Measurement and Analysis of 4G/5G Mobile Signal Coverage in a Heavy Industry Environment

In the evolving landscape of Industry 4.0, the integration of advanced wireless technologies into manufacturing processes holds the promise of unprecedented connectivity and efficiency. In particular, the data transmission in a heavy industry environment needs stable connectivity with mobile operators. This paper deals with the performance study of 4G and 5G mobile signal coverage within a complex factory environment. For this purpose, a cost-effective and portable measurement setup was realized and used to provide long-term measurement campaigns monitoring and recording several key parameter indicators (KPIs) in 4G/5G downlink and upload. To support the reproducibility of the provided study and other research activities, the measured dataset is publicly available for download. Among others findings, the obtained results show how the performance of 4G/5G is influenced by a heavy industry environment and of the time of day on the network load.

Start and turn performances of elite male swimmers: benchmarks and underlying mechanisms

The aim was to provide benchmarks and investigate contribution of start and turn performances in the European Short-Course Swimming Championship. Over all race distances, 932 individual races of male competitors were video captured and the start and turn performances were analysed. Start and turn performances contributed up to 26% and 56% of the total race time. Analysis of variance showed that the 15 m start times were faster for Freestyle and Butterfly (p < 0.001) compared to the other swimming strokes. In-water starts (Backstroke) were slower at the 5 m mark compare to on-block starts (p < 0.001). Tumble turns were faster than open turns (p < 0.001). Multiple linear regression analysis explained 82-97% of total variance in the race results with a decreasing effect of start performance for the longer distance races. Turn performance affected the results across all race distances (p < 0.001). The benchmarks and percentiles provide comparative data for swimmers of different performance levels. Considering the large contribution of start and turn performance to race time and the high effect in the regression model, training regimes that are mainly based on conditioning of free-swimming should be reconsidered.

Key Performance Indicators: A Framework for Allied Healthcare Educational Institutions

Background

Performance evaluation in the allied healthcare education sector is complex, making it essential for policymakers and managers to approach it comprehensively and thoughtfully to understand their performance. Hence, the development and monitoring of Key Performance Indicators (KPIs) in this domain must be considered one of the key priorities for the policymakers in AHIs.

Aim

This study aims to develop a framework for the AHIs to extract and profile the indicators, measure, and report the results appropriately.

Methods

The authors adopted a general review of the literature approach to study the primary goals of the institutional KPI framework, emphasizing the need for benchmarking while implementing KPIs and how to track performance using a KPI dashboard.

Results

The study provides the scope, relevant KPI categories, and a list of KPIs for evaluating the effectiveness of allied healthcare programs. The study findings also emphasized the need for benchmarking the KPIs and establishing a KPI dashboard while measuring and monitoring performance.

Conclusion

KPIs are considered an invaluable tool that contributes immensely to the performance monitoring process of AHIs, irrespective of the specialties. This helps to identify and guide AHIs for developing KPIs and the associated minimum data set to measure organizational performance and monitor the quality of teaching and learning. In addition, the KPI framework reported in this study is a tool to assist performance monitoring that can subsequently contribute to the overall quality of AHIs.

Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center

Introduction  Patient experience is a crucial aspect of healthcare delivery, and it encompasses various elements that contribute to a patient's perception of the care they receive. Patient satisfaction and patient experience are related but distinct concepts. Patient experience focuses on whether specific aspects of care occurred, while patient satisfaction gauges whether patient expectations were met. It goes beyond mere satisfaction and delves into the broader aspects of how patients interact with the healthcare system and the quality of those interactions, with health plans, doctors, nurses, and staff in various healthcare facilities. Other aspects highly valued by patients include elements such as timely access to care and information, good communication with the healthcare team, and friendly staff. Patient experience can influence both the healthcare and financial outcomes of healthcare facilities. It is well understood that positive patient experiences may lead to better care adherence, improved clinical outcomes, enhanced patient safety, and better care coordination. Payers, both public and private, have recognized the importance of patient experience. Improving patient experience benefits healthcare facilities financially by strengthening customer loyalty, building a positive reputation, increasing referrals, and reducing medical malpractice risk and staff turnover.  Methodology A multidisciplinary retrospective quality improvement initiative was initiated to effectively improve nurse-physician communication and organizational outcomes in several hospital units. Results Using an innovative staff-developed and driven acronym, IMOMW (I'm on my way), the study demonstrated significant positive outcomes such as increased Epic documentation (Epic Systems Corporation, Verona, Wisconsin, United States) of physician and nursing rounding by 13%, a 10.5% rise in recommend facility net promoter score (NPS) patient experience survey scores, 13.4% increase in physician and nurse team communication, 5.4% increase in nursing communication, and a 5.3% increase in physician communication. Moreover, pilot units outperformed the control group consisting of medical-surgical units located in newer portions of the hospital. Conclusion This quality improvement study demonstrates improved interdisciplinary nurse-physician communication, Epic documentation, and patient experience scores. Further investigation is necessary to better understand the specific factors and/or processes that influence the sustainability of interventions that improve nurse-physician communication and patient experience.

Diving into a pool of data: Using principal component analysis to optimize performance prediction in women's short-course swimming

This study aimed to optimise performance prediction in short-course swimming through Principal Component Analyses (PCA) and multiple regression. All women's freestyle races at the European Short-Course Swimming Championships were analysed. Established performance metrics were obtained including start, free-swimming, and turn performance metrics. PCA were conducted to reduce redundant variables, and a multiple linear regression was performed where the criterion was swimming time. A practical tool, the Potential Predictor, was developed from regression equations to facilitate performance prediction. Bland and Altman analyses with 95% limits of agreement (95% LOA) were used to assess agreement between predicted and actual swimming performance. There was a very strong agreement between predicted and actual swimming performance. The mean bias for all race distances was less than 0.1s with wider LOAs for the 800 m (95% LOA -7.6 to + 7.7s) but tighter LOAs for the other races (95% LOAs -0.6 to + 0.6s). Free-Swimming Speed (FSS) and turn performance were identified as Key Performance Indicators (KPIs) in the longer distance races (200 m, 400 m, 800 m). Start performance emerged as a KPI in sprint races (50 m and 100 m). The successful implementation of PCA and multiple regression provides coaches with a valuable tool to uncover individual potential and empowers data-driven decision-making in athlete training.

Prioritizing Quality over Quantity: Defining Optimal Pharmacist-to-Patient Ratios to Ensure Comprehensive Direct Patient Care in a Medical or Surgical Unit

Background

The expanding scope of practice of hospital pharmacists has contributed to improvements in patient care; however, workload remains a barrier to the provision of optimal pharmaceutical care. Established ratios to guide clinical pharmacy staffing on medical and surgical units are lacking in Canada.

Objectives

To determine the pharmacist-to-patient ratio that allows for provision of comprehensive pharmaceutical care to each patient on a medical or surgical unit and to determine which comprehensive care tasks can be delivered in settings where staffing is limited.

Methods

A multiphase study was conducted in 6 hospitals. First, a modified Delphi study was conducted to define and prioritize the elements of comprehensive pharmaceutical care. Next, a work sampling study was conducted to establish the frequency of each task and the time required for completion. Finally, a workforce calculator was used to determine pharmacy staffing ratios.

Results

Ten pharmacists participated in the modified Delphi study, and 31 participated in the work sampling study. A total of 15 comprehensive care tasks were identified, 7 of which were categorized as tasks to prioritize in settings where staffing is limited. The optimal staffing ratios were 1 pharmacist to 13 patients in internal medicine teaching units, 1 pharmacist to 26 patients in hospitalist or internal medicine nonteaching units, and 1 pharmacist to 14 patients in surgical units.

Conclusions

The optimal staffing ratios determined in this study should enable pharmacists to provide comprehensive care to each patient. Implementing these staffing ratios could increase the consistency of clinical pharmacy services, improve patient outcomes, and improve pharmacists' work satisfaction. Further research is required to validate these ratios in a variety of settings.

Rapid response teams in the Eastern Mediterranean Region: Results from the baseline survey of country-level capacities, operations and outbreak response capabilities

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response.

