Fishbone Analysis Research Articles

ANALYSIS OF PERIODIC SELF-ASSESSMENTS WITHIN THE SCOPE OF HEALTH QUALITY STANDARDS IN TERMS OF MATERIAL MANAGEMENT AS A PREVENTIVE ACTIVITY: A RETROSPECTIVE STUDY IN A UNIVERSITY HOSPITAL

This study aims to investigate the effects of periodic self-assessments on materials management within the framework of quality management in healthcare. The retrospective study, conducted in a university hospital, evaluates the effectiveness of quality improvement initiatives and compliance with health standards, while examining in detail the effects of these processes on materials management. It also investigates how self-assessment processes improve healthcare service delivery and contribute to materials management processes. Problems identified through Fishbone and Pareto analysis are examined, prioritised and solutions are developed. The findings obtained aim to improve material management processes and increase quality standards in health. The main purpose of the research is to examine the effects of periodic self-assessments on materials management in order to improve the quality of healthcare services. The findings emphasise the importance of maintaining quality standards in health services and systematic handling of periodic self-assessments. Problems identified by Fishbone and Pareto analysis are analysed by root cause analysis and solutions are developed. This approach aims to contribute to the development of materials management processes and to the improvement of quality standards in healthcare. The results of the research are an important guide for practitioners, managers and policy makers in the fields of quality management and materials management in health services.

Quality Improvement Measures in Reducing Hypothermia Among At-risk Preterm Neonates in a Neonatal Intensive Care Unit

Background Hypothermia is a significant concern in most neonatal units in both term and preterm, which increases the risk of mortality and morbidity. We aimed to reduce the incidence of hypothermia among at-risk preterm neonates upon admission to the neonatal intensive care unit (NICU) from a baseline of 75%-30% over 15 months. Methods This quality improvement study in a tertiary NICU implemented multiple plan-do-study-act (PDSA) cycles for all inborn neonates with a gestational age of less than 34 weeks or birth weight under 1500 g. The key outcome measure was the incidence of hypothermia, expressed as a percentage. Potential barriers to normothermia were evaluated using fishbone analysis and a key-driver diagram. Baseline data were collected over 3 months, and two PDSA cycles were performed over 18 weeks using a bundled approach and a sustenance phase over 9 months. Key interventions involved the optimization of environmental temperature at various locations, the use of polyethylene wraps for resuscitation, the proper use of transport incubators, and through raising awareness among healthcare professionals. Results A total of 319 neonates were part of the study. The baseline incidence of hypothermia (outcome measure) decreased from a median of 83% to 20.5% after two PDSA cycles and was sustained for over 9 months with reinforcement measures. Only two neonates had hyperthermia during the study period (balancing measure), and 96% compliance with documentation was achieved. Conclusions Quality improvement measures with simple policy reinforcement and a bundled approach can help reduce the incidence of hypothermia in at-risk preterm neonates.

Application of Safety Procedure As Efforts To Prevent Work Accidents In MT. Serang Jaya Engine Room

Safety Procedure is a formal written safety procedure and contains procedures, identification and obligations to carry it out while working. Not optimal due to lack of understanding of Safety Procedures that pose a risk of work accidents. This study aims to determine the causes and impacts of the non-optimal implementation of Safety Procedures and efforts so that the Safety Procedure can run optimally so as to prevent work accidents in the engine room. The research method used in this study is a qualitative method with a descriptive pattern. Research data sources are obtained from primary and secondary data. Data collection techniques through observation, literature study, interviews and documentation during the time researchers carried out marine practices on the MT ship. Serang Jaya. The data analysis techniques used are by collecting data, reducing data, presenting data and drawing conclusions or verifying data which is also supported by fishbone analysis. Testing the validity of data using the tringulation method. The results stated that the factors of not optimal Safety Procedure due to lack of crew understanding of Safety Procedure, and crew concern for safety as well as lack of supervision and coordination between crew and management are the reasons why Safety Procedure cannot run optimally. The impact of not optimal Safety Procedure is the high risk of work accidents, hampering ship operations, harming the ship or the parties concerned. Efforts that can be made to optimize this are by carrying out Safety meeting activities, Toolbox Meeting, Drill, installing Safety Signs. And always provide counseling related to Safety Procedure in the engine room.

