Minimization of the perianal infection rate of hematological malignancies with agranulocytosis by quality control circle activity and patient-hospital-student win-win concept.

Objective The agranulocytosis-associated perianal infection (PI) rate ranges from 60% to 100% among patients with hematopoietic malignancies. In this study, we assessed the efficacy of a quality control circle (QCC) to minimize the PI rate. Methods Among 274 patients with severe immunodeficiency (agranulocytosis of ≥2 weeks) in our bone marrow transplantation center, the PI rate was 17.20%. A QCC was established following the 10 steps of the plan-do-check-act (PDCA) model; this was scientifically supported by culturing the bacterial colony from patients' perianal skin to determine the sanitization effect and interval time. Because a warm aqueous solution of potassium permanganate is recommended for sanitization, the bacterial colony culture was also used to determine the proper drug concentration, water temperature, and soaking time. All procedures were standardized. Patients, hospital staff, and medical students were enrolled into the QCC team based on the patient-hospital-student (PHS) win-win concept. Results After establishment of the PDCA model, the PI rate among 253 patients decreased from 17.20% to 5.93% and remained at 5.25% during the following year. The medical expenses and length of hospital stay consequently decreased. Conclusion The QCC and PHS win-win concept can reduce the PI rate and promote medical quality.

Implementación de círculos de calidad para la mejora del registro de Enfermería / Implementation of quality control circles for the improvement of nursing records

El registro de Enfermería es una herramienta que facilita la recolección y consulta de datos para el desarrollo de planes de cuidados, el intercambio de información y como medio de referencia. Sin embargo, por factores asociados a la labor de Enfermería no siempre cumplen con todos los estándares, incluido los de índole legal. El propósito de este trabajo es dar a conocer cómo se llevó a cabo un proceso de mejora de la calidad del registro de Enfermería de un hospital público, sobre todo, en los aspectos relacionados con el cumplimiento de la normativa institucional. Para ello, se definieron enfermeros líderes del método que se iba a usar mediante el establecimiento de círculos de calidad, quienes recibieron capacitación, asesoría y seguimiento durante todo el proceso. Paralelamente se incluyeron otros profesionales enfermeros que formarían parte de estos círculos de calidad. Por otro lado, cada líder pudo identificar áreas de mejora, que conllevaron actividades orientadas a la mejora del registro de Enfermería. Al final del proceso, participaron 31 enfermeras y enfermeros (siete líderes y 24 integrantes del círculo), de los 51 que eran responsables de la cumplimentación de los registros (participación del 61%), distribuidos en siete círculos de calidad, consiguiendo una mejora del 75% respecto a la cumplimentación de calidad de los registros. Sin duda, para favorecer el cumplimiento de este objetivo se requirió, no solo la capacitación de los profesionales en la mejora de la ejecución de los registros, sino también su participación constante y un alto grado de compromiso y responsabilidad. En esta ocasión el uso de los círculos de calidad fue una metodología pertinente y factible en la detección de áreas de mejora en beneficio de la organización

Nursing record is a tool which facilitates data collection and search for the development of care plans, information exchange, and as information and means of reference. However, due to factors associated with the nursing job, these records won’t always meet all standards, including those of legal nature. The objective of this article is to provide information about the manner in which a process for improving the quality of nursing records was conducted in a public hospital, mostly regarding those aspects associated with meeting the institutional rules. To this aim, there was a determination of nurses leading the method that would be used, through the implementation of quality control circles; these nurses received training, counselling, and follow-up throughout the process. At the same time, other nursing professionals were included, who would form part of these quality control circles. On the other hand, each leader could identify areas for improvement, which entailed activities orientated to an improvement in nursing records. At the end of the process, 31 male and female nurses were involved (seven leaders and 24 circle members), of the 51 nurses who were responsible for record completion (61% participation), distributed into seven quality control circles, and achieving a 75% improvement regarding the quality of record completion. Undoubtedly, meeting this objective not only required the training of professionals on the improvement of record execution, but also their constant involvement, and a high level of commitment and responsibility. In this occasion, the use of quality control circles was a relevant and feasible methodology for detecting areas for improvement that would benefit the organization

