Applying Quality Improvement Approaches for the Control of Critical Medical Processes in a Healthcare Facility

Healthcare facilities face major challenges as patients require for the continuous improvement of the healthcare quality. We have used as research method the study of the scientific literature from the medical databases, and we have identified the categories of processes that ensure the quality in a healthcare facility. It is drawn a detailed map of the basic medical processes which highlights the sequence and interaction of medical processes that take place on requesting patients until they become resolved patients. The particularization of quality improvement methods for the improvement of critical medical processes is presented. By using the Pareto diagram it is analyzed the adverse events associated with healthcare and by employment of Ishikawa diagram it is analyzed the causes of associated infections highlighting the factors that contributed to the increase of confirmed healthcare associated infections, which are assigned to the hospital information system and the hospital monitoring system.

The 5 Dimensions of Problem Solving using Dinna: Case Study in the Electronics Industry

Based on the principle that perfection is a divine criterion, process management exists on the one hand to achieve excellence (near perfection) and on the other hand to avoid imperfection. In other words, Operational Excellence (EO) is one of the approaches, when used rigorously, aims to maximize performance. Therefore, the mastery of problem solving remains necessary to achieve such performance level. There are many tools that we can use whether in continuous improvement for the resolution of chronic problems (KAIZEN, DMAIC, Lean six sigma…) or in resolution of sporadic defects (8D, PDCA, QRQC ...). However, these methodologies often use the same basic tools (Ishikawa diagram, 5 why, tree of causes…) to identify potential causes and root causes. This result in three levels of causes: occurrence, no detection and system. The research presents the development of DINNA diagram [1] as an effective and efficient process that links the Ishikawa diagram and the 5 why method to identify the root causes and avoid recurrence. The ultimate objective is to achieve the same result if two working groups with similar skills analyse the same problem separately, to achieve this, the consistent application of a robust methodology is required. Therefore, we are talking about 5 dimensions; occurrence, non-detection, system, effectiveness and efficiency. As such, the paper offers a solution that is both effective and efficient to help practitioners of industrial problem solving avoid missing the real root cause and save costs following a wrong decision.

Risk assessment of consumer properties of products made from vegetable raw materials

По результатам опубликованных мониторингов проведено исследование по определению и оценке рисков, оказывающих влияние на потребительские свойства продуктов из овощного сырья с построением причинно-следственной диаграммы Исикавы. Предложенная диаграмма позволила визуализировать проблемы на всем жизненном цикле пищевого производства и выявить наиболее уязвимые факторы, оказывающие негативное влияние на изменение состава продукции из овощей. Based on the results of the published monitoring, a study was conducted to determine and assess the risks that affect the consumer properties of products made from vegetable raw materials with the construction of a causal Ishikawa diagram. The proposed diagram made it possible to visualize problems throughout the life cycle of food production and identify the most vulnerable factors that have a negative impact on changes in the composition of vegetable products.

The 5 Dimensions of Problem Solving using Dinna: Case Study in the Electronics Industry

Based on the principle that perfection is a divine criterion, process management exists on the one hand to achieve excellence (near perfection) and on the other hand to avoid imperfection. In other words, Operational Excellence (EO) is one of the approaches, when used rigorously, aims to maximize performance. Therefore, the mastery of problem solving remains necessary to achieve such performance level. There are many tools that we can use whether in continuous improvement for the resolution of chronic problems (KAIZEN, DMAIC, Lean six sigma…) or in resolution of sporadic defects (8D, PDCA, QRQC ...). However, these methodologies often use the same basic tools (Ishikawa diagram, 5 why, tree of causes…) to identify potential causes and root causes. This result in three levels of causes: occurrence, no detection and system. The research presents the development of DINNA diagram [1] as an effective and efficient process that links the Ishikawa diagram and the 5 why method to identify the root causes and avoid recurrence. The ultimate objective is to achieve the same result if two working groups with similar skills analyse the same problem separately, to achieve this, the consistent application of a robust methodology is required. Therefore, we are talking about 5 dimensions; occurrence, non-detection, system, effectiveness and efficiency. As such, the paper offers a solution that is both effective and efficient to help practitioners of industrial problem solving avoid missing the real root cause and save costs following a wrong decision.

