Fishbone Diagram Research Articles

Strategically reducing carbapenem-resistant Acinetobacter baumannii through PDCA cycle-driven antibiotic management

PurposeWith the escalating global challenge of antibiotic resistance, particularly the resistance rate of Acinetobacter baumannii, the need to rationalize carbapenem antibiotic use in clinical settings has become paramount. Our study tapped into a fishbone diagram to uncover the irrationalities in applying these antibiotics and highlight potential influencing factors. MethodsBased on these analyses, we initiated targeted intervention strategies. A PDCA cycle-based scientific management approach was implemented through the combined efforts of our antimicrobial stewardship team and relevant departments. ResultsOur study showed a significant post-intervention increase in the rational use of carbapenem antibiotics (P < 0.01) and a concurrent decrease in the detection of carbapenem-resistant Acinetobacter baumannii. ConclusionOur findings underscore that carbapenem usage can be effectively minimized with the continuous refinements offered by the PDCA cycle, leading to a reduction in multidrug-resistant bacteria, thus fostering rational drug use in healthcare.

Risk Assessment of Potential Injury during School Chemical Experiments Supported by the Database of Safe and Didactically Validated Procedures e-BEDOX

Considering the importance of the use of experiment as a source of knowledge in chemistry and its teaching, it is necessary to pay attention to the risks of its implementation. The text presents the procedures and results of a risk assessment of 101 selected school chemical experiments that are used in lower secondary school practice, including their inclusion in textbooks, as well as in leisure activities. The actual risk assessment of these chemical experiments has been carried out using the Ishikawa diagram, also known as the cause and effect diagram, in order to highlight the possible hazards involved in their conduct. In relation to the identified risks, the existing instructions for all selected experiments were evaluated and new information and safety instructions were added to meet the requirements for safe and didactically validated procedures according to standard CSN 01 8003. As the processed experiments contain chemicals of virtually all hazard classes, it is very important that all real risks are taken into account when using them in schools. The entire set of produced materials, including the original video recordings, has been processed into an electronic database e‑BEDOX, which is available at: https://ebedox.cz.

Unveiling Key Factors and Solutions to Boost MSME Food Productivity

Sidoarjo, known as Indonesia's MSME city, faces productivity challenges in its MSME food cluster due to factors like motivation, salary, competency, facilities, legality, health, and marketing. This study uses a mixed-method approach, combining qualitative and quantitative data, to identify these issues. A fishbone diagram was created with seven variables, and data were collected from 50 MSME actors through questionnaires and interviews. Analysis using SPSS revealed that employee salaries had the most significant impact on productivity, along with issues in operational management, facilities, supply chains, and digital marketing. The study underscores the need for better management, competitive salaries, and enhanced marketing strategies to boost productivity in Sidoarjo's MSME food sector. Highlights: Factors Identified: Salary, competency, and facilities affect MSME food cluster productivity. Data Analysis: Used fishbone diagrams and SPSS to analyze MSME data. Recommendations: Improve management, salaries, and digital marketing for better productivity. Keywords: MSME, productivity, food cluster, fishbone diagram, SPSS

Analisis Pengendalian Kualitas Menggunakan Metode Statistical Process Control (SPC) Pada Part Lever Comp Throttle Di PT.OMI

PT. OMI is a company that operates in the automotive industry in the Karawang area, the goods it produces are very varied and have quite a lot of customers. To increase customer trust, customer satisfaction is the most important thing, with the aim of knowing the process and quality results of a product by using a p-control chart and knowing the various types of defects that occur in the product. The research uses data collection methods in the form of production data as well as product defect data produced and data processing using p control charts and Minitab software to analyze the causes of types of defects and provide suggestions for companies. The results of production quality control in 2022 samples were obtained CL (Middle limit) is 0.0077%, LCL (Lower limit) is 0.0074% and UCL (Upper limit) is 0.0080%. From the analysis, there are 3 types of defects, namely color defects at 48%, chip defects at 40%, and finally burry defects at 12%. Problems occur due to several causes such as human factors, machines, methods, and materials. To solve these problems, a fishbone diagram was created. Product control at PT OMI is under controlled conditions. Keywords: Control Chart, Defect, Quality

