Reduction of average lead time in outpatient service of obstetrics through six sigma methodology

In hospital services, operations efficiency and healthcare quality are two critical factors since both define the financial sustainability of the hospitals as well as patient health, safety and satisfaction. For this reason, it is necessary to explore different strategies for the improvement of quality and efficiency indicators in the provision of healthcare services. Specifically, this paper focuses on the application of Six Sigma methodology as an important option to solve this problematic. This methodology begins with the identification of improving opportunities that are aligned with the organization goals. Then, a portfolio of potential improvement projects is created. Later, these projects are prioritized with basis on multicriteria decision making techniques, with the purpose of choosing the project with the highest impact on the organization quality and efficiency. Finally, the selected project is developed through DMAIC cycle. An application case related to the process of obstetric outpatient in a maternal-child hospital located in the city of Barranquilla (Colombia) is presented to prove the validity of the proposed approach. The results show that the average lead time in the obstetric outpatient service in which pregnant women are monitored, was reduced from about 7 days/appointment to approximately 4 days/appointment

Lean Six Sigma en pequeñas y medianas empresas: Un enfoque metodológico

Six Sigma and Lean Manufacturing are quality improvement and productivity approaches which have been implemented with great success in large global companies in the field of manufacturing and services. But now researchers and experts in the field have found that small and medium enterprises (SMEs) have difficulties in implementing such approaches. For this reason, this paper aims to develop a methodology for the implementation of an integrated approach, commonly called Lean Six Sigma (LSS), which is adapted to the needs and characteristics of SMEs. The methodology consists of four phases: the first phase establishes the key factors in which SMEs must be prepared to implement LSS, secondly the identification of improvement areas and definition of a project portfolio is set; as third phase, prioritized projects are executed, and finally, the results are evaluated. The methodology was validated in a SME dedicated to the manufacture of wooden furniture, where the execution of the first two LSS projects provided important savings in poor quality costs, reduction of product returns in addition to achieving the implementation of best practices in the process management.Six Sigma y Manufactura Esbelta son enfoques de mejora de la calidad y productividad que han sido implementados con gran éxito en grandes empresas a nivel mundial, en el ámbito de la manufactura y los servicios. Pero en la actualidad investigadores y expertos en el tema han encontrado hallazgos que evidencian dificultades en la implementación de este tipo de enfoques en pequeñas y medianas empresas (PYMES). Por esta razón, el presente artículo propone una metodología para la implementación de un enfoque integrado, comúnmente llamado Lean Six Sigma (LSS), el que se adapta a las necesidades y características de las PYMES

Lean Six Sigma en pequeñas y medianas empresas: un enfoque metodológico

Six Sigma and Lean Manufacturing are quality improvement and productivity approaches which have been implemented with great success in large global companies in the field of manufacturing and services. But now researchers and experts in the field have found that small and medium enterprises (SMEs) have difficulties in implementing such approaches. For this reason, this paper aims to develop a methodology for the implementation of an integrated approach, commonly called Lean Six Sigma (LSS), which is adapted to the needs and characteristics of SMEs. The methodology consists of four phases: the first phase establishes the key factors in which SMEs must be prepared to implement LSS, secondly the identification of improvement areas and definition of a project portfolio is set; as third phase, prioritized projects are executed, and finally, the results are evaluated. The methodology was validated in a SME dedicated to the manufacture of wooden furniture, where the execution of the first two LSS projects provided important savings in poor quality costs, reduction of product returns in addition to achieving the implementation of best practices in the process management.Six Sigma y Manufactura Esbelta son enfoques de mejora de la calidad y productividad que han sido implementados con gran éxito en grandes empresas a nivel mundial, en el ámbito de la manufactura y los servicios. Pero en la actualidad investigadores y expertos en el tema han encontrado hallazgos que evidencian dificultades en la implementación de este tipo de enfoques en pequeñas y medianas empresas (PYMES). Por esta razón, el presente artículo propone una metodología para la implementación de un enfoque integrado, comúnmente llamado Lean Six Sigma (LSS), el que se adapta a las necesidades y características de las PYMES

