introduction of a new lodging facility,” Carnella brings his unique insight to the table with regard to the specialization process. The demand is already there; just waiting to be tapped. In closing, “…there must be a consideration of the unique attributes of a lodging facility relative to its ability to attract guests to a subject market, just as there must be an examination of the property's ability to draw guests from within the subject market,” Carnella proposes.

Occupational therapists as consultants in Florida schools : a survey

Little research has been done on how well prepared occupational therapists feel to perform the role of consultant. This study investigated the perceptions of occupational therapists acting as consultants in Florida schools, how much education/training they have received and how they perceive their consultation skills. Participants in the study were sent a questionnaire and measures of central tendency were calculated on each item. Crosstabulations using Fisher's exact test were completed to investigate any relationship between type of consultation model used and relationships with educators. A one way ANOVA was conducted to investigate any relationship between self-perceived consultant skills and age, amount of experience, and training. The results indicate that occupational therapists providing consultative services rate their abilities as more than adequate and believe formal training in consultation is only mildly important. No significant relationships were found between training and skills or model used and relationships with educators.

Gestão de recursos hídricos: governança e gerenciamento de conflitos pelo uso da água em região do Semiárido Nordestino

The water being vital natural resource and factor of economic and social development requires effective management and protection by the State. This thesis examines the panorama of National Water Resources Policy and the establishment of an effectively integrated management, shared and participative, contextualizing the principles foreseen in the policy. The work is focused on the discussion of public policies of access to water, analyzing the Fresh Water Program in semi-arid region of Brazil as a strategy of coexistence and permanence of a public policy that ensures the priority use, which is for human consumption. The conceptual framework of this study relies primarily on the contributions of authors in the field recognized as governance and water management. A study on the process of implementation of the various "institutions and policies" related to water management was promoted, contextualizing the change of paradigm in the transition from the centralized model to the one that takes into account the social participation, opening in this way broader perspectives for the analysis of the contents and of the impacts of these policies. The development of this study was conducted by the follow-up – both face-to-face as documentary-field – of the activities carried out while consultant of the Fresh Water Program. The history of water management in the semi-arid region was studied, depicting conflict movements and cooperation among actors. Despite the great obstacles to accomplish the shared and decentralized management, the study of this thesis points to a gradual improvement in the formulation of public policies that take into consideration governance and participatory management of water resources, with positive prospects towards the implementation of coordinated and cooperative actions in the region that mainly suffers from the shortage of rainfall, hence of shortage of water for irrigation and human consumption

Integração da simulação termoenergética com o processo de projeto: a análise de 6 casos

This work consists of the integrated design process analyses with thermal energetic simulation during the early design stages, based on six practical cases. It aims to schematize the integration process, identifying the thermal energetic analyses contributions at each design phase and identifying the highest impact parameters on building performance. The simulations were run in the DesignBuilder energy tool, which has the same EnergyPlus engine, validated. This tool was chosen due to the flexible and user friendly graphic interface for modeling and output assessment, including the parametric simulation to compare design alternatives. The six case studies energy tools are three architectural and three retrofit projects, and the author the simulations as a consultant or as a designer. The case studies were selected based on the commitment of the designers in order to achieve performance goals, and their availability to share the process since the early pre-design analyses, allowing schematizing the whole process, and supporting the design decisions with quantifications, including energy targets. The thermoenergetic performance analyses integration is feasible since the early stages, except when only a short time is available to run the simulations. The simulation contributions are more important during the sketch and detail phases. The predesign phase can be assisted by means of reliable bioclimatic guidelines. It was verified that every case study had two dominant design variables on the general performance. These variables differ according the building characteristics and always coincide with the local bioclimatic strategies. The adaptation of alternatives to the design increases as earlier it occurs. The use of simulation is very useful: to prove and convince the architects; to quantify the cost benefits and payback period to the retrofit designer; and to the simulator confirm the desirable result and report the performance to the client

Right Ventricular Involvement and Recovery after Acute Stress-Induced (Tako-tsubo) Cardiomyopathy

We would like to thank all NHS Consultant Colleagues at Aberdeen Royal Infirmary for their help with prompt recruitment of these patients (Dr M Metcalfe, Dr AD Stewart, Dr A Hannah, Dr A Noman, Dr P Broadhurst, Dr D Hogg, Dr D Garg) and to Dr Gordon Prescott for help and advice with the Statistical Methods.

