Ware units measuring tool
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To develop an instrument to measure organizational attributes relevant for family practices using the perspectives of clinicians, nurses, and staff.
A survey, designed to measure a practices' internal resources for change, for use in family medicine practices was created by a multidisciplinary panel of experts in primary care research and health care organizational performance. This survey was administered in a cross-sectional study to a sample of diverse practices participating in an intervention trial.
A factor analysis identified groups of questions relating to latent constructs of practices' internal resources for capacity to change. ANOVA methods were used to confirm that the factors differentiated practices. The factor analysis resulted in four stable and internally consistent factors.
A item questionnaire can reliably measure four important organizational attributes relevant to family practices. These attributes can be used both as outcome measures as well as important features for targeting system interventions. The impact of the work environment on clinical performance and outcomes is receiving renewed interest by health systems researchers, health care administrators, and policy makers IOM Committee on Quality of Health Care in America ; Shortell ; Shortell and Selberg A growing body of literature derived from research in large health care settings, such as hospitals and large multispecialty group practices, suggests that better health outcomes are associated with particular organizational attributes Shortell and LoGerfo ; Shortell , , ; Davies and Ware ; Shortell, O'Brien et al.
Similar studies within primary care have the potential to impact a broader spectrum of the American population. In a given year most Americans visit a primary care physician Benson and Marano , with more than a quarter of these visits to family medicine practices Woodwell Primary care practices, including family medicine, general internal medicine, and pediatric practices, are unique among health providers in that they must serve as the front line for large variety of health care needs, from prevention to identification of disease and illness to the treatment of ailments or referral to specialists.
To understand the impact of organizational attributes of primary care practices on delivery of patient care, one first needs to understand the attributes of these typically small medical providers and develop a method for measuring these attributes. A key element of a practice's ability to maintain and improve quality of care for their patients is their ability to adapt to the evolving understanding of medicine, to demands for enhanced clinical performance, and to changes in the larger health care management system.
While general models of change have been proposed Senge , ; Rogers , these models have typically not incorporated the features unique to primary care practices. One exception is the primary care change model recently described by Cohen et al. The model identifies clinician and staff characteristics, particularly their interrelationships, as important in distinguishing the between practices' abilities to improve their rates of delivery of prevention services.
Of the four elements described by Cohen et al. The resources for change element includes internal resources such as relationships among practice members, leadership and decision-making approaches, communication and perception of competing demands. Information management and management infrastructure, are also facets of the internal resources for change element.
Measurement tools exist for assessing important organizational attributes of larger health systems, such as hospitals Shortell ; Shortell et al. These attributes include: 1 leadership that engages a diversity of perspectives and shares critical information in order to enhance problem solving processes; 2 a culture that fosters openness, connectedness, and learning; 3 relationships that foster communication and collaboration; 4 management functions that describe presence of diverse structural components and processes such as fiscal, material, clinical, recognition, and feedback, and strategic planning; and 5 information mastery that includes the access and use of information that supports learning and problem solving activities Shortell et al.
The first three of these attributes, in particular, were also identified by Cohen et al. However, a systematic tool to measure these attributes in primary care practices has not been developed. Because these practices are much smaller and have much more limited resources than hospitals and other larger health systems, instruments for measuring attributes of larger health systems are not expected to describe and differentiate between primary care practices well.
As such, an instrument must be created specifically for use in the primary care practice. This study aims to develop an instrument to measure organizational attributes of primary care practices and to evaluate the measurement properties of this newly developed instrument. The instrument, intended to be a survey of clinicians, nurses and staff within the practice, seeks to measure some facets of resources for change, including relationships among practice members, leadership and decision-making approaches, communication, and perception of competing demands.
The other facets, specifically information management and management infrastructure, are thought to be better addressed at the practice level by one or two key members of the practice, for example the office manager or medical director. This instrument is developed based on the experience of investigators in family medicine, internal medicine, and pediatric practices; however, its use will be evaluated within family medicine practices.
It was hypothesized that this instrument's items would measure internal resources for change and be able to sort practices according to the strength of their available internal resources. To develop such a tool, the ULTRA team summarized existing data, reviewed existing instruments, and convened an expert panel.
With the model for practice change in mind, the research team reviewed published instruments that have been validated for measuring organizational performance in the hospital ICU Shortell et al.
While few of these had been applied in smaller practices, some of the items included in these instruments described the experiences of the research team in primary care practices. Additional items were pulled from an unpublished instrument developed to assess practice organization in a pilot project for the MacArthur Initiative on Depression and Primary Care and other projects.
The team culled through the items from each of these instruments to generate a list of approximately items focusing on concepts of communication, relationships, leadership, and decision making. A panel of experts convened in early for two, 2-day instrument development working sessions.
The panel initially reviewed the core concepts and sorted items accordingly. Obvious duplicates were removed and remaining items were checked to be sure the wording was appropriate for a primary care practice versus a larger health system. Questions were adapted or eliminated with the following goals: 1 the complete survey could be finished by practice employees in less than 15 minutes; 2 items accurately characterized small family practices; 3 items retained the original wording whenever possible; 4 items were clear and brief; 5 items addressed a single issue; and 6 wording of the items was simple enough to be comprehended by most clinicians, nurses, and office staff in family practice.