Diagnosis of healthcare issues in clinics and hospital of Barranquilla

Objetivo Identificar y evaluar las principales problemáticas asistenciales en clínicas y hospitales de la ciudad de Barranquilla, Colombia. Método Estudio descriptivo aplicado a población de clínicas [23] y hospitales [5]. Se utilizó un nivel de confianza del 95 %, nivel de error del 5 % y p=0.5. El tamaño de muestra resultante para la población de clínicas y hospitales fue de 18 y 4 respectivamente. Los hospitales y clínicas fueron seleccionados aleatoriamente. Se diseñó una encuesta compuesta por 21 preguntas acerca del estado de los diferentes procesos asistenciales del sector. Los resultados se procesaron con la ayuda del software Microsoft Excel 2010. Resultados El 50 % de los hospitales manifestaron tener problemáticas en las áreas de Consulta Externa, Hospitalización y Estadística. Por su parte, el 61,1 % de las clínicas presentan dificultades en el área de Urgencias, 50 % en Intervención Quirúrgica, 50 % en Hospitalización y 38,9 % en Consulta Externa. Conclusiones El diagnóstico de problemáticas asistenciales en clínicas y hospitales de la ciudad de Barranquilla determina que si bien el proceso de hospitalización es un punto común de mejora potencial en clínicas y hospitales de la ciudad; las mayores prioridades de intervención las presentan en su orden Intervención Quirúrgica, Urgencias y Estadística.Methods Descriptive study applied on two populations: clinics [23] and hospitals [5]. A confidence level of 95 % and the alpha level of 5 % and p=0.5 were used in the study. The resulting sample size for clinics and hospitals was 18 and 4, respectively. Clinics and hospitals were randomly and a 21-question survey was designed to find out the status of the different healthcare processes in the Health Care Sector. The results were processed by using Microsoft Excel 2010 software. Results On one hand, 50 % of the hospitals expressed having problems in outpatient, hospitalization and statistical departments. On the other hand, 61.1 % of the clinics have difficulties in Emergency rooms, 50 % in Surgical Services, 50% in Hospitalization and 38.9 % in Outpatient Department. Conclusions The diagnosis regarding healthcare issues in clinics and hospitals of Barranquilla determines that although the Hospitalization process is a common point for potential improvement in both hospitals and clinics of the city, the greatest priority should be given to Surgical Services, Emergency Department and Statistical Department, due to their average intervention priority

Metodología miceps para control estadístico de procesos: caso aplicado al proceso de producción de vidrio templado

El Control Estadístico de procesos es considerado como una herramienta de la Gestión de la Calidad orientada a la mejora de procesos y productos. Su aplicación exitosa en la industria manufacturera y de servicios ha representado beneficios a nivel financiero y de mercado. Para ello, es importante garantizar una efectiva articulación entre las perspectivas del cliente y la compañía. Por tal motivo, el presente estudio tiene como objetivo el desarrollo de un enfoque basado en la metodología MICEPS (Methodology for integrating customer expectations and production systems) que ayuda a las compañías a traducir las expectativas del cliente en sistemas efectivos de control de calidad. Primero, se efectúa un análisis de proceso y luego se aplica el enfoque MICEPS para el establecimiento de puntos de monitoreo y control basados en el cliente. Un caso de estudio de la industria de vidrio templado ha sido empleado para explorar la efectividad del enfoque propuesto.Statistical Process Control is regarded as a Quality Management tool for the improvement of processes and products. Its successful implementation on manufacturing and service industries has provided financial and market benefits. Therefore, it is very important to guarantee an efficacious link between customer expectations and companies. This study aims to develop an approach based on MICEPS (Methodology for integrating customer expectations and production systems) to help companies design effective systems of quality control. First, a process analysis is carried out and then MICEPS is applied to establish monitoring and control points with customer focus. A case study from tempered glass industry is used to explore the effectiveness of the proposed approach

Diagnosis of healthcare issues in clinics and hospital of Barranquilla

Objective To identify and assess the main healthcare issues found in clinics and hospitals in Barranquilla. Methods Descriptive study applied on two populations: clinics [23] and hospitals [5]. A confidence level of 95% and the alpha level of 5% and p=0.5 were used in the study. The resulting sample size for clinics and hospitals was 18 and 4, respectively. Clinics and hospitals were randomly and a 21-question survey was designed to find out the status of the different healthcare processes in the Health Care Sector. The results were processed by using Microsoft Excel 2010 software. Results On one hand, 50% of the hospitals expressed having problems in outpatient, hospitalization and statistical departments. On the other hand, 61.1% of the clinics have difficulties in Emergency rooms, 50% in Surgical Services, 50% in Hospitalization and 38.9% in Outpatient Department. Conclusions The diagnosis regarding healthcare issues in clinics and hospitals of Barranquilla determines that although the Hospitalization process is a common point for potential improvement in both hospitals and clinics of the city, the greatest priority should be given to Surgical Services, Emergency Department and Statistical Department, due to their average intervention priority

Uso de la metodología Six Sigma para reducir el tiempo de atención de citas en el departamento ambulatorio de obstetricia

