Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments

Objectives The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED). Methods A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation. Results In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay. Conclusions This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions to improve any suboptimal processes of care. Further validation and utility of the indicators in a wider population is now indicated.

Design process

Christina Waterson interviews Queensland interior designer Marisha McAuliffe about her PhD research into process, and why some people are drawn to create.

Collaborative learning model of infrastructure construction: A capability perspective

Purpose Performance heterogeneity between collaborative infrastructure projects is typically examined by considering procurement systems and their governance mechanisms at static points in time. The literature neglects to consider the impact of dynamic learning capability, which is thought to reconfigure governance mechanisms over time in response to evolving market conditions. This conceptual paper proposes a new model to show how continuous joint learning of participant organisations improves project performance. Design/methodology/approach There are two stages of conceptual development. In the first stage, the management literature is analysed to explain the Standard Model of dynamic learning capability that emphasises three learning phases for organisations. This Standard Model is extended to derive a novel Circular Model of dynamic learning capability that shows a new feedback loop between performance and learning. In the second stage, the construction management literature is consulted, adding project lifecycle, stakeholder diversity and three organisational levels to the analysis, to arrive at the Collaborative Model of dynamic learning capability. Findings The Collaborative Model should enable construction organisations to successfully adapt and perform under changing market conditions. The complexity of learning cycles results in capabilities that are imperfectly imitable between organisations, explaining performance heterogeneity on projects. Originality/value The Collaborative Model provides a theoretically substantiated description of project performance, driven by the evolution of procurement systems and governance mechanisms. The Model’s empirical value will be tested in future research.

Extending building information models to construction specifications

This project examined the role that written specifications play in the building procurement process and the relationship that specifications should have with respect to the use of BIM within the construction industry. A three-part approach was developed to integrate specifications, product libraries and BIM. Typically handled by different disciplines within project teams, these provide the basis for a holistic approach to the development of building descriptions through the design process and into construction.

Mining process risks and resource profiles

This research contributes novel techniques for identifying and evaluating business process risks and analysing human resource behaviour. The developed techniques use predefined indicators to identify process risks in individual process instances, evaluate overall process risk, predict process outcomes and analyse human resource behaviour based on the analysis of information about process executions recorded in event logs by information systems. The results of this research can help managers to more accurately evaluate the risk exposure of their business processes, to more objectively evaluate the performance of their employees, and to identify opportunities for improvement of resource and process performance.

Education for sustainability in construction management curricula

In response to the call for sustainability education in construction courses, higher education institutions have started to incorporate sustainability components into their construction courses to some extent. This research aims to investigate sustainability embedded in construction management (CM) courses using the Queensland University of Technology as a case study. A content analysis of its CM course structure, unit aims, learning objectives and lecture materials is conducted to examine the sustainability elements incorporated into the CM curriculum. The results show that the course incorporates sustainability components into the existing course structure mainly through horizontal integration, embedding sustainability into general units rather than as an add-on subject. Additionally, the sustainability topics embedded in the course cover a comparatively broad and balanced range of sustainability categories, i.e. background knowledge, policies and regulations, environmental issues, social issues and economic issues as well as technology and innovation, although social sustainability aspects need to be further strengthened. This research addresses the need for urgency in the development of an effective sustainability education framework for construction courses. It is expected that the findings from this study will facilitate the improvement of sustainability education in construction courses generally.

Scoring rules and abnormally low bids criteria in construction tenders: A taxonomic review

In the global construction context, the Best Value or Most Economically Advantageous Tender is becoming a widespread approach for contractor selection, as an alternative to other traditional awarding criteria such as the Lowest Price. In these multi-attribute tenders, the owner or auctioneer solicits proposals containing both a price bid and additional technical features. Once the proposals are received, each bidder's price bid is given an economic score according to a scoring rule, generally called an Economic Scoring Formula (ESF) and a technical score according to pre-specified criteria. Eventually, the contract is awarded to the bidder with the highest weighted overall score (economic + technical). However, Economic Scoring Formula selection by auctioneers is invariably and paradoxically a highly intuitive process in practice, involving few theoretical or empirical considerations, despite having being considered traditionally and mistakenly as objective, due to its mathematical nature. This paper provides a taxonomic classification of a wide variety of ESF and Abnormally Low Bid Criteria (ALBC) gathered in several countries with different tendering approaches. Practical implications concern the optimal design of price scoring rules in construction contract tenders, as well as future analyses of the effects of ESF and ALBC on competitive bidding behaviour.

