Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.777
Filtrar
1.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 346-352, oct. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-184125

RESUMEN

Aunque son muchos los indicadores de calidad (IC) definidos para establecer un sistema común, homogéneo y fiable de evaluación sobre la actividad en los servicios de urgencias, es escasa la información acerca de los IC relacionados con las emergencias atendidas en el ámbito extrahospitalario. El objetivo de este trabajo es identificar y analizar, a través de la literatura científica publicada, los IC específicos de dicha atención ante emergencias fuera del contexto hospitalario. Se realizó una revisión sistemática de la literatura según las recomendaciones PRISMA. Se exploraron 5 bases de datos y se elaboraron protocolos de búsqueda para localizar estudios que aportasen información sobre IC para evaluar la atención en emergencias extrahospitalarias, entre noviembre de 2017 y julio de 2018, tanto en inglés como en español. Se analizaron un total de 22 estudios y se identificaron un total de 333 IC en emergencias extrahospitalarias que fueron clasificados en clínicos y no clínicos, con sus subdominios correspondientes para cada grupo. El número de IC no clínicos identificados en la búsqueda fue superior, pudiendo concluir que son los más utilizados para evaluar la atención en las emergencias extrahospitalarias en la actualidad y dejando la puerta abierta para el diseño e implementación de nuevos IC capaces de evaluar la actividad fuera del contexto hospitalario


Although many health care quality indicators have been defined for establishing a common, homogeneous, and reliable system for assessing emergency department care, less information is available on the use of indicators of quality in attending emergencies outside the hospital. We aimed to identify and analyze quality indicators that have appeared in the literature on out-of-hospital emergencies. This systematic review of the literature followed the ations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We developed protocols for searching 5 databases to locate studies using quality indicators to evaluate care in out-of-hospital emergencies. Studies were published between July 2017 and July 2018 in either English or Spanish. We identified 22 studies naming 333 quality indicators in out-of-hospital emergencies. The indicators were classified as clinical or nonclinical; within each of these 2 sets, we also identified domains, or subcategories. As nonclinical quality identifiers were more numerous in the literature, it seems that they are the ones most often used to assess out-of-hospital emergency care at this time. This finding leaves the door open to designing and implementing new indicators able to measure quality of care in this clinical setting


Asunto(s)
Humanos , Indicadores de Calidad de la Atención de Salud , Servicios Médicos de Urgencia/métodos , Seguridad del Paciente , Gestión de la Calidad Total/métodos , Gestión de la Calidad Total/normas , Ambulancias/organización & administración
2.
Surv Ophthalmol ; 64(5): 720-728, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30951728

RESUMEN

Lean management is a set of principles aimed at improving processes by identifying and eliminating steps that do not add value to the consumer. Such steps lead to wasted time, resources, and expenses and result in customer and employee dissatisfaction. Although initially invented and perfected for factory assembly lines in the automobile industry, it has since disseminated extensively and has repeatedly proven a powerful "engine" for improving quality and quantity in the health-care setting. Lean implementation benefits include improved safety, reduced waiting times, increased patient satisfaction, and cost reduction. Nevertheless, it appears to be less familiar and appreciated in ophthalmology and more specifically as a tool for managing an efficient eye care clinic. In this review, we explain what "Lean" and Six Sigma are and highlight their implementation in settings such as cataract surgery, laser capsulotomy, an ophthalmic emergency room and its role as a powerful tool for improving clinic patient flow. We discuss basic principles of Lean management, review examples of implementing these principles in an ophthalmology practice, and finally, offer physicians practical tools for identifying "wasteful" processes and ways to eliminate them.


