Search Results (74)

Background: Central line-associated bloodstream infections (CLABSIs) in neonatal intensive care units (NICUs) pose a significant risk, especially for very low birth weight infants due to their immature immune systems and the need for invasive procedures. The implementation of evidence-based bundles, as recommended by international guidelines, has proven effective in significantly reducing CLABSI rates, improving clinical outcomes, and lowering hospital costs. However, evidence from long-term, real-world quality-improvement programs in European NICUs—especially those using repeated PDSA cycles and detailed monitoring across multiple periods—remains limited. Methods: This quality improvement prospective study, conducted in the NICU of “V. Buzzi” Children’s Hospital, aimed to reduce high CLABSI rates using a plan-do-study-act (PDSA) framework. A multidisciplinary team developed and implemented a new evidence-based central line bundle in 2021, focusing on standardized practices, enhanced training, and monitoring. The study analyzed 594 CVCs placed in 348 neonates across a total 4-years period (P1–P12). Results: Implementation of a central line bundle significantly reduced CLABSI rates from 29.1 to 2.2 per 1000 CVC days (p-value 0.002), with notable variations during intermediate periods. Birth weight and study period progression were the only variables significantly associated with CLABSI reduction. Conclusions: Infection rates dropped significantly post-intervention, achieving zero in one of the latest periods: continuous monitoring, staff training, and targeted interventions were pivotal. Future efforts will focus on refining practices, increasing tunneled centrally inserted central catheter (CICC) use, and sustaining prevention measures. Full article

Reducing energy consumption and improving energy efficiency are essential objectives in the productive sector to ensure economic growth and reduce emissions. However, some energy management models do not include tools such as the balanced scorecard (BSC) and energy-based key performance indicators (KPIs). These tools help organisations make decisions and support continuous improvement actions. To address this gap, this study developed a methodology to facilitate the implementation of an Energy Management System. Specifically, this system evaluates the energy performance of processes within the abrasives industry, using KPIs based on energy efficiency. The proposed model, based on the Deming Cycle (PDCA, Plan-Do-Check-Act), consists of three stages: first, profiling and planning; second, implementation and maintenance; and third, surveillance. To support these stages, the main KPIs of energy typology were determined using AHP. Following this, the KPIs were prioritised based on energy efficiency. The results indicate that the company’s highest priority is meeting international goals, followed by reducing production costs and avoiding energy-related penalties. The energy baseline developed through regression analysis yielded a coefficient of 0.7794 and a specific consumption of 0.0345 kWh per manufactured piece for electricity alone, which increases by 107.25% when all energy sources used in the process are included. Within this context, the key indicators for monitoring energy efficiency strategies were established, demonstrating that model-assisted energy management not only supports the identification of improvement opportunities and internal control of production parameters but also provides a robust framework for evaluating, measuring, reporting, and improving energy efficiency targets. Full article

Ensuring consistent quality and safety in agri-food processing is a strategic priority for firms seeking compliance with international standards such as ISO 9001 and ISO 22000. Traditional inspection practices in Ecuador’s food industry remain largely destructive, labor-intensive, and subjective, limiting real-time decision-making. This study developed a non-destructive, ISO-aligned framework for process-level quality control by integrating digital (RGB) imaging for surface-level inspection, hyperspectral imaging (HSI) for internal-quality prediction (e.g., moisture, firmness, and freshness), near-infrared spectroscopy (NIRS) for compositional and authenticity analysis, and deep learning (DL) models for automated classification of ripeness, maturity, and defects. Experimental results across four flagship commodities—bananas, cacao, coffee, and shrimp—achieved classification accuracies above 88% and ROC AUC values exceeding 0.90, confirming the robustness of AI-driven, multimodal (RGB–HSI–NIRS) inspection under semi-industrial conveyor conditions. Beyond technological performance, the findings demonstrate that digital inspection reinforces ISO principles of evidence-based decision-making, conformity verification, and traceability, thereby operationalizing the Plan–Do–Check–Act (PDCA) cycle at digital speed. The study contributes theoretically by advancing the conceptualization of Quality 4.0 as a socio-technical transformation that embeds AI-driven sensing and analytics within management standards, and practically by providing a roadmap for Ecuadorian SMEs to strengthen export competitiveness through automated, real-time, and auditable quality assurance. Full article

