A Framework for Prioritizing Opportunities of Improvement in the Context of Business Excellence Model in Healthcare Organization

In today\u27s world, the healthcare sector is facing challenges to improve the efficiency and effectiveness of its operations. More and more improvement projects are being adopted to enhance healthcare services, making it more patient-centric, and enabling better cost control. Healthcare organizations strive to identify and carry out such improvement initiatives to sustain their businesses and gain competitive advantage. Seeking to reach a higher operational level of excellence, healthcare organizations utilize business excellence criteria to conduct assessment and identify organizational strengths and weaknesses. However, while such assessments routinely identify numerous areas for potential improvement, it is not feasible to conduct all improvement projects simultaneously due to limitations in time, capital, and personnel, as well as conflict with other organization\u27s projects or strategic objectives. An effective prioritization and selection approach is valuable in that it can assist the organization to optimize its available resources and outcomes. This study attempts to enable such an approach by developing a framework to prioritize improvement opportunities in healthcare in the context of the business excellence model through the integration of the Fuzzy Delphi Method and Fuzzy Interface System. To carry out the evaluation process, the framework consists of two phases. The first phase utilizes Fuzzy Delphi Method to identify the most significant factors that should be considered in healthcare for electing the improvement projects. The FDM is employed to handle the subjectivity of human assessment. The research identifies potential factors for evaluating projects, then utilizes FDM to capture expertise knowledge. The first round in FDM is intended to validate the identified list of factors from experts; which includes collecting additional factors from experts that the literature might have overlooked. When an acceptable level of consensus has been reached, a second round is conducted to obtain experts\u27 and other related stakeholders\u27 opinions on the appropriate weight of each factor\u27s importance. Finally, FDM analyses eliminate or retain the criteria to produce a final list of critical factors to select improvement projects. The second phase in the framework attempts to prioritize improvement initiatives using the Hierarchical Fuzzy Interface System. The Fuzzy Interface System combines the experts\u27 ratings for each improvement opportunity with respect to the factors deemed critical to compute the priority index. In the process of calculating the priority index, the framework allows the estimation of other intermediate indices including: social, financial impact, strategical, operational feasibility, and managerial indices. These indices bring an insight into the improvement opportunities with respect to each framework\u27s dimensions. The framework allows for a reduction of the bias in the assessment by developing a knowledge based on the perspectives of multiple experts

Existe uma relação entre os programas de acreditação e os modelos de excelência organizacional?