The questionnaires were distributed by the office manager at each practice and later returned to the office manager in sealed envelopes. Staff were reminded to complete and return the questionnaires. Initially, practices were mailed or faxed material about the study. Out of these, we were unable to speak directly with practice leadership in 85 practices, leaving 94 who were actively invited to participate through a phone or in-person conversation with practice leadership.
Out of these 94, 61 65 percent were consented. Out of the 61 who consented, seven practices withdrew from the study and three practices had not returned surveys at the time of this paper, leaving 51 for this analysis.
Of the 51 practices, six had 11 or more clinicians, six had seven to 10 clinicians, 19 had four to six clinicians, 19 had two to three clinicians, and seven had a single clinician. Weekly patient volume ranged from 12 practices that saw less than patients per week, to 19 with — patients per week, to 11 practices with — patients per week, and nine practices with more than patients per week. Six practices were located in an urban area, while 44 were suburban and one rural. Thirty-eight practices were owned by physicians, nine by a hospital health system, two by a university, one by a church, and one by a corporation.
Nine practices were owned by minority clinicians. On average 10 percent of patients were Hispanic, and 90 percent were non-Hispanic. Minority patient populations tended to be clustered in a few practices. For example, in one practice 80 percent of patients were Hispanic, yet in another practice only 1 percent of patients were Hispanic.
On average, 17 percent of patients seen in the practices were under age 17, 31 percent were ages 18 to 44, 30 percent were ages 45 to 65, and 22 percent were age 65 and older. Additionally, outliers were identified and the problem of missing data was assessed. Items with good variation across practice variation relative to the within-practice variation were identified.
A scree plot was used to identify the appropriate number of factors. Factor analysis with oblique varimax rotation, allowing for correlation between factors, was used to sort the items. Factor loadings of at least 0. The decision to include or eliminate individual items in a shortened version of the questionnaire weighed a number of considerations.
Note that if practices were homogeneous in terms of the proportion of office staff, nurses and other clinical staff answering the SOAPC, then methods that maximize the distance between groups of observations, such as canonical discriminant analysis, would have been appropriate. In this case, due to the heterogeneity of distributions of responders in each practice, it was better to treat each staff respondent as an individual observation in a factor analysis.
A practice score for each factor was created by averaging the scores for each individual staff member in that practice.
The score for an individual was the average of the items belonging to that factor. Thus, the practice scores range from 1 to 5. Means and variances of the practice scores for each factor were calculated to determine if the factors distinguished between practices.
Further, a correlation analysis studied the relationship between factor scores for each practice. Data in these analyses were collected from staff, including clinicians, nurses, and office staff, from 51 family practices, representing a response rate of 58 percent. Of physicians from the practices surveyed, We were unable to identify the roles of 25 staff members, of which 17 All except one of the returned questionnaires had at least 25 of the 28 questions answered.
The one questionnaire in which all of the questions were left blank was excluded from this analysis. Further, no one question was left blank by more than four individual respondents.
Listed along with each item Table 3 are the means, standard deviations, multiple correlations and initial factor loadings along the four dimensions. Multiple correlations ranged from 0. R 2 values that give rough description of the variation attributable to practice membership varied between 0. The scree plot indicated that a four-factor solution was appropriate.
Eigenvalues from the principle component analysis were 9. Factor loadings generally lead to straightforward assignment of items to factors. The only exceptions were items 24 and 25, which were cross-loaded with communication and decision making. The factor loadings for these items were also less than other loadings within these factors.
Thus, these items were eliminated. Items 22, 23, and 26 were removed from consideration as part of the remaining factors, because they did not load significantly with any factor.
Although item 27 had a significant factor loading, it had a somewhat lower multiple correlation which reflects the conceptual reality that it addressed leadership in a much different way than many of the other questions on leadership. Finally, although item 28 loaded significantly with chaos, it was eliminated because of its higher multiple correlation 0. The fourth factor, based on three items, was retained because it provided a meaningful measure of perceived change, which would be of particular use in distinguishing practices at the end of an intervention trial.
Correlations between the factors, when factors are measured on each individual employee and when factors are measured at the practice level, are given in the first and second rows, respectively, of each cell in Table 4. As anticipated, according to the perceptions of family physician practice employees, better communication and teamwork is associated with more participatory the decision making; more stressful and chaotic work environments are associated with less communication and with less participatory decision making.
First correlation in each cell measures relationships between factors when measured on individual subjects; second correlation measures association between practice level scores for each factor. Table 4 also presents percentiles and interquartile ranges of the practice scores. The interquartile range, the distance between the 25th and 75th percentiles, is much greater for communication and decision making than for the other two factors, indicating that the practices differ most on these factors.
Surprise and uncertainty are the norm in this rapidly changing landscape McDaniel et al. Many practices are faced with constant turnover of both clinicians and staff Ruhe et al. Thus, there is a critical need to monitor organizational performance of primary care practices and search for interventions and models of care that promote practices' capacity to thrive as demands on the practice are continually changing.