Departure Delay of a Semi Container Passenger Ship: A Case Study in KM Nggapulu

Departure schedule is an important thing to be considered by the companies and ship crews providing passenger ship. KM Nggapulu experienced a delay in departure at Fak-Fak Port on January 26, 2023. This raised complaints from passengers due to their inconvenience. This study aims to analyze the problem of departure delay of KM Nggapulu by identifying the factors and impacts of the delays, as well as actions to prevent delays in passenger ship. Qualitative method using fishbone analysis was applied in this research. Data were collected through observation, interviews, documentation studies, and literature studies. To test the validity of the data, researchers used triangulation. The research found that the delay in departure of KM Nggapulu is due to the late loading of containers. This occurred due to the negligence of the container loading and unloading party and the lack of coordination between PT SBN, the owner of the goods (shipper), and the ship’s crew. The delay of containers loading resulted in the ship's delayed departure for 5 (five) hours and caused complaints from passengers. Optimizing coordination between related parties, increasing manpower, and optimizing loading and unloading facilities at the port were the actions taken to prevent the delay.

Review of The Financial Health of Bank During Increasing Foreclosed Assets and The Application of Analytic Hierarchy Process (AHP) in Selecting Strategies to Reduce Them

PT Bank Laju International Tbk (the Bank) has struggled with its increased foreclosed assets, particularly those originating from mortgage loans, which could affect its financial health. The research assessed Bank’s financial health using Risk Based Bank Rating (RBBR) framework by analysing key financial ratios and investigating the root causes of rising foreclosed assets through Fishbone and Pareto analysis. Key factors include customer income instability, slow progress in selling foreclosed assets, and lack of insurance protection during economic downturns. To select effective strategies for managing foreclosed assets, the research utilized Analytic Hierarchy Process (AHP), a Multi-Criteria Decision-Making method, to evaluate multiple alternatives based on various criteria, which were derived from Focus Group Discussion (FGD) with Bank’s officers, who directly involved in mortgage loans and foreclosed assets activities, also reference with Bank’s SWOT analysis. The research evaluated three alternatives strategy: Protection Insurance for Customer’s Mortgage Loans. Actively Partnering with property agents to accelerate sale of foreclosed assets as-is. Collaborating with property agents to renovate foreclosed assets. The result showed that despite the increase in foreclosed assets, the Bank remains financially sound, with key financial ratios within acceptable regulatory limits. AHP analysis revealed that alternative 1 stands in first place to be prioritized, followed by alternative 2, however between both alternatives indicates a very small difference in prioritization weight, which means that both strategies are important to be executed and prioritized. Proposal to implement both alternatives in parallel would be a very effective strategy, where alternative 1 conduct as Preventive Strategy in preventing customer’s mortgage loans defaults, while alternative 2 as Corrective Strategy in lowering foreclosed assets volume. Alternative 3 acts as a complement strategy, where renovating foreclosed assets could facilitate quicker sales, however it’ll take longer time for renovation itself.

Perencanaan Strategi Untuk Mengurangi Produk Reject Dengan Pendekatan Lean Manufacturing

Company X, a feed manufacturer, faced a significant challenge related to a high product rejection rate of 10%. This study aimed to identify the root causes of the problem and implement lean manufacturing-based solutions to reduce waste. Through fishbone and Pareto analysis, the study revealed that human errors and non-standard measuring instruments were the primary contributors to the issue. The PDCA cycle was utilized as a framework for implementing solutions. The results demonstrated that the company reduced the product rejection rate by improving employee adherence to production procedures and conducting regular calibrations of measuring instruments. This research highlights the importance of lean manufacturing approaches in optimizing production processes and enhancing product quality in the feed industry.

Implementation of Facility and Safety Management at Public Health Center Pesantren II Kediri

Health Health centers must be accredited to improve the quality of health services. In order for accreditation to be achieved, Public Health Center has requirements that must be met regarding buildings, infrastructure, equipment, and providing a safe environment for service users, visitors, officers, and the community, including patients with physical limitations. Patients with physical limitations are given access to obtain services, so facility and safety management are needed. Community service activities carried out by the Postgraduate Program in Public Health IIK Strada Indonesia, which was carried out from May 22, 2023, to June 17, 2023, aim to identify the implementation and implementation strategies for facility management and safety using Fishbone, USG, and SWOT analysis at Public Health Center Pesantren II Kediri. One of the implementations was the socialization of facility and safety management to all employees, and the results of the Wilcoxon statistical test pre-test and post-test showed a sig value. 0.000 (<0.05) means that there is an effect of socialization of facility management and security among Public Health Center Pesantran II employees. Implementation and management strategies for facilities and security management at Public Health Center Pesantren II Kediri have been well implemented. To improve service quality, there are several conditions that can be optimized. Public Health Center management has a big role to play in ensuring the management of facility management and security in accordance with applicable regulations.

