Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

Combination of product quality management and exports: The case of Colombian fruits companies

Quality management provides to companies a framework to improve quality in overall systems, reduction of costs, reallocation of resources efficiently, correct planning of strategies, prevent or correct errors in the right time and increase the performance of companies. In this text, we discuss the different theories in this field, their obligatory or non-obligatory compliance, the importance of quality management for exporting companies and a case study of a Colombian firm that its main objective is to manage quality. In conclusion, we find out that there is different types of quality management systems such as Juran’s trilogy, Deming 14 points, Six sigma, HACCP, and so on; also that companies have to manage suppliers and that quality has a positive influence on exports volume; in the case of Colombian small and medium enterprises, it can be mentioned that the majority has implemented tools regarding quality management but is not enough.

Power flow forecasting and smart charging for electric vehicle charging systems with photovoltaic integration

An essential role in the global energy transition is attributed to Electric Vehicles (EVs) the energy for EV traction can be generated by renewable energy sources (RES), also at a local level through distributed power plants, such as photovoltaic (PV) systems. However, EV integration with electrical systems might not be straightforward. The intermittent RES, combined with the high and uncontrolled aggregate EV charging, require an evolution toward new planning and paradigms of energy systems. In this context, this work aims to provide a practical solution for EV charging integration in electrical systems with RES. A method for predicting the power required by an EV fleet at the charging hub (CH) is developed in this thesis. The proposed forecasting method considers the main parameters on which charging demand depends. The results of the EV charging forecasting method are deeply analyzed under different scenarios. To reduce the EV load intermittency, methods for managing the charging power of EVs are proposed. The main target was to provide Charging Management Systems (CMS) that modulate EV charging to optimize specific performance indicators such as system self-consumption, peak load reduction, and PV exploitation. Controlling the EV charging power to achieve specific optimization goals is also known as Smart Charging (SC). The proposed techniques are applied to real-world scenarios demonstrating performance improvements in using SC strategies. A viable alternative to maximize integration with intermittent RES generation is the integration of energy storage. Battery Energy Storage Systems (BESS) may be a buffer between peak load and RES production. A sizing algorithm for PV+BESS integration in EV charging hubs is provided. The sizing optimization aims to optimize the system's energy and economic performance. The results provide an overview of the optimal size that the PV+BESS plant should have to improve whole system performance in different scenarios.

Development and testing of methodologies for the control and diagnosis of innovative combustion systems

In pursuit of aligning with the European Union's ambitious target of achieving a carbon-neutral economy by 2050, researchers, vehicle manufacturers, and original equipment manufacturers have been at the forefront of exploring cutting-edge technologies for internal combustion engines. The introduction of these technologies has significantly increased the effort required to calibrate the models implemented in the engine control units. Consequently the development of tools that reduce costs and the time required during the experimental phases, has become imperative. Additionally, to comply with ever-stricter limits on 〖"CO" 〗_"2" emissions, it is crucial to develop advanced control systems that enhance traditional engine management systems in order to reduce fuel consumption. Furthermore, the introduction of new homologation cycles, such as the real driving emissions cycle, compels manufacturers to bridge the gap between engine operation in laboratory tests and real-world conditions. Within this context, this thesis showcases the performance and cost benefits achievable through the implementation of an auto-adaptive closed-loop control system, leveraging in-cylinder pressure sensors in a heavy-duty diesel engine designed for mining applications. Additionally, the thesis explores the promising prospect of real-time self-adaptive machine learning models, particularly neural networks, to develop an automatic system, using in-cylinder pressure sensors for the precise calibration of the target combustion phase and optimal spark advance in a spark-ignition engines. To facilitate the application of these combustion process feedback-based algorithms in production applications, the thesis discusses the results obtained from the development of a cost-effective sensor for indirect cylinder pressure measurement. Finally, to ensure the quality control of the proposed affordable sensor, the thesis provides a comprehensive account of the design and validation process for a piezoelectric washer test system.