The factor labeled communication simply describes whether all members of the practice are able to work through problems as a team through discussion and consultation with one another. High scores indicate better communication. High scores on decision making indicate that within the practice there is a participatory approach to making decisions and that the leadership encourages input from all employees of the practice.
Explore PCE Instruments' selection of accurate, affordable thickness meter, coating thickness gauge, surface testing and film gauge devices used for automotive paint inspection, material testing and manufacturing quality control applications. A thickness meter is an essential quality assurance tool when anodizing, galvanizing and applying zinc coating to metallic surfaces. A thickness meter also is used to measure body paint thickness and uniformity on pre-owned cars, revealing repainted spots, identifying hidden damages and exposing undisclosed accidents.
The particular piece of glassware chosen in any situation will depend primarily upon two factors: the required volume and the accuracy required for the measurement. Beakers and Erlenmeyer flasks can be used to make coarse measurements of volumes, provided that graduated volume levels are printed on the side of the beaker or flask not all beakers and flasks have these marks. The volumetric flask, designed for greater precision, is typically accurate to within 0. Its uses include the preparation of solutions of known concentration.
GymAware is the leading tool to measure barbell performance, velocity and power.
This product is not in stock. An aluminum ruler that uses visual hierarchies of color and shape to articulate the process of measurement. Hye Jin and Allon have regular weekend meetings in the cafes around Stockholm. The cafe, like many public spaces, transforms into an impromptu workspace perfectly suited for the work at hand. Allon usually brings a book, a random pen, and some scrap paper. Hye Jin brings her notebook and her pens. During the week, they work together as part of a larger team of designers. On the weekends they collaborate and test out ideas on their own.
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A measuring instrument is a device for measuring a physical quantity. In the physical sciences , quality assurance , and engineering , measurement is the activity of obtaining and comparing physical quantities of real-world objects and events. Established standard objects and events are used as units , and the process of measurement gives a number relating the item under study and the referenced unit of measurement. Measuring instruments, and formal test methods which define the instrument's use, are the means by which these relations of numbers are obtained.
The NeoSpectra-Scanner is built around Si-Ware's award-winning NeoSpectra spectral sensor technology, with a wide spectral range for many applications. A market-ready tool for resellers, it is expected to help drive on-site material analysis into a broad range of industries. The NeoSpectra-Scanner enables users to add on-site intelligence in their operations, instantly identifying and quantifying composition of materials used in farming, food processing, and industry. With the device's streamlined 5-step application development, resellers and direct users can quickly deploy the tool to the field for their market of choice.
Calibration is the process of evaluating and adjusting the precision and accuracy of measurement equipment. Proper calibration of an instrument allows people to have a safe working environment and produce valid data for future reference. Calibration refers to the act of evaluating and adjusting the precision and accuracy of measurement equipment. Instrument calibration is intended to eliminate or reduce bias in an instrument's readings over a range for all continuous values.
Using Eggware sensory observations can be added to the standard egg quality tests, such as blood spots, meat spots, odour and yolk colour if the TSS colorimeter is not used. The reflectometer is used to measure shell colour the uniformity of which is perceived by many consumers as an indication of overall egg quality. Indeed so important has this trait become that many retailers now insist that eggs supplied to them have a specific depth of colour. Results expressed in a world standard form, can be displayed on the instrument itself or on the microprocessor. Calibration takes less than a minute.
For many years we are supplying hand held Pyrometers for the quick and easy measurement of glass mould temperatures. As an option the unit can be equipped with an interface for the PC or Laptop which allows the user to transfer easily and quickly all measurements from the device into the software Microsoft EXCEL. Especially if a glass plants operates several pyrometers it is important to ensure that all devices show identical temperature readings. In addition, the natural aging of the fiberoptic probes can be compensated by regular calibration of the devices.
Q: Is RockWorks industry-specific? A: RockWorks was designed with numerous geological industries in mind: environmental, geotechnical, petroleum, and mining to name a few. It offers many generalized subsurface visualization and modeling tools, as well as some that are more industry-specific. Shallow environmental data lends itself to lithology modeling, while deep petroleum wells will focus on stratigraphic layers.
Designed and produced in Australia, GymAware is used by elite sporting teams and institutions internationally. GymAware has the worlds largest repository of strength related data - for over 15yrs coaches have been benefiting from the features of the GymAware Cloud. GymAware has been validated by the Australian Institute of Sport and is extensively used in research papers worldwide. Use velocity to determine load, optimize and individualize your athletes strength training.
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A tape measure or measuring tape is a flexible ruler used to measure distance. It consists of a ribbon of cloth, plastic, fibre glass, or metal strip with linear-measurement markings. It is a common measuring tool. Its design allows for a measure of great length to be easily carried in pocket or toolkit and permits one to measure around curves or corners. Today it is ubiquitous, even appearing in miniature form as a keychain fob , or novelty item. There are two basic types of tape measures with cases, spring return pocket tape measures and long tape measures.
Information you need to know before using the software Essential reading. Be aware of the following points listed below. This software is freeware.