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

An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector

[EN] Emergency Care Networks (ECNs) were created as a response to the increased demand for emergency services and the ever-increasing waiting times experienced by patients in emergency rooms. In this sense, ECNs are called to provide a rapid diagnosis and early intervention so that poor patient outcomes, patient dissatisfaction, and cost overruns can be avoided. Nevertheless, ECNs, as nodal systems, are often inefficient due to the lack of coordination between emergency departments (EDs) and the presence of non-value added activities within each ED. This situation is even more complex in the public healthcare sector of low-income countries where emergency care is provided under constraint resources and limited innovation. Notwithstanding the tremendous efforts made by healthcare clusters and government agencies to tackle this problem, most of ECNs do not yet provide nimble and efficient care to patients. Additionally, little progress has been evidenced regarding the creation of methodological approaches that assist policymakers in solving this problem. In an attempt to address these shortcomings, this paper presents a three-phase methodology based on Discrete-event simulation, payment collateral models, and lean six sigma to support the design of in-time and economically sustainable ECNs. The proposed approach is validated in a public ECN consisting of 2 hospitals and 8 POCs (Point of Care). The results of this study evidenced that the average waiting time in an ECN can be substantially diminished by optimizing the cooperation flows between EDs.The authors would like to express his gratitude to Giselle Polifroni Avendaño for supporting this research.Ortiz-Barrios, MA.; Alfaro Saiz, JJ. (2020). An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector. 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Methodological approaches to support process improvement in emergency departments: a systematic review

The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rate

Improvement of the filling line of a company of the agrochemical sector through the application of CTS satisfaction criteria and the PHVA cycle

Hoy las organizaciones tienen el desafío de adaptarse a un entorno que puede ser cambiante e impredecible, con un alto nivel de competencia y demanda para mejorar, crecer y desarrollarse de acuerdo con las necesidades del Mercado. Por lo tanto las organizaciones necesitan herramientas que les ayuden en su evolución para garantizar la satisfacción del cliente y ser más competitivas; incluido en estas herramientas está el ciclo PHVA, que permite mejorar continuamente los procesos de una organización y contribuye de manera beneficiosa a una organización, por esta razón este estudió apunta a un enfoque basado en la identificación de CTS y la implementación de un ciclo PHVA que es una herramienta de gestión en la cual esta metodología permitirá resolver problemas recurrentes crónicos determinando las causas de la calidad más importante. Problemas en el proceso de llenado, de la llenadora PACKER LLPAC-02, en el área de producción para resolver estos problemas que tiene un impacto en la empresa; primero, se lleva a cabo la identificación de los criterios de satisfacción de CTS en el proceso de llenado y luego se aplica la metodología del ciclo PHVA para determinar los problemas crónicos que afectan dicho proceso.Este artículo tiene la intención de llevar a cabo un estudio de caso de una empresa del sector agroquímico para contribuir a su desarrollo y proporcionar beneficios con su implementaciónToday organizations have the challenge of adapting to an environment that can be changing and unpredictable, with a high level of competence and demand to improve, grow and develop according to market needs. Therefore, organizations need tools that help them in their evolution to ensure customer satisfaction and be more competitive; Included in these tools is the PHVA cycle, which allows to continuously improve the processes of an organization and contributes beneficially to an organization. For this reason, this study aims at an approach based on the identification of CTS and the implementation of a PHVA cycle that is a management tool in which this methodology will allow to solve recurrent and chronic problems by determining the root causes for the most important quality problems in the filling process of the PACKER LLPAC-02 filler, in the production area to solve these problems that have an impact on the company; First, the identification of CTS satisfaction critics in the filling process is carried out and then the PHVA cycle methodology is applied to determine the chronic problems that affect said process. This article intends to carry out a case study of a company in the agrochemical sector to contribute to its development and provide benefits with its implementation

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

Applying computer simulation modelling to minimizing appointment lead-time in elderly outpatient clinics: a case study

Appointment lead-time is a pivotal parameter in elderly outpatient clinics. In this regard, delayed medical care may represent complications in the elderly population and the development of more severe diseases. However, healthcare managers are not skilled in methods effectively reducing waiting times. Therefore, this paper presents the computer simulation modelling to tackle this problem. In this regard, the real-world system was initially simulated and then, three improvement scenarios were designed and validated operationally and financially. The results evidenced that Scenario 2 was the best choice since it provided a low investment per reduced day and a significant reduction (47.1%) regarding the probability of waiting for more than 8 days per appointment. With this proposal, the quality of medical care in elderly population can be meaningfully increased and decisionmaking process can be effectively supporte