This paper focuses on the issue of longer appointment lead-time in the obstetrics outpatient department of a maternal-child hospital in Colombia. Because of extended appointment lead-time, women with high-risk pregnancy could develop severe complications in their health status and put their babies at risk. This problem was detected through a project selection process explained in this article and to solve it, Six Sigma methodology has been used. First, the process was defined through a SIPOC diagram to identify its input and output variables. Second, six sigma performance indicators were calculated to establish the process baseline. Then, a fishbone diagram was used to determine the possible causes of the problem. These causes were validated with the aid of correlation analysis and other statistical tools. Later, improvement strategies were designed to reduce appointment lead-time in this department. Project results evidenced that average appointment lead-time reduced from 6,89 days to 4,08 days and the deviation standard dropped from 1,57 days to 1,24 days. In this way, the hospital will serve pregnant women faster, which represents a risk reduction of perinatal and maternal mortality.Este documento se enfoca en el tema del tiempo de consulta más prolongado en el departamento ambulatorio de obstetricia de un hospital materno-infantil en Colombia. Debido a la prolongada cita de tiempo, las mujeres con embarazos de alto riesgo podrían desarrollar complicaciones graves en su estado de salud y poner en riesgo a sus bebés. Este problema se detectó a través de un proceso de selección de proyecto explicado en este artículo y para resolverlo, se ha utilizado la metodología Six Sigma. Primero, el proceso se definió a través de un diagrama SIPOC para identificar sus variables de entrada y salida. En segundo lugar, se calcularon seis indicadores de rendimiento sigma para establecer la línea de base del proceso. Luego, se utilizó un diagrama de espina de pescado para determinar las posibles causas del problema. Estas causas fueron validadas con la ayuda del análisis de correlación y otras herramientas estadísticas. Más tarde, las estrategias de mejora se diseñaron para reducir el tiempo de entrega en este departamento. Los resultados del proyecto evidenciaron que el tiempo de entrega promedio de la cita se redujo de 6,89 días a 4,08 días y la norma de desviación se redujo de 1,57 días a 1,24 días. De esta manera, el hospital atenderá a las mujeres embarazadas más rápido, lo que representa una reducción del riesgo de mortalidad perinatal y materna

Miceps methodology for statistical process control: a case study applied in production process of tempered glass

El Control Estadístico de procesos es considerado como una herramienta de la Gestión de la Calidad orientada a la mejora de procesos y productos. Su aplicación exitosa en la industria manufacturera y de servicios ha representado beneficios a nivel financiero y de mercado. Para ello, es importante garantizar una efectiva articulación entre las perspectivas del cliente y la compañía. Por tal motivo, el presente estudio tiene como objetivo el desarrollo de un enfoque basado en la metodología MICEPS (Methodology for integrating customer expectations and production systems) que ayuda a las compañías a traducir las expectativas del cliente en sistemas efectivos de control de calidad. Primero, se efectúa un análisis de proceso y luego se aplica el enfoque MICEPS para el establecimiento de puntos de monitoreo y control basados en el cliente. Un caso de estudio de la industria de vidrio templado ha sido empleado para explorar la efectividad del enfoque propuesto.Abstract: Statistical Process Control is regarded as a Quality Management tool for the improvement of processes and products. Its successful implementation on manufacturing and service industries has provided financial and market benefits. Therefore, it is very important to guarantee an efficacious link between customer expectations and companies. This study aims to develop an approach based on MICEPS (Methodology for integrating customer expectations and production systems) to help companies design effective systems of quality control. First, a process analysis is carried out and then MICEPS is applied to establish monitoring and control points with customer focus. A case study from tempered glass industry is used to explore the effectiveness of the proposed approach

Computers & Industrial Engineering

En este documento, presentamos una encuesta de vanguardia sobre el problema de enrutamiento de vehículos con múltiples depósitos (MDVRP). Nuestra revisión consideró los artículos publicados entre 1988 y 2014, en los que se estudian varias variantes del modelo: ventanas de tiempo, entrega dividida, flota heterogénea, entregas periódicas y recolección y entrega. La revisión también clasifica los enfoques según los objetivos únicos o múltiples que están optimizados. También se presentan algunas líneas para futuras investigaciones.In this paper, we present a state-of-the-art survey on the vehicle routing problem with multiple depots (MDVRP). Our review considered papers published between 1988 and 2014, in which several variants of the model are studied: time windows, split delivery, heterogeneous fleet, periodic deliveries, and pickup and delivery. The review also classifies the approaches according to the single or multiple objectives that are optimized. Some lines for further research are presented as well

A literature review on the vehicle routing problem with multiple depots

15 páginasIn this paper, we present a state-of-the-art survey on the vehicle routing problem with multiple depots (MDVRP). Our review considered papers published between 1988 and 2014, in which several variants of the model are studied: time windows, split delivery, heterogeneous fleet, periodic deliveries, and pickup and delivery. The review also classifies the approaches according to the single or multiple objectives that are optimized. Some lines for further research are presented as well