Application of industry 4.0 technologies for mitigating humanitarian supply chains risks: the case of Covid-19

ABSTRACT The study aims at integrating and combining successful digital tools such as Blockchain technology, Internet of Things (IoT), and Cloud Computing (CC) to digitalise HSC. To show the enabling of these digital tools, we first conducted a real case study in collaboration with a major leader in real estate diagnostics and building technical data. Second, to mitigate the impact of various disturbances and risks of COVID-19 on supply chain (SC) performances, we modelled two logistics networks, i.e. before and after the COVID-19 pandemic. Finally, we proposed two efficient solutions. In the first solution, we proposed a risk mitigation matrix model based on the cause-effect diagram. In the second one, we developed an advanced digital model which is completely based on Industry 4.0 technologies. Results showed that the new digital model was more efficient since it enables to enhance HSC performances by mitigating risks and enabling tracking, monitoring, facilitating coordination, real-time information sharing, and flexibility during humanitarian operations.

Fostering Economic Resilience in Pangkalpinang: A Qualitative Investigation into MSME Development Strategies

Micro, small and medium enterprises (MSMEs) have a significant role in the economies of developing countries. After the Covid-19 pandemic, the transformation of MSMEs needs to be strengthened through optimizing the use of digital technology. MSME development is carried out through the pillars of corporatization, capacity building, and financing policies, in order to create productive, innovative, and adaptive MSMEs. The number of cooperatives and MSMEs in Pangkalpinang City in 2022 will reach 23,119 MSMEs and is the largest sector in absorbing labor in Pangkalpinang City. Optimizing the role of MSMEs as the backbone of the economy will continue to be directed at efforts to increase productivity and inclusive regional economic growth, through adaptation to digital changes. This study is a strategic step in developing cooperatives and SMEs to increase regional economic growth to provide answers to current problems. The data used in this study are qualitative data and quantitative data. Data collection techniques are questionnaires, interviews and documentation. This study uses fishbone diagram analysis and SWOT analysis. The results of this study are that MSMEs in Pangkalpinang City are in quadrant I position. This means that MSMEs are advised to carry out an aggressive strategy by using internal strengths to take advantage of external opportunities to achieve increased MSME growth. Weak elements of the marketing strategy for Cooperatives and MSMEs in Pangkalpinang City are caused by weak digital marketing factors, product innovation, and partnerships with market places, startups, and others

Analysis Riplle Mill Machine Damage Analysis Using the FMEA Method at the PT Argo Sinergi Nusantara Palm Oil Factory

PT Agro Sinergi Nusantara (ASN), one of the industries engaged in the Palm Oil Mill (PKS) industry, is located in Teunom, Aceh Jaya Regency. The Ripple Mill machine is one of the important machines used in Palm Head Mills which functions as a separator or splitter of kernel kernels and palm shells by utilizing centrifugal force to produce Palm Kernel Oil. From the initial analysis, it is known that the use of Ripple Mill machines in the industry today often experiences donwtime or damage. The purpose of this study is to analyze the damage of the Ripple Mill machine at PT ASN's Palm Oil Mill using the Failure Mode and Effects Analysis (FMEA) method and Fishbone diagram. The results of the study obtained damage to the Ripple Mill machine in the identification of 5 (five) malfunctions or failure modes that occurred. using the FMEA method, it is known that the most dominant Ripple Mill machine failure mode occurs is the fracture of rotor bar components due to the entry of hard objects with the Risk Priority Number (RPN) which is 384 and using the fishbone diagram method, it is known that there are (four) influencing factors, namely human, machine, environmental and method factors.

Research on Full-Chain Operation of Products from the Perspective of Digital Empowerment ---- Taking Xiaomi as the Case

As a native digital enterprise, Xiaomi Company created a model for developing, producing, and marketing products. In order to analyze the full-link process of product operation and users' evaluation, providing suggestions for the company's future product improvement, this paper uses three models of House of Quality, flow chart, and fish-bone diagram for analysis. All the graphs are original. It makes a questionnaire for a broader range of users' views. Through the House of Quality, it is found that customers' most critical needs are storage capacity and system running speed, and Xiaomi has a particular reputation gap compared with Huawei, Apple, and other leading enterprises. Through the flow chart, Xiaomi established hunger marketing and pre-sale marketing strategies and formed a procurement and production model based on strategy. The fishbone diagram is used to analyze the problem of Xiaomi's mobile phone card machine. The report makes recommendations from three aspects, research, personnel, and supply chain, to improve Xiaomi's operation management.

