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https://www.readbyqxmd.com/read/28538054/achieving-high-reliability-with-people-processes-and-technology
#1
Candice L Saunders, John A Brennan
High reliability as a corporate value in healthcare can be achieved by meeting the "Quadruple Aim" of improving population health, reducing per capita costs, enhancing the patient experience, and improving provider wellness. This drive starts with the board of trustees, CEO, and other senior leaders who ingrain high reliability throughout the organization. At WellStar Health System, the board developed an ambitious goal to become a top-decile health system in safety and quality metrics. To achieve this goal, WellStar has embarked on a journey toward high reliability and has committed to Lean management practices consistent with the Institute for Healthcare Improvement's definition of a high-reliability organization (HRO): one that is committed to the prevention of failure, early identification and mitigation of failure, and redesign of processes based on identifiable failures...
July 2017: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/28532463/exploring-patient-centered-hospitals-a-systematic-review-to-understand-change
#2
Irene Gabutti, Daniele Mascia, Americo Cicchetti
BACKGROUND: The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff...
May 22, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28528621/using-lean-to-rapidly-and-sustainably-transform-a-behavioral-health-crisis-program-impact-on-throughput-and-safety
#3
Margaret E Balfour, Kathleen Tanner, Paul J Jurica, Dawn Llewellyn, Robert G Williamson, Chris A Carson
BACKGROUND: Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. METHODS: A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal...
June 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28514618/aerobic-or-resistance-exercise-or-both-in-dieting-obese-older-adults
#4
RANDOMIZED CONTROLLED TRIAL
Dennis T Villareal, Lina Aguirre, A Burke Gurney, Debra L Waters, David R Sinacore, Elizabeth Colombo, Reina Armamento-Villareal, Clifford Qualls
BACKGROUND: Obesity causes frailty in older adults; however, weight loss might accelerate age-related loss of muscle and bone mass and resultant sarcopenia and osteopenia. METHODS: In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs - aerobic training, resistance training, or combined aerobic and resistance training - or to a control group (no weight-management or exercise program)...
May 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28501537/effects-of-exercise-on-liver-fat-and-metabolism-in-alcohol-drinkers
#5
David Houghton, Kate Hallsworth, Christian Thoma, Sophie Cassidy, Timothy Hardy, Sarah Heaps, Kieren G Hollingsworth, Roy Taylor, Christopher P Day, Steve Masson, Stuart McPherson, Quentin M Anstee, Michael I Trenell
BACKGROUND & AIMS: Exercise is an important component of obesity associated disorders and has been shown to reduce markers of non-alcoholic fatty liver disease (NAFLD). However, little is known about how these effects are influenced by alcohol intake. We performed a randomized controlled trial to investigate the effects of exercise on hepatic triglyceride content (HTGC) and metabolism in overweight or obese patients who consume alcohol. METHODS: We performed a prospective study of 27 patients (mean age 54±11years, body mass index [BMI], 31±4kg/m2) with >5% HTGC in the United Kingdom, consuming alcohol (mean 221±75 g/week)...
May 10, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28497213/bone-pain-and-muscle-weakness-in-cancer-patients
#6
REVIEW
Daniel P Milgrom, Neha L Lad, Leonidas G Koniaris, Teresa A Zimmers
PURPOSE OF REVIEW: In this article, we will discuss the current understanding of bone pain and muscle weakness in cancer patients. We will describe the underlying physiology and mechanisms of cancer-induced bone pain (CIBP) and cancer-induced muscle wasting (CIMW), as well as current methods of diagnosis and treatment. We will discuss future therapies and research directions to help patients with these problems. RECENT FINDINGS: There are several pharmacologic therapies that are currently in preclinical and clinical testing that appear to be promising adjuncts to current CIBP and CIMW therapies...
May 11, 2017: Current Osteoporosis Reports
https://www.readbyqxmd.com/read/28494624/an-overview-of-the-performance-improvement-initiatives-by-the-ministry-of-health-in-the-kingdom-of-saudi-arabia
#7
Mazen Hassanain
Saudi Arabia's Ministry of Health (MOH) use corporate performance improvement methodologies to develop and implement performance improvement initiatives designed to continue building on the Ministry's vision of transforming hospital operations and instituting a culture of quality and performance focused on the "patient first" principle. We evaluated the feasibility of setting up a performance improvement unit (PIU) within the MOH to apply the principles of Lean Six Sigma and to change management methodologies...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/28478740/improving-autopsy-report-turnaround-times-by-implementing-lean-management-principles
#8
Susan Cromwell, David A Chiasson, Debra Cassidy, Gino R Somers
The autopsy is an integral part of the service of a large academic pathology department. Timely reporting is central to providing good service and is beneficial for many stakeholders, including the families, the clinical team, the hospital, and the wider community. The current study aimed to improve hospital-consented autopsy reporting times (turnaround time, TAT) by using lean principles modified for a healthcare setting, with an aim of signing out 90% of autopsies in 90 days. An audit of current and historical TATs was performed, and a working group incorporating administrative, technical, and professional staff constructed a value stream map documenting the steps involved in constructing an autopsy report...
