Fishbone Diagram Research Articles

Clinical Pathway Adherence and Missed Diagnostic Opportunities Among Children with Musculoskeletal Infections.

Clinical care pathways (CPs) integrate best evidence into the local care delivery context to promote efficiency and patient safety. However, the impact of CPs on diagnostic performance remains poorly understood. The objectives of this study were to evaluate adherence to a musculoskeletal infection (MSKI) diagnostic CP and identify recurrent failure points leading to missed diagnostic opportunities (MDOs). Retrospective chart review was performed from January 2018 to February 2022 for children 6 months to 18 years of age who had an unplanned admission for MSKI after being evaluated and discharged from the pediatric emergency department (PED) for related complaints within the previous 10 days. MDOs were identified using the Revised Safer Dx. Demographic and clinical characteristics of children with and without MDOs were compared using bivariate descriptive statistics. An improvement team reviewed the diagnostic trajectories of MDOs for deviations from the MSKI CP and developed a fishbone diagram to describe contributing factors to CP deviations. The study identified 21 children with and 13 children without MSKI-associated MDOs. Children with MDOs were more likely to have an initial C-reactive protein value > 2 mg/dL (90.0% vs. 0%, p = 0.01) and returned to care earlier than children without MDOs (median 2.8 days vs. 6.7 days, p = 0.004). Factors contributing to MDOs included failure to obtain screening laboratory tests, misinterpretation of laboratory values, failure to obtain orthopedic consultation, and failure to obtain definitive imaging. Several recurrent deviations from an MSKI diagnostic CP were found to be associated with MDOs. Future quality improvement efforts to improve adherence to this MSKI CP may prevent MDOs.

PRODUCT QUALITY IMPROVEMENT CHANNEL C AT PT. SINARINDO MEGAH PERKASA WITH SIX S

In the current era of global competition, many companies were looking for alternative solutions to compete with other companies in order to survive in competition, one of which is by improving product quality. Product quality can be seen from the number of defective products produced by the product. This study aimed to analyze Channel C defective products at PT. Sinarindo Megah Perkasa in order to improve its quality. The data used is Channel C production from 2015-2022 with a total production of 3,860 products with 73 defective products. The results showed that the causes of defective products in Channel C came from several factors which were analyzed using a fishbone diagram including machine, human, environmental, method, and material factors. The DPMO value obtained was 56,735.75 with a sigma level of 3.0828. The recommended improvements were to carry out regular maintenance on the machine, make notes on the size of the machine roll, add people for Quality Control , make Standard Operating Procedures (SOP), and provide detailed training to operators after the SOP is implemented.

Proactive method for identification and handling of patient complaints with root cause analysis in Surabaya Islamic Hospital.

Errors or cases that occur in health care organizations are very fatal because they can reduce the quality of life of patients and the worst is cause the death of the patient. One of the appropriate tools to be applied in analyzing cases/problems that occur in Surabaya Islamic Hospitals is root cause analysis. The complaints were addressed to the medical services, medical support, general, administration and verification, information systems and management, and finance sections. This research uses secondary data on hospital patient complaints in 2022 and is supported by the results of online interviews with the head of marketing public relations. Secondary data was processed through a six stages of root cause analysis and analyzed with the help of a fishbone diagram to determine the root cause of the problem in the health care sector. There were 261 complaints received by customer service addressed to the medical services, medical support, general, administration and verification, information systems and management, and finance departments. There are eight root causes found in Surabaya Islamic Hospital inpatient complaints. This proves that there must be improvements/ interventions made by the Surabaya Islamic Hospital to overcome inpatient complaints. Inpatient complaints at Surabaya Islamic Hospital prove the need for a number of interventions/improvements, especially in the field of human resources, namely the level of discipline, skills, empathy, communication, limited medical, and financial staff.

