834 resultados para Hospital performance improvement
Resumo:
Live migration of multiple Virtual Machines (VMs) has become an indispensible management activity in datacenters for application performance, load balancing, server consolidation. While state-of-the-art live VM migration strategies focus on the improvement of the migration performance of a single VM, little attention has been given to the case of multiple VMs migration. Moreover, existing works on live VM migration ignore the inter-VM dependencies, and underlying network topology and its bandwidth. Different sequences of migration and different allocations of bandwidth result in different total migration times and total migration downtimes. This paper concentrates on developing a multiple VMs migration scheduling algorithm such that the performance of migration is maximized. We evaluate our proposed algorithm through simulation. The simulation results show that our proposed algorithm can migrate multiple VMs on any datacenter with minimum total migration time and total migration downtime.
Resumo:
Purpose:Multifocal contact lenses (MCLs) have been available for decades. A review of the literature suggests that while, historically, these lenses have been partially successful, they have struggled to compete with monovision (MV). More recent publications suggest that there has been an improvement in the performance of these lenses. This study set out to investigate whether the apparent improved lens performance reported in the literature is reflected in clinical practice. Methods:Data collected over the last 5yrs via the International Contact Lens Prescribing Survey Consortium was reviewed for patients over the age of 45yrs. The published reports of clinical trials were reviewed to assess lens performance over the time period. Results:Data review was of 16,680 presbyopic lens fits in 38 countries. The results are that 29% were fit with MCLs, 8% MV and 63% single vision (SV). A previous survey conducted in Australia during 1988-89 reported that 9% of presbyopes were fit with MCLs, 29% MV and 63% SV. The results from our survey for Australia alone were 28% (MV 13%) vs 9% (MV 29%) suggesting an increase in usage of MCLs from 1988-89 to 2010. A review of the literature indicates the reported level of visual acuities with MCLs in comparison to MV has remained equivalent over this time period, yet preference has switch from MV to MCLs. Conclusions:There is evidence that currently more MCLs than MV are being fit to presbyopes, compared to 1988-89. This increased use is likely due to the improved visual performance of these lenses, which is not demonstrated with acuity measures but reported by wearers, suggesting that patient-based subjective ratings are currently the best way to measure visual performance.
Capital Formation in the Futures Focused School : Indicators of a Breakthrough in School Improvement
Resumo:
In this environmental scan of research and policy literature, the authors consider various definitions of trust as they seek to address and inform the hypothesis that ‘a culture of trust enhances performance’ in schools. The discussion draws on the work of the Australian Institute for Teaching and School Leadership in school leadership and research by Caldwell and Harris (2008) to consider ways in which trust is linked to performance in schools and organisations. It explores the concept of trust as a form of capital available to schools, and highlights how successful school leaders work to align trust, strategy and passion in implementing effective change. At the heart of the review is the relationship between trust and school improvement. An adapted model of the elements of a culture of trust developed by Bryk and Schneider in their influential study of trust in school reform in Chicago is used to frame this aspect of the review. The authors identify four essential categories of relationships that enable schools to be described as having a culture of trust. The review concludes with a discussion of the relationship between trust and school governance.
Resumo:
The aim of this research is to report initial experimental results and evaluation of a clinician-driven automated method that can address the issue of misdiagnosis from unstructured radiology reports. Timely diagnosis and reporting of patient symptoms in hospital emergency departments (ED) is a critical component of health services delivery. However, due to disperse information resources and vast amounts of manual processing of unstructured information, a point-of-care accurate diagnosis is often difficult. A rule-based method that considers the occurrence of clinician specified keywords related to radiological findings was developed to identify limb abnormalities, such as fractures. A dataset containing 99 narrative reports of radiological findings was sourced from a tertiary hospital. The rule-based method achieved an F-measure of 0.80 and an accuracy of 0.80. While our method achieves promising performance, a number of avenues for improvement were identified using advanced natural language processing (NLP) techniques.
