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

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

Knowledge-based management systems for the police force

Knowledge-Based Management Systems enable new ways to process and analyse knowledge to gain better insights to solve a problem and aid in decision making. In the police force such systems provide a solution for enhancing operations and improving client administration in terms of knowledge management. The main objectives of every police officer is to ensure the security of life and property, promote lawfulness, and avert and distinguish wrongdoing. The administration of knowledge and information is an essential part of policing, and the police ought to be proactive in directing both explicit and implicit knowledge, whilst adding to their abilities in knowledge sharing. In this paper the potential for a knowledge based system for the Mauritius police was analysed, and recommendations were also made, based on requirements captured from interviews with several long standing officers, and surveying of previous works in the area.

Investigating the Roles and Requirements, Manifestations and Management of Metadata in the Creation of Reliable and Preservation of Authentic Electronic Entities Created by Dynamic, Interactive and Experiential Systems: Report on the Work and Findings of the Interpares 2 Description Cross Domain Group

Metadata that is associated with either an information system or an information object for purposes of description, administration, legal requirements, technical functionality, use and usage, and preservation, plays a critical role in ensuring the creation, management, preservation and use and re-use of trustworthymaterials, including records. Recordkeeping1 metadata, of which one key type is archival description, plays a particularly important role in documenting the reliability and authenticity of records and recordkeeping systemsas well as the various contexts (legal-administrative, provenancial, procedural, documentary, and technical) within which records are created and kept as they move across space and time. In the digital environment, metadata is also the means by which it is possible to identify how record components – those constituent aspects of a digital record that may be managed, stored and used separately by the creator or the preserver – can be reassembled to generate an authentic copy of a record or reformulated per a user’s request as a customized output package.Issues relating to the creation, capture, management and preservation of adequate metadata are, therefore, integral to any research study addressing the reliability and authenticity of digital entities, regardless of the community, sector or institution within which they are being created. The InterPARES 2 Description Cross-Domain Group (DCD) examined the conceptualization, definitions, roles, and current functionality of metadata and archival description in terms of requirements generated by InterPARES 12. Because of the needs to communicate the work of InterPARES in a meaningful way across not only other disciplines, but also different archival traditions; to interface with, evaluate and inform existing standards, practices and other research projects; and to ensure interoperability across the three focus areas of InterPARES2, the Description Cross-Domain also addressed its research goals with reference to wider thinking about and developments in recordkeeping and metadata. InterPARES2 addressed not only records, however, but a range of digital information objects (referred to as “entities” by InterPARES 2, but not to be confused with the term “entities” as used in metadata and database applications) that are the products and by-products of government, scientific and artistic activities that are carried out using dynamic, interactive or experiential digital systems. The nature of these entities was determined through a diplomatic analysis undertaken as part of extensive case studies of digital systems that were conducted by the InterPARES 2 Focus Groups. This diplomatic analysis established whether the entities identified during the case studies were records, non-records that nevertheless raised important concerns relating to reliability and authenticity, or “potential records.” To be determined to be records, the entities had to meet the criteria outlined by archival theory – they had to have a fixed documentary format and stable content. It was not sufficient that they be considered to be or treated as records by the creator. “Potential records” is a new construct that indicates that a digital system has the potential to create records upon demand, but does not actually fix and set aside records in the normal course of business. The work of the Description Cross-Domain Group, therefore, addresses the metadata needs for all three categories of entities.Finally, since “metadata” as a term is used today so ubiquitously and in so many different ways by different communities, that it is in peril of losing any specificity, part of the work of the DCD sought to name and type categories of metadata. It also addressed incentives for creators to generate appropriate metadata, as well as issues associated with the retention, maintenance and eventual disposition of the metadata that aggregates around digital entities over time.

Integrated soil fertility management in eastern and western Africa: The role of knowledge and innovation systems, its adoption and impact

The rise in population growth, as well as nutrient mining, has contributed to low agricultural productivity in Sub-Saharan Africa (SSA). A plethora of technologies to boost agricultural production have been developed but the dissemination of these agricultural innovations and subsequent uptake by smallholder farmers has remained a challenge. Scientists and philanthropists have adopted the Integrated Soil Fertility Management (ISFM) paradigm as a means to promote sustainable intensification of African farming systems. This comparative study aimed: 1) To assess the efficacy of Agricultural Knowledge and Innovation Systems (AKIS) in East (Kenya) and West (Ghana) Africa in the communication and dissemination of ISFM (Study I); 2) To investigate how specifically soil quality, and more broadly socio-economic status and institutional factors, influence farmer adoption of ISFM (Study II); and 3) To assess the effect of ISFM on maize yield and total household income of smallholder farmers (Study III). To address these aims, a mixed methodology approach was employed for study I. AKIS actors were subjected to social network analysis methods and in-depth interviews. Structured questionnaires were administered to 285 farming households in Tamale and 300 households in Kakamega selected using a stratified random sampling approach. There was a positive relationship between complete ISFM awareness among farmers and weak knowledge ties to both formal and informal actors at both research locations. The Kakamega AKIS revealed a relationship between complete ISFM awareness among farmers and them having strong knowledge ties to formal actors implying that further integration of formal actors with farmers’ local knowledge is crucial for the agricultural development progress. The structured questionnaire was also utilized to answer the query pertaining to study II. Soil samples (0-20 cm depth) were drawn from 322 (Tamale, Ghana) and 459 (Kakamega, Kenya) maize plots and analysed non-destructively for various soil fertility indicators. Ordinal regression modeling was applied to assess the cumulative adoption of ISFM. According to model estimates, soil carbon seemed to preclude farmers from intensifying input use in Tamale, whereas in Kakamega it spurred complete adoption. This varied response by farmers to soil quality conditions is multifaceted. From the Tamale perspective, it is consistent with farmers’ tendency to judiciously allocate scarce resources. Viewed from the Kakamega perspective, it points to a need for farmers here to intensify agricultural production in order to foster food security. In Kakamega, farmers with more acidic soils were more likely to adopt ISFM. Other household and farm-level factors necessary for ISFM adoption included off-farm income, livestock ownership, farmer associations, and market inter-linkages. Finally, in study III a counterfactual model was used to calculate the difference in outcomes (yield and household income) of the treatment (ISFM adoption) in order to estimate causal effects of ISFM adoption. Adoption of ISFM contributed to a yield increase of 16% in both Tamale and Kakamega. The innovation affected total household income only in Tamale, where ISFM adopters had an income gain of 20%. This may be attributable to the different policy contexts under which the two sets of farmers operate. The main recommendations underscored the need to: (1) improve the functioning of AKIS, (2) enhance farmer access to hybrid maize seed and credit, (3) and conduct additional multi-locational studies as farmers operate under varying contexts.

