Practitioner Perceptions of the A3 Method for Process Improvement in Health Care

The focus of this article is to present students’ perceptions of the recently developed A3 method, a structured problem-solving approach based on lean concepts and tools that have been adapted to the health care environment. The students were all employees of a large health care provider and were enrolled in a customized health care executive MBA Program. Each student was required to complete an individual A3 Project in order to improve a process at the department for which they worked. At the end of the semester the students presented their A3 projects to their peers who voted on the best projects. A survey measuring perceptions of the A3 method for problem solving in health care was administered and from it we present propositions for A3 implementation. These propositions are applicable both to health care practitioners and to academic researchers

Organizational Factors that Contribute to Operational Failures in Hospitals

The performance gap between hospital spending and outcomes is indicative of inefficient care delivery. Operational failures—breakdowns in internal supply chains that prevent work from being completed—contribute to inefficiency by consuming 10% of nurses’ time (Hendrich et al. 2008, Tucker 2004). This paper seeks to identify organizational factors associated with operational failures, with a goal of providing insight into effective strategies for removal. We observed nurses on medical/ surgical units at two hospitals, shadowed support staff who provided materials, and interviewed employees about their internal supply chain’s performance. These activities created a database of 120 operational failures and the organizational factors that contributed to them. We found that employees believed their department’s performance was satisfactory, but poorly trained employees in other departments caused the failures. However, only 14% of the operational failures arose from errors or training. They stemmed instead from multiple organizationally-driven factors: insufficient workspace (29%), poor process design (23%), and a lack of integration in the internal supply chains (23%). Our findings thus suggest that employees are unlikely to discern the role that their department’s routines play in operational failures, which hinders solution efforts. Furthermore, in contrast to the “Pareto Principle” which advocates addressing “large” problems that contribute a disproportionate share of the cumulative negative impact of problems, the failures and causes were dispersed over a wide range of factors. Thus, removing failures will require deliberate cross-functional efforts to redesign workspaces and processes so they are better integrated with patients’ needs

Lean healthcare supply chain management: minimizing waste and costs

The purpose of this research is to investigate the management models applied in the supply chain providing services in healthcare organizations, considering the lenses of lean. The aim of this is to develop a model of supply chain management focusing on the identification and minimization of waste, assisting in decision making and contributing to the quality of services and as a consequence the reduction of the costs involved in healthcare supply chain. The philosophies of continuous improvement and lean techniques have a role to play in helping healthcare to provide quality service and support to reduce costs in the current budget constraints. In the supply chain of hospitals the financial costs can be around 40% of its budget (MASOUMI et al. 2012; SOUZA et al., 2013). This article sheds light on the improvement in decision making and the effect of reducing costs in the healthcare supply chain. In this sense, the research intend to expand knowledge related to supply chain management in the area of provision of healthcare services through the use of the philosophy of continuous improvement and lean principles, helping healthcare to provide quality service within their current budget constraints

Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

Frontline care providers in hospitals spend at least 10% of their time working around operational failures, which are situations where information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at two hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of over 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments' routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals' internal supply departments. Four dimensions of interconnectedness include (1) hospital-level—rather than department-level—performance measures; (2) internal supply department routines that respond to specific patients' needs rather than to predetermined stocking routines; (3) knowledge that is necessary for efficient handoffs of materials is translated across departmental boundaries; and (4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries

The relationship between green supply chain integration and sustainable performance

