In the dynamic environment of increasing regulations, increasing patient demand, decentralization of budgets and enforcement of efficiency, small sized healthcare institutions in the Netherlands are having a difficult time. Although these service providers are usually capable of flexibly delivering healthcare, the investment and overhead for implementing and executing on required quality management standards like ISO 9001 is difficult. In this paper we construct a method for the implementation of an IT-enabled quality management system for small sized healthcare institutions, which is applied through case study. The case organisation provides intra- and extramural care for mentally handicapped persons and young adults with a psychiatric disorder. The quality management system implementation is based on 1) a lightweight IT infrastructure (based at a secure data centre and accessible through remote login) implying secure storage of patients' medical and personal information. Furthermore, the Deming (Deming, 1982) cycle enabled processes and protocols are 2) described in an e-handbook and prototyped via an open source process management system which supports the quality regulation demanded for providing care to patients. The case study supports the validity of our method and the fact that small sized healthcare institutions are able to execute their care while adhering to ISO 9001-like standards, with limited initial costs and relatively low cost of ownership
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Experts like Jouslin de Noray, Shiba and Hardjono discern three paradigms in quality management: control, continuous improvement and breakthrough. Van Kemenade argues that before being able to reach breakthrough you need another paradigm: commitment.
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How to design and implement a system of Total Quality Management in education
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Do individual characteristics influence how the quality of work is related to the use of a workflow management system (WFM) in a Dutch social insurance organisation? This key question is addressed in this paper. Building upon DeLone and McLean’s model, we investigated the effects of gender, age, education, system experience and computer skills on the relationship between the level of user satisfaction with a WFM system and the perceived quality of work. The expected effects of individual characteristics were tested using survey data collected from 143 end users of a large Dutch social insurance organisation that recently deployed a WFM system. The results of the regression analysis show that: 1 user satisfaction has a positive relationship with quality of work 2 age has a significant moderating influence on the perceived quality of work 3 gender and system experience have no moderating effects 4 education and system computer skills (as individual characteristics) had a degree of moderating effects. These results imply that it is valuable to focus on older employees when deploying information technology as WFM systems, i.e., by improving their computer skills in particular.
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Climate change and urbanization will increase the frequency and magnitude of urban flooding and water quality problems in many regions of the world. In coastal and delta areas like The Netherlands and the Philippines, where urbanization is often high, there has been an increase in the adoption of sustainable urban drainage systems (SUDS). SUDS are installed around the world with the expectation to reduce urban flooding and reduce the pollution impact on receiving waters. Most cities in Asia are starting to implement SUDS as their strategy to make their cities sustainable and resilient.The combination of SUDS with appropriate wastewater treatment and management systems have the potential to be multifunctional in alleviating flood run-off, improving water quality, alleviating heat stress and as a source for reusing the stormwater and wastewater.Since the earliest SUDS are implemented in Europe decades ago it is advised to use the lessons learnt in this process. International knowledge exchange is promoted in projects as IWASTO where several organisations from the Philippines and The Netherlands join forces on a specific region as the Pateros riverin Manila with the aim to minimise the pollution impact on this receiving water. The first findings of this project related to storm water and wastewater management are presented in this paper. In this stage of the project high level support models that map the challenges in the city (such as flooding and heatstress) arevaluable tools for implementing cost effective sustainable drainage for improving water quality.
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There are lots of definitions of quality, and also of quality in education. Garvin (1984)discerns five approaches: the transcendental approach, the product-oriented approach, the customeroriented approach, the manufacturing-oriented approach and the value-for-money approach. Harvey and Green (1993) give five interrelated concepts of quality as: exceptional, perfection (or consistency), fitness for purpose, value for money and transformative. A new definition of quality is needed to explain recent quality issues in higher education. This article describes a quality concept with four constituents: object, standard, subject and values. The article elaborates on the values. Four value systems derived from Beck and Cowan (1996) are transformed into four value systems on quality and quality management: control, continuous improvement, commitment and breakthrough. These value systems make it possible to explain some recent developments in quality management in higher education.
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This paper contributes to the knowledge of the performativity of accounting by exploring the unexpected consequences of a management accounting and control system (MAC) as designed in a large public organization. In an organization in the Dutch sector of Nursing Homes, Homes for the Elderly and Homecare MAC turns from a system into an actor-network. Rather than being a stable answer machine in the context of decision making or a ready-made tool for performance management by which distant (top) managers and controllers aim to measure and manage performance from time-space distances, MAC is grounded in relations and performatively develops. As such, it becomes multiple. The study shows how the performativity of MAC goes beyond its functionality. Though originating from MAC’s functional design, MAC’s performativity is not simply about the degree to which it realizes the intentions of its designers, but is about its dynamic relational consequences. Controllers should mediate in the dynamics of MAC so that processes of learning are enhanced and the quality and efficiency of the care practices develop
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The main question in this PhD thesis is: How can Business Rules Management be configured and valued in organizations? A BRM problem space framework is proposed, existing of service systems, as a solution to the BRM problems. In total 94 vendor documents and approximately 32 hours of semi-structured interviews were analyzed. This analysis revealed nine individual service systems, in casu elicitation, design, verification, validation, deployment, execution, monitor, audit, and version. In the second part of this dissertation, BRM is positioned in relation to BPM (Business Process Management) by means of a literature study. An extension study was conducted: a qualitative study on a list of business rules formulated by a consulting organization based on the Committee of Sponsoring Organizations of the Treadway Commission risk framework. (from the summary of the Thesis p. 165)
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Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Western-European consumers have become not only more demanding on product availability in retail outlets but also on other food attributes such as quality, integrity, and safety. When (re)designing food supply-chain networks, from a logistics point of view, one has to consider these demands next to traditional efficiency and responsiveness requirements. The concept ‘quality controlled logistics’ (QCL) hypothesizes that if product quality in each step of the supply chain can be predicted in advance, goods flows can be controlled in a pro-active manner and better chain designs can be established resulting in higher product availability, constant quality, and less product losses. The paper discusses opportunities of using real-time product quality information for improvement of the design and management of ‘AgriFood Supply Chain Networks’, and presents a preliminary diagnostic instrument for assessment of ‘critical quality’ and ‘logistics control’ points in the supply chain network. Results of a tomato-chain case illustrate the added value of the QCL concept for identifying improvement opportunities in the supply chain as to increase both product availability and quality. Future research aims for the further development of the diagnostic instrument and the quantification of costs and benefits of QCL scenarios.
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