UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

Introduction
Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim
To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods
Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results
71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion
The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems

BACKGROUND: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. METHOD: The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. RESULTS: The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. CONCLUSIONS: Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts

Influence of software development process quality on product quality

Ohjelmistojen tärkeys nykypäivän yhteiskunnalle kasvaa jatkuvasti. Monia ohjelmistoprojekteja vaivaavat ongelmat aikataulussa pysymisestä, korkean tuottavuuden ylläpitämisestä ja riittävän korkeasta laadusta. Ohjelmistokehitysprosessien parantamisessa on naiden ongelmien minimoimiseksi tehty suuria investointeja. Investointien syynä on ollut olettamus ohjelmistokehityksen kapasiteetin suora riippuvuus tuotteen laadusta. Tämän tutkimuksen tarkoituksena oli tutkia Ohjelmistokehitysprosessien parantamisen mahdollisuuksia. Olemassaolevat ohjelmistokehityksen ja Ohjelmistokehitysprosessin parantamisen mallit, tekniikat ja metodologiat esiteltiin. Esiteltyjen mallien, tekniikoiden ja metodologioiden soveltuvuus analysoitiin ja suositus mallien käytöstä annettiin.

JOB SATISFACTION: A QUALITY INDICATOR IN NURSING HUMAN RESOURCE MANAGEMENT

This descriptive study addresses the job satisfaction of nurse managers and clinical nurses working at the Hematology and Hemotherapy Services of a public hospital in Sao Paulo. The study objectives were to identify the factors that caused job satisfaction among nurse managers and clinical nurses, and support the results in the development of indicators to evaluate the quality of nursing human resource management. The components of the study were: autonomy, interaction, professional status, job requirements, organizational norms and remuneration. Participants were 44 nurses. Data were collected using a Job Satisfaction Index (JSI) questionnaire. In conclusion, this study permitted the identification of the clinical nurse group, which was the most satisfied, with a JSI of 10.5; the managerial group scored 10.0. Regarding the satisfaction levels in regards to the current activity, 88.9% of the nurse managers reported feeling satisfied, as did 90.9% of clinical nurses. For both groups, autonomy was the component with the highest level of professional satisfaction.

Obstruction and infiltration: a proposal of a quality indicator.

Background The quest for continuous improvement of the quality of provided care is the objective of nursing care. However, the insertion and permanence of a peripheral venous catheter has been associated to complications, thus making a systematic evaluation of the performance of professionals and the management of health services important. Objective: Analyse complications that caused removal of intravenous catheters. Methods A prospective study with 64 patients of a health service of Portugal, from July to September/2015. Included patients with age 18 years, with a peripheral venous catheter. Descriptive analysis using SPSS. Ethical requirements were met. Results Two hundred three (203) intravenous catheters, in 64 patients, most elderly (section 95.3 %), with mean age of 80 years were evaluated. The catheters remained inserted between one and 12 days (mean 2 days), 66 % of the devices were removed because of complications, such as: removal by the patient (17.7 %), obstruction (17.2 %), infiltration (14.8 %), phlebitis (9.4 %) and fluid exiting the insertion site (6.4 %). The prevalence of obstruction and infiltration per patient was respectively 36 % and 39 %. Conclusions Obstruction and infiltration were the complications of higher prevalence that led to the removal and reinsertion of a new peripheral venous catheter with the possibility of increased pain, infection and hospital costs. Faced with the risk of compromising patient safety and being able to contribute to the improvement of health care, we suggest the inclusion of obstruction and infiltration in the indicators of quality of care, in order to have systematic evaluation of results, (re)plan and implement preventive measures.

Quality of sugarcane in productive process of ethanol evaluated by INAA

Soil as an impurity in sugarcane is a serious problem for the ethanol industry, increasing production and maintenance costs and reducing the productivity. Fe, Hf, Sc and Th determined by INAA were used as tracers to assess the amount of soil in sugarcane from truckloads as well as in the juice extraction process. Quality control tools were applied to results identifying the need for stratification according to soil type and moisture. Soil levels of truckloads had high variability indicating potential for improving cut and loading operations. Samples from the juice extraction process allowed tracking the soil in the mill tandem.

