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

Let's read! We will often find out this sentence everywhere. When still being a kid, mom used to order us to always read, so did the teacher. Some books are fully read in a week and we need the obligation to support reading. What about now? Do you still love reading? Is reading only for you who have obligation? Absolutely not! We here offer you a new book enPDFd the perception of the visual world to read.

The Perception of the Visual World. By James J. Gibson. U.S.A.: Houghton Mifflin Company, 1950 (George Allen & Unwin, Ltd., London). Price 35s.

ロジックモデル策定ガイド = Logic model development guide

Quality improvement (QI) methods have been introduced to healthcare to support the delivery of care that is safe, timely, effective, efficient, equitable and cost effective. Of the many QI tools and methods, the Plan-Do-Study-Act (PDSA) cycle is one of the few that focuses on the crux of change, the translation of ideas and intentions into action. As such, the PDSA cycle and the concept of iterative tests of change are central to many QI approaches, including the model for improvement,1 lean,2 six sigma3 and total quality management.4

PDSA provides a structured experimental learning approach to testing changes. Previously, concerns have been raised regarding the fidelity of application of PDSA method, which may undermine learning efforts,5 the complexity of its use in practice5 ,6 and as to the appropriateness of the PDSA method to address the significant challenges of healthcare improvement.7

This article presents our reflections on the full potential of using PDSA in healthcare, but in doing so we explore the inherent complexity and multiple challenges of executing PDSA well. Ultimately, we argue that the problem with PDSA is the oversimplification of the method as it has been translated into healthcare and the failure to invest in a rigorous and tailored application of the approach.

The purpose of the PDSA method lies in learning as quickly as possible whether an intervention works in a particular setting and to making adjustments accordingly to increase the chances of delivering and sustaining the desired improvement. In contrast to controlled trials, PDSAs allow new learning to be built in to this experimental process. If problems are identified with the original plan, then the theory can be revised to build on this learning and a subsequent experiment conducted to see if it has resolved the problem, and …

https://qualitysafety.bmj.com/content/qhc/25/3/147.full.pdf

The problem with Plan-Do-Study-Act cycles

Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action.

Background The identification and articulation of programme theory can support effective design, execution and evaluation of quality improvement (QI) initiatives. Programme theory includes an agreed aim, potential interventions to achieve this aim, anticipated cause/effect relationships between the interventions and the aim and measures to monitor improvement. This paper outlines the approach used in a research and improvement programme to support QI initiatives in identifying and articulating programme theory: the action effect method. Background to method development Building on a previously used QI method, the driver diagram, the action effect method was developed using co-design and iteration over four annual rounds of improvement initiatives. This resulted in a specification of the elements required to fully articulate the programme theory of a QI initiative. The action effect method The action effect method is a systematic and structured process to identify and articulate a QI initiative’s programme theory. The method connects potential interventions and implementation activities with an overall improvement aim through a diagrammatic representation of hypothesised and evidenced cause/effect relationships. Measure concepts, in terms of service delivery and patient and system outcomes, are identified to support evaluation. Discussion and conclusions The action effect method provides a framework to guide the execution and evaluation of a QI initiative, a focal point for other QI methods and a communication tool to engage stakeholders. A clear definition of what constitutes a wellarticulated programme theory is provided to guide the use of the method and assessment of the fidelity of its application.

https://qualitysafety.bmj.com/content/qhc/23/12/1040.full.pdf

Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory

Objectives Our aim was to explore junior doctors’ attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process. Method An online survey about medication review was distributed among all 42 foundation year one (FY1) doctors at the Chelsea and Westminster Hospital NHS Foundation Trust in November 2014. Descriptive statistics were used for analysis. Results Twenty doctors completed the survey (48%). Of those, 17 believed that it was the pharmacist’s duty to review medicines; and 15 of 20 stated the general practitioner (GP). Sixteen of 20 stated that they would consult a senior doctor first before stopping medication. Eighteen of 20 considered the GP and consultant to be responsible for alterations, rather than themselves. Sixteen of 20 respondents were not aware of the availability of a medication review tool. Seventeen of 20 felt that more support from senior staff would help them become involved with medication review. Conclusions Junior doctors report feeling uncomfortable altering mediations without consulting a senior first. They appear to be building confidence with prescribing in their first year but not about the medication review process or questioning the drugs already prescribed. Consideration should be given to what we have termed a ‘bottom-up’ educational approach to provide early experience of and change the culture around medication review, to include the education of undergraduate and foundation doctors and pharmacists.

https://ejhp.bmj.com/content/ejhpharm/22/4/243.full.pdf

A pilot survey of junior doctors' attitudes and awareness around medication review: time to change our educational approach?

When reaching for objects, humans make saccades to fixate the object at or near the time the hand begins to move. In order to address whether the CNS relies on a common representation of target positions to plan both saccades and hand movements, we quantified the contributions of visual short-term memory (VSTM) to hand and eye movements executed during the same coordinated actions. Subjects performed a sequential movement task in which they picked up one of two objects on the right side of a virtual display (the "weapon"), moved it to the left side of the display (to a "reloading station") and then moved it back to the right side to hit the other object (the target). On some trials, the target was perturbed by 1° of visual angle while subjects moved the weapon to the reloading station. Although subjects did not notice the change, the original position of the target, encoded in VSTM, influenced the motor plans for both the hand and the eye back to the target. Memory influenced motor plans for distant targets more than for near targets, indicating that sensorimotor planning is sensitive to the reliability of available information; however, memory had a larger influence on hand movements than on eye movements. This suggests that spatial planning for coordinated saccades and hand movements are dissociated at the level of processing at which online visual information is integrated with information in short-term memory.

http://www.cvs.rochester.edu/knill_lab/papers/58_issen_knill.pdf

Decoupling eye and hand movement control: Visual short-term memory influences reach planning more than saccade planning

While we know that humans are extremely sensitive to optic flow information about direction of heading, we do not know how they integrate information across the visual field. We adapted the standard cue perturbation paradigm to investigate how young adult observers integrate optic flow information from different regions of the visual field to judge direction of heading. First, subjects judged direction of heading when viewing a three-dimensional field of random dots simulating linear translation through the world. We independently perturbed the flow in one visual field quadrant to indicate a different direction of heading relative to the other three quadrants. We then used subjects' judgments of direction of heading to estimate the relative influence of flow information in each quadrant on perception. Human subjects behaved similarly to the ideal observer in terms of integrating motion information across the visual field with one exception: Subjects overweighted information in the upper half of the visual field. The upper-field bias was robust under several different stimulus conditions, suggesting that it may represent a physiological adaptation to the uneven distribution of task-relevant motion information in our visual world.

Spatial integration of optic flow information in direction of heading judgments

It's time for academic institutions to take responsibility for protecting students and staff, says Laurel Issen.

/pdf/university-systems-allow-sexual-harassers-to-thrive-4n7jcndcao.pdf

Laurel Issen

Papers

Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory

A pilot survey of junior doctors' attitudes and awareness around medication review: time to change our educational approach?

Decoupling eye and hand movement control: Visual short-term memory influences reach planning more than saccade planning

Spatial integration of optic flow information in direction of heading judgments

University systems allow sexual harassers to thrive