Quality prioritising

For improved quality of care in the elderly we must first define and measure the problem and the magnitude of the problem. We must also prioritise between problems and select the most important issue. Of course the aim must be improvement for the individual patient. But since quality in healthcare normally is complicated and multifactorial a systematic change in structures and processes is required. 

The recommendations for chemicals prioritised for risk-reduction measures correspond to the current proposal for the new EU-legislation, REACH, and also to the environmental quality objective a Non Toxic Environment adopted by the Swedish parliament. The tool is also appreciated by companies and organisations outside Sweden, as a source of knowledge or inspiration. This tool may be used and further developed by Asian ASEM countries to suit their chemicals management needs. 

The primary task of SCHER is to review Risk Assessment Reports established according to the regulation on evaluation and control of risks of existing substances (EEC 1993). These reports evaluate the risks of prioritised substances, and they are drafted by member state rapporteurs and decided on through comitology procedures. The job of SCHER is to review the scientific quality of these reports, particularly with regard to how they specify risks to public health, consumers and the environment. The committee put together its review in an opinion , which basically clarifies what it considers to be the health and environmental risks of the substance under study. Opinions also discuss the level and conditions of scientific uncertainty as well as whether and, if so, what further research is called for. The Commission may also ask SCHER for advice on other specific issues, even if there is no RAR to review. 

It is necessary to highlight the effects of aerosols and other chemical species on meteorological parameters, which have many different pathways (direct, semi-direct, and indirect effects, etc.) and they have to be prioritised and considered in on-line coupled modelling systems. Sensitivity studies are needed to understand the relative importance of different feedback mechanisms for different species and conditions relevant to air quality and climate interactions. A concerted action to mobilise and coordinate research in this area is needed. 

Heat demands are covered by a prioritised succession of options first solar collectors, then heat stores and finally electric heating by heat pumps (which in areas with district heating lines may be placed centrally, for maximum efficiency). High-quality energy demands are first covered by direct renewable electricity and then by hydrogen (or methanol) or electricity regenerated from... 

Step 5 (Prioritise Measures) If several factors are found to be responsible for the observed effect, priorities have to be set. Considerations include the likely effectiveness and feasibility (including cost) of the planned measures. One must also investigate whether measures to improve one quality element are likely to adversely affect another (for instance, reducing the amount of nutrients in Lake IJssehneer would lead to lower fish production). 

In order to enhance the use of risk analysis results as a safety optimisation aid, and to extend prioritisation and resource allocation to cover also impact of manufacturing and operational factors, it has been proposed [Wright Peltonen 92] that the dynamic impact of these quality related "Risk Influencing Factors" should be considered in support of resource allocation during Safety Risk Management. 

For the first time, the analysis prioritised the quality of the commercial product (train or aircraft safety) rather than the site where it is designed and produced. The approach had become decentralised to encompass both design and use. Safety problems within the factory became secondary problems relating to product use and product quality were the priority. 

The IHT guidelines describe how Road Safety Audits may be carried out on local streets in relation to advice given in Manual for Streets. In this case, it is recommended that Road Safety Audits should be carried out as part of a comprehensive quality audit. The use of risk assessments is also suggested for schemes in local streets as a way of prioritising the safety issues identihed, and a methodology for such assessments is included. 

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