Improvement of outpatient service processes based on BRP theory and information technology: a case study of the University of Hong Kong-Shenzhen Hospital

JEL Classification: M15 – IT Management, I12 – Health ProductionCurrently, due to some irrational allocation of medical and healthcare resources, a considerable proportion of state-of-the-art medical equipment and talented medical personnel are concentrated in large urban hospitals. This situation is particularly common in 3A hospitals (3A hospitals are hospitals which are equipped with more than 501 beds, can provide medical and healthcare services with high-level specialty to various regions and with scores higher than 900 according to the grading standard), which are often crowded with patients. According to the normal outpatient process, patients need to undergo a prolonged procedure from registration, treatment, laboratory test, diagnosis to drug dispensing. Often patients have to spend a long time waiting for treatment, receiving tests and paying for medical care. The congestion of patients at certain time-consuming processes allows doctors little time to check and treat patients thoroughly. As a result, doctors are often unable to make accurate and comprehensive diagnosis. Considered the window of a hospital, outpatient service is extremely important. Whether the design of its process is reasonable and whether its management is able to maximize interests for patients will directly affect the hospital’s medical level, and even its social benefits and reputation. Therefore, it has become a major issue for a hospital achieves to optimize the business process of its outpatient service. Outpatient process, as a core business process of a hospital, is critical to improving the quality of its medical service, upgrading its performance and minimizing its operating costs. Therefore, re-designing the outpatient process of a hospital can help enhance its comprehensive strength by endowing it with a core competence. In addition, the hospital will be impelled to provide patients with more convenient medical services with higher quality and lower price. This work conducts a case study on The University of Hong Kong-Shenzhen Hospital (HKU-SZH), which was the first to implement an outpatient appointment registration system. This thesis gives an anatomy of the outpatient process of the hospital through various methods and theories, such as literature review, field research, expert consultation, Business Process Reengineering Theory and Information technology, aiming to identify objectives and strategies of the case hospital in improving its outpatient process. The study consists of: - An investigation into the current situation of HKU-SZH’s outpatient registration process: through questionnaires and structured interviews, the defects and weak links in the hospital’s appointment registration model were analyzed. A structural equation model for existing outpatient processes was established and the influence of different variables on patients’ satisfaction level as well as the correlation between these variables was analyzed by means of a simulation model. - Research on outpatient process reengineering: with the needs and satisfaction of patients as a goal, this thesis reexamines the strategic goals and internal and external environment of HKU-SZH on the basis of Business Process Reengineering Theory, Queuing Theory, Six Sigma Theory and Information technology. This thesis improves HKU-SZH’s registration process, using methods of order modification, integration, simplification and automation and materializes the process by network technology and outpatient information system. - An empirical study on outpatient process: this thesis conducts a systemic and empirical analysis in a functional integration of registration and payment, process reengineering research through information technology (development of new functions of appointment system) and an empirical study on queuing theory. - Research on local adaptation of outpatient process: this thesis explores solutions and suggestions for HKU-SZH with the objective of optimize its outpatient process through the perspectives of hospital organizational structure, information technology, human resources, building of outpatient culture and optimization of waiting cost. By means of outpatient process reengineering, this thesis aim to increase the case hospital’s efficiency and raise its patients’ satisfaction so that the hospital may enhance its comprehensive competence. In addition, an effective and operable methodology will be generated, which is expected to serve as a reference for other hospitals to improve their operation and their management.Atualmente, devido a alguma