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.

First international workshop on theory and applications of process visualization

The representation of business process models has been a continuing research topic for many years now. However, many process model representations have not developed beyond minimally interactive 2D icon-based representations of directed graphs and networks, with little or no annotation for information over- lays. With the rise of desktop computers and commodity mobile devices capable of supporting rich interactive 3D environments, we believe that much of the research performed in computer human interaction, virtual reality, games and interactive entertainment has much potential in areas of BPM; to engage, pro- vide insight, and to promote collaboration amongst analysts and stakeholders alike. This initial visualization workshop seeks to initiate the development of a high quality international forum to present and discuss research in this field. Via this workshop, we intend to create a community to unify and nurture the development of process visualization topics as a continuing research area.

Performance analysis of PTP components for IEC 61850 process bus applications

New substation automation applications, such as sampled value process buses and synchrophasors, require sampling accuracy of 1 µs or better. The Precision Time Protocol (PTP), IEEE Std 1588, achieves this level of performance and integrates well into Ethernet based substation networks. This paper takes a systematic approach to the performance evaluation of commercially available PTP devices (grandmaster, slave, transparent and boundary clocks) from a variety of manufacturers. The ``error budget'' is set by the performance requirements of each application. The ``expenditure'' of this error budget by each component is valuable information for a system designer. The component information is used to design a synchronization system that meets the overall functional requirements. The quantitative performance data presented shows that this testing is effective and informative. Results from testing PTP performance in the presence of sampled value process bus traffic demonstrate the benefit of a ``bottom up'' component testing approach combined with ``top down'' system verification tests. A test method that uses a precision Ethernet capture card, rather than dedicated PTP test sets, to determine the Correction Field Error of transparent clocks is presented. This test is particularly relevant for highly loaded Ethernet networks with stringent timing requirements. The methods presented can be used for development purposes by manufacturers, or by system integrators for acceptance testing. A sampled value process bus was used as the test application for the systematic approach described in this paper. The test approach was applied, components were selected, and the system performance verified to meet the application's requirements. Systematic testing, as presented in this paper, is applicable to a range of industries that use, rather than develop, PTP for time transfer.

Gartner Surface Process Modelling movie

AR process modelling movie presented at Gartner BPM Summit in Sydney, August, 2011. Video showing us using the MS Surface at QUT to perform collaborative process modelling.

The entrepreneurial process

This chapter revolves around research-based insights into the entrepreneurial process. By is meant the process of setting up a new business activity resulting in a new market offer. This new offer may be made by a new or an existing firm, although the main focus here is on the start-up of new, independent firms. Further, the new offer may be innovative, bringing to the market something that was not offered before or imita­tive i.e., a new competitor enters the market with products or services very similar to what other firms are already offering. Although the lsatter type of process may be less complex and also have less market impact, it still entails most of the steps that typically have to be taken in order to get a business up and running. If successful, it also shares, at least to some degree, the consequences that signify entrepreneurial processes: - it gives consumers new choice alternatives - it gives incumbent firms reason to shape up - it attracts additional followers to enter the market, further reinforcing the first two effects (Davidsson, 2004). Besides, imitatlve starr-ups outnumber by far innovative ones (Reynolds et al., 2003; Samuelsson and Davidsson, 2009).

Improvisation, process drama and dramatic art

This paper re-conceptualises the notion of improvisation as it has developed in schools since the 1960s. It outlines the theoretical case for naming the distinctive improvisational practice that has emerged in schools - namely Process Drama. The paper sketches seven characteristics of Process Drama and then outlines the case for seeing it as an emerging but robust form of dramatic art. It concludes by arguing that drama teachers, in developing process drama, have created a new form of both education and art.

Improving remote collaborative process modelling using embodiment in 3D virtual environments

Identifying, modelling and documenting business processes usually require the collaboration of many stakeholders that may be spread across companies in inter-organizational settings. While modern process modelling technologies are beginning to provide a number of features to support remote, they lack support for visual cues used in co-located collaboration. In this paper, we examine the importance of visual cues for collaboration tasks in collaborative process modelling. Based on this analysis, we present a prototype 3D virtual world process modelling tool that supports a number of visual cues to facilitate remote collaborative process model creation and validation. We then report on a preliminary analysis of the technology. In conclusion, we proceed to describe the future direction of our research with regards to the theoretical contributions expected from the evaluation of the tool.

