Search results

The purpose of this explanatory case study is to explain the implementation of interprofessional, multitiered lean daily management (LDM) and to quantitatively report its impact on hospital safety.

This case study explained the framework for LDM implementation and changes in quality metrics associated with the interprofessional, multitiered LDM, implemented at Saint Francis Hospital and Medical Center (SFHMC) at the end of 2018. Concepts from lean, Total Quality Management (TQM) and high reliability science were applied to develop the four tiers and gemba rounding components of LDM. A two-tailed t-test analysis was utilized to determine statistical significance for serious safety events (SSEs) comparing the intervention period (January 2019–December 2019) to the baseline period (calendar years 2017 and 2018). Other quality and efficiency metrics were also tracked.

LDM was associated with decreased SSEs in 2019 compared to 2017 and 2018 (p ≤ 0.01). There were no reportable central line-associated blood stream infection (CLABSI) or catheter-associated urinary tract infection (CAUTI) for first full calendar quarter in the hospital's history. Hospital-acquired pressure injuries were at 0.2 per 1,000 patient days, meeting the annual target of <0.5 per 1,000 patient days. Outcomes for falls with injury, hand hygiene and patient experience also trended toward target. These improvements occurred while also observing a lower observed to expected length of stay (O/E LOS), which is the organizational marker for hospital’s efficiency.

LDM may contribute greatly to improve safety outcomes. This observational study was performed in an urban, high-acuity, low cost hospital which may not be representative of other hospitals. Further study is warranted to determine whether this model can be applied more broadly to other settings.

LDM can be implemented quickly to achieve an improvement in hospital safety and other health-care quality outcomes. This required a redistribution of time for hospital staff but did not require any significant capital or other investment.

As hospital systems move from a volume-based to value-based health-care delivery model, dynamic interventions using LDM can play a pivotal role in helping all patients, particularly in underserved settings where lower cost care is required for sustainability, given limited available resources.

While many hospital systems promote organizational rounding as a routine quality improvement process, this study shows that a dynamic, intense LDM model can dramatically improve safety within months. This was done in a challenging urban environment for a high-acuity population with limited resources.

This chapter provides an assessment of the sustainability of Ireland's health care system. It starts by describing the historical development of the Irish system and identifying key features of the current system that raise potential challenges for sustainability. It then provides an analysis of recently compiled and up-to-date data on trends in health care expenditures. A number of specific demand and supply side challenges to sustainability are then described and discussed. This is followed by an examination of recent and current reforms to the health care system, focussing on their likely impact on sustainability, as well as a discussion of how health economics has and can inform policy, practice and debate. We also discuss the potential implications of the COVID-19 pandemic for the Irish system.

A CORRESPONDENT complains that he has undertaken a course for his final examination, after spending six years from Dunkirk to the Elbe far removed from library opportunities—only to find that librarians and libraries are building up their staffs now. The Times Literary Supplement, he says, carries column after column of advertisements of desirable posts for which he, as he thinks, is a desirable and legitimate aspirant, but he is barred by his academic obligations. This appears to be a genuine grievance and we place it first in these notes in the hope that authorities, and especially librarians, may be induced to consider it. It may be answered that there is a present urgent need to tune up libraries of every kind to meet the great public need and that many of them have already waited some years. It is perhaps a pity that they did not wait a little longer so that the men who deserve most of the country could have been brought into the competition.

THE library year ends in no spectacular way. If posterity has any cause to remember 1932 it will probably be as of a year when the doctrine of economy was raised to the rank of a divine dogma by a world of debtors and creditors all crazed with fear over international debts. A year of hurried committees producing reports for the reduction of expenditures, beneficient or otherwise; especially, in this last month, a report which if implemented would cripple almost every local activity, and set back the clock of social effort at least thirty years. The intention of such reports is no doubt good; their effects are yet to be seen. So far, the increased parsimony in national and local affairs seems only to have intensified unemployment without bettering the general situation. A reaction against all this is beginning, not a moment too soon, and all who care for the finer things in our civilisation will be compelled to stand against the more unsocial recommendations of these reports.

The aim of this paper is to discuss a selection of policy strategies, regional initiatives and market approaches to uncover the realities of twenty-first-century building energy performance. A position that market-based approaches, human influence and policy interventions are part of an ecosystem of building energy performance is presented.

An exploratory search of secondary sources spanning the last three decades was conducted. Both peer-reviewed and grey literature were included to capture a broader understanding of the discourse in literature. Research questions guided the literature search, and a data extraction tool was designed to categorise the literature. The primary limitation of this study is that only a few applications could be discussed in a condensed format.

Several challenges about the current status quo of building energy performance were identified and summarised as follows. (1) Inconsistencies in measurement and verification protocols, (2) Impacts of market approaches, (3) National policy priorities that are at variance with regional targets and (4) Ambiguous reporting on environmental impacts of energy efficiency (EE) technologies.

The practical implications of the findings in this paper for practice and research are that as part of the building energy performance ecosystem, national responses through government interventions must become adaptive to keep up with the fast-paced energy sector and social trends. Simultaneously, before market-based approaches overcome the messiness of socio-economic dynamics, institutional conditions and cultural nuances, they ought to transparently address environmental impacts and the infringement of several SDGs before they can become viable solutions to building energy performance.

This paper presents building energy performance as an ecosystem comprising human influence, market-based approaches and policy interventions which form interdependent parts of the whole. However, evidence in the literature shows that these aspects are usually investigated separately. By presenting them as an ecosystem, this paper contributes to the discourse by advocating the need to re-align building energy performance to socio-economic-political dynamics and contextually viable solutions.

This chapter presents a form of both co-participation theory and artful inquiry methodology as useful approaches in carrying out research into the student experience. Participatory Pedagogy is predicated on repositioning participants as co-producers of knowledge by introducing them to important aspects of the research, providing a platform to foster expression and affording opportunities to co-shape the research process. Artful inquiry can take many different forms, but collage in particular has the capacity to bring new meanings to the surface even in well-researched fields, such as the student experience. In supporting a Participatory Pedagogy approach, collage can unpack powerful testimonies of personal experience. A practical application of this pairing is also presented based on research into the student experience. This gives readers an insight into how it can be applied to a study, what its limitations might be and especially how students, particularly those from under-represented backgrounds, can benefit from being involved.

Litigation is part of the American policymaking playbook as diverse groups routinely turn to courts to pursue their agendas. All of this litigation raises questions about its consequences. This essay examines the literature on the political risks of litigation. It argues that this literature identifies four potential risks – crowd out, path dependence, backlash, and individualization – but offers less insight into the likelihood of these risks in practice. It ends by offering suggestions about how to advance our understanding of when litigation casts a negative political shadow in the current age of judicialization.

Fifty years ago the political scientist Robert Dahl concluded that courts are usually in sync with “the policy views dominant among the lawmaking majorities” and thus offer little help to aggrieved minorities (Dahl, 1957, p. 285). In recent years, Dahl's classic formulation has received renewed attention. This chapter uses the example of the Rehnquist Court's First Amendment decisions to analyze “regime politics” theory. On religion cases the Rehnquist Court was generally in sync with the socially conservative strain in the Republican Party, but in other First Amendment areas the pattern is far more complex, raising questions about the relationship between conservative judges and the political movements that brought them to office.

The enormous danger of enemy influence in regard to the control and management of the food supply of the country and the great evils attributable to this cause justify us in reproducing the following able article by MR. RONALD MCNEILL, M.P., from the Evening Standard of October 26th:—