Asunto(s)
Oftalmopatías/terapia , Adhesión a Directriz , Oftalmología/normas , Satisfacción del Paciente , Mejoramiento de la Calidad , Gestión de la Calidad Total/métodos , Humanos
3.
Rev Bras Enferm ; 72(suppl 1): 235-242, 2019 Feb.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30942368

RESUMEN

OBJECTIVE: To identify the nonconformities of the enteral diet therapy process. METHOD: Exploratory case study, using as a theoretical framework the philosophy of Lean Healthcare in an inpatient unit of a large hospital in Minas Gerais State. The sample consisted of 19 professionals from the multidisciplinary team involved in the enteral nutritional therapy process and the unit's documentary sample. For the data collection, we used a semi-structured script, participant observation and documentary analysis. RESULTS: There were eight nonconformities related to enteral diet therapy. During the participant observation, there was a lack of a management model that seeks the continuous improvement of the process, as well as resistance to change. CONCLUSION: Although enteral diet therapy is important in the patient's evolution, there are adverse events that could be prevented and the Lean philosophy assists in the identification of process nonconformities.


Asunto(s)
Nutrición Enteral/normas , Mejoramiento de la Calidad , Gestión de la Calidad Total/métodos , Adulto , Nutrición Enteral/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
4.
Rev Bras Enferm ; 72(1): 140-146, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30916279

RESUMEN

OBJECTIVE: To identify and eliminate steps that do not add value for customers in the disinfection center. METHOD: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. RESULT: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. CONCLUSION: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.


Asunto(s)
Desinfección/normas , Esterilización/normas , Gestión de la Calidad Total/métodos , Gestión de la Calidad Total/normas , Desinfección/métodos , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/normas , Calidad de la Atención de Salud/normas , Esterilización/métodos
5.
J Appl Psychol ; 104(7): 851-887, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30676036

RESUMEN

This integrative conceptual review is based on a critical need in the area of performance management (PM), where there remain important unanswered questions about the effectiveness of PM that affect both research and practice. In response, we create a theoretically grounded, comprehensive, and integrative model for understanding and measuring PM effectiveness, comprising multiple categories of evaluative criteria and the underlying mechanisms that link them. We then review more than 30 years (1984-2018) of empirical PM research vis-à-vis this model, leading to conclusions about what the literature has studied and what we do and do not know about PM effectiveness as a result. The final section of this article further elucidates the key "value chains" or mediational paths that explain how and why PM can add value to organizations, framed around three pressing questions with both theoretical and practical importance (How do individual-level outcomes of PM emerge to become unit-level outcomes? How essential are positive reactions to the overall effectiveness of PM? and What is the value of a performance rating?). This discussion culminates in specific propositions for future research and implications for practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Administración de Personal/métodos , Gestión de la Calidad Total/métodos , Rendimiento Laboral/organización & administración , Recursos Humanos/organización & administración , Humanos , Administración de Personal/normas , Gestión de la Calidad Total/organización & administración , Gestión de la Calidad Total/normas , Rendimiento Laboral/normas , Recursos Humanos/normas
6.
Qual Manag Health Care ; 28(1): 15-24, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30586118

RESUMEN

BACKGROUND: Quality improvements are notoriously followed by "backsliding" or relapse to the status quo. This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. METHODS: We conducted qualitative interviews of 57 leaders and frontline providers, and fielded post-Lean implementation surveys to 1164 physicians and staff in 17 primary care clinics across the system. We analyzed interviews and conducted independent sample t tests to identify key factors that facilitated the sustainment of new workflows among primary care teams. All analyses were conducted after Lean redesigns were implemented and scaled across the system in 3 consecutive phases. RESULTS: Adherence to Lean redesigns was highest in the pilot clinic, despite having the longest postdesign measurement period. Members of the pilot clinic reported greatest participation in designing workflows, were most highly engaged in quality improvement efforts, and held most favorable beliefs about Lean changes. Adherence to redesigns was lowest among clinic members in the second phase of implementation; these members also reported highest levels of burnout. CONCLUSIONS: Staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care.