Upaya Pengendalian DBD Hasil Evaluasi Survey Mawas Diri Di Rw 2 Kelurahan Tenggilis Mejoyo Kecamatan Tenggilis Mejoyo

The Self-Introduction Survey (SMD) is an activity for identifying, collecting, and assessing people's health. It is carried out by cadres and local community leaders under the guidance of the Kelurahan/Kelurahan head and health officers. The aim of the study was to identify problems in controlling dengue hemorrhagic fever (DHF), the underlying factors, and alternative solutions to DHF control problems in RW 02, Tenggilis Mejoyo Village. A descriptive research method with a cross-sectional study was used. Data collection was carried out by a self-introduction survey (SMD), and respondents were interviewed using a questionnaire instrument. The respondents were 20 Great Surabaya Cadres (KSH). DHF control priority issues were prepared using the CARL method, and causative factor analysis was done using a fish bone Ishikawa diagram. The study found that most of the KSH in the RW 02 area of Tenggilis Mejoyo Village were aged between 25 and 60 years and had a bachelor's degree. The most common health problem was DHF, caused by cadres' lack of knowledge and inappropriate behavior in eradicating mosquito larvae nests (PSJN). The alternative solutions to the problem were proposing regular additions of cadres according to their area and providing the widest possible opportunity for cadres to obtain information regarding PSJN properly through counseling. The chosen problem-solving method was to provide counseling to KSH. The SMD activity carried out in RW 02 Tenggilis Mejoyo Village identified DHF as the priority health problem. Counseling on KSH was selected as the follow-up problem-solving method, which was in line with the findings in the field, namely the need for additional information regarding DHF knowledge and appropriate behavior in PSJN.

Quality improvement initiative for a sustained increase in human milk donation during the hospital stay

BackgroundThe demand for donors' human milk is much more than the availability of the same due to the myriad challenges faced during the collection process.MethodsBaseline milk volume donation done in...

Analysis and Improvement of Production Process Activities of Arikyd 36xx HV Products at PT. Highpolymer Aristek with Manufacturing Cycle Effectiveness and Fishbone Diagram Technique

PT. Aristek Highpolymer is a company engaged in the chemical industry by producing synthetic resins and polyurethanes. In carrying out its business processes, PT. Aristek Highpolymer produces 6 types of products, one of which is arikyd 36xx hv products. In carrying out the production process arikyd 36xx hv there is a delay due to high cycle time that affects effectiveness. With these problems, it is necessary to conduct an analysis of production process activities in order to find the root cause of delays and solutions that are expected to minimize or reduce delays that occur. In this study, the manufacturing cycle effectiveness (MCE) method will be used to be able to determine and improve production effectiveness and identify non-value-adding activities using Fishbone Diagram. From the results of research using the Manufacturing Cycle Effectiveness (MCE) method, the effectiveness of the production process was obtained by 74%, this shows that in carrying out the production process there are still activities not adding value by 26%. Then the root cause of the problem was identified using the fishbone diagram method and it was known that there were 4 main factors that became the problem of non-value added in the production process, namely: Lack of training in production activities, less ergonomic machines and lack of maintenance, Lack of tools in production process activities and inefficient production process layout.

ANALISIS PENGENDALIAN KUALITAS PRODUK PADA KONVEKSI NITRA JAYA DI KABUPATEN BADUNG

Declining product quality often occurs during the production process which can affect product quality. Damaged products can be done by the company by controlling the quality of the products produced through many methods such as DMAIC (Define, Measure, Analyze, Improve and Control), Six Sigma and Statistical Quality Control (SQC). This research was conducted at the Nitra Jaya Convection which is located on Jalan Raya Panglan, Banjar Cepaka Kapal, Mengwi District, Badung Regency, Bali. The data analysis technique used is statistical quality control (SQC) by using tools such as check sheets, P-charts, Fishbone diagrams and Quality Costs. The results of the analysis of the cost of production quality at the Nitra Jaya Convection for the 2019 period still show that the actual quality costs incurred by the company are still greater than the optimal quality costs that should be incurred by the company. The actual damage was 116 pcs of uniforms, with a total cost of quality (TQC) of Rp13.244.958. The lowest point or the optimal point of quality costs is at the damage limit of 195 pcs of uniforms with an optimum total cost of quality (TQC) of Rp11.647.055. This shows that quality control has not been implemented optimally.