Peningkatan Produktivitas Bagian Pengepakan Menggunakan Basic Quality Tools di PT. XYZ

This research is the application of quality control tools within the scope of increasing productivity of the packaging department at PT. XYZ. This study aims to determine the factors causing the decline in productivity in the packing warehouse area. The first step of the research is to analyze the input data using a Pareto diagram. The source of problems that occur from outside the packing area are four cases, namely Canceled Delivery, Part Received Without Documents, No Stock and Quality Issue. Meanwhile, for problems that occur from internal packaging, there are two, namely the No Packaging Box and No Operator Entering. By using the Ishikawa diagram and 5 whys, the sources of problems that occur in the internal packing area are analyzed further and obtained several sources of problems that contribute greatly to the decline in productivity in the packaging area, namely the process of purchasing packaging boxes which takes quite a long time and long working hours from the packaging team. Some of the solutions for internal problems offered include changing the carton box procurement process using blanket orders, upgrading the team leader's capabilities with order and budget monitoring capabilities, proposing changes in the production flow for semi-finished goods and a proposal to create a temporary warehouse for semi-finished goods. Abstrak: Penelitian ini merupakan penerapan dari alat pengendalian qualitas dalam lingkup peningkatan produktivitas bagian pengepakan di PT. XYZ. Penelitian ini bertujuan untuk mengetahui faktor penyebab penurunan produktivitas diarea gudang pengepakan. Langkah awal penelitian dengan menganalisa data masukan menggunakan diagram Pareto. Sumber masalah yang terjadi dari luar area pengepakan ada empat kasus yaitu Pengiriman Dibatalkan, Part Diterima Tanpa Dokumen, Stock Tidak Ada dan Ada Issue Kualitas. Sementara untuk masalah yang terjadi dari internal pengepakan ada dua yaitu Box Pengemas Tidak ada dan Operator Tidak Masuk. Dengan menggunakan diagram Ishikawa dan 5 whys , sumber masalah yang terjadi di internal area pengepakan dianalisa lebih lanjut dan diperoleh beberapa sumber masalah yang berkontribusi besar terhadap penuruan produktivitas di area pengepakan yaitu proses pembelian box pengemas yang memakan waktu cukup lama dan jam kerja yang panjang dari tim pengepakan. Beberapa solusi untuk permasalah internal yang ditawarkan antara lain merubah proses pengadaan karton box dengan menggunakan blanket order, mengupgrade kemampuan team leader dengan kemampuan order dan budget monitoring, mengusulkan perubahan alur produksi untuk barang-barang setengah jadi serta usulan untuk membuat gudang sementara untuk barang setengah jadi.

Migration and human development in Ukraine: features of interaction and priorities of state regulation