Asunto(s)
Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud , Mejoramiento de la Calidad , Gestión de la Calidad Total/métodos , Instituciones de Atención Ambulatoria , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Encuestas y Cuestionarios , Flujo de Trabajo
7.
Qual Manag Health Care ; 28(1): 25-32, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30586119

RESUMEN

BACKGROUND: In this article, we propose a method that integrates systematic layout planning techniques to lean health care practices aided by multicriteria decision analysis that could be applied to reformulate the layout of health care facilities. METHODS: We analyze a high-variety sterilization unit of a large public hospital located in Brazil. The unit is currently implementing lean practices, and layout changes are required to provide more efficient materials and information flows. RESULTS: Traditional design of health care facilities is not aligned with lean implementation and its underlying practices and principles. We propose the integration of such approaches to enhance their benefits. To rank and select the best layout alternative, a multicriteria decision analysis method (analytic hierarchy process) is adopted. CONCLUSIONS: There are 3 contributions here: the integration of lean principles into traditional health care facility design practices, the use of multicriteria decision analysis to refine the determination of the best layout solution, and the application of our propositions in a real case study.


Asunto(s)
Arquitectura y Construcción de Instituciones de Salud/normas , Hospitales Universitarios , Gestión de la Calidad Total/métodos , Brasil , Central de Suministros en Hospital , Esterilización
9.
J Clin Lab Anal ; 33(2): e22682, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30280434

RESUMEN

CONTEXT: The results of detection assays for the same specimen are usually quite different in different laboratories or when tested with different detection systems. OBJECTIVE: This study was designed to investigate the value of applying sigma metrics derived from different standards for allowable total error (TEa) in evaluating the analytical quality of tumor marker assays. METHODS: Assays were evaluated for these six tumor markers: total prostate-specific antigen (tPSA), carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), and carbohydrate antigen 153 (CA153). Sigma values were calculated for two concentrations of quality control products to assess differences in quality of tumor marker assays. Improvement measures were recommended according to the quality goal index, and appropriate quality control rules were selected according to the sigma value. RESULTS: The sigma value was highest using the higher biological variation-derived "appropriate" TEa standard: it was sigma ≥6 or higher in 16.7% of tumor markers. Sigma was below 6 for all tumor markers using the other three TEa. CEA, AFP, CA199, CA125, and CA153 required improved precision. The marker tPSA required improve precision and accuracy. According to sigma values by using China's external quality assessment standards, CEA, AFP, CA125, and CA153 require 13s /22s /R4s /41s multirules for internal quality control, CA199 requires use of 13s /22s /R4s /41s /8x multirules, and tPSA requires maximum quality control rules. CONCLUSION: Six Sigma is useful for evaluating performance of tumor markers assays and has important application value in the quality control of these assays.


Asunto(s)
Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/normas , Gestión de la Calidad Total/métodos , Gestión de la Calidad Total/normas , Antígeno Ca-125/análisis , Antígeno Carcinoembrionario/análisis , China , Humanos , Reproducibilidad de los Resultados , alfa-Fetoproteínas/análisis
10.
J Nurs Care Qual ; 34(1): 61-65, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29889720

RESUMEN

BACKGROUND: Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend. PURPOSE: The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design. RESULTS: There was a statistically significant decrease in wait times (P < .0019) and an increase in patient satisfaction scores in 3 areas: registration wait times (from 17 to 99 percentiles), test/treatment (from 19 to 60 percentiles), and likelihood to recommend (from 6 to 97 percentiles). CONCLUSIONS: Lean Six Sigma was an effective framework for use in decreasing wait times and improving patient satisfaction.


Asunto(s)
Eficiencia Organizacional , Satisfacción del Paciente , Gestión de la Calidad Total/métodos , Listas de Espera , Adulto , Humanos , Persona de Mediana Edad , Mejoramiento de la Calidad , Factores de Tiempo
11.
J Nurs Care Qual ; 34(3): 236-241, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30198954

RESUMEN

BACKGROUND: Hospital controlled drug processes are established to adhere to legislation, with little consideration of efficiency of processes. LOCAL PROBLEM: A controlled drug process existed, where nurses requested a porter to collect a hand-written order; however, only 19% of drug orders were processed this way. Instead, an unscheduled, ad hoc process led to an average of 17 nurse journeys to pharmacy daily. We aimed to reduce nurse journeys to the pharmacy by 25% to release nursing time. METHODS: A pre-/postintervention design was used with Lean Six Sigma methods. INTERVENTIONS: A multifaceted intervention involved process redesign, increasing the frequency of a porter-led delivery service, amending delivery times to reflect times of greatest need, and streamlining checking requirements. RESULTS: Following implementation, there was a statistically significant 44% decrease in nurse journeys to pharmacy for drug collections, which was maintained after 18 months. CONCLUSIONS: Interprofessional collaboration improving hospital-wide processes can have significant benefits for the release of nursing time.