OBJECTIVE To evaluate whether accredited health organizations perform better management practices than non-accredited ones. METHOD The study was developed in two stages: a literature review, and a study of multiple cases in 12 healthcare organizations in the state of São Paulo, Brazil. It surveyed articles comparing hospital accreditation with the EFQM (European Foundation for Quality Management) model of excellence in management. According to the pertinent literature, the accreditation model and the EFQM model are convergent and supplementary in some aspects. RESULTS With 99% confidence, one can say that there is evidence that accredited organizations scored better in the evaluation based on the EFQM model in comparison to non-accredited organizations. This result was also confirmed in the comparison of results between the categories Facilitators and Results in the EFQM model. CONCLUSION There is convergence between the accreditation model and the EFQM excellence model, suggesting that accreditation helps the healthcare sector to implement the best management practices already used by other business sectors.OBJETIVO Evaluar si la organizaciones sanitarias acreditadas tienen mejores prácticas de gestión que las no acreditadas. MÉTODO La investigación fue dividida en dos etapas: revisión de la literatura y estudio de casos múltiples con 12 organizaciones sanitarias, ubicadas en el Estado de São Paulo - Brasil. Fueron investigados artículos que comparaban la acreditación hospitalaria con el modelo de excelencia en gestión de la EFQM (European Foundation for Quality Management), siendo que la literatura pertinente considera que el modelo de acreditación y el modelo de la EFQM son convergentes y, a la vez, complementarios en determinados aspectos. RESULTADOS Con el 99% de confianza, se puede afirmar que existe evidencia de que las organizaciones con acreditación obtuvieron una puntuación mayor en la evaluación basada en el modelo EFQM comparativamente con las organizaciones no acreditadas. Dicho resultado también se confirmó en la comparación de los resultados de las categorías Facilitadores y Resultados del modelo EFQM. CONCLUSIÓN Existe una convergencia entre el modelo de acreditación y el modelo de excelencia de la EFQM, sugiriendo que la acreditación contribuye a que el sector de salud implemente las mejores prácticas de gestión ya difundidas en otros sectores de negocio.OBJETIVO Avaliar se as organizações de saúde acreditadas possuem melhores práticas de gestão do que as não acreditadas. MÉTODO A pesquisa foi dividida em duas etapas: revisão da literatura e estudo de casos múltiplos com 12 organizações de saúde, localizadas no estado de São Paulo ‒ Brasil. Foram pesquisados artigos que comparavam a acreditação hospitalar com o modelo de excelência em gestão da EFQM (European Foundation for Quality Management), sendo que a literatura pertinente considera que o modelo de acreditação e o modelo da EFQM são convergentes e, ao mesmo tempo, complementares em determinados aspectos. RESULTADOS Com 99% de confiança, pode-se afirmar que há evidência de que as organizações com acreditação obtiveram uma pontuação maior na avaliação baseada no modelo EFQM comparativamente às organizações não acreditadas. Este resultado também se confirmou na comparação dos resultados das categorias Facilitadores e Resultados do modelo EFQM. CONCLUSÃO Há uma convergência entre o modelo de acreditação e o modelo de excelência da EFQM, sugerindo que a acreditação contribui para o setor de saúde implementar as melhores práticas de gestão já difundidas em outros setores de negócio

A fuzzy multi-layer assessment method for EFQM.

Although the European Foundation for Quality Management (EFQM) is one of the best-known business excellence frameworks, its inherent self-assessment approaches have several limitations. A critical review of self-assessment models reveals that most models are ambiguous and limited to precise data. In addition, the impact of expert knowledge on scoring is overly subjective, and most methodologies assume the relationships between variables are linear. This paper presents a new fuzzy multi-layer assessment method that relies on fuzzy inference systems (FISs) to accommodate imprecise data and varying assessor experiences to overcome uncertainty and complexity in the EFQM model. The method was implemented, tested, and verified under real conditions in a regional electricity company. The case was assessed by internal company experts and external assessors from an EFQM business excellence organization, and the model was implemented using Matlab software. When comparing the classical model with the new model, assessors and experts favored outputs from the new model.N/

Assessing the leanness of a supply chain using multi-grade fuzzy logic: a health-care case study

Purpose Numerous and diverse organizations have implemented lean principles and practices, which concentrate on improving the efficiency of business processes by reducing cost, waste, consumptions and effort. However, previous assessments have not focused on the leanness of the supply chain in a health-care setting. This paper aims to introduce a method for assessing the successful implementation of lean principles and tools in a supply chain. Furthermore, this paper validates the method in a health-care organization. Design/methodology/approach This paper starts with an extensive literature review on assessing leanness and using multi-grade fuzzy logic. Then, a conceptual model was developed to measure leanness. The conceptual model was validated by discussing the initial version with select academic experts, especially those who deal with leanness in health-care organizations. After responding to the experts’ valuable comments, the health-care organization that is the focus of this case study was chosen based on two criteria. The first criterion was the organization’s ability to participate in the study, and the second was the organization’s commitment to implementing lean principles. These criteria were important to ensure the organization had the necessary foundation for implementing change initiatives such as lean process improvements. Next, a multi-grade (multi-attributes) fuzzy logic was used for leanness measurement. A leanness index was calculated, and the results were validated using experts from the case study organization. Finally, the weaker areas of the organization’s processes were identified to point the way for further improvements. Findings The assessment indicated that the case study organization is not lean. The organization’s weaker attributes were identified, and improvements have been suggested. Research limitations/implications This study focused on a single health-care organization, which was selected from a limited pool of potential organizations, namely, organizations which are accredited by both the Saudi Central Board for Accreditation of Healthcare Institutions and the Joint Commission International. The scope of future research should be extended to multi-case studies to enhance the findings presented in this paper. This paper’s findings can be used to help decision-makers at health-care providers to implement lean thinking in supply chain processes. Practical implications This research may be interest to practicing supply chain managers, as it proposes what enablers, factors and attributes should be emphasized in lean implementation. The proposed model can work as an assessment tool to identify the gap between the present level of leanness and the desired leanness state so the health-care organization can identify what can be improved. This model enables decision-makers in hospital supply chain to take suitable actions for improving lean implementation level. Originality/value This study makes an original contribution to the body of research concerning lean principles; the study developed a conceptual model for leanness assessment that can be applied to the supply chain of health-care organizations. Indeed, the conceptual model is likely to be useful for assessing leanness outside of the health-care field, which suggests avenues for future research

