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.     

The Role of Internal and External Complexity in Global Factory Performance: An NKC Application

The global factory literature suggests that MNCs can take advantage of global operations by extensively offshoring and outsourcing activities. However, the added difficulty for the lead firm to coordinate the resulting complex structure is often underestimated. Evidence could be found in Boeing's 787 Dreamliner project, in which the external complexity disrupted MNC performance. Motivated by the gap between theory and practice, this study focuses on systems of MNCs connected with each other with supplier-client relationships and/or outsourcing. In particular it investigates the interplay of the internal and external complexity in such systems and how their balance affects the system performance. The study models the internal and external complexity by using the NKC-simulation methodology and adjusting it to the specific MNC context. The NKC methodology is widely used in organization theory to study complex systems. Simulations comparing the performance of MNCs that use outsourcing to different degrees indicate that a balanced level of internal and external complexity is beneficial in the context of global factory.     

Maintaining Sexual Desire in Long-Term Relationships: A Systematic Review and Conceptual Model

The most universally experienced sexual response is sexual desire. Though research on this topic has increased in recent years, low and high desire are still problematized in clinical settings and the broader culture. However, despite knowledge that sexual desire ebbs and flows both within and between individuals, and that problems with sexual desire are strongly linked to problems with relationships, there is a critical gap in understanding the factors that contribute to maintaining sexual desire in the context of relationships. This article offers a systematic review of the literature to provide researchers, educators, clinicians, and the broader public with an overview and a conceptual model of nonclinical sexual desire in long-term relationships. First, we systematically identified peer-reviewed, English-language articles that focused on the maintenance of sexual desire in the context of nonclinical romantic relationships. Second, we reviewed a total of 64 articles that met inclusion criteria and synthesized them into factors using a socioecological framework categorized as individual, interpersonal, and societal in nature. These findings are used to build a conceptual model of maintaining sexual desire in long-term relationships. Finally, we discuss the limitations of the existing research and suggest clear directions for future research.     

The Times They are A’changing: Multigenerational Family Simulations

Multigenerational households are increasingly affecting both the individual and family as well as community organizations and social policies. Social work and other family studies students can profit from educational modalities that use adult learning applications through a systems life-course perspective, the whole family aging over time. Family simulation software—addressing multigenerational families, such as two or more adult generations living together—builds on a previous paper (Marriage & Family Review, Feb. 2015). Social class, among other demographic and environmental variables, is emphasized. Agent-based family social network simulation of multigenerational families can facilitate experiential learning. An automatically generated life events report, based on both factual data and specific family characteristics, can be used as a classroom case study for role playing and assessing.     

Relationship building and message planning: An exploration of media challenges and strategies used during school crises at the P-12 level

Schools at the P-12 level increasingly face crises related to school shootings, violence, and other tragedies. Understanding the communication challenges schools face is paramount to assisting schools with communication before, during, and after crisis events. The current study focuses on the challenges created by media interest in such crises and the strategies implemented to overcome these challenges and provide responsible information to stakeholders. Interviews conducted with 21 school crisis teams at the P-12 level revealed that sensationalism, seeking alternative routes to information, and framing were key challenges in working with the media. In light of these challenges, administrators focused on creating media plans, building relationships with the media, being accurate but guarded, and communicating reassurance and reunification. Implications are discussed for school districts nationally.     

Implementing School Based Youth Courts in a Rural Context: The Impact on Students’ Perceptions of School Climate,Individual Functioning,and Interpersonal Relationships

The Youth Court in Schools Project was implemented in two low-income, violent, racially/ethnically diverse rural counties. This study examined if the presence of Youth Court impacted students’ perceptions of school danger, individual functioning, and interpersonal relationships. Data were gathered from 3454 youth; following multiple imputation, data were analyzed using paired samples t tests. Results indicated that perceptions of school danger increased significantly and self-esteem decreased significantly in the control schools pretest to posttest. Violent behavior, anxiety, friend rejection, and bullying victimization decreased significantly in the Youth Court intervention schools pretest to posttest, but did not change significantly in the control schools. Findings provide preliminary evidence that Youth Court is an effective way of improving school climate, individual functioning, and interpersonal relationships.     

