A qualitative exploration of the experiences of doctors, nurses and pharmacists regarding medication management in outpatient setting.

AIM: To understand how the medications are managed by the multidisciplinary team and their suggestions for nursing management, and to develop a framework for safe medication management in hospital-based outpatient. BACKGROUND: More than 80% of hospital-based outpatient visits involve medication prescriptions, indicating the importance of safe medication management there. METHODS: This was a qualitative study with face-to-face interviews with physicians, nurses and pharmacists from 11 medical outpatient units. RESULTS: Four themes elicited were categorized as follows: unclear professional roles and functions in outpatient medication management; intertwined communications; moving from data to wisdom; and ambiguous culture of safety. The resulting model is a collaboration of physicians, nurses, pharmacists, and patients and families integrated with hospital administrative support and information technology in a culture of safety. CONCLUSIONS: Medication management in outpatient is critical but usually overlooked. Nursing leaders should develop a culture of safety and provide more support and training for nurses to provide comprehensive medication management for outpatients. IMPLICATIONS FOR NURSING MANAGEMENT: It is important to develop outpatient nurses' role and competence in managing patient medication safety. Nurses in management would benefit from applying the 'framework of efficient and safe medication management for outpatients' to assess and identify weak areas for improvement.

Organization Science improves management effectiveness of Marine Protected Areas.

The ecological management effectiveness (EME) of Marine Protected Areas (MPAs) is the degree to which MPAs reach their ecological goals. The significant variability of EME among MPAs has been partly explained by MPA design, management and implementation features (e.g. surface area, enforcement, age of protection). We investigated EME variability by employing, for the first time, Organization Science. Eight Mediterranean MPAs were taken into account as case studies to explore the relationships between EME and MPA features, such as: 1) organizational size (i.e. the ratio between the number of full-time employees and the total MPA surface area), 2) management performance (i.e. the level of effort exerted to enhance and sustain the MPA management, including enforcement), 3) total surface area, and 4) MPA age. The log-response ratios of fish biomass and density in protected vs unprotected (control) areas were used as a proxy of EME. Management performance, organizational size and, to a lesser extent, MPA age were positively correlated with the log-response ratio of fish biomass, whereas total surface area did not display a significant role. None of the four features considered was significantly correlated with the log-response ratio of fish density. Based on our findings, we argue that the employment of Organization Science in the management effectiveness assessment can assist MPA managers to reach MPAs goals more effectively, with a more efficient use of available resources.

Safe medication management in specialized home healthcare - an observational study.

BACKGROUND: Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering. METHOD: Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory. RESULTS: The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies. CONCLUSIONS: To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

Use of failure mode effect analysis (FMEA) to improve medication management process.

Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions. Practical implications FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type. Originality/value The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.

Mechanism of knowledge management process towards minimizing manufacturing risk under green technology implementation: an empirical assessment.

Given the critical importance of green technology implementation (GTI) is important for production process improvement and an eco-friendly environment. The present study investigates the connection between GTI and the knowledge management (KM) process to minimize manufacturing risk. This research also validates that an assured combination of green implementation and KM can lead to minimizing manufacturing risk. The sample data (153) was taken from those manufacturing companies that utilize green technologies. Smart PLS 3.2.9 analyzes the relationship between certain variables of GTI and the KM process. Furthermore, fuzzy set qualitative comparative analysis (fsQCA) is used for a combined configurational approach to examine manufacturing risk minimization. The study's outcome validated that green implementation positively correlated with KM to minimize production risk. fsQCA approach, KM, and green implementation outcome indicated that production risks are minimized. This study contributes to bridging research gaps in the literature and advances understanding of the interrelationship between green implementation and KM processes to minimize manufacturing risk. In addition, research is vital to combine direct and configurational methodologies to highlight two distinct facets of green implementation and the KM process for minimizing manufacturing risk.

Grasping the structure of the care management process evaluation items that are related to care management skills with regard to individual users: conducting verification through self-assessment by care managers.