Analisis Kendala Jobdesc Admin Administrasi Sales Rental Dan Penjualan Unit Di PT Bina Pertiwi Menggunakan Fishbone Diagram

The faster economic development in the world causes tighter business competition. Plus the rapid progress of increasingly sophisticated technology. Many companies are currently competing to use technology to increase performance efficiency advantages in other companies and competition. Information technology that is quite popular in the current generation is System Application and Product In Data Processing (SAP). SAP is a system that runs a business using one database which can then be accessed by all departments in the company. This research aims to provide evaluation and input on the problems faced by SAP admin sales users at PT Bina Pertiwi Surabaya Branch. In this research, a qualitative approach was used by conducting interviews with resource persons from the administration department and Branch Administration Supervisors using a fishbone diagram. The results of the evaluation of the implementation of the admin job description for sales rental administration and units using SAP are quite good, but there are still problems caused by discrepancies between the actual cash in and the cash in plan, so AR monitoring must be carried out.

Patient Satisfaction with the Outpatient Department Services at a Tertiary Care Hospital in Northern India and Root Cause Analysis of the Lowest-Scoring Attribute using Fishbone Diagram.

Assessing patients' satisfaction is an easy and cost-effective method of evaluating the outpatient services provided by health-care institutions. The objectives of this study were to determine patient satisfaction among patients attending various outpatient departments (OPDs) at a tertiary care hospital and the factors affecting their satisfaction. A cross-sectional study was conducted among patients attending various OPDs at a tertiary care hospital in Faridabad. Exit face-to-face interviews were conducted for 334 patients above 18 years of age who availed OPD services followed by pharmacy services. Information regarding sociodemography, rating of satisfaction with various attributes of OPD services on a 5-point Likert scale, and reasons for dissatisfaction was collected. Data were analyzed using SPSS version 22. Root cause analysis for the lowest-scoring attribute was done using fishbone diagram. About 64% of the patients were satisfied with the OPD services. "Attitude and communication of doctors" was the prime contributor to patient satisfaction. "Promptness at medicine distribution counter" was the attribute that scored lowest followed by "waiting time at the registration counter." The mean waiting time for registration was 38.2 min, for consultation with doctor 41.3 min, for collection of samples 49.6 min, and for drug dispensing 61 min. The issues related to pharmacy services need to be promptly acknowledged and addressed.

Brainstorming and Fishbone diagram Tools for Enhancing the Student Placement in Technical Education System

Increased engineering colleges and unemployment have raised critical issues of quality for sustaining invisible competition all around the globe. In the olden days, higher education success was truly measured based on the performance (ability to apply knowledge and skills in resolving problems) of graduates in industries, which in turn ranked the colleges. In recent years, campus placement for engineering students has been treated as an institution’s responsibility, and the institute, upon successful job placement and average salary offered for the academic year. Since there are many engineering colleges, the reputed companies select to conduct placement drives for those institutes whose courses/programs have been accredited by quality assessment bodies. The accreditation to engineering institutions and their performance are tested for different attributes such as admission, teaching-learning process, infrastructure, curriculum and examination, placement, and career. Placement and carrier could directly or indirectly affect the other qualities and hence their improvement being the major concern to many engineering colleges. Brainstorming technique is first applied to know the possible methods for enhancing placement of students. The fishbone diagram is a standard way of representing in a more structured and precise manner that helps to identify the root causes that affect the graduate outcome, institution’s quality, which in turn is the placement of students. The generic framework module is defined for enhancing the placement of students with the help of brainstorming and the fishbone diagram tool.