Blood culture quality and turnaround time of clinical microbiology laboratories in Chinese Teaching Hospitals: A multicenter study

PURPOSE

Blood culture (BC) remains the gold standard for the diagnosis of bloodstream infections. Improving the quality of clinical BC samples, optimizing BC performance, and accelerating antimicrobial susceptibility test (AST) results are essential for the early detection of bloodstream infections and specific treatments.

METHODS

We conducted a retrospective multicenter study using 450,845 BC specimens from clinical laboratories obtained from 19 teaching hospitals between 1 January 2021 and 31 December 2021. We evaluated key performance indicators (KPIs), turnaround times (TATs), and frequency distributions of processing in BC specimens. We also evaluated the AST results of clinically significant isolates for four different laboratory workflow styles.

RESULTS

Across the 10 common bacterial isolates (n = 16,865) and yeast isolates (n = 1011), the overall median (interquartile range) TATs of AST results were 2.67 (2.05-3.31) and 3.73 (2.98-4.64) days, respectively. The specimen collections mainly occurred between 06:00 and 24:00, and specimen reception and loadings mainly between 08:00 and 24:00. Based on the laboratory workflows of the BCs, 16 of the 19 hospitals were divided into four groups. Time to results (TTRs) from specimen collection to the AST reports were 2.35 (1.95-3.06), 2.61 (1.98-3.32), 2.99 (2.60-3.87), and 3.25 (2.80-3.98) days for groups I, II, III, and IV, respectively.

CONCLUSION

This study shows the related BC KPIs and workflows in different Chinese hospitals, suggesting that laboratory workflow optimization can play important roles in shortening time to AST reports and initiation of appropriate timely treatment.

Construction and demolition waste framework of circular economy: A mini review

As the demand for materials continues to increase and building lifespans shorten, the construction industry faces mounting pressure to reduce its material and environmental impacts. Mismanagement of construction and demolition waste (CDW) can have severe environmental consequences. To address this, material recovery and circular economy approaches offer significant potential for reducing construction waste through the sustainable use of resources. Existing circular economy and material recovery models that prioritize recycling and reuse efforts demonstrate a sustained commitment to supporting circular practices in the construction and demolition sector. The goal is to minimize waste production, which poses environmental challenges such as raw material shortages and sustainability concerns. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for recruiting relevant literature, this mini review aims to identify the obstacles to implementing circular economy practices in the construction industry, while exploring opportunities for material recovery and circularity. The ultimate aim is to facilitate a fair and smooth transition towards sustainable development, while addressing environmental, social and economic barriers. A more sustainable and circular approach to building construction and management can be attained by considering all the aspects of the CDW cycle, resulting in significant benefits for the environment and society as a whole.

A mixed-method analysis of the consistency of intake information reported by shelter staff upon owner surrender of dogs

Data collected by animal shelters can provide an overview of population numbers and recommendations for shelter management and community programming. While studies utilize data from shelter software, questions remain on whether such data are reliable. The objective of the online experiment was to determine the agreement in data input for surrender reason, breed, and color across shelter staff (n = 81) when presented with four complex narratives of fictional owners surrendering dogs. Additionally, we aimed to understand how staff select surrender reasons for data input through qualitative analysis. Out of 40 possible surrender reasons, the number of unique reasons selected for each scenario ranged from 12-16, suggesting a variety of possible data entries for the same surrender narrative. Agreement was also low for breed and color. Shelter staff described a variety of different methods of determining the surrender reason for input into shelter software, such as asking the owner for their most influential reason or inferring the underlying reason. Further research is required to understand how animal shelter data can be collected consistently in a way that can meaningfully inform shelter management decisions.

Child and Adolescent Mental Health Services in Australia: A descriptive analysis between 2015-16 and 2019-20

OBJECTIVE

To provide analysis and commentary on Australian state/territory child and adolescent mental health service (CAMHS) expenditure, inpatient and ambulatory structure and key performance indicators.

METHOD

Data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics were descriptively analysed.

RESULTS

Between 2015-16 and 2019-20, overall CAMHS expenditure increased by an average annual rate of 3.6%. Per capita expenditure increased at a higher rate than for other subspeciality services. CAMHS admissions had a higher cost per patient day, shorter length of stay, higher readmission rate and lower rates of significant improvement. Adolescents aged 12-17 had high community CAMHS utilisation, based on proportion of population coverage and number of service contacts. CAMHS outpatient outcomes were similar to other age-groups. There were high rates of 'Mental disorder not otherwise specified', depression and adjustment/stress-related disorders as principal diagnoses in community CAMHS episodes.

CONCLUSIONS

CAMHS inpatient admissions had lower rates of significant improvement and higher 14-day readmission rates than other ages. Australia's young population had a high outpatient CAMHS contact rate. Evidence-based modelling of CAMHS providers and outcomes may inform future service improvement.

Greek Hospital Data Mining and Analysis

Monitoring the performance of hospitals is a crucial issue related both with the quality of healthcare services and with country's economy. An easy and trustful way of evaluating health systems is through key performance indicators (KPIs). Such indicators are widely used for the identification of gaps in the quality or efficiency of the services provided. The main aim of this study is the analysis of the financial and operational indicators at hospitals in the 3rd and 5th Healthcare Regions of Greece. In addition, through cluster analysis and data visualization we attempt to uncover hidden patterns that may lie within our data. The results of the study support the need for re-evaluation of the assessment methodology of Greek hospitals to identify the weaknesses in the system, while evidently unsupervised learning exposes the potential of group-based decision making.

The preanalytical process in the emergency department, a European survey

OBJECTIVES

Clinical decision-making in emergency medicine is under constant pressure from demand and performance requirements, with blood tests being a fundamental part of this. However, the preanalytical process has received little attention. Therefore, this study aimed to investigate the quality of preanalytical phase processes in European emergency departments (EDs) from the perspectives of the three main providers: clinicians, nurses, and laboratory specialists.

METHODS

This online survey, distributed among European EDs and laboratories, was supported by the European Society for Emergency Nursing (EUSEN), European Society for Emergency Medicine (EuSEM), and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). The size of the centres, the European region, the responder's profession and the country's economic condition were used as co-variables.

RESULTS

We included 376 responses from all ED-related professions from 306 European centres. In 66.9% of all ED visits, at least one blood test was performed. Tests were requested mostly by nurses (44.6%) using electronic Order/Entry systems (65.4%). Only a minority (19%) reported not using laboratory quality indicators (QIs). Most responders defined the TAT starting point "when the laboratory receives the sample" (66.1%), defining the goal to be "less than 60 min" (69.9%), but only 42.4% of the centres estimated achieving this goal.

CONCLUSIONS

Our survey illustrates the current situation on preanalytical blood sample processing in European EDs from the clinical and laboratory perspectives. The results emphasise the importance of the IT infrastructure and QI usage in this process and highlight some differences between European regions.

Development of the key performance indicators for digital health interventions: A scoping review

Background

Digital health interventions offer new methods for delivering healthcare, with the potential to innovate healthcare services. Key performance indicators play a role in the evaluation, measurement, and improvement in healthcare quality and service performance. The aim of this scoping review was to identify current knowledge and evidence surrounding the development of key performance indicators for digital health interventions.

Methods

A literature search was conducted across ten key databases: AMED - The Allied and Complementary Medicine Database, CINAHL - Complete, Health Source: Nursing/Academic Edition, MEDLINE, APA PsycINFO, EMBASE, EBM Reviews - Cochrane Database of Systematic Reviews, EBM Reviews - Database of Abstracts of Reviews of Effects, EBM Reviews - Health Technology Assessment, and IEEE Xplore.

Results

Five references were eligible for the review. Two were articles on original research studies of a specific digital health intervention, and two were overviews of methods for developing digital health interventions (not specific to a single digital health intervention). All the included reports discussed the involvement of stakeholders in developing key performance indicators for digital health interventions. The step of identifying and defining the key performance indicators was completed using various methodologies, but all centred on a form of stakeholder involvement. Potential options for stakeholder involvement for key performance indicator identification include the use of an elicitation framework, a factorial survey approach, or a Delphi study.