Asunto(s)
Sustancias Controladas/administración & dosificación , Sistemas de Medicación/normas , Proceso de Enfermería/estadística & datos numéricos , Humanos , Sistemas de Medicación/legislación & jurisprudencia , Proceso de Enfermería/normas , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Factores de Tiempo , Gestión de la Calidad Total/métodos
12.
Int J Health Plann Manage ; 34(1): e274-e290, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30206989

RESUMEN

The purpose of this study was to improve the organization of work, reduce physical effort, and obtain greater satisfaction of workers in the Pre-analytical Area of the Clinical Biochemistry Service at the Miguel Servet University Hospital of Zaragoza, in Spain, by applying Lean techniques. Such techniques were applied in two steps to obtain a final situation where the reduction of the space occupied, the required physical effort, and the work time is clear. The satisfaction of the workers was analyzed during the whole process by means of surveys, concluding that the sum of all the improvements managed to increase the satisfaction of the professionals. One key aspect to get these results was to use always the information and opinions of the staff making them feel the protagonists of the process. For that, it was essential the role of the agent of change that fundamentally sought the involvement of professionals in the improvement processes. Another key point was the careful application of Lean techniques always little by little, by applying small changes that became habits and achieved permanent results. In conclusion, in this work, a methodology to improve involvement and satisfaction of workers in health care has been presented and validated.


Asunto(s)
Personal de Salud/psicología , Satisfacción en el Trabajo , Gestión de la Calidad Total/métodos , Eficiencia Organizacional , Hospitales Universitarios , España , Encuestas y Cuestionarios , Gestión de la Calidad Total/organización & administración
13.
Einstein (Sao Paulo) ; 16(4): eGS4200, 2018 Nov 08.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30427480

RESUMEN

OBJECTIVE: To verify the impact of the Lean Six Sigma methodology in reducing incorrect entries of non-appropriated revenues and expenses. METHODS: Process for the review and application of the Lean Six Sigma methodology between December 2015 and September 2016, in a high-complexity general hospital in the city of São Paulo (SP). RESULTS: A total of 3,756,814 (100%) entries were audited between December 2015 and September 2016. The Sigma level evolved over the course of the process and increased from 3.44 Sigma in December 2015 to 5.92 Sigma in September 2016. Entries classified as non-appropriated revenues and expenses were brought down to 0% at the end of the study. CONCLUSION: The use of the Lean Six Sigma methodology was efficient in reducing incorrect entries, calculating costs, ensuring compliance in rendering of accounts and accurately determining cost-outcome ratios.


Asunto(s)
Eficiencia Organizacional/normas , Hospitales Públicos/organización & administración , Mejoramiento de la Calidad/organización & administración , Gestión de la Calidad Total/métodos , Hospitales Públicos/normas , Humanos , Mejoramiento de la Calidad/normas
14.
Int J Health Care Qual Assur ; 31(7): 810-821, 2018 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-30354882

RESUMEN

PURPOSE: Globally, healthcare managers continue to struggle with increasing demands for their services being delivered with limited or shrinking resources. It is, therefore, clear that systems, processes and practices need to change to meet these challenges. The purpose of this paper is to assess how integrating two improvement technologies, Lean and integrated care pathways (ICP) might help. DESIGN/METHODOLOGY/APPROACH: Lean and ICP in healthcare provide a platform to develop conceptual frameworks for integrating two approaches. FINDINGS: A conceptual integrated framework is provided to assist care pathway designers and implementers to consider the synergistic benefits of combining approaches to improvement. RESEARCH LIMITATIONS/IMPLICATIONS: The authors provide a conceptual framework that requires empirically testing. PRACTICAL IMPLICATIONS: This research provides a conceptual framework to aid practitioners to improve healthcare design and delivery. ORIGINALITY/VALUE: For the first time, the authors bring together two approaches to improving patient care pathway design and consider how these are linked in relation to improving healthcare delivery.


