Bayesian hierarchical models in statistical quality control methods to improve healthcare in hospitals

Quality oriented management systems and methods have become the dominant business and governance paradigm. From this perspective, satisfying customers’ expectations by supplying reliable, good quality products and services is the key factor for an organization and even government. During recent decades, Statistical Quality Control (SQC) methods have been developed as the technical core of quality management and continuous improvement philosophy and now are being applied widely to improve the quality of products and services in industrial and business sectors. Recently SQC tools, in particular quality control charts, have been used in healthcare surveillance. In some cases, these tools have been modified and developed to better suit the health sector characteristics and needs. It seems that some of the work in the healthcare area has evolved independently of the development of industrial statistical process control methods. Therefore analysing and comparing paradigms and the characteristics of quality control charts and techniques across the different sectors presents some opportunities for transferring knowledge and future development in each sectors. Meanwhile considering capabilities of Bayesian approach particularly Bayesian hierarchical models and computational techniques in which all uncertainty are expressed as a structure of probability, facilitates decision making and cost-effectiveness analyses. Therefore, this research investigates the use of quality improvement cycle in a health vii setting using clinical data from a hospital. The need of clinical data for monitoring purposes is investigated in two aspects. A framework and appropriate tools from the industrial context are proposed and applied to evaluate and improve data quality in available datasets and data flow; then a data capturing algorithm using Bayesian decision making methods is developed to determine economical sample size for statistical analyses within the quality improvement cycle. Following ensuring clinical data quality, some characteristics of control charts in the health context including the necessity of monitoring attribute data and correlated quality characteristics are considered. To this end, multivariate control charts from an industrial context are adapted to monitor radiation delivered to patients undergoing diagnostic coronary angiogram and various risk-adjusted control charts are constructed and investigated in monitoring binary outcomes of clinical interventions as well as postintervention survival time. Meanwhile, adoption of a Bayesian approach is proposed as a new framework in estimation of change point following control chart’s signal. This estimate aims to facilitate root causes efforts in quality improvement cycle since it cuts the search for the potential causes of detected changes to a tighter time-frame prior to the signal. This approach enables us to obtain highly informative estimates for change point parameters since probability distribution based results are obtained. Using Bayesian hierarchical models and Markov chain Monte Carlo computational methods, Bayesian estimators of the time and the magnitude of various change scenarios including step change, linear trend and multiple change in a Poisson process are developed and investigated. The benefits of change point investigation is revisited and promoted in monitoring hospital outcomes where the developed Bayesian estimator reports the true time of the shifts, compared to priori known causes, detected by control charts in monitoring rate of excess usage of blood products and major adverse events during and after cardiac surgery in a local hospital. The development of the Bayesian change point estimators are then followed in a healthcare surveillances for processes in which pre-intervention characteristics of patients are viii affecting the outcomes. In this setting, at first, the Bayesian estimator is extended to capture the patient mix, covariates, through risk models underlying risk-adjusted control charts. Variations of the estimator are developed to estimate the true time of step changes and linear trends in odds ratio of intensive care unit outcomes in a local hospital. Secondly, the Bayesian estimator is extended to identify the time of a shift in mean survival time after a clinical intervention which is being monitored by riskadjusted survival time control charts. In this context, the survival time after a clinical intervention is also affected by patient mix and the survival function is constructed using survival prediction model. The simulation study undertaken in each research component and obtained results highly recommend the developed Bayesian estimators as a strong alternative in change point estimation within quality improvement cycle in healthcare surveillances as well as industrial and business contexts. The superiority of the proposed Bayesian framework and estimators are enhanced when probability quantification, flexibility and generalizability of the developed model are also considered. The empirical results and simulations indicate that the Bayesian estimators are a strong alternative in change point estimation within quality improvement cycle in healthcare surveillances. The superiority of the proposed Bayesian framework and estimators are enhanced when probability quantification, flexibility and generalizability of the developed model are also considered. The advantages of the Bayesian approach seen in general context of quality control may also be extended in the industrial and business domains where quality monitoring was initially developed.