Conclusions

Few articles were identified, highlighting a significant gap in evidence-based knowledge in this domain. All the included articles discussed the involvement of stakeholders in developing key performance indicators for digital health interventions, which were performed using various methodologies. The articles acknowledged a lack of literature related to key performance indicator development for digital health interventions. To allow comparability between key performance indicator initiatives and facilitate work in the field, further research would be beneficial to develop a common methodology for key performance indicators development for digital health interventions.

Characterization of Laboratory Flow and Performance for Process Improvements via Application of Process Mining

BACKGROUND

The rising level of laboratory automation provides an increasing number of logged events that can be used for the characterization of laboratory performance and process improvements. This abundance of data is often underutilized for improving laboratory efficiency.

OBJECTIVES

The first aim of this descriptive study is to provide a structured approach for transforming raw laboratory data to data that is suitable for process mining. The second aim is to describe a process mining approach for mapping and characterizing the sample flow in a clinical chemistry laboratory to identify areas for improvement in the testing process.

METHODS

Data were extracted from instrument log files and the middleware between laboratory instruments and information technology infrastructure. Process mining was used for automated process discovery and analysis. Laboratory performance was quantified in terms of relevant key performance indicators (KPIs): turnaround time, timeliness, workload, work-in-process, and machine downtime.

RESULTS

The method was applied to two Dutch university hospital clinical chemistry laboratories. We identified areas where alternative routes might increase laboratory efficiency and observed the negative effects of machine downtime on laboratory performance. This encourages the laboratory to review sample routes in its analyzer lines, the routes of high priority samples during instrument downtime, as well as the preventive maintenance policy.

CONCLUSION

This article provides the first application of process mining to event data from a medical diagnostic laboratory for automated process model discovery. Our study shows that process mining, with the use of relevant KPIs, provides valuable insights for laboratories that motivates the disclosure and increased utilization of laboratory event data, which in turn drive the analytical staff to intervene in the process to achieve the set performance goals. Our approach is vendor independent and widely applicable for all medical diagnostic laboratories.

National Mental Health Performance Framework: Descriptive analysis of state and national data for 2019-2020

OBJECTIVE

To compare key performance indicators for public state and territory specialist mental health services in Australia.

METHODS

A descriptive analysis of the publicly-available National Mental Health Performance Framework key performance indicators (KPI), hosted by the Australian Institute of Health and Welfare for 2019-2020, at the national level and for states and territories.

RESULTS

The real-world performance of public mental health services varied across the eight states and territories of Australia. Western Australia had the longest acute hospital stays and the lowest rates of involuntary admissions. Queensland (QLD) had the shortest acute hospital stays at the lowest cost. While the Australian Capital Territory had the highest rates of community treatment at the lowest cost, the Northern Territory had highest hospital and community costs with the most involuntary admissions. Victoria (VIC) had the lowest population percentage receiving specialised mental health services, the highest readmission rates after 28 days, and highest physical and mechanical restraint rates.

CONCLUSIONS

The KPIs indicate that some states and territories show deviations from national benchmarks that may be important for consumers, carers and clinicians. For further improvement in quality and efficiency, more detailed contextual information is required, including detailed mapping of services.

Progressing the aerospace performance factor toward nonlinear interactions

Evaluation of safety performance remains central to any safety and risk management. Currently, there are very few support tools and methods which allow for quantitative approach in this domain. One of the successful methods available to this end is the Aerospace Performance Factor (APF). The method is based on hierarchical clustering of taxonomy-based safety performance indicators, using simple and intelligible formula to compute the overall safety performance signal. The work presented in this study deals with one of the APF shortcomings, namely the absence of nonlinear relations among the performance indicators to capture more accurately the risk in the assessed system. It proposes an addition of new decision criteria behind the APF method as part of the application of Analytical Hierarchy Process (AHP), namely the impact of respective performance indicator on other indicators, regardless of their hierarchical structure. This addition leads to relative changes of performance indicators significance, where those with the highest potential for nonlinear interactions among the entire set of performance indicators are emphasized and the change in their weight ultimately leads to changes in the overall APF signal. The study results indicate that the extended APF signal is refined in terms of extremes and it draws more accurate picture about the actual safety performance, eventually supporting better identification of deviations from its acceptable values. The study was experimentally carried out in the aviation with data from the European Central Repository (ECR) originating from United Kingdom during the years 2013-2015 and verified further on data sets from Finland and Denmark.

The experience of staff utilizing data to evaluate and improve person-centred practice: An action research study

AIM

Explore how nurses and midwives use patient experience data collected from a mobile health app to influence the development of person-centred practice.

DESIGN

Participatory action research, underpinned by the Person-Centred Nursing Framework and Practice Development principles.

METHODS

Six clinical units in a large health district engaged in three action cycles from 2018 to 2020 using a mobile health app. Nursing/midwifery staff on the units (N = 177) utilized data collected via the app to evaluate and improve person-centred practice. A pre-post survey using the PCPI-S was conducted to evaluate staff perceptions of person-centredness. Data from the surveys (n = 101 in 2018 and n = 102 in 2020) and 17 semi-structured interviews were used to understand the influence working with these data had on person-centred practice. The Guidelines for Best Practices in the Reporting of Participatory Action Research have been used to report this study.

RESULTS

Improvements in person-centred practice were noted across both data sets. There was a statistically significant increase in two domains of the PCPI-S in the independent t-test and across all three domains in the paired t-test results. Thematic analysis resulted in the identification of six themes: Getting everyone on board, once we understood, keeping on track, there's a person in the bed, knowing you're doing a good job and improving over time.

CONCLUSION

Engaging with the data collected from the app in a facilitated and collaborative way results in increases in person-centredness.

IMPACT

This study provides insight into how nurses and midwives used data from a mHealth app to evaluate and improve person-centred practice. Utilizing the data generated by the app resulted in increased person-centredness amongst staff and changes to practice and culture. Nursing and midwifery teams who are supported to engage with patient experience data in an action-oriented way will see person-centred practice improvements, affecting patients and staff.

Operational Gaps in Implementing the COVID-19 Case Investigation and Contact Tracing in Madhesh Province of Nepal, May-July 2021

In Nepal, case investigation and contact tracing (CICT) was adopted as an important public health measure to reduce COVID-19 transmission. In this study, we assessed the performance of CICT in Madhesh Province of Nepal against national benchmarks, using routine programmatic data reported by district CICT teams. Between May and July 2021, 17,943 COVID-19 cases were declared in the province, among which case investigation was performed for 30% (95% CI: 29.6–31.0%) within 24 h (against 80% benchmark). As a result of case investigations, 6067 contacts were identified (3 contacts per 10 cases), of which 40% were traced and tested for SARS-CoV-2 infection (against 100% benchmark). About 60% of the contacts tested positive. At most 14% (95% CI: 13.1% to 14.9%) of traced contacts underwent a 14-day follow-up assessment (against 100% benchmark). We found the performance of the CICT program in Madhesh Province to be sub-optimal and call for corrective measures to strengthen CICT in the province and the country at large. Similar studies with wider geographical scope and longer time frames are needed to identify and address deficiencies in data recording and reporting systems for COVID-19, in low- and middle-income countries like Nepal and others.

Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review

INTRODUCTION

Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address.

METHODS

A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses.

RESULTS

We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted.

CONCLUSION

Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.

Big Data Health Care Innovations: Performance Dashboarding as a Process of Collective Sensemaking

Big data is poised to revolutionize health care, and performance dashboards can be an important tool to manage big data innovations. Dashboards show the progress being made and provide critical management information about effectiveness and efficiency. However, performance dashboards are more than just a clear and straightforward representation of performance in the health care context. Instead, the development and maintenance of informative dashboards can be more productively viewed as an interactive and iterative process involving all stakeholders. We refer to this process as dashboarding and reflect on our learnings within a large European Union–funded project. Within this project, multiple big data applications in health care are being developed, piloted, and scaled up. In this paper, we discuss the ways in which we cope with the inherent sensitivities and tensions surrounding dashboarding in such a dynamic environment.