Penerapan Metode Overall Equipment Effectiveness (OEE) dan Six Big Losses untuk Mengukur Efektivitas Mesin Packing pada PT. Surya Tsabat Mandiri

This research aims to investigate the risk of six big losses and the effectiveness of packing machines at PT Surya Tsabat Mandiri in South Lampung using monthly data on production of bread products from March 2021 to February 2022 used in the research. Research was carried out on packing machine objects using quantitative data or data that can be measured systematically. The Overall Equipment Effectiveness (OEE) method is applied to measure the total performance of equipment as a whole according to what must be done and to assess the dominant factors of the Six Big Losses which are dominantly used by the fishbone diagram approach. The research results show that the average OEE value of packing machines is 78.17% and is still below world standards (≥85%). Apart from that, evidence was found that the most dominant six big losses factors were idling and minor stoppage losses with a value of 16.85% and reduced speed losses with a value of 7.85%. Based on the fishbone diagram, the aspects that cause speed losses on packing machines are humans (lack of operator knowledge, lack of workers guarding bread baskets), machines (repair of damaged machines, unstable center and end seal temperatures), environment (unstable production room temperature) and method (non-periodic machine maintenance). The recommendation given to reduce these two losses is to use the TPM pillars, namely education and training, autonomous maintenance and planned maintenance.

Re-Layout Design of the Kalus 1.6 Warehouse Using the Class-Based Storage Method at PT XYZ

<span lang="ES">PT XYZ is a company engaged in the electricity sector, where the main tasks are to produce, distribute, and provide electricity to the public. PT XYZ has Distribution Parent Units, such as the Greater Jakarta Distribution Parent Unit, which is responsible for distributing electricity in Jakarta and electrical equipment such as Miniature Circuit Breakers (MCB), Molded Case Circuit Breakers (MCCB), Kilowatt Hour (kWh) Meters, and others. Problems that exist in the Kalus Warehouse 1.6 of PT XYZ include the placement of goods that are less organized and the First In First Out (FIFO) system has not been running properly. This research aims to see the application of the fishbone diagram and class-based storage method in the Kalus Warehouse 1.6 of PT XYZ which previously still used a randomized storage system, namely the placement of goods randomly in any available space. The method used is to determine the cause of the problems that have been mentioned, design a layout with a minimum total displacement distance and optimize the allocation of types of goods. Based on the ranking of T/S calculation results, 2 proposed layouts were generated. Then, the two layouts are compared to find the most suitable warehouse layout which is the optimal condition with a decrease in rectlinear travel distance which is greater than the existing travel distance. to be applied to the Kalus Warehouse 1.6 of PT XYZ.</span>

Role of due diligence in business takeover

Motivation: The topic of the article is of paramount importance in today’s ever-evolving business landscape. As companies strive to expand their operations and stay ahead of the competition, mergers and acquisitions have become a popular strategy. However, the risks and complexities associated with these transactions cannot be overlooked. Understanding the role of due diligence is essential for any organization considering a business takeover. It serves as a powerful tool to uncover potential risks, assess the viability of the transaction, and make well-informed decisions. By conducting a thorough due diligence process, companies can identify financial discrepancies, legal liabilities, operational inefficiencies, and hidden risks that may impact the success of the transaction.Aim: The goal of the research was to analyze to what extent is the resulting value of a business is affected by improperly performed due diligence. The method used for data collection was in-debt literature research based on the Web of Science database. Subsequent content analysis was used to identify the 10 most common errors that can occur during the process of due diligence. The following research used the data obtained from answering the first research question with. Ishikawa fishbone diagram was used as a specific method of causal analysis.Results: The main findings include the identification of the most common errors occurring during the performance of due diligence, such as wrong financial analysis, incomplete financial accounts, Incomplete accounting statements, or adjusting entries for receivables. The main causes include excessive work pressure on auditors, past due receivables, poor supplier vetting, or failure to document the application of prices. The research is beneficial for auditors or audited companies so that they could avoid such errors. However, there are also several limitations as it is very time and cost-consuming to deal with due diligence on a company-by-company basis. Also, the application of Ishikawa fishbone diagram and brainstorming prior to diagram depends on the number of experts involve. Another limitation is that the research results applied under current accounting legislation only, and there are different laws and regulations in different countries.

