Continuous Improvement Methodology Research Articles

Impact of an Integrated Hip Fracture Inpatient Program on Length of Stay and Costs.

Hip fractures are associated with significant morbidity and mortality. Co-management models pairing orthopaedic surgeons with hospitalists or geriatricians may be effective at improving processes of care and outcomes such as length of stay (LOS) and cost. We set out to determine the effect of an integrated hip fracture co-management model on LOS, cost, and process measures. We conducted a single-center pre-post study of 571 patients admitted to an academic medical center with hip fractures between January 2009 and December 2013. The group receiving an integrated medical-surgical co-management incorporating continuous improvement methodology was compared with a control population. Primary outcome was LOS. Secondary outcomes included cost per case, time to surgery, osteoporosis (OP) treatment, preoperative echocardiogram utilization, mortality, and readmission. LOS decreased from 18.2 (1.1) to 11.9 (1.5) days, a reduction of 6.3 days (P < 0.001). Mean cost decreased by $4953 (P < 0.001) per case. Mean time to surgery decreased from 45.8 (66.8) to 29.7 (17.9) hours (P < 0.001). Initiation of OP treatment increased from 55.8% to 96.4% (P < 0.001). Preoperative echocardiogram use decreased from 15.8% to 9.1% (P < 0.05). There was a nonsignificant difference in mortality rate (5.0% vs. 2.1%, P = 0.06). Readmission rate remained unchanged (4.6% vs. 6.0%, P = 0.56). An integrated medical-surgical co-management model incorporating continuous improvement methodology was associated with reduced LOS, costs, time to surgery, and increased initiation of appropriate OP treatment. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A Nonlinear Integer Programming Approach to Solving the Robust Parameter Design Optimization Problem

Robust parameter design is a widely implemented design methodology for continuous quality improvement by identifying optimal factor level settings with minimum product variation. However, apparent flaws surrounding the original version of robust parameter design have resulted in alternative approaches, of which response surface methodology using the central composite design, in particular, has drawn a great deal of attention. There is a large number of practical situations in which some or all of variables must be integers; however, the design space associated with the traditional central composite design is typically a bounded convex feasible set involving real numbers. The purpose of this paper is twofold. First, we discuss why the Box–Behnken design may be preferred over the central composite design and other three‐level designs when maintaining constant or nearly constant prediction variance associated with a second‐order model is crucial to integer‐valued robust parameter design problems. Second, we lay out the foundation to show how the Box–Behnken design is transformed into a nonlinear integer programming framework. In this paper, we develop Box–Behnken design embedded nonlinear integer programming models, using the sequential quadratic integer programming and the Karush–Khun–Tucker conditions. Comparison studies of the proposed models and traditional counterparts are also conducted. It is believed that the proposed models have the potential to impact a wide range of engineering problems, ultimately leading to process and quality improvement. Copyright © 2016 John Wiley &amp; Sons, Ltd.

Scales to Measure Culture Change in Healthcare Organizations Implementing Continuous Improvement Methodologies

Scales to Measure Culture Change in Healthcare Organizations Implementing Continuous Improvement Methodologies

The Implementation of Continuous Improvement (CI) Methodology

This study aims to identify the expected benefits of continuous improvement (CI) implementation, to determine the critical success factors that contribute to CI implementation and to detect the expected problems that impede the implementation of CI programmes at Al-Sindian Paper Mills. The data analysed in this article was collected from a mail questionnaire sent to all staff who worked on a CI (Six Sigma) project at Al-Sindian Paper Mills. The findings of this study indicate that specialised training is necessary for master black and green belts, implementation of the CI requires a quality assurance and also CI approach is not only concerned with selecting a method and forming teams, but extends to covering the enhancement of improvement skills for operators. Finally avenues for future research were provided.

