Enhancing patient flow in emergency department (ED) using lean strategies–an integrated voice of customer and voice of process perspective

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ali Alowad ◽  
Premaratne Samaranayake ◽  
Kazi Ahsan ◽  
Hisham Alidrisi ◽  
Azharul Karim
Keyword(s):  
Waiting Time ◽  
Emergency Services ◽  
Single Case ◽  
Patient Flow ◽  
Waiting Times ◽  
Small Sample ◽  
Content Type ◽  
Lean Tools ◽  
And Performance ◽  
Voice Of Customer

PurposeThe purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.Design/methodology/approachA survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.FindingsThe results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.Research limitations/implicationsThe research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.Originality/valueThis research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

Using Lean tools to reduce patient waiting time

2018 ◽  
Vol 31 (3) ◽  
pp. 343-351 ◽  
Author(s):  
Luciana Teixeira Lot ◽  
Alice Sarantopoulos ◽  
Li Li Min ◽  
Simone Reges Perales ◽  
Ilka de Fatima Santana Ferreira Boin ◽  
...  
Keyword(s):  
Health Care ◽  
Waiting Time ◽  
Patient Flow ◽  
Good Practice ◽  
Value Added ◽  
Research Strategy ◽  
Social Needs ◽  
Public Health Services ◽  
Content Type ◽  
Lean Tools

Purpose This paper aims to address problems in patient flow and identify the reasons behind extensive wait time at a public liver transplant outpatient clinic in an education and research hospital through the use of Lean health-care theories. Design/methodology/approach This paper opted for the application of Lean thinking and action research strategy. Data were collected through personal observations, interviews with users and team brainstorming. A value stream map was developed, improvement possibilities were identified and non-value-added activities were attempted to be eliminated. Findings Significant problems were identified and improvements were implemented and measured. The major remedial measures were: change the scheduling pattern, create a flow chart and a Kanban visual guide for medical students. In addition, an institutional change in the medical appointment scheduling software collaborated in the reduction of time and in the patient’s displacement. The waiting time was reduced by 4.5 h, and the per cent complete and accurate increased by 50 per cent. Practical implications The flow was redesigned, and a culture of continuous improvement was introduced. Visiting the place where work was being done, leaders identified and created more value to the process without significant costs. The Gemba Walk was a powerful tool, interacting with people and processes in a Kaizen spirit. Originality/value Public health services in developing countries are one of the most deprived social needs of good practice. It will be useful for those who need examples about how to apply Lean tools in health care.

scholarly journals Waiting time in public hospitals: case study of total joint replacement in Hong Kong

2018 ◽  
Vol 21 (2) ◽  
pp. 120-133 ◽  
Author(s):  
Yee-man Tsui ◽  
Ben Y.F. Fong
Keyword(s):  
Hong Kong ◽  
Waiting Time ◽  
Joint Replacement ◽  
Process Management ◽  
Emergency Services ◽  
Total Joint Replacement ◽  
Care Quality ◽  
Public Hospitals ◽  
Content Type

Purpose The purpose of this paper is to review the causes of long waiting time in Hong Kong public hospitals and to suggest solutions in the service, organisational, systems, financial and policy perspectives. Design/methodology/approach The paper is a review of waiting time of public hospital services. Total joint replacement, which is one of the elective surgeries in public hospitals, is presented as a case study. Findings The average waiting time of semi-urgent and non-urgent patients in the accident and emergency departments of public hospitals is two hours, and that of specialist outpatient (SOP) clinics is from 1 to 144 weeks. For total joint replacement, it is from 36 to 110 months. Measures like Government subsidisation programme for the replacement surgery and employing adequate physiotherapists, Chinese medicine practitioners, clinical psychologists and nurses to reduce the waiting time are suggested. Issues concerning the healthcare system of Hong Kong, such as structural reform, service delivery model, primary care, quality and process management, and policy reviews, are also discussed. Originality/value The ‬over-reliance of public services has resulted in long waiting time in public hospitals in Hong Kong, particularly in the emergency services and SOP clinics. However, the consequences of long waiting period for surgical operations, though much less discussed by the media and public, can be potentially detrimental to the patients and families, and may result in more burdens to the already stretched public hospitals‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

scholarly journals How performance measurement influences stakeholders in not-for-profit organizations

