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Identification and analysis of the system archetypes which impede performance standards.
Growth rate and underinvestment.
Recommended new state VSM...
Intended and unintended consequences of system..
The emergency department of public hospital faces the problem of overcrowding as well as a limited budget and staff to deal with a huge number of patients. This requires an improvement in the patient flow in emergency department and reduction in the non-value added processes to make it easier and more quick process for the patients. In this regard, this report is about the improvement in the operations management for the emergency department of a public hospital in which the previous value stream map of operations was critically evaluated on the bases of patients feedback and then by highlighting the system archetypes that were effecting the most to the operations of the emergency department operations of the hospital. It also includes the analysis of current value stream map of the system and a new value stream map has been introduced that is proposed and designed on the bases of improvement in the patients experience in the emergency department.
The number of patients in the public hospitals has been increasing day by day and there is not enough space in most of the hospitals to provide the health facilities to these patients due to the increase in number of patients and a shrinking budget for health facilities as well as a smaller number of staff available to deal with the patients. So it is very important to apply the lean management in the emergency departments of hospitals. This lean management method was firstly applied by the Toyota production system and has been used in a number of manufacturing industries successfully. The lean management is a management technique that is used to point out the non-value added processes and then to remove them in order to make the process flow more efficient. Hospitals are basically patient oriented systems. One of the major aims of public hospitals is to increase the efficiency and cost effective for the healthcare services. The major focus or key concepts of lean management are value and flow. The values in the emergency department of public hospital are the activities that enhance the healthcare services and their quality that promote the well-being of the patient. The value worth’s for a patient when it meets the patient needs and satisfy the patient in a specific time and cost.so the value is specifically from the patient’s perspective. Gerban defines the waste as any activity that does not helps the patient to move away from the sickness and takes time. One of the main wastage of time in emergency department is the waiting time of patient. This waiting time includes the time to wait for first examine or the time for further treatment and the time taken for the results of tests. (C. Steinlicht, 2010)
The role of emergency department is vital in the initial checkup of the patients and is recognized by their contribution to the society. The health care delivery system shows one of the most visible and effective part of the system that has very sharp effects on the society. Any delay or poor service can make a difference between life and death. Legal and social consequences of poor services are immense and it is very important to improve the health services and process flow in the emergency department of the hospital. For this purpose it is very important to first highlight the no value added processes and time taken by then in order to reduce them in the designing of value stream map for the future. (Faisal, 2016)
The most effective tools to evaluate the architectural behavior of an organizational infrastructure, the behavioral pattern and reflective structure of organization are system archetypes. It could be applied to the system in two different ways which are perspective applications and diagnostic application. Both of the applications could be used to measure and monitor the performance of staff as well as the process flow and time taken by it, in different departments. Among the above two systems, archetypes is a system that could be used for the improvement in previous system of emergency room and the information flow of the hospital for emergency department and other departments. The overall efficiency of archetypes is a remedial structure that is used for the development of foundations of the system. This is a common way to observe and monitor the behavioral outcomes of the organization. The archetypes application can be used to develop the diagnostic prospectively. The principles of diagnostic application are used to examine the problems and find the solutions to deal with them while the archetypes can be used for the improvement in the treatment process for the patients. A number of factors limit to the growth of positive reinforcing behavior. (Kayakutlu, 2012)
Dynamic Theory: According to this theory the archetypes determine the reinforcement of accelerating growth. It highlights the external factors that can increase the limitations of the behavioral process.