Die crack failure mechanism investigations depending on the time of failure

The quality and reliability concern of the die crack failure mechanism needs to be addressed at each step of the supply chain, from the wafer supplier, semiconductor fabrication, package assembly, Tier1 manufacturer assembly, to the end customer application. Finding the critical factors of a die crack is crucial for the root cause investigation, allowing the implementation of accurate corrective actions. The various analytical methods that can be employed are numerous, from standard FA techniques (mainly SAM & fractography) to advanced techniques like TherMoiré Analysis or Finite Element Simulation. Application-level analysis, problem solving and continuous improvement methodologies are also key success factors for such problems: Fault Tree Analysis and Ishikawa diagram will enable complete process assessment, including package and die integrity, assembly process, Surface-mount technology (SMT) process, and stress condition at the end customer application. This paper first introduces the different and complementary FA techniques, then presents three case studies that illustrate the difficulty to identify the cause of such die cracks, as a function of the time of failure.

Improving ED specimen TAT using Lean Six Sigma.

Lean and Six Sigma are continuous improvement methodologies that have garnered international fame for improving manufacturing and service processes. Increasingly these methodologies are demonstrating their power to also improve healthcare processes. The purpose of this paper is to discuss a case study for the application of Lean and Six Sigma tools in the reduction of turnaround time (TAT) for Emergency Department (ED) specimens. This application of the scientific methodologies uncovered opportunities to improve the entire ED to lab system for the specimens. This case study provides details on the completion of a Lean Six Sigma project in a 1,000 bed tertiary care teaching hospital. Six Sigma's Define, Measure, Analyze, Improve, and Control methodology is very similar to good medical practice: first, relevant information is obtained and assembled; second, a careful and thorough diagnosis is completed; third, a treatment is proposed and implemented; and fourth, checks are made to determine if the treatment was effective. Lean's primary goal is to do more with less work and waste. The Lean methodology was used to identify and eliminate waste through rapid implementation of change. The initial focus of this project was the reduction of turn-around-times for ED specimens. However, the results led to better processes for both the internal and external customers of this and other processes. The project results included: a 50 percent decrease in vials used for testing, a 50 percent decrease in unused or extra specimens, a 90 percent decrease in ED specimens without orders, a 30 percent decrease in complete blood count analysis (CBCA) Median TAT, a 50 percent decrease in CBCA TAT Variation, a 10 percent decrease in Troponin TAT Variation, a 18.2 percent decrease in URPN TAT Variation, and a 2-5 minute decrease in ED registered nurses rainbow draw time. This case study demonstrated how the quantitative power of Six Sigma and the speed of Lean worked in harmony to improve the blood draw process for a 1,000 bed tertiary care teaching hospital. The blood draw process is a standard process used in hospitals to collect blood chemistry and hematology information for clinicians. The methods used in this case study demonstrated valuable and practical applications of process improvement methodologies that can be used for any hospital process and/or service environment. While this is not the first case study that has demonstrated the use of continuous process improvement methodologies to improve a hospital process, it is unique in the way in which it utilizes the strength of the project focussed approach that adheres more to the structure and rigor of Six Sigma and relied less on the speed of lean. Additionally, the application of these methodologies in healthcare is emerging research.

Total Quality Standards to Activate Sports Training Process in Sports Competitions

The quality of Physical Education and Sports is considered a process to achieve the needs and desires of the beneficiary or customer expectations in sports institutions in various sports activities. In fact, achieving the required level and quality performance in sports institutions depends on vocational and scientific preparation at different sports institutions and activities. Thus, it was important to take into account this modern management style and try to take advantage of the training process for each of the coach, player and administrator. In order to achieve effective administrative work in Egyptian sports federations we must rely on the criterion of intonation in administrative practices. Quality is no longer just , standards, targets or set of requirements which sports federations seek to achieve, but it became a continuous effort built on the methodology of appropriate continuous improvement , innovation and development to achieve the objectives of the sports federations as winning in Olympic tournaments. The present research aims at determining the Total Quality Standards needed to activate the sports training process in sports competitions through: the senior management focus on beneficiaries to achieve their needs and desires, quality level of sports training programs, coaches absorbance of the scientific principles and foundations of athletic training, availability and use of physical, human and information technology resources in sports training programs, financing plans of athletic training programs for marketing tournaments and competitions and using beneficiaries’ incentives principle (physical and moral). The research team followed the descriptive approach as it suits the research nature. Research sample consisted of (110) board members, technical staff, administration staff, and players, some of which were individuals or team sports federations. The questionnaire form has been used as a tool for data collection. Study results proved the need for the application of Total Quality Standards to activate the process of training in sports competitions.Â