From Foster Care to Adoption and Guardianship: A Twenty-First Century Challenge

For nearly four decades, child welfare policy and practice have focused on the achievement of legal permanence for children in foster care. Although federal child welfare policy has resulted in the movement of children from state custody to legally permanent adoptive or guardianship families, little is known about the quality and enduring nature of these placements. A significant challenge of the twenty-first century child welfare system is how to ensure the well-being of children currently living with adoptive parents or guardians. This paper discusses child welfare policy and trends related to post-permanency well-being, including the decrease in Title IV-E foster care caseloads nationwide and the simultaneous increase in Title IV-E adoptive and guardianship caseloads. We highlight the needs of a twenty-first century child welfare system, including increased federal efforts to ensure child permanence and well-being after legal adoption or guardianship has been achieved, as well as more rigorous longitudinal and interdisciplinary research focused on the post-permanency adjustment of children and their families.     

The Influence of Career Planning on Career Thoughts in STEM‐Interested Undergraduates

Undergraduate career planning courses have shown efficacy in decreasing students’ negative career thoughts; however, universities have minimally applied these courses to science, technology, engineering, and math (STEM) populations. This study compared the influence of a STEM‐focused career planning course for undecided STEM students with a seminar course for decided STEM majors. An analysis of covariance with covariate adjustment revealed that undecided career planning students had lower adjusted mean scores on a measure of negative career thinking than the decided STEM majors after the first semester of college. The results provide support for the efficacy of STEM‐focused career planning courses and measuring negative career thoughts with STEM undergraduates.     

The ‘First Generation’ in Historical Perspective: Canadian Students in the 1960s

Over the past few years a number of studies have focused on the disadvantages confronted by students who are the first in their families to attend university. Their liabilities include relatively low levels of preparedness, a lack of involvement in campus activities, and low levels of academic achievement. Rather than accepting the universality of this characterization, in this article, these negative characteristics and experiences were viewed as one ‘ideal type.’ Using this ideal type as a reference point, the current study focused on a period in Canadian history in which first generation students were the norm. In an examination of Glendon College, York University, located in Toronto Canada, in the mid 1960s, it was found that the experiences of the first generation did not fit the ideal type. Those who likely were the first in their families to attend university were prepared for their studies, involved in campus activities, and earned good grades. Possible explanations for this deviation from the ideal type include the buoyancy of the economy in the mid-sixties, an expanding university sector, the size and relative intimacy of the College, the way in which high schools prepared students for university, and stringent admission requirements.     

THE USE OF AGGREGATE DATA TO ESTIMATE GOMPERTZ‐TYPE OLD‐AGE MORTALITY IN HETEROGENEOUS POPULATIONS

We consider two related aspects of the study of old‐age mortality. One is the estimation of a parameterized hazard function from grouped data, and the other is its possible deceleration at extreme old age owing to heterogeneity described by a mixture of distinct sub‐populations. The first is treated by half of a logistic transform, which is known to be free of discretization bias at older ages, and also preserves the increasing slope of the log hazard in the Gompertz case. It is assumed that data are available in the form published by official statistical agencies, that is, as aggregated frequencies in discrete time. Local polynomial modelling and weighted least squares are applied to cause‐of‐death mortality counts. The second, related, problem is to discover what conditions are necessary for population mortality to exhibit deceleration for a mixture of Gompertz sub‐populations. The general problem remains open but, in the case of three groups, we demonstrate that heterogeneity may be such that it is possible for a population to show decelerating mortality and then return to a Gompertz‐like increase at a later age. This implies that there are situations, depending on the extent of heterogeneity, in which there is at least one age interval in which the hazard function decreases before increasing again.