Introdução à administração

Este livro oferece a professores e estudantes uma visão abrangente do processo de administrar sistemas de recursos. As funções administrativas (planejamento, organização, execução, liderança e controle) são analisadas por meio de conceitos sintéticos, que dão ênfase à aplicação prática. O texto, auxiliado por ilustrações que resumem as ideias principais, foi planejado para facilitar a leitura e a aquisição rápida de ideias e técnicas.Esta nova edição é resultado de um processo de aprimoramento contínuo. O autor procurou incorporar as inovações da prática administrativa e as sugestões dos professores que adotam este livro em inúmeras instituições de ensino superior. Algumas das novas ideias exploradas neste livro são as seguintes: Comunicação gerencial, dinâmica de grupo, somos todos administradores, grupos autogeridos, competitividade, intuição e processo decisório, contexto da liderança, balanced scorecard e Prêmio Europeu da Qualidade. O texto está dividido em 18 capítulos, agrupados em cinco partes: Conceitos básicos, Planejamento, Organização, Liderança e gestão de pessoas e Integração de conceitos. Cada capítulo apresenta um estudo de caso com questões para estudo. Os casos retratam situações reais, enfrentadas por organizações e administradores no Brasil e em outros países.O livro procura atender especificamente aos cursos que focalizam o estudo do processo administrativo e o desenvolvimento de competências gerenciais nos estudantes.Livro-texto para as disciplinas Introdução à Administração, Teoria Geral da Administração, Teoria das Organizações, Processo Administrativo e Fundamentos da Administração, dos cursos de Administração, Contabilidade, Economia, Engenharia e outros cursos técnicos de nível superior. Leitura para cursos que enfatizem o estudo das organizações, do processo administrativo e do papel gerencial.

Experiencia de unidad de soporte a las segundas víctimas (USVIC) / Experience of a second victims support unit (USVIC)

No disponible

European Network for Patient Safety and Quality of Care: PaSQ / La red de la Unión Europea para la Seguridad del Paciente y la Calidad Asistencial: PasQ

No disponible

Process Improvement: Customer Service.

Utilizing the comment section of patient satisfaction surveys, Clark Memorial Hospital in Jeffersonville, IN went through a thoughtful process to arrive at an experience that patients said they wanted. Two Lean Six Sigma tools were used--the Voice of the Customer (VoC) and the Affinity Diagram. Even when using these tools, a facility will not be able to accomplish everything the patient may want. Guidelines were set and rules were established for the Process Improvement Team in order to lessen frustration, increase focus, and ultimately be successful. The project's success is driven by the team members carrying its message back to their areas. It's about ensuring that everyone is striving to improve the patients' experience by listening to what they say is being done right and what they say can be done better. And then acting on it.

Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton / Consequences of errors in the translation of questionnaires: spanish version of Downton index

La aplicación de escalas para detectar el riesgo de caídas en pacientes hospitalizados se ha generalizado. Durante el desarrollo de una revisión sistemática se detectó una disparidad grave en 3 ítems de la versión española del índice Downton respecto a la versión original. El objetivo de este estudio fue determinar el impacto de este error y comparar el riesgo estimado de caídas con cada versión, su validez y consistencia interna. Material y métodos. Se realizó un estudio transversal descriptivo en pacientes agudos hospitalizados durante 2011 en el Hospital Costa del Sol, Marbella. El riesgo de caídas de los pacientes se valoró mediante la versión española del índice Downton, y se recalculó conforme a los ítems de la versión original. Se calculó sensibilidad, especificidad y alfa de Cronbach. Resultados. La aplicación de la versión original de la escala redujo el número de pacientes clasificados como de «alto riesgo» de caer un 24,2%. Con la versión española de la escala, la posibilidad de ser clasificado como de «alto riesgo» de caer fue 3,3 veces mayor (OR: 3,3). Ambas versiones del índice Downton mostraron escasa precisión y validez diagnóstica. La sensibilidad de la escala original fue del 28% y la especificidad del 82%. Su consistencia interna fue baja (alfa de Cronbach: 0,51). Conclusiones. La escala Downton, dada su poca precisión y validez diagnóstica, baja consistencia interna y el error significativo observado en su traducción al español, no es el instrumento más adecuado para evaluar el riesgo de caídas en pacientes agudos hospitalizados (AU)