Assessment and Continuous Improvement of Information Security Based on TQM and Business Excellence Principles

Abstract This paper highlights a part of the results of a doctoral research regarding information security management systems in the context of business excellence conducted by authors in the Research Centre of Business Administration of The Bucharest University of Economic Studies, Romania. It focuses on an approach for self-assessment and continuous improvement of information security based on the fundamental concepts and criteria of the European Foundation for Quality Management (EFQM) Business Excellence Model. The first objective of this paper is to highlight the state of the art regarding the approaches used for the assessment and continuous improvement of information security. A second objective is to propose a methodology for assessment and continuous improvement of information security integrating the criteria of the EFQM Model and its RADAR (Results, Approaches, Deploy, Assess and Refine) logic. The methodology presented can be used by organisations wishing to go beyond compliance with the requirements for Information Security Management System defined in standards such as ISO 27001 or NIST standards, to identify opportunities for improvement and to coordinate efforts towards sustainable information security performance.

Assessment of Efficiency and Sustainability in a Chemical Industry Using Goal Programming and AHP

Abstract This paper proposes a methodology for continuous assessment and improvement of the efficiency and sustainability in a Chemical Industry. This segment was chosen due to its importance both in the international (sixth largest worldwide revenues) and in Brazilian economic scenario (fourth segment in importance in the formation of industrial GDP). An exploratory analysis was performed by applying nonparametric techniques to measure and compare the efficiency and sustainability in a fictitious chemical production plant. The analyzed variables were identified and it was defined the importance (weight) of each of these by using the AHP (Analytic Hierarchy Process) method. It was defined a standard to be used as a benchmark and it was identified the implemented actions (projects) to achieve the proposed targets, using the technique of Goal Programming. The variables were defined considering sustainability and efficiency performance indicators. For sustainability were used as reference the standards defined in “Responsible Care®” program and the efficiency performance indicators were chosen considering some key items used by the market to assess efficiency of a production plant.

Learning Strategic Orientation for Enhancing Business Performance

In the present globalized business climate, it is imperative for firms to interact with their environment and adopt the culture which stimulates behavioral change and performance improvements. In this context, strategic orientation has been accepted across the world as an excellent methodology for continuous improvement in every part of the organization. The study emphasizes the significance of different strategic orientations of firms by exploring seven important business philosophies (orientations), viz., production, selling, customer, market, learning, entrepreneurial, and relationship marketing orientation. It also throws light on the role of each strategic orientation in achieving competitive advantage and better firms performance. The study suggests that practicing single strategic orientation by firms is not appropriate for divergent market contexts. Further, firms adopting plural orientation are more likely to perform even better than firms adopting only single strategic orientation. Therefore, firms should shift their focus from one strategic orientation to the combination of strategic orientation that firms can pursue in different situations as their success and survival depend on the integration of different strategic orientations.

&lt;p&gt;Proposed Progression of Lean Six Sigma&lt;/p&gt;

Lean Six Sigma is a hybrid continuous improvement methodology that has various definitions, from those that are Lean dominant to those that are Six Sigma dominant. Text mining and cluster analysis based research has helped to illuminate the degree to which Lean Six Sigma models, as described in articles published in the International Journal of Lean Six Sigma, are Lean dominant versus Six Sigma dominant. The iterative cluster analysis was used to identify clusters of articles that were interpretable. The research found that some Lean dominant Lean Six Sigma articles ascertain Lean as the dominant philosophy and Six Sigma as a subordinate tool used in achieving the Lean objectives. The findings of this research as well extrapolation of the literature informed a recommended Lean Six Sigma model as described in this article. The recommended model is Lean dominant and consists of two subordinate methods – Six Sigma and statistical process control. The three synergistic approaches not only each serve in their own way to manifest process improvements, they also all contribute to organizational learning, which is considered a chief contributor to competitive advantage.