Barriers to good occupational health and safety (OHS) practices by small construction firms

The construction industry has long been considered to have unacceptably high injury and fatality rates. Previous research has shown that small construction companies sustain higher injury rates than large companies. However, despite the industry being dominated by a very large number of such small companies, little is known of their occupational health and safety (OHS) needs, practices and constraints. This paper takes a first step in aiming to identify the principal barriers that affect good OHS performance of small construction companies so that effective OHS practices can be developed to improve this in future. The contents of the literature are first summarised, in which three critical barriers to good OHS practice in small construction firms are proposed. They are : cost, time, lack of safety awareness and concern. The results of a questionnaire survey carried out with South East Queensland construction personnel are presented, which largely confirm what is suggested by the literature research and also succeed in providing an indication of their ranking in terms of importance and suggestions for overcoming these barriers. The research results provide a better understanding of the issues that restrict good OHS practice in small construction companies and potential measures for improvement.

The technological readiness of construction contractors

The Australian construction industry is often criticized for its comparatively low productivity. The most significant future productivity gains are predicted to arise from improvement in the firm’s project management. Information Communication Technologies (ICTs) are thought to offer such improvement. ICT adoption is particularly poor among Small and Medium Enterprises (SMEs). Existing studies provide only a general overview of adoption and diffusion of ICTs in SMEs, with no previous research measuring their readiness to adopt ICT. This paper outlines a theoretical approach to address this gap, exploring how to improve ICT adoption in Australian construction SMEs. A review of literature is undertaken to address the research question ‘What is the best conceptual approach to understanding ICT adoption in SMEs?’ The results emphasize the efficacy of a novel Technology Readiness and Acceptance Model (TRAM) to assess SMEs’ ICT implementation readiness. The proposed model consists of four major constructs to measure readiness comprising: - (1) optimism, - (2) innovativeness, - (3) discomfort and - (4) insecurity; two major constructs to measure technological acceptance comprising: - (1) perceived ease of use and - (2) perceived usefulness; and two extension variables comprising: - (1) self-efficacy and - (2) facilitating conditions. A limitation is that the performance of the conceptual model is yet to be tested empirically. Such research is planned in the coming year by the authors.

Underlying knowledge of construction management consultants in China

To meet clients/owners’ multidimensional and changing requirements, construction management consultants (CMCs) ought to possess a diverse and dynamic knowledge structure. In China, although the population of CMCs has grown to the point of their being indispensable in the industry, their knowledge structure has not been explored explicitly. The study presented in this paper investigated this by first conducting a comprehensive content analysis of the curricula of the highest ranked construction management university courses in China. This was followed by in-depth interviews with experts, resulting in the identification of 22 main knowledge areas that can be grouped into technology, economy, management and law. A questionnaire survey was then conducted among 115 experienced CMCs to evaluate the current level of knowledge in these areas together with their importance and need-for-improvement. The main findings demonstrate the significance of the identified 22 knowledge areas, and they also need substantial improvement in practice. The research has practical implications for China's CMCs to develop necessary knowledge and the extent to which they need to be improved to provide a better quality of services in future.

Leveraging Lean Production Philosophy for Rationalising a Non-Linear Representation of Construction Specifications

This paper presents an approach, based on Lean production philosophy, for rationalising the processes involved in the production of specification documents for construction projects. Current construction literature erroneously depicts the process for the creation of construction specifications as a linear one. This traditional understanding of the specification process often culminates in process-wastes. On the contrary, the evidence suggests that though generalised, the activities involved in producing specification documents are nonlinear. Drawing on the outcome of participant observation, this paper presents an optimised approach for representing construction specifications. Consequently, the actors typically involved in producing specification documents are identified, the processes suitable for automation are highlighted and the central role of tacit knowledge is integrated into a conceptual template of construction specifications. By applying the transformation, flow, value (TFV) theory of Lean production the paper argues that value creation can be realised by eliminating the wastes associated with the traditional preparation of specification documents with a view to integrating specifications in digital models such as Building Information Models (BIM). Therefore, the paper presents an approach for rationalising the TFV theory as a method for optimising current approaches for generating construction specifications based on a revised specification writing model.