Communication Requirements in 5G-Enabled Healthcare Applications: Review and Considerations

Fifth generation (5G) mobile communication technology can enable novel healthcare applications and augment existing ones. However, 5G-enabled healthcare applications demand diverse technical requirements for radio communication. Knowledge of these requirements is important for developers, network providers, and regulatory authorities in the healthcare sector to facilitate safe and effective healthcare. In this paper, we review, identify, describe, and compare the requirements for communication key performance indicators in relevant healthcare use cases, including remote robotic-assisted surgery, connected ambulance, wearable and implantable devices, and service robotics for assisted living, with a focus on quantitative requirements. We also compare 5G-healthcare requirements with the current state of 5G capabilities. Finally, we identify gaps in the existing literature and highlight considerations for this space.

Design, Development, and Evaluation of 5G-Enabled Vehicular Services: The 5G-HEART Perspective

The ongoing transition towards 5G technology expedites the emergence of a variety of mobile applications that pertain to different vertical industries. Delivering on the key commitment of 5G, these diverse service streams, along with their distinct requirements, should be facilitated under the same unified network infrastructure. Consequently, in order to unleash the benefits brought by 5G technology, a holistic approach towards the requirement analysis and the design, development, and evaluation of multiple concurrent vertical services should be followed. In this paper, we focus on the Transport vertical industry, and we study four novel vehicular service categories, each one consisting of one or more related specific scenarios, within the framework of the “5G Health, Aquaculture and Transport (5G-HEART)” 5G PPP ICT-19 (Phase 3) project. In contrast to the majority of the literature, we provide a holistic overview of the overall life-cycle management required for the realization of the examined vehicular use cases. This comprises the definition and analysis of the network Key Performance Indicators (KPIs) resulting from high-level user requirements and their interpretation in terms of the underlying network infrastructure tasked with meeting their conflicting or converging needs. Our approach is complemented by the experimental investigation of the real unified 5G pilot’s characteristics that enable the delivery of the considered vehicular services and the initial trialling results that verify the effectiveness and feasibility of the presented theoretical analysis.

Impact of the COVID-19 pandemic on coastal environment: positive or negative? A 1-year study on litter in Caspian coasts

Litter is one of the major environmental problems. These wastes cause adverse health, environmental, and even economic effects. One of the consequences of the COVID-19 pandemic is the impact on litter composition and density due to its changes in lifestyle and consumption patterns. In this study, the effect of the COVID-19 pandemic on the composition and density of litter on the ten southern beaches of the Caspian Sea in Iran in 1 year was investigated. The results showed that the density of the litters was in the range of 36.5–306 items/m2. The highest and lowest proportions of the COVID-related litters on the locations studied were 2.54 and 5.95%, respectively. The indexes in the areas studied showed that the COVID-19 pandemic has reduced the density of the litter in 90% of the beaches studied by changing the style of citizens, but the emergence of new dumping related to COVID-19 has increased the potential for health and environmental hazards caused by litters. The effects of the COVID-related litters increased the clean environment index by 5 to 12% on the beaches. This study shows that the impact of social phenomena such as a pandemic on litter and its results can be used for the better management of municipal solid wastes, including litter in similar situations in the future.

Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis

Background

Mitigation of the spread of infection relies on targeted approaches aimed at preventing nonhousehold interactions. Contact tracing in the form of digital proximity tracing apps has been widely adopted in multiple countries due to its perceived added benefits of tracing speed and breadth in comparison to traditional manual contact tracing. Assessments of user responses to exposure notifications through a guided approach can provide insights into the effect of digital proximity tracing app use on managing the spread of SARS-CoV-2.

Objective

The aim of this study was to demonstrate the use of Venn diagrams to investigate the contributions of digital proximity tracing app exposure notifications and subsequent mitigative actions in curbing the spread of SARS-CoV-2 in Switzerland.

Methods

We assessed data from 4 survey waves (December 2020 to March 2021) from a nationwide panel study (COVID-19 Social Monitor) of Swiss residents who were (1) nonusers of the SwissCovid app, (2) users of the SwissCovid app, or (3) users of the SwissCovid app who received exposure notifications. A Venn diagram approach was applied to describe the overlap or nonoverlap of these subpopulations and to assess digital proximity tracing app use and its associated key performance indicators, including actions taken to prevent SARS-CoV-2 transmission.

Results

We included 12,525 assessments from 2403 participants, of whom 50.9% (1222/2403) reported not using the SwissCovid digital proximity tracing app, 49.1% (1181/2403) reported using the SwissCovid digital proximity tracing app and 2.5% (29/1181) of the digital proximity tracing app users reported having received an exposure notification. Most digital proximity tracing app users (75.9%, 22/29) revealed taking at least one recommended action after receiving an exposure notification, such as seeking SARS-CoV-2 testing (17/29, 58.6%) or calling a federal information hotline (7/29, 24.1%). An assessment of key indicators of mitigative actions through a Venn diagram approach reveals that 30% of digital proximity tracing app users (95% CI 11.9%-54.3%) also tested positive for SARS-CoV-2 after having received exposure notifications, which is more than 3 times that of digital proximity tracing app users who did not receive exposure notifications (8%, 95% CI 5%-11.9%).

Conclusions

Responses in the form of mitigative actions taken by 3 out of 4 individuals who received exposure notifications reveal a possible contribution of digital proximity tracing apps in mitigating the spread of SARS-CoV-2. The application of a Venn diagram approach demonstrates its value as a foundation for researchers and health authorities to assess population-level digital proximity tracing app effectiveness by providing an intuitive approach for calculating key performance indicators.

Key Performance Indicators for Quality Imaging Practice: Why, What, and How

A common trend across health care organizations is the development of key performance indicators (KPIs) for characterizing quality, identifying areas in need of change, and quantifying the impact of change. This article outlines a list of KPIs that can be used to quantify, target, and optimize value and value delivery in medical imaging practice. Of particular focus here is the aspect of practice that should be overseen and informed by the work of medical physicists, along the trajectory and expectations of a Medical Physics 3.0 model. The authors offer a framework for developing site-specific KPIs and several demonstrative clinical examples.

Analysis of Life Cycle Environmental Impacts of Using Enogen Corn in Beef Cattle Rations

Agricultural production systems have been identified as significant sources of anthropogenic impacts across several environmental key performance indicators (KPIs). Livestock husbandry is growing in global importance as the demand for high-quality protein continues to increase. It is therefore imperative to have sustainable intensification technologies, and we describe one such technology. The purpose of this study was to evaluate the performance of Enogen^® corn grain compared to conventional feed corn when used as an ingredient in backgrounding and feed yard beef rations using life cycle assessment. The project was conducted in compliance with ISO standards, including a third-party panel review. A series of scenarios were analyzed to evaluate the impacts of boundaries and functional units on the outcomes. The use of Enogen corn as a feed component in beef production showed a quantifiable benefit in terms of the sustainability metrics of primary interest in this study. The gate-to-gate improvements at the feed yard and backgrounding based on full field trial datasets from field trials conducted at Kansas State University and at the University of Nebraska, Lincoln showed 3.4 and 5.8 percent reductions in Global Warming Potential, respectively. It is particularly noteworthy that the improvement in feed conversion ratio at the feed yard results in approximately 6 percent improvement in the four key environmental performance metrics of beef production, which demonstrates potential for the sector to meet its sustainability targets.

A structured approach to analyse logistics risks in the blood transfusion process

Blood transfusion is a critical health care process due to the nature of the products handled and the complexity driven by the strong interdependence among the sub-processes involved. Most of the errors causing adverse events originate during the blood logistics activities. Several literature contributions apply risk management to the transfusion process but often in a fragmented and reactive way. Moreover, few of them focus on logistics risks and assess the effectiveness of risk responses through operational key performance indicators (KPIs). The present paper applies a comprehensive and structured approach to proactively identify and analyse logistics risks as well as define responses to improve blood bag traceability, focusing on hospital wards. The implementation of such actions is monitored by specific KPIs whose measurement enables an improved communication flow among actors allowing to uncover residual risks. Future research will extend the application to further blood transfusion settings and supply chain echelons. The outcomes of this work might assist practitioners in improving policy making about blood supply chains. As a matter of fact, they allow a better understanding of the associated material and informational flows and the related risks, which supports setting effective strategies to either prevent adverse events or mitigate their effects.

