Browsing Open Access Journals by Subjects
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The influence of Georgia’s Quality Rated System on school readiness in pre-school childrenBackground: Georgia rates the quality of early childcare learning centers using a tiered quality improvement system. Georgia’s Quality Rated system (QR) designates a star level, (one star, two stars or three stars) to each center based on a portfolio of QR standards and an onsite assessment by Georgia Department of Early Care and Learning (DECAL). Childcare centers applying for QR status first submit a portfolio documenting how their practices align with QR standards centered on staff qualifications; child health, nutrition and physical activity; family engagement; holistic curricula and teacher-to-student ratios. Subsequently, an on-site assessment of the center is performed by DECAL using the Early Childhood Environment Rating Scale– Revised (ECERS-R). Methods: The Bracken School Readiness Assessment-3rd Edition (BSRA-3) was administered to children in various one-star (N=2), two-star (N=4) and three-star (N=6) childcare learning centers in Georgia. Children’s height and weight were recorded and BMI assessments were conducted. Results: Significant differences were found in school readiness scores based on quality rating with two and three star centers scoring higher than one star centers. Children in childcare centers at the one-star level (Mean = 95.00, SD = 16.80) performed lower than children in childcare centers at the two-star level (Mean = 103.67, SD = 16.55) and three-star level (Mean = 100.42, SD = 14.35). Multiple comparison tests did not reveal differences between two-star and three-star level centers. Conclusions: Higher levels of quality in QR childcare centers displayed more school readiness than centers with lower levels of quality. Future studies should examine differences in higher quality centers to further explore the influence of QR programs on school readiness.
Kaizen: Improving patient flowBackground: Since Cobb & Douglas Public Health (CDPH) achieved accreditation in May 2015, efforts to mature a culture of quality have been emphasized. In addition, the Adult Health Clinic moved to a new facility in Spring 2016. This move has improved many patient flow issues, but also has had unexpected consequences that spurred interest in doing several quality improvement (QI) projects. Methods: Rather than doing one QI project at a time, a kaizen event was held. Kaizen is a Japanese term for continuous improvement. This workshop allowed the Adult Health Team to plan seven QI projects and implement them simultaneously over the next several weeks. After the first six weeks of implementation, nearly 14 different projects were in various stages of the Plan-Do-Study-Act (PDSA) cycle. Baseline average patient flow for 1880 patient encounters was 75.11 minutes. Results: Results are still pending. Preliminary results reflect increased collaboration among clinic staff and an increase in staff members taking the initiative to make improvements. Employee morale has improved, and employee and customer satisfaction seems to be improved. Conclusions: The Adult Health Clinic used the LEAN methodology to reduce waste in the patient flow process and used the PDSA framework to structure their 14 QI projects. A kaizen event allows rapid improvements to be planned and implemented in a short period of time.
Screening for developmental delay in Georgia's family shelters: Formative evaluation of a quality improvement initiativeBackground: Children in families experiencing homelessness are at elevated risk for cognitive, motor, speech, and other developmental delays. Given the prevalence of family homelessness in Georgia and across the U.S., investigating the feasibility of implementing developmental screeners while families are in shelters is warranted. Methods: Three pilot shelters were selected for the development and implementation of Quality Improvement (QI) Teams, who used Plan-Do-Study-Act (PDSA) Cycles to make progress towards universally screening children for delay. We employed a formative evaluation to (1) characterize screening rates and shifts in shelter as a result of QI initiatives, and (2) identify barriers and facilitators to implementing QI interventions in family shelters. Results: Screening rates in all three shelters increased over the study period between 13-50%. Primary implementation facilitators included team members with experience in QI principles; having a medical provider on the team; possessing an “improvement culture;” and having diverse perspectives represented. Primary barriers included a lack of time or commitment in QI team leaders; medical providers with limited time in shelter; lack of training on how to represent and discuss QI data; and restrictive organizational policies. Conclusions: Family shelters demonstrate promise for implementing developmental screeners for at-risk children. Although challenges have been identified, facilitating factors are prevalent and underscore the importance of QI team preparation, composition, and cohesion. The relative availability, low-cost, and potential for impact of developmental screeners offer credence to their uptake and implementation within shelter clinical contexts.