Second-life electric vehicle batteries (SLBs) represent a promising asset for enhancing grid flexibility and advancing circular economy objectives in the power sector. This paper proposes a conceptual trigger-based PDCA (Plan–Do–Check–Act) framework for the sustainable grid integration of SLBs, enabling adaptive operational control across diverse application scenarios. The framework combines lifecycle KPI monitoring, degradation and performance tracking, and economic feasibility assessment with trigger-driven dispatch logic. Technical, financial, and environmental indicators are systematically integrated into the four PDCA phases, providing a structured basis for adaptive management. To illustrate applicability, indicative KPI calculations are presented for three representative scenarios (HV Backup, RES Smoothing, and Frequency Regulation). These examples demonstrate how the framework supports scenario-based planning, performance evaluation, and decision-making under uncertainty. Compared with existing state-of-the-art approaches, which typically analyse technical or economic aspects in isolation, the proposed framework introduces a modular, multi-model architecture that aligns operational triggers with long-term sustainability goals. By embedding reuse-oriented strategies into an adaptive PDCA cycle, the study offers a clear and practical methodology for maximising SLB value while minimising degradation and environmental impacts. The framework provides a valuable reference framework for structured SLB deployment, supporting more resilient, cost-effective, and low-carbon energy systems. Full article

Background: Inpatient palliative care consultation services operate with an interdisciplinary team, where effective handoffs are crucial for coordinated patient care. We aimed to replace encrypted email handoffs with a more concise and uniform handoff using I-PASS (illness severity, patient summary, action list, situational awareness, contingency planning, and synthesis by receiver) integrated within the electronic medical record (EMR). Aim and Measures: Within six months of launch, our goal was to achieve 90% I-PASS utilization for hospitalized acutely ill patients with cancer receiving palliative care consultation. Intervention: In January 2021, our quality improvement team, consisting of physicians, advanced practice providers, and trainees, began implementing I-PASS using the plan–do–study–act cycle. After providing training sessions for all palliative care clinicians, I-PASS went live on October 1, 2021. I-PASS utilization was tracked via random and monthly audits of EMRs. Through anonymous surveys, both pre- and post-implementation, we gathered clinician feedback and concerns about the handoff system. Survey responses were compared using the Mann–Whitney test. Outcomes: Within six months of implementation, the I-PASS utilization rate reached > 99%. The survey participation rates were 70% (45/64) and 82% (49/60) for the pre-and post-implementation periods, respectively. Respondents provided answers on one to five scale (mean, standard deviation, SD): lower accuracy with email (3.53, SD = 0.98) vs. I-PASS (4.20, SD = 0.83), p < 0.001; handoff lengthier with email (4.17, SD = 1.05) vs. I-PASS (2.1, SD = 1.15), p < 0.001; the time required was longer with email (3.0, SD = 1.22) vs. I-PASS (1.71, SD = 0.73), p < 0.001. Overall, respondents found I-PASS to be significantly better (4.69, SD = 0.58). Conclusion: I-PASS was fully adopted by the team, with nearly 100% utilization and strong clinician endorsement as an effective communication tool. Future efforts should focus on optimizing usability, particularly by educating clinicians on smartphone EMR access and enabling the timely and streamlined editing of I-PASS. Full article

As newborn screening (NBS) programs deal with growing complexities, including adding new disorders to their screening panels, adopting new technologies/screening methods, and workforce shortages, there is a greater need for continuous quality improvement (CQI) to ensure the NBS system is meeting its primary goal of identifying infants with NBS disorders in a timely fashion. In 2019, the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) awarded funding to the Association of Public Health Laboratories’ (APHL) Newborn Screening Technical assistance and Evaluation Program (NewSTEPs) to address CQI in the NBS system through a collaborative, data-driven process. From 2019–2024, NewSTEPs funded 36 quality improvement (QI) projects from a variety of state NBS programs and research centers across the U.S., to address timeliness, detection of out-of-range results, communication of results, and/or confirmation of diagnosis. Thirty-three QI teams completed their projects, and 85% achieved their specified goal outlined in their aim statement. Despite limitations, the QI Projects Collaborative provided NBS programs with funding and resources to begin and sustain quality improvement initiatives. This model of a technical assistance and central resource center for CQI was effective in achieving quality improvements within the national NBS system. Full article

