Objectives: In the post-surgical setting, active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care. This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients. Methods: We used a quality improvement project following a multi-phase design. In Phase 1, an iterative method was used to combine evidence from a narrative review and professionals’ preferences. In Phase 2, the logic model underlying the program was developed guided by four steps: (1) confirm situation, intervention aim, and target population; (2) documented expected outcomes, and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review. In Phase 2, the logic model was developed and includes (1) the inputs (e.g. educational- and environmental support), (2) the ultimate outcomes (e.g. reduction of postoperative complications), (3) the intermediate outcomes (e.g. behavioural changes), and (4) immediate outcomes (e.g. improved knowledge, skills and attitude). Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards, and how we took different factors into account. The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.
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Introduction: The implementation of oncology care pathways that standardize organizational procedures has improved cancer care in recent years. However, the involvement of “authentic” patients and caregivers in quality improvement of these predetermined pathways is in its infancy, especially the scholarly reflection on this process. We, therefore, aim to explore the multidisciplinary challenges both in practice, when cancer patients, their caregivers, and a multidisciplinary team of professionals work together on quality improvement, as well as in our research team, in which a social scientist, health care professionals, health care researchers, and experience experts design a research project together. Methods and design: Experience-based co-design will be used to involve cancer patients and their caregivers in a qualitative research design. In-depth open discovery interviews with 12 colorectal cancer patients, 12 breast cancer patients, and seven patients with cancer-associated thrombosis and their caregivers, and focus group discussions with professionals from various disciplines will be conducted. During the subsequent prioritization events and various co-design quality improvement meetings, observational field notes will be made on the multidisciplinary challenges these participants face in the process of co-design, and evaluation interviews will be done afterwards. Similar data will be collected during the monthly meetings of our multidisciplinary research team. The data will be analyzed according to the constant comparative method. Discussion: This study may facilitate quality improvement programs in oncologic care pathways, by increasing our real-world knowledge about the challenges of involving “experience experts” together with a team of multidisciplinary professionals in the implementation process of quality improvement. Such co-creation might be challenging due to the traditional paternalistic relationship, actual disease-/treatment-related constraints, and a lack of shared language and culture between patients, caregivers, and professionals and between professionals from various disciplines. These challenges have to be met in order to establish equality, respect, team spirit, and eventual meaningful participation.
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Obesity, especially morbid obesity, is a major health problem with considerable impact on physical, mental and social quality of life. Assessment of quality of life is considered crucial to understand and evaluate the consequences of obesity. Obesity has major consequences for quality of life, e.g., as a result of co-morbidities of obesity and weight stigmatization.Bariatric surgery has been proven to lead to significant weight loss and improvement of quality of life. Besides obesity, also personal and psychosocial variables influence quality of life and affect the outcome of surgery. Moreover, obesity, even after substantial weight loss by gastric bypass surgery, is a chronic disease requiring life long consideration, in order to sustain long standing quality of life improvement.
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Objectives There is a broad call for change towards € new era' quality systems in healthcare, in which the focus lies on learning and improving. A promising way to establish this in general practice care is to combine audit and feedback with peer group discussion. However, it is not known what different stakeholders think of this type of quality improvement. The aim of this research was to explore the opinions of different stakeholders in general practice on peer discussion of audit and feedback and on its opportunities and risks. Second, their thoughts on transparency versus accountability, regarding this system, were studied. Design An exploratory qualitative study within a constructivist paradigm. Semistructured interviews and focus group discussions were held and coded using thematic analysis. Included stakeholders were general practitioners (GP), patients, professional organisations and insurance companies. Setting General practice in the Netherlands. Participants 22 participants were purposively sampled for eight interviews and two focus group discussions. Results Three main opportunities of peer discussion of audit and feedback were identified: deeper levels of reflection on data, adding context to numbers and more ownership; and three main risks: handling of unwilling colleagues, lacking a safe group and the necessity of patient involvement. An additional theme concerned disagreement on the amount of transparency to be offered: insurance companies and patients advocated for complete transparency on data and improvement of outcomes, while GPs and professional organisations urged to restrict transparency to giving insight into the process. Conclusions Peer discussion of audit and feedback could be part of a change movement, towards a quality system based on learning and trust, that is initiated by the profession. Creating a safe learning environment and involving patients is key herein. Caution is needed when complete transparency is asked, since it could jeopardise practitioners' reflection and learning in safety.
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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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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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Obesity, especially morbid obesity, is a major health problem with considerable impact on physical, mental and social quality of life. Assessment of quality of life is considered crucial to understand and evaluate the consequences of obesity. However, the heterogeneity of the quality of life concept makes it difficult to compare and value studies on quality of life. Both generic -applying to any disease- and obesity specific quality of life instruments can be used as assessment instruments in obesity. Generic instruments have the advantage that they can be used to compare the quality of life consequences of divergent diseases, whereas the major advantage of obesity specific instruments is that these are more sensitive to changes in obesity. Obesity has major consequences for quality of life, as a result of co-morbidities of obesity, weight stigmatization, and other less frequently ventilated problems. Bariatric surgery has been proven to lead to significant weight loss and improvement of quality of life. Instruments differ in the suitability to assess quality of life after surgery and weight loss, and they differ in the domains of quality of life that are tapped by the instruments. Besides obesity, also personal and psychosocial variables influence quality of life and affect the outcome of surgery. Obesity, even after substantial weight loss by gastric bypass surgery, is a chronic disease requiring life long consideration, in order to attain long standing quality of life improvement.
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Waste from raw materials has a direct influence on the final price of a product. However, since waste has no added value to products, customers are unwilling to pay for it. Reducing waste along the production process and supply chain allows companies to decrease costs and remain competitive in product prices. This research is conducted in a medical device manufacturing company located in Tijuana (Mexico). The company found a negative variation in part number 9540, a metallic foil used for hot stamping. During inventory cycle counts, the company found that they were purchasing rawer material than necessary due to a 50% of waste generated along the production process. We implemented two process improvement methodologies, namely Practical Process Improvement (PPI) and the Plan-Do-Check-Act model, to eliminate 100% of the raw material waste, specifically regarding the foil's waste. The improvement project comprised two phases: a) adjusting the parameters of the hot foil stamping machine and b) replacing the hot foil stamping machine with a pad printing machine. In our research, the PPI methodology is presented in 8 detailed stages as a simple problem-solving method, in contrast with five stages reported in other documented cases. This case study presents how a company can apply continuous improvement programs and its managerial implications, even without having a structured and defined systems for quality, such as Six Sigma or Lean Manufacturing implemented. After the two implementation phases, the improvement project led to economic savings of $\$ $ 165,000 in a year.
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How to design and implement a system of Total Quality Management in education
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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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