Public Service Quality Improvement Strategy by Cirebon City Government Regarding the Granting of Trade-Business-License

This study aims to identify and analyze the strategy to improve trade business licensing (SIUP) services implemented by the Cirebon City Government. The research method used is the descriptive qualitative research method. Data was collected using interviews, observation, documentation, and online data searching techniques. The results of this study indicate that: 1. The quality of SIUP services has been running quite well but not optimal enough when viewed from the dimensions of reliability, physical evidence of service, responsiveness, assurance, and empathy. 2. To improve the quality of SIUP services, BPMPP and the Cirebon City government implement several strategies: core strategy, consequence strategy, customer strategy, control strategy, and cultural strategy. However, the customer strategy still needs to be reformulated because it has not shown satisfactory results. The conclusions of this study are: The quality of SIUP services is still not optimal. This is based on several indicators, e.g., first, In the dimension of reliability, has not been able to meet the timely issuance. Second, in terms of tangibles, the appearance of infrastructure and arrangement of licensing service rooms is quite good; Third, the assurance dimension has provided information certainty starting from the clarity of terms, procedures, and cost certainty.

The role of testing centers in the implementation of the Strategy-2030

Высокий уровень присутствия в обороте пищевой продукции некачественных и фальсифицированных продуктов питания определил необходимость разработки и внедрения государственной программы «Стратегия повышения качества пищевой продукции в Российской Федерации до 2030 года». При этом значительный акцент в Стратегии 2030 сделан на мониторинге качества пищевой продукции. В статье рассматриваются два возможных направления его реализации. Первое направление представляет собой ограниченный функционал мониторинга - определение качества пищевых продуктов, проводимое испытательными лабораториями (центрами), и передача данных (протоколов) в реестр информационной системы. Данное направление мониторинга ограничивает доступ некачественной продукции в торговый оборот, но при этом не позволяет влиять непосредственно на процесс повышения качества пищевой продукции в процессе производства. Второе направление предполагает непосредственное участие испытательных центров в управлении повышением качества продуктов на основе полученных результатов испытаний, разработки предложений по повышению качества продукции и передачи соответствующих документов производителю. Реализация данного направления подразумевает создание отраслевых центров мониторинга (ОЦМ) качества продукции на базе испытательных центров отраслевых институтов пищевого профиля в рамках Национального центра мониторинга качества пищевой продукции, создание которого является необходимым условием реализации Стратегии-2030. ОЦМ могут быть созданы на базе испытательных центров, обладающих достаточным потенциалом, в отличие от испытательных лабораторий с ограниченными возможностями. Оперативная связь ОЦМ с предприятиями в рамках мониторинга качества пищевой продукции не только сократит сроки реализации Стратегии-2030, но и позволит придать существенный импульс взаимодействию лабораторий НИИ с предприятиями пищевой отрасли страны. The high level of presence in the circulation of food products of poor quality and adulterated foods identified the need for the development and implementation of the state program «Quality Improvement Strategy of food products in the Russian Federation up to 2030». At the same time, a significant emphasis in Strategy-2030 is placed on monitoring the quality of food products. The article discusses two possible directions for its implementation. The first direction is limited monitoring functionality - determining the quality of foods, conducted testing laboratories (centers) and data transfer (protocols) in the register of information system. This monitoring direction restricts access of substandard products in the turnover, but it does not allow direct influence on the process of improving the quality of food products in the production process. The second direction involves the direct participation of test centers in the management of improving the quality of products based on the test results obtained, developing proposals for improving the quality of products and transferring the relevant documents to the manufacturer. The implementation of this direction implies the creation of a sectoral monitoring center (SMC) of product quality on the basis of testing centers of sectoral institutes of the food profile within the framework of the National Center for Monitoring Food Quality, the creation of which is a prerequisite for the implementation of the Strategy-2030. SMC can be created on the basis of testing centers with sufficient capacity, in contrast to testing laboratories with limited capabilities. SMC immediate connection with the companies within the food quality monitoring not only reduce the time implementation of the Strategy-2030, but will give a significant impetus to cooperation with the Research Institute laboratories enterprises of food industry of the country.

Strategy for Prevention and Quality Improvement of Urban Slumps Based on Community Empowerment

The purpose of this study was to examine the characteristics of slum areas and to analyze strategies for preventing and improving the quality of community empowerment-based slum settlements in Langara City, Konawe Islands Regency. This research method is descriptive qualitative with a case study approach, while the research informants are individuals and groups who are involved in the slum prevention and quality improvement program. The data were collected using in-depth interviews, observation, and document studies, while the data analysis techniques were carried out qualitatively. The results show that the indicators of a slum in Langara City are: the condition and quality of houses are generally less regular, dense, with minimal air and light circulation, environmental sanitation is not supported by wastewater disposal, access to settlements is relatively good, the garbage disposal system is not supported by landfills. Finally, limited distribution of net water, and the unavailability of fire protection. Furthermore, the strategy for preventing and improving the quality of slum based on community empowerment shows 1) slum prevention strategies with indicators: the high rate of community participation in attending counseling on the importance of maintaining environmental health and the high involvement of residents in preventing slums through cooperation, community service, and helping out; 2) slum quality improvement strategy with indicators: high capacity and community involvement in the renovation and restoration of slum shelters; and the low level of public awareness of joining the relocation program in slum pockets.