January 1, 2017: Pediatric and Developmental Pathology
https://www.readbyqxmd.com/read/28464448/gene-expression-changes-of-thermo-sensitive-transient-receptor-potential-channels-in-obese-mice
#9
Wuping Sun, Chen Lib, Yonghong Zhang, Changyu Jiang, Mingzhu Zhai, Qian Zhou, Lizu Xiao, Qiwen Deng
Adipose tissues play key roles in energy homeostasis. Brown adipocytes and beige adipocytes in white adipose tissue (WAT) sharethe similar characters of thermogenesis, both of them could be potential targets for obesity management. Several thermo-sensitive transient receptor potential channels (thermoTRPs) are shown to be involved in adipocyte biology. However, the expression pattern of thermoTRPs in adipose tissues from obese mice is still unknown. The mRNA expression of thermoTRPs in subcutaneous WAT (sWAT) and interscapular brown adipose tissue (iBAT) from lean and obese mice were measured using Reverse Transcriptase-quantitative PCRs (RT-qPCR)...
May 2, 2017: Cell Biology International
https://www.readbyqxmd.com/read/28457964/multiple-pre-and-post-analytical-lean-approaches-to-the-improvement-of-the-laboratory-turnaround-time-in-a-large-core-laboratory
#10
Amy H Lou, Manal O Elnenaei, Irene Sadek, Shauna Thompson, Bryan D Crocker, Bassam A Nassar
BACKGROUND: Core laboratory (CL), as a new business model, facilitates consolidation and integration of laboratory services to enhance efficiency and reduce costs. This study evaluates the impact of total laboratory automation system (TLA), electric track vehicle (ETV) system and auto-verification (AV) of results on overall turnaround time (TAT) (phlebotomy to reporting TAT: PR-TAT) within a CL setting. METHODS: Mean, median and percentage of outlier (OP) for PR-TAT were compared for pre- and post-CL eras using five representative tests based on different request priorities...
April 27, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28439190/review-metabolic-syndrome-in-black-south-african-women
#11
REVIEW
Philippe Jean-Luc Gradidge, Nigel J Crowther
The prevalence of metabolic syndrome is increasing in African populations, and is particularly high in Black South African women (42%) vs women in the United Kingdom (23%) and the United States of America (36%). This population group is also known to have the highest prevalence of obesity in the sub-Saharan African region (42%), and consequently, a high risk of non-communicable diseases. In this article, we discuss factors (abdominal subcutaneous fat, visceral fat, lean mass, adiponectin, leptin, vitamin D, smoking and menopausal status) that have been investigated for their possible association with metabolic syndrome in African women, and discuss some recommendations for management of the syndrome...
2017: Ethnicity & Disease
https://www.readbyqxmd.com/read/28379719/a-simple-anthropometric-tool-for-the-assessment-of-pre-sarcopenia-in-postmenopausal-women
#12
M E Morosano, I M Menoyo, M F Tomat, A M Masoni, S M Pezzotto
OBJECTIVES: The purpose of this research was to explore the performance of anthropometric tools in the assessment of low muscle mass in a group of postmenopausal women. METHOD: Fifty consecutive ambulatory postmenopausal women were studied. A complete clinical examination and an anthropometric evaluation following a standardized procedure were performed. Three indicators were devised: upper limb adjusted perimeter (ULAP), lower limb adjusted perimeter (LLAP), and appendicular adjusted perimeter (AAP)...
April 5, 2017: Climacteric: the Journal of the International Menopause Society
https://www.readbyqxmd.com/read/28375955/using-lean-management-to-reduce-emergency-department-length-of-stay-for-medicine-admissions
#13
Nazima Allaudeen, Anita Vashi, Julia S Breckenridge, Farnoosh Haji-Sheikhi, Sarah Wagner, Keith A Posley, Steven M Asch
BACKGROUND: The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. OBJECTIVE: To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. DESIGN, SETTING, PATIENTS: Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016...
April 2017: Quality Management in Health Care
https://www.readbyqxmd.com/read/28358788/an-application-of-business-process-management-to-health-care-facilities
#14
Mohsen M D Hassan
The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella...