atribuição irracional dos recursos médicos e de saúde, uma proporção considerável de modernos equipamentos médicos e pessoal médico talentoso estão concentrados em grandes hospitais urbanos. Esta situação é particularmente comum em hospitais 3A (hospitais 3A são os hospitais que estão equipados com mais de 501 camas, e que podem fornecer serviços médicos e de saúde com alto nível de especialidade para diversas regiões e com pontuações superiores a 900 de acordo com o padrão de classificação), que são frequentemente sobrelotados com pacientes. De acordo com o processo ambulatório normal, os pacientes precisam passar por um procedimento prolongado desde o registo, tratamento, análise laboratorial, diagnóstico, até à distribuição de medicamentos. Muitas vezes os pacientes têm de passar um longo tempo de espera para tratamento, para receber testes e para pagar por cuidados médicos. O congestionamento de pacientes em determinados processos demorados, leva a que os médicos tenham pouco tempo para verificar e tratar os pacientes completamente. Como resultado, os médicos são muitas vezes incapazes de fazer um diagnóstico preciso e abrangente. Considerado a montra de um hospital, o serviço ambulatório é extremamente importante. Se o desenho do seu processo é razoável e se a sua gestão é capaz de maximizar os interesses dos pacientes, irá afetar diretamente o nível médico do hospital, e até mesmo os seus benefícios sociais e reputação. Portanto, tornou-se um importante problema para um hospital conseguir otimizar o processo do seu serviço ambulatório. O processo ambulatório, como um processo de negócio nuclear de um hospital, é fundamental para melhorar a qualidade do seu serviço médico, aumentar o seu desempenho e minimizar seus custos operacionais. Portanto, reprojetar o processo ambulatório de um hospital pode ajudar a aumentar a sua força global dotando-o de uma competência essencial. Além disso, o hospital será impelido a oferecer aos pacientes serviços médicos mais convenientes com maior qualidade e menor preço. Este trabalho apresenta um estudo de caso sobre o Hospital da Universidade de Hong Kong-Shenzhen (HKU-SZH), que foi o primeiro a implementar um sistema de registo de consulta externa. Esta tese apresenta uma análise do processo ambulatório do hospital através de vários métodos e teorias, como a revisão de literatura, pesquisa de campo, consultas a especialistas, teoria da reengenharia de processos e tecnologias da informação, com o objetivo de identificar os objetivos e estratégias do hospital na melhoria do seu serviço ambulatório. O estudo consiste em: - Investigação sobre a situação atual do processo de registo ambulatório de HKU-SZH. Através de questionários e entrevistas estruturadas, foram analisados os defeitos e pontos fracos no modelo de registro de consultas do hospital. Um modelo de equações estruturais para os processos ambulatórios existentes foi estabelecido, e a influência de diferentes variáveis sobre o nível de satisfação dos pacientes, bem como a correlação entre essas variáveis foi analisada por meio de um modelo de simulação. - Investigação sobre a reengenharia do processo ambulatório. Tendo as necessidades e satisfação dos pacientes como objetivo, esta tese reexamina as metas estratégicas e o ambiente interno e externo de HKU-SZH com base na Teoria da Reengenharia de Processos, Teoria das Filas, Teoria Six Sigmae Tecnologias da Informação. Esta tese melhora o processo de registro de HKU-SZH, usando métodos de modificação, integração, simplificação e automação e materializa o processo através de tecnologias de rede e um sistema de informação para o processo ambulatório. - Estudo empírico sobre o processo ambulatório. Esta tese conduz uma análise sistémica e empírica sobre a integração funcional de inscrições e pagamentos, a pesquisa de reengenharia de processos através de tecnologias da informação (desenvolvimento de novas funções do sistema de consultas) e um estudo empírico sobre a teoria das filas. - Investigação sobre a adaptação local do processo ambulatório. Esta tese explora soluções e sugestões para o HKU-SZH para otimizar seu processo ambulatório através das perspetivas de estrutura hospitalar organizacional, tecnologias da informação, recursos humanos, construção da cultura do ambulatório e otimização do custo de espera. Por meio do processo de reengenharia do serviço de ambulatório, esta tese visa aumentar a eficiência do processo de internamento e aumentar a satisfação dos seus pacientes para que o hospital possa aumentar a sua capacidade global. Além disso, foi gerada uma metodologia eficiente e operacionalizavel, a qual se espera possa servir como referência para outros hospitais, para melhorar o seu funcionamento e a sua gestão