How to work the crowd : a snapshot of barriers and motivations to crowdfunding

Introduction This study is a snapshot of Australian donor motivations and donor barriers to crowdfunding, and provides some indicative recommendations on ways the uptake of crowdfunding in the creative industries might increase. It is based upon a literature review and semi-structured interviews with 17 stakeholders who have used crowdfunding in Australia, including: creative producers seeking funds; financial crowdfunding donors; Artsupport Australia mentors of artists who are using crowdfunding; and crowdfunding site stakeholders. About the report Artsupport Australia commissioned the Queensland University of Technology Creative Industries team to produce a report on trends related to crowdfunding, particularly identifying barriers and motivations that might be associated with it. Artsupport Australia suggested a list of interview candidates, based on those individuals’ knowledge or experience with crowdfunding, to provide a better understanding of perceptions of this emerging practice, and to inform discussions on whether it is a useful revenue generating mechanism for the cultural sector.

Teamwork in first year law units : can it work?

Since the 1980s, higher education in Australia has undergone significant change which has led to the belief that universities should cultivate students’ generic skills and attributes. For example, Achieving Quality states that generic skills ‘should represent the central achievements of higher education as a process’ (Higher Education Council, 1992, p 20). The CALD Standards for Australian Law Schools also recognise that tertiary curricula should ‘seek to develop knowledge, understanding, skills, and values’ (Council of Australian Law Deans, 2009, [2.3]. See also AQF Council, 2010, pp 32-5, 40-2; AQF Council, 2011, p 45-50). This more instrumentalist view of education is similarly exhibited by students (Saulwick and Muller, 2006, pp 7, 34). No longer does the modern graduate expect their university degree to equip them solely with the content knowledge of their discipline, but also with the skills and attributes relevant to their career and prospective employment.

Evolving directions in health promotion workforce development

PROJECT CONTEXT: Leaders in the fields of public health and health promotion increasingly advocate a socio-ecological approach to meet contemporary and emerging population health challenges. It is essential that health promotion workforce development initiatives mirror the evolving direction of the field to facilitate translation of theory into practice. To date, there has been limited effort to map the socio-ecological approach into tertiary education curricula. PROJECT DESCRIPTION: This project was undertaken as part of the development process for an undergraduate health promotion degree in Queensland, Australia. A review of the health promotion workforce development literature was undertaken. Group processes, key informant interviews and a Delphi technique were used to engage health promotion academics and practitioners, including an International Health Promotion Expert Advisory Panel, and an Industry Advisory Group in defining the components of the program. FINDINGS: The consultative processes facilitated the development of an undergraduate health promotion degree program underpinned by the socio-ecological approach with strong emphases upon the processes or 'how you do it' of health promotion together with evidence-based decision making and practice. CONCLUSIONS: As the basis and practice of health promotion progresses toward a socio-ecological approach, workforce training needs to keep pace with these developments to ensure an appropriately skilled health promotion workforce to meet emerging population health challenges. The reported project and the degree program that has been developed is an example of one step towards achieving this important and necessary shift in health promotion workforce development in Australia.

Nerves of steel? Stress, work performance and elite athletes

There is a notable shortage of empirical research directed at measuring the magnitude and direction of stress effects on performance in a controlled environment. One reason for this is the inherent difficulties in identifying and isolating direct performance measures for individuals. Additionally, most traditional work environments contain a multitude of exogenous factors impacting individual performance, but controlling for all such factors is generally unfeasible (omitted variable bias). Moreover, instead of asking individuals about their self-reported stress levels, we observe workers’ behaviour in situations that can be classified as stressful. For this reason, we have stepped outside the traditional workplace in an attempt to gain greater controllability of these factors using the sports environment as our experimental space. We empirically investigate the relationship between stress and performance, in an extreme pressure situation (football penalty kicks) in a winner take all sporting environment (FIFA World Cup and UEFA European Cup competitions). Specifically, we examine all the penalty shootouts between 1976 and 2008 covering in total 16 events. The results indicate that extreme stressors can have a positive or negative impact on individuals’ performance. On the other hand, more commonly experienced stressors do not affect professionals’ performances.