2017 ◽  
Vol 37 (9) ◽  
pp. 1164-1184 ◽  
Author(s):  
Haley Allison Beer ◽  
Pietro Micheli
Keyword(s):  
Performance Measurement ◽  
Single Case ◽  
Institutional Logics ◽  
Performance Goals ◽  
Content Type ◽  
For Profit ◽  
Not For Profit ◽  
And Performance ◽  
The Uk

Purpose The purpose of this paper is to examine the influences of performance measurement (PM) on not-for-profit (NFP) organizations’ stakeholders by studying how PM practices interact with understandings of legitimate performance goals. This study invokes institutional logics theory to explain interactions between PM and stakeholders. Design/methodology/approach An in-depth case study is conducted in a large NFP organization in the UK. Managers, employees, and external partners are interviewed and observed, and performance-related documents analyzed. Findings Both stakeholders and PM practices are found to have dominant institutional logics that portray certain goals as legitimate. PM practices can reinforce, reconcile, or inhibit stakeholders’ understandings and propensity to act toward goals, depending on the extent to which practices share the dominant logic of the stakeholders they interact with. Research limitations/implications A theoretical framework is proposed for how PM practices first interact with stakeholders at a cognitive level and second influence action. This research is based on a single case study, which limits generalizability of findings; however, results may be transferable to other environments where PM is aimed at balancing competing stakeholder objectives and organizational priorities. Practical implications PM affects the experience of stakeholders by interacting with their understanding of legitimate performance goals. PM systems should be designed and implemented on the basis of both their formal ability to represent organizational aims and objectives, and their influence on stakeholders. Originality/value Findings advance PM theory by offering an explanation for how PM influences attention and actions at an individual micro level.

scholarly journals Robust capacity planning for accident and emergency services

2020 ◽  
Vol 54 (6) ◽  
pp. 1757-1773
Author(s):  
Elvan Gökalp
Keyword(s):  
Capacity Planning ◽  
Emergency Services ◽  
Simulation Optimization ◽  
Patient Flow ◽  
Waiting Times ◽  
Model Parameters ◽  
Planning Problem ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
The Impact

Accident and emergency departments (A&E) are the first place of contact for urgent and complex patients. These departments are subject to uncertainties due to the unplanned patient arrivals. After arrival to an A&E, patients are categorized by a triage nurse based on the urgency. The performance of an A&E is measured based on the number of patients waiting for more than a certain time to be treated. Due to the uncertainties affecting the patient flow, finding the optimum staff capacities while ensuring the performance targets is a complex problem. This paper proposes a robust-optimization based approximation for the patient waiting times in an A&E. We also develop a simulation optimization heuristic to solve this capacity planning problem. The performance of the approximation approach is then compared with that of the simulation optimization heuristic. Finally, the impact of model parameters on the performances of two approaches is investigated. The experiments show that the proposed approximation results in good enough solutions.

Housing satisfaction in a traditional neighborhood of Izmit, Turkey

2019 ◽  
Vol 13 (2) ◽  
pp. 251-266
Author(s):  
Nevnihal Erdogan ◽  
Pınar Kisa Ovali ◽  
Özgur Kayapinar
Keyword(s):  
Active Role ◽  
Small Sample ◽  
Living Conditions ◽  
Equation Modeling ◽  
Housing Satisfaction ◽  
Content Type ◽  
Effective Strategies ◽  
Peripheral Areas ◽  
And Performance ◽  
The Relationship

Purpose The purpose of this paper was to investigate housing satisfaction in a traditional neighborhood of Izmit, Turkey. According to this purpose, it was investigated whether the perceived living conditions (PLC) were mediating the effect on participants’ general housing satisfaction caused by satisfaction with the perceived quality of facilities (FQP), satisfaction with performance of local authorities (LA), satisfaction with social relations (SR) and satisfaction with physical surrounding (PS) in the Topçular neighborhood of Izmit District in Kocaeli, Turkey. Design/methodology/approach According to the hypotheses developed within the framework of the theoretical model, by using structural equation modeling (SEM), first, the direct relations between the variables were tested (PLC → overall housing satisfaction (OHS); PS, SR, LA → PLC; FQP → LA), then the indirect relationships between the variables were analyzed with the mediated role of OHS (PS, SR, LA → OHS → PLC). Findings The results show that all factors affected the OHS through the PLC. In conclusion, as the living conditions of the individual living in the neighborhood improve, the conditions take an active role in the relationship between the OHS and the satisfaction with the other relevant factors in the neighborhood, namely, PS, SR and performance of LA. In this relationship, it is seen that the satisfaction with PS has a negative effect, while the satisfaction with SR and satisfaction with the performance of LA have positive effects. Research limitations/implications The study was applied only to Turkey’s Izmit Province. Research may also be applied to other cities apart from those in Turkey. A small sample was also used in the study. Reaching a wider sampling for SEM can lead to different results. Practical implications Planners and designers should consider satisfaction – including various factors involved in planning, designing and refurbishing the neighborhoods – as the most important design data. Social implications The results of this study show that living conditions had an active role in the relationship between OHS and certain factors in the neighborhood: satisfaction with PS, SR and performance of LA. This study offers a framework to LA such as policymakers and urban planners to develop relevant and effective strategies and to improve dissatisfactory conditions in new and peripheral areas. Originality/value The originality of the paper is based on revealing the factors affecting the housing satisfaction of people living in the province of Izmit. This study offers a framework to LA such as policymakers and urban planners to develop relevant and effective strategies and to improve dissatisfactory conditions in new and peripheral areas.

scholarly journals Service quality at the London 2012 games – a paralympics athletes survey

2016 ◽  
Vol 33 (2) ◽  
pp. 142-159 ◽  
Author(s):  
David Bamford ◽  
Benjamin Dehe
Keyword(s):  
Service Quality ◽  
Single Case ◽  
The Body ◽  
Evidence Based ◽  
Sporting Events ◽  
Defined Contribution ◽  
Content Type ◽  
London 2012 ◽  
And Performance ◽  
Mega Event

Purpose – The purpose of this paper is to report on aspects of service quality at the London 2012 Paralympic Games, from a rather unusual perspective, the athletes. To date there has been little evidence captured about athlete’s satisfaction at sporting events, and specifically about their perceptions of the service quality provided. Design/methodology/approach – Unique “full” access to the London 2012 Paralympics allowed to the collection of data directly from the athletes. The study reports the questionnaire findings from a sample of 250 respondents. Findings – From this study an operational assessment and performance framework has been generated composed of ten criteria and 73 items or sub-criteria, which can be used as a benchmarking tool to plane, design and compare future sport mega-event. Moreover, the study evidence based the high quality of the 2012 Paralympics Games, as he athletes rated, on a five point Likert scale, 64 items in the “very satisfied” category, a very positive set of feedback for the Games organisers. Research limitations/implications – The methodology applied was appropriate, generating data to facilitate discussion and draw specific conclusions from. A perceived limitation is the single case approach; however, this can be enough to add to the body of knowledge where very little evidence has been captured so far and where the objectives were to explore the Paralympics games service quality and performance. Practical implications – This research provides a tangible evidence base to support future sport event decision makers, planners and designers in this highly complex “arena”. In any system there are always areas for improvement, these are highlighted within the paper for further investigation. Originality/value – This is the first paper to identify and synthesize aspects of sport mega event service quality from the athletes viewpoint and informs how well designed, organised and managed the London 2012 Games were from a primary user perspective. The paper makes a defined contribution by developing evidence based recommendations for this important yet under researched area.

The mediating effect of strategy on entrepreneurial orientation and performance

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Yuli Budiati ◽  
Wisnu Untoro ◽  
Lilik Wahyudi ◽  
Mugi Harsono
Keyword(s):  
Entrepreneurial Orientation ◽  
Waiting Times ◽  
Partial Least Square ◽  
Least Square ◽  
Mediating Effect ◽  
Market Development ◽  
Survey Method ◽  
Content Type ◽  
The Government ◽  
And Performance

Purpose This study aims to examine the effect of entrepreneurial orientation (EO) on performance and mediation differentiation strategies and market development in small and medium enterprises (SMEs). Design/methodology/approach This research was conducted using a survey method with a population of furniture SMEs in Jepara, Central Java, Indonesia using a sample area by collecting 158 questionnaires. The data analysis method used the partial least square. Findings The result shows that EO has an impact on differentiation, market development and performance. Differentiation strategies and market development mediate the influence of EO and performance. The differentiation strategy further mediates the influence of EO on market development and market development mediates the effect of differentiation on performance. Practical implications Managers instill entrepreneurial practice in the organization by proactively creating the market and taking high-risk jobs to provide quality products and services. SMEs require capabilities that are difficult to imitate in creating designs and product quality that are different, providing pre and post-sales services and maintaining good relationships with customers and partners. SMEs emphasize flexibility and speed of operation by adjusting the production process to short waiting times and reliable delivery. The government must support general training and market information, network development, access to capital and knowledge transfer. Originality/value This paper explains the importance of differentiation and market development strategies in determining the relationship between EO and performance that has not been explored in the context of SMEs in developing countries.

Improving process quality for pediatric emergency department

2014 ◽  
Vol 27 (4) ◽  
pp. 336-346 ◽  
Author(s):  
Byungjoon B.J. Kim ◽  
Theodore R. Delbridge ◽  
Dawn B. Kendrick
Keyword(s):  
Flow Control ◽  
Waiting Time ◽  
Pediatric Patients ◽  
Waiting Times ◽  
Discrete Event ◽  
Process Quality ◽  
Content Type ◽  
Arrival Times ◽  
Number Of Patients ◽  
Control Management

Purpose – Overcrowding in emergency departments (EDs) leads to longer waiting times and results in higher number of patients leaving the ED without being seen by a physician. EDs need to improve quality for patients’ waiting time and length of stay (LoS) from the perspective of process and flow control management. The paper aims to discuss these issues. Design/methodology/approach – The retrospective case study was performed using the computerized ED patient time logs from arrival to discharge between July 1, 2009 and June 30, 2010. Patients were divided into two groups either adult or pediatric with a cutoff age of 18. Patients’ characteristics were measured by arrival time periods, waiting times before being seen by a physician, total LoS and acuity levels. A discrete event simulation was applied to the comparison of quality performance measures. Findings – Statistically significant differences were found between the two groups in terms of arrival times, acuity levels, waiting time stratified for various arrival times and acuity levels. The process quality for pediatric patients could be improved by redesign of patient flow management and medical resource. Research limitations/implications – The results are limited to a case of one community and ED. This study did not analyze the characteristic of leaving the ED without being seen by a physician. Practical implications – Separation of pediatric patients from adult patients in an ED can reduce the waiting time before being seen by a physician and the total staying time in the ED for pediatric patients. It can also lessen the chances for pediatric patients to leave the ED without being seen by a physician. Originality/value – A process and flow control management scheme based on patient group characteristics may improve service quality and lead to a better patient satisfaction in ED.

Lean implementation in small- and medium-sized enterprises

2018 ◽  
Vol 25 (4) ◽  
pp. 1121-1147 ◽  
Author(s):  
Saumyaranjan Sahoo ◽  
Sudhir Yadav
Keyword(s):  
Lean Manufacturing ◽  
Management Practices ◽  
Practical Implication ◽  
Performance Criteria ◽  
Research Approach ◽  
Lean Implementation ◽  
Content Type ◽  
Positive Effects ◽  
Lean Tools ◽  
And Performance

Purpose The purpose of this paper is to examine the extent to which lean management practices are adopted by small- and medium-sized manufacturing organizations in India and their impact on firm’s operational performance (OP). Also, the paper makes an attempt to identify the barriers and challenges faced by Indian SMEs that are striving to succeed with improvement efforts based on lean manufacturing. Design/methodology/approach In this paper, acceptability and implementation of lean manufacturing in Indian Manufacturing SMEs were analyzed using three constructs, namely, process improvement (PI), flow management (FM) and waste minimization (WM). The responding firms were categorized into “lean-Beginners,” “In-transition lean” and “lean” group based on their phases of lean implementation. Using a survey questionnaire, data were collected from 121 manufacturing SMEs in India. Lean tools and barriers, identified from the literature review, were also included in the survey. The reliability and validity of the practice and performance measures were evaluated. Correlation analysis was employed to investigate the effects of three constructs on OP. Findings The results indicate that all the three lean constructs are significantly related to OP. In the context of Indian manufacturing SMEs, “PI” and “WM” practices have shown a higher level of significance on OP, compared to “FM” practices. “5S -workplace organization” was found to be the most practiced lean tool. “Attitude of workmen” was highlighted as the main obstacle in successfully implementing lean. The findings suggest overall positive effects as a result of applying lean tools and philosophy in Indian SMEs. Research limitations/implications The research results may lack qualitative justification because of the chosen research approach. Therefore, the researchers are encouraged to explore the inter-relationship among various lean tools/practices and performance criteria by conducting a qualitative study in the form of a case study or action research. Practical implications This paper is a beneficial source of information that highlights the contribution of lean implementation in enhancing manufacturing productivity. The major tools and techniques used by Indian SMEs have been highlighted and discussed; it could be a genuine source of motivation to lean practitioner and entrepreneurs of SMEs to go in for lean implementation. The findings are also expected to benefit the lean practitioners and entrepreneurs of SMEs to focus on vital issues to facilitate successful lean implementation in an organization. Originality/value The paper demonstrates that practical implication of lean implementation can bring real breakthroughs in productivity to small- and medium-scale manufacturing firms.

Driving acquisition performance: how much integration is enough?

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nitin Pangarkar
Keyword(s):  
Design Methodology ◽  
Small Sample ◽  
Key Factors ◽  
Acquisition Performance ◽  
Content Type ◽  
Managerial Resources ◽  
The World ◽  
And Performance ◽  
Practical Implications ◽  
Key Industry

Purpose This paper aims to develop a generalizable framework for acquisition performance. Design/methodology/approach This paper attempts to simulate a controlled experiment by examining the strategies and performance of the same acquired company under different acquirers. The inductive methodology is used to derive a generalizable framework about the key factors impacting the performance of the acquired firm. Findings This study finds that the acquired firm’s performance is better when the environment is munificent and the acquirer uses an appropriate level of integration. Several antecedents of each of these dimensions were identified. Research limitations/implications Because the inferences are based on a small sample, the study’s framework needs to be tested in other settings and possibly empirically tested in larger samples to improve its generalizability. Practical implications Every year, corporations around the world spend large sums of capital on acquisitions and significant managerial resources on integrating the acquired firms, with decidedly mixed results. The framework proposed in the paper can help managers to improve the performance of their acquisitions. Originality/value Unlike prior studies that have quantitatively analysed mixed samples of acquisitions and often arrived at inconclusive results, this study uses the inductive approach based on a few case studies to derive a framework that can be applied across industries. The framework accounts for the key industry and transaction-related contingent factors that can influence the performance of acquisitions under varied circumstances.

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