Modeling and analysis of patient flow in hospital emergency department (ED) is of significant importance. In a hospital ED, the patients spend most of their time in the patient room and most of the ...care delivery services are carried out during this time period. In this paper, we propose a system model to study patient (or work) flow in the patient room of an ED when the resources are partially available. A closed and re-entrant process model is developed to characterize the care service activities in the patient room with limited resources of doctors, nurses, and diagnosis tests. Analytical calculation of patient’s length of stay in the patient room is derived, and monotonic properties with respect to care service parameters are investigated.
Research is needed to validate effective and practical strategies for improving the provision of evidence-based medicine in primary care.
To determine whether a multimethod quality improvement ...intervention was more effective than a less intensive intervention for improving adherence to 21 quality indicators for primary and secondary prevention of cardiovascular disease and stroke.
2-year randomized, controlled clinical trial with the practice as the unit of randomization.
20 community-based family or general internal medicine practices in 14 states. All used the same electronic medical record.
44 physicians, 17 midlevel providers, and approximately 200 staff members; data from the electronic medical records of 87,291 patients.
All practices received copies of practice guidelines and quarterly performance reports. Intervention practices also hosted quarterly site visits to help them adopt quality improvement approaches and participated in 2 network meetings to share "best practice" approaches.
The percentage of indicators at or above predefined targets and the percentage of patients who had achieved each clinical indicator.
Intervention practices improved 22.4 percentage points (from 11.3% to 33.7%) in the percentage of indicators at or above the target; control practices improved 16.4 percentage points (from 6.3% to 22.7%). The 6.0-percentage point absolute difference between the intervention and control group was not statistically significant (P > 0.2). Patients in intervention practices had greater improvements than those in control practices for diagnoses of hypertension (improvement difference, 15.7 percentage points 95% CI, 5.2 to 26.3 percentage points) and blood pressure control in patients with hypertension (improvement difference, 8.0 percentage points CI, 0.0 to 16.0 percentage points).
The study involved a small number of practices and lacked a pure control group.
Primary care practices that use electronic medical records and receive regular performance reports can improve their adherence to clinical practice guidelines for cardiovascular disease and stroke prevention.
The history of chemoinformatics is reviewed in a decade-by-decade manner from the 1940s to the present. The focus is placed on four traditional research areas: chemical database systems, ...computer-assisted structure elucidation systems, computer-assisted synthesis design systems, and 3D structure builders. Considering the fact that computer technology has been one of the major driving forces of the development of chemoinformatics, each section will start from a brief description of the new advances in computer technology of each decade. The summary and future prospects are given in the last section.
A nurse's optimism or skepticism toward an organization-mandated change initiative largely depends on their experience with similar change initiatives and their unit's and organization's track record ...with previous change efforts. Thus, depending on the context, organization tenure can work in favor or against any particular change initiative. However, few studies have examined the impact of organization tenure on perceptions toward change initiatives. The few studies that have been conducted have yielded mixed results and have only targeted single or similar work initiatives.
The aim of this study was to examine how organization tenure impacts nurses' perceptions toward a diverse array of work process improvement initiatives.
The data are derived from a survey of 421 medical-surgical nurses representing 41 units across four hospitals. The survey was designed to capture nurses' perceptions toward three change initiatives-AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You), hourly rounding, and discharge phone calls-and their impact across two subscales-patient care and individual work change.
Organization tenure is significantly and negatively associated with change receptivity for the non-patient safety-oriented initiative (AIDET). This negative relationship dissipates as we evaluate more patient safety-oriented work process initiatives (hourly rounding and discharge phone calls).
Significant differences in nurses' perceptions toward change do exist depending on how long they have worked for their employer. For non-patient safety-oriented change initiatives, veteran-to-the-organization nurses may exhibit more recalcitrance than their new-to-the-organization counterparts. However, our findings also suggest the presence of a patient safety exception rule where veteran-to-the-organization nurses do not exhibit differences in opinion than their new-to-the-organization counterparts for patient safety-oriented change initiatives.
Magnet® Model component NE6EO indicates that nurses should be involved in workflow improvements and space design to improve nursing practice. The Magnet Model can be used as a framework for ensuring ...that the structures and processes are in place to support nurses’ participation in the design of new facilities or remodel spaces.
Overcoming the improvement paradox Keating, Elizabeth; Oliva, Rogelio; Repenning, Nelson ...
European management journal,
04/1999, Letnik:
17, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Despite the demonstrated benefits of improvement programs such as total quality management and reengineering, most improvement programs end in failure. Companies have found it extremely difficult to ...sustain even initially successful process improvement programs. Even more puzzling, successful improvement programs sometimes worsen business performance, triggering layoffs, low morale, and the collapse of commitment to continuous improvement. We term this phenomenon the `Improvement Paradox.' For the last four years, we have worked with a variety of firms to understand the paradox and design policies to overcome it. Our findings suggest that the inability to manage an improvement program as a dynamic process is the main determinant of program failure. Improvement programs are tightly coupled to other functions and processes in the firm, and to the firm's customers, suppliers, competitors and capital markets. Failure to account for the feedbacks among these tightly coupled activities leads to unanticipated and often harmful side effects. We describe these dynamics and offer some guidance for managers seeking to design sustainable process improvement programs.
Sustaining change in the behaviors and habits of experienced practicing nurses can be frustrating and daunting, even when changes are based on evidence. Partnering with an active shared governance ...structure to communicate change and elicit feedback is an established method to foster partnership, equity, accountability, and ownership. Few recent exemplars in the literature link shared governance, change management, and evidence-based practice to transitions in care models. This article describes an innovative staff-driven approach used by nurses in a shared governance performance improvement committee to use evidence-based practice in determining the best methods to evaluate the implementation of a new model of care.
Today's managers face a paradox. On the one hand, the number of tools, techniques, and technologies available to improve operational performance is growing rapidly. On the other hand, despite ...dramatic success in a few companies, most efforts to use them fail to produce significant results. To understand and resolve this paradox, this article investigates the difficulties organizations face in implementing processes and techniques such as lean production, TQM, computer-aided design and development tools, stage-gate product development processes, and improved customer service systems. The inability of most organizations to reap the full benefit of these innovations has little to do with the specific technique. Instead, the problem has its roots in how the introduction of a new improvement effort interacts with the physical, economic, social, and psychological structures in which implementation takes place. This article presents a framework to understand how these failures arise and illustrates strategies for overcoming the pathological behaviors through case studies of successful improvement.
One question facing a company wanting to improve manufacturing performance is whether to implement improvement initiatives in parallel or sequentially. This article examines whether any sequences of ...manufacturing improvement initiatives exist and what these sequences are. For two and a half years, the author participated in and studied one company's implementation of lean production. The findings group the principles of lean production into four different categories, depending on when management devoted effort and resources to the principles. The conclusions indicate that there are sequences in which lean production principles are implemented, but management also need to devote effort and resources to a set of principles in parallel.
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