The use of virtual prototyping to rehearse the sequence of construction work involving mobile cranes

Purpose – Rehearsing practical site operations is without doubt one of the most effective methods for minimising planning mistakes, because of the learning that takes place during the rehearsal activity. However, real rehearsal is not a practical solution for on-site construction activities, as it not only involves a considerable amount of cost but can also have adverse environmental implications. One approach to overcoming this is by the use of virtual rehearsals. The purpose of this paper is to investigate an approach to simulation of the motion of cranes in order to test the feasibility of associated construction sequencing and generate construction schedules for review and visualisation. Design/methodology/approach – The paper describes a system involving two technologies, virtual prototyping (VP) and four-dimensional (4D) simulation, to assist construction planners in testing the sequence of construction activities when mobile cranes are involved. The system consists of five modules, comprising input, database, equipment, process and output, and is capable of detecting potential collisions. A real-world trial is described in which the system was tested and validated. Findings – Feedback from the planners involved in the trial indicated that they found the system to be useful in its present form and that they would welcome its further development into a fully automated platform for validating construction sequencing decisions. Research limitations/implications – The tool has the potential to provide a cost-effective means of improving construction planning. However, it is limited at present to the specific case of crane movement under special consideration. Originality/value – This paper presents a large-scale, real life case of applying VP technology in planning construction processes and activities.

Mandated literacy assessment and the reorganisation of teachers’ work : federal policy, local effects

This paper explores how mandated literacy assessment is reorganising teachers’ work in the context of Australia’s National Assessment Program – Literacy and Numeracy (NAPLAN), which was implemented in 2008. Students in Years 3, 5, 7 and 9 are tested annually, with school results publicly available. The wider policy context and the emergence of different forms of interconnected educational work associated with the testing phenomenon are described. Taking an Institutional Ethnography approach, the local effects of the federal policy regime are examined through a case study of one school. What mandated literacy assessment does to educators’ work in a culturally diverse low socioeconomic school community is discussed. Key themes include strategic exclusions of students from the testing process, appropriations and adaptations of literacy theory, work intensification, and ethical mediation of results. Questions concerning equity are raised about the differential effects of policy in different school contexts.

One size fits one : customizing work through manager-employee exchange

While prior research has addressed how collective workplace outcomes are negotiated between employers and trade unions, less attention has been afforded to the ‘everyday’, micro-level exchanges between managers and employees in adjusting work, alongside the ‘standard’ terms and conditions set out in employment contracts. Building on previous work on idiosyncratic deals and requests for flexible scheduling, this article presents the findings from a survey of Australian parents which addressed manager-employee exchanges which led to customized work arrangements. The survey examined the frequency with which various employment terms and conditions were negotiated, who initiated the interactions, where they occurred, and the extent of perceived compromise. The study revealed that manager-employee exchanges occur frequently in the context of roles in nuclear and extended families, and are influenced by the parameters around which formal childcare and educational settings function. Women rated the exchanges as more important than men, but men and women were similarly comfortable with the interactions and satisfied with outcomes. The findings have important implications for managers and organizations in terms of balancing the goals of efficiency with employees’ preferences for workplace flexibility and other terms beyond those which are standardized.

Observational research and verbal protocol methods

This paper describes observational research and verbal protocols methods, how these methods are applied and integrated within different contexts, and how they complement each other. The first case study focuses on nurses’ interaction during bandaging of patients’ lower legs. To maintain research rigor a triangulation approach was applied that links observations of current procedures, ‘talk-aloud’ protocol during interaction and retrospective protocol. Maps of interactions demonstrated that some nurses bandage more intuitively than others. Nurses who bandage intuitively assemble long sequences of bandaging actions while nurses who bandage less intuitively ‘focus-shift’ in between bandaging actions. Thus different levels of expertise have been identified. The second case study consists of two laboratory experiments. It focuses on analysing and comparing software and product design teams and how they approached a design problem. It is based on the observational and verbal data analysis. The coding scheme applied evolved during the analysis of the activity of each team and is identical for all teams. The structure of knowledge captured from the analysis of the design team maps of interaction is identified. The significance of this work is within its methodological approach. The maps of interaction are instrumental for understanding the activities and interactions of the people observed. By examining the maps of interaction, it is possible to draw conclusions about interactions, structure of knowledge captured and level of expertise. This research approach is transferable to other design domains. Designers will be able to transfer the interaction maps outcomes to systems and services they design.

