A mixed method analysis of patients' complaints: Underpinnings of theory-guided strategies to improve quality of care

Purpose:Patients'complaints can be predictors of patient care quality and safety.Understanding patients'complaints could help healthcare organizations target the areas for improvements.The purpose of this study is to use a mixed method analysis to a)examine the characteristics and categories of patients'complaints,b)explore the relationships of patients'complaints with professions and units,and c)propose theory-based strategies to improve care quality.Methods:This is a descriptive mixed method study.Data examined are patients'complaints filed at a university-affiliated hospital in China from January 2016 to December 2017.A qualitative content analysis was conducted to categorize complaints.A TwoStep cluster analysis was performed to provide an overall profile of patients'complaints.Chi-Square tests were conducted to investigate the relationships among complaints,professions,and units.Results:838 complaints were filed,with 821 valid cases for analysis.Six categories surfaced from the qualitative analysis:uncaring attitudes,unsatisfactory quality of treatment or competence,communication problems,the process of care,fees and billing issues,and other miscellaneous causes.Physicians received most of the complaints(56.6%).The unit receiving the most complaints were outpatient clinics and medical support units(52.7%).The cluster analysis indicated four distinct clusters.Significant relationships existed between complaints and professions(x2(20)=178.82,P<0.01),and between complaints and units(x2(15)=42.72,P<0.01).Conclusions:Patients'complaints are valuable sources for quality improvements.Healthcare providers should be not only scientifically knowledgeable,but also humanistic caring.Caring-based theories may provide guidance in clinical practice.

Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.

Post-operative morbidity after neoadjuvant chemotherapy and resection for gallbladder cancer: A national surgical quality improvement program analysis

BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer.As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative period.We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity.AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery.METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had surgery.To calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was performed.RESULTS Of the 452 patients,52 patients received NACT prior to surgery.There were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.

Enhancing Private Healthcare Effectiveness in Lagos State, Nigeria: An Overview of the Effect of Quality Improvement Initiatives and Implications for Sustainable Healthcare Delivery

Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.

Research on the Construction and Quality Improvement of Art Curriculum in Rural Primary Schools

Curriculum quality is the foundation of education development and the core element of primary education and teaching.It is a key indicator to measure and evaluate the level of educational development in a country and region.Curriculum quality needs to be examined not only from the perspective of the degree of achievement of the preset curriculum goals,but also from the perspective of students’subjective feelings and experiences.Art course is the core service provided by the school for students,and the quality of the course is judged by the acquisition and development of students.At the same time,the value of aesthetic education also calls for the reform and improvement of the fine arts curriculum,which requires the fine arts curriculum in all stages in rural areas to get closer and change in this direction.After the promulgation of art curriculum standards,the fine arts curriculum of rural primary schools should follow high quality standards,which is a process of optimization and iteration of various elements of primary art curriculum.The fine arts curriculum of rural primary schools needs to meet the exploration needs of current students,effectively and appropriately develop excellent local resources while enriching the curriculum content,introduce the essence of regional culture and art,improve the evaluation of curriculum quality,and form a scientific curriculum management system,so as to promote the sustainable development of students.According to this understanding,we can improve the quality of art curriculum in rural primary schools from four dimensions:curriculum objectives,curriculum content,curriculum implementation,and curriculum evaluation.

Phytosynthetic bacteria (PSB) as a water quality improvement mechanism in saline-alkali wetland ponds

The efficiency of phytosynthetic bacteria (PSB) to improve the water quality in saline alkali ponds was studied, the result showed that (1) PSB application could increase the content of DO, NO\+-\-3\|N and effective phosphorus (EP) in ponds; (2) the changes of COD were not evident, just effective in later period after PSB application; (3) PSB application could decrease the contents of NH\+-\-4\|N (NH\-3\|N), NO\+-\-2\|N ; (4) PSB application could improve the structure of the effective nitrogen (EN) and EP, stimulate the growth of phytoplankton, and increase primary productivity, and finally increase the commercial profits of ponds because of the increase of EP and the decrease of EN contents; (5) the effect exerting speed of PSB was slower, but the effect sustaining time was longer; (6) the appropriate concentration of PSB application in saline alkali wetland ponds was 10×10 -6 mg/L, one time effective period was more than 15 days. So PSB was an efficient water quality improver in saline alkali ponds.

