A framework and a measurement instrument for sustainability of work practices in long-term care

<p>Abstract</p> <p>Background</p> <p>In health care, many organizations are working on quality improvement and/or innovation of their care practices. Although the effectiveness of improvement processes has been studied extensively, little attention has been given to sustainability of the changed work practices after implementation. The objective of this study is to develop a theoretical framework and measurement instrument for sustainability. To this end sustainability is conceptualized with two dimensions: routinization and institutionalization.</p> <p>Methods</p> <p>The exploratory methodological design consisted of three phases: a) framework development; b) instrument development; and c) field testing in former improvement teams in a quality improvement program for health care (N _teams= 63, N _individual= 112). Data were collected not until at least one year had passed after implementation.</p> <p>Underlying constructs and their interrelations were explored using Structural Equation Modeling and Principal Component Analyses. Internal consistency was computed with Cronbach's alpha coefficient. A long and a short version of the instrument are proposed.</p> <p>Results</p> <p>The χ²- difference test of the -2 Log Likelihood estimates demonstrated that the hierarchical two factor model with routinization and institutionalization as separate constructs showed a better fit than the one factor model (p < .01). Secondly, construct validity of the instrument was strong as indicated by the high factor loadings of the items. Finally, the internal consistency of the subscales was good.</p> <p>Conclusions</p> <p>The theoretical framework offers a valuable starting point for the analysis of sustainability on the level of actual changed work practices. Even though the two dimensions routinization and institutionalization are related, they are clearly distinguishable and each has distinct value in the discussion of sustainability. Finally, the subscales conformed to psychometric properties defined in literature. The instrument can be used in the evaluation of improvement projects.</p

Conjugate Direction Methods and Polarity for Quadratic Hypersurfaces

We use some results from polarity theory to recast several geometric properties of Conjugate Gradient-based methods, for the solution of nonsingular symmetric linear systems. This approach allows us to pursue three main theoretical objectives. First, we can provide a novel geometric perspective on the generation of conjugate directions, in the context of positive definite systems. Second, we can extend the above geometric perspective to treat the generation of conjugate directions for handling indefinite linear systems. Third, by exploiting the geometric insight suggested by polarity theory, we can easily study the possible degeneracy (pivot breakdown) of Conjugate Gradient- based methods on indefinite linear systems. In particular, we prove that the degeneracy of the standard Conjugate Gradient on nonsingular indefinite linear systems can occur only once in the execution of the Conjugate Gradient