Changes in Beer Labels and their Meaning : A Holistic Approach to the Semiosic Process

The purpose of this study is to find a framework for a holistic approach to, and form a conceptual toolbox for, investigating changes in signs and in their interpretation. Charles S. Peirce s theory of signs in a communicative perspective is taken as a basis for the framework. The concern directing the study is the problem of a missing framework in analysing signs of visual artefacts from a holistic perspective as well as that of the missing conceptual tools. To discover the possibility of such a holistic approach to semiosic processes and to form a conceptual toolbox the following issues are discussed: i) how the many Objects with two aspects involved in Peirce s definition of sign-action, promote multiple semiosis arising from the same sign by the same Interpretant depending on the domination of the Objects; ii) in which way can the relation of the individual and society or group be made more apparent in the construction of the self since this construction is intertwined with the process of meaning-creation and interpretation; iii) how to account for the fundamental role of emotions in semiosis, and the relation of emotions with the often neglected topic of embodiment; iv) how to take into account the dynamic, mediating and processual nature of sign-action in analysing and understanding the changes in signs and in the interpretation of signs. An interdisciplinary approach is chosen for this dissertation. Concepts that developed within social psychology, developmental psychology, neurosciences and semiotics, are discussed. The common aspect of the approaches is that they in one way or another concentrate on mediation provided by signs in explaining human activity and cognition. The holistic approach and conceptual toolbox found are employed in a case study. This consists of an analysis of beer brands including a comparison of brands from two different cultures. It becomes clear that different theories and approaches have mutual affinities and do complement each other. In addition, the affinities in different disciplines somewhat provide credence to the various views. From the combined approach described, it becomes apparent that by the semiosic process, the emerging semiotic self intertwined with the Umwelt, including emotions, can be described. Seeing the interpretation and meaning-making through semiosis allows for the analysis of groups, taking into account the embodied and emotional component. It is concluded that emotions have a crucial role in all human activity, including so-called reflective thinking, and that emotions and embodiment should be consciously taken into account in analysing signs, the interpretation, and in changes of signs and interpretations from both the social and individual level. The analysis of the beer labels expresses well the intertwined nature of the relationship between signs, individual consumers and society. Many direct influences from society on the label design are found, and also some indirect attitude changes that become apparent from magazines, company reports, etc. In addition, the analysis brings up the issues of the unifying tendency of the visual artefacts of different cultures, but also demonstrates that the visual artefacts are able to hold the local signs and meanings, and sometimes are able to represent the local meanings although the signs have changed in the unifying process.