Performance evaluation of onsite sewage treatment : results of soil investigations

Background The onsite treatment of sewage and effluent disposal is widely prevalent in rural and urban fringe areas due to the general unavailability of reticulated wastewater collection systems. Despite the low technology of the systems, failure is common and in many cases leading to adverse public health and environmental consequences. It is important therefore that careful consideration is given to the design and location of onsite sewage treatment systems. This requires an understanding of the factors that influence treatment performance. The use of subsurface absorption systems is the most common form of effluent disposal for onsite sewage treatment, particularly for septic tanks. Also, in the case of septic tanks, a subsurface disposal system is generally an integral component of the sewage treatment process. Site specific factors play a key role in the onsite treatment of sewage. The project The primary aims of the research project were: • to relate treatment performance of onsite sewage treatment systems to soil conditions at site; • to evaluate current research relating to onsite sewage treatment; and, • to identify key issues where currently there is a lack of relevant research. These tasks were undertaken with the objective of facilitating the development of performance based planning and management strategies for onsite sewage treatment. The primary focus of this research project has been on septic tanks. By implication, the investigation has been confined to subsurface soil absorption systems. The design and treatment processes taking place within the septic tank chamber itself did not form a part of the investigation. Five broad categories of soil types prevalent in the Brisbane region have been considered in this project. The number of systems investigated was based on the proportionate area of urban development within the Brisbane region located on each of the different soil types. In the initial phase of the investigation, the majority of the systems evaluated were septic tanks. However, a small number of aerobic wastewater treatment systems (AWTS) were also included. The primary aim was to compare the effluent quality of systems employing different generic treatment processes. It is important to note that the number of each different type of system investigated was relatively small. Consequently, this does not permit a statistical analysis to be undertaken of the results obtained for comparing different systems. This is an important issue considering the large number of soil physico-chemical parameters and landscape factors that can influence treatment performance and their wide variability. The report This report is the last in a series of three reports focussing on the performance evaluation of onsite treatment of sewage. The research project was initiated at the request of the Brisbane City Council. The project component discussed in the current report outlines the detailed soil investigations undertaken at a selected number of sites. In the initial field sampling, a number of soil chemical properties were assessed as indicators to investigate the extent of effluent flow and to help understand what soil factors renovate the applied effluent. The soil profile attributes, especially texture, structure and moisture regime were examined more in an engineering sense to determine the effect of movement of water into and through the soil. It is important to note that it is not only the physical characteristics, but also the chemical characteristics of the soil as well as landscape factors play a key role in the effluent renovation process. In order to understand the complex processes taking place in a subsurface effluent disposal area, influential parameters were identified using soil chemical concepts. Accordingly, the primary focus of this final phase of the research project was to identify linkages between various soil chemical parameters and landscape patterns and their contribution to the effluent renovation process. The research outcomes will contribute to the development of robust criteria for evaluating the performance of subsurface effluent disposal systems. The outcomes The key findings from the soil investigations undertaken are: • Effluent renovation is primarily undertaken by a combination of various soil physico-chemical parameters and landscape factors, thereby making the effluent renovation processes strongly site dependent. • Decisions regarding site suitability for effluent disposal should not be based purely in terms of the soil type. A number of other factors such as the site location in the catena, the drainage characteristics and other physical and chemical characteristics, also exert a strong influence on site suitability. • Sites, which are difficult to characterise in terms of suitability for effluent disposal, will require a detailed soil physical and chemical analysis to be undertaken to a minimum depth of at least 1.2 m. • The Ca:Mg ratio and Exchangeable Sodium Percentage are important parameters in soil suitability assessment. A Ca:Mg ratio of less than 0.5 would generally indicate a high ESP. This in turn would mean that Na and possibly Mg are the dominant exchangeable cations, leading to probable clay dispersion. • A Ca:Mg ratio greater than 0.5 would generally indicate a low ESP in the profile, which in turn indicates increased soil stability. • In higher clay percentage soils, low ESP can have a significant effect. • The presence of high exchangeable Na can be counteracted by the presence of swelling clays, and an exchange complex co-dominated by exchangeable Ca and exchangeable Mg. This aids absorption of cations at depth, thereby reducing the likelihood of dispersion. • Salt is continually added to the soil by the effluent and problems may arise if the added salts accumulate to a concentration that is harmful to the soil structure. Under such conditions, good drainage is essential in order to allow continuous movement of water and salt through the profile. Therefore, for a site to be sustainable, it would have a maximum application rate of effluent. This would be dependent on subsurface characteristics and the surface area available for effluent disposal. • The dosing regime for effluent disposal can play a significant role in the prevention of salt accumulation in the case of poorly draining sites. Though intermittent dosing was not considered satisfactory for the removal of the clogging mat layer, it has positive attributes in the context of removal of accumulated salts in the soil.

A framework for cost-aware process management : generation of accurate and timely management accounting cost reports

Organisations are constantly seeking efficiency improvements for their business processes in terms of time and cost. Management accounting enables reporting of detailed cost of operations for decision making purpose, although significant effort is required to gather accurate operational data. Business process management is concerned with systematically documenting, managing, automating, and optimising processes. Process mining gives valuable insight into processes through analysis of events recorded by an IT system in the form of an event log with the focus on efficient utilisation of time and resources, although its primary focus is not on cost implications. In this paper, we propose a framework to support management accounting decisions on cost control by automatically incorporating cost data with historical data from event logs for monitoring, predicting and reporting process-related costs. We also illustrate how accurate, relevant and timely management accounting style cost reports can be produced on demand by extending open-source process mining framework ProM.

Modeling resource management in the building design process by information constraint Petri nets

The effect of resource management on the building design process directly influences the development cycle time and success of construction projects. This paper presents the information constraint net (ICN) to represent the complex information constraint relations among design activities involved in the building design process. An algorithm is developed to transform the information constraints throughout the ICN into a Petri net model. A resource management model is developed using the ICN to simulate and optimize resource allocation in the design process. An example is provided to justify the proposed model through a simulation analysis of the CPN Tools platform in the detailed structural design. The result demonstrates that the proposed approach can obtain the resource management and optimization needed for shortening the development cycle and optimal allocation of resources.

Preliminary insights from a multiple case study on process modelling impact

Process modelling – the design and use of graphical documentations of an organisation’s business processes – is a key method to document and use information about business processes in organisational projects. Still, despite current interest in process modelling, this area of study still faces essential challenges. One of the key unanswered questions concerns the impact of process modelling in organisational practice. Process modelling initiatives call for tangible results in the form of returns on the substantial investments that organisations undertake to achieve improved processes. This study explores the impact of process model use on end-users and its contribution to organisational success. We posit that the use of conceptual models creates impact in organisational process teams. We also report on a set of case studies in which we explore tentative evidence for the development of impact of process model use. The results of this work provide a better understanding of process modelling impact from information practices and also lead to insights into how organisations should conduct process modelling initiatives in order to achieve an optimum return on their investment.

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.

Detecting approximate clones in process model repositories with Apromore

Approximate clone detection is the process of identifying similar process fragments in business process model collections. The tool presented in this paper can efficiently cluster approximate clones in large process model repositories. Once a repository is clustered, users can filter and browse the clusters using different filtering parameters. Our tool can also visualize clusters in the 2D space, allowing a better understanding of clusters and their member fragments. This demonstration will be useful for researchers and practitioners working on large process model repositories, where process standardization is a critical task for increasing the consistency and reducing the complexity of the repository.

Performance analysis of IEC 61850 sampled value process bus networks

Process bus networks are the next stage in the evolution of substation design, bringing digital technology to the high voltage switchyard. Benefits of process buses include facilitating the use of Non-Conventional Instrument Transformers, improved disturbance recording and phasor measurement and the removal of costly, and potentially hazardous, copper cabling from substation switchyards and control rooms. This paper examines the role a process bus plays in an IEC 61850 based Substation Automation System. Measurements taken from a process bus substation are used to develop an understanding of the network characteristics of "whole of substation" process buses. The concept of "coherent transmission" is presented and the impact of this on Ethernet switches is examined. Experiments based on substation observations are used to investigate in detail the behavior of Ethernet switches with sampled value traffic. Test methods that can be used to assess the adequacy of a network are proposed, and examples of the application and interpretation of these tests are provided. Once sampled value frames are queued by an Ethernet switch the additional delay incurred by subsequent switches is minimal, and this allows their use in switchyards to further reduce communications cabling, without significantly impacting operation. The performance and reliability of a process bus network operating with close to the theoretical maximum number of digital sampling units (merging units or electronic instrument transformers) was investigated with networking equipment from several vendors, and has been demonstrated to be acceptable.

Vaccination strategies for the prevention of cervical cancer

Infection with high-risk human papillomaviruses (HPVs) is an essential step in the multistep process leading to cervical cancer. There are approximately 120 different types of HPV identified: of these, 18 are high-risk types associated with cervical cancer, with HPV-16 being the dominant type in most parts of the world. The major capsid protein of papillomavirus, produced in a number of expression systems, self assembles to form virus-like particles. Virus-like particles are the basis of the first generation of HPV vaccines presently being tested in clinical trials. Virus-like particles are highly immunogenic and afford protection from infection both in animal models and in Phase IIb clinical trials. A number of Phase III trials are in progress to determine if the vaccine will protect against cervical disease and, in some cases, genital warts. However, it is predicted that these vaccines will be too expensive for the developing world, where they are desperately needed. Another problem is that they will be type specific. Novel approaches to the production of virus-like particles in plants, second-generation vaccine approaches including viral and bacterial vaccine vectors and DNA vaccines, as well as different routes of immunization, are also reviewed. © 2005 Future Drugs Ltd.