A Case Study on the Method of the Development of Ishikawa Diagram for the Quality and Competence in Clinical Laboratory

A Case Study on the Method of the Development of Ishikawa Diagram for the Quality and Competence in Clinical Laboratory

ROOT MAP OF RISK, PERCEPTION AND ACTION AT RETAIL TRADERS OF HONEY WATERMELON

The front side of the coin represents business potential, while the reverse side depicts the associated business hazards, indicating that risk is an important component of enterprise. The root cause of the risk, which can be used to decide what action to take, can be difficult to identify, when the hazard is not clearly characterized, as this may result in action simply covering the risk. Similar concerns exist in the honey watermelon business. This study involved 28 fruit traders (retailers) who were selected based on the census method. This research has three objectives. First, find out the root cause (risk) of the honey water melon trade to fruit traders in Bengkulu City by using the Ishikawa diagram analysis tool (risk causal map analysis). The research results obtained are prejudiced. Second, to find out the perceptions of fruit traders on the risks of the honey watermelon trade in Bengkulu City using the Likert-scale-analysis tool, the results are 75% categorized as neutral. Third, to find out the actions of the trader group on the risk of buying and selling honey melon. iIt is mostly carried out in Bengkulu City using a qualitative descriptive analysis tool, and the research results obtained by the traders choose to do research (examine) and carry out risk identification.

Factors Causing Inadequate Implementation of the HIMS Electronic Medical Records Outpatient at Level II Hospital, dr. Soepraoen Malang

The use of HIMS operationally is useful for improving performance and service, facilitating coordination between units, and increasing HR capabilities. The formation of HIMS not only automates old procedures, but organizes and updates and even creates new and more efficient data flows, this is very important, especially the implementation of HIMS in the field of radiology. The purpose of this Community Services residency is to analyze the factors that cause inadequate implementation of HIMS Electronic Medical Record Outpatient Level II Hospital dr. Soepraoen Malang. Therefore, this residency discusses existing problems using fishbone diagrams, USG (Urgency, Seriousness, Growth), and SWOT Analysis (Strengh, Weakness, Opportunity, Treats). The results of the residency show that after analyzing the problem with fishbone, USG, and SWOT, the implementation of a strategy that can be applied to community service residency activities is to make regulations in the form of SOPs regarding data input for medical, non-medical, radiology requests and conducting training activities for Outpatient Polyclinic operators. Evaluation of the strategy that has been made is by coordinating between management and sections/fields according to their respective duties, principals and functions in an attempt to optimize the implementation of electronic medical record HIMS in outpatient services at polyclinics.

Service Performance of Indonesian Private Hospitals: An Empirical Study Using the SERVPERF and IPA Approach

Patient perceptions have become an important component in determining the quality of a hospital’s service. This study attempts to analyze hospital performance from the customer perspective by adopting the SERVPERF method through five variables, namely tangibles, reliability, assurance, responsiveness, and empathy, with the aim of identifying and recommending areas that the hospital needs to focus on. A total of 100 respondents as outpatients were involved in this study. The cross-sectional survey was conducted online using Google Forms during the pandemic in 2020. According to the research findings, the hospital's overall performance is 4.24. Three indicators with low performance but high importance were examined using IPA. A fishbone diagram is used to identify the source of these indicators and to be the reason to propose recommendations. The study is limited to outpatient care departments from a private hospital in Yogyakarta, Indonesia. However, its findings have important implications for hospital managers for measuring their performance from the patients' perspective.