Simulation of Soil Carbon Dynamics under Sugarcane with the CENTURY Model

Currently there is a trend for the expansion of the area cropped with sugarcane (Saccharum officinarum L.), driven by an increase in the world demand for biofuels, due to economical, environmental, and geopolitical issues. Although sugarcane is traditionally harvested by burning dried leaves and tops, the unburned, mechanized harvest has been progressively adopted. The use of process based models is useful in understanding the effects of plant litter in soil C dynamics. The objective of this work was to use the CENTURY model in evaluating the effect of sugarcane residue management in the temporal dynamics of soil C. The approach taken in this work was to parameterize the CENTURY model for the sugarcane crop, to simulate the temporal dynamics of soil C, validating the model through field experiment data, and finally to make predictions in the long term regarding soil C. The main focus of this work was the comparison of soil C stocks between the burned and unburned litter management systems, but the effect of mineral fertilizer and organic residue applications were also evaluated. The simulations were performed with data from experiments with different durations, from 1 to 60 yr, in Goiana and Timbauba, Pernambuco, and Pradopolis, Sao Paulo, all in Brazil; and Mount Edgecombe, Kwazulu-Natal, South Africa. It was possible to simulate the temporal dynamics of soil C (R(2) = 0.89). The predictions made with the model revealed that there is, in the long term, a trend for higher soil C stocks with the unburned management. This increase is conditioned by factors such as climate, soil texture, time of adoption of the unburned system, and N fertilizer management.

Performance analysis of a single-user MISO ultra-wideband time reversal system with DFE

This paper presents an analysis of the performance of a baseband multiple-input single-output (MISO) time reversal ultra-wideband system (TR-UWB) incorporating a symbol spaced decision feedback equalizer (DFE). A semi-analytical performance analysis based on a Gaussian approach is considered, which matched well with simulation results, even for the DFE case. The channel model adopted is based on the IEEE 802.15.3a model, considering correlated shadowing across antenna elements. In order to provide a more realistic analysis, channel estimation errors are considered for the design of the TR filter. A guideline for the choice of equalizer length is provided. The results show that the system`s performance improves with an increase in the number of transmit antennas and when a symbol spaced equalizer is used with a relatively small number of taps compared to the number of resolvable paths in the channel impulse response. Moreover, it is possible to conclude that due to the time reversal scheme, the error propagation in the DFE does not play a role in the system`s performance.

An object-oriented neural network approach to short-term traffic forecasting

This paper discusses an object-oriented neural network model that was developed for predicting short-term traffic conditions on a section of the Pacific Highway between Brisbane and the Gold Coast in Queensland, Australia. The feasibility of this approach is demonstrated through a time-lag recurrent network (TLRN) which was developed for predicting speed data up to 15 minutes into the future. The results obtained indicate that the TLRN is capable of predicting speed up to 5 minutes into the future with a high degree of accuracy (90-94%). Similar models, which were developed for predicting freeway travel times on the same facility, were successful in predicting travel times up to 15 minutes into the future with a similar degree of accuracy (93-95%). These results represent substantial improvements on conventional model performance and clearly demonstrate the feasibility of using the object-oriented approach for short-term traffic prediction. (C) 2001 Elsevier Science B.V. All rights reserved.

Crisis, change, and institutions in forest management: the Wet Tropics of northeastern Australia

This paper tests the four-phase heuristic model of change in resource management regimes developed by Gunderson et al. (1995. In: Barriers and Bridges to the Renewal of Ecosystems and Institutions. Columbia University Press, New York, pp. 489-533) by applying it to a case analysis of rainforest management in northeastern Australia. The model suggests that resource management regimes change in four phases: (i) crisis caused by external factors, (ii) a search for alternative management solutions, (iii) creation of a new management regime, and (iv) bureaucratic implementation of the new arrangements. The history of human use arid management of the tropical forests of this region is described and applied to this model. The ensuing analysis demonstrates that: (i) resource management tends to be characterized by a series of distinct eras; (ii) changes to management regimes are precipitated by crisis; and (iii) change is externally generated. The paper concludes by arguing that this theoretical perspective oil institutional change in resource management systems has wider utility. (C) 2002 Elsevier Science Ltd. All rights reserved.