Description of changes of key performance indicators and PRRSV shedding over time in a naïve breeding herd following a PRRS MLV exposure

Porcine reproductive and respiratory syndrome (PRRS) is an important economic swine disease. The usage of PRRS-modified live vaccines (MLV) is the predominant breeding herd immunologic solution used in the United States to minimize the economic losses associated with wild-type PRRS infection. Most of the current information on the effects of contemporary PRRS MLV vaccination on breeding herd performance under field conditions comes from herds with previous PRRS virus (PRRSV) exposure. Hence, there is little information on key performance indicators (KPI) changes after the exposure to a PRRS MLV in PRRSV-naïve breeding herds. The main objective of this longitudinal observational study was to describe selected KPI changes in a naïve breeding herd after PRRS MLV exposure. The secondary objective was to describe the pattern of detection of PRRSV RNA by the quantitative reverse transcriptase-polymerase chain reaction in processing fluid samples. There were transient increases for mummies during weeks 4-23 (+0.86%); increased pre-weaning mortality on weeks 3-5 (+3.76%); a decrease in live born on weeks 4-5 (-0.46) leading to a decreased pig weaned/litter on weeks 5-10 (-0.69) and increased repeated services on weeks 3-23 (+5.53%). Transient changes observed after PRRS MLV exposures did not move total pigs weaned to outside the control intervals. Starting on week 83 and for 53 consecutive weeks, there was no PRRSV detection in processing fluids, even though two whole-herd MLV exposures occurred within that period.

Exploring how key performance indicators influence nursing and midwifery practice: A mixed-methods study

AIMS

To scope the key performance indicators (KPIs) used in nursing and midwifery across the United Kingdom and Republic of Ireland and explore how they influence practice in healthcare organizations.

DESIGN

The study adopted a sequential, exploratory mixed-methods design.

METHODS

Phase 1 incorporated a multiple-choice questionnaire completed by 77 Directors of Nursing recruited using voluntary response sampling. In phase 2, 35 nurses and midwives who were working at executive, senior manager and clinical levels, participated in semi-structured interviews. Data collection of both phases was conducted from January 2016 to October 2016.

FINDINGS

Quantitative data revealed over 100 nursing and midwifery-specific KPIs. National requirements were a deciding factor in KPI selection, while clinical involvement was mainly through data collection. Respondents stated that they used patient experience KPIs, but only one was assessed as valid. Thematic analysis identified two themes: The leadership challenge (including 'voiceless in the national conversation', 'aligning KPIs in the practice context' and 'listening to those who matter'); and taking action (including 'establishing ownership and engaging staff', 'checks and balances' and 'closing the loop').

CONCLUSION

The large volume of KPI measurement taking place makes meaningful evaluation of performance and quality of care difficult, both in and across organizations. Nurses and midwives require enhanced knowledge of the nature and purpose of KPIs, as evidence gained from KPI data collection is insufficient to lead to improvements in practice. A practice context that encourages collective leadership, where multiple sources of evidence are gathered and everyone is included in KPI evaluation and subsequent decision-making, is key.

IMPACT

This study adds to the body of evidence on KPI understanding. It informs the future effective management of indicators that will facilitate the delivery of meaningful care and reduce the cost, time and effort invested in the implementation of KPIs and data management.

Healthcare Human Resources: Trends and Demand in Saudi Arabia

This paper estimates the impact of policies on the current status of Healthcare Human Resources (HHR) in Saudi Arabia and explores the initiatives that will be adopted to achieve Saudi Vision 2030. Retrospective time-series data from the Ministry of Health (MOH) and statistical yearbooks between 2003 and 2015 are analyzed to identify the impact of these policies on the health sector and the number of Saudi and non-Saudi physicians, nurses and allied health specialists employed by MOH, Other Government Hospitals (OGH) and Private Sector Hospitals (PSH). Moreover, multiple regressions are performed with respect to project data until 2030 and meaningful inferences are drawn. As a local supply of professional medical falls short of demand, either policy to foster an increase in supply are adopted or the Saudization policies must be relaxed. The discrepancies are identified in terms of a high rate of non-compliance of Saudization in the private sector and this is being countered with alternative measures which are discussed in this paper. The study also analyzed the drivers of HHR demand, supply and discussed the research implications on policy and society. The findings suggest that the 2011 national Saudization policy yielded the desired results mostly regarding allied health specialists and nurses. This study will enable decision-makers in the healthcare sector to measure the effectiveness of the new policies and, hence, whether to continue in implementing them or to revise them.

The Maribor consensus: report of an expert meeting on the development of performance indicators for clinical practice in ART

STUDY QUESTION

Is it possible to define a set of performance indicators (PIs) for clinical work in ART, which can create competency profiles for clinicians and for specific clinical process steps?

SUMMARY ANSWER

The current paper recommends six PIs to be used for monitoring clinical work in ovarian stimulation for ART, embryo transfer, and pregnancy achievement: cycle cancellation rate (before oocyte pick-up (OPU)) (%CCR), rate of cycles with moderate/severe ovarian hyperstimulation syndrome (OHSS) (%mosOHSS), the proportion of mature (MII) oocytes at ICSI (%MII), complication rate after OPU (%CoOPU), clinical pregnancy rate (%CPR), and multiple pregnancy rate (%MPR).

WHAT IS KNOWN ALREADY

PIs are objective measures for evaluating critical healthcare domains. In 2017, ART laboratory key PIs (KPIs) were defined.

STUDY DESIGN, SIZE, DURATION

A list of possible indicators was defined by a working group. The value and limitations of each indicator were confirmed through assessing published data and acceptability was evaluated through an online survey among members of ESHRE, mostly clinicians, of the special interest group Reproductive Endocrinology.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The online survey was open for 5 weeks and 222 replies were received. Statements (indicators, indicator definitions, or general statements) were considered accepted when ≥70% of the responders agreed (agreed or strongly agreed). There was only one round to seek levels of agreement between the stakeholders.

Indicators that were accepted by the survey responders were included in the final list of indicators. Statements reaching less than 70% were not included in the final list but were discussed in the paper.

MAIN RESULTS AND THE ROLE OF CHANCE

Cycle cancellation rate (before OPU) and the rate of cycles with moderate/severe OHSS, calculated on the number of started cycles, were defined as relevant PIs for monitoring ovarian stimulation. For monitoring ovarian response, trigger and OPU, the proportion of MII oocytes at ICSI and complication rate after OPU were listed as PIs: the latter PI was defined as the number of complications (any) that require an (additional) medical intervention or hospital admission (apart from OHSS) over the number of OPUs performed. Finally, clinical pregnancy rate and multiple pregnancy rate were considered relevant PIs for embryo transfer and pregnancy. The defined PIs should be calculated every 6 months or per 100 cycles, whichever comes first. Clinical pregnancy rate and multiple pregnancy rate should be monitored more frequently (every 3 months or per 50 cycles). Live birth rate (LBR) is a generally accepted and an important parameter for measuring ART success. However, LBR is affected by many factors, even apart from ART, and it cannot be adequately used to monitor clinical practice. In addition to monitoring performance in general, PIs are essential for managing the performance of staff over time, and more specifically the gap between expected performance and actual performance measured. Individual clinics should determine which indicators are key to the success in their organisation based on their patient population, protocols, and procedures, and as such, which are their KPIs.

LIMITATIONS, REASONS FOR CAUTION

The consensus values are based on data found in the literature and suggestions of experts. When calculated and compared to the competence/benchmark limits, prudent interpretation is necessary taking into account the specific clinical practice of each individual centre.

