Measuring Lean Management Penetration on the Hospital Nursing Frontline: Instrument Development

Purpose: It is imperative to assure that health care organizations provide excellent care and create value by improving quality while eliminating unnecessary costs. Lean management is a continuous improvement management plan that uses work flow design to produce improvements in quality, safety, cost and productivity; it has been used in manufacturing, service and, more recently, healthcare industries. This study developed and tested an instrument to measure frontline nurse caregivers' perception of the penetration of lean management in hospitals that report using lean strategies. Methods: The study consisted of three phases. In Phase 1, using the Delphi technique, an on-line survey of experts (n=10) and a review of the literature identified the domains and subdomains of lean management. Ideas from each domain were formed into items on the Frontline Improvement Thinking (FIT) instrument. The experts also assessed content validity. In Phase 2, nurses assessed the instrument's format, on-line usability of the instrument and content validity. In Phase 3, the instrument was administered to frontline nurses working on units in hospitals that reported using lean methods. Their responses (n= 212) provided the data for assessing the instrument's psychometric properties. Results: Exploratory factor analysis yielded a scale with 75 items in 12 factors. Three domains were identified: organizational, unit and individual areas of improvement. The 4-factor, 29-item, FIT Unit had the highest reliability (α=.86-0.94; inter-item correlation range=.26-0.63). The 2-factor, 10-item FIT Organization was also acceptable (α=.87 and 0.79, inter-item correlation range=.30-0.72. The FIT Individual had less than desired reliability on one factor (α=.66) but had acceptable reliability on the other six factors (0.75-0.94; inter-item correlation range =.25-0.89). Test-retest reliability estimates were acceptable for the organization and unit based on Pearson's R correlations (0.53-0.77). Conclusion: In the early stage of development, the FIT instrument proved helpful in describing diffusion of lean management. Sample size and quality proved to be problems, however. Nurses from hospitals with a history of lean quality improvement did not participate in the study and some of the hospitals studied were in the very early phases of lean management. Recommendations include continuing work on measure development by increasing the sample of lean-thinking nurses.Doctor of Philosoph

Constraints on the Mode and Extent of Sedimentary Rock Alteration in Hyper-Arid and Hypo-Thermal Environments

Geologic evidence suggests that the surface of Mars has been dominated by cold, dry, and relatively stable environmental conditions over the past ~3.5 Ga. These conditions differ from those pre-sumed to be present prior to ~3.5 Ga, when observa-tions indicate that the martian surface was at least in-termittently able to support the prolonged flow of liq-uid water. Despite the more than 75% of martian his-tory dominated by cold, dry, and stable conditions, few investigations have studied weathering and alteration processes that may influence the martian surface dur-ing this time. Please see attachment

Final Report of the AFIT Quality Initiative Internal Discovery Committee

This document contains results of a study designed to document the key elements for student success at AFIT in our continuing education and graduate programs and discover to what degree they exist at AFIT. The effort represents an attempt to guide improvement of our graduate and continuing education programs through experience available from our faculty, staff and students. The process outlined herein was designed to achieve success by allowing the participants to define what it means to succeed and then self-assess the presence of these factors at AFIT. It’s therefore a true internal discovery process since its output reflects the state of our internal understanding of teaching and learning excellence. This inclusive approach, which garnered participation from 400 people across AFIT’s schools, will be used in conjunction with the external committee\u27s recommendations to determine a course of action to invest into AFIT\u27s instructional capabilities

Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: an exploratory survey study in four USA hospitals