Field hydraulic properties of an Alfisol under various fallow systems in southwestern Nigeria

The effects of various fallow management systems and cropping intensities on water infiltration were measured on an Alfisol at Ibadan in southwestern Nigeria. The objective was to determine the influence of the land use systems (a combination of crop-fallow sequences and intercropping types) on soil hydraulic properties obtained by disc permeameter and double-ring infiltration measurements. The experiment was established in 1989 as a split-plot design with four replications. The main plots were natural fallow, planted Pueraria phaseoloides and planted Leucaena leucocephala. The subplots were 1 year of maize/cassava intercrop followed by 3-year fallow (25% cropping intensity), or 2-year fallow (33% cropping intensity), or 1-year fallow (50% cropping intensity), or no fallow period (100% cropping intensity). Water infiltration rates and sorptivities were measured under saturated and unsaturated flow. Irrespective of land use, infiltration rates at the soil surface (121-324 cm h(-1)) were greater than those measured at 30 cm depth (55-144 cm h(-1)). This indicated that fewer large pores were present below 30 cm depth compared with 0-30 cm, depth. Despite some temporal variation, sorptivities with the highest mean value of 93.5 cm h(-1/2) increased as the cropping intensity decreased, suggesting a more continuous macropore system under less intensive land use systems. This was most likely due to continuous biopores created by perennial vegetation under long fallow systems. Intercropped maize and cassava yields also increased as cropping intensity decreased. The weak relationship between crop yields and hydraulic conductivity/infiltration rates suggests that the rates were not limiting.

A gest??o de pessoas como um recurso estrat??gico

O texto examina as estrat??gias e os sistemas que devem ser considerados para se alcan??ar a melhor gest??o de recursos humanos no setor p??blico. Inicialmente, baseado em tr??s modelos tradicionais de administra????o p??blica, sugere uma abordagem hol??stica para aumentar a efetividade da gest??o. Em seguida, defende a id??ia de um ??rg??o ???guardi??o??? central, que considere o princ??pio do m??rito e que divida com os ??rg??os de linha a responsabilidade sobre a GRH. Mostra, ainda, a import??ncia de institucionalizar os valores da imparcialidade, do profissionalismo e da responsividade. Ao tratar da profissionaliza????o da GRH, ressalta a necessidade de uma pol??tica que defina como a gest??o de pessoas contribuir?? para o alcance de objetivos governamentais. Para isso, prop??e a aplica????o de um modelo integrado baseado em compet??ncias e o desenvolvimento de uma pol??tica salarial que permita a atra????o e reten????o de talentos no setor p??blico. Ao final, o texto apresenta os pr??s e contras da gest??o por desempenho, bem como os desafios de um redimensionamento organizacional no servi??o p??blico.

The estimation of the return on firms’ investments – as to ISO 9001

The aim of this paper was to estimate the return on investment in QMS (quality management systems) certification undertaken in Portuguese firms, according to the ISO 9000 series. A total of 426 certified Portuguese firms were surveyed. The response rate was 61.03 percent. The different payback periods were validated through statistical analysis and the relationship between expected and perceived payback periods was discussed. This study suggests that a firm’s sector of activity, size and degree of internationalization are related to the length of the investment in QMS certification recovery period. Furthermore, our findings suggest, that the time taken to obtain the certification is not directly related to the economic component of the certification. The majority of Portuguese firms (58.9%) took up to three years to recoup their investment and 35.5% of companies said they had not yet recovered the initial investment made. The recoup of investment was measured by the increase in the number of customers and consequent volume of deliveries, improved profitability and productivity of the company, improvement of competitive position and performance (cost savings), reduction in the number of external complaints and internal defects/scrap, achievement of some important clientele, among others. We compared our work to similar studies undertaken in other countries. This paper provides a contribution to the research related to the return on investment for costs related to the certification QMS according to ISO 9000. This paper provides a valuable contribution to the field and is one of the first studies to undertake this type of analysis in Portugal.