The application of screening tools to detect the risk of falls in hospitalized patients is in general use. During the development of a systematic review a serious disparity in three items of the Spanish version of the Downton index was detected, compared to the original version. The aim of this study was to determine the impact of this error and to compare the estimated risk of falls with each of these versions, its validity and internal consistency. Material and methods. A descriptive cross-sectional study in acute hospitalised patients was performed during 2011 in Hospital Costa del Sol, Marbella. The patients’ risk of falling was assessed by the Spanish version of the Downton index, and then it was re-calculated according to the items in the original version. Sensitivity, specificity and Cronbach's alpha were calculated. Results. Application of the original version of the index reduced the number of patients classified as “high risk” of falling by 24.2%. With the Spanish version of the tool, the possibility of being classed as “high risk” of falling was considerably 3.3 times higher (OR: 3.3). Both versions of the Downton index showed low accuracy and diagnostic validity. The sensitivity of the original scale was 28% and specificity of 82%. Its internal consistency was low (Cronbach's alpha: .51). Conclusions. The Downton index, given its poor accuracy and diagnostic validity, low internal consistency, and the significant error observed in its Spanish translation, is not the most appropriate tool to assess the risk of falls in hospitalised acute patients (AU)

[Guideline implementation study on asthma: Results of a pragmatic implementation approach]. / Leitlinien-Implementierungs-Studie Asthma (L.I.S.A.): Ergebnisse eines pragmatischen Implementierungsansatzes.

OBJECTIVE: Knowledge transfer from theory to practice in healthcare systems poses a challenge worldwide. Typical examples include national disease management guidelines. The present study contributes towards improving implementation strategies for an asthma guideline. METHODS: A guideline implementation strategy was examined in a four-armed, non-randomised, controlled intervention study with an additional control group. The study participants were general practitioners and paediatricians recruited from primary care quality circles. All study participants attended an interactive seminar on the evidence-based recommendations for patients with asthma. In addition, the participants were asked to choose among the following options: no further intervention, additional e-learning, training of their practice nurses, or e-learning and training of their practice nurses. The success of the intervention was measured by questionnaire (and the success rate expressed as a percentage). RESULTS: About one third of all participants (n=313) opted for the combination of an interactive seminar and a training of practice nurses; two third preferred the classic way of continuing medical education with an interactive seminar without a further intervention. Just 10 % of the physicians participated in e-learning. Independently of their choice for continuing medical education, all participants demonstrated an increase in knowledge about asthma and an improvement in the management of asthma. The physicians exhibited an average increase in both categories of about 10 % of the percentage values, compared to an increase of about 28 % among the practice nurses without continuing medical education. CONCLUSIONS: The physicians' free choice of the educative modules might be an integral part of successful implementation strategies. However, this will require a change of focus from general continuing medical education packages to a more individualised culture of continuing professional development in Germany.

Application of a Quality Control Circle to Reduce the Wait Times between Continuous Surgeries.

PURPOSE: To investigate how to shorten patient wait times between continuous ocular operations and to evaluate the influence of a quality control circle (QCC) on operating room management. METHODS: QCC management was established to conduct activities. Clinical data were collected to analyze the causes of long wait times between continuous surgeries. Effective measures were undertaken correspondingly. RESULTS: The staff from QCC actively undertook measures that would significantly shorten patient wait times between continuous ocular surgeries (P < 0.05). CONCLUSION: Multiple measures, such as setting up a QCC, enhancing the arrangement of surgical procedures, establishing effective communication channels, optimizing human resources, and integrating the use of instruments, can effectively shorten patient wait times between continuous vitreous or retinal surgeries.

