Continuous quality improvement impact

Shortell SM, Bennett CL, Byck GR, 1998. Assessing the impact of continuous quality improvement on clinical practice What it will take to accelerate progress. Mil-... 

Pharmaceutical outcome data are also used to improve the quality of care, identify potential problems, and improve patient outcomes. These data are often used within a continuous quality improvement (CQI) cycle, where rate-based performance measures are tracked over time and used in conjunction with control charts to show changes in quality and assess the impact of programs or changes in process. Information can be fed back to front line health care practitioners, areas for possible improvement identified, appropriate changes made, and reassessments initiated. 

The documentation that guides a preparation, called batch preparation instmction and batch preparation record, has two functions the documentation of aU operations to be carried out during the entire process (from weighing of ingredients to the release) and the traceability of all used materials, premises and equipment (see Sect. 33.4). It is possible to refer to the instructions and procedures available for the preparation concerned. Due to the potential impact on the quality of the product and the consequences for the quality control all deviations from the intended process and the conclusion must be recorded. As part of the continuous quality improvement, it is also useful to record suggestions for improving the preparation instructions on the preparation record (see Sect. 33.4). 

It is important that we enable and facilitate such developments in Europe to continue the improvement of its air quality. The new directions will improve our understanding of air quality in urban environments, allowing us to bring forward the best and most cost-effective abatement measures for minimising the significant impacts of urban air pollution. 

The issue of quality health care has become an increasing issue of concern in the face of cost constraints and limited access to health care. The President s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (32) states that the purpose of the health care system must be to continuously reduce the impact and burden of illness, injury and disability and to improve the health and functioning of the people of the U.S. According to the Commission, there are basic characteristics of health care that, as a nation, we should strive to achieve. The Commission has created Guiding Principles for the Consumer Bill of Rights and Responsibilities for the health care of people in the United States. These include the following ... 

It is, of course, important that the mechanical fuse is replaced after use, but this may be taken care of by periodic vehicle inspection and by having the bumper rattle after an impact. The problem of enforcement appears to be no more difficult than in the case of the electrical fuse. If we are to continue to improve the quality of life, it is important to eliminate waste associated with unnecessary design requirements and over restrictive construction codes. 

The pilot study is likely to use all the same Quality Management tools that were used for the integration framework development (Chapter 5). However, the limited scope of the pilot study enforces some limitations and compromises—it will not be possible to make changes outside of the department covered by the pilot. Any existing interfaces with other departments must remain the same. This will impact the design phases of the work. For example, Material Safety Data Sheets (MSDS) may currently be prepared locally, in the overall project it might be proposed to develop these centrally. However, for the pilot study it will not be possible develop the central resource so the pilot would have to continue to rely on local resources and there will be no efficiency improvement. 

Union Carbide (34) and in particular Dow adopted the continuous mass polymerization process. Credit goes to Dow (35) for improving the old BASF process in such a way that good quality impact-resistant polystyrenes became accessible. The result was that impact-resistant polystyrene outstripped unmodified crystal polystyrene. Today, some 60% of polystyrene is of the impact-resistant type. The technical improvement involved numerous details it was necessary to learn how to handle highly viscous polymer melts, how to construct reactors for optimum removal of the reaction heat, how to remove residual monomer and solvents, and how to convey and meter melts and mix them with auxiliaries (antioxidants, antistatics, mold-release agents and colorants). All this was necessary to obtain not only an efficiently operating process but also uniform quality products differentiated to meet the requirements of various fields of application. In the meantime this process has attained technical maturity over the years it has been modified a number of times (Shell in 1966 (36), BASF in 1968 (37), Granada Plastics in 1970 (38) and Monsanto in 1975 (39)) but the basic concept has been retained. 

The reduction in the lead content of gasoline and the introduction of reformulated gasoline have been very successful in reducing automobile emissions, due to changes in gasoline composition, with further improvements in fuel quality proposed for the early decades of this new millennium. These projections are accompanied by a noticeable and measurable decrease in crude oil quality, and the reformulated gasoline will help meet environmental regulations for emissions for liquid fuels but will be subject to continuous review because of the potential for environmental impact. 

Water pollution resulting from the production or use of detergents represents a typical case of the problems that followed the very rapid evolution of industrialization that contributed to the improvement of quality of life after World War II. Prior to that time, this problem did not exist. The continuing increase in consumption of detergents (in particular, their domestic use) and the tremendous increase in production of surfactants are the origin of a type of pollution whose most significant impact is the formation of toxic or nuisance foams in rivers, lakes, and treatment plants. 

Generally the term continuous improvement is broadly used for all improvement efforts including corrective actions and the ensuing preventive actions. In the regulatory setting a distinction between corrective action and continuous improvement is essential. Need for corrective actions occur when product quality characteristics are in question (e.g., out of specification). Such a situation can require urgent risk assessment and sound quality decisions to prevent any adverse impact on patients. 

Given the data challenges discussed previously and the increasing use of streamlined methods, it is necessary to continuously improve the consistency and transparency of the information and the assumptions used in such tools to ensure the quality and the validity of the decisions made with the aid of LGA metrics. The inclusion of quality indicators (such as sensitivity and uncertainty analysis) will continue to be an important step to estimate the uncertainties involved in the inventory and impact models. Finally, there is a need to continuously perform peer review assessments by LGA experts, as the current LGA expertise in pharmaceuticals is very limited. When these requirements are fulfilled, LGA metrics are powerful tools to aid the decision making leading to more sustainable pharmaceutical processes. For further examples of FLASG scores and other LGA analyzes being applied, see Section 10.4.1. 

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