The Cost of Meeting Compliance: A Case Study of Challenges,Time Investments, and Dollars Spent

Management, especially how it relates to staff time investments tracking outcomes and reporting results, is not clearly understood across the nonprofit sector (Gawande & Wheeler, 1999). To date, there is no systematic study that examines investments made by nonprofit staff to meet funder compliance. Recently, the Stanford Project on the Evolution of Nonprofits (SPEN) at Stanford University completed a two-year investigation of nonprofits in the Bay Area and found that many funders differ in their demands for meeting compliance, which created conflicting demands (Gammal, Simard, Hwang, & Powell, 2005). However, the study did not examine the amount of time nonprofit leaders spend on such activities or how much of the funding resources are used toward such activities. Thus, both nonprofits and funders alike have not been able to quantify, in dollars, how much is invested in meeting compliance. To address this gap, The Forbes Funds commissioned Sandraluz Lara-Cinisomo to conduct a research case study of one Pittsburgh-area nonprofit to determine how the organization makes staffing decisions and carries out compliance-related activities; how much time is invested in these tasks; and how this time translates into dollars spent

Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. FINDINGS: Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. PRACTICE IMPLICATIONS: Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality

Service Level Agreement-based GDPR Compliance and Security assurance in (multi)Cloud-based systems

Compliance with the new European General Data Protection Regulation (Regulation (EU) 2016/679) and security assurance are currently two major challenges of Cloud-based systems. GDPR compliance implies both privacy and security mechanisms definition, enforcement and control, including evidence collection. This paper presents a novel DevOps framework aimed at supporting Cloud consumers in designing, deploying and operating (multi)Cloud systems that include the necessary privacy and security controls for ensuring transparency to end-users, third parties in service provision (if any) and law enforcement authorities. The framework relies on the risk-driven specification at design time of privacy and security level objectives in the system Service Level Agreement (SLA) and in their continuous monitoring and enforcement at runtime.The research leading to these results has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644429 and No 780351, MUSA project and ENACT project, respectively. We would also like to acknowledge all the members of the MUSA Consortium and ENACT Consortium for their valuable help

Impact of Level of Effort on the Effects of Compliance with the 3-Hour Rule

Objective To determine if patients’ level of effort (LOE) in therapy sessions during traumatic brain injury (TBI) rehabilitation modifies the effect of compliance with the 3-Hour Rule of the Centers for Medicare & Medicaid Services. Design Propensity score methodology applied to the TBI-Practice-Based Evidence (TBI-PBE) database, consisting of multi-site, prospective, longitudinal observational data. Setting Acute inpatient rehabilitation facilities (IRF). Participants Patients (n=1820) who received their first IRF admission for TBI in the US and were enrolled for 3 and 9 month follow-up. Main Outcome Measures Participation Assessment with Recombined Tools-Objective-17, FIMTM Motor and Cognitive scores, Satisfaction with Life Scale, and Patient Health Questionnaire-9. Results When the full cohort was examined, no strong main effect of compliance with the 3-Hour Rule was identified and LOE did not modify the effect of compliance with the 3-Hour Rule. In contrast, LOE had a strong positive main effect on all outcomes, except depression. When the sample was stratified by level of disability, LOE modified the effect of compliance, particularly on the outcomes of participants with less severe disability. For these patients, providing 3 hours of therapy for 50%+ of therapy days in the context of low effort resulted in poorer performance on select outcome measures at discharge and up to 9 months post discharge compared to patients with <50% of 3-hr therapy days. Conclusions LOE is an active ingredient in inpatient TBI rehabilitation, while compliance with the 3-Hour Rule was not found to have a substantive impact on the outcomes. The results support matching time in therapy during acute TBI rehabilitation to patients’ LOE in order to optimize long-term benefits on outcomes

Resistance Training Effects on Arterial Compliance in Premenopausal Women

Endurance training has been shown to increase arterial compliance; however, the effect of resistance training is unclear. Purpose: The purpose of this study was to examine the effect lower body resistance training on arterial compliance in healthy premenopausal women. Methods: Thirty-two women were assigned to a resistance training group (n = 21) or a control group (n = 11). Large (C1) and small (C2) arterial compliance (Pulse Contour Analysis) were measured at baseline and after twelve weeks of training. Results: Two-way (group × time) repeated measured ANOVA did not detect significant group, time effects or group × time interactions for small arterial compliance (P > 0.05). There was a significant time effect for large arterial compliance (P < 0.05), which increased in both groups. Conclusions: In contrast to previous studies in men, which found decrease in arterial compliance with resistance training, no decrease in arterial compliance was observed.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