STRATEGI PRODUK TENGTENG BERBASIS KEARIFAN LOKAL DALAM UPAYA MENGEMBANGKAN PEMASARAN UMKM SARI PUTRA DESASUKAMANAH

This study aims to analyze the Tengteng product strategy to develop the marketing of Sari Putra SMEs in Sukamanah Village. The population in this study is Sari Putra SMEs, while the sample is the owners, employees, and consumers of Sari Putra SMEs, where there is one key informant and fifteen supporting informants. The data collection technique used a triangulation technique which consisted of observation, interview, and documentation with primary data and secondary data as the source of research data. Data analysis in this study uses the Fishbone Diagram Analysis model with assessment, data presentation from interviews with key informants and supporting informants, and then leveraging data and conclusions. The results showed that: (1) Tengteng product strategy based on local wisdom to develop marketing on product identity brands by 75% and brand rights by 31%, packaging attractiveness by 50%, innovation in product quality by 100%, product variants by 75% and design 69% products, 62% on product information labels and 100% halal certification. (2) the factors that hinder Tengteng's product strategy to develop marketing are 31% brand rights and 50% attractiveness of packaging. (3) innovations made by Sari Putra SMEs on local wisdom Tengteng products which consist of local materials, production, and marketing processes. (4) implementation of product strategies that are still simple using local marketing, production processes without machines, and lack of Human Resources in each part of production management does not yet have rights to Tengteng products because it is influenced by the marketing system of Tengteng products.

Teaching root cause analysis in healthcare management with Grey's Anatomy

AbstractOver the past 20 years, root cause analysis (RCA) has become one of the most widely used retrospective methods for detecting safety hazards in medicine and healthcare. Despite its wide use in management practice and growing popularity in academic research, there is currently a dearth of coverage of RCA in popular healthcare management textbooks and pedagogical publications. This paper addresses this gap by presenting innovative instructional materials and recommendations for teaching RCA in healthcare management. Using an episode of Grey's Anatomy TV show, this experiential learning exercise takes students through the steps of RCA and makes use of a range of RCA tools, including high‐level flowchart, fishbone diagram, “five whys”, corrective action plan, and others. The exercise, which was classroom tested and received positive student feedback, can be adapted to a range of healthcare management classes. Because RCA can have widespread, lifesaving consequences, healthcare management courses can significantly benefit from integrating this exercise into classroom pedagogies.

Laboratuvarlar Tarafından Reddedilen Hasta Numunelerinin Kök Neden Analizi: 21 Adım Uygulaması Örneği

Aim: Root cause analysis is widely used in healthcare services to analyze the causes of near misses and adverse events with a systematic approach. This study, it is aimed to determine the root causes of rejected samples, define corrective/preventive actions, and create an action plan that will help the implementation of the suggested remedial actions and evaluate their effectiveness.
 Material and Methods: For the 21-step methodology, observation, interview, document and record review techniques were applied. The steps of the process were visualized with the flowchart technique and the reasons for rejected samples were analyzed with team members. The identified causes were visualized with the Fishbone Diagram technique, and the risk reduction strategies and improvement actions for rejected samples were determined by the Failure Mode Effect Analysis (FMEA) method. The Action Hierarchy tool was used to evaluate the power of improvement actions.
 Results: The root causes of rejected samples were identified as inadequate orientation and training practices, lack of applicability of policies and procedures, lack of monitoring and evaluation, inefficient process flow and lack of equipment. A total of 11 improvement actions were determined and planned for these root causes. It was predicted that there will be an approximately 64.5% decrease in risk scores in general with the basic measures presented in the performed FMEA.
 Conclusion: Overall, it was found that the 21-step methodology is suitable for determining root causes by offering detailed guidance.