<p>Abstract</p> <p>Background</p> <p>Little research has been done on patient call light use and staff response time, which were found to be associated with inpatient falls and satisfaction. Nurses' perspectives may moderate or mediate the aforementioned relationships. This exploratory study intended to understand staff's perspectives about call lights, staff responsiveness, and the reasons for and the nature of call light use. It also explored differences among hospitals and identified significant predictors of the nature of call light use.</p> <p>Methods</p> <p>This cross-sectional, multihospital survey study was conducted from September 2008 to January 2009 in four hospitals located in the Midwestern region of the United States. A brief survey was used. All 2309 licensed and unlicensed nursing staff members who provide direct patient care in 27 adult care units were invited to participate. A total of 808 completed surveys were retrieved for an overall response rate of 35%. The SPSS 16.0 Window version was used. Descriptive and binary logistic regression analyses were conducted.</p> <p>Results</p> <p>The primary reasons for patient-initiated calls were for toileting assistance, pain medication, and intravenous problems. Toileting assistance was the leading reason. Each staff responded to 6 to 7 calls per hour and a call was answered within 4 minutes (estimated). 49% of staff perceived that patient-initiated calls mattered to patient safety. 77% agreed that that these calls were meaningful. 52% thought that these calls required the attention of nursing staff. 53% thought that answering calls prevented them from doing the critical aspects of their role. Staff's perceptions about the nature of calls varied across hospitals. Junior staff tended to overlook the importance of answering calls. A nurse participant tended to perceive calls as more likely requiring nursing staff's attention than a nurse aide participant.</p> <p>Conclusions</p> <p>If answering calls was a high priority among nursing tasks, staff would perceive calls as being important, requiring nursing staff's attention, and being meaningful. Therefore, answering calls should not be perceived as preventing staff from doing the critical aspects of their role. Additional efforts are necessary to reach the ideal or even a reasonable level of patient safety-first practice in current hospital environments.</p

The relationship between teacher perceptions of pupil attractiveness and academic ability.

There is an established literature that suggests teacher perceptions of pupils affect how they interact with them, how they teach them and how they rate their ability and behaviour. Evidence also indicates that a teacher’s perception of a child is often based on ascriptive characteristics such as gender, ethnicity and socio-economic background independent of a child’s ability. This paper builds on the literature by examining the relationship between teacher perceptions of a child’s ability and behaviour and their perceptions of a particular ascriptive characteristic of those children - their attractiveness. Using data from the National Child Development Study (NCDS) results show that not only do teachers rate the academic ability of pupils they perceive to be attractive more highly than less attractive students both in terms of their performance across different areas of learning (general knowledge, numbers, books and oral ability) and whether they show any outstanding potential but they are also more likely to over rate and less likely to under rate their ability than other students. This is true even after controlling for a wide range of other factors related to the child, their family, their teacher and their school that could influence the relationship, many of which are shown to be independently related to teacher’s ratings

Fundulus as the premier teleost model in environmental biology : opportunities for new insights using genomics

Author Posting. © Elsevier B.V., 2007. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Comparative Biochemistry and Physiology Part D: Genomics and Proteomics 2 (2007): 257-286, doi:10.1016/j.cbd.2007.09.001.A strong foundation of basic and applied research documents that the estuarine fish Fundulus heteroclitus and related species are unique laboratory and field models for understanding how individuals and populations interact with their environment. In this paper we summarize an extensive body of work examining the adaptive responses of Fundulus species to environmental conditions, and describe how this research has contributed importantly to our understanding of physiology, gene regulation, toxicology, and ecological and evolutionary genetics of teleosts and other vertebrates. These explorations have reached a critical juncture at which advancement is hindered by the lack of genomic resources for these species. We suggest that a more complete genomics toolbox for F. heteroclitus and related species will permit researchers to exploit the power of this model organism to rapidly advance our understanding of fundamental biological and pathological mechanisms among vertebrates, as well as ecological strategies and evolutionary processes common to all living organisms.This material is based on work supported by grants from the National Science Foundation DBI-0420504 (LJB), OCE 0308777 (DLC, RNW, BBR), BES-0553523 (AW), IBN 0236494 (BBR), IOB-0519579 (DHE), IOB-0543860 (DWT), FSML-0533189 (SC); National Institute of Health NIEHS P42-ES007381(GVC, MEH), P42-ES10356 (RTD), ES011588 (MFO); and NCRR P20 RR-016463 (DWT); Natural Sciences and Engineering Research Council of Canada Discovery (DLM, TDS, WSM) and Collaborative Research and Development Programs (DLM); NOAA/National Sea Grant NA86RG0052 (LJB), NA16RG2273 (SIK, MEH,GVC, JJS); Environmental Protection Agency U91620701 (WSB), R82902201(SC) and EPA’s Office of Research and Development (DEN)