REAL-TIME SENSING AND CONTROL OF DEVELOPING WELD PENETRATION THROUGH REFLECTION VIBRATION IN GTAW

GTAW (Gas Tungsten Arc Welding) weld pool surface is believed to contain sufficient information to determine the weld penetration, from which skilled welders are able to control the welding process to desired penetration states. However, it is unclear how human welders extract the weld penetration from the observed weld pool surface. In this research, a novel method is studied to determine the weld penetration based on the dynamic change of the weld pool surface. This study observes/measures/analyzes the development of a weld pool from partial to full penetration and correlates such change to the weld penetration. Similar trends in the weld pool surface are observed when the weld penetration changes from partial to full penetration despite the amperage used and material welded. Correlating the weld pool surface reflecting grayness and the development of the weld penetration from experiments shows: (1) the weld pool reflection intensity will increase while the weld penetration is increasing; (2) the increasing trends of weld pool reflection intensity will decrease when the full penetration is achieved; (3) the weld pool reflection intensity will increase after the full penetration is achieved. Such trend in the weld pool surface reflection intensity when the weld penetration develops is used as feedback signal to detect the weld pool penetration. To control the weld pool penetration, a first-order dynamic model is identified. Model Predictive Control (MPC) is used to control the weld penetration. Experiments verified the feasibility of this proposed method and established system

A Comparison of Maximum Likelihood and Expected A Posteriori Estimation for Polychoric Correlation Using Monte Carlo Simulation

This study aims to compare the maximum likelihood (ML) and expected a posterior (EAP) estimation for polychoric correlation (PCC) under diverse conditions, especially when considering a sample size. As the ML is the classical solution to estimate PCC, the EAP is a new method based on Bayes’ theorem. Different types of prior distributions are also adapted to investigate the sensitivity of prior distribution onto the PCC estimate for the EAP case. The Monte Carlo simulation is used for this comparison by a specialized program code in MATLAB

Band structures of II-VI semiconductors using Gaussian basis functions with separable ab initio pseudopotentials: Application to prediction of band offsets

We describe the implementation of a separable pseudopotential into the dual space approach for ab initio density-functional calculations using Gaussian basis functions. We apply this Gaussian dual space method (GDS/DFT) to the study of II-VI semiconductors (II=Zn, Cd, Hg; VI=S, Se, Te, Po). The results compare well with experimental data and demonstrate the general transferability of the separable pseudopotential. We also introduce a band-consistent tight-binding (BC-TB) model for calculating the bulk contributions to the valence-band offsets (VBO’s). This BC-TB approach yields good agreement with all-electron ab initio GDS/DFT results. Comparisons between BC-TB results of VBO obtained with and without p-d coupling demonstrate quantitatively the importance of d electrons and cation-d–anion-p coupling in II-VI systems. Agreement between ab initio results and experimental results is excellent

Spectral Mixture Kernels with Time and Phase Delay Dependencies

Spectral Mixture (SM) kernels form a powerful class of kernels for Gaussian processes, capable to discover patterns, extrapolate, and model negative covariances. Being a linear superposition of quasi-periodical Gaussian components, an SM kernel does not explicitly model dependencies between components. In this paper we investigate the benefits of modeling explicitly time and phase delay dependencies between components in an AM kernel. We analyze the presence of statistical dependencies between components using Gaussian conditionals and posterior covariance and use this framework to motivate the proposed SM kernel extension, called Spectral Mixture kernel with time and phase delay Dependencies (SMD). SMD is constructed in two steps: first, time delay and phase delay are incorporated into each base component; next, cross-convolution between a base component and the reversed complex conjugate of another base component is performed which yields a complex-valued and positive definite kernel representing correlations between base components. The number of hyper-parameters of SMD, except the time and phase delay ones, remains equal to that of the SM kernel. We perform a thorough comparative experimental analysis of SMD on synthetic and real-life data sets. Results indicate the beneficial effect of modeling time and phase delay dependencies between base components, notably for natural phenomena involving little or no influence from human activity.Comment: 28 page

First principles studies of band offsets at heterojunctions and of surface reconstruction using Gaussian dual-space density functional theory

The use of localized Gaussian basis functions for large scale first principles density functional calculations with periodic boundary conditions (PBC) in 2 dimensions and 3 dimensions has been made possible by using a dual space approach. This new method is applied to the study of electronic properties of II–VI (II=Zn, Cd, Hg; VI=S, Se, Te, Po) and III–V (III=Al, Ga; V=As, N) semiconductors. Valence band offsets of heterojunctions are calculated including both bulk contributions and interfacial contributions. The results agree very well with available experimental data. The p(2 × 1) cation terminated surface reconstructions of CdTe and HgTe (100) are calculated using the local density approximation (LDA) with two-dimensional PBC and also using the ab initio Hartree–Fock (HF) method with a finite cluster. The LDA and HF results do not agree very well