The OneTogether collaborative approach to reduce the risk of surgical site infection: identifying the challenges to assuring best practice

Background: Surgical site infections (SSI) account for 16% of healthcare associated infections, and are associated with considerable morbidity, mortality and increased costs of care. Ensuring evidence-based practice to prevent SSI is incorporated across the patient’s surgical journey is complex. OneTogether is a quality improvement collaborative of infection prevention and operating department specialists, formed to support the spread and adoption of best practice to prevent SSI. This paper describes the findings of an expert workshop on infection prevention in operating departments. Methods: A total of 84 delegates from 75 hospitals attended the workshop, comprising 46 (55%) theatre nurses/operating department practitioners; 16 (19%) infection control practitioners and 22 (26%) other healthcare practitioners. Discussion focused on evidence, policy implementation and barriers to best practice. Responses were synthesised into a narrative review. Results: Delegates reported significant problems in translating evidence-based guidance into everyday practice, lack of local polices and poor compliance. Major barriers were lack of leadership, poorly defined responsibilities, and lack of knowledge/training. Conclusions: This workshop has provided important insights into major challenges in assuring compliance with best practice in relation to the prevention of SSI. The OneTogether partnership aims to support healthcare practitioners to improve the outcomes of patients undergoing surgery by reducing the risk of SSI

Surfacing ERP exploitation risks through a risk ontology

Purpose – The purpose of this paper is to develop a risk identification checklist for facilitating user companies to surface, organise and manage potential risks associated with the post-adoption of Enterprise Resource Planning (ERP) systems. Design/methodology/approach – A desktop study, based on the process of a critical literature review, was conducted by the researchers. The critical review focused on IS and business research papers, books, case studies and theoretical articles, etc. Findings – By systematically and critically analysing and synthesising the literature reviewed, the researchers identified and proposed a total of 40 ERP post-implementation risks related to diverse operational, analytical, organisation-wide and technical aspects. A risk ontology was subsequently established to highlight these ERP risks, as well as to present their potential causal relationships. Research limitations/implications – For researchers, the established ERP risk ontology represents a starting point for further research, and provides early insights into a research field that will become increasingly important as more and more companies progress from implementation to exploitation of ERPs. Practical implications – For practitioners, the risk ontology is an important tool and checklist to support risk identification, prevention, management and control, as well as to facilitate strategic planning and decision making. Originality/value – There is a scarcity of studies focusing on ERP post-implementation in contrast with an over abundance of studies focusing on system implementation and project management aspects. This paper aims to fill this significant research gap by presenting a risk ontology of ERP post-adoption. It represents a first attempt in producing a comprehensive model in its area. No other such models could be found from the literature reviewed

Putting Community First: A Promising Approach to Federal Collaboration for Environmental Improvement: An Evaluation of the Community Action for a Renewed Environment (CARE) Demonstration Program

This report is an independent evaluation of the Environmental Protection Agency's (EPA) Community Action for a Renewed Environment (CARE) Demonstration Program, a community-driven process that uses the best available data to help communities set priorities and take action on their greatest environmental risks. CARE fosters local partnerships that seek participation from business, government, organizations, residents and EPA staff. It also supports a public, transparent planning and implementation process based on collaborative decision-making and shared action.Key FindingsThe National Academy Panel overseeing this effort was impressed by the dedication of the EPA staff to this unique initiative and commended the EPA for its efforts to partner with communities in achieving important long-term and sustainable environmental improvements at the local level. Recommended actions for the CARE Program include: (1) develop and implement a multifaceted information sharing approach; (2) coordinate and refine internal program management activities; and (3) develop a strategic plan and a business plan for CARE

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Study on cash transfers for seed security in humanitarian settings

