According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

To provide an update to “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012”. A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

https://link.springer.com/content/pdf/10.1007%2Fs00134-017-4683-6.pdf

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Established in 2006, TATA Africa Services (Nigeria) Limited operates as the nodal point for Tata businesses in West Africa. TATA Africa Services (Nigeria) Limited has a strong presence in Nigeria with investments exceeding USD 10 million. The company was established in Lagos, Nigeria as a subsidiary of TATA Africa Holdings (SA) (Pty) Limited, South Africa and serves as the hub of Tata’s operations in Nigeria and the rest of West Africa.

What About Us

Qualitative researchers rely — implicitly or explicitly — on a variety of understandings and corresponding types of validity in the process of describing, interpreting, and explaining phenomena of ...

Understanding and Validity in Qualitative Research

Climate change 2014 - Synthesis Report

SummaryObjectives To demonstrate a statistical method to enable theidentiﬁcation of key drivers of quality from a patient perspective that canbe used by service providers to help drive improvement.Design Cross-tabulation, Chi-square analysis and Cramer’s Vcalculation using SPSS software of NHS Inpatient Surveys 2006 and 2007.Setting TheNHSInpatientSurveyisastandardizedsurveydesignedbythe Picker Institute conducted on a sample of patients across all acute carehospital trusts in England.Participants Thesurveys(availablefromtheUKDataArchive)provideanonymized patient data for over 77,000 patients in 2006 and 72,000patients in 2007.Main outcome measures Cramer’s V score testing associationsbetweenpatientratingsonmultiplecomponentsofcareandratingsontheoverall quality of care.Results Of the 58 questions analysed, some questions correlate morestrongly with overall satisfaction of care than others and there is strongagreement of results over the two years. Of the top 20 rated components,communication (both between professionals and between professionalsand patients) and trust engendered by that communication is a recurringtheme.Conclusions Hospital trusts are required to develop quality indicatorsand collate detailed feedback from patients in addition to the annualinpatient survey to measure these. To make best use of resources,additional data collection should focus on those aspects of care of mostimportance to patients locally. This analysis demonstrates a statisticaltechnique that can help to identify such priority areas by showing thoseaspects of care most strongly associated with the overall rating of care.The analysis uses national level data to demonstrate how this can beachieved. This shows the importance to patients of being treated withdignity and respect, and good communication between staff and betweenstaff and patients.

patients - identifying key patients' perceptions of quality

The idea of environmental citizenship has “humble origins in a 1990s Environment Canada publication”. The environmental citizen is someone who “does their bit” for the environment. Environmental citizenship has been presented as a practical ideal by a diverse range of actors in environmental politics. The use of the term “environmental citizenship” might have become less common but the practice of environmental citizenship remains extremely important. The practical ideal of the environmental citizen is someone who is concerned about the global environment and recognizes her responsibility or duty to play her part in preventing environmental harms. The discursive use of the ideal of environmental citizenship by both state and non-state actors in the 1990s and 2000s prompted academic discussion of the concept. Kelvin Mason also proposes an account of “green citizenship” based on the experience of environmental activism. 

Environmental citizenship

https://www.cell.com/trends/parasitology/pdf/S1471-4922(15)00232-9.pdf

New Malaria Tests: Square Pegs for Round Holes?

(2) that patients who have experienced an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) should participate in pulmonary rehabilitation (PR) within 4 weeks after hospital discharge, the uptake of this treatment remains low (3). This is of concern, as PR has been shown to improve dyspnea, quality of life, and exercise capacity, and reduces hospital readmissions among patients with AECOPD (2). The authors rightly indicate that to date, very few studies have investigated the effects of interventions that aim to increase uptake of PR after an AECOPD (4). None of the existing published studies used a randomized controlled trial (RCT) design. Barker and colleagues conducted an RCT to investigate the effects of an intervention, an educational video about PR, as an adjunct to usual care (1). Their primary outcome was uptake of PR within 28 days of hospital discharge. They concluded that a video delivered at hospital discharge did not improve uptake of PR. Although their RCT was well conducted, it does not appear that the authors applied behavioral theory to guide the key messages included in the video, nor was there a progressive and systematic framework guiding the development of their behavior-change intervention as suggested by the Obesity-related Behavioral Intervention Trials (ORBIT) model (5). The ORBIT model encourages investigators to complete a series of studies to define and refine the intervention (phase I) and to preliminarily test it (phase II) before conducting efficacy (phase III) and effectiveness (phase IV) trials, akin to the usual practice of pharmaceutical studies. These suggested steps for behavioral intervention development ensure that the treatment package includes essential components offered in an efficient way and, importantly, helps to ensure a clinically significant effect on the behavioral risk factor (5). Although this process can be long and laborious, it is a critical step to prevent a potential waste of resources—for example, by conducting a large RCT for a treatment that cannot impact the target clinical outcomes (5). It seems that Barker and colleagues designed their RCT before they determined whether their video intervention included the essential components (e.g., a motivational communication style and the optimal frequency, duration, and timing of contacts to show the video). The video was only shown once at hospital discharge, a time that can be very overwhelming for patients and family members, and thus is not the best time to make such a decision (6). Indeed, 6 out of the 15 participants interviewed did not recall even watching the video at hospital discharge. Furthermore, at the outset of the RCT, the potential effect on behavioral risk factors (such as knowledge about PR, and self-efficacy/readiness for commencing PR) was not known, as no preliminary testing of these important mediate outcomes was performed. Finally, the rationale for their secondary outcomes is not clear. It is unlikely that an educational video shown once at hospital discharge would have an impact on PR completion rates and adherence, physical performance, or health-related quality of life. The present study by Barker and colleagues addresses a very important question and was well conducted for an RCT. However, if the authors had used a theoretical framework such as the ORBIT model, they would have had the opportunity to strengthen their behavioral intervention and make it as effective as possible before conducting an RCT. It is important to emphasize the value of using a systematic, phased approach to develop a behavioral treatment before testing it in rigorous effectiveness trials. n Author disclosures are available with the text of this letter at www.atsjournals.org.

Reply to Janaudis-Ferreira et al.: One Step at a Time: A Phased Approach to Behavioral Treatment Development in Pulmonary Rehabilitation.

OBJECTIVES Care providers need accurate information to help them effectively manage patient flow in emergency departments (EDs) and deliver high-quality care within time constraints. Data should alert care providers to clinical risk and poor patient experience. In England, NHS A&E guidance proposes, among others, three measures to understand the distribution of waiting times in EDs - the median wait, 95th percentile and maximum wait. This study explores how well these three measures monitor performance and the potential added value of scatterplots. PATIENTS AND METHODS Anonymized patient-level data on 463 000 patient visits collected over 2 full years recording length of stay to the nearest minute from four separate EDs were analysed. Scatterplots providing a detailed representation of the distribution of waiting times were produced for all sites. For each hospital, we explored how informative the scatterplots were compared with the single measures required under the NHS Outcomes Framework. RESULTS There are several instances where the use of scatterplots adds value by identifying concerns that are not detected by the use of single measures alone. CONCLUSION The use of scatterplots could help care providers better understand the distribution of waiting times in EDs, identify where EDs struggle to deliver care against time constraints and highlight poor patient experience and prompt action to address concerns.

Derek Bell

Papers

patients - identifying key patients' perceptions of quality

Environmental citizenship

New Malaria Tests: Square Pegs for Round Holes?

Reply to Janaudis-Ferreira et al.: One Step at a Time: A Phased Approach to Behavioral Treatment Development in Pulmonary Rehabilitation.

Monitoring patient flow in emergency departments: the use of scatterplots versus time-based measures to assess patient flow in A&E.