Process Improvement in Healthcare

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The internal and external customer focused process improvement and the performance analysis studies in healthcare systems

The internal and external customer focused process improvement and the performance analysis studies in healthcare systems

Design/methodology/approach: It is essential to define the system well in order to ensure that the working staff and patients use their time very efficiently and that the process flows continuously. By having examined a sample healthcare system through the help of a study addressed in such context, studies on process improvement in line with the dissatisfactions of the working staff and patients have been carried out. Within the scope of the study, the operation of 7 Departments in a dental hospital undergoing a treatment process have been reviewed and examined. The problems encountered as result of the observations made are discussed in detail, and formerly and recently designed system performance analyses are conducted by having performed the respective process improvement studies. The relevant samplings of this study are modeled via the Arena Simulation Program. The data of the previous four months is used in the parameters, which are used through the modellings. The system data are entered by taking into account seasonal characteristics of the data.
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“Advance and Continuous Process Improvement in Healthcare Industries: A Systematic Review” by V.D.Chaudhari, Ravindra R.P, India.

“Advance and Continuous Process Improvement in Healthcare Industries: A Systematic Review” by V.D.Chaudhari, Ravindra R.P, India.

Generally the term continuous improvement is broadly used for all improvement efforts including corrective actions and the ensuing preventive actions. In the regulatory background a distinction between corrective action and continuous improvement is necessary. Necessitate 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 quality decisions to avoid any adverse impact on patients. Innovation is different from continuous improvement as it is not a part of routine production operations and requires significant investment of resources and may require changes in production design and operation.
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Process flow improvement using value stream mapping to reduce waste and lead time in Malaysia healthcare

Process flow improvement using value stream mapping to reduce waste and lead time in Malaysia healthcare

Process improvement in healthcare should not be neglected by the management of healthcare organizations since inefficient and faulty of processes in healthcare are one of the main causes that can lead practitioners to make technical mistakes (Rebuge & Ferreira, 2012). In addition, Garland (2005) found that 15% of medical errors are due to human error while the balance of 85% is the result of flaws in processes and the overall healthcare system that obstructs individuals from performing their jobs. In other words, processes involved are the contributing factors to quality and performance as they affect the efficiency and outcomes of the entire system (Matthews, 2013). Lowe (2013) stated that everyone should rethink the way they work and make inevitable changes as they go on their daily tasks. Healthcare professionals will need a strategy or method to attain this aim while maintaining or improving their current level of care.
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Lean Healthcare Framework for Sri Lankan Healthcare Supply Chains: A Case Study of Teaching Hospitals

Lean Healthcare Framework for Sri Lankan Healthcare Supply Chains: A Case Study of Teaching Hospitals

Abstract This paper aims to show how lean six-sigma philosophy can be integrated to improve productivity of the patient care supply chains. Case study approach was used and three main hospitals in Sri Lanka were studied where the results can be generalized as applicable to other contexts. The main outcome of the research, lean six sigma process improvement framework was developed to address cost effectiveness, waste reduction and quality improvements in terms facilities, input resources and processes through blending lean six sigma best practices. Efforts to apply lean healthcare concept into different aspects of healthcare supply chain is rare in existing literature thus the paper fills the gap in the literature through addressing wide range of supply chain components.
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Design of Software Process Improvement Model

Design of Software Process Improvement Model

At the initial level (level 1), an organization can be characterized as having an ad hoc, or possibly chaotic, process. Typically, the organization operates without formalized procedures, cost estimates, and project plans. Even if formal project control procedures exist, there are no management mechanisms to ensure that they are followed. Tools are not well integrated with the process, nor are they uniformly applied. Change control is generally lax and senior management is not exposed to or does not understand the key software problems and issues. When projects do succeed, it is generally because of the heroic efforts of a dedicated team rather than the capability of the organization
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From the wider literature, Damanpour [15] defines innovation as the ‘generation, development, and implementation of new ideas or behaviours’. Furthermore, innovation is a means of changing an organisation and can be broadly defined to include types of innovations that might be new products or services, new process technologies, new organisational structures or administrative systems, or new plans or programs. [15] Gault, [16] proposed a general definition of four types of innovation. A product innovation is new or significantly changed with respect to its characteristics or intended uses. A production or delivery innovation is the implementation of new or significantly changed delivery or production processes. While marketing/communication innovations are the implementation of a new or changed method of promoting the products of the organisation. Finally, organisational innovations are new or changed methods in business practice, workplace organisation or external relationships.
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Current concept review: quality and process improvement in orthopedics