Resumo:
As the biggest expo site in history, construction of the Shanghai Expo site faced a lot of challenges, including involvement of lots of investors, megaconstruction scale, concurrent construction mode, involvement of more than 40,000 migrant workers, and extremely tight completion deadlines, among others. Consequently, these challenges imposed great obstacles on accomplishing the safety, quality, and environmental goals. Through a case study of the Shanghai Expo construction, this paper paper presents the design and implementation of multicriteria incentives in megaprojects to accomplish the safety, quality, and environmental goals. Both quantitative and qualitative findings were triangulated to demonstrate the outcome of the incentives. Six critical success factors (CSFs) for the incentives, rule design, process orientation, top management support, training and promotion, communication in process, and process learning and improvement are identified and validated through case study data and content analysis. It is believed that the findings of this paper can enhance understanding of multicriteria incentive schemes in general and provide insights in implementing these incentive schemes in future megaprojects, particularly in the People’s Republic of China (PRC).
Resumo:
Gross value of cons truction work in the repair , maintenance, minor alte ration and addition (RMAA) sector in Hong Kong has expanded dramatically by 58% from 1998 to 2007, accounting for over 53% of the whole construction market in 2007. Unfortunately, the portion of industrial accidents arising from this sector also increased substantially during the same period. It is important to improve the safety performance of the RMAA sector. This paper has set out the objectives to examine safety statistics of RMAA works; to compare them with those of green field projects; and more importantly, to highlight potential hurdles en countered in the process of comparison and finally to provide effective recommendations for overcoming these impediments. To strive for continuous safety improvement of RMAA works, comparable safety statistics should be compiled for this sector.
Resumo:
Aim. This paper is a report of a development and validation of a new job performance scale based on an established job performance model. Background. Previous measures of nursing quality are atheoretical and fail to incorporate the complete range of behaviours performed. Thus, an up-to-date measure of job performance is required for assessing nursing quality. Methods. Test construction involved systematic generation of test items using focus groups, a literature review, and an expert review of test items. A pilot study was conducted to determine the multidimensional nature of the taxonomy and its psychometric properties. All data were collected in 2005. Findings. The final version of the nursing performance taxonomy included 41 behaviours across eight dimensions of job performance. Results from preliminary psychometric investigations suggest that the nursing performance scale has good internal consistency, good convergent validity and good criterion validity. Conclusion. The findings give preliminary support for a new job performance scale as a reliable and valid tool for assessing nursing quality. However, further research using a larger sample and nurses from a broader geographical region is required to cross-validate the measure. This scale may be used to guide hospital managers regarding the quality of nursing care within units and to guide future research in the area.
Resumo:
Background Patient satisfaction is influenced by the setting in which patients are treated and the employees providing care. However, to date, limited research has explained how health care organizations or nurses influence patient satisfaction. Objectives The purpose of this study was to test the model that service climate would increase the effort and performance of nursing groups and, in turn, increase patient satisfaction. Method This study incorporated data from 156 nurses, 28 supervisors, and 171 patients. A cross-sectional design was utilized to examine the relationship between service climate, nurse effort, nurse performance and patient satisfaction. Structural equation modeling was conducted to test the proposed relationships. Results Service climate was associated with the effort that nurses directed towards technical care and extra-role behaviors. In turn, the effort that nurses exerted predicted their performance, as rated by their supervisors. Finally, task performance was a significant predictor of patient satisfaction. Conclusions This study suggests that both hospital management and nurses play a role in promoting patient satisfaction. By focusing on creating a climate for service, health care managers can improve nursing performance and patient satisfaction with care.
Resumo:
Objectives To evaluate quality of care delivered to patients presenting to the emergency department (ED) with pain and managed by emergency nurse practitioners by measuring: 1) Evaluate time to analgesia from initial presentation 2) Evaluate time from being seen to next analgesia 3) Pain score documentation Background The delivery of quality care in the emergency department (ED) is emerging as one of the most important service indicators being measured by health services. Emergency nurse practitioner services are designed to improve timely, quality care for patients. One of the goals of quality emergency care is the timely and effective delivery of analgesia for patients. Timely analgesia is an important indicator of ED service performance. Methods A retrospective explicit chart review of 128 consecutive patients with pain and managed by emergency nurse practitioners was conducted. Data collected included demographics, presenting complaint, pain scores, and time to first dose of analgesia. Patients were identified from the ED Patient Information System (Cerner log) and data were extracted from electronic medical records Results Pain scores were documented in 67 (52.3%; 95% CI: 43.3-61.2) patients. The median time to analgesia from presentation was 60.5 (IQR 30-87) minutes, with 34 (26.6%; 95% CI: 19.1-35.1) patients receiving analgesia within 30 minutes of presentation to hospital. There were 22 (17.2%; 95% CI: 11.1-24.9) patients who received analgesia prior to assessment by a nurse practitioner. Among patients that received analgesia after assessment by a nurse practitioner, the median time to analgesia after assessment was 25 (IQR 12-50) minutes, with 65 (61.3%; 95% CI: 51.4-70.6) patients receiving analgesia within 30 minutes of assessment. Conclusions The majority of patients assessed by nurse practitioners received analgesia within 30 minutes after assessment. However, opportunities for substantial improvement in such times along with documentation of pain scores were identified and will be targeted in future research.