Objective: This study aimed to understand the structure of a self-assessment for evaluating the care management skills of individuals in the care management process. Materials and Methods: A survey was distributed to 964 care managers in home care management hailing from each committee in Japanese municipalities in Ibaraki, Chiba, Saitama, Kanagawa, and Tokyo. The process implementation degree of care management in 46 care management process evaluation items was assessed using a five-point method. Cronbach's alpha coefficients were derived for the items, and an exploratory factor analysis was conducted to ascertain the factor structure. We also verified the relationship between the factor scores, presence or absence of a chief care manager, and years of experience. Results: We received 385 responses (response rate: 39.9%), of which 372 were included in the analysis (valid response rate: 96.6%). Six factors were extracted, and 29 items were retained because of the exploratory factor analysis. Three of the six factors did not exist in the existing scales and had a unique structure. The cumulative contribution rate of the six factors was 64.9%, and Cronbach's alpha coefficient for all items was α=0.95, with Factor 1 being 0.88; Factor 2 being 0.83; Factor 3 being 0.86; Factor 4 being 0.85; Factor 5 being 0.80; and Factor 6 being 0.87. The total score for Factors 1, 2, 4, and 5 was significantly higher among chief care managers. Pearson's correlation coefficients were calculated to determine the correlation between scale scores and years of experience. Factor 1 (r=0.22) and Factor 2 (r=0.21) showed a modest positive correlation between the scale scores and years of experience. Conclusion: We retained 29 items and extracted six factors for the care manager self-assessment items that had a unique factor structure while following existing scales' factor structure.

Analysis of knowledge management process towards minimizing supply chain risks under the green technology: a direct and configurational approach.

Adopting green technologies is crucial for a sustainable supply process and organization development. In this construct, the current study analyzes how green technology adoption (GTA) and knowledge management (KM) processes could minimize supply risk in large manufacturing companies. The current study utilizes research techniques based on the resource-based view and contingency theories to minimize supply chain risk. The present study selected green variables (learning, productivity, raw materials, and resource utilization) along with KM processes (acquisition, sharing, and utilization) to investigate these connections to achieve the research objective. The author collected the data (203) from manufacturing firms in Zhengzhou city and used PLS-SEM, fuzzy set qualitative comparative analysis (fsQCA) to examine the study aims. The relationship between the adoption of green technologies and the KM process, which may reduce supply risk, was verified via PLS-SEM. fsQCA is employed as a combined strategy with green technology and the KM dimension to examine supply risk. The study results showed a significant correlation between the KM process's ability to reduce supply risk under the GTA. The results of the fsQCA specify the numerous dimensions of green implementation enablers, and the KM process produced superior results in terms of supply risk minimization. This research contributes to bridging gaps and understanding the interrelationship between green measurement and the supply risk process minimization. The current study provides practical and social justification for enlightening the relationship between GTA and the KM process, aiming to minimize the supply risk. Based on the study outcome and ground information, this study reported limitations and future research direction.

Evaluation of physicochemical characteristics and centerline temperatures of Sr ceramic waste form.

When disposing of spent fuel, nuclides such as Cs-137 and Sr-90, which generate short-term decay heat, must be removed from the spent nuclear fuel for efficient storage facility utilization. The Korea Atomic Energy Research Institute (KAERI) has been developing a nuclide management process that can enhance disposal efficiency by sorting and collecting primary nuclides and a technology for separating Sr nuclides from the spent nuclear fuels using precipitation and distillation. In this study, we prepared Sr ceramic waste form, SrTiO3, using the solid-state reaction method to immobilize the Sr nuclides, and its physicochemical properties were evaluated. Moreover, the radiological and thermal characteristics of the Sr waste form were evaluated by estimating the composition of Sr nuclides considering the spent nuclear fuel history such as burn-up and cooling period. The waste form was found to be stable with good mechanical strength and leaching properties in addition to a low coefficient of thermal expansion, which would be advantageous for intermediate storage. Based on the experimental and radiological results, the centerline temperature of the waste form caused by Sr-90 nuclide was estimated using the steady-state conduction equation. The centerline temperature increased with increasing diameter of the waste form. When generating the SrTiO3 waste form using the Sr nuclide recovered after a cooling period of 10 years, the centerline temperature was estimated to exceed the melting point of SrTiO3 at a diameter of 0.275 m, under all burn-up conditions. These results provide fundamental data for the management and intermediate storage of Sr waste.