Purpose. The purpose of the article is to substantiate theoretically the relationship between migration and human development in the system of achieving the Sustainable Development Goals, to reveal a modern understanding environment of the opportunities as a factor in shaping the migration potential, to formulate recommendations for the implementation of the state policy for human development under conditions of high migration activity of the population, relevant for Ukraine. Methodology / approach. The general scientific methods (analysis, synthesis, generalization, systematization, graphic method) and special ones (statistical analysis, comparison, organizational and managerial modeling) were the basis of the methodological approach. Current ideas in determining the competitive conditions of environment of opportunities for human development were systematized in order to generalize the theoretical foundations of the study. Statistical analysis was performed on the example of Ukraine as a migration-active country using data from international statistical platforms UNDP, IОМ, ILO, Eurostat, Worldometer. Interstate comparative analysis made it possible to substantiate the need for the formation and implementation of the state policy for human development under conditions of high migration activity of the population. Ishikawa diagram specifying the target areas and the measures algorithm of their achievement was used to determine the catalyze priorities of such a policy. Results. In the article there were made the theoretical and applied justifications for the modern understanding of migration, human development and their interaction in terms of the formation of the internal environment of opportunities in the global mobile space of competitive redistribution of human potential. The interstate comparative analysis of the main socio-economic indicators on the example of Ukraine to identify applied problems of human development of a migration-active society was conducted. The excessive gaps indicated the priority spheres of state policy for human development as a measures’ set of demographic, valeological, educational, economic, environmental and security nature, aimed at ensuring decent, socially just and active living conditions with respect for choice and movement freedom. The priorities of the state policy for human development under the conditions of high migration activity of the population were offered. They provide an opportunity to substantiate management focuses on the implementation of monitoring of human development and migration, improving the efficiency of migration capital and the welfare of the population, stimulating demographic reproduction, the formation of social unity and legal culture. Originality / scientific novelty. There were improved the theoretical and applied bases of research of relationship between human development and population migration in the context of realization of choice right and movement freedom. The methodical bases of the comparative analysis of the internal opportunities’ environment of human development of migration-active society were further developed. The method of Ishikawa diagram (Constructing a Fishbone) to specify the priorities of the state policy for human development under the conditions of high migration activity of the population was used for the first time. Practical value / implications. The content, purpose, spheres and priorities of the state policy for human development under the conditions of high migration activity of the population were substantiated. The applied recommendations for the implementation of such a policy for migration-active Ukrainian society were formulated.

Improving performance of the hospitalization process by applying the principles of Lean Thinking

PurposeThe goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).Design/methodology/approachThe methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.FindingsThe authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.Originality/valueThe methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.

QUALITY OF PRESCRIPTIONS IN PRIMARY CARE: WE NEED TO TARGET THAT

Aim: To identify errors in drug prescriptions and its causes in a primary healthcare center. Method: Cross-sectional study carried out in a primary healthcare center in northeastern Brazil. A total of 707 drug prescriptions were analyzed using an instrument with pre-established criteria, according to the country's legal provisions regarding drug prescription. An Ishikawa diagram was created to identify the possible causes for the identified errors. Results: A total of 138 drug prescriptions (19.5%) presented information failure or inadequacy. From the errors found, 116 (16.41%) were related to information on dosage. The Ishikawa diagram showed opportunity for improvement in management, training, and technical/professional qualification. Conclusion: The errors seen on drug prescriptions at a primary healthcare center were related to illegibility, absence of dosage, and absence of mandatory patient information. Organizational, technical, scientific, and political factors were identified as the roots of the identified errors.

Documentation of Prognostication Discussion

Background: Our organization is a NGO that provides palliative and supportive care at outpatient (OP), home visits and inpatient (IP), and Hospice settings. During patient encounter at different settings, documentation of discussion on prognostication was not done on the patients’ case sheets. This had created communication gap between the professionals, the patients and their family members. Due to this, there was a mismatch between the patients’ expectations and the services provided. Aims: The aim of the study was to implement A3 protocol and to increase the documentation status from zero to 75% by the end of five months after the commencement of the project. Settings and Design: OP - Department of Palliative Care Clinic A3 method. Material and Methods: The process map of the newly registered patients was followed. Root cause analysis was done using the Ishikawa Diagram. The main cause was that there was no specific format for documentation of prognostication. The professionals also felt some difficulty in disclosing the information as they were not following any prognostication tools upon which such discussions can be made. The key drivers were identified. Interventions were focused with specific contributors. A run chart was maintained to assess the progress of the interventions Statistical Analysis Used: Percentage calculation. Results: This endeavor has resulted in raising the documentation status from 0 to 80%. Conclusion: A3 protocol has been successful in developing the format for documentation of prognostication. Our team has gained confidence in implementing the A3 in other domains too.