Analysis of Damage to Main Bearing on The Diesel Generator Motors at KM Sabuk Nusantara 89

Main bearings are made from special metal materials that are resistant to hot engine friction. The main bearing has holes in several parts which function to allow fluid (lubricating oil) to flow. Metal sitting is two plates that have a very smooth surface and consist of several layers of metal that have different hardness. The main bearing is a very vital part to support the performance of the crankshaft. The aim of this research is to determine the factors that cause damage to main bearings in diesel generator motors. The research method used is a qualitative descriptive method using observation, interviews and documentation methods and using the fishbone analysis method. The results obtained from this research show that the causes of damaged main bearings in diesel generator motors are decreased lubricating oil pressure, lack of understanding of maintenance procedures and fatigue of the seated metal component materials.

Statistical Quality Control (SQC) Method Analysis Regarding Qualty Control of Shoe Products (Case Study of PT-X)

The shoe industry plays an important role in the economy with mass production, creating fierce competition. Companies need to plan production carefully to meet market demand. Observations show that there are production defects that reduce performance and cause losses, especially in distribution. This research uses P-Chart Analysis to compare the proportion of defective products, aiming to detect errors before sale. The application of a quality control method through Statistical Quality Control (SQC) is proposed. The Pareto diagram identifies the main types of damage: over cementing (35.9%), open bonding (27.7%), overlay (24.1%), metal material damage (6.3%), and material damage (6.1 %). P-Chart analysis found points outside the control limits in the 15th and 18th data, which were removed for sample stabilization. Fishbone analysis helps identify the cause of the problem. Over cementing, open bonding, and overlay are caused by human, material, and machine factors. Damage to metal materials and materials is also caused by human, material and machine factors, as well as method factors. This research shows the importance of implementing quality control to reduce production defects and improve company performance.

Analyzing Occupational Accidents by Using Fishbone for Enhanced Safety: A case study in Excavation Work

Excavation and earthworks are considered fundamental activities within the construction sector, and therefore, accidents occurring during excavation work cannot be separated from general accidents within the construction industry. These activities entail a range of hazards and risks, highlighting the critical importance of taking necessary precautions and providing training before commencing excavation work. The aim is to eliminate potential risks at their source by using appropriate equipment and adopting suitable excavation methods. If risks cannot be entirely eliminated, it is crucial to reduce them to acceptable levels by ensuring that workers use appropriate personal protective equipment, conducting regular maintenance of vehicles and equipment, and providing ongoing training. In this study, an incident that occurred during excavation work in Iğdır province was evaluated through a Fishbone analysis within the context of cause-and-effect relationships. The origins of the accident were thoroughly examined, and the results were assessed. Factors such as the absence of occupational health and safety measures, lack of workplace organization, and absence of trained personnel were identified as contributors to increased accident probability. Additionally, the study suggests that along with the absence of preventive measures, post-accident protective measures were also inadequate. It emphasizes that individuals lacking sufficient knowledge during rescue operations exacerbate the situation. Furthermore, it was concluded that activities performed by individuals lacking adequate knowledge of the equipment and machinery used in excavation work pose higher risks. The necessity of fostering a culture of occupational health and safety is underscored, highlighting its role in anticipating potential accidents and adhering to necessary procedures.

Tata Kelola Galangan Kapal Kayu di Desa Bahari I, Kecamatan Sampolawa Kabupaten Buton Selatan

The wooden shipyard in Bahari Village is a privately-owned facility that conducts maintenance, repair, and construction of new wooden ships. The vessels serviced at this shipyard range from 10 GT to 25 GT and are made from wood. The purpose of this research is to evaluate the management of the wooden shipyard in Bahari I Village, Sampolawa District, South Buton Regency. The methodology used is a survey method, and the data is analyzed using fishbone analysis followed by a descriptive approach. The results of this study indicate that the construction and repair processes of wooden ships in Bahari I Village are not efficient due to facilities that do not meet standards, with only 22% of the necessary conditions being fulfilled. The management of this wooden shipyard is still far from adequate because several aspects remain uncontrolled, such as the shipbuilding process not meeting expected targets, delays in the availability and delivery of raw materials, and the use of very basic tools and outdated technology.