Qualifound – a modular tool developed for quality improvement in foundries

Purpose – Castings defects are usually easy to characterize, but to eradicate them can be a difficult task. In many cases, defects are caused by the combined effect of different factors, whose identification is often difficult. Besides, the real non-quality costs are usually unknown, and even neglected. This paper aims to describe the development of a modular tool for quality improvement in foundries, and its main objective is to present the application potential and the foundry process areas that are covered and taken into account. Design/methodology/approach – The integrated model was conceived as an expert system, designated Qualifound, which performs both qualitative and quantitative analyses. For the qualitative analyses mode, the nomenclature and the description of defects are based on the classification suggested by the International Committee of the Foundry Technical Association. Thus, a database of defects was established, enabling one to associate the defects with the relevant process operations and the identification of their possible causes. The quantitative analysis mode deals with the number of produced and rejected castings and includes the calculation of the non-quality costs. Findings – The validation of Qualifound was carried out in a Portuguese foundry, whose quality system had been certified according to the ISO 9000 standards. Qualifound was used in every management area and it was concluded that the application had the required technological requisites to provide the necessary information for the foundry management to improve process quality. Originality/value – The paper presents a successful application of an informatics tool on quality improvement in foundries.

Evaluation of the improvements on pharmacy technicians' work practices after implementation of operational procedures

Several antineoplasic drugs have been demonstrated to be carcinogenic or to have mutagenic and teratogenic effects. The greatest protection is achieved with the implementation of administrative and engineering controls and safety procedures. Objective: to evaluate the improvements on pharmacy technicians' work practices, after the implementation of operational procedures related to individual protection, biologic safety cabinet disinfection and cytotoxic drug preparation. Method: case-study in a hospital pharmacy undergoing a certification process. Six pharmacy technicians were observed during their daily activities. Characterization of the work practices was made using a checklist based on ISOPP and PIC guidelines. The variables studied concerning cleaning/disinfection procedures, personal protective equipment and procedures for preparing cytotoxic drugs. The same work practices were evaluated after four months of operational procedures implementation. Concordance between work practices and guidelines was considered to be a quality indicator (guidelines concordance practices number/total number of practices x 100). Results: improvements were observed after operational procedures implementation. An improvement of 6,25% in personal protective equipment practice was achieved by changing second pair of gloves every thirty minutes. The major progress, 10%, was obtained in disinfection procedure, where 80% of tasks are now realized according to guidelines.By now, we hot an improvement of only 1% at drug preparation procedure by placing one cytotoxic drug at a time inside the biological safety cabinet. Then, 85% of practices are according to guidelines. Conclusion: before operational procedures implementation 80,3% of practices were according to the guidelines, while now is 84,4%. This indicates that is necessary to review the procedures frequently in the benefit to reduce the risks associated with handling cytotoxic drugs and maintenance of drug specifications.

Investigation of Electromagnetic Gauges for Determining In-Place HMA Density, 2007

Density is an important component of hot-mix asphalt (HMA) pavement quality and long-term performance. Insufficient density of an in-place HMA pavement is the most frequently cited construction-related performance problem. This study evaluated the use of electromagnetic gauges to nondestructively determine densities. Field and laboratory measurements were taken with two electromagnetic gauges—a PaveTracker and a Pavement Quality Indicator (PQI). Test data were collected in the field during and after paving operations and also in a laboratory on field mixes compacted in the lab. This study revealed that several mix- and project-specific factors affect electromagnetic gauge readings. Consequently, the implementation of these gauges will likely need to be done utilizing a test strip on a project- and mix-specific basis to appropriately identify an adjustment factor for the specific electromagnetic gauge being used for quality control and quality assurance (QC/QA) testing. The substantial reduction in testing time that results from employing electromagnetic gauges rather than coring makes it possible for more readings to be used in the QC/QA process with real-time information without increasing the testing costs.