Current concept review: quality and process improvement in orthopedics

Abstract: Multiple health care stakeholders are increasingly scrutinizing musculoskeletal care to optimize quality and cost efficiency. This has led to greater emphasis on quality and process improvement. There is a robust set of business strategies that are increasingly being applied to health care delivery. These quality and process improvement tools (QPITs) have specific applications to segments of, or the entire episode of, patient care. In the rapidly changing health care world, it will behoove all orthopedic surgeons to have an understanding of the manner in which care delivery processes can be evaluated and improved. Many of the commonly used QPITs, including checklist initiatives, standardized clinical care pathways, lean methodol- ogy, six sigma strategies, and total quality management, embrace basic principles of quality improvement. These principles include focusing on outcomes, optimizing communication among health care team members, increasing process standardization, and decreasing process variation. This review summarizes the common QPITs, including how and when they might be employed to improve care delivery.
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Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

Depicting the interplay between organisational tiers in the use of a national quality registry to develop quality of care in Sweden

The structural characteristics differed between regions; while all stakeholders considered the NQRs an asset for local quality improvement, not all regions had structures and processes in place for the management of quality improvement using NQRs. Both regions A and B had initiated and performed large collaborative projects across tiers, securing a common stroke process for the hospitals within their regions. In region C, the politico- administrative management had recently initiated such efforts to better streamline the stroke care process. In regions A and B, clinical stakeholders had been engaged in these process projects led by politico-administrative representatives, and the politico-administrative represen- tatives suggested this would be the case for region C as well. For region D, stakeholders at all tiers described a lack of proper structures for quality management, and limited contact between tiers. Rather, the stroke unit in the main hospital within region D had improved the stroke care process some years ago, without involving the politico-administrative leadership, who had little insight in terms of clinical quality improvement projects. Further, the understanding of the structural character- istics for quality improvement within the stroke units was discussed in more detail by the physicians and RNs engaged in the local Riksstroke work compared to the politico-administrative stakeholders. More or less all healthcare provider level informants described the stroke care budgets as strained, and cited general difficulties in attracting and retaining medical and nursing staff specia- lised in stroke. While all eight stroke units in the four regions had allocated resources for the local Riksstroke work, the assignments of the clinical stakeholders varied. All clinical stakeholders described a responsibility for managing the registry and establishing high coverage, yet some also worked with compilation and communica- tion of data to fellow staff and managers. Whether or not this was done depended on how much time they had set aside, the individual’s interest in stroke care, and the interest of their fellow staff and managers. Meanwhile, stakeholders at stroke units within the same regions described differences in terms of internal collaboration. Further, the collaboration with and the interest of the politico-administrative level for stroke care and the out- comes of Riksstroke varied.
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Volume 2, Issue 1 (2016)

Volume 2, Issue 1 (2016)

In order to realize the objectives of the organization, first of all, they are required to have a healthy structure and proce ss. Gaining competitive advantage by a health care facility should be managed with scientific methods in addition to providing good service. Accurate, reliable and prompt data entry in the information systems is under the responsibility of the medical personnel in t he health institutions. This process causes heavy burden for doctors who work very busy and results in delays. It also ca uses completion time of works to increase and sometimes causes works not to be completed, economic losses, cause employee dissatisfaction and even losses of patients. This study will focus on the need of medical assistant in the success of Hospita l Information System. The conceptual framework was created in this context, literature search was made and process improvement example was presented for an IVF embryology laboratory process.
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Improvement of Product and Process Planning

Improvement of Product and Process Planning

Generative method is a highly effective technology for discrete manufacturers with a significant number of products and process steps. Rapid strides are being made to develop generative planning capabilities and incorporate CAPP into a computer integrated manufacturing architecture. The first step is the implementation of GT or FT classification and coding. Commercially available software tools currently exist to support both GT and CAPP. As a result, many companies can achieve the benefits of GT and CAPP with minimum cost and risks. Effective use of these tools can improve a manufacturer’s competitive advantage too.
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NHS England Always Events® program: Developing a national model for co-production

NHS England Always Events® program: Developing a national model for co-production