Asunto(s)
Vías Clínicas/normas , Atención al Paciente , Mejoramiento de la Calidad/organización & administración , Gestión de la Calidad Total/métodos , Humanos
16.
J Nutr Gerontol Geriatr ; 37(3-4): 145-157, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30376418

RESUMEN

Malnutrition in older adults residing in long-term care facilities continues to be a problem in the United States. Existing research has identified a list of possible contributing factors, including staffing problems. Few studies on food and nutrition care have attempted to gain the perspectives of nursing or dietary aides (henceforth, aides), the frontline staff who work most closely with the residents of long-term care facilities. The current study takes a qualitative approach grounded in a theoretical perspective based on Total Quality Management (TQM) to increase understanding of the interpersonal and management practices that affect resident wellbeing, health, and nutrition. Four focus groups (n = 24) were conducted with aides working in long-term care facilities. Aides expressed emotional closeness with residents and provided detailed knowledge about food and nutrition care. They reported both compassion fatigue and satisfaction. An element of dissatisfaction related to aide relationships with management and other employees who did not actively solicit their perspectives and knowledge on resident feeding. The knowledge and experience of aides could be better utilized by shifting management strategies to focus on employee empowerment and training. Principles of TQM could be applied to improve food and nutrition care in long-term care facilities.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Cuidados a Largo Plazo , Desnutrición , Terapia Nutricional/métodos , Instituciones de Cuidados Especializados de Enfermería , Gestión de la Calidad Total/métodos , Anciano , Actitud del Personal de Salud , Femenino , Calidad de los Alimentos , Humanos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/normas , Masculino , Desnutrición/diagnóstico , Desnutrición/epidemiología , Desnutrición/prevención & control , Casas de Salud/organización & administración , Casas de Salud/normas , Mejoramiento de la Calidad/organización & administración , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Instituciones de Cuidados Especializados de Enfermería/normas , Estados Unidos
17.
BMC Med Res Methodol ; 18(1): 96, 2018 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-30249204

RESUMEN

BACKGROUND: We are witnessing an exponential increase in the number of randomized controlled trials (RCTs) reported from mainland China. The increase is particularly notable in the field of new generation antidepressants and antipsychotics. Several previous studies have raised doubts regarding their quality. However, the quality of most recent RCTs published in China may have improved. METHODS: We searched RCTs that examined new generation antidepressants and antipsychotics published between 2013 and 2016 in the China National Knowledge Infrastructure (CNKI), the largest database of scientific publications in China. We interviewed the authors of a random subset of the identified references. We assessed the methodological rigor of each study based on the published reports and telephone interviews with the authors using six methodological domains adapted from the Cochrane's risk of bias tool. RESULTS: The final sample consisted of 138 studies, for which we interviewed 58 authors; the authors of 51 studies declined the interview, and the authors of 29 studies could not be contacted. The 51 studies with refused interviews were significantly less likely to be reported from university-affiliated hospitals and were less likely to be published in Chinese core journals. Based on the published reports, most of the 58 studies were assessed to be at unclear risk of bias in most methodological domains. After the interview, only 10 studies were assessed to be at low risk of bias for sequence generation and allocation concealment. Assuming that the studies for which the authors declined interviews had an unclear risk, the proportion of RCTs at low risk of bias in both sequence generation and allocation concealment was 9.2% (10/109, 95% confidence interval [CI]: 5.0 to 16.2). The interviews indicated that the studies were at high risk of bias for most of the other domains. CONCLUSION: In general, RCTs that evaluate new generation antidepressants or antipsychotics and are indexed in the CNKI continue to be of low quality. When conducting systematic reviews and meta-analyses in this field, it would be wise to include a specialist from China as a coresearcher to help assess the risk of bias in the identified studies.