Rethinking the risk matrix

So far risk has been mostly defined as the expected value of a loss, mathematically PL (being P the probability of an adverse event and L the loss incurred as a consequence of the adverse event). The so called risk matrix follows from such definition. This definition of risk is justified in a long term “managerial” perspective, in which it is conceivable to distribute the effects of an adverse event on a large number of subjects or a large number of recurrences. In other words, this definition is mostly justified on frequentist terms. Moreover, according to this definition, in two extreme situations (high-probability/low-consequence and low-probability/high-consequence), the estimated risk is low. This logic is against the principles of sustainability and continuous improvement, which should impose instead both a continuous search for lower probabilities of adverse events (higher and higher reliability) and a continuous search for lower impact of adverse events (in accordance with the fail-safe principle). In this work a different definition of risk is proposed, which stems from the idea of safeguard: (1Risk)=(1P)(1L). According to this definition, the risk levels can be considered low only when both the probability of the adverse event and the loss are small. Such perspective, in which the calculation of safeguard is privileged to the calculation of risk, would possibly avoid exposing the Society to catastrophic consequences, sometimes due to wrong or oversimplified use of probabilistic models. Therefore, it can be seen as the citizen’s perspective to the definition of risk

Gestión de la calidad bajo el modelo EFQM

Esta investigación tiene como objetivo principal presentar los resultados obtenidos sobre gestión de calidad bajo el modelo EFQM. Para este estudio se analizaron 19 artículos de investigación los cuales cumplieron con los criterios necesarios para ser considerados. Después de haberse realizado todo el análisis respectivo se obtuvo que este modelo con mayor frecuencia es utilizado en Europa, con más uso en el sector salud, se destaca su complejidad al aplicarse y sus resultados precisos que arrojan información muy relevante para las empresas, a esto le sumamos que tenemos empresas que lo utilizan como diagnóstico para poder revisar qué factores obtuvieron buenos o malos resultados y de esa manera mejorarlos mediante un plan de acción, pero por otro tenemos a las empresas que lo aplican para obtener la certificación de excelencia que este modelo ofrece, con el fin de diferenciarse y utilizarlo como una ventaja competitiva , ya que con eso estarían certificando todos sus procesos. Independientemente de la manera como se aplique los resultados obtenidos suman fructíferamente a las empresas mejorando todos sus procesos internos