Correction of step artefact associated with MRI scanning of long bones

3D models of long bones are being utilised for a number of fields including orthopaedic implant design. Accurate reconstruction of 3D models is of utmost importance to design accurate implants to allow achieving a good alignment between two bone fragments. Thus for this purpose, CT scanners are employed to acquire accurate bone data exposing an individual to a high amount of ionising radiation. Magnetic resonance imaging (MRI) has been shown to be a potential alternative to computed tomography (CT) for scanning of volunteers for 3D reconstruction of long bones, essentially avoiding the high radiation dose from CT. In MRI imaging of long bones, the artefacts due to random movements of the skeletal system create challenges for researchers as they generate inaccuracies in the 3D models generated by using data sets containing such artefacts. One of the defects that have been observed during an initial study is the lateral shift artefact occurring in the reconstructed 3D models. This artefact is believed to result from volunteers moving the leg during two successive scanning stages (the lower limb has to be scanned in at least five stages due to the limited scanning length of the scanner). As this artefact creates inaccuracies in the implants designed using these models, it needs to be corrected before the application of 3D models to implant design. Therefore, this study aimed to correct the lateral shift artefact using 3D modelling techniques. The femora of five ovine hind limbs were scanned with a 3T MRI scanner using a 3D vibe based protocol. The scanning was conducted in two halves, while maintaining a good overlap between them. A lateral shift was generated by moving the limb several millimetres between two scanning stages. The 3D models were reconstructed using a multi threshold segmentation method. The correction of the artefact was achieved by aligning the two halves using the robust iterative closest point (ICP) algorithm, with the help of the overlapping region between the two. The models with the corrected artefact were compared with the reference model generated by CT scanning of the same sample. The results indicate that the correction of the artefact was achieved with an average deviation of 0.32 ± 0.02 mm between the corrected model and the reference model. In comparison, the model obtained from a single MRI scan generated an average error of 0.25 ± 0.02 mm when compared with the reference model. An average deviation of 0.34 ± 0.04 mm was seen when the models generated after the table was moved were compared to the reference models; thus, the movement of the table is also a contributing factor to the motion artefacts.

Employment and industrial law in paramedic practice

This chapter will provide you with the some of the information you may need to make information on decisions in cases such as the one given above. In particular it will help you answer questions such as: 1. As Molly and Vikram are approaching the end of their shift, to attend will force them into overtime; could they refuse to attend the job on the basis of the refusal to do overtime outside of contracted hours? 2. Would their refusal be viewed as a breach of contract and therefore a disciplinary issue? 3. Why? 4. Does the need to attend this possibly gravely ill patient outweigh the demands of the paramedics to finish on time?

Friend or foe? The impact of the Hawke/Keating neoliberal reforms on Australian workers and the Australian public sector

Over the last three decades neoliberalism has transitioned from occupying the margins of economic policy debate to becoming the dominant approach by governments and their economic advisers, a process that has accelerated with the collapse of the former Stalinist states in Eastern Europe and the Soviet Union. This thesis adopts a Marxist framework for understanding this process, beginning as it did in the realm of relatively abstract philosophical and ideological debate to the permeation of neoliberal values throughout all capitalist institutions, including the state bureaucracy. This necessarily means a focus on the dialectical relationship between the rise of neoliberalism and the shifting balance of class forces that accompanied the success of the neoliberal project in transforming the dominant economic policy paradigm. The extent to which neoliberal reforms impacted on workers and public sector institutions, along with the success or otherwise of traditional working class institutions in defending the material interests of workers will therefore be a recurring theme throughout this body of work. The evidence borne from this research and analysis suggests a major shift in the dialectic of class struggle in favour of the power of capital over labour during the period covered, with the neoliberal age being one of defeat for a labour movement that largely failed to adopt successful strategies for defending itself.