The Impact of Knowledge Management Process and Intellectual Capital on Entrepreneurial Orientation and Innovation.

Innovation is considered to be a dominant cause for sustainable business success. Knowledge management and intellectual capital are powerful tools to promote innovation in the organization. Therefore, this study aims to explore the influence of knowledge management process and intellectual capital on innovation with the mediating effect of entrepreneurial orientation and moderating role of leader education level. Data were collected from a sample of 393 IT firms listed in the Pakistan Software Houses Association and applied a partial least squares structural educational modeling (SEM) technique. The results show that the knowledge management process and intellectual capital have a positive effect on innovation. Moreover, the study confirms that entrepreneurial orientation partially mediates the relationship between knowledge management and intellectual capital on innovation. Furthermore, the moderation effect of a leader's education was confirmed for the knowledge management-innovation relationship whereas, the moderation effect of the leader's education on intellectual capital and innovation relationship was insignificant. Recommendations for practitioners and future research directions were also discussed.

Fuzzy TOPSIS framework for promoting win-win project procurement negotiations.

In recent years, organizations worldwide have widely applied the project approach in business and value delivery. Negotiation is essential to the success of a project; however, it has not been explored systematically in the project context. A gap remains between knowledge and practical behavior during negotiation settlements throughout projects. Many project procurement (PP) negotiations do not work as expected. This study develops a practical framework using the scientific method to help close the gap and improve PP negotiations. The proposed framework uses the fuzzy TOPSIS (technique for order preference by similarity to ideal solution) method to integrate the PP management process (PPMP) and the three-phase negotiating model. Through this approach, notable variables and potential solutions under uncertain negotiation situations are quantitatively examined in the early stage and managed until the completion of PP. Thus, expected agreements can be obtained in a timely and efficient manner, with negotiating parties committing to implementing what has been agreed on. Such a commitment facilitates win-win outcomes. An example is presented to demonstrate how the proposed framework operates, and practical implications for managers of project-based organizations are offered. This study provides researchers and practitioners with a foundation to study refined models to enhance project negotiations with interdisciplinary integration.

Relating Sustainable Business Development Practices and Information Management in Promoting Digital Green Innovation: Evidence From China.

Digital green innovations are being implemented in manufacturing to help organizations achieve sustainability by adopting sustainable development practices (SDPC). However, little is known about the impact of the information management process (IMP) on organizations' digital green innovation. To address this gap, we devised a multidimensional framework based on the resource-based view (RBV) theory that serves as a basis for sculpting how the IMP captured and sustained organizational digital green innovation via SDPCs. 533 respondents from big and medium-sized manufacturing businesses in China were surveyed, and data were analyzed using the structural equation modeling (SEM) approach. The study makes numerous significant findings. Firstly, the SDPC's dimensions (environment, economic, and social) are considerably improved by the IMP' dimensions (acquisition, dissemination, and application). Secondly, SDPC's dimensions are critical for attaining organizations' digital green innovation. Thirdly, SDPCs' implementation mediates the linkage between the IMP and organizations' digital green innovation. Our findings suggest that investing in and implementing cutting-edge technology and sustainable practices are critical for long-term success. Still, soft issues, such as organizational information management, are equally critical in today's information-based economy. Finally, in light of the study findings, we present theoretical and managerial implications.

Biosorption as a Perfect Technique for Purification of Wastewater Contaminated with Ammonia.

Eichhornia crassipes root powder (ECRP) has been used to remove ammonia from aqueous solutions. The biosorption factors such as biosorbent dosage, pH, initial ammonia concentration, and contact time have been considered in batch conditions. The optimal conditions, at pH (6), sorbent dose 5 g/l, time (30 min) ammonia concentration (10 mg/l). Langmuir is better suited than Freundlich isotherm. The kinetic models Thomas, Yoon-Nelson, and Bohart-Adams were applied. These models showed that the adsorption capacity decreased with flow rate increases as follows: 32.57, 31.82, 31.25, and 30.17 mg/g, respectively, at a flow rate 10, 15, 20, and 25 ml/min. The root powder of Eichhornia crassipes was used to treat specific drainage wastewater obtained from the Sabal drain at Menoufia, Egypt. The average efficiency of ammonia removal was 87% per batch adsorption method at pH value = 7.5, sorbent dose 5 g/l, uptake period (30 min), and primary load 7.1 mg/l; however, ammonia removal by column continuous adsorption method exceeded 94%. In addition, ECRP is efficient in removing arsenic, sulfate, nitrates, nitrite, silica, iron, manganese, copper, zinc, aluminum, and lead from actual sewage wastewater, in addition to removing more than 75% COD.