In and out of Africa

"During the colonial period in the 1920's, European interest in collecting African art stimulated a transnational trade between Africa and the West. Today this multi-million dollar trade lies largely in the hands of Muslim merchants. This is a story about Gabai Baare, a merchant who brings 'wood' from West Africa to sell in the United States. It is a story about the meaning of art"--Opening credits.

The spiritual and professional impact of stillbirth

Stillbirth is without question one of the most devastating experiences of grief for parents and families. The death of a baby is also a distressing experience for healthcare professionals who share hopes of a live healthy baby at the end of pregnancy. It is a sad reality however, that in Ireland one in 238 babies will die before birth. The creation and nurture of new life in pregnancy is a spiritual experience as a new baby is at the same time experienced and anticipated. There is little in the published literature concerning the spiritual impact of stillbirth on healthcare chaplains who are the main providers of spiritual care for parents and staff colleagues in Irish maternity units. In addition there are few qualitative studies that explore the impact of stillbirth on consultant obstetricians and no published studies on the spiritual impact of stillbirth on bereaved parents. This study explored the spiritual and professional impact of stillbirth on Irish maternity healthcare chaplains, consultant obstetricians and bereaved parents. Following an overall review of spiritual care provision following stillbirth in the Irish maternity services, thematic analysis was used in the first phase of the study following in-depth interviews with maternity healthcare chaplains. Interpretative Phenomenological Analysis was used in the second and third phases with consultant obstetricians and bereaved parents respectively. The data from both maternity healthcare chaplains and consultant obstetricians revealed that stillbirth posed immense personal, spiritual and professional challenges. Chaplains expressed the spiritual and professional impact of stillbirth in terms of perception of their role, suffering, doubt and presence as they provided care for bereaved parents. A review of spiritual care provision in the Irish maternity services revealed a diversity of practice. The data from consultant obstetricians identified considerable personal, professional and spiritual impact following stillbirth that was identified in superordinate themes of human response to stillbirth, weight of professional responsibility, conflict of personal faith and incongruence between personal faith and professional practice. Data from bereaved parents revealed that stillbirth was spiritually challenging and all parents expressed that stillbirth posed considerable challenge to their faith/ belief structure. The parents of only three babies felt that their spiritual needs were adequately addressed while in hospital. The data had six superordinate themes of searching for meaning, maintaining hope, importance of personhood, protective care, questioning core beliefs and relationships. Other findings from the data from bereaved parents outlined the importance of environment of care and communication. This study has revealed the immense impact of stillbirth on healthcare chaplains, consultant obstetricians and most especially the spiritual impact for bereaved parents. Recommendations are made for improvements in clinical and spiritual care for bereaved parents following stillbirth and for staff wellbeing and support initiatives. Further research areas are recommended in the areas of spiritual care, theological reflection, bereavement care, post-mortem consent procedures and staff wellbeing.

Simulating Business Processes of Manufacturing SMEs on the Cloud

Simulating the efficiency of business processes could reveal crucial bottlenecks for manufacturing companies and could lead to significant optimizations resulting in decreased time to market, more efficient resource utilization, and larger profit. While such business optimization software is widely utilized by larger companies, SMEs typically do not have the required expertise and resources to efficiently exploit these advantages. The aim of this work is to explore how simulation software vendors and consultancies can extend their portfolio to SMEs by providing business process optimization based on a cloud computing platform. By executing simulation runs on the cloud, software vendors and associated business consultancies can get access to large computing power and data storage capacity on demand, run large simulation scenarios on behalf of their clients, analyze simulation results, and advise their clients regarding process optimization. The solution is mutually beneficial for both vendor/consultant and the end-user SME. End-user companies will only pay for the service without requiring large upfront costs for software licenses and expensive hardware. Software vendors can extend their business towards the SME market with potentially huge benefits.