Spirit of change : a quest for the heart of quality

Why do quality initiatives work in some organisations but not in others? In a quest to discover the heart of quality, this thesis sets change programmes within the context of a turbulent global environment, where learning to adapt is the key to survival. The research explores how individuals, organisations and government use learning to promote change, as well as respond to it. Two case studies demonstrate how management style can influence learning, and hence the changes needed to achieve 'real' quality.Seeking to achieve quality through systems and procedures provides only nominal quality. This research suggests that, for some people at least, work is used for self-fulfilment, and in the quest for 'real' quality, aspirations for self-fulfilment within the workplace must be addressed. By using the metaphor of 'work as part of the heroic quest' for self-fulfilment, links are made between Maslow's concept of self-actualisation and the new literature on organizational 'soul' and spiritual intelligence.The conclusion is that if 'real' quality is the goal, self-fulfilment is the path. By establishing a community of learners in the workplace, tremendous energy - the spirit of change - is released and that energy leads straight to the heart of quality

Business excellence models in UK Universities: two contrasting case studies

The overall aim of the research was to explore the reason(s) for the apparent disparity in acceptance and adoption of Business Excellence Models (BEMs) in UK universities and to identify ways to help quality assurance staff make the best use of these models. BEMs provide organisations with management frameworks based around quality and are praised for allegedly improving global competitiveness and performance. BEMs are also criticised for allegedly being fads, over-promising and contradicting the nature of HE. This study also investigated whether BEMs were seen as fads and what makes them sustainable. Two contrasting case studies in London were examined: a research-intensive Russell Group university and a teaching-focused newer (Post 92s) university. 18 semi-structured interviews were conducted with Vice Chancellors/Pro-Vice Chancellors; senior managers; heads of department and professional services/quality assurance staff. In contrast to previous literature, only one interviewee thought BEMs were fads. All the Russell Group interviewees thought BEMs were applicable to the HE sector whereas some interviewees from the newer university were more sceptical. Advocates of BEMs cited their intrinsic value as well as operational benefits. Critics said BEMs were too complicated and conflicted with academic freedom. Although all the participants agreed that effective leadership was vital for successful implementation, they disagreed on what this meant. Some emphasised motivation and inspiration but others highlighted the need to occasionally force change. Participants generated six criteria for evaluating BEMs. Four of these ((a) improved student experience; (b) adequately trained and mentored staff; (c) increased community engagement and (d) compatibility with league table requirements) are found in previous literature. Two ((a) strong personal tutoring and (b) students informing resource allocation and report generation) are not. Participants also identified seven Critical Success Factors (CSFs) that influenced their institution’s choice of BEM. Three of these (team, process and collaboration) are found in previous literature. Four (location, brand, personal tutoring and transparency) are not. Finally, a conceptual framework was developed to explain how BEMs can be sustained. Three elements of the framework match previous literature (human resource management, institutionalisation and feedback). Four (leadership, resource allocation, monitoring and collaboration with the Student Union) are new

Mediating role of core total quality management in the relationship between infrastructure total quality management and organizational performance of public Hospital in Pakistan

Health care organizations in developing countries face great challenges from both inside and outside the organization. In light of this, the contribution of total quality management (TQM) is extremely valuable for health care organizations to overcome these challenges. Drawing upon resource based view (RBV) of the firm; this study examines the mediating role of core TQM on the relationship between infrastructure TQM and performance of public hospitals in Pakistan, and moderating role of national culture on the link between core TQM and performance of public hospitals in Pakistan. This study applied a hypo deductive research approach. Using cross sectional data, a total 378 valid questionnaires were collected to confirm the proposed hypothesis by using partial least square (PLS) path modeling approach a variance based structural equation modeling technique (SEM). Statistical results show that infrastructure TQM is positively related to core TQM. Core TQM is also found to be positively related to organizational performance. Moreover, results reveal that core TQM mediates the relationship between infrastructure TQM and organizational performance. However, no significant result is found for the moderating effect of national culture on the relationship between core TQM and organizational performance. For theoretical and practical contribution this study contributes to the RBV by providing empirical evidence to support the assertion of the theory. Therefore, this study can also help the physicians, surgeons, pharmacist and health professionals to contribute their services to gain organizational performance. Finally, the limitations and suggestions for future research this study restraints the sample that was taken from the public hospitals of Pakistan and cannot be generalized to the other service organizations