Investigating the management of alcohol-related presentations in an Australian teaching hospital.

INTRODUCTION AND AIMS: Alcohol-related morbidity is estimated to range from 10-38% of the presentations to hospital emergency departments. This study aims to investigate the actual management process for alcohol-related presentations in a teaching hospital in Australia. DESIGN AND METHODS: Retrospective audit was conducted on the electronic medical records of 210 presentations with a primary or secondary diagnosis of 'alcohol use disorder' at discharge between November 2016 and February 2017. Six key management steps were investigated: identification of alcohol use disorder, documentation, thiamine, alcohol withdrawal assessment, benzodiazepine for alcohol withdrawal and referral to the drug and alcohol consultation liaison service. RESULTS: Of all the 210 presentations, 77.1% (162) were identified with alcohol use disorder in the initial assessments; 64.3% (135) were documented with alcohol use history, 49.5% (104) were prescribed with thiamine, 48.1% (101) were assessed with the alcohol withdrawal scale, 41% (86) were prescribed with benzodiazepine for alcohol withdrawal and only 38.6% (81) were referred to the drug and alcohol consultation liaison service. Only 8.6% (18) of the initial presentations were directly related to alcohol. These presentations had a higher completion rate in each of the six steps than those (91.4%, 192) not directly related to alcohol. Only 6.2% (13) were formally screened for alcohol use. DISCUSSION AND CONCLUSIONS: The findings suggest a need to improve the alcohol management practice in the hospital. Routine use of an alcohol screening tool can enable early identification of the alcohol use disorder and to improve the management of this problem in the hospital.

Modeling the Pathways of Knowledge Management Towards Social and Economic Outcomes of Health Organizations.

Despite the increasing emphasis placed on knowledge management (KM) by the business sector and the common belief that creating, acquiring, sharing, and the use of knowledge enable individuals, teams, and communities to achieve superior performance, within the healthcare context, there is still room from improvements from both the theoretical and empirical perspectives. The purpose of this paper is to outline the contribution of KM process to the social- and economic-related outcomes in the context of health organizations. Given the theoretical approach on the considered concepts and their relationships, a conceptual model and seven research hypotheses were proposed. The empirical data were provided by a cross-sectional investigation including 459 medical and nonmedical employees of Romanian heath organizations, selected by a mixed method sampling procedure. A partial least squares structural equation modeling (PLS-SEM) approach was selected to provide information on the relevance and significance of the first- and second-order constructs, test the hypotheses, and conduct an importance performance matrix analysis. The PLS-SEM estimation showed positive and significant relationships between KM process and quality of healthcare, and organizational-level social and economic outcomes. Moreover, the research results provided evidences for the complex complementary mediation of the quality of healthcare and social-related outcomes on the relationships between KM process and social and economic outcomes. The theoretical and managerial implications are discussed and suggestions for future research are provided at the end of the paper.

The impact of mapping interictal discharges using EEG-fMRI on the epilepsy presurgical clinical decision making process: A prospective study.

