Sustainability in Quality Improvement and Patient Safety Initiatives

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term \u27evaporation of improvements\u27 addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & Ketley, 2007). This article addresses the components of what makes a quality initiative sustainable by applying a framework developed that identifies components necessary within a sustainable quality initiative evident from the development process through to the implementation phase of the initiative which becomes part of the fabric of an organization

Tools for Thought: The Case of Mathematics

The objective of this article is to take into account the functioning of representational cognitive tools, and in particular of notations and visualizations in mathematics. In order to explain their functioning, formulas in algebra and logic and diagrams in topology will be presented as case studies and the notion of manipulative imagination as proposed in previous work will be discussed. To better characterize the analysis, the notions of material anchor and representational affordance will be introduced