A Study of Costs of Compliance Related to Non-point Pollution Rules for Wisconsin Crop Producers

The non-point pollution rules proposed by the Wisconsin Department of Natural Resources (DNR) have generated questions regarding the costs of compliance for Wisconsin agriculture. It is clear that some agricultural practices will have to change if the proposed rules are enacted, but the costs of these changes are less clear. The DNR proposals include cost sharing for the introduction of best management practices, but constrain the cost share program to essentially out of-pocket expenses. In general, there is no compensation for costs associated with additional management time, or lost revenue. The purpose of this project is to generate a set of estimates relating to net costs of compliance for Wisconsin crop producers. The intent is to develop a baseline for discussion of rule adoption and the share of total costs paid by producers.

Evaluation of Pre-Trial Diversion Project, State of Alaska, Department of Law

In February 1978 the Alaska Department of Law initiated a pilot pretrial intervention (PTI) project in Anchorage directed at first-time property offenders with no history of violence and no current drug or alcohol dependency. The project was aimed at reducing recidivism and costs to the criminal justice system, and included a built-in evaluation component. This report explores the PTI project's impact by (1) comparing PTI clients with other defendants; (2) investigating compliance of PTI clients with contracts to which they agree at time of program entry; (3) comparing costs of PTI compared with those generated in ordinary criminal cases; (4) evaluating the program's administration, identifying its deficiencies, and suggesting improvements; and (5) looking at recidivism rates of PTI clients.State of Alaska Department of Law Grant No. 78-A-014 Law Enforcement Assistance Administration, United States Department of JusticeAcknowledgements / Introduction / Project Background / Project Clientele / Client Performance / Cost Comparisons / Project Administration / Appendix A. Eligibility Criteria / Appendix B. Data Collection For

Feasibility of monitoring compliance with intermittent occlusion therapy glasses for amblyopia treatment

Background Liquid crystal glasses use an intermittent occlusion technique and may improve compliance compared to adhesive patches. Previous studies support the effectiveness of intermittent occlusion therapy (IO therapy) glasses for amblyopia treatment. However, objective compliance for these glasses has not been measured. The purpose of this study was to investigate the feasibility of using a microsensor to monitor objective compliance with IO therapy glasses. Methods Children 3 to ≤8 years of age with unilateral amblyopia were enrolled. All subjects had optimal refractive correction (if needed) for at least 5 weeks without improvement. Subjects were prescribed IO therapy glasses, set at 30-second opaque/transparent intervals (ie, occluded 50% of wear time). Wear time was prescribed according to amblyopia severity. For each patient, objective compliance with the IO therapy glasses was monitored by means of a microsensor. Results A total of 13 subjects returned with microsensor data. Compliance varied among and within individuals. General compliance averaged 51.6% (range, 10%-97%). Mean daily compliance decreased slightly over time. On average, patients’ visual acuity improved 0.14 ± 0.15 logMAR (range, −0.1 to 0.5 logMAR). No parents reported that their child had social concerns related to the attached microsensor. Conclusions Objective compliance with IO therapy glasses can be monitored by a simple microsensor reliably. In our study cohort, objective compliance with IO therapy glasses varied among individuals, but on average it declined slightly over time

Hand hygiene techniques:Still a requirement for evidence for practice?

Introduction Two hand hygiene techniques are promoted internationally: the World Health Organisation’s 6 step and the Centre for Disease Control’s 3 step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based hand rub (ABHR). Objectives The aim of the study was to compare the effectiveness of the two techniques in clinical practice. Methods A prospective parallel group randomised controlled trial (RCT) was conducted with 1:1 allocation of 6 step versus the 3 step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital. Results The 6 step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300, 2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the 3 step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65%, compared to 100% compliance with 3 step technique. Further those participants with 100% compliance with 6 step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65% compliance with 6 step technique (p=0.01). Conclusion To our knowledge this is the first published RCT to demonstrate the 6 step technique is superior to the 3 step technique in reducing the residual bacterial load after hand hygiene using alcohol based hand rub in clinical practice. What remains unknown is whether the residual bacterial load after the 3 step technique is low enough to reduce risk of transmission from the hands and whether the 6 step technique can be adapted to enhance compliance in order to maximise reduction in residual bacterial load and reduce duration