Acute Spinal Cord Compression: CQI Framework Increases Resource Efficiency While Promoting Delivery of High-Quality Care

PurposeLiterature reports indicate that advanced imaging is overutilized, especially in the emergency setting. At our institution, stat spinal MRI for suspected acute spinal cord compression (ASCC) was perceived to be excessively utilized. A continuous quality improvement process was employed to investigate this trend and improve the efficiency of this diagnosis. MethodsSpine imaging in patients with suspected ASCC was retrospectively evaluated for appropriateness of indications and quality of imaging. Based on the results, a new institutional policy for ordering MR for suspected ASCC was implemented, concurrent with development of a new screening spine MRI protocol. Subsequently, indications, efficacy, and imaging utilization of the new strategy were analyzed for improved operational effectiveness. ResultsThe initial retrospective study demonstrated only a 1.4% positive rate of ASCC as well as image-quality degradation due to patient motion resulting from prolonged scan times. Based on these results, a new institutional policy for ordering stat ASCC spine MRI was instituted with an updated screening MRI protocol. This policy resulted in a positive rate of ASCC of 4.4%, and decreased scan time by 50%-70%, while preserving diagnostic image quality and decreasing resource utilization. ConclusionsAs suspected, stat spinal MRI for ASCC was excessively utilized at our institution. The study demonstrated that systemic improvements regarding this issue can be achieved by using a multidisciplinary approach and following a continuous quality improvement methodology. A new MRI protocol for identification of ASCC was found to preserve image quality and diagnostic confidence, while simultaneously decreasing scan time and use of valuable health care resources.

A structured methodology to optimise throughput of production lines

The increasing social and environmental demands, financial and operational restraints, and high qualification requirements constantly affect the competitiveness and performance of the mining industry. In the literature, a wide range of techniques have been developed to cope with these challenges. However, a structured methodology to integrate solutions of a diverse nature considering physical asset management perspectives has not been developed in depth. In this work, we introduce a continuous improvement methodology based on prioritising and optimising the best opportunities in different asset management areas to achieve throughput targets. The proposed procedure, called throughput-oriented system improvement methodology, starts with a criticality analysis to identify the bottleneck components. It is followed by the application of an optimisation technique, finishing with the implementation and evaluation of policy changes. The aforementioned steps have to be applied cyclically until the production target is reached. We illustrate its use in a case study from a mining company in northern Chile. Results show that the operational efficiency can be significantly improved by optimally changing the maintenance policy and the plant layout.

A Case Study of the Use of A3 Thinking in Radiation Oncology

Radiation oncology is a complex, intricate field that is consistently developing and changing. The need for robust constant problem solving and process improvement is crucial for clinical operations and patient safety. This is a case study on the use of “A3 thinking” in a complex academic medical radiation oncology department. A3 thinking is a problem solving methodology that operationalizes the concept of Plan-Do-Study-Act (PDSA) and lean methodology of continuous improvement by using the A3 tool.

OC-039 Improving Quality In A National Intestinal Failure Unit: Greater Efficiency, Improved Access, Reduced Mortality

IntroductionIn 2010, there was a significant waiting list for admission to the Intestinal Failure Unit (IFU) at Salford, one of two current nationally-accredited centres. There had also been a steady...

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Impact of Throughput Optimization on Intensive Care Unit Occupancy

Intensive care unit (ICU) resources are scarce, yet demand is increasing at a rapid rate. Optimizing throughput efficiency while balancing patient safety and quality of care is of utmost importance during times of high ICU utilization. Continuous improvement methodology was used to develop a multidisciplinary workflow to improve throughput in the ICU while maintaining a high quality of care and minimizing adverse outcomes. The research team was able to decrease ICU occupancy and therefore ICU length of stay by implementing this process without increasing mortality or readmissions to the ICU. By improving throughput efficiency, more patients were able to be provided with care in the ICU.