April 2017: Health Care Manager
https://www.readbyqxmd.com/read/28350314/integrating-quality-improvement-and-continuing-professional-development-at-an-academic-medical-center-a-partnership-between-practice-plan-hospital-and-medical-school
#15
Barbara Gold, Dawn England, William Riley, Ginny Jacobs-Halsey, Corinne Webb, Bobbi Daniels
INTRODUCTION: While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts...
October 2016: Journal of Continuing Education in the Health Professions
https://www.readbyqxmd.com/read/28348479/non-alcoholic-fatty-liver-disease-connections-with-fat-free-tissues-a-focus-on-bone-and-skeletal-muscle
#16
REVIEW
Eleonora Poggiogalle, Lorenzo Maria Donini, Andrea Lenzi, Claudio Chiesa, Lucia Pacifico
The estimates of global incidence and prevalence of non-alcoholic fatty liver disease (NAFLD) are worrisome, due to the parallel burden of obesity and its metabolic complications. Indeed, excess adiposity and insulin resistance represent two of the major risk factors for NAFLD; interestingly, in the last years a growing body of evidence tended to support a novel mechanistic perspective, in which the liver is at the center of a complex interplay involving organs and systems, other than adipose tissue and glucose homeostasis...
March 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28335529/effects-of-momordica-charantia-bitter-melon-on-ischemic-diabetic-myocardium
#17
Attila Czompa, Alexandra Gyongyosi, Kitti Szoke, Istvan Bak, Evelin Csepanyi, David D Haines, Arpad Tosaki, Istvan Lekli
Objective: A rat model is here used to test a hypothesis that Momordica charantia (Bitter melon (BM)) extract favorably alters processes in cardiovascular tissue and is systemically relevant to the pathophysiology of type 2 diabetes (T2DM) and related cardiovascular disease. Methods: Male Lean and Zucker Obese (ZO) rats were gavage-treated for six weeks with 400 mg/kg body weight bitter melon (BM) extract suspended in mucin-water vehicle, or with vehicle (Control). Animals were segregated into four treatment groups, 10 animals in each group, according to strain (Lean or ZO) and treatment (Control or BM)...
March 20, 2017: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/28306660/obesity-and-disability-in-older-adults
#18
Lorraine M Novosel, Catherine A Grant, Lauren M Dormin, Timothy M Coleman
The prevalence of obesity and disability in older adults has significant public health implications. This case review discusses the benefits and risks of weight loss in older adults and outlines treatment options available to Medicare beneficiaries. The importance of preserving lean muscle mass in weight management is emphasized.
April 16, 2017: Nurse Practitioner
https://www.readbyqxmd.com/read/28292761/optimization-of-tolerability-and-efficacy-of-dual-amylin-and-calcitonin-receptor-agonist-kbp-089-through-dose-escalation-and-combination-with-a-glp-1-analogue
#19
Sofie Gydesen, Kim Vietz Andreassen, Sara Toftegaard Hjuler, Lars I Hellgren, Morten Asser Karsdal, Kim Henriksen
Amylin and GLP-1 agonism induce a well-known anorexic effect at dose initiation, which is managed by dose escalation. In this study, we investigated how to optimize tolerability, while maintaining efficacy of KBP-089. Furthermore, we tested the GLP-1 add-on potential of KBP-089 in HFD rats. KBP-089 potently activated both the amylin and calcitonin receptors in vitro, demonstrated a prolonged receptor activation, and potently reduced acute food intake. HFD rats dosed every or every second day obtained equal weight loss at study end, albeit with an uneven reduction in both food intake and bodyweight in rats dosed every second day...
March 14, 2017: American Journal of Physiology. Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28288149/prenatal-exposure-to-maternal-very-severe-obesity-is-associated-with-impaired-neurodevelopment-and-executive-functioning-in-children
#20
Theresia H Mina, Marius Lahti, Amanda J Drake, Fiona C Denison, Katri Räikkönen, Jane E Norman, Rebecca M Reynolds
BACKGROUND: Prenatal maternal obesity has been associated with an increased risk of neurocognitive problems in childhood, but there are fewer studies on executive functioning. METHODS: Tests and questionnaires to assess neurodevelopment, executive functioning and the ability to delay gratification were administered to 113 children (mean (SD)=4.24 (0.63) years of age) born to very severely obese mothers (SO, BMI≥ 40 Kg/m(2), n=51) or to lean mothers (BMI≤ 25 Kg/m(2), n=62)...
March 13, 2017: Pediatric Research
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