How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

基于质量意识的复杂产品质量控制激励策略

激励在复杂产品供应链中对主供协同合作关系及质量控制发挥了重要作用。本文研究基于主制造商在复杂产品生产研发前按照客户要求形成的质量意识的激励策略是否可以实现复杂产品质量控制问题。考虑具有质量意识的主制造商和其系统供应商组成的两级供应链，建立以主制造商为领导者的Stackelberg博弈模型，分别讨论无激励和存在激励时的主供生产最优决策。基于激励方式的不同，将激励策略分为根据供应商产品质量水平激励以及根据主制造商质量意识水平激励两种方式。研究结果表明激励是供应商加强协同合作、改进产品质量的内在动力，主制造商根据质量意识激励供应商可以进一步促使双方协同合作，提高产品质量，使双方获得更高的利润从而实现供应链整体利润最大化。此外用灵敏度分析发现提高主制造商质量意识水平可以增加双方协同合作努力程度，有效提升产品质量水平并实现帕累托改进。     

Perceptions of participants and staff of implementing a physical activity program in rural primary care

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention utilizing a Fitbit to increase PA behavior in inactive rural adults recruited from a primary care clinic. Semi-structured interviews were conducted with study participants (n=10) and a focus group was held with nurses (n=7) from the primary care clinic. Data were analyzed using the process of immersion/crystallization. Participants and nurses both felt the program had a positive impact on PA and that the program was needed in the community. Study participants most often reported their favorite part of the study was being able to track their activity as well as the goal setting. However, study participants reported barriers to continued participation in PA related to a lack of time and ability to be active in cold weather. Further, nursing staff reported barriers in regard to a lack of resources (staffing and money) These barriers need to be examined further and addressed in order to implement a sustainable PA program that can be maintained through a primary care clinic.     

Clarifying the role of belief-motive explanations in multi-stakeholder realist evaluation

In realist evaluation, where researchers aim to make program theories explicit, they can encounter competing explanations as to how programs work. Managing explanatory tensions from different sources of evidence in multi-stakeholder projects can challenge external evaluators, especially when access to pertinent data, like client records, is mediated by program stakeholders. In this article, we consider two central questions: how can program stakeholder motives shape a realist evaluation project; and how might realist evaluators respond to stakeholders’ belief-motive explanations, including those about program effectiveness, based on factors such as supererogatory commitment or trying together in good faith? Drawing on our realist evaluation of a service reform initiative involving multiple agencies, we describe stakeholder motives at key phases, highlighting a need for tactics and skills that help to manage explanatory tensions. In conclusion, the relevance of stakeholders’ belief-motive explanations (‘we believe the program works’) in realist evaluation is clarified and discussed.     

Enhancing practitioner-led education in social work: developing a secondment project

ABSTRACT

This paper illustrates the development of a secondment project designed to enhance practitioner-led social work education in a Higher Education Institution. The project was developed as part of a Teaching Partnership initiative to establish joint working and standardized approaches to social work education between Higher Education Institutes and Local Authorities across a UK region. Highlighted is how the project utilized a six-stage strategy designed to gather information to produce an evidence-base to support the implementation of a pilot practitioner secondment arrangement. The paper discusses strategies used to gather information from a range of stakeholders to inform the project, the project outcome and some considerations for future secondment arrangements. Contributing to a limited source of literature, challenges and limitations of developing formal secondment arrangements and delivering practitioner-led education in Higher Education Institutes are highlighted. This paper will assist Higher Education Institutes and Local Authorities in the design and implementation of formal secondment arrangements where these are identified as in need of development.     

基于OBE教育理念的土木工程专业英语教学改革实践

为提高土木工程专业学生的英语应用能力和《土木工程专业英语》课程的教学效果，本次教改实践以OBE（成果导向教育）教育理念为教改指导思想，以土木工程专业英语教学为教改对象，设计了土木工程专业英语教学的教学内容、教学组织和教学评价等教学环节，在河北工程大学土木工程专业学生中进行了教改实践。教改实践结果表明，基于OBE的土木工程专业英语教学模式在提升土木工程专业学生英语应用能力方面具有很好的效果。本次教改实践的成果值得本校其他工科专业和其他兄弟院校借鉴。     

Integrating risk and performance management in quality management systems for the development of complex bespoke systems (CBSs)

Abstract

Risk and performance management are at the core of complex bespoke systems (CBSs). CBSs are developed to customer–specified requirements in terms of structure, functionality and conformance. This article examines how risk and performance management are integrated as essential systems in the successful development of projects across multi-organizational functions in complex bespoke system (CBS) organizations. The article argues for the development of a quality management system that consists of two sub-processes: quality control and quality development. Using three case studies from engineering companies, we provide evidence and insights of the way change control, quality development and quality performance are developed in innovating business solutions.     

三级装备制造业供应链质量管理行为研究

作为我国工业化建设和国民经济发展的根本保证，供应链环境下装备制造企业的产品质量问题受到了广泛关注。本文重点考虑产品质量对供应链收益的影响，运用微分对策理论研究由单一制造商、单一部件供应商和单一零件供应商构成的三级装备制造业供应链质量管理行为的协调问题。通过对比Nash非合作博弈和Stackelberg主从博弈两种分散式决策模式及集中式决策模式下协同合作博弈的均衡结果，得到相关结论，并利用算例进行验证。研究表明，①分散式决策下，制造商的质量管理行为相同，但相比于Nash非合作博弈，Stackelberg主从博弈能够改善部件供应商和零件供应商的质量管理行为，提升供应链成员的收益水平；②集中式决策下，供应链成员的质量管理行为达到最优，系统整体收益实现最大。研究结论为装备制造业供应链成员间质量管理战略联盟的构建提供了理论依据。     

Transition probabilities and ARL performance of Six Sigma zone control charts

In this article, Six Sigma zone control charts (SSZCCs) are proposed for world class organizations. The transition probabilities are obtained using the Markov chain approach. The Average Run Length (ARL) values are then presented. The ARL performance of the proposed SSZCCs and the standard Six Sigma control chart (SSCC) without zones or run rules is studied. The ARL performance of these charts is then compared with those of the other standard zone control charts (ZCCs), the modified ZCC and the traditional Shewhart control chart (SCC) with common run rules. As expected, it is shown that the proposed SSZCC outperforms the standard SSCC without zones or run rules for process shifts of any magnitude. When compared to the other standard ZCCs and the Shewhart chart with common run rules, it is observed that the proposed SSZCCs have much higher false alarm rates for smaller shifts and hence they prevent unwanted process disturbances. The application of the proposed SSZCC is illustrated using a real time example.