Discussion on strategy of grain quality improvement for super high yielding japonica rice in Northeast China

japonica rice is mainly distributed in Northeast China and accounts for 44.6% of the total cultivated area of japonica rice in China. The comprehensive using of inter-subspecies heterosis is the main breeding mode of super japonica rice varieties in this region. Improving rice quality at relative high yielding level is the current research focus. Performing crosses between indica and japonica lines allows for the recombination of regulatory genes and genetic backgrounds, leading to complicated genetic rice quality characteristics, which can be used to explore patterns of quality improvement. In the present study, we utilize recombinant inbred lines （RILs） derived from indica-japonica hybridization to analyze the effect factors of rice quality derived from genetic factors, which contain both regulatory genes concerning rice quality and genetic backgrounds＇ random introduction frequency coming from indica （Di value）, and the improvement strategy was further discussed. The regulatory genes involved in amylase content （Wx） and nitrogen utilization efficiency （NRT1.1B） were the major factors affecting the amylose content （AC） and protein content （PC） in RILs, respectively. Both the Di value and the major grain width gene （GS5） had regulatory effects on milled rice width （MRW） in RILs, and their interaction explained the major variance of MRW in the RILs. With the mediation of MRW and chalkiness degree （C）, Di value had a further impact on head rice rate （HR）, which was relatively poor when the Di value was over 40%. In Northeast China, the Di value should be lowered by backcrossing or multiple crosses during the breeding of indica-japonica hybridization to maintain the whole better HR and further to emphasize the use of favorable genes in individual selection.

Targeted mutagenesis of amino acid transporter genes for rice quality improvement using the CRISPR/Cas9 system

High grain protein content(GPC) reduces rice eating and cooking quality(ECQ). We generated OsAAP6 and OsAAP10 knockout mutants in three high-yielding japonica varieties and one japonica line using the CRISPR/Cas9 system. Mutation efficiency varied with genetic background in the T_0 generation, and GPC in the T_1 generation decreased significantly,owing mainly to a reduction in glutelin content. Amylose content was down-regulated significantly in some Osaap6 and all Osaap10 mutants. The increased taste value of these mutants was supported by Rapid Visco Analysis(RVA) profiles, which showed higher peak viscosity and breakdown viscosity and lower setback viscosity than the wild type. There were no significant deficiencies in agronomic traits of the mutants. Targeted mutagenesis of OsAAP6 and OsAAP10, especially OsAAP10, using the CRISPR/Cas9 system can rapidly reduce GPC and improve ECQ of rice, providing a new strategy for the breeding cultivars with desired ECQ.

Study on Quality Improvement Effect and Separate Character of Soybean Male Sterile (MS1) Recurrent Selection Population

To solve the problem that soybean has narrow genetic base, we constructed a series of male sterile recurrent selection populations, and studied the effects of quality improvement and practical value. An LD-base population, which fits to our ecology type was constructed by 6 years＇ gene enrichment through the introduction of new genes from 23 local varieties and recurrent selection. The LD-base populations were then improved by making crosses with high protein and high oil genotypes. As a result we obtained a high protein sub-population （db） and a high oil sub-population （gy）, For the db sub-population, the protein content is 1.18% higher than the base population, 22.38% of the individuals contain 45% or more of protein, which is 10.99% higher than the base population. For the gy sub-population, oil content is 0.24% higher than the base population. Individuals with oil content of 20% or more are 11.05% higher than the base population. The quantitative characters such as flowering date, mature date, pod habit, and hilum color, etc., all showed wide range of separation, and the segregation ratio approached balance. The c.v. of branch number of ms1 recurrent population （72.8%） is higher than general cross-population （57.3%）, and the c.v. of 100 seed weight of ms1 （18.1%） is higher than general cross population （16.5%）, the coefficient of variation of plant height, pods per plant, and seeds per pod were not significantly different. It was demonstrated in this paper that the quality character of ms 1 male sterile recurrent selection population was improved by adding new genes. And the segregation of other characters widened, making the populations suitable for the objective of soybean breeding. In this paper, we also discussed the breeding method, key technology, and selection effect of soybean ms 1 population.