This study examines the barriers and opportunities for cash transfers to be used to address seed security in humanitarian situations. Cash, while not a new approach, has gained momentum in recent years, especially with the emergence of the Cash Learning Partnership (CaLP) and humanitarian organizations’ commitments through the Grand Bargain.2 Historically, direct seed distribution (DSD) has dominated agricultural responses in emergencies. While effective in many situations, other modalities of addressing farmers’ needs have also proven to be effective, including seed and voucher fairs and, increasingly, cash transfer responses. The latter response typically provides farmers greater choices to make decisions about their seed needs and preferences. However, as with direct distribution and vouchers, cash can be a viable option but may not always be appropriate in every situation. The quality of seed is of paramount importance in choosing a response and has been an ongoing (and often contentious and political) discussion for decades. The results of this study advocate for a multi- stakeholder perspective on the quality of seed, while offering farmers the most flexible and most appropriate response possible for their given situation. In some cases, this will be cash transfers, but certainly not in all cases. A range of options offers the best chance for a successful, responsive, and appropriate program. The evidence base on outcomes from using cash for seed in humanitarian contexts is limited, however, reviewing a series of examples shows the breadth and range of options that are being explored. The cases from an array of organizations and countries including Iraq, Ethiopia, Nigeria, Uganda, Zambia, Zimbabwe, Malawi, Madagascar, and Guatemala, show that understanding the context is key to the response analysis and the choice of modality. Organizational approaches and previous experience also played a role in the choice of modality. The evidence to date shows that cash, in addition to complementary programming such as technical or business training, offers promise for seed security interventions. In addition, initiatives to support both the demand and supply side of the market have proven to be effective. Key findings include: 1. Market and needs assessments must include a seed component or SSSA to ensure a response designed to address the right problem, not the assumption. For markets, both informal and formal seed markets need to be included. 2. Good needs assessments, response analysis and program design help ensure participants’ spending cash on what implementers anticipate they will. 3. Program participants’ preferences on modalities are not consistently included in response analysis. 4. Mixed modalities (cash and vouchers, or cash and DSD) can broaden crop choices. 5. Quality screenings for seed are taking place; the quality of seed is important to organizations and project participants. 6. Cash for seed security interventions are limited, but growing in prevalence. 7. Providing cash plus complementary support is a promising practice for fostering seed security. 8. The nexus between relief and development is critical—designing projects with a longer-term development view: cash can prepare the way for farmers to continue true market engagement post-relief, spur business development in subsequent seasons, and offer opportunities for financial inclusion. 9. Supporting supply side to bring quality seed markets ‘closer’ to project participants should be considered along with demand-side interventions (cash, voucher and other). 10. Investment in preparedness provides a better foundation to implement impactful cash for seed security response. The risks, mitigating actions, opportunities and enablers for cash and seed security response are also explored. The study concludes with actionable and practical recommendations for further advancing the evidence base, as well as implementation suggestions. Continuous collaboration of key stakeholders in seed systems is essential to advance the discussions and action on the way forward with cash and seed systems

Scientific Standards and the Regulation of Genetically Modified Insects

Experimental releases of genetically modified (GM) insects are reportedly being evaluated in various countries, including Brazil, the Cayman Islands (United Kingdom), France, Guatemala, India, Malaysia, Mexico, Panama, Philippines, Singapore, Thailand, the United States of America, and Vietnam. GM mosquitoes (Aedes aegypti) have already been released for field trials into inhabited areas in the Cayman Islands (2009–?), Malaysia (2010–2011), and Brazil (2011–2012). Here, we assess the regulatory process in the first three countries permitting releases (Malaysia, US, and the Cayman Islands) in terms of pre-release transparency and scientific quality. We find that, despite 14 US government–funded field trials over the last 9 years (on a moth pest of cotton), there has been no scientific publication of experimental data, and in only two instances have permit applications been published. The world's first environmental impact statement (EIS) on GM insects, produced by US authorities in 2008, is found to be scientifically deficient on the basis that (1) most consideration of environmental risk is too generic to be scientifically meaningful; (2) it relies on unpublished data to establish central scientific points; and (3) of the approximately 170 scientific publications cited, the endorsement of the majority of novel transgenic approaches is based on just two laboratory studies in only one of the four species covered by the document. We find that it is not possible to determine from documents publically available prior to the start of releases if obvious hazards of the particular GM mosquitoes released in Malaysia, the Cayman Islands, and Brazil received expert examination. Simple regulatory measures are proposed that would build public confidence and stimulate the independent experimental studies that environmental risk assessments require. Finally, a checklist is provided to assist the general public, journalists, and lawmakers in determining, from documents issued by regulators prior to the start of releases, whether permit approval is likely to have a scientifically high quality basi