With the rapid development of technology, an increasingly competitive environment, and evolving consumer behaviour, the use of modern marketing tools has become a key challenge for companies of various types (manufacturing, providing services, sports organizations, universities, etc.). Although sustainable digital communication methods are gaining prominence, existing research often focuses merely on describing communication trends without providing decision-making frameworks for strategy optimisation. This paper addresses this gap by mapping the current state of marketing communication strategies among large telecommunication companies in Slovakia and assessing their impact on customer behaviour and market position. Data were analysed through a combination of qualitative and quantitative research methods, including document analysis, annual reports, surveys, and personal observations. One enterprise was selected for detailed data analysis. The results confirm a significant relationship between the use of communication channels and the company’s market position, brand popularity, and the strong influence of employee recommendations. Unlike previous studies, which predominantly describe marketing communication trends and tools, this research integrates the evaluation of communication strategy effectiveness with a systematic management decision-making model based on the PDCA (Plan-Do-Check-Act) continuous improvement cycle. This approach enables continuous optimisation of sustainable communication strategies and provides actionable managerial guidance for improving resource allocation, market position, and organisational adaptability in dynamic market environments. Full article

The UI GreenMetric World University Ranking has become a widely adopted instrument for benchmarking institutional sustainability performance; nevertheless, empirically grounded evidence from universities in diverse regional contexts remains scarce. This study undertakes a rigorous appraisal of the extent to which Mahasarakham University (MSU) has institutionalized the United Nations Sustainable Development Goals (SDGs) within its pedagogical offerings, research portfolio, community outreach, and governance arrangements during the 2021–2024 strategic cycle. Employing a mixed-methods design and guided by the 2024 UI GreenMetric Education and Research indicators, this investigation analyzed institutional datasets pertaining to curriculum provision, ring-fenced research funding, 574 peer-reviewed sustainability publications, student-led community initiatives, and supporting governance mechanisms; the analysis was interpreted through a Plan–Do–Check–Act management lens. The number of sustainability-oriented academic programs expanded from 49 to 58. Student participation in community service activities strongly recovered following the COVID-19 pandemic, and MSU’s GreenMetric score increased from 7575 to 8475, thereby elevating the institution to the 100th position globally. These gains were facilitated by strategic SDG-aligned investment, cross-sector collaboration, and the consolidation of international partnerships anchored in Thailand’s Isaan region. The MSU case provides a transferable model for universities—particularly those operating in resource-constrained contexts—endeavoring to align institutional development with the SDGs and internationally recognized quality benchmarks. The findings substantiate the capacity of transformative education and applied research to engender enduring societal and environmental benefits. Full article

The modern workplace grapples with a human energy crisis, characterized by chronic exhaustion, disengagement, and emotional depletion among employees. Traditional well-being initiatives often fail to address this systemic challenge, particularly in industrial contexts. This study introduces the Human Energy Management System (HEMS), a strategic framework to develop, implement, and refine strategies for optimizing workforce energy. Grounded in Industry 5.0’s human-centric, resilient, and sustainable principles, HEMS integrates enterprise risk management (ERM), design thinking, and the Plan-Do-Check-Act (PDCA) cycle. Employing a qualitative Design Science Research (DSR) methodology, the study reframes human energy depletion as an organizational risk, providing a proactive, empathetic, and iterative approach to mitigate workplace stressors. The HEMS framework is developed and evaluated through theoretical modeling, literature benchmarking, and secondary case studies, rather than empirical testing, aligning with DSR’s focus on conceptual validation. Findings suggest HEMS offers a robust tool to operationalize human energy reinforcement strategies in industrial settings. Consistent with the European Union’s vision for human-centric industrial transformation, HEMS enables organizations to foster a resilient, engaged, and thriving workforce in both stable and challenging times. Full article