Developing an evidence-based and theory informed intervention to involve families in patients care after surgery: A quality improvement project

Objectives: In the post-surgical setting,active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care.This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients.Methods: We used a quality improvement project following a multi-phase design.In Phase 1,an iterative method was used to combine evidence from a narrative review and professionals' preferences.In Phase 2,the logic model underlying the program was developed guided by four steps: (1) confirm situation,intervention aim,and target population;(2) documented expected outcomes,and outputs of the intervention;(3) identify and describe assumptions,external factors and inputs;and (4) confirm intervention components.Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review.In Phase 2,the logic model was developed and includes (1) the inputs (e.g.educational-and environmental support),(2) the ultimate outcomes (e.g.reduction of postoperative complications),(3) the intermediate outcomes (e.g.behavioural changes),and (4) immediate outcomes (e.g.improved knowledge,skills and attitude).Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards,and how we took different factors into account.The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.

Interventions to Improve HIV Viral Load Suppression among the Adolescents: Evidence of Improvement Science through a Quality Improvement Approach in Eastern Uganda

Introduction: Achieving viral load suppression among the adolescents living with HIV continues to hold back attainment of sustainable development goals. TASO Mbale realized a viral load suppression rate of 63.1% among the adolescents living with HIV in care in quarter 4 of 2016. We therefore, instituted a quality imrpovement project to improve Viral load suppression from 63.1% in quarter 4 2016 to 90% by the end of quarter 4 2017. Method: Baseline data from the Uganda viral load dashboard were analyzed, and fishbone diagram was utilized to provide root causes of low viral load suppression among the adolescents living with HIV at TASO Mbale. The identified barriers were Knowlegde gap, among the adolescents, on positive living, Missing clinic appointments, Sub-optimal adherence, Poorly planned adolescent HIV clinic, Inadequate follow-up and Low use of data for informed decisions. A plan-do-study-act (PDSA) model was applied to implement tested changes. Strategies that worked included introduction of appointment register to track appointment behaviour of the adolescents, generating lists of clients on appointment who were due for Viral Load bleeding, telephone calls for follow up, increasing the frequency of reviewing adolescents from once a month to twice a week, committing a dedicated team responsible for adolescent care. Results: The viral load suppression improved from 63.1% in quarter 4 of 2016 to 63.8% in the first quarter of 2017, to 87.5% in quarter 2 of 2017, 97.6% in the third quarter and 91.4% in quarter 4 of 2017. Conclusion: The use of quality improvement in addressing gaps in HIV service delivery is highly effective.

CONTINUOUS IMPROVEMENT THROUGH INTEGRATION OF QUALITY TOOLS

The relationship between major quality tools such as quality function development （QFD）, failure mode and effects analysis （FMEA）, design of experiments （DOE） and statistical process control （SPC） is analyzed through an extensive review of the literature and the concurrent quality engineering philosophy, and a basic structure for the integration of quality tools is presented. An integrated quality management system （IQMS） is developed using C＋＋ Builder, running in the Windows 2000 Server environment with the basic internet connections, and SQL Server 2000 as the platform for developing the database, An illustrative example applying IQMS to the continuous quality improvement for a crane equipment manufacturing is reported. The result shows that the application of IQMS can optimize the process of design and manufacturing, shorten the cycle time of product, reduce the cost, and realize quality improvement continuously, The proposed integrated framework with IOMS is believed to be applicable to continuous quality improvement in many manufacturing companies.

A continuous quality improvement project to reduce medication error in the emergency department

BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department(ED) that has a number of factors that make it prone to medication errors.This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.METHODS:In 2009,a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.RESULTS:Responsible officers were assigned to look after seven error-prone areas.Strategies were proposed,discussed,endorsed and promulgated to eliminate the problems identified.A reduction of medication incidents(Ml) from 16 to 6 was achieved before and after the improvement work.CONCLUSION:This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

Improvement of Fiber Quality by Distant Hybridization in the Green Cotton

In order to improve fiber quality of green cotton,a wide hybrid was used between a green fiber cotton and Sea Island cotton.The results show that the hybrid F1 plants were stable,but F2

Using Target Ablation for Ion Beam Quality Improvement

During the laser foil interaction, the output ion beam quality including the energy spread and beam divergence can be improved by the target ablation, due to the direct laser acceleration （DLA） electrons generated in tile ablation plasma. The acceleration field established at the target rear by these electrons, which is highly directional and triangle-envelope, is helpful for the beam quality. With the help of the target ablation, both the beam divergence and energy spread will be reduced. If the ablation is more sufficient, the impact of DLA-electron-caused field will be strengthened, and the beam quality will be better, confirmed by the particle-in-cell simulation.