Green supply chain management (GSCM) has recently emerged to comply with regulations for environmental protection as a result of increasing environmental concerns over the past decades. Since manufacturing companies have often been charged for the environmental liabilities of their suppliers, there has been urgency for integration of environmental initiatives, not only within the walls of the company, but across the entire supply chain in order to ensure the company’s sustainable performance. Consequently, Green Supply Chain Integration (GSCI) was introduced to integrate the environmental management practices within manufacturing companies, with the suppliers and the customers. However, there is lack of discoveries in terms of GSCI conceptualization. Therefore, this study was conducted to identify the relationship between Green Supply Chain Integration and sustainable performance. Specifically, the objective of this study is to examine the relationship between supplier integration, customer integration, internal integration, logistic integration, technology integration, and dimensions of sustainable performance namely economic, environmental, and social. A survey was conducted on ISO14001 Environmental Management System (EMS) certified manufacturing firms in Malaysia. A total of 107 questionnaires was completed by the respondents and considered to be appropriate for data analysis. The data was analyzed using Pearson’s correlation analysis and multiple regression analysis. It was found that each variable in the GSCI is positively correlated with sustainable performance. Further investigation using multiple regression has shown that internal integration and technology integration to be the strongest predictors of sustainable performance. Apart from contribution to theoretical knowledge, the results would also be valuable in providing new insights to management in their environmental goals and sustaining successful performance within the pressures of stakeholders, customers, and environmental regulation

Applying Behavioural Economics to International Development Policy

behavioural economics, policy

Engine Data Interpretation System (EDIS), phase 2

A prototype of an expert system was developed which applies qualitative constraint-based reasoning to the task of post-test analysis of data resulting from a rocket engine firing. Data anomalies are detected and corresponding faults are diagnosed. Engine behavior is reconstructed using measured data and knowledge about engine behavior. Knowledge about common faults guides but does not restrict the search for the best explanation in terms of hypothesized faults. The system contains domain knowledge about the behavior of common rocket engine components and was configured for use with the Space Shuttle Main Engine (SSME). A graphical user interface allows an expert user to intimately interact with the system during diagnosis. The system was applied to data taken during actual SSME tests where data anomalies were observed

The unequal lag in Latin American schooling since 1900: follow the money

Special Issue on Latin American Inequality.Focusing on education–income anomalies, in which a richer country delivers less education than a poorer country, seems a promising way to harvest a part of the rich history that does not lend itself to econometrics. To test the chain of alleged causation from unequal power and wealth to poor schooling, one must follow the public money, or lack of it, in as many contexts as the data will allow. Public funding for mass schooling is the hitherto untested middle link in the chain. The key to Latin America’s poor schooling was the failure to supply tax money, not gender discrimination or any shortfall in market demand for skills. The most glaring anomalies were the Venezuelan and Argentine failures to supply the levels of tax support for mass schooling that their high income could have afforded.Este artículo estudia algunas irregularidades de la relación entre educación y renta, por la que los países ricos ofrecen menos educación que los pobres. Esta relación no parece encajar con la historia de los países ricos ni se presta a una comprobación econométrica. Para comprobar la cadena causal acreditada entre la desigualdad de poder o riqueza y baja escolarización, uno tiene que seguir el dinero público o la ausencia de éste en tantos contextos como sea posible. La financiación pública de la escolarización de masas aún no ha sido examinada en el eslabón medio en la cadena. La clave de la baja escolarización latinoamericana fue un problema de ingreso fiscal, no de discriminación de género o de un fallo de mercado en la demanda de mano de obra cualificada. Las irregularidades más flagrantes las encontramos en Venezuela y Argentina que fallaron en el nivel de apoyo fiscal a la escolarización de masas en relación con los ingresos medios disponibles

Explaining the Cross-National Time Series Variation in Life Expectancy: Income, Women’s Education, Shifts, and What Else?

This paper examines the variation across countries and evolution over time of life expectancy. Using historical data going back to the beginning of the 20th century several basic facts about the relationship between national income and life expectancy are established. The paper shows that even by examining the augmented Preston curve there is no indication that the Preston curve is “breaking down” and no indication from over 100 years of data that a very strong relationship between national income and life expectancy will not persist, particularly over the ranges of income of primary interest to the Human Development Report. Empirical findings show that there are actually fewer “puzzles” than might appear while trying to reconcile the strong cross-sectional association with the time evolution of life expectancy in specific countries and most of the existing “puzzles” come from using either very short time-horizons or very small moves in income per capita when the Preston curve is a long-run phenomena. The paper also discusses the phenomena of the cross-national convergence, with the life expectancy of the poorer countries increasing, in absolute terms, faster than those of the rich countries and how the findings about the augmented Preston curve relate to discussions of health policy.economic development, economic growth, health, life expectancy, mortality.