Gestión y desarrollo del equipo de psicología de un servicio de salud mental / No disponible

Si bien parece obvio, por los estudios previos, y por propia intuición que los equipos motivados obtienen una excelencia en su eficacia laboral, existen pocos estudios que reporten resultados concretos sobre todo en el campo de la salud. Específicamente, en el campo de la salud mental, no existen apenas experiencias en cómo una gestión eficiente del equipo se traduce en una mejora de la satisfacción y eficacia de los profesionales. Este trabajo tiene dos objetivos principales, por una parte describir la metodología realizada en la dirección del equipo de trabajo, y por otra aportar algunos resultados sobre la eficiencia conseguida

While it seems obvious from previous studies, and intuition that motivated teams get an excellence in their work, there are few studies that reports specific results in health work. Specifically, in the area of mental health, there is hardly any experience in how efficient management team results in improved satisfaction and professional effectiveness. This paper has two main objectives, first describe the methodology employed in the direction of the team, and on the other provide some results on the efficiency achieved

A management, leadership, and board road map to transforming care for patients.

Over the last decade I have studied 115 healthcare organizations in II countries, examining them from the boardroom to the patient bedside. In that time, I have observed one critical element missing from just about every facility: a set of standards that could reliably produce zero-defect care for patients. This lack of standards is largely rooted in the Sloan management approach, a top-down management and leadership structure that is void of standardized accountability. This article offers an alternative approach: management by process--an operating system that engages frontline staff in decisions and imposes standards and processes on the act of managing. Organizations that have adopted management by process have seen quality improve and costs decrease because the people closest to the work are expected to identify problems and solve them. Also detailed are the leadership behaviors required for an organization to successfully implement the management-by-process operating system and the board of trustees' role in supporting the transformation.

Using the Malcolm Baldrige "are we making progress" survey for organizational self-assessment and performance improvement.

A national healthcare company applied the Malcolm Baldrige Criteria for Performance Excellence and its "Are We Making Progress?" survey as an annual organizational self-assessment to identify areas for improvement. For 6 years, Liberty Healthcare Corporation reviewed the survey results on an annual basis to analyze positive and negative trends, monitor company progress toward targeted goals and develop new initiatives to address emerging areas for improvement. As such, the survey provided a simple and inexpensive methodology to gain useful information from employees at all levels and from multiple service sites and business sectors. In particular, it provided a valuable framework for assessing and improving the employees' commitment to the company's mission and values, high standards and ethics, quality of work, and customer satisfaction. The methodology also helped the company to incorporate the philosophy and principles of continuous quality improvement in a unified fashion. Corporate and local leadership used the same measure to evaluate the performance of individual programs relative to each other, to the company as a whole, and to the "best practices" standard of highly successful companies that received the Malcolm Baldrige National Quality Award.

[Physicians-pharmacists quality circles: shared responsibility of the freedom of prescription]. / Cercles de qualité médecins-pharmaciens, pour une responsabilité partagée de la liberté de prescription.

Physicians-pharmacists quality circles (PPQCs) were introduced in 1997-98 by visionary healthcare practitioners of the French-speaking part of Switzerland with the aim to improve the quality of drug prescription. Indeed the challenge is to manage the 7917 brand names of the Swiss drug market (2010), including 19793 different dosages, galenic formulations and packaging. The impact of these PPQCs on the containment of drug costs and on drug prescribing profiles has been demonstrated and has led to their spread throughout Switzerland. PPQCs provide clear educational benefits and have thus been accredited by various continuous education bodies. In this article, participating physicians and pharmacists share their vision and illustrate how they work and influence the safety and efficiency of drug prescription, a routine process complex enough to warrant sharing of its burden in a constructive interdisciplinary collaboration.

Eletrobras management program in ergonomics: the pursuit of excellence through maturity levels.

Ergonomics for Eletrobras arose from the need in having an environment more suitable to the characteristics and circumstances of employees, in compliance with Regulation Standard no. 17 - Ergonomics (NR17) of the Ministry of Labor and Employment. Being a mixed economy company with regionalized anthropometric characteristics of its employees, the study of ergonomic adjustments and improvement of the concept of Ergonomics were and have been of great importance to the company's production environment. These advances have contributed to the development of specific technical criteria for the purchase of furniture and work tools (accessories), apart from their possible effects on the user. Ergonomics has been perceived as a technical-scientific tool, aimed to study labor interactions, new technologies and specific characteristics of the activities performed. To meet these demands a multidisciplinary Ergonomics Committee was created in Eletrobras, and effectively established the Ergonomics Management Program in the company; This program is marked by well-defined phases with great success in making use of these studies for other types of corporate activities and also facilitating the program control and its maturity levels, even at a business level.