Rice Quality Improvement in China

1. Demand for high quality rice in ChinaRice is the leading cereal crop that contributes about40% of the national grain production in China. The totaloutput and areas rank the first and the second position inthe world, respectively. In recent years, rice productiongrows steadily, but the quality improvement has beenlagged and the quality becomes a limiting factor. As the

Quality Improvement of Granular Wastes-The Effective Way to Recycle Secondary Raw Building Materials

Granular wastes have negative effects on the environment due to contamination. On the other hand, stony components in granular wastes have a potential good perspectives for utilization in civil engineering works as secondary raw building materials. To reuse such materials without environmental risks, all contaminants must be removed or reduced to an acceptable level. Therefore liberation of materials is an important step in waste treatment. For this purpose, separation and cleansing techniques are suitable. Based on the analysis of contaminants in wastes, it is discussed how to select suitable techniques. The rules for technique selection and processes for quality improvement are set up. To evaluate the environmental quality and technical quality of output products, it is necessary to check leaching behaviours and physical properties.

Improving testicular examinations on paediatric patients in the emergency department:A quality improvement study to improve early diagnosis of testicular torsion

Objective:Male paediatric patients presenting with abdominal and/or testicular pain are common in the emergency department.As a time-sensitive diagnosis,the importance of early recognition,referral,and definitive management is critical.Missed or delayed diagnoses and management of testicular torsion can result in significant long-term sequelae including impaired fertility and psychological burden.In this quality improvement study,we utilised educational posters aiming to improve awareness of testicular torsion as a differential for abdominal pain and therefore,improve the quality of testicular examinations performed in the emergency department.Methods:Observational pre-and post-intervention study was conducted at a tertiary hospital emergency department.A pre-interventional retrospective review of the electronic medical records was conducted.All male patients under 16-years-old presenting with“abdominal pain”or“testicular problem”were included.We assessed the rate of testicular examination and the quality of the examination based on four domains:Cremasteric reflex,lie,swelling,and hardness.Educational posters targeting both patients and clinicians were placed around the emergency department.Subsequent review of the electronic medical records post-intervention was performed assessing the same domains.Results:A total of 235 presentations were analysed with 124 in the pre-intervention group and 111 in the post-intervention group.Overall rate of documented testicular examinations increased by 14%(p=0.032).The quality of testicular examinations also improved from an average of 0.85 domains documented to 2.29 post-intervention(p<0.001).Subgroup analysis found doctors in training had a greater improvement in both rate and quality of documented testicular examination.Conclusion:Our study demonstrated the value of continuing education in promoting awareness of testicular torsion in the emergency department.We found a clear improvement in the quality of clinical documentation of a time-sensitive condition which may infer a decreased risk of missed and delayed diagnosis of testicular torsion.

Molecular Markers in Improvement of Fiber Quality Traits in Cotton

Cotton is the worlds leading natural fiber crop,and it is the cornerstone of textile industries worldwide.The cotton industry is confronted with problems in cost of production and

Progress in applying patient experience in nursing quality improvement

Background： Improving and sustaining the quality of nursing care is an intractable and persistent challenge. The patient experience of nursing care can give a different perspective on nursing quality and help clinical nursing staff to direct quality improvement. Attempts to identify what is patient experience,the relationship with nursing care, and the application of patient experience in nursing quality improvement practice, in order to provide advices for constructing the quality standards and quality improvement strategies of nursing care.Methods： We conducted a literature review of original research publications. The database platforms Pubmed, Web of Science, China National Knowledge Infrastructure（CNKI） and Wanfang were searched from inception until end of August 2015. After screening retrieved articles, 40 sources（articles and organizational websites） were selected for analysis for the connotation, development and application of patient experience in nursing quality researches.Results： Our study identified several concepts about patient experience, roughly sorted out the development path of patient experience in worldwide and the application of patient experience in nursing quality improvement. It points out four precautions when applying patient experience in nursing quality improvement, which are differentiating patient satisfaction and patient experience, choosing appropriate data collection method and appropriate feedback time, and the last but the most important, applying theories to actual clinical practice.Conclusions： Professional indexes are important to maintain the care quality, but it cannot fully reflect quality of nursing care, which needs patient experience as the supplement. Nursing staffs need to make more efforts to enhance patient＇s nursing care experience, and apply the research results to clinical practice, and finally make patient-centered care come true. For future study, the evaluation system and management strategies about patient experience need to be developed to guide nursing quality improvement.