Background and Objective: Despite growing emphasis on quality and safety in healthcare, there remains a limited understanding of how Quality Improvement and Patient Safety (QI/PS) training for health workers has evolved in response to global events like the COVID-19 pandemic and the WHO Global Patient Safety Action Plan. This rapid scoping review aimed to not only identify existing curricula but also uncover trends, innovation gaps, and global inequities in QI/PS education—providing timely insights for reshaping future training strategies. Methods: We searched MEDLINE and Scopus for English-language studies published between January 2020 and April 2024, describing QI and/or PS curricula across graduate, postgraduate, and continuing education levels. All healthcare worker groups were eligible, with no geographic limitations. Two reviewers conducted independent screening and data extraction; a third verified the results. Results: Among 3290 records, 74 curricula met inclusion criteria, with a majority originating from the US (58, 78.4%) and targeting physicians—especially residents and fellows (43/46, 93.5%). Only 27% of curricula were multidisciplinary. While traditional didactic (66.2%) and interactive (73%) approaches remained prevalent, curricula launched after 2020 introduced novel formats such as Massive Open Online Courses and gamification, with long-term programs uniformly leveraging web-based platforms. Common thematic content included Root Cause Analysis, Plan-Do-Study-Act cycles, QI tools, communication skills, and incident reporting. English-language peer-reviewed published literature indicated a marked lack of structured QI/PS training in Europe, Asia, and Africa. Conclusions: This review reveals both an uneven development and fragmentation in global QI/PS training efforts, alongside emerging opportunities catalyzed by digital transformation and pandemic-era innovation. The findings highlight a critical gap: while interest in QI/PS is growing, scalable, inclusive, and evidence-based curricula remain largely concentrated in a few high-income countries. By mapping these disparities and innovations, this review provides actionable direction for advancing more equitable and modern QI/PS education worldwide, whilst showcasing the need to systematically delve into QI/PS training in underrepresented regions. Full article

The main aim of this study is to investigate the association of an assortment of factors pertaining to the implementation of a Health and Safety Management System (HSMS) with firms’ Health and Safety (H&S) level and employees’ satisfaction and performance. The proposed research model incorporates six independent factors: (i) the development of a safety culture, (ii) the availability of H&S specific procedures/instructions/rules, (iii) the forethought of H&S-focused training, (iv) the availability of the essential resources to improve H&S equipment, (v) the augmentation of employee motivation for safe behavior, and (vi) the top management commitment to upgrade H&S at the workplace. The model was empirically tested using primary data from 230 employees of 10 manufacturing firms operating in Greece. It was found that H&S meliorates employees’ performance, but, on the other hand, firm’s management should be committed towards creating a high-level safety culture. To achieve this, proper resources should be invested, comprehensible procedures/instructions/rules should be established, and focused training should be provided. The acceptance of this policy would result in an enhanced safety culture, an augmented firm H&S level, amplified employee satisfaction and, accordingly, improved employee performance. In addition, this article suggests a new HSMS model, which, by relying on the principles of the Plan–Do–Check–Act cycle, incorporates the examined six H&S factors, which can upgrade other known standards (like OHSAS 18001 and ISO 45001). Full article

This study aims to present an integrated approach to customer experience, which was developed considering the identification and application of essential factors from the product life cycle. The study was conducted in the automotive industry and may be transferable to other products with high complexity and medium–long in-service use. The main goal is to identify the determining factors and perform a regression analysis of the effect of attribute-level performance on overall customer satisfaction through the customer’s entire journey during the product development phase. This study is based on a generic example that is meant to capture trends influencing customer satisfaction in the launch of a new product vehicle, focusing on factors that influence each stage of the process, from planning–exploration, design and development, and manufacturing and validation to performance measurement and after-sales assistance. Based on multiple surveys that were used as the main instruments for measuring the level of customer satisfaction at defined touchpoints, the product life cycle was followed through several stages: prospecting survey, upstream survey, launch preparation survey, post-launch investigation, life cycle survey, and after-sales support. Three meta-factors were identified—design, price, and durability—for which the ordinal regression demonstrated that they are significant predictors of customer experience in general. The approach may be transferable to other sectors by identifying relevant attributes and adapting tools for measuring customer satisfaction, customer experience, and consumer concerns, which act as key vectors influencing the product life cycle and, by extension, business sustainability. Full article