Mission drift or strategic shift? Group formation strategies within MEPs

Microenterprise development programs (MEPs) have been recognised as a valuable way to help the poor engage in micro-businesses (Green et al., 2006; Vargas, 2000), presenting a way out of poverty (Choudhury et al., 2008; Strier, 2010). Concerns have been raised however, that the benefits of MEPs often don’t reach the extremely poor (Jones et al., 2004; Midgley, 2008; Mosley and Hulme, 1998; Nawaz, 2010; Pritchett, 2006). Balancing reach of these programs with depth is a challenging task. Targeting as many poor people as possible often results in MEPs focusing on the upper or middle poor, overlooking the most challenging group. As such, MEPs have been criticised for mission drift – losing sight of the organisation’s core purpose; assisting those more likely to succeed.

Negligible heat strain in armored vehicle officers wearing personal body armor

Objectives This study evaluated the heat strain experienced by armored vehicle officers (AVOs) wearing personal body armor (PBA) in a sub-tropical climate. Methods Twelve male AVOs, aged 35-58 years, undertook an eight hour shift while wearing PBA. Heart rate and core temperature were monitored continuously. Urine specific gravity (USG) was measured before and after, and with any urination during the shift. Results Heart rate indicated an intermittent and low-intensity nature of the work. USG revealed six AVOs were dehydrated from pre through post shift, and two others became dehydrated. Core temperature averaged 37.4 ± 0.3°C, with maximum's of 37.7 ± 0.2°C. Conclusions Despite increased age, body mass, and poor hydration practices, and Wet-Bulb Globe Temperatures in excess of 30°C; the intermittent nature and low intensity of the work prevented excessive heat strain from developing.

Quality of work life among primary health care nurses in the Jazan region, Saudi Arabia : a crosssectional study

Background: Quality of work life (QWL) is defined as the extent to which employee is satisfied with personal and working needs through participating in the workplace while achieving the organisation’s goals. QWL has been found to influence the commitment and productivity of employees in healthcare organisations, as well as in other industries. However, reliable information on the QWL of PHC nurses is limited. The purpose of this study was to assess the QWL among PHC nurses in the Jazan region, Saudi Arabia. Methods: A descriptive research design, namely, a cross-sectional survey was used in this study. Data were collected using Brooks’ survey of quality of nursing work life (QNWL) and demographic questions. A convenience sample was recruited from 143 PHC centres in Jazan, Saudi Arabia. The Jazan region is located in the southern part of Saudi Arabia. A response rate of 91% (N = 532/585) was achieved (effective RR = 87%, n = 508). Data analysis consisted of descriptive statistics, t-test and one way-analysis of variance. Total scores and sub-scores for QWL Items and item summary statistics were computed and reported, using SPSS version 17 for Windows. Results: Findings suggested that the respondents were dissatisfied with their work life. The major influencing factors were unsuitable working hours/shifts, lack of facilities for nurses, inability to balance work with family needs, inadequacy of family-leave time, poor staffing, management and supervision practices, lack of professional development opportunities, and inappropriate working environment in terms of the level of security, patient care supplies and equipment, and recreation facilities (Break-area). Other essential factors include the community’s view of nursing and inadequate salary. More positively, the majority of nurses were satisfied with their co-workers, satisfied to be nurses and had a sense of belonging in their workplaces. Significant differences were found according to gender, age, marital status, dependent children, dependent adults, nationality, ethnicity, nursing tenure, organisational tenure, positional tenure, and payment per month. No significant differences were found according to education level and location of PHC. Conclusions: These findings can be used by PHC managers and policy makers for developing and appropriately implementing successful plans to improve the QWL. This will help to enhance the home and work environments, improve individual and organisation performance and increase nurses’ commitment.