Healthcare providers have used several outcome measures to assess if their Always Events have had the predicted impact on patient/service user experience. Positive impacts have been demonstrated in some organizations. For example, Lancashire Care used follow-up calls with service users two weeks after discharge from the service to determine impact. The call was conducted to understand the service user’s experience of being discharged and to measure the impact of their Always Event activities by asking five questions (developed by the co-design group). Results from this telephone survey showed that more than 80% of people responded positively to the questions about their discharge, thereby achieving the threshold set in their aim statement (Figure 4). Positive impacts on the service users involved in co-producing the changes at Lancashire Care were also evident:
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Language games and quality improvement in healthcare in England

Language games and quality improvement in healthcare in England

The picture that thus begins to emerge is one of complexity, nuance, varied perceptions and sometimes contradictions; a recognition that different inspectors have particular personalities, and may have different views and make different judgements; where informal feedback sometimes seems at odds with final feedback [23] – an observation noted too by the House of Commons Committee of Public Accounts [33]. Some methods that the CQC uses (e.g. patient questionnaires) may not be sensitive to local circumstances [33], and particular terms used in the inspection report may send out misleading messages (i.e. have different meanings to those intended) to local media and patients [21]. Even when an inspection leads to an overall rating of ‘Inadequate’, there can be certain services rated as good or where “most patients were positive about the care that they had received from staff and the way they had their treatment explained to them” [25], and where “feedback from survey results showed high levels of satisfaction by patients and relatives with most of the services provided” [25]. It is also useful to highlight that, in spite of recent changes to the inspection model, the mission and purpose of the CQC in general, and of inspection in particular, are, perhaps necessarily, complex. All this is a long way from any simplistic interpretation of ‘quality in healthcare’, which can be inspected and assessed from some exterior, neutral standpoint to arrive at definitive ratings. It would seem, as Maxwell noted over 20 years ago, and as noted again more recently, that quality in healthcare is indeed “multidimensional” [43, 44].
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Improvement on Thixocasting and Rehocasting Process: A Review

Improvement on Thixocasting and Rehocasting Process: A Review

In the year 1825 Aluminium was discovered by a Denmark scientist Mr. Hans, by chemical process [1] and in 1876, the first Aluminium casting was produced by using sand moulds. By 2010, near about 33 plus different processes are available. From these processes most of the important commercially desirable process is “Conventional high pressure die-casting”, but it has some major drawbacks such as “air” and “gas blow holes”, “shrinkages”, “swirl”, “sink”, severe surface defects like “cold shuts” and many more[2,3]. Due to these defects we are unable to weld and heat-treat to enhance the mechanical properties of the castings. To overcome these defects, use of SSM casting process, eliminate all defects and increases the casting strength. Thus minimum wall thickness has been achieved from 6 mm (sand casting) to 0.8 mm in the Vacuum die-castings and still upto 0.5 mm [4].
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SPI assessment retrospective: evaluating long-term benefits for small firms

SPI assessment retrospective: evaluating long-term benefits for small firms

The need for a more formalised testing process was identified as a major issue at the initial assessment, and treated as a high priority in the recommendations. The firm employed a tester to develop test cases and record test logs in a MS Access database, but this person was gradually diverted to a technical support role and has since left the firm. Rational Robot (test automation tool) was implemented for regression testing and as a first step towards using the Rational Rose suite. Staff attended Rational Robot training in Sydney, and a test suite was developed for the core product. After this, the firm decided to develop a new version of the core product to provide a new ‘look and feel’, using components to give themes capability to the product. When themes were added, every single form in the project had changed its reference. Consequently, the regression tests no longer functioned, as the objects sought were no longer referenced in the same way. After adding the themes capability, the developers also found some problems with Rational Robot not correctly recognising the state of some of the properties, causing more time to be spent in investigating incorrect test results. Management decided it was not worth the cost to build a new suite of regression tests in Rational Robot, and the ongoing costs to maintain a licence for the product were not justified and so the firm discontinued its use.
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Application of Continuous Improvement Process in Manufacturing Industry

Application of Continuous Improvement Process in Manufacturing Industry

The continuous improvement main process are kaizen,5s,PDSA cycle, Lean,Kanban,Value stream mapping, Standard work, DMAIC,Catch ball,Gemba walks, Hoshin kanri and Jurans trilogy. It’s all based on similar principles and forms a key part of both of those practices. Continuous improvement is largely practiced using two disciplines; incremental and breakthrough improvements. The way of working enables efficient workflows that save time and money, allowing you to reduce wasted time and effort. Nowadays companies around the world face new challenges day by day; globalization has increased competition among them and eliminates. Kaizen is a compound of two Japanese words that together translate as “good change” or
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Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare

Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare

Some items show quite high floor/ceiling effects. Nor- mally this indicates that the scales are too narrow to sepa- rate extremes [14]. The possibility to tell something about those extremes doesn’t exist, and the variation of the scale is therefore often found to be too narrow, the variation too limited. In this kind of questionnaire, however, this must not be seen as a problem. If more than 50% of the respon- dents stated that the leaders trust the team members, this must be considered positive. Probably (and hopefully), a broader scale would not have changed that statement. Another problem is the zeros: if the scale is not fully used, the scale can not be considered a “five-point scale”. Perhaps the variation would not have been greater using a scale with more alternatives. The zeros in the endpoints can not be more then “Absolutely” in the scale ends. Then, one can argue, is there a need to measure if the majority is that positive? This questionnaire is to be used to measure the processes, repeated during the improvement program, and perhaps (and hopefully) some more differen- tiation will be shown over time. Another possible explanation may be the small sample size. The scales are different, and in some cases the questionnaire probably would have benefited from more consistent scales, although Strainer and Norman argue that it is
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Improvement of Equality in the Distribution of Human Resources in Polish Healthcare

Improvement of Equality in the Distribution of Human Resources in Polish Healthcare

The results showed that the geographical distribution of all types of human resources and and specialists in various fields of medicine is less equitable then in case of population distribution. It implies there is ready access to healthcare in all regions, whilst the coefficients by geographical area apparently indicate inequality, which means that the equality of Poland's demographically assessed distribution of health care resources is greater than that of its geographically measured distribution. It can be also found out in research conducted in other country (e.g. 27,29]). This could be the result of the sparsity of population. Probably, most of the Polish health care resources are distributed within the developed provinces, especially in large cities developing provinces, fewer health care resources are allocated. The problem, however, requires further analysis, which should be expanded by including for example the analysis of the availability based on actual consumption of health care services provided by the above human resources.
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Documentation framework for healthcare simulation quality improvement activities

Documentation framework for healthcare simulation quality improvement activities

Medical simulation methodology is increasingly being uti- lised beyond the traditions of education to evaluate patient care workflows, processes, and systems within the health context. A literature review of healthcare facility testing showed that individual clinical departments and singular patient flow processes had been tested under a variety of simulated conditions, such as virtual environments, table top exercises, and live simulation exercises. Each method demonstrated strengths and weaknesses in finding active or latent system failures [1–4]. With the building of our new healthcare facility, it was decided that live (physical) testing of the environment using a medical simulation methodology was the best approach to bridge the gap from architectural plans, to real-world efficient and effective patient care, and for orientation and training of teams to their new environment [4–7]. Although the hos- pital had yet to open, testing the systems under immersive simulated conditions at the point of care delivery effect- ively replicated real-world workflows and systems [1, 6]. Within Australia, two new hospitals reported using med- ical simulation to test specific clinical scenarios and pa- tient flow journeys prior to service delivery. Unfortunately in both instances, testing beyond the first round did not occur due to funding and human resource limitations. This led to considerable staff workarounds, rectification of process errors after commencement of patient care, and unfavourable media reports [8, 9].
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Productivity Improvement by Optimum Utilization of Plant Layout: A Case Study

Productivity Improvement by Optimum Utilization of Plant Layout: A Case Study

animals contributing 96% of total milk production of Country. But there are few problems faced by small and medium dairy industry. The paper is intended to study, understand the problems/issue faced by these small industry and its implementational study on small plants among those one to improve its efficiency and reliability. This research aims to improve the plant layout of milk industries to eliminate obstructions in material flow and thus obtain maximum productivity. The study of present plant layout, operation of process and material flow of each section w.r.t time provide idea to construct new optimized plant with rise in productivity.
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Coaching for recovery: a quality improvement project in mental healthcare

Coaching for recovery: a quality improvement project in mental healthcare

- The educational range in the group was very wide; several students had literacy issues or specific learning difficulties. Some students had no formal education qualifications whilst others had doctorate or professional qualifications. Coming from the healthcare sector we had not given this issue enough thought in our original design of the courses and materials. We were extremely grateful that students offered each other high levels of peer support both educationally and emotionally and that we had dedicated volunteers who could offer individual students one-to-one support. We were also extremely grateful for the fantastic input from adult education colleagues, who provided us with expertise and technical help. In two of the PDSA trials, adult education colleagues attended the college at lunchtime and their informal presence became a key route for many students to discuss how they mights access mainstream adult education classes. Adult education's continued input into the project as a part of the steering group, is also helping us to address the educational elements of the project
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