Visions of Past Glory: Nationalism and the Construction of Early Finnish History

The study is an examination of how the distant national past has been conceived and constructed for Finland from the mid-sixteenth century to the Second World War. The author argues that the perception and need of a national 'Golden Age' has undergone several phases during this period, yet the perceived Greatness of the Ancient Finns has been of great importance for the growth and development of the fundamental concepts of Finnish nationalism. It is a question reaching deeper than simply discussing the Kalevala or the Karelianism of the 1890s. Despite early occurrences of most of the topics the image-makers could utilize for the construction of an Ancient Greatness, a truly national proto-history only became a necessity after 1809, when a new conceptual 'Finnishness' was both conceived and brought forth in reality. In this process of nation-building, ethnic myths of origin and descent provided the core of the nationalist cause - the defence of a primordial national character - and within a few decades the antiquarian issue became a standard element of the nationalist public enlightenment. The emerging, archaeologically substantiated, nationhood was more than a scholarly construction: it was a 'politically correct' form of ethnic self-imaging, continuously adapting its message to contemporary society and modern progress. Prehistoric and medieval Finnishness became even more relevant for the intellectual defence of the nation during the period of Russian administrative pressure 1890-1905. With independence the origins of Finnishness were militarized even further, although the 'hot' phase of antiquarian nationalism ended, as many considered the Finnish state reestablished after centuries of 'dependency'. Nevertheless, the distant past of tribal Finnishness and the conceived Golden Age of the Kalevala remained obligating. The decline of public archaeology is quite evident after 1918, even though the national message of the antiquarian pursuits remained present in the history culture of the public. The myths, symbols, images, and constructs of ancient Finnishness had already become embedded in society by the turn of the century, like the patalakki cap, which remains a symbol of Finnishness to this day. The method of approach is one of combining a broad spectrum of previously neglected primary sources, all related to history culture and the subtle banalization of the distant past: school books, postcards, illustrations, festive costumes, drama, satirical magazines, novels, jewellery, and calendars. Tracing the origins of the national myths to their original contexts enables a rather thorough deconstruction of the proto-historical imaginary in this Finnish case study. Considering Anthony D. Smith's idea of ancient 'ethnies' being the basis for nationalist causes, the author considers such an approach in the Finnish case totally misplaced.

Construction, installation, and performance of two repacked weighing lysimeters

Weighing lysimeters are the standard method for directly measuring evapotranspiration (ET). This paper discusses the construction, installation, and performance of two (1.52 m × 1.52 m × 2.13-m deep) repacked weighing lysimeters for measuring ET of corn and soybean in West Central Nebraska. The cost of constructing and installing each lysimeter was approximately US $12,500, which could vary depending on the availability and cost of equipment and labor. The resolution of the lysimeters was 0.0001 mV V-1, which was limited by the data processing and storage resolution of the datalogger. This resolution was equivalent to 0.064 and 0.078 mm of ET for the north and south lysimeters, respectively. Since the percent measurement error decreases with the magnitude of the ET measured, this resolution is adequate for measuring ET for daily and longer periods, but not for shorter time steps. This resolution would result in measurement errors of less than 5% for measuring ET values of ≥3 mm, but the percent error rapidly increases for lower ET values. The resolution of the lysimeters could potentially be improved by choosing a datalogger that could process and store data with a higher resolution than the one used in this study.

Viisi vuotta tiedonrakentamista yhteisö- ja teknologiaelementtien muovautumisen näkökulmasta

The object of this study was to examine the phenomena of a long-term Knowledge Building process. The subject was OECD/ENSI/FI-project's Knowledge Building in Knowledge Forum®3.4 environment from 8.9.2000 to 8.9.2005. Research was based on socio-cognitive and socio-cultural learning approaches and the theoretical background consisted of models of collaborative learning and knowledge processing. These theoretical applications were first structured using metaphors of language and then assembled into five main theoretical motifs. The main motifs were 1) context, 2) inter-subjective, shared area, 3) community's practices and participation, 4) developing expertise and 5) the sequential construction of processes. These themes were assembled in interpreting the results using the Mutual Shaping of Technological and Social Elements by Boczkowski (1999) as a conceptual tool. The social elements of the mutual shaping process were defined as 1) community structure, 2) discourse and 3) the meanings of activity. The technological elements were defined as 1) shared artefacts, 2) features of technology-use and 3) other technological conventions perceived in activity. The five main theoretical motifs were used as the basis for creating the research problems, which were divided into three themes: 1) shared artefacts, themes of Knowledge Building and participant formation, 2) patterns of participation and interaction and 3) the meanings of activity. As methods I used content analysis of the messages, the quantitative profiling of changes in the database, social network analysis, discourse analysis of selected message threads and theme interviews of eleven participants. Based on my study it's possible to say, that a long-term setting of this kind provides a different perspective on Knowledge Building from most of the previous research. The most valuable conclusions from the data are: 1) The centralisation of interaction in this type of setting is a feature that supports the improvement in the quality of action. 2) The participation in a long-term Knowledge Building process seems to support the concious effort on professional development and the expert-identity. 3) The quality of plasticity of the technology-in-use has implication for how the communal features of activity will develop. The agency is seen to initiate processes that in turn open up new possibilities for the quality of action on both the communal and individual levels.