This type of archetype limits the growth by evaluating the need for investment in the resources, which follows a process of growing actions, demand, performance and the requirement of investment including the capacity of growth. The major focus of growth and underinvestment are long term requirements and the core competencies, so this type of archetype cannot be used for the reduction in the waiting time of patients in emergency department due to its major focus on external developments instead of improvement in internal system. Given value stream diagram is a type of flow chart for the process flow inside the emergency department that gives an overview of flow of inventory and the information flow of the organization. Following are the major purposes of developing a new stream mapping diagram:
Major focus of value stream graph is the value expectations including price, quality and reliability. Different types of symbols are used in value determining such as some symbols indicate the consumer, some symbols represent the process and a few symbols are used for the indication of work cell icon. (Ratnayake, 2015)
While designing the value stream mapping for the emergency department, there are a number of factors to be considered such as the new mapping should reduce the process time for the patients. It should be free of non-value added process and should be easier and reliable for the patients to deal with. It should increase the efficiency of the system while utilizing all the available resources and should be patient oriented in which the improvement in the state of patient should be more important and the process flow should be free from any type of operational and functional hazards. (Yang, 2017)
Future state value mapping for the given emergency department has been designed above to reduce the waiting time for the patients. In this design all the non-value added entities has been removed to reduce the waiting time of the patients. In this system, whenever a patient will come to the emergency department, only the registration process will be completed and then the patient will be taken to the emergency room. In emergency room the doctor will examine the patient and then the nurse will go to bring the medical necessities for the patient and after the treatment, the patient will be discharged from the hospital after taking the specific departing instructions. Then the record of patient will go to the hospital record and then forwarded to the insurance company for the payment processing of the patient bill. (Kayakutlu, 2012)
Intended consequences are those which are not only desirable while designing a system but also can be seen after the development of it while the unintended sequences are those which are not expected and you are giving them a negative while considering the system consequences. In order to develop the emergency room in the given system, the unintended consequences evaluate the efficiency of the archetype system. Unintended consequences can be different in different scenarios and it might range to a number of areas and types in the development of given system for the hospital to make the process floe compatible. Unintended consequences that could happen in various types of archetypes are listed below:
A large number of patients visit the public hospitals daily. Due to an increase in number of patients and lack of management, the public hospitals face the issue of longer waiting time for the patients that are visiting the hospital. This waiting time is larger than the private hospital due to a number of systematic procedures that are being followed till now and have no impact on the heath or experience of the patient. Such processes could be eliminated which add no value to the system and thus the waiting time could be reduced to increase the efficiency while using the available staff and resources. Long waiting time in the public hospitals has damaged the reputation of the hospitals a lot. (Faisal, 2016) Due to this issue the hospital management is now willing to bring reforms in their operations to reduce the waiting time for the patients while keeping the quality of treatment same for the patients. This report analyses different perspectives such as the fixes theory, and the consequences to find the suitability to solve the issues regarding the waiting time of hospital. While keeping an eye on the consequences of the system, a new value mapping graph has been presented along with the recommendations to tackle the issue related to this mapping.
There are a number of things that should be modified and improved in the emergency department of a public hospital in order to provide a better experience to the patient and to provide the quality services in a little time to the patients of emergency department in order to cure maximum number of patients using the available resources. Few of the recommendations after designing the value mapping diagram are given below:
Steinlicht, A. N. (2010). Program development work in progress: Value stream mapping the educational process outcomes. IEEE Frontiers in Education Conference (FIE), (pp. T1H-1-T1H-2). Washington.
Faisal, A. M. (2016). Simulation modeling and analysis of value stream mapping for the implementation of lean manufacturing in labour-intensive small and medium-sized enterprises. International Conference on Electrical, Electronics, and Optimization Techniques (ICEEOT), (pp. 3567-3569). Chennai.
Jungthawan, K. B. (2015). Lean supply chain management-based value stream mapping in a case of Thailand automotive industry. 4th International Conference on Advanced Logistics and Transport (ICALT), (pp. 65-69). Valenciennes.
Kayakutlu, C. K. (2012). Value stream maps for industrial energy efficiency. Proceedings of PICMET '12: Technology Management for Emerging Technologies, (pp. 2824-2831). Vancouver.
Ratnayake, D. S. (2015). Simple approach for Value Stream Mapping for business process analysis. IEEE International Conference on Industrial Engineering and Engineering Management (IEEM), (pp. 88-94). Singapore.
Yang, Q. L. (2017). Lean implementation through value stream mapping: A case study of a footwear manufacturer. 29th Chinese Control And Decision Conference (CCDC), (pp. 3390-3395). Chongqing.
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