Iterative development of visual control systems in a research vivarium.

The goal of this study was to test the hypothesis that reintroduction of Continuous Performance Improvement (CPI) methodology, a lean approach to management at Seattle Children’s (Hospital, Research Institute, Foundation), would facilitate engagement of vivarium employees in the development and sustainment of a daily management system and a work-in-process board. Such engagement was implemented through reintroduction of aspects of the Toyota Production System. Iterations of a Work-In-Process Board were generated using Shewhart’s Plan-Do-Check-Act process improvement cycle. Specific attention was given to the importance of detecting and preventing errors through assessment of the following 5 levels of quality: Level 1, customer inspects; Level 2, company inspects; Level 3, work unit inspects; Level 4, self-inspection; Level 5, mistake proofing. A functioning iteration of a Mouse Cage Work-In-Process Board was eventually established using electronic data entry, an improvement that increased the quality level from 1 to 3 while reducing wasteful steps, handoffs and queues. A visual workplace was realized via a daily management system that included a Work-In-Process Board, a problem solving board and two Heijunka boards. One Heijunka board tracked cage changing as a function of a biological kanban, which was validated via ammonia levels. A 17% reduction in cage changing frequency provided vivarium staff with additional time to support Institute researchers in their mutual goal of advancing cures for pediatric diseases. Cage washing metrics demonstrated an improvement in the flow continuum in which a traditional batch and queue push system was replaced with a supermarket-type pull system. Staff engagement during the improvement process was challenging and is discussed. The collective data indicate that the hypothesis was found to be true. The reintroduction of CPI into daily work in the vivarium is consistent with the 4P Model of the Toyota Way and selected Principles that guide implementation of the Toyota Production System.

Readiness factors for the Lean Six Sigma journey in the higher education sector

Purpose– The purpose of this paper is to reveal the readiness factors (RFs) which are required for the successful introduction and development of a Lean Six Sigma (LSS) initiative within the context of higher education (HE) sector. These RFs are a pre-requisite for the successful implementation, deployment and sustainability of LSS in higher education institutions (HEIs).Design/methodology/approach– The author uses secondary data from literature to justify the need for RFs before any HEI invests on continuous improvement (CI) methodologies such as LSS. The author would argue that these RFs must be assessed properly to understand the strengths and weaknesses of the HEI.Findings– The paper presents the RFs which are essential for the implementation and sustainability of LSS. It is important to note that RFs are prior to embarking on a CI initiative whereas success factors are determined once the senior management team decides to invest on a specific CI initiative (Lean, LSS, etc.)Research limitations/implications– This is a very theoretical paper based on the existing literature and authors’ experiences in the HE sector. The next stage of the research is to carry out empirical studies in a number of HEIs to determine the RFs for LSS as a business process improvement methodology.Originality/value– This paper makes an attempt to derive the RFs for the successful development of LSS in the HE sector from the current literature. The RFs would assist any HE sector who would like to launch a LSS journey for improving the efficiency and effectiveness of business processes across the business.

A cost-benefit ergonomics methodology applied to service industry with digital human modelling

Diverse authors have shown the influence and importance that ergonomics has on the optimisation and improvement of processes quality and management, and in company business strategies. This paper intends to show the advantages that can arise by joining an ergonomic project methodology with a continuous improvement procedure unified with a cost-benefit analysis with the help of digital human modelling (DHM) tools in any service industry. The aim of this study particularises this continuous improvement methodology in an industrial laundry workplace, identifying and analysing the work related musculoskeletal disorders with risk assessment methods together with 3D CAD design and DHM. It also performs a cost-benefit analysis as a systematic process, in order to continuously improve ergonomic design of existence or future workplaces. The implementation offered good results, obtaining safer and more efficient workplaces and therefore it can be assured that it can be extrapolated to different work scenarios.