Quality Control Analysis of Piston Gasoline Products using the DMAICApproach

The manufacturing company in this study is a company engaged in the automotive sector that produces pistons and non-pistons. The problem that occurs in the company is that the average percentage of defects exceeds the company's standard limit of 5% while the maximum defect limit is set by the company at 1%. Identify the dominant type of defect, identify the biggest factors causing the dominant type of defect and make suggestions for improvement. In this study using the DMAIC method (Define, Measure, Analyze, Improve and Control) in the production process of the type x gasoline piston, there are several types of defects, namely monoiri, misrun,coating loss. The types of defects that occur are based on the Pareto diagram, namely the type of defect monoiri with a percentage of 56%, misrun 28% and coating loss 16%, and the causal factors are known using a fishbone diagram, there are 5 factors, namely material, people, methods, machines and environment. Based on the results of the identification of FMEA and the calculation of the highest RPN, it is known that the monoirritic defects that occur in the causative factor of the material with an RPN value of 175. For proposed improvements, namely monitoring and creating monitoring forms to facilitate cleaning of materials on a scale, and to facilitate cleaning of larger materials. scheduled.

Improving the Packaging Quality of Surgical Suture Products at PT. XYZ with the Application of the Six Sigma Method and Failure Mode Effect Analysis (FMEA)

The medical industry today upholds strict quality standards for medical products, including surgical sutures. PT XYZ, a leading manufacturer in this sector, faces challenges in mitigating surgical suture product defects. This research focuses on the packaging of surgical suture products produced by PT XYZ, with a focus on the production period from January to March. During this time period, there was a significant level of packaging production defects. The aim of future research is to improve the quality of packaging for surgical suture products. Specifically, it aims to identify the causes of defects in PT The Six Sigma method, using DMAIC, will be used in this research. The Define stage combines tools such as the Supplier, Input, Process, Output, and Customer (SIPOC) diagram, along with Critical to Quality (CTQ) identification. The Measure stage involves calculations using the P control chart, C control chart, DPMO, and sigma level. During the Analysis phase, a thorough analysis of the causes of failure is carried out using tools such as Pareto diagrams, fishbone diagrams, and Failure Mode Effects Analysis (FMEA). Moving to the Improve stage, FMEA identifies high-risk defects, including torn cartons, inconsistent colors, and damp cartons. Therefore, the proposed defect repair involves analysis of 5W 1H cartons. The results of the analysis provide alternative solutions such as increasing the frequency of replacing cutting tools on mold cutting machines, using cleaning aids on molding machines, and improving environmental monitoring SOPs in factories. An additional suggestion is to include antiseptic wet wipes in each carton of surgical suture products. After making improvements in the Improve stage, the final Control stage is carried out to assess the impact of the proposed changes on the company. The results show a positive impact, with an increase in the sigma value to 3.670.

Powder Detergent Packaging Line Improvement by Lean Six Sigma DMAIC Methodology

This investigation was a case of study in the powder detergent packaging line and aimed to reduce all those wastes that do not add value to the product, increasing the cost of production. Reducing or eliminating waste within the manufacturing industry becomes necessary for sustainable businesses over time and keeps generating development. To achieve it, the Lean Six Sigma DMAIC methodology was implemented in a detergent powder packaging line, to identify the problems that afflicted and made production more expensive. By using quality tools (such as Pareto and Ishikawa diagrams, 5S application, Poka-Yokes, SMED, training personnel, and standardizing processes) it was possible to reduce unproductive times. Energy consumption was reduced by up to 20 %, also efficiency and machine availability increased by 10.98 % and 7.32 %, respectively. The general performance of the line increased by 15.16 %, which translates into significant monthly savings of USD 71 442.05. By applying these improvement techniques, the most significant efficiency was registered in 1 kg packages, going from 47 % to 89 %, approximately. To maintain this productivity and even to perfect it, it is necessary to hire specialized personnel who know the production processes and industrial operations.