Reducing Blood Culture Contamination in Adult Patients with Cancer Presenting to the Emergency Department

Background: Infection is one of the most common complications of cancer and cancer treatment. Most patients admitted for fever or infection come through the Emergency Department (ED), which is a primary site for blood culture collection. Contamination of blood cultures complicates the diagnoses, compromises quality of care, leads to unnecessary antibiotic exposure and increases financial burdens. It may also lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was over twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses, instead of phlebotomists, draw most blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the ED contamination rate by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared ED contamination rates versus other hospital inpatient floors and outpatient centers over a three-month period. We then evaluated the contamination rates of ED nurses versus ED phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and potential interventions were ranked on a prioritization matrix. Results: We identified use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as critical contributors to increased contamination rates in the ED. Our intervention was creating premade blood culture kits promoting the use of chlorhexidine swabs through availability and easy access in the fast-paced ED environment. Ten cubic centimeter (cc) syringes in the kits encouraged withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off ED nurses at the bedside, implementing education and adherence in using the blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. A reduction in blood culture contamination from 2.46 percent to 1.89 percent was seen after two months. Conclusions: A guideline-driven, standardized blood culture collection process followed by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available premade blood culture kits improve compliance with materials and techniques associated with best practices.

"Covering provider": an effort to streamline clinical communication chaos.

This report describes a root cause analysis of incorrect provider assignments and a standardized workflow developed to improve the clarity and accuracy of provider assignments. A multidisciplinary working group involving housestaff was assembled. Key drivers were identified using value stream mapping and fishbone analysis. A report was developed to allow for the analysis of correct provider assignments. A standardized workflow was created and piloted with a single service line. Pre- and post-pilot surveys were administered to nursing staff and participating housestaff on the unit. Four key drivers were identified. A standardized workflow was created with an exclusive treatment team role in Epic held by a single provider at any given time, with a corresponding patient list column displaying provider information for each patient. Pre- and post-survey responses report decreased confusion, decreased provider identification errors, and increased user satisfaction among RNs and residents with sustained uptake over time. This work demonstrates structured root cause analysis, notably engaging housestaff, to develop a standardized workflow for an understudied and growing problem. The development of tools and strategies to address the widespread burdens resulting from clinical communication failures is needed.

Improving Remote Leadership on PT. XYZ Business Development Expansion Team

This study analyzes and enhances the effectiveness of remote leadership within PT. XYZ’s Business Development Expansion team, crucial to the company’s growth. Despite PT. XYZ’s expansion beyond Jabodetabek, the remotely managed business development team’s performance has lagged compared to the directly managed Jabodetabek team. Using the DMAIC framework, this research identifies and addresses inefficiencies in remote leadership. Data was collected through interviews and company documents, employing methods such as fishbone analysis and the 5 Whys technique. Key findings indicate issues in leadership and management, tools and technology, and skills and impact. Problems include the absence of Standard Operating Procedures (SOPs), lack of Key Performance Indicators (KPIs), poor integration with support divisions, centralized data management, complex products, inadequate training, and lack of an integrated system for remote operations. The study recommends creating comprehensive SOPs, establishing specific KPIs, improving communication with support departments, decentralizing data management, simplifying product offerings, conducting regular training, and implementing an integrated management system to enhance remote leadership practices.

Evaluasi Efektivitas Strategi 5S dalam Meningkatkan K3 di Lingkungan Kerja: Studi Kasus pada PT Manakarra Unggul Lestari

This study focuses on improving occupational safety and health (OSH) at PT Manakarra Unggul Lestari, a company engaged in palm oil plantation and processing, through the implementation of the 5S method. The analysis primarily examines the Shitsuke (Discipline) aspect, which was found to have the lowest score with an average of 3.092. The objective of this research is to enhance OSH standards within the company by implementing clear steps in Seiri, Seiton, Seiso, Seiketsu, and Shitsuke, supported by Safety measures. Observations were conducted before and after implementation using the 5S and Safety Checklist developed by Todd MacAdam. The results indicate a positive impact of 5S and Safety activities on improving OSH standards, reflected in increased employee discipline and significant changes. Fishbone analysis was also employed to identify key issues within the company, enabling more targeted improvement efforts. This study makes a significant contribution to enhancing OSH in palm oil plantation and processing environments, concluding that the implementation of 5S and Safety can foster a safer work culture and improve employee well-being, aligning with higher OSH standards.