WIDER IMPLICATIONS OF THE FINDINGS

The defined PIs complement the earlier defined indicators for the ART laboratory. Together, both sets of indicators aim to enhance the overall quality of the ART practice and are an essential part of the total quality management. PIs are important for education and can be applied during clinical subspecialty.

STUDY FUNDING/COMPETING INTEREST(S)

This paper was developed and funded by ESHRE, covering expenses associated with meetings, literature searches, and dissemination. The writing group members did not receive payment.

Dr G.G. reports personal fees from Merck, MSD, Ferring, Theramex, Finox, Gedeon-Richter, Abbott, Biosilu, ReprodWissen, Obseva, PregLem, and Guerbet, outside the submitted work. Dr A.D. reports personal fees from Cook, outside the submitted work; Dr S.A. reports starting a new employment in May 2020 at Vitrolife. Previously, she has been part of the Nordic Embryology Academic Team, with meetings were sponsored by Gedeon Richter. The other authors have no conflicts of interest to declare.

DISCLAIMER

This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation.

The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type.

Furthermore, ESHREs recommendations do not constitute or imply the endorsement, recommendation, or favouring of any of the included technologies by ESHRE.

Using 3D CityGML for the Modeling of the Food Waste and Wastewater Generation-A Case Study for the City of Montréal

The paper explains a workflow to simulate the food energy water (FEW) nexus for an urban district combining various data sources like 3D city models, particularly the City Geography Markup Language (CityGML) data model from the Open Geospatial Consortium, Open StreetMap and Census data. A long term vision is to extend the CityGML data model by developing a FEW Application Domain Extension (FEW ADE) to support future FEW simulation workflows such as the one explained in this paper. Together with the mentioned simulation workflow, this paper also identifies some necessary FEW related parameters for the future development of a FEW ADE. Furthermore, relevant key performance indicators are investigated, and the relevant datasets necessary to calculate these indicators are studied. Finally, different calculations are performed for the downtown borough Ville-Marie in the city of Montréal (Canada) for the domains of food waste (FW) and wastewater (WW) generation. For this study, a workflow is developed to calculate the energy generation from anaerobic digestion of FW and WW. In the first step, the data collection and preparation was done. Here relevant data for georeferencing, data for model set-up, and data for creating the required usage libraries, like food waste and wastewater generation per person, were collected. The next step was the data integration and calculation of the relevant parameters, and lastly, the results were visualized for analysis purposes. As a use case to support such calculations, the CityGML level of detail two model of Montréal is enriched with information such as building functions and building usages from OpenStreetMap. The calculation of the total residents based on the CityGML model as the main input for Ville-Marie results in a population of 72,606. The statistical value for 2016 was 89,170, which corresponds to a deviation of 15.3%. The energy recovery potential of FW is about 24,024 GJ/year, and that of wastewater is about 1,629 GJ/year, adding up to 25,653 GJ/year. Relating values to the calculated number of inhabitants in Ville-Marie results in 330.9 kWh/year for FW and 22.4 kWh/year for wastewater, respectively.

An integrated outsourcing practice of nonclinical LC-MS bioanalysis and toxicokinetics at Novartis small molecule drug development

With decommissioning of internal regulated bioanalytical (BA) and toxicokinetic (TK) capabilities, Novartis has relied on external service providers (ESPs) for all nonclinical LC-MS BA and majority of the associated TK work since 2017. This paper outlines an integrated outsourcing practice of the Novartis nonclinical LC-MS BA/TK group, which covers the roles and responsibilities of Novartis nonclinical LC-MS BA/TK expert scientific monitors, selection of ESPs for Novartis nonclinical LC-MS BA/TK studies, qualification of BA/TK ESPs, study conduct and completion, ESP oversight and evaluation, issue mitigation, and future perspectives.

Improving on Half-Lightweight Male Judokas' High Performance by the Application of the Analytic Network Process

Judo is a multifactorial sport where many variables or key performance indicators (KPIs) such as force-velocity profile, bioenergetic capacity, technical and tactical skills, and cognitive and emotional competence play a role and influence the final result. While there have been many academic studies of these variables, usually in isolation, none have examined KPIs holistically or analyzed their impact on strategic performance. The main objective of the present study, therefore, is to apply a novel and easily replicable methodology to identify and prioritize the main KPIs affecting performance in professional judo. Such a methodology was applied to the High-Performance Judo Centre of Valencia, using a multi-criteria decision aid technique: the analytic network process (ANP). The ANP is used to identify and quantify cause and effect relationships not only between KPIs but also between KPIs and performance objectives. Further, the ANP offers effective results when there is a lack of historical KPI data, because it is based on experts' opinions and judgments. A judo expert group (JEG) comprising elite judo coaches and half-lightweight (under 66 kg) male judokas applied the methodology to discriminate between the characteristics required when aiming to reach high-level strategic objectives (such as participating in the Olympic Games or winning a medal in a Grand Slam/Gran Prix). The JEG, which consisted of five elite judokas, national and international champions, and three Olympic coaches-including a former European champion and silver medalist in a world championship-provided high added value to the study. The main findings were that the KPIs that made the most difference were mostly psychological, specifically motivation, stress, and team cohesion. Of these, motivation was by far the most important KPI for success in our case study, so judokas should make sure that they analyze it properly. Motivation is usually intrinsic to the competitor and should be maintained at a high level, not only during tournaments but also during daily training and lifestyle activities. Physical and other specific forms of training, as well as lifestyle KPIs, are very important for the elite competitor but are not sufficient to reach high-level objectives. The most important of these KPIs were Kumi-Kata (grip work), dual career, focus and concentration level, scouting, nutrition, and basic technique. Power and strength were the most important physical KPIs. In general, these are essential for meeting strategic objectives, but they do not make the crucial difference. This suggests that professional psychological support should be provided in daily training and that international team composition and internships should be fostered.

Effect of the SARS-CoV2 Pandemic on Endoscopy Provision - The Impact of Compliance with National Guidance

Objective: There are limited data on the impact of the pandemic upon endoscopy service provision and quality indicators.Methods: Analysis of number and type of procedure, in-room time (minutes), key performance indicators, and list utilization was performed over three periods; pre-lockdown, lockdown, and early recovery and compared with the previous year.Results: Endoscopy activity reduced to 13.3% of the same period in 2019 with the largest drops in colonoscopy and flexible sigmoidoscopy numbers. In-room time increased significantly for gastroscopy (35 vs. 24, p < 0.0001), flexible sigmoidoscopy (20 vs. 15, p < 0.0001), endoscopic ultrasound (40 vs. 32, p = 0.0009), and ERCP (59 vs. 45, p = 0.0041). There was no increase for colonoscopy (35 vs 35, p = 0.129). There was a significant reduction in in-room time for gastroscopy alone (44.5 vs. 30.0, p = 0.0002) over the study period. There was no significant difference in cecal intubation rate, polyp detection rate, or biliary cannulation rate compared to the previous year.Conclusions: The pandemic has profoundly reduced the number of endoscopies performed with some recovery. In-room time has significantly increased but with the preservation of key performance indicators. List utilization remains a significant problem and resources need to be adequately aligned to improve this.

Urban strategies evaluation for waste management in coastal areas in the framework of area metabolism

Europe is considered one of the most attractive and safe prevalent tourist destinations in the entire world. Approximately half (47.4%) of European tourist visits occurred in coastal regions, defined "on the basis of and consist of local administrative units or municipalities that border the sea, or have at least half of their total surface area within a distance of 10 km from the sea." Destinations such as Malta, Greece, Cyprus, Spain and Croatia presented with an increased level of tourist accommodation establishments, as well as, the overall flow of tourism in the European Union is mostly concentrated on Mediterranean coastal regions (as nine out 10 tourists, in 2015, spent their holidays at coastal areas). This paper, is dealing with the assessment of a tourist area and how the concept of urban metabolism has been affected by touristic activities. Moreover, this research using several key performance indicators such as waste compositional analysis, the clean coast index, the accumulation rate, and accumulation index, etc., tries to measure the level of environmental performance, and furthermore, to assess the existing infrastructures and the waste management plan, that are being implemented. The results are very useful, for any policy-maker, as well as competent authorities and/or tourist organizations which are dealing with tourist activities and aim to propose or re-schedule any waste strategy targeting the goals of United Nations Sustainable Development Goals, European Green Deal, and the new circular economy strategy.