Investigation of Electromagnetic Gauges for Determining In-Place HMA Density, Final Report, May 2007

Density is an important component of hot-mix asphalt (HMA) pavement quality and long-term performance. Insufficient density of an in-place HMA pavement is the most frequently cited construction-related performance problem. This study evaluated the use of electromagnetic gauges to nondestructively determine densities. Field and laboratory measurements were taken with two electromagnetic gauges—a PaveTracker and a Pavement Quality Indicator (PQI). Test data were collected in the field during and after paving operations and also in a laboratory on field mixes compacted in the lab. This study revealed that several mix- and project-specific factors affect electromagnetic gauge readings. Consequently, the implementation of these gauges will likely need to be done utilizing a test strip on a project- and mix-specific basis to appropriately identify an adjustment factor for the specific electromagnetic gauge being used for quality control and quality assurance (QC/QA) testing. The substantial reduction in testing time that results from employing electromagnetic gauges rather than coring makes it possible for more readings to be used in the QC/QA process with real-time information without increasing the testing costs.

Optimizing the Testing Process in Module Testing – Functional Testing Interface

Today's business environment has become increasingly unexpected and fast changing because of the global competition. This new environment requires the companies to organize their control differently, e.g. by logistic process thinking. Logistic process thinking in software engineering applies the principles of production process to immaterial products. Processes must be optimized, so that every phase adds value to the customer, and the lead times can be cut shorter to meet the new customer requirements. The purpose of this thesis is to examine and optimize the testing processes of software engineering concentrating on module testing, functional testing and their interface. The concept of logistic process thinking is introduced through production process, value added model and process management. Also theory of testing based on literature is presented, concentrating on module testing and functional testing. The testing processes of the Case Company are presented together with the project models in which they are implemented. The real life practices in module testing and functional testing and their interface are examined through interviews. These practices are analyzed against the processes and the testing theory, through which ideas for optimizing the testing process are introduced. The project world of the Case Company is also introduced together with two example testing projects in different life cycle phases. The examples give a view of how much effort of the project is put in different types of testing.

Tehtaan alueella tapahtuvan välivarastoinnin laadunvarmistus

Sisälogistiikassa on monissa eri vaiheissa varastointia. Raaka-aineita, keskeneräisiä ja valmiita tuotteita joudutaan varastoimaan yrityksen tiloissa. Varastoinnin laatuun tulee kiinnittää huomiota kaikissa vaiheissa. Varastoinnin laadunhallintaan voidaan käyttää standardin ISO 9000 mukaista laadunhallinta järjestelmää, johon kuuluu osa-alueina johdon vastuu, resurssien hallinta tuotteen toteuttaminen sekä mittaus, analysointi ja parantaminen. Logistiikan ja varastoinnin laadun tärkein mittari on asiakastyytyväisyys. Asiakkaat päättävät loppukädessä onko tuote tai palvelu vaatimusten mukainen, joten asiakkaan määrittelemien vaatimusten täyttäminen on ensiarvoisen tärkeää. Muita varastoinnin mittareita ovat suorituskyvyn mittarit sisältäen laatu- ja kustannusmittarit sekä uudistumiskyky. Työn empiriaosassa on kartoitettu Metso Paper Oy:n Rautpohjan yksikön välivarastoinnin mahdollisia laatupuutteita erilaisilla mittareilla. Tuloksien perusteella on kehitetty toimintamalli, kartoitettu ohjeistusta vaativat tahot sekä ehdotus seurannan järjestämisestä. Työssä on myös tarkasteltu vastuun jakautumista välivarastoinnin osalta.

Monitoring of mechanical sugarcane harvesting through control charts

ABSTRACT Statistical process control in mechanized farming is a new way to assess operation quality. In this sense, we aimed to compare three statistical process control tools applied to losses in sugarcane mechanical harvesting to determine the best control chart template for this quality indicator. Losses were daily monitored in farms located within Triângulo Mineiro region, in Minas Gerais state, Brazil. They were carried over a period of 70 days in the 2014 harvest. At the end of the evaluation period, 194 samples were collected in total for each type of loss. The control charts used were individual values chart, moving average and exponentially weighted moving average. The quality indicators assessed during sugarcane harvest were the following loss types: full grinding wheel, stumps, fixed piece, whole cane, chips, loose piece and total losses. The control chart of individual values is the best option for monitoring losses in sugarcane mechanical harvesting, as it is of easier result interpretation, in comparison to the others.