Identifikasi Faktor–Faktor Penyebab Cost Overrun dan Time Overrun pada Proyek Konstruksi Gedung Di Kota Banda Aceh

Projects of building construction develops acordance with the implementation of the fulfillment of human life. During implementation, the project did not always as expected. These things happen due to cost and time deviations. The problem in this research is what are the factors that cause cost overrun and time overrun in the implementation of building construction projects in Banda Aceh city. The purpose of the study was to determine the causes of cost overrun and time overrun in the implementation of building construction projects toward minimize the impact of failure in the implementation of a construction project. The research data was obtained by distributing questionnaires to 40 respondents from qualified (small) and (medium) of contractors in Banda Aceh city. The sampling technique used is purposive sampling with the criteria of fulfilling the experience of having been involved in the implementation of building construction projects. Data processing was carried out with SPSS version 24 software with confirmatory factor analysis, descriptive analysis and fishbone analysis. The results of factor analysis obtained the average value of the MSA test of 0.694, the KMO test of 0.684. The value of a variable can be analyzed further if the value exceeds 0.5 and the Bartlett test obtained a value of 0.000 <0.05, it explaned each variable is correct. The total value of variance explained is 50.91%, it means the nine factors can form the factors causing cost overrun and time overrun, while the remaining 49.08% is explained by other factors. From the loading factor value, the dominant factor is material factor (X4) with a loading value of 0.91. The results of the descriptive analysis show causing of cost overrun and time overrun are an increase in material prices (X4.3) with mean value is 4.13 and poor quality control of materials (X4.4) with mean value is 4.03.

Identifikasi Problematika Pendidikan Di Sekolah Dasar MIS Modern Az-Zakky

Basic education is the primary foundation in the development of human and societal quality. However, the quality of learning in primary schools is often influenced by the availability of adequate educational facilities. This study aims to identify educational problems at MIS Modern Az-Zakky Elementary School through a literature review and fishbone analysis. In this study, we collected and analyzed various relevant literature on the topic. The analysis results show that several educational problems, such as inadequate classrooms, insufficient learning equipment, and other supporting facilities, can significantly affect the quality of learning in primary schools. Existing educational problems can hinder the learning process, reduce student interest in learning, and lower students' academic achievement. Additionally, the impact of these problems can worsen educational disparities and the overall quality of education.

Does electronic data collection perform better than paper-based data collection in health research fieldwork? A participatory action research in Zanzibar

IntroductionTechnological advancement in low-resource settings is opening the gateway to implementation of electronic data collection methods that improve data quality. We examined the concerns to use electronic data collection tool...

Konsep Video Konten Edukasi Kesehatan Mental untuk Remaja

Mental health is one of the most highlighted health issues by many people around the world. During this time, many adolescents experience mental health problems. The most common mental health problem in adolescents is depression or anxiety. Deviant behavior to harm oneself, as a result of a lack of understanding in the management of adolescent emotions, is one of the reasons why the phenomenon of suicide itself comes from the individual concerned who is experiencing social problems. The purpose of making this video concept is to educate adolescents in understanding emotional management, how to develop themselves in the environment, and provide information and raise awareness of adolescents about the importance of maintaining mental health. In designing this video concept, primary and secondary data were collected from interviews and observations. In analyzing the data, using fishbone analysis and 5W + 1H. In designing the concept of this content video, it pays attention to aspects of its function to educate teenagers that are not boring and easy to understand. For an emotional attachment by providing a color mood according to the background of the situation. There is an explanation of emotional management and self-development in the environment in teenagers which aims to educate teenagers about the importance of mental health for themselves and others. Self-development is needed to explore and increase the potential that exists within teenagers. It is hopefully that the design of mental health educational content videos can provide new insights for adolescents and the messages conveyed can be well received.

Perancangan Kampanye Digital Pencegahan Anemia untuk Perempuan Usia 16-19 Tahun di Surabaya

Anemia occurs due to a condition of lack of red blood cells or hemoglobin. Factors that can affect a person affected by Anemia such as an unhealthy and unbalanced diet to the lack of knowledge of women about Anemia. Prevention can be done by holding an Anemia prevention campaign for women aged 16-19 years who live in Surabaya. The campaign is carried out in a fun and cheerful way that suits the interests of young women aged 16-19 years old today, especially through social media. The media designed uses main media and various supporting media. The design was carried out using qualitative and quantitative research methods. Data acquisition is done through primary and secondary data. Primary data is done by interview and observation. Secondary data is obtained from literature studies and literature studies. The results of the data that have been collected are then analyzed using fishbone analysis. The results of the fishbone analysis are continued to obtain keywords or big ideas that are used as the initial design concept. Keywords are developed to become visual concepts, character concepts, and media concepts. The design concept features design colors that combine the color concepts of health and cheerfulness. The character concepts used are women aged 16-19 years and nutritionists. Visuals are presented with a combination of vectors and illustrations as well as sans serif typography and layouts. The campaign aims to change the behavior and lifestyle patterns of adolescent girls to be healthy and balanced and increase awareness of the importance of preventing Anemia. The overall design of the campaign is an effective strategy in increasing awareness and knowledge about Anemia through the delivery of interesting information and appropriate learning so as to change behavior related to health.