Solving flexible job-shop scheduling problem with transfer batches, setup times and multiple resources in apparel industry

Apparel industry is characterized by the presence of flexible job-shop systems that have been structured to manufacture a wide range of customized products. However, Flexible Job-shop Scheduling is really chal-lenging and even more complex when setup times, transfer batches and multiple resources are added. In this paper, we present an application of dispatching algorithm for the Flexible Job-shop Scheduling Problem (FJSP) presented in this industry. Days of delay, throughput, earlier date and monthly demand are used as rules of operation selection. A case study in apparel industry is shown to prove the validity of the proposed framework. Results evidence that this approach outperforms the company solution and other algorithms (PGDHS and HHS/LNS) upon reducing average tardiness by 61.1%, 2.63% and 1.77% respectively. The inclusion of throughput in the model resulted in low tardiness for orders with high speed to make money. Promising directions for future research are also proposed

Selecting the most suitable classification algorithm for supporting assistive technology adoption for people with dementia: a multicriteria framework

The number of people with dementia (PwD) is increasing dramatically. PwD exhibit impairments of reasoning, memory, and thought that require some form of self‐management intervention to support the completion of everyday activities while maintaining a level of independence. To address this need, efforts have been directed to the development of assistive technology solutions, which may provide an opportunity to alleviate the burden faced by the PwD and their carers. Nevertheless, uptake of such solutions has been limited. It is therefore necessary to use classifiers to discriminate between adopters and nonadopters of these technologies in order to avoid cost overruns and potential negative effects on quality of life. As multiple classification algorithms have been developed, choosing the most suitable classifier has become a critical step in technology adoption. To select the most appropriate classifier, a set of criteria from various domains need to be taken into account by decision makers. In addition, it is crucial to define the most appropriate multicriteria decision‐making approach for the modelling of technology adoption. Considering the above‐mentioned aspects, this paper presents the integration of a five‐phase methodology based on the Fuzzy Analytic Hierarchy Process and the Technique for Order of Preference by Similarity to Ideal Solution to determine the most suitable classifier for supporting assistive technology adoption studies. Fuzzy Analytic Hierarchy Process is used to determine the relative weights of criteria and subcriteria under uncertainty and Technique for Order of Preference by Similarity to Ideal Solution is applied to rank the classifier alternatives. A case study considering a mobile‐based self‐management and reminding solution for PwD is described to validate the proposed approach. The results revealed that the best classifier was k‐nearest‐neighbour with a closeness coefficient of 0.804, and the most important criterion when selecting classifiers is scalability. The paper also discusses the strengths and weaknesses of each algorithm that should be addressed in future research

Evaluation of hospital disaster preparedness by a multi-criteria decision making approach: The case of Turkish hospitals

Considering the unexpected emergence of natural and man-made disasters over the world and Turkey, the importance of preparedness of hospitals, which are the first reference points for people to get healthcare services, becomes clear. Determining the level of disaster preparedness of hospitals is an important and necessary issue. This is because identifying hospitals with low level of preparedness is crucial for disaster preparedness planning. In this study, a hybrid fuzzy decision making model was proposed to evaluate the disaster preparedness of hospitals. This model was developed using fuzzy analytic hierarchy process (FAHP)-fuzzy decision making trial and evaluation laboratory (FDEMATEL)-technique for order preference by similarity to ideal solutions (TOPSIS) techniques and aimed to determine a ranking for hospital disaster preparedness. FAHP is used to determine weights of six main criteria (including hospital buildings, equipment, communication, transportation, personnel, flexibility) and a total of thirty-six sub-criteria regarding disaster preparedness. At the same time, FDEMATEL is applied to uncover the interdependence between criteria and sub-criteria. Finally, TOPSIS is used to obtain ranking of hospitals. To provide inputs for TOPSIS implementation, some key performance indicators are established and related data is gathered by the aid of experts from the assessed hospitals. A case study considering 4 hospitals from the Turkish healthcare sector was used to demonstrate the proposed approach. The results evidenced that Personnel is the most important factor (global weight = 0.280) when evaluating the hospital preparedness while Flexibility has the greatest prominence (c + r = 23.09

Process improvement approaches for increasing the response of emergency departments against the Covid-19 pandemic: a systematic review

The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions