The safety case and the lessons learned for the reliability and maintainability case

This paper examine the safety case and the lessons learned for the reliability and maintainability case

Defrauding the Public Interest: A Critical Examination of Reengineered Audit Processes and the Likelihood of Detecting Fraud

In the past few years, most of the major international public accounting firms have reengineered their audit processes to improve the cost effectiveness of completing an audit and to focus on value-added services for clients. The reengineered audit processes generally focus on a client’s business processes and the information systems used by the client to generate financial information. In essence, the new audit approaches deemphasize direct testing of the underlying transactions and account balances. Such an approach emphasizes analytical procedures as the main source of substantive evidence. During this same time period, however, the profession (through the AICPA) explicitly acknowledged the profession’s responsibility for fraud detection. The main premise of this paper is that the increased emphasis on systems assessments is at odds with the profession’s position regarding fraud detection because most material frauds originate at the top levels of the organization, where controls and systems are least prevalent and effective. As such, the profession may be paying lip service to fraud detection, while at the same time changing the audit process in a manner that is less effective at detecting the most common frauds

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND: The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS: The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS: A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS: The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours

Aeronautical Engineering: A special bibliography with indexes, supplement 55

This bibliography lists 260 reports, articles, and other documents introduced into the NASA scientific and technical information system in February 1975

The South African Regulatory System: Past, Present, and Future

The drive for improved regulatory systems and the establishment of a more effective regulatory framework in South Africa has been evident for the past two decades but despite political intentions and legislative revisions success has been limited to date. Efforts to address the increasing volume of applications that have been received have to date failed and resources have been stretched to capacity resulting in the development of a significant backlog and extended timelines for product registration. The promulgation of the recently amended Medicines and Related Substance Act of 1965 triggered the establishment of the South African Health Products Regulatory Authority (SAHPRA) as a separate juristic person outside of the National Department of Health to replace the former medicine regulatory authority the Medicines Control Council (MCC). The aim of this review is to provide the historical context supporting the new regulatory environment in South Africa and the transition from the MCC to SAHPRA. Key recommendations to SAHPRA to ensure the full potential of the new regulatory environment in South Africa include: establishing a quality management system to safeguard accountability, consistency and transparency and to streamline the implementation of good review practices including quality decisionmaking practices and benefit-risk assessment; the measurement and monitoring of regulatory performance, targets for overall approval time and key review milestones to instill a culture of accurate metrics collection and measurement of key performance indicators and their continuous improvement and the employment of a risk-based approach to the evaluation of medical products and codify the use of facilitated regulatory pathways in policy and culture. The application of a risk-based approach to regulatory review commensurate with a product’s risk to patients will facilitate the application of increased resources for pharmacovigilance activities and to support the reliance and recognition of reference agencies.Peer reviewe

Enhancing student learning through the assessment of outcomes:developing and demonstrating essay writing skills

This paper documents current developments in the UK Open University (UK/OU) with reference to the requirement in the UK that all Higher Education institutions now have to describe their programmes in terms of learning outcomes. In response to this, the UK/OU set up a three-year Learning Outcomes and Their Assessment (LOTA) Project to explore and implement an outcomes-based approach to curriculum design and delivery throughout the university. The intended learning outcomes for all courses and all programmes of study have now been documented in course and programme specifications. Currently the challenge is to ensure that assessment strategies and assessment methods support the development of the stated outcomes and enable them to be appropriately assessed. The LOTA Project has always seen assessment as part of the learning process through both formative and summative assignments. In many OU courses academic essays are used to assess students work, both throughout a course and in the final examination. The paper goes on to describe an action research project that set out to examine the extent to which assessment through essays encouraged students to both develop and demonstrate the outcomes claimed by each course. The aim of the project was to explore the process of essay writing and essay marking. It involved pairs of tutors who exchanged and double-marked the essays of two of their students throughout the course and met at the end of the year to compare their experiences. The assessment materials provided by the course team were examined and the progress of the students analysed through their essays. The evidence suggests that essay writing can be used to assess learning outcomes but that present practice shows these are not explicit and that many students fail to demonstrate them. With clearer guidance to tutors and to students, both cognitive and communication skills could be developed more effectively and assessed more rigorously. The findings contribute to on-going work to find better ways of enhancing students' learning through the articulation and assessment of outcomes. The paper concludes that moving towards an outcomes-based curriculum, with appropriate assessment strategies, can enhance student learning but the process needs to be more transparent and to explicitly encourage a meta-cognitive approach