Constraint-Informed Information Systems in Space Management Utilization

Declarative techniques such as Constraint Programming can be very effective in modeling and assisting management decisions. We present a method for managing university classrooms which extends the previous design of a Constraint-Informed Information System to generate the timetables while dealing with spatial resource optimization issues. We seek to maximize space utilization along two dimensions: classroom use and occupancy rates. While we want to maximize the room use rate, we still need to satisfy the soft constraints which model students’ and lecturers’ preferences. We present a constraint logic programming-based local search method which relies on an evaluation function that combines room utilization and timetable soft preferences. Based on this, we developed a tool which we applied to the improvement of classroom allocation in a University. Comparing the results to the current timetables obtained without optimizing space utilization, the initial versions of our tool manages to reach a 30% improvement in space utilization, while preserving the quality of the timetable, both for students and lecturers.

AgroDB - integration of database management systems with crop models.

2016

Physical soil attributes of Conilon coffee (Coffea canephora) under organic and conventional management systems.

Coffea sp. is cultivated in large areas, using both conventional and organic management. However, information about the sustainability of these two management systems is still deficient. The objective of the present study was to evaluate the physical properties of soil cultivated with Conilon coffee (C. canephora) under organic and conventional management. Two areas cultivated with Conilon coffee (under organic and conventional management) and a fragment of Atlantic forest, used as a reference, were selected for the experiment. Soil granulometry, hydraulic conductivity, water retention curve, resistance to penetration, porosity, optimal hydric interval, and other physical characteristics were measured at depths of 0 to 10 and 10 to 20 cm. The data was submitted to multivariate and descriptive statistical analyses. Higher similarity was observed between the soil cultivated with Conilon coffee under organic management and the Atlantic forest soil. Soil resistance to penetration at 10, 30, 100, 500 and 1500 kPa, macro porosity, density and total porosity were the main physical properties that differentiated both management systems studied. The non-use of agricultural machinery and the addition of organic matter may be the main reasons for higher soil sustainability observed under organic management when compared with the conventional system.

Soil management systems for sustainable melon cropping in the Submedian of the São Francisco Valley.

Changes in soils management systems, including the application of green manure, are able to increase crop productivity. The aim of this study was to propose a soil management system with the use of green manure to improve the nutritional status and melon productivity in the submedian of the São Francisco Valley. The experiment was installed in Typic Plinthustalf and conducted in split plot. There were two soil tillage systems, tillage (T) and no tillage (NT), and three types of green manure (two vegetal cocktails: VC1- 75% legumes (L) + 25% non-legumes (NL); VC2- 25% L+ 75% NL and spontaneous vegetation (SV)). The experimental design was a randomised block with four replications. Fourteen species of legumes, grasses and oilseeds were used for the composition of the plant cocktails. We evaluated production of the dry shoot and root biomass and carbon and nutrient accumulation by green manures and melon plant. Data were subjected to analysis of variance and the treatment means were compared by Tukey´s test (P<0.05). Shoot biomass production and carbon and nutrient accumulation were higher in plant mixtures compared to spontaneous vegetation. The root system of the plant cocktails added larger quantities of biomass and nutrients to the soil to a depth of 0.60 m when compared to the spontaneous vegetation. The cultivation of plant cocktails with soil tillage, regardless of their composition, is a viable alternative for adding biomass and nutrients to the soil in melon crops in semi-arid conditions, providing productivity increases.

Relationships between labile soil organic carbon fractions under different soil management systems.

ABSTRACT: The study of labile carbon fractions (LCF) provides an understanding of the behavior of soil organic matter (SOM) under different soil management systems and cover crops. The aim of this study was to assess the effect of different soil management systems with respect to tillage, cover crop and phosphate fertilization on the amount of the LCF of SOM. Treatments consisted of conventional tillage (CT) and no-tillage (NT) with millet as the cover crop and a no-tillage system with velvet bean at two phosphorus dosages. Soil samples were collected and analyzed for organic carbon (OC), C oxidizable by KMnO4 (C-KMnO4), particulate OC (POC), microbial biomass carbon and light SOM in the 0.0-0.05, 0.05-0.10 and 0.10-0.20 m soil layers. The Carbon Management Index (CMI) was calculated to evaluate the impacts of soil management treatments on the quality of the SOM. The different LCFs are sensitive to different soil management systems, and there are significant correlations between them. C-KMnO4 is considered the best indicator of OC carbon lability. In the soil surface layers, the CT reduced the carbon content in all of the labile fractions of the SOM. The use of phosphorus led to the accumulation of OC and carbon in the different soil fractions regardless of the tillage system or cover crop. The application of phosphate fertilizer improved the ability of the NTsystem to promote soil quality, as assessed by the CMI.