Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

An Evaluation of Staff Preference for Graphic Characteristics

The purpose of the current study was to assess staff preference for how data were displayed on graphs. Specifically, preference for line versus bar graphs was assessed, as well as preference for data displayed as one date in time versus multiple dates showing performance trends. A secondary purpose of the study was to assess staff comprehension of the data presented across different graphic displays. Participants included 60 entry-level direct care staff and 25 seasoned therapists. Therapists had more advanced training in applied behavior analysis than the direct care staff. The vast majority of direct care staff preferred data depicted as a bar graph versus data depicted as a line graph, even preferring a single bar graph over a time-series line graph. The therapists preferred time-series line graphs to bar graphs. Most staff demonstrated understanding of the data, regardless of how it was depicted.     

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。     

多边贸易体制下中国发展中国家地位问题研究——基于历史、现实与规范的多维考察

当前,发展中国家地位问题受到国际社会的高度关注,已成为世界贸易组织改革中的主要讨论议题。然而,现行世界贸易组织多边规则体系中并没有关于“发展中国家地位”的清晰界定,“自我认定”的方式正遭受一些国家的挑战。发展中国家地位和特殊与差别待遇条款密切相关,世界贸易组织规则体系中涵盖的155项特殊与差别待遇条款为发展中国家的国内政策提供了一定的灵活性,尽管多数为“最佳努力条款”。中国的发展中国家地位兼具身份和契约的双重属性,部分发达国家迫使中国放弃发展中国家地位,本质上旨在继续维持其在国际经济秩序中的主导地位。虽然中国的发展正处于“强起来”的第三阶段,但仍须坚持发展中国家地位不动摇。放弃发展中国家地位并不等于将获得发达国家的自动接纳,相反,还会影响到在其他国际组织和国际事务中的角色扮演,中国的发展离不开广大发展中国家的支持。当然,坚持发展中国家地位并不等于需要和其他发展中成员享受完全一致的差别待遇,在后续谈判中,中国可以保持一定的灵活性。在国际治理中,中国也将继续为国际社会的发展提供解决方案,树立负责任大国形象。     

Transnational policy entrepreneurs and the cultivation of influence: individuals,organizations and their networks

ABSTRACT

The ‘policy entrepreneur’ concept arises from the Multiple Streams’ theory of agenda setting in Policy Studies. Through conceptual stretching’, the concept is extended to global policy dynamics. Unlike ‘advocacy networks’ and ‘norm entrepreneurs’, the discussion addresses the strategies of ‘insider’ or ‘near-governmental’ non-state actors. The analysis advances the policy entrepreneur concept in three directions. First, the discussion develops the transnational dimensions of this activity through a case study of International Crisis Group. Second, rather than focusing on charismatic individuals, the discussion emphasizes the importance of organizational resources and reputations for policy entrepreneurship and access into international policy communities. Organizations maintain momentum behind policy solutions and pressures for change over the long term when individuals retire or depart for other positions. Third, the discussion outlines four distinct entrepreneur strategies and techniques that both individuals and organizations cultivate and deploy to enhance their power and persuasion in global policy processes and politics.     

Creating Connections,Building Community: The Role of Oral History Collections in Documenting and Sharing Campus Diversity

Abstract

The collection and sharing of oral history is a growing area that libraries and archives are using to connect with their communities and document campus diversity. This column discusses opportunities for libraries and archives to include diverse and underrepresented voices in the historical record, highlighting the Wolf Tales project from the North Carolina State University Libraries, which was the topic of a talk by Virginia Ferris at the 2018 North Carolina Serials Conference. This column discusses that presentation and briefly examines oral history projects at several other institutions, providing perspective on the efforts to use oral histories to document campus and community diversity in the profession. Further resources for institutions interested in pursuing or growing oral history programs are also provided.     

Risk‐Cost‐Benefit Analysis for Transportation Corridors with Interval Uncertainties of Heterogeneous Data

Access management, which systematically limits opportunities for egress and ingress of vehicles to highway lanes, is critical to protect trillions of dollars of current investment in transportation. This article addresses allocating resources for access management with incomplete and partially relevant data on crash rates, travel speeds, and other factors. While access management can be effective to avoid crashes, reduce travel times, and increase route capacities, the literature suggests a need for performance metrics to guide investments in resource allocation across large corridor networks and several time horizons. In this article, we describe a quantitative decision model to support an access management program via risk‐cost‐benefit analysis under data uncertainties from diverse sources of data and expertise. The approach quantifies potential benefits, including safety improvement and travel time savings, and costs of access management through functional relationships of input parameters including crash rates, corridor access point densities, and traffic volumes. Parameter uncertainties, which vary across locales and experts, are addressed via numerical interval analyses. This approach is demonstrated at several geographic scales across 7,000 kilometers of highways in a geographic region and several subregions. The demonstration prioritizes route segments that would benefit from risk management, including (i) additional data or elicitation, (ii) right‐of‐way purchases, (iii) restriction or closing of access points, (iv) new alignments, (v) developer proffers, and (vi) etc. The approach ought to be of wide interest to analysts, planners, policymakers, and stakeholders who rely on heterogeneous data and expertise for risk management.     

论生态伦理及其内涵

有人认为生态伦理就是人际伦理的移用,就是把社会道德规范、原则简单移用到环境事务中来。这样来理解生态伦理是肤浅的,忽略了其质的规定性。其实,生态伦理就是指人类在关于自然环境、生态环境的实践活动中所形成的伦理关系及其调节原则,其内涵包括两个紧密联系的方面:首先,它表征的是一种客观的关系,即人与自然之间的道德关系;其次,它是用以调整相应的关系的积极手段,即生态道德。