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC in our level III NICU. Methods: Our QI team implemented a bundle of nine of these evidenced-based practices for NEC prevention and disseminated information among the NICU team. Items in the bundle included delayed cord clamping, parental education on the importance of breast milk, obtaining early consent for donor breast milk, adherence to the unit’s feeding protocol, avoiding routine gastric residual checks, the discontinuation of antibiotics at 48 h once blood cultures were negative, restricting the use of antacids, nasogastric tube (NGT) replacement every 72 h and the removal of central lines once a feeding volume of 100 mL/kg/day was attained. The baseline incidence of clinically proven NEC was found to be 7% at the start of the intervention. We conducted two Plan-Do-Study-Act (PDSA) cycles over a 2-year period from 1 January 2021 to 31 December 2022. Results: There were 74 infants who met the inclusion criteria of being <1500 g and/or at <32 weeks of gestation. The adherence to our process measures improved over the course of our two PDSA cycles from 78% adherence to 91.6%, p < 0.05. The incidence of NEC decreased from 7% to 5.3% following the first PDSA cycle, a 24% reduction. Following the second PDSA cycle, the incidence decreased even further from 5.3% to 2.8%, a 60% reduction from baseline, although this was not statistically significant due to the small sample size. Conclusions: In this QI initiative, we achieved improved adherence to several evidence-based interventions over a two-year period with the aim of reducing the incidence of NEC at our institution. Full article

Background: While multimodal analgesia is the standard of care for postoperative pain relief, opioid medications continue to be a part of the treatment regimen, especially for more invasive surgeries such as spinal fusion, craniofacial reconstruction, laparotomy, and others. In pediatric patients, safe usage, storage, and dosing are especially important, along with clear instructions to caregivers on how to manage their child’s pain. Combination opioids such as hydrocodone with acetaminophen and acetaminophen with codeine are the most commonly prescribed opioid medications for postoperative pain control. However, these combination products can lead to acetaminophen toxicity, limit the ability to prescribe acetaminophen or ibuprofen, and add to caregiver confusion. Administering acetaminophen and ibuprofen individually rather than in combination products allows the maximal dosing of these nonopioid medications. The primary aim of this quality improvement (QI) project was to increase the utilization of single-agent opioids for postoperative pain control, primarily oxycodone, by the various surgical groups here at Cook Children’s Medical Center (CCMC). Methods: The project setting was a tertiary-level children’s hospital with a level 2 trauma center, performing over 20,000 surgeries annually. The opioid stewardship committee (OSC) mapped the steps and overlapping activities in the intervention that led to changes in providers’ prescription practices. A Plan–Do–Study–Act continuous improvement cycle allowed for an assessment and modification of implementation strategies. Statistical control process charts were used to detect the average percentage change in surgical specialties using single-agent opioid therapy. Data were monitored for three periods: one-year pre-intervention, one-year post-intervention, and one-year sustainment periods. Results: There were 4885 (41%) pre-intervention procedures, 3973 (33%) post-intervention procedures, and 3180 (26%) sustainment period procedures that received opioids. During the pre-intervention period, the average proportion of single-agent opioids prescribed was 8%. This average shifted to 89% for the first five months of the post-intervention period, then to 91% for the remainder of the study. Conclusions: The methodical application of process improvement strategies can result in a sustained change from outpatient post-surgical combination opioid prescriptions to single-agent opioid prescriptions in multiple surgical departments. Full article

Background/Objectives: Cognitive functions are a crucial part of daily living, especially for adults with Down syndrome (DS) who have a high likelihood of developing Alzheimer’s disease in adulthood. In addition, adults with DS move slower and are not meeting the standard aerobic activity guidelines each week. The aim of this study was to examine if Assisted Cycle Therapy (ACT) would improve cognitive planning as measured by the Tower of London (TOL), set switching as measured by the modified Wisconsin Card Sorting Test, and spatial memory as measured by the Corsi Block Test in adults with DS as compared to self-paced cycling. Methods: Twenty-four participants were randomly assigned to one of two interventions over eight weeks. (1) Thirteen older adults with DS completed the ACT intervention, which is stationary cycling with the assistance of a motor to maintain a cadence at least 35% greater than voluntary cycling. (2) Eleven older adults with DS completed voluntary cycling (VC). Results: Our results showed that cognitive planning as measured by total correct score in the TOL showed improvement for both ACT and VC after 8 weeks of exercise, F(1, 22) = 6.22, p = 0.021. There were no significant differences for spatial memory or set switching. Conclusions: We concluded that cycling exercise has a positive impact on cognitive function, especially problem solving in older adults with DS. Our results are discussed with respect to upregulation of neurotrophic factors that increase functioning in the prefrontal cortex that accompanies exercise and leads to improvements in cognitive planning which is essential to many activities of daily living and quality of life for older adults with DS. Full article