Laboratory Medicine and Healthcare Excellence - Till Death do us Part

The union between laboratory medicine and healthcare excellence is strong, interconnected and has stood the test of time. This partnership is essential in the quest for value-based health care, expanding the strategic role of the clinical laboratory from traditional, transactional models to strategic ones that expedite or activate new cascades of care. This paper reviews outcomes and key trends following global recognition of integrated clinical care teams for exemplary outcomes of measurably better health care. In all cases, laboratory medicine was either a key contributor or leader in predictive risk management, preventative health, and integration of clinical care through active synthesis of relevant data: data that are too often under-used, under-recognized, or even missing in traditional models of care. Outcomes connect multi-disciplinary teams with favorable key performance indicators across patients, payors, clinicians and health systems, as well as top disease burdens and unmet gaps of care. Results affirm the possibilities ahead with proactive engagement across healthcare professionals including the vital and active role of laboratory medicine. With the future upon us, it is incumbent upon all healthcare professionals to work together, learn from others, champion health outcomes and join in a pledge for healthcare excellence.

Implementing person-centred key performance indicators to strengthen leadership in community nursing: A feasibility study

AIMS

To explore the utility and feasibility of implementing eight person-centred nursing key performance indicators in supporting community nurses to lead the development of person-centred practice.

BACKGROUND

Policy advocates person-centred health care, but few quality indicators exist that explicitly focus on evaluating person-centred practice in community nursing. Current quality measurement frameworks in the community focus on incidences of poor or missed opportunities for care, with few mechanisms to measure how clients perceive the care they receive.

METHODS

An evaluation approach derived from work of the Medical Research Council was used, and the study was underpinned by the Person-centred Practice Framework. Participatory methods were used, consistent with person-centred research.

RESULTS

Data were thematically analysed, revealing five themes: giving voice to experience; talking the language of person-centredness; leading for cultural change; proud to be a nurse; and facilitating engagement.

CONCLUSIONS

The findings suggest that implementing the eight person-centred nursing key performance indicators (KPIs) and the measurement framework is feasible and offers a means of evidencing person-centredness in community nursing.

IMPLICATIONS FOR NURSING MANAGEMENT

Person-centred KPI data, used alongside existing quality indicators, will enable nurse managers to evidence a high standard of care delivery and assist in the development of person-centred practice.

The Managerial Implications of the Key Performance Indicators in Healthcare Sector: A Cluster Analysis

The aim of the paper is to identify a set of the key performance indicators (KPIs) in order to provide managers and employees from the healthcare system with recommendations for evaluating, monitoring, and controlling the critical factors that influence the performance of the healthcare sector in Algeria during a pandemic crisis. During February–August 2020, a cross-sectional survey design was administrated to medical employees from hospitals situated in the northeastern part of Algeria. Our findings proved that the four groups of KPIs correlate to each other, and during this period, the triple relationship among human factor-technology-medication plays a decisive role in reducing the pressure on the medical system and overcoming the crisis. In order to increase the efficiency of the decision-making process, a hierarchy of KPIs is recommended in terms of their impact on the performance of medical staff. The practical importance of our research consists in ranking KPIs on four clusters that support managers to focus on both the human factor (clinical errors, infection rate, and medication errors) and the technical elements of maximum importance (laboratory test time, location of the facility, and sufficient air).

Competition-Based Success Factors During the Talent Pathway of Elite Male Swimmers

Marginal differences in race results between top swimmers have evoked the interest in competition-based success factors of long-term athlete development. To identify novel factors for the multi-dimensional model of talent development, the aim of the study was to investigate annual variation in competition performance (ACV), number of races per year, and age. Therefore, 45,398 race results of all male participants (n = 353) competing in individual events, i.e., butterfly, backstroke, breaststroke, freestyle, and individual medley, at the 2018 European Long-Course Swimming Championships (2018EC) were analyzed retrospectively for all 10 years prior to the championships with Pearson's correlation coefficient and multiple linear regression analysis. Higher ranked swimmers at the 2018EC showed significant medium correlations with a greater number of races per year and small but significant correlations with higher ACV in 10 and nine consecutive years, respectively, prior to the championships. Additionally, better swimmers were older than their lower ranked peers (r = −0.21, p < 0.001). Regression model explained a significant proportion of 2018EC ranking for 50 m (47%), 100 m (45%), 200 m (31%), and 400 m races (29%) but not for 800 and 1,500 m races with number of races having the largest effect followed by age and ACV. In conclusion, higher performance variation with results off the personal best in some races did not impair success at the season's main event and young competitors at international championships may benefit from success chances that increase with age. The higher number of races swum per year throughout the career of higher ranked swimmers may have provided learning opportunities and specific adaptations. Future studies should quantify these success factors in a multi-dimensional talent development model.

Role of Dedicated Cardiac Emergency Unit in Early Identification and Management of Acute Myocardial Infarction in a Developing Country of South Asia

Background

The care of patients presenting with chest pain to multidisciplinary services hospital gets compromised due to the busy triage system. A separate and specialized equipped cardiac emergency unit (CAR-ERU) can improve patient’s outcomes.

Objectives

To enhance early recognition and treatment of acute myocardial infarction (AMI) patients. To sustain key performance quality indicators (KPIs) for AMI.

Methods

In October 2016, a separate CAR-ERU was established inside the multidisciplinary emergency department (MED). A dedicated specialized heart-lung and vascular teams were hired under the supervision of service line leadership. The KPIs that were identified benchmark with international practice guidelines. Data were collected and stored for analysis. Exemption from the ethical review committee was obtained.

Results

A total of 2914 patients visited CAR-ERU from October 2016 to September 2017 for a period of one year. Out of which 30% were diagnosed with acute coronary syndrome (ACS) and this included 8% diagnosis with ST-segment elevation myocardial infarction (STEMI). Over 98.8% of the electrocardiogram (ECG) was done within 10 minutes of arrival while aspirin was given to 96.5% of patients within one hour. The door to balloon time (DBT) of <90 min was achieved in 70% of patients. A significant reduction in length of stay in the emergency department and financial burden was noted. Sustainability of major KPI was observed over the subsequent years. 

Conclusion

The introduction of a dedicated CAR-EU improved clinical outcomes, reduced length of stay and financial burden in AMI patients managed in CAR-EU. Our tertiary care hospital is the first one of its kind to take this quality initiative in a lower-middle-income country (LMIC) Pakistan.

Resuming Assisted Reproduction Services during COVID-19 Pandemic: An Initial Indian Experience

BACKGROUND

The pandemic of COVID-19 has affected many countries and medical services including assisted reproductive treatment (ART) have been hampered.

AIM

The study was conducted to assess the preparedness of ART clinics and staff to resume services; patients' reasons to initiate treatment; and key performance indicators (KPIs) of ART laboratories during the pandemic.

SETTING AND DESIGN

This was a semidescriptive, prospective study in two private in vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable.

MATERIALS AND METHODS

Time required for replenishing consumables and clinic preparedness to function under "new norms" of pandemic was documented. Infection mitigation measures and triaging strategy were evaluated. KPIs following resumption were analyzed. The Student's t-test was performed for comparing parameters.

RESULTS

Thirty percent of the patients consulted through telemedicine accepted or were eligible to initiate treatment on clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and 9% delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands was achieved within a week, but procuring consumables and injections was time-consuming. Fifty-two cycles of IVF were performed including fresh and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval were associated with reduced procedure time and no intervention for airway maintenance compared to general anesthesia. Self-reported pain scores by patients ranged from nil to mild on a graphic rating scale.

CONCLUSIONS

This study provides practical insight for the resumption of IVF services during the COVID-19 pandemic.