Resumo:
Aim Performance measures for Australian laboratories reporting cervical cytology are a set of quantifiable measures relating to the profile and accuracy of reporting. This study reviews aggregate data collected over the ten years in which participation in the performance measures has been mandatory. Methods Laboratories submit annual data on performance measures relating to the profile of reporting, including reporting rates for technically unsatisfactory specimens, high grade or possible high grade abnormalities and abnormal reports. Cytology-histology correlation data and review findings of negative smears reported from women with histological high grade disease are also collected. Suggested acceptable standards are set for each measure. This study reviews the aggregate data submitted by all laboratories for the years 1998-2008 and examines trends in reporting and the performance of laboratories against the suggested standards. Results The performance of Australian laboratories has shown continued improvement over the study period. There has been a fall in the proportion of laboratories with data outside the acceptable standard range in all performance measures. Laboratories are reporting a greater proportion of specimens as definite or possible high grade abnormality. This is partly attributable to an increase in the proportion of abnormal results classified as high grade or possible high grade abnormality. Despite this, the positive predictive value for high grade and possible high grade abnormalities has continued to rise. Conclusion Performance measures for cervical cytology have provided a valuable addition to external quality assurance procedures in Australia. They have documented continued improvements in the aggregate performance, as well as providing benchmarking data and goals for acceptable performance for individual laboratories.
Resumo:
Construction is one of the most hazardous industries due to its dynamic, temporary, and decentralized nature. The Hong Kong Commissioner for Labor identifies worker behavior as the root cause of construction accidents. Behavior-based safety (BBS) is one effective approach in managing employee safety issues. However, there is little research on the application of BBS in the construction industry. This research proposes an extension of the BBS approach, proactive behavior-based safety (PBBS), to improve construction safety. PBBS integrates the theory of BBS with the technology of Proactive Construction Management System (PCMS). The innovations of PBBS are: (1) automatically monitoring location-based behaviors; (2)quantitatively measuring safety performance; (3) investigating potential causes of unsafe behaviors; and (4) improving the efficiency of safety management. A pilot study of a Hong Kong construction site practicing PBBS was conducted. The experiment results showed that PBBS performed well on construction accident prevention and the Safety Index (SI) of the two project teams, with increased improvements by 36.07% and 44.70% respectively. It is concluded that PBBS is effective and adaptable to construction industry.
Resumo:
Organisations are constantly seeking new ways to improve operational efficiencies. This study investigates a novel way to identify potential efficiency gains in business operations by observing how they were carried out in the past and then exploring better ways of executing them by taking into account trade-offs between time, cost and resource utilisation. This paper demonstrates how these trade-offs can be incorporated in the assessment of alternative process execution scenarios by making use of a cost environment. A number of optimisation techniques are proposed to explore and assess alternative execution scenarios. The objective function is represented by a cost structure that captures different process dimensions. An experimental evaluation is conducted to analyse the performance and scalability of the optimisation techniques: integer linear programming (ILP), hill climbing, tabu search, and our earlier proposed hybrid genetic algorithm approach. The findings demonstrate that the hybrid genetic algorithm is scalable and performs better compared to other techniques. Moreover, we argue that the use of ILP is unrealistic in this setup and cannot handle complex cost functions such as the ones we propose. Finally, we show how cost-related insights can be gained from improved execution scenarios and how these can be utilised to put forward recommendations for reducing process-related cost and overhead within organisations.