PURPOSE: We set out to establish the clinical utility of EEG-correlated fMRI as part of the presurgical evaluation, by measuring prospectively its effects on the clinical decision. METHODS: Patients with refractory extra-temporal focal epilepsy, referred for presurgical evaluation were recruited in a period of 18 months. The EEG-fMRI based localization was presented during a multi-disciplinary meeting after the team had defined the presumed RESULTS: Sixteen patients (six women), with a median age of 28 years, were recruited. Interpretable EEG-fMRI results were available in 13: interictal epileptic discharges (IEDs) were recorded in eleven patients and seizures were recorded in two patients. In three patients, no epileptic activity was captured during EEG-fMRI acquisition and in two of those an IED topographic map correlation was performed (between EEG recorded inside the scanner and long-term video EEG monitoring). EEG-fMRI results presentation had no impact on the initial clinical decision in three patients (23%) of the thirteen and resulted in a modification of the initial surgical plan in ten patients (77%) of the thirteen finally presented in MDT; in eight patients the impact was on the planned placement of invasive electrodes and in two patients the EEG-fMRI led to additional non-invasive tests before proceeding further with surgery. CONCLUSION: The study is a prospective observational cohort study specifically designed to assess the impact of EEG-fMRI on the clinical decision making process, suggesting a significant influence of EEG-fMRI on epilepsy surgery planning.

A risk-based approach to cumulative effect assessments for marine management.

Marine ecosystems are increasingly threatened by the cumulative effects of multiple human pressures. Cumulative effect assessments (CEAs) are needed to inform environmental policy and guide ecosystem-based management. Yet, CEAs are inherently complex and seldom linked to real-world management processes. Therefore we propose entrenching CEAs in a risk management process, comprising the steps of risk identification, risk analysis and risk evaluation. We provide guidance to operationalize a risk-based approach to CEAs by describing for each step guiding principles and desired outcomes, scientific challenges and practical solutions. We reviewed the treatment of uncertainty in CEAs and the contribution of different tools and data sources to the implementation of a risk based approach to CEAs. We show that a risk-based approach to CEAs decreases complexity, allows for the transparent treatment of uncertainty and streamlines the uptake of scientific outcomes into the science-policy interface. Hence, its adoption can help bridging the gap between science and decision-making in ecosystem-based management.

Knowledge Management Enablers and Process in Hospital Organizations.

OBJECTIVES: This research aimed to investigate the effects of knowledge management enablers, such as organizational structure, leadership, learning, information technology systems, trust, and collaboration, on the knowledge management process of creation, storage, sharing, and application. METHODS: Using data from self-administered questionnaires in four Korean tertiary hospitals, this survey investigated the main organizational factors affecting the knowledge management process in these organizations. A total of 779 questionnaires were analyzed using SPSS 18.0 and AMOS 18.0. RESULTS: The results showed that organizational factors affect the knowledge management process differently in each hospital organization. CONCLUSION: From a managerial perspective, the implications of these factors for developing organizational strategies that encourage and foster the knowledge management process are discussed.

Costs and hospital procedures in an urology department of a tertiary hospital. Analysis of groups related by their diagnosis. / Costes y procesos hospitalarios en un servicio de urología de un hospital terciario. Análisis de los grupos relacionados por el diagnóstico.

INTRODUCTION: The health care system has management tools available in hospitals that facilitate the assessment of efficiency through the study of costs and management control in order to make a better use of the resources. OBJECTIVE: The aim of the study was the calculation and analysis of the total cost of a urology department, including ambulatory, hospitalization and surgery activity and the drafting of an income statement where service costs are compared with income earned from the Government fees during 2014. MATERIAL AND METHODS: From the information recorded by the Economic Information System of the Department of Health, ABC and top-down method of cost calculation was applied by process care activity. The cost results obtained were compared with the rates established for ambulatory and hospital production in the Tax Law of the Generalitat Valenciana. The production was structured into outpatient (external and technical consultations) and hospital stays and surgeries (inpatient). RESULTS: A total of 32,510 outpatient consultations, 7,527 techniques, 2,860 interventions and 4,855 hospital stays were made during 2014. The total cost was 7,579,327€; the cost for outpatient consultations was 1,748,145€, 1,229,836 Euros for technical consultations, 2,621,036€ for surgery procedures and 1,980,310€ for hospital admissions. Considered as income the current rates applied in 2014 (a total of 15,035,843€), the difference between income and expenditure was 7,456,516€. CONCLUSIONS: The economic balance was positive with savings over 50% and a mean adjusted hospitalization stay rate (IEMAC) rate of 0.67 (33% better than the standard). CMA had a favorable impact on cost control.