Assessment of Key Performance Indicators of the Primary Health Care in Oman: A Cross-Sectional Observational Study

Objective

Effective primary health care (PHC) is the key to attaining universal health coverage. The key performance indicators (KPIs), is a component of quality improvement in the PHC service sector that provides feedback to inform and better public service delivery and promoting accountability. We assessed the current performance of PHC service by using KPIs to identify the possible challenges that necessitate being confronted, highlight the lessons learnt, and propose steps towards improvements.

Methods

We conducted a cross-sectional observational study across 12 PHC centers in 6 governorates in Oman during the period of June 2017 to June 2018. Secondary data from the computerized medical records of the PHC centers on six key indicators, accessibility, workload, outcomes, timeliness, satisfaction, and safety were analysed to assess the performance of PHC service and to identify challenges confronted and propose steps towards further service improvement.

Results

The mean overall KPIs scores across the ten PHC centers were 174.5 (SD: 9.80) or 67.01%. The overall scores were normally distributed with a median score of 175 (IQR: 171-181). The lowest percentage score was obtained by Al Qabil (61.35%) with the highest mark being at Wadi Kabir (70.54%). The mean score across all KPIs was 3.84 (SD:0.94) with a median score of 3.9 (IQR: 3.43-4.5). Of the six KPI components, safety (4.85), satisfaction (4.67), timeliness (4.44), and accessibility (4.31) had the highest performance scores, whilst workload (4.15) and outcomes (3.75) lagged behind.

Conclusions

Performance across the KPIs exhibited a considerable variation between facilities, with workload and outcome performing lower than other components. The findings of this study offered a measure of internal strengths that need to be sustained, challenges that require quality improvement initiatives, and external factors such as social determinants that impact overall performance PHC.

National feasibility survey of peritoneal dialysis key performance indicators in Thailand from provider perspective

BACKGROUND

Peritoneal dialysis (PD) has been the main method of renal replacement therapy under the "PD First" policy in Thailand since 2008. Initially, the proposed 13 key performance indicators (KPIs) raised feasibility concerns because of inequitable distribution of resources such as laboratory facilities and/or specialized health-care staff for PD care throughout the country.

METHODS

Data availability and goals from the health-care providers' perspective were explored using an online questionnaire survey for all PD centers registered with the Nephrology Society of Thailand from May to June 2016. The availability of essential data required for each KPI indicator to achieve the desired target was assessed using a 5-point Likert scale.

RESULTS

Of the 197 centers, 119 responded to the survey (response rate of 60.41%). PD indicators with a high percentage of strongly disagree or disagree were "PD adequacy measured in the last 12 months" (26.83%), "Total weekly Kt/V ≥ 1.7" (24.59%), "3-year PD technique survival" (21.31%), "Serum parathyroid levels within 150 to 500 pg/mL" (16.94%), and a "3-year PD patient survival" (19.01%). As many as 34.17%, 39.19%, 27.27%, 28.93%, and 22.00%, respectively, did not anticipate that the targets could be achieved. Based on the findings from this survey, the national committee concluded that these indicators be removed, and only eight PD indicators were launched.

CONCLUSION

Given the importance of KPIs for quality assurance and financial reimbursement, inputs from health-care providers especially data availability and achievement of targets should be considered to ensure feasibility before the final list of indicators are launched.

Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa

In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa. In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014. By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level. After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.

Integration of Green Energy and Advanced Energy-Efficient Technologies for Municipal Wastewater Treatment Plants

Wastewater treatment can consume a large amount of energy to meet discharge standards. However, wastewater also contains resources which could be recovered for secondary uses under proper treatment. Hence, the goal of this paper is to review the available green energy and biomass energy that can be utilized in wastewater treatment plants. Comprehensive elucidation of energy-efficient technologies for wastewater treatment plants are revealed. For these energy-efficient technologies, this review provides an introduction and current application status of these technologies as well as key performance indicators for the integration of green energy and energy-efficient technologies. There are several assessment perspectives summarized in the evaluation of the integration of green energy and energy-efficient technologies in wastewater treatment plants. To overcome the challenges in wastewater treatment plants, the Internet of Things (IoT) and green chemistry technologies for the water and energy nexus are proposed. The findings of this review are highly beneficial for the development of green energy and energy-efficient wastewater treatment plants. Future research should investigate the integration of green infrastructure and ecologically advanced treatment technologies to explore the potential benefits and advantages.

Key performance indicators and administrative data in an early psychosis service

AIM

This study aimed to introduce a set of administrative key performance indicators (KPIs) for Early Psychosis Services.

METHODS

The study design was longitudinal with data retrieved from a 4-year period between January 2009 and December 2013 included in the study. Descriptive statistics and t tests were used to evaluate the KPIs.

RESULTS

Results in the 1 year before early psychosis (EP) intervention and 1-year postintervention were calculated for most items, and entry and exit scores were calculated for involuntary treatment orders (ITOs) and Health of the Nation Outcome Scale (HoNOS) scores. There was a 54% reduction in mental health emergency department presentations representing a cost saving of $62 524.00 (AUD). There was also an improvement in the number and duration of mental health admissions with a financial saving of $1 653 534.00 (AUD). Patients improved on all HoNOS scores from entry to exit from the services. ITOs were reduced by approximately 29% on discharge from the service.

CONCLUSIONS

Administrative data can provide useful KPIs to measure the effectiveness of EP teams and allow benchmarking with similar services.

Improving emergency department trauma care in Fiji: Implementing and assessing the trauma call system

OBJECTIVE

The trauma team process was recently implemented at the Colonial War Memorial (CWM) Hospital, Suva. This study audits the trauma call procedure at the hospital over a period of 12 months.

METHOD

Retrospective descriptive study of trauma calls from August 2015 to July 2016 at CWM Hospital. Data relating to patient demographics, time of presentation, time to team assembly and time to computed tomography (CT) scan were extracted from the ED trauma call database. Disposition from the ED and status at hospital discharge was extracted from the hospital patient information system.

RESULTS

There were 38 trauma calls for 46 patients. Seventy-two per cent were male. Eighty-two per cent occurred when the CT radiographer was off site (16.00-08.00 h), including 47% that occurred between midnight and 08.00 h. Fifty-two per cent of patients were intubated, 43% went to ICU, 26% went directly to the operating theatre, and 37% died. Benchmarks for time to trauma team assembly and time to CT scan were met in 50% of cases.

CONCLUSION

This was a severely injured cohort of patients with a high mortality rate. The rate of missed calls was not assessed in this study. Time to CT scan could be improved with an onsite radiographer. Time to team assembly could be improved with trauma team training and early notification from pre-hospital providers. There is a need to continue to monitor and refine the trauma call process and to extend data capture to measure injury severity and outcomes.

Ethical leadership and why health information management professionals need to be involved. Commentary on Health information is central to changes in healthcare: a clinician's view (Hoyle, 2019)

Philip Hoyle presents a compelling argument for the significant and highly valued role that the management of health information plays in the Australian healthcare system and the delivery of health services in this country. However, he also brings to our attention the ill-defined nature of the ethical oversight of this very information. Hoyle uses words such as "honesty," "commitment to beneficence," "commitment to equity" and "respect for variation" when describing the characteristics of ethical leadership. He singles out health information management professionals - Health Information Managers (HIMs) and Clinical Coders (CCs) - as the key professional group who need to step up and seize the initiative, get conversations going, form partnerships, do research and publish findings, so the knowledge and insights that the health information management profession has the potential to offer are not only more widely known and understood but also more useful to others working in the healthcare arena. Hoyle calls on health information management professionals to step out from behind the scenes and take responsibility for the ethical use of the information they help produce. Hoyle's words resonated powerfully with me, particularly with respect to the clinical coding workforce in Australia, which is made up of trained CCs and qualified HIMs. In a truly ethical environment, HIMs and CCs would not be asked to meet performance indicators for increased funding metrics or to change codes to avoid triggering certain indicators; they would simply be asked to ensure complete, accurate coding for every episode of care. This is what ethical leadership would look like. I am concerned about our clinical coding workforce. I am now asking, are our CCs and HIMs up to the task of taking back absolute and unchallenged ownership of their particular skill set, which makes them the keepers of the clinical coding standards and the experts in accurate and complete code assignment?