Understanding of Optimum Antibiotic Prophylaxis is Inconsistent Among Orthopaedic Surgery and Anesthesia Teams

Background Antibiotic surgical prophylaxis is a core strategy for the prevention of surgical site infections (SSI). Despite best practice guidelines and known efficacy of antibiotic prophylaxis in decreasing SSI risk, there is often wide variation in its use. We performed this study to assess antibiotic prophylaxis perspectives of orthopaedic surgery and anesthesiology teams at our institution regarding preoperative antibiotic choice, dosing, and timing.Methods An IRB approved questionnaire was distributed amongst orthopaedic surgery and anesthesia team members involved in preoperative antibiotic decision making from August 2017 to June 2019. The questionnaire addressed ten key practices relating to preoperative antibiotic use, including antibiotic choice, timing, rate of infusion, and dosing. Provider and service type responses were also compared using Chi-square tests. Results Two nurse practitioner (NP), 22 resident, and 23 attending orthopaedic surgery providers completed the survey. Twelve nurse anesthetist (CRNA), 6 resident, and 8 attending anesthesiology providers completed the survey. Only 30% of all providers agreed that both vancomycin and cefazolin are equally effective for the purpose of antibiotic prophylaxis. As for the antibiotic choice in patients with penicillin allergies, 50% agreed with vancomycin, 28% agreed with clindamycin, and 22% disagreed with both alternatives. Furthermore, resident physicians more frequently agreed with vancomycin (71%) compared to NPs (29%), and attendings physicians (35%) (p=0.014). A majority of providers agreed with the necessity of weight-based dosing and timely infusion of vancomycin.Conclusions There is no clear consensus amongst providers for which antibiotic to administer for antibiotic prophylaxis despite existing guidelines. Discrepancy exists between orthopaedic and anesthesia providers for which antibiotic to administer in patients with penicillin allergies. Institutions should evaluate antibiotic prophylaxis perspectives amongst their perioperative staff in order to identify any inconsistencies that could result in inappropriate antibiotic prophylaxis for patients. A multifactorial quality improvement strategy that includes development of a protocol, displaying prophylaxis guidelines in perioperative areas, educational training, a preoperative checklist, and optimizing the electronic medical record should be implemented to standardize prophylaxis practices. It is also integral to involve both the orthopaedic and the anesthesia staff in the quality improvement process otherwise discrepancies may continue to persist.

Algorithmic surveillance of ICU patients with acute respiratory distress syndrome (ASIC): protocol for a multicentre stepped-wedge cluster randomised quality improvement strategy

IntroductionThe acute respiratory distress syndrome (ARDS) is a highly relevant entity in critical care with mortality rates of 40%. Despite extensive scientific efforts, outcome-relevant therapeutic measures are still insufficiently practised at the bedside. Thus, there is a clear need to adhere to early diagnosis and sufficient therapy in ARDS, assuring lower mortality and multiple organ failure.Methods and analysisIn this quality improvement strategy (QIS), a decision support system as a mobile application (ASIC app), which uses available clinical real-time data, is implemented to support physicians in timely diagnosis and improvement of adherence to established guidelines in the treatment of ARDS. ASIC is conducted on 31 intensive care units (ICUs) at 8 German university hospitals. It is designed as a multicentre stepped-wedge cluster randomised QIS. ICUs are combined into 12 clusters which are randomised in 12 steps. After preparation (18 months) and a control phase of 8 months for all clusters, the first cluster enters a roll-in phase (3 months) that is followed by the actual QIS phase. The remaining clusters follow in month wise steps. The coprimary key performance indicators (KPIs) consist of the ARDS diagnostic rate and guideline adherence regarding lung-protective ventilation. Secondary KPIs include the prevalence of organ dysfunction within 28 days after diagnosis or ICU discharge, the treatment duration on ICU and the hospital mortality. Furthermore, the user acceptance and usability of new technologies in medicine are examined. To show improvements in healthcare of patients with ARDS, differences in primary and secondary KPIs between control phase and QIS will be tested.Ethics and disseminationEthical approval was obtained from the independent Ethics Committee (EC) at the RWTH Aachen Faculty of Medicine (local EC reference number: EK 102/19) and the respective data protection officer in March 2019. The results of the ASIC QIS will be presented at conferences and published in peer-reviewed journals.Trial registration numberDRKS00014330.