Teaching novice clinicians how to reduce diagnostic waste and errors by applying the Toyota Production System

Abstract Background Diagnostic waste, defined as the ordering of low value tests, increases cost, causes delays, increases complexity, and reduces reliability. The Toyota Production System (TPS) is a powerful approach for process improvement that has not been applied to the diagnostic process. We describe a curriculum based on tools and principles of TPS that provides medical students with an approach for reducing diagnostic waste and improving patient management. Methods A 2-day elective course “Fixing Healthcare Delivery” was offered to medical students at the University of Florida, Gainesville. A section within the course had three learning objectives related to TPS: (1) define value in health care; (2) describe how diagnostic waste leads to time delays and diagnostic errors; and (3) apply sequential and iterative value streams for patient management. Instruction methods included videos, readings, and online quizzes followed by a 2-h seminar with facilitated discussion and active problem solving. Results During the 3 years the course was offered students (n = 25) achieved average scores of 95% on a pre-seminar test of manufacturing principles applied to the diagnostic and management process. Course evaluations averaged 4.94 out of 5 (n = 31). Conclusions Students appreciated the application of the TPS principles to the diagnostic process and expressed the desire to apply these manufacturing principles in their future diagnostic and management decision-making.

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Can Doctors Still Have a Voice in Healthcare?

International Journal of Whole Person Care ◽

10.26443/ijwpc.v7i1.215 ◽

2020 ◽

Vol 7 (1) ◽

pp. 14

Author(s):

Howard Stuart ◽

Nilay Ozen ◽

Vivian Petropoulos

Keyword(s):

Sense Of Community ◽

Healthcare Professionals ◽

Community Hospital ◽

Healthcare Delivery ◽

Management Decision ◽

Healthcare Network ◽

Large Numbers ◽

Management Decision Making ◽

Independent Organization

In the fall of 2014 the Quebec Health Ministry announced plans for a broad restructuring of the entire Healthcare network, implemented shortly thereafter in 2015. The effect on institutions was dramatic and immediate. Local management was eradicated, concentrating and centralizing control of the entire system ultimately into the office of the Minister. With the abrupt reorganization of services came relocation of large numbers of personnel. Management at a distance became the norm. In many institutions, the commonly held view among physicians with regard to relations with management can be summarized as, “Suddenly there was no one to talk to.”Confusion and tension were prevalent and palpable. In this context, in attempt to have a voice, a group of physicians at one community hospital formed an independent organization. It developed into an influential body which continues to remain active. This workshop will use the experiences and reflections of physicians from that organization as a basis to explore questions such as: -Is there a difference between Health Services and Health Care? Do we care? -Does worker engagement matter in Healthcare delivery? Or are good systems and modern equipment all we really need? -Does sense of community matter within a healthcare institution? If so why?If it matters, is it just for the benefit of those working for the organization? Or is there a benefit for the users too? -What is the basis for sense of community? Where does it come from? Can it be destroyed? Can it be developed? -Is there an importance to the quality of relationships between people working within Healthcare? Do these relationships have impact on quality of care? -Should the perspective of those working in the system be incorporated input Management decision making? If so how? -What can physicians, nurses and other allied Healthcare professionals do in order to have a voice?

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Models for Drone Delivery of Medications and Other Healthcare Items

Unmanned Aerial Vehicles ◽

10.4018/978-1-5225-8365-3.ch016 ◽

2019 ◽

pp. 376-392 ◽

Cited By ~ 2

Author(s):

Judy E. Scott ◽

Carlton H. Scott

Keyword(s):

Decision Making ◽

Developing Countries ◽

Healthcare Delivery ◽

Decision Models ◽

Current Status ◽

Management Decision ◽

Delivery Service ◽

New Models ◽

Management Decision Making ◽

Delivery Networks

This article describes how a healthcare delivery drone has the potential for developing countries to leapfrog the development of traditional transportation infrastructure. Inaccessible roads no longer will prevent urgent delivery of blood, medications or other healthcare items. This article reviews the current status of innovative drone delivery with a particular emphasis on healthcare. The leading companies in this field and their different strategies are studied. Further, this article reviews the latest decision models that facilitate management decision making for operating a drone fleet. The contribution in this article of two new models associated with the design of a drone healthcare delivery networks will facilitate a more timely, efficient, and economical drone healthcare delivery service to potentially save lives.

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Using the NAM diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical students

Diagnosis ◽

10.1515/dx-2020-0031 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Yvonne Covin ◽

Palma Longo ◽

Neda Wick ◽

Katherine Gavinski ◽

Blake Barker ◽

...

Keyword(s):

Medical Students ◽

Instructional Strategy ◽

Diagnostic Errors ◽

Diagnostic Reasoning ◽

Diagnostic Process ◽

Major Barrier ◽

Case Presentation ◽

Summary Statement ◽

Preclinical Medical Students ◽

Case Presentations

AbstractObjectivesExplicit education on diagnostic reasoning is underrepresented relative to the burden of diagnostic errors. Medical educators report curricular time is a major barrier to implementing new curricula. The authors propose using concise student-identified educational opportunities -- differential diagnosis and summary statement writing -- to justify curriculum development in diagnostic reasoning.MethodsEighteen clerkship and 235 preclinical medical students participated in a 1 h computerized case presentation and facilitated discussion. Students were surveyed on their attitudes toward the case.ResultsAll 18 (100% response) clerkship students and 121 of the 235 preclinical students completed the survey. Students felt the module was effective and relevant. They proposed medical schools consider longitudinal computerized case presentations as an educational strategy.ConclusionsA computerized case presentation is a concise instructional strategy to teach critical points in diagnosis to clerkship and preclinical medical students.

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Developing practical digital e-learning tools in times of Covid-19: The experience of our Pathology department (Preprint)

10.2196/preprints.26191 ◽

2020 ◽

Author(s):

FATIMA Boukis ◽

Fayçal Abbad ◽

Najat Cherif Idrissi El Ganouni ◽

Aboubakr Matrane ◽

Mouna Khouchani ◽

...

Keyword(s):

Medical Students ◽

Patient Management ◽

Treatment Options ◽

Daily Practice ◽

Digital Tools ◽

Rational Approach ◽

Diagnostic Process ◽

Pathology Department ◽

E Learning ◽

Decision Algorithms

BACKGROUND E-learning is the use of Internet technologies to enhance knowledge and performance. Due to the education disruption caused by the spread of the Coronavirus disease 2019 (COVID 19), our aim was developing digital tools representing practical educational documents answering the questions asked by pathologists in training in front of important and complicated situations faced in the daily practice, thus enabling particularly pathologists in training, medical students and doctors in general, to better understand the diagnostic process by developing simplified decision algorithms while ensuring the management of small and precious samples, and therefore the relevance of treatment options and patient management. OBJECTIVE In our Pathology department, we have started utilizing this didactic method of learning way before COVID-19 pandemic, by developing digital tools, allowing medical students and residents in training to learn at their own pace. We believe a hybrid model of education has significant benefits, as traditional offline learning and e-learning are complementary. METHODS Self- training kits were designed to provide practical educational tools that offer a clear and rational approach for residents in training to face challenges in their daily practice, by using numorous diagnosis algorithms, this enables them to better understand the diagnostic process. The project was planned in multiple phases; it has two main components, a medical component that comprises the scientific content and the informatic one that allows the user to access the final version. RESULTS The digital tools contain definitions and general recent information on the subject selected, clinical, biological and radiological study to help managing pathological cases in a multidisciplinary approach, and most importantly, a detailed histopathological chapter, rich in simplified decision algorithms, tables and illustrative practical clinical cases. A final chapter is dedicated to the evaluation which aims to identify the specific needs of each user. Once inserted, users browse the kit’s content and clicks on the file "index.html" to find the different sections on the horizontal menu bar. CONCLUSIONS Self-training kits help controlling the pace and sequence of instruction and make personally meaningful choices which should help residents in training to understand and orient towards a pertinent diagnosis in order to improve the management of small and precious samples, and therefore the relevance of treatment options and patient management.

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Teaching about diagnostic errors through virtual patient cases: a pilot exploration

Diagnosis ◽

10.1515/dx-2018-0023 ◽

2018 ◽

Vol 5 (4) ◽

pp. 223-227 ◽

Cited By ~ 1

Author(s):

Rabih Geha ◽

Robert L. Trowbridge ◽

Gurpreet Dhaliwal ◽

Andrew P.J. Olson

Keyword(s):

Medical Students ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Virtual Patient ◽

Faculty Members ◽

Diagnostic Process ◽

Medicine Clerkship ◽

Effective Strategies ◽

Internal Medicine Clerkship ◽

Medical Educators

Abstract Background: Diagnostic error is a major problem in health care, yet there are few medical school curricula focused on improving the diagnostic process and decreasing diagnostic errors. Effective strategies to teach medical students about diagnostic error and diagnostic safety have not been established. Methods: We designed, implemented and evaluated a virtual patient module featuring two linked cases involving diagnostic errors. Learning objectives developed by a consensus process among medical educators in the Society to Improve Diagnosis in Medicine (SIDM) were utilized. The module was piloted with internal medicine clerkship students at three institutions and with clerkship faculty members recruited from listservs. Participants completed surveys on their experience using the case and a qualitative analysis was performed. Results: Thirty-five medical students and 25 faculty members completed the survey. Most students found the module to be relevant and instructive. Faculty also found the module valuable for students but identified insufficient curricular time as a barrier to implementation. Conclusions: Medical students and faculty found a prototype virtual patient module about the diagnostic process and diagnostic error to be educational.

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Models for Drone Delivery of Medications and Other Healthcare Items

International Journal of Healthcare Information Systems and Informatics ◽

10.4018/ijhisi.2018070102 ◽

2018 ◽

Vol 13 (3) ◽

pp. 20-34 ◽

Cited By ~ 13

Author(s):

Judy E. Scott ◽

Carlton H. Scott

Keyword(s):

Decision Making ◽

Developing Countries ◽

Healthcare Delivery ◽

Decision Models ◽

Current Status ◽

Management Decision ◽

Delivery Service ◽

New Models ◽

Management Decision Making ◽

Delivery Networks

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Centralization and Effectiveness of Reward Management in Multinational Enterprises

Journal of Personnel Psychology ◽

10.1027/1866-5888/a000195 ◽

2018 ◽

Vol 17 (2) ◽

pp. 55-65 ◽

Cited By ~ 1

Author(s):

Michael Tekieli ◽

Marion Festing ◽

Xavier Baeten

Keyword(s):

Decision Making ◽

Social Identity Theory ◽

Multinational Enterprises ◽

Role Identity ◽

Management Decision ◽

Role Identities ◽

Management Decision Making ◽

New Perspective ◽

Subsidiary Managers ◽

The Relationship

Abstract. Based on responses from 158 reward managers located at the headquarters or subsidiaries of multinational enterprises, the present study examines the relationship between the centralization of reward management decision making and its perceived effectiveness in multinational enterprises. Our results show that headquarters managers perceive a centralized approach as being more effective, while for subsidiary managers this relationship is moderated by the manager’s role identity. Referring to social identity theory, the present study enriches the standardization versus localization debate through a new perspective focusing on psychological processes, thereby indicating the importance of in-group favoritism in headquarters and the influence of subsidiary managers’ role identities on reward management decision making.

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