Maize nitrogen fertilization in two crop rotation systems under no-till

The objective of this study was to evaluate split nitrogen (N) fertilization of maize applied in band at sowing and top dressing with and without crop rotation, under no-till. The experiment was conducted with six N rates at sowing (0, 20, 30, 40, 50 and 60 kg ha-1) combined with three rates in top dressing (40, 70, 100 kg ha-1) and two management systems: after five cropping sequences of maize and crop rotation (maize + soybean + oat + soybean + corn) in a randomized block design with four replications. The crop rotation system increased yield in approximately 7% in relation to the area without rotation. The split of nitrogen fertilization, in rates above 39 and 54 kg ha-1 at sowing and 70 and 40 kg ha-1 in top dressing, resulted in yield higher than that obtained with the application of 100 kg ha-1 in top dressing. Grain yield was higher with the rates 50 and 70 kg ha-1 of N compared with that obtained with 20 and 100 kg ha-1 at sowing and top dressing, respectively. The rate 70 kg ha-1 of N resulted in the highest yield at the lowest cost compared with the revenues and costs incurred with the rates 40 and 100 kg ha-1.

O IMPACTO FINANCEIRO DAS AUDITORIAS DA QUALIDADE NAS EMPRESAS PORTUGUESAS

This paper discusses the main theme the financial implications that Portuguese companies with the implementation and subsequent certification of the Quality System and respective Quality Audits. The literature review shows that companies do not publish financial results on the subject in question, making it necessary to acquire information through a questionnaire. About 126 questionnaires were sent. Our sample is however 32 validados.Pode to complete questionnaires that the top 5 overall benefits or indirect financial benefits for Portuguese companies were, respectively: improving internal organization; improving the company's image; increasing customer satisfaction; continuous improvement in customer service; improving competitive position. In terms of direct financial benefits the 3 main benefits obtained by the companies were: turnover increase; Performance (cost reduction); Increased business productivity. So it is expected to contribute to the knowledge of the impact, notably financial of Quality Management Systems and respective audits in Portuguese companies.

Use of performance information by local politicians: a field study in the Portuguese context.

This paper seeks to investigate the use of performance information by politicians and whether the institutional reforms on performance management (PM) have been operationalized by local politicians. Differences on the policy field and the organizational context have been analyzed. Our goal is contribute to knowledge on PM in the political sphere and understand the different responses of politicians to government change initiatives (mainly coercive pressures). Our findings show that local politicians support the notion that greater attention should be devoted to the use of performance information on the evaluation process. Nevertheless they are very skeptic in relation to effective execution of government reforms. There is an internal culture where agencies are embedded, strongly influenced by the high degree of politicisation among senior managers, that lead politicians to be more concerned about personal opinions and informal performance information rather than to use more sophisticated information (output and outcome measures). The institutional approach helps us to identify political responses to institutional pressures and understand the reasons for a reduced use in the Portuguese context.

Relationships between NPM, the use of PM practices and the organizational performance: empirical evidence from government agencies

Purpose – this paper has two main purposes: (1)explore if government agencies more oriented to NPM postulates are more willing to use PM practices and to improve their performance; and (2) investigate whether the fit between the use of PM practices and the organizationa performance is dependent upon from the capacity of agencies to adapt its structures to changes introduced by NPM reforms. Design/methodology/approach - this paper is based on the survey method and provides empirical evidence from Portuguese government agencies.Findings (mandatory) - Our findings suggest that government agencies that made structural arrangements under the NPM reforms are more willing to use PM practices and will perform better than other agencies. In addition, this paper show that therelationship between the use of PM practices and the organizational performance is dependent upon from the agencies capacity to adopt new structural arrangements under the NPM reforms.Practical implications – this paper has three main contributions: (1) contribute to knowledge about the relationship between the introduction of NPM changes in the use of PM practices; (2) contribute to clarify whether agencies more oriented to NPM postulates are improving performance; and (3) help to clarify the way the organizations should adapt their structures for to be more effective in the use of PM practices. Originality/value - The quantitative empirical research, based on the unique survey applied to Portuguese government agencies on this field, allow us to add to prior research mainly based on case studies and oriented to local governments (Budding, 2004).