Exploring Blockchain Implementation Challenges for Sustainable Supply Chains: An Integrated Fuzzy TOPSIS–ISM Approach

This study investigates the challenges in implementing blockchain technology (BT) in sustainable supply chain management (SSC). The study thoroughly analyzes the literature and expert opinions on BT, SCM, and sustainability. A total of 24 barriers are identified, categorized into the Internet of Things, strategic, supply chain, legislation, and external factors. The findings are evaluated using the Integrated Fuzzy TOPSIS–ISM tool. The results indicate that barriers related to the supply chain have the most significant impact on the adoption of BT in SSC. The study also reveals the interrelation among sub-barriers within the supply chain, providing valuable insights to improve adoption. Finally, a strategic action plan based on a fishbone diagram is provided to reduce the effects of supply chain barriers. This study provides a theoretical foundation for using BT to achieve long-term supply chain goals.

Business Development Strategy for Rolling Bearing Product and Related Services in Food and Beverage Industry

In running the business, every company has objective to grow and develop. Each company has different objective anddevelopment strategy, but identical in final goal, that is to gain profitable growth. Correct strategy is mandatory in developing business, where each company has its own unique character in term of product and penetrated market. Therefore, proper analysis is required in order to determine the correct business development strategy. Starts from market & customer intelligence, to decide whether the targeted market is potential or not. Continue with competitive position analysis, to evaluate whether the company is competitive or not and define what is needed to improve competitiveness in the market. Bearing X as one of market leader in bearing industry and related service, is developing their business to F&B sector. Writer is assigned as sector manager in the respective sector. Writer is doing market potential and competitive position analysis, to be reference in developing proper strategy development, based on Ansoff Matrix market and product development. Defined strategy also closely related with Bearing X’s Unique Selling Preposition (USP) as well as Total Cost of Ownership (TCO) which is proposed to each customer in F&B sector. Using Fishbone Diagram, Bearing X defines business development strategy and put it in to a roadmap, also plans the required investment in order to achieve the target of this business development.

Green HPLC Method for Simultaneous Analysis of Three Natural Antioxidants by Analytical Quality by Design.

Glutathione, silybin, and curcumin are well-known potential antioxidants that are recommended as adjuvant therapy in cancer treatment. Based on the principles of Analytical Quality by Design (AQbD) and green analytical chemistry, a simple, robust, and environmentally benign HPLC method for the simultaneous estimation of glutathione, silybin, and curcumin in bulk and formulation was performed. Elution was achieved by an Agilent Eclipse XDB C18 (150 mm × 4.6 mm id, 3.5 μm) column using a gradient mobile phase composed of ethanol-water pH 6.7 (with 0.1%, v/v orthophosphoric acid) and 1.07 mL/min flow rate with PDA detection at 215 nm. Critical method variables were identified by risk assessment using an Ishikawa diagram, and multivariate optimization of the experimental conditions for the HPLC technique was accomplished by central composite design using design of experiments (DoE) software. The separation was achieved within 15 min, where the retention time of glutathione, silybin, and curcumin were 3.3, 4.9, and 7.3 min, respectively. The standard curve was linear in the range of 3.75-26.25 µg/mL for glutathione, 62.50-437.50 µg/mL for silybin, and 12.5-87.50 µg/mL for curcumin. The developed method was validated as per ICH guidelines Q2 (R1), and all the parameters are within specified limits. The proposed method is simple, precise, and robust, which can be employed for routine analysis and also concluded to be a greener approach according to AGREE, Green Analytical Procedure Index, and analytical eco-scale tools. The chosen antioxidants were evaluated for the very first time simultaneously using the chromatographic technique in bulk and dosage forms employing green solvents. The peak purity of all three compounds was studied using a PDA detector. Wastage was reduced in terms of time, cost, and solvents by employing AQbD elements and tools. Complete application of environmentally sustainable safe solvents were employed.