Asunto(s)
Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Exactitud de los Datos , Bases de Datos Factuales/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , China , Humanos , Entrevistas como Asunto/estadística & datos numéricos , Publicaciones/normas , Publicaciones/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Proyectos de Investigación/normas , Proyectos de Investigación/tendencias , Gestión de la Calidad Total/métodos , Gestión de la Calidad Total/normas , Gestión de la Calidad Total/tendencias
18.
Syst Rev ; 7(1): 137, 2018 09 11.
Artículo en Inglés | MEDLINE | ID: mdl-30205842

RESUMEN

BACKGROUND: Lean is a quality improvement management system from the Toyota manufacturing industry. Since the early 2000's, Lean has been used as an intervention for healthcare improvement. Lean is intended to reduce costs and improve customer value through continuous improvement. Despite its extensive use, the contextual factors and mechanisms that influence the sustainability of Lean in healthcare have not been well studied. Realist synthesis is one approach to "unpack" the causal explanations of how and why Lean is sustained or not in healthcare. We conducted a realist synthesis using the context (C) + mechanim (M) = outcome (O) heuristic, to further develop and refine an initial program theory with seven CMO hypotheses, on the sustainability of Lean efforts across pediatric healthcare. METHODS: Our search strategy was multi-pronged, iterative, and purposeful in nature, consisting of database, gray literature, and contact with three healthcare organizations known for Lean implementation. We included primary research studies, published and unpublished case studies or reports, if they included Lean implementation with a pediatric focus and sustainability outcome. We used the Normalization Process Theory and the National Health Services Sustainability Model, an operational definition for Lean and a comprehensive definition for sustainability as guidance for data extraction and analysis. Our initial program theory with was refined using a blend of abductive and retroductive analytical processes. RESULTS: We identified six published primary research studies, two published quality improvement case studies, and three unpublished quality improvement case reports. Five CMO hypotheses from our initial program theory were substantially supported after synthesis, "sense-making and value congruency," "staff engagement and empowerment," and the "ripple effect" or causal pathway between Lean implementation outcomes that served as facilitating or hindering contexts for sustainability. Overall, there was variation with the conceptualization and measurement of sustainability. CONCLUSIONS: This study is the first to examine Lean sustainability in pediatric healthcare using realist methods. Future research should examine whether the predictors of implementation are the same or different to sustainability and evaluate the underlying mechanisms that influence the sustainability of Lean. There is also a need for research to develop and test conceptual models and frameworks on sustainability. SYSTEMATIC REVIEW REGISTRATION: PROSPERO-CRD42015032252 .


Asunto(s)
Prestación de Atención de Salud/organización & administración , Pediatría , Mejoramiento de la Calidad/organización & administración , Gestión de la Calidad Total/métodos , Humanos , Ciencia de la Implementación
20.
Biochem Med (Zagreb) ; 28(2): 020101, 2018 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-30022877

RESUMEN

Reliability of laboratory results is determined by the ratio of incorrect results expected in long-term. Sigma is a measure of defect ratio, therefore long-term Sigma is a measure of the reliability of laboratory results. Commonly, long-term Sigma is estimated based on the short-term Sigma. The Six Sigma methodology assumes that in long-term performances will shift up to 1.5 Sigma, and therefore the long-term Sigma is considered 1.5 Sigma less than short-term Sigma. Analytical performance in the medical laboratory is prone to shifts larger than 1.5 Sigma. Thus, the 1.5 Sigma shift assumed in the Six Sigma is not a correct estimate in the medical laboratory. On the other hand, in the medical laboratory statistical quality control procedure (SQC) is applied to detect and correct shifts. Since SQC can be planned to trap shifts of different sizes, the threshold set for SQC determines the defect rate expected for long-term.


Asunto(s)
Técnicas de Laboratorio Clínico , Gestión de la Calidad Total/métodos , Humanos , Seguridad del Paciente , Factores de Tiempo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA