scholarly journals LEAN HEALTHCARE APPLICATION IN A SURGICAL PROCEDURES APPOINTMENT SCHEDULING CENTER IN A MATERNITY

2016 ◽  
Vol 13 (4) ◽  
pp. 452
Author(s):  
Rafael Paim ◽  
Amanda Costa ◽  
Jonathan De Carvalho ◽  
Inácio Araripe Costa Lima
Keyword(s):  
Action Research ◽  
Scientific Method ◽  
Working Condition ◽  
Appointment Scheduling ◽  
Theoretical Frameworks ◽  
Root Cause ◽  
Surgical Scheduling ◽  
Lean Healthcare ◽  
Before And After ◽  
Healthcare Application

The study aimed to apply Lean Healthcare concepts and tools in surgical scheduling process. The intention was to structure and implement an appointment-scheduling central that was able to manage more effectively the demand for elective obstetrical surgeries in a neonatal maternity. The study used action research as a scientific method in order to solve a problem encountered in scheduling procedures involving employees in a cooperative and participatory improvement initiative. The method used was based on literature review, benchmarking visits and studies to identify good practices, and on current working condition analysis and comparison of indicators before and after the intervention.  The Lean and TOC theoretical frameworks was used to improve the process, creating value for the patients and professionals, conducting root-cause analysis, identifying wastes and constrains, and proposing and implementing solutions. Using action research in the study and applying the concepts and tools was possible to reach different results as the 70% reduction in cancellations, the increase in the number of procedures scheduled in the units, and increased 97% level of appointment scheduling service among other results.

Wittgenstein’s philosophy and action research

2003 ◽  
Vol 8 (3) ◽  
pp. 295-301 ◽  
Author(s):  
John Shotter
Keyword(s):  
Action Research ◽  
Social Isolation ◽  
Scientific Method ◽  
Gain Control ◽  
Participatory Culture ◽  
Ordinary People ◽  
Making Sense ◽  
The Social ◽  
Professional Research ◽  
The Many

Three themes seem to be common to both Greenwood’s and Gustavsen’s accounts: One is the social isolation of professional [research] elites from the concerns of ordinary people, which connects with another: the privileging of theory over practice. Both of these are connected, however, with a third: the great, unresolved struggle of ordinary people to gain control over their own lives, to escape from schemes imposed on them by powerful elites, and to build a genuinely participatory culture. An understanding of Wittgenstein’s later philosophy, and the recognition of its striking differences from any previous philosophical works, can make some important contributions to all these issues. Wittgenstein’s aim is not, by the use of reason and argument, to establish any foundational principles to do with the nature of knowledge, perception, the structure of our world, scientific method, etc. Instead, he is concerned to inquire into the actual ways available to us of possibly making sense in the many different practical activities we share in our everyday lives together: “We are not seeking to discover anything entirely new, only what is already in plain view.”

scholarly journals Perbaikan Efisiensi Jalur Layanan Pasien Rumah Sakit dengan Menggunakan Pendekatan Lean Healthcare

2020 ◽  
Vol 3 (4) ◽  
pp. 509-521
Author(s):  
Wresni Anggraini ◽  
Anifah Naswan Ilhamda
Keyword(s):  
Value Added ◽  
Root Cause Analysis ◽  
Value Stream Mapping ◽  
Cause Analysis ◽  
Value Stream ◽  
Root Cause ◽  
Current State ◽  
Future State ◽  
Lean Healthcare ◽  
Cycle Efficiency

Standar pelayanan minimal rumah sakit tentang waktu tunggu untuk rawat jalan yang ditetapkan oleh Kemenkes Nomor. 129/Menkes/SK/II/2008 adalah tidak lebih dari 60 menit.  Masalah yang dihadapi oleh Poli Tulip Rumah Sakit X Pekanbaru adalah waktu menunggu pasien lebih dari 60 menit.  Tujuan dari penelitian ini adalah memberikan usulan perbaikan untuk mengurangi waktu tunggu pasien.. Metode yang digunakan pada penelitian ini adalah  lean healthcare menggunakan analisis Value Stream Mapping (VSM) untuk menentukan nilai Process Cycle Efficiency (PCE). Berdasarkan current state value stream mapping nilai PCE saat ini adalah 16,85%, ini berarti efisiensi lini pada Poli Tulip Rumah Sakit X Pekanbaru masih sangat rendah. Proses usulan perbaikan efisiensi lini dengan cara mengidentifikasi dan mengurangi non value added activity dan waste yang paling sering terjadi pada proses pelayanan pasien. Ditemukan waste yang berpengaruh menyebabkan waste delay adalah waste unnecessary movement dan lost oppurtunity to retain or win customers yaitu sebesar 22,11%. Untuk mencari akar penyebab waste dilakukan root cause analysis. Akar penyebab masalah dari waste yang terjadi di lini pelayanan pasien bersumber dari faktor individual pegawai dan manajerial Rumah Sakit. Simulasi future state value stream mapping dengan menggunakan ARENA dilakukan untuk menguji usulan perbaikan, didapatkan  nilai PCE harapan sebesar 36,18 %, yang berarti dengan usulan perbaikan yang diberikan telah meningkatkan efisiensi jalur layanan pasien di Poli Tulip sebesar 19,33%.

scholarly journals Students’ willingness to participate in speaking activities through the use of scripted role-plays

2019 ◽  
Vol 28 (2-2019) ◽  
pp. 71-89
Author(s):  
Jonathan Antonio Lara Castro ◽  
Claudio Díaz Larenas
Keyword(s):  
Social Skills ◽  
Action Research ◽  
Foreign Language ◽  
Role Play ◽  
Social Risk ◽  
Willingness To Participate ◽  
Seventh Grade ◽  
English Class ◽  
Language Class ◽  
Before And After

The following study is a result of an action research carried out in an English as a foreign language class in a subsidized Chilean school, where 77 % of its population is at social risk. 38 of the participants are seventh grade students. The study addresses students’ willingness to participate in speaking activities in English class before and after the implementation of a drama based pedagogy strategy known as scripted role-play. The students showed great commitment to scripted role-play as a way to learn English. Participants had the chance to work collaboratively with their peers in a safe and engaging environment, improving their social skills as they performed different roles. The study concludes that students are willing to participate in speaking activities after the use of scripted role-plays. This result is also coherent with the students’ perceptions of the intervention.

scholarly journals THE IMPLEMENTATION OF BUSINESS MODEL CANVAS (BMC) TO IMPROVE STUDENTS’ ENTREPRENEURSHIP MINDSET

2021 ◽  
Vol 2 (3) ◽  
pp. 395-403
Author(s):  
Anaseputri Jamira ◽  
Nur Agustiningsih ◽  
Yulita Febriani
Keyword(s):  
Action Research ◽  
Business Model ◽  
Research Method ◽  
Analysis Techniques ◽  
Business Model Canvas ◽  
Traditional Research ◽  
Before And After ◽  
Develop Theory ◽  
Level 2 ◽  
Descriptive Statistical Analysis

The purpose of this study is to understand the implementation Business Model Canvas (BMC) to improve students’ entrepreneurship mindset. There is a gap from previous researches that using traditional research which just focus to develop theory. Action Research gives appropriate approach to improve work or study situation effectively and efficiency. In each cycle in the Level 2 Action Research Method using descriptive statistical analysis techniques through a comparison of the average students' entrepreneurship mindset before and after the application of the BMC method. There are 84 students who participated in this research. The results show that the hypothesis which indicates the BMC method can increase the students' entrepreneurship mindset is empirically proven. The BMC method deserves to be introduced to students. Students have knowledge about how to start a business, and have the courage, ability to create, and innovate and have a high interest in starting a business.

scholarly journals Improving timely analgesia administration for musculoskeletal pain in the emergency department

2020 ◽  
Vol 9 (1) ◽  
pp. e000797
Author(s):  
Victoria Woolner ◽  
Reena Ahluwalia ◽  
Hilary Lum ◽  
Kevin Beane ◽  
Jackie Avelino ◽  
...  
Keyword(s):  
Medication Administration ◽  
Academic Hospital ◽  
Front Line ◽  
Statistical Process ◽  
Process Measures ◽  
Root Cause ◽  
Patient Complaints ◽  
Number Of Patients ◽  
Before And After ◽  
Medical Directives

Delays to adequate analgesia result in worse patient care, decreased patient and provider satisfaction and increased patient complaints. The leading presenting symptom to emergency departments (EDs) is pain, with approximately 34 000 such patients per year in our academic hospital ED and 3300 visits specific for musculoskeletal (MSK) injuries. Our aim was to reduce the time-to-analgesia (TTA; time from patient triage to receipt of analgesia) for patients with MSK pain in our ED by 55% (to under 60 min) in 9 months’ time (May 2018). Our outcome measures included mean TTA and ED length of stay (LOS). Process measures included rates of analgesia administration and of use of medical directives. We obtained weekly data capture for Statistical Process Control (SPC) charts, as well as Mann-Whitney U tests for before-and-after evaluation. We performed wide stakeholder engagement, root cause analyses and created a Pareto Diagram to inform Plan–Do–Study–Act (PDSA) cycles, which included: (1) nurse-initiated analgesia at triage; (2) a new triage documentation aid for medication administration; (3) a quick reference medical directive badge for nurses; and (4) weekly targeted feedback of the project’s progress at clinical team huddle. TTA decreased from 129 min (n=153) to 100 min (22.5%; n=87, p<0.05). Special cause variation was identified on the ED LOS SPC chart with nine values below the midline after the first PDSA. The number of patients that received any analgesia increased from 42% (n=372) to 47% (n=192; p=0.13) and those that received them via medical directives increased from 22% (n=154) to 44% (n=87; p<0.001). We achieved a significant reduction of TTA and an increased use of medical directives through front-line focused improvements.

scholarly journals LO86: Improving time to analgesia administration for musculoskeletal injuries in the emergency department.

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S39
Author(s):  
V. Woolner ◽  
R. Ahluwalia ◽  
H. Lum ◽  
K. Beane ◽  
J. De Leon ◽  
...  
Keyword(s):  
Medication Administration ◽  
Statistical Process ◽  
Process Measures ◽  
Pareto Chart ◽  
Root Cause ◽  
Included Patient ◽  
Number Of Patients ◽  
Before And After ◽  
Medical Directives ◽  
Clinician Assessment

Background: Greater than 80% of patient visits to emergency departments (EDs) are for a pain-related concerns. Approximately 38,000 patients per year have such complaints in our academic hospital ED. 3,300 (8.6%) of those visits are for musculoskeletal (MSK) pain (i.e. back or extremity injury/pain), which are typically triaged as low-acuity presentations, leading to longer times to clinician assessment. Delays to adequate analgesia result in unnecessary suffering, worse patient care and satisfaction, and increased patient complaints. Aim Statement: We aimed to reduce the time-to-analgesia (TTA; time from patient triage to receipt of analgesia) for patients with MSK pain in our ED by 55% (to under 60 minutes) in 9 months’ time (May 2018). Measures &amp; Design: Our outcome measures were TTA (in minutes) and ED length of stay (LOS; in minutes). Process measures included nurses’ use of medical directive and rate of analgesia administration. Balancing measures included patient adverse events and time spent triaging for nurses. We utilized weekly data capture for the Statistical Process Control (SPC) chart, and we used Mann-Whitney U test for our before-and-after evaluation. Utilizing the Model for Improvement, we performed wide stakeholder engagement and root cause analyses, and we created a Pareto chart. This led to our Plan-Do-Study-Act (PDSA) cycles: 1) nurse-initiated analgesia (NIA) at triage; 2) new triage documentation aid for medication administration; 3) quick reference medical directive badge tag for nurses; 4) weekly targeted feedback of the project's progress at clinical team huddle. Evaluation/Results: TTA decrease from 129 minutes (n = 153) to 100 minutes (22.5%; n = 87, p &lt; 0.05). ED LOS decreased from 580 minutes (n = 361) to 519 minutes (10.5%; n = 187; p = 0.77). Special cause variation was identified on the ED LOS SPC chart with eight consecutive points below the midline, after PDSA 1. The number of patients who received any analgesia increased from 42% (n = 361) to 47% (n = 187; p = 0.13). The number of patients who received medications via medical directives increased from 22% (n = 150) to 44% (n = 87; p &lt; 0.001). Balancing measures were unchanged. Discussion/Impact: The significant reduction in the TTA and increase in the use of medical directives in the before-and-after analyses were likely due to our front-line focused improvements and deliberate nursing engagement. With continued success and sustainable processes, we are planning to spread our project to other EDs and broaden our initiative to all pain-related concerns.

Hamilton Acute Pain Service Safety Study

2014 ◽  
Vol 120 (1) ◽  
pp. 97-109 ◽  
Author(s):  
James E. Paul ◽  
Norman Buckley ◽  
Richard F. McLean ◽  
Karen Antoni ◽  
David Musson ◽  
...  
Keyword(s):  
Acute Pain ◽  
Root Cause Analysis ◽  
Acute Pain Service ◽  
Patient Controlled Analgesia ◽  
Cause Analysis ◽  
Root Cause ◽  
Analysis Process ◽  
Severe Hypotension ◽  
Before And After ◽  
Address System

Abstract Background: Although intravenous patient-controlled analgesia opioids and epidural analgesia offer improved analgesia for postoperative patients treated on an acute pain service, these modalities also expose patients to some risk of serious morbidity and even mortality. Root cause analysis, a process for identifying the causal factor(s) that underlie an adverse event, has the potential to identify and address system issues and thereby decrease the chance of recurrence of these complications. Methods: This study was designed to compare the incidence of adverse events on an acute pain service in three hospitals, before and after the introduction of a formal root cause analysis process. The “before” cohort included all patients with pain from February 2002 to July 2007. The “after” cohort included all patients with pain from January 2009 to December 2009. Results: A total of 35,384 patients were tracked over the 7 yr of this study. The after cohort showed significant reductions in the overall event rate (1.47 vs. 2.35% or 1 in 68 vs. 1 in 42, the rate of respiratory depression (0.41 vs. 0.71%), the rate of severe hypotension (0.78 vs. 1.34%), and the rate of patient-controlled analgesia pump programming errors (0.0 vs. 0.08%). Associated with these results, the incidence of severe pain increased from 6.5 to 10.5%. To achieve these results, 26 unique recommendations were made of which 23 being completed, 1 in progress, and 2 not completed. Conclusions: Formal root cause analysis was associated with an improvement in the safety of patients on a pain service. The process was effective in giving credibility to recommendations, but addressing all the action plans proved difficult with available resources.

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