Rfid-based business process and workflow management in healthcare:design and implementation

The healthcare system in the United States is considered one of the most complex systems and has encountered challenges related to patient safety concerns, escalating costs, and unpredictable outcomes. Many of these problems share a common cause - a lack of efficient business process management and visibility into the real-time location, status, and condition of medical resources. The goal of this research is to propose a newly integrated system to model, automate, and monitor healthcare business processes using an automatic data collection technology to record the timing and location of activities and identify their various resources. This dissertation makes several contributions to the design and implementation of RFID-based business process and workflow management in healthcare. First, I propose a road map to implement RFID in hospitals with performance matrixes for technology evaluation, key criteria for resolution level setting, and business rules for information extraction. Second, RFID-based business process management (BPM) concepts and workflow technologies are used to transform the reprocessing procedures in a Sterile Processing Department (SPD) for the purpose of reducing infections caused by unclean reusable medical equipment. In the proposed pattern for healthcare business process management, the importance of execution status control is emphasized as a key component to handle complex and dynamic healthcare processes. A five-level framework for service-oriented business process management is designed for SPDs to share information, integrate distributed systems, and manage heterogeneous resources among multiple stakeholders. This research proposes a healthcare workflow system as a deliverable solution to manage the execution phase of reprocessing procedures, which supports the design, execution, monitoring, and automation of services supplied in SPDs. RFID techniques are adopted to collect relative real-time data for SPD performance management. Finally, by identifying key architectural requirements, the subsystems of a service-oriented architecture for the SPD workflow prototyping system, SPDFLOW, are discussed in detail. This research is the first attempt to explore healthcare workflow technologies in the SPD domain to improve the quality of reusable medical equipment and ensure patient safety

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

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

Lean in healthcare: The unfilled promise?

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean ‘tools’, such as ‘kaizen blitz’ and ‘rapid improvement events’, which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the ‘tool level’. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining ‘customer value’ that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily ‘professional’ in origin but actually more ‘organisational’ and ‘managerial’ and, if not addressed could severely constrain Lean’s impact on healthcare productivity at the systems level

Lean in healthcare: the unfilled promise?

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level. © 2011 Elsevier Ltd

The Rise of Innovation Districts: A New Geography of Innovation in America

As the United States slowly emerges from the great recession, a remarkable shify is occurring in the spatial geogrpahy of innovation. For the past 50 years, the landscape of innovation has been dominated by places like Silicon Valley - suburban corridors of spatially isolated corporate campuses, accessible only by car, with little emphasis on the quality of life or on integrating work, housing, and recreation. A new complementary urban model is now emerging, giving rise to what we and others are calling "innovation districts." These districts, by our definition, are geographic areas where leading-edge anchor institutions and companies cluster and connect with start-ups, business incubators, and accelerators. They are also physically compact, transit-accessible, and technicall

Dynamics of High-Technology Firms in the Silicon Valley

The pace of technological innovation since World War II is dramatically accelerating following the commercial exploitation of the Internet. Since the mid 90’s fiber optics capacity (infrastructure for transmission of information including voice and data) has incremented over one hundred times thanks to a new technology, dense wave division multiplexing, and Internet traffic has increased over 1.000 times. The dramatic advances in information technology provide excellent examples of the critical relevance of the knowledge in the development of competitive advantages. The Silicon Valley (SV) that about fifty years ago was an agricultural region became the center of dramatic technological and organizational transformations. In fact, most of the present high-tech companies did not exist twenty years ago. Venture capital contribution to the local economy is quite important not only due to the magnitude of the financial investment (venture investment in SV during 2000 surpassed 25.000 millions of dollars) but also because the extent and quality of networks (management teams, senior employees, customers, providers, etc.) that bring to emerging companies. How do new technologies develop? What is the role of private and public investment in the financing of R&D? Which are the most dynamical agents and how do they interact? How are new companies created and how do they evolve? The discussion of these questions is the focus of the current work.Technological development, R&D, networks