Application of Lean Six Sigma to Reduce Delays in Engineering Changes

Quality methodologies have provided improvements for the organizations, increasing their competitive nature. Therefore, the present article was developed toward the reduction in the incidence of delays while developing engineering changes in an agricultural machine factory through the application of Lean Six Sigma concepts. An engineering change consists of a multitasking process for a product change. The article stages were developed following the sequence proposed by the DMAIC methodology. Several tools associated with Lean Six Sigma, such as process mapping, Ishikawa diagram, brainstorming, and Kanban were used in this article. Also, statistical tests were carried out to check the consistency of the goals established by the organization regarding the deadline for carrying out the analyzed tasks and for proposing new goals. The development of this article allowed the identification and elimination of root causality which culminated in delays during the implementation of engineering changes, and in turn, reduced the incidence of delays by 95&#x0025;. The article shows the importance of companies applying scientific methodologies and statistical analysis in their processes to improve their results. Finally, it contributes to the scientific community, exposing an adaptation of tools and showing that the implementation of a set of management tools can contribute to process improvements.

Standardizing Medication Reconciliation in a Pediatric Emergency Department.

Medication errors are common during transitions of care, such as discharge from the emergency department (ED) or urgent care (UC). The Joint Commission has identified medication reconciliation as a key safety practice. Our aim was to increase the percentage of patients with completed medication reconciliation at discharge from our pediatric ED and 4 UCs from 25% to 75% in 12 months. Key stakeholders included ED and UC physicians and nurses, informatics, and quality management. The baseline process for medication reconciliation was mapped and modified to create a standard process for nurses and physicians. An Ishikawa diagram was created to assess potential failures. Electronic health record interventions included adapting an inpatient workflow and using a clinical decision support tool. Educational interventions included just-in-time training, physician education via division meeting presentations, video tutorials, and physician-specific and group feedback using funnel plots. The secondary process measure was the proportion of patients discharged from the ED and UCs with completed home medication nursing review. We used statistical process control to analyze changes in measures over time. In the UCs, home medication nursing review increased from 91% to 98% and medication reconciliation increased from 35% to 82% within 4 months. In the ED, home medication nursing review increased from 2% to 83% within 8 months and medication reconciliation increased from 26% to 64% within 18 months. We successfully increased the proportion of UC and ED discharged patients with completed medication reconciliation.

ОГЛЯД МЕХАНІЗМІВ ROOT CAUSE АНАЛІЗУ ТЕЛЕКОМУНІКАЦІЙНИХ МЕРЕЖ

Telecommunication networks are an integral part of modern information society, providing data transmission and communication among millions of users worldwide. The complexity and scale of these networks are constantly growing, which increases the demands on their reliability and stability. One of the key tasks in ensuring the efficient operation of telecommunication networks is the identification and elimination of the root causes of failures and anomalies that can significantly affect the quality of service for end users. Root cause analysis (RCA) is a powerful tool for identifying the primary causes of problems, preventing their recurrence, and enhancing the overall reliability of networks. The article provides a detailed review of contemporary methods and tools of RCA used in telecommunication networks. In particular, methods such as fishbone diagram analysis, the «five whys» method, fault tree analysis, and the application of machine learning for big data analysis are considered. Each of these approaches has its advantages and disadvantages, and their comprehensive use allows for higher accuracy and efficiency in identifying the root causes of problems. Practical examples demonstrate the effectiveness of applying various RCA methods to solve specific problems in telecommunication networks. For instance, the use of fishbone diagram analysis and the «five whys» method allows for the identification of the primary causes of network delays and equipment issues at base stations. The implementation of failure prediction systems based on machine learning significantly enhances network reliability by allowing for the early detection of potential problems and the necessary technical measures. The prospects for the development of RCA in telecommunication networks are outlined. The primary focus is on the development of adaptive and self-learning systems capable of dynamically responding to changing network conditions. The use of more complex artificial intelligence algorithms and tools for predicting potential problems will significantly improve the effectiveness of RCA and ensure high-quality telecommunication services.

Utilizing Lean Six Sigma and Waste Assessment Model to Reduce Waste in the Hot Rolled Coil Production

The global steel industry is pivotal, driven by substantial demand. In Indonesia, a leading steel manufacturing company, boasting significant production capacities for Hot Rolled Coil (HRC) and Cold Rolled Coil (CRC) products, with capacities of 2,400,000 and 850,000 tons per year. However, current production lags at 1,500,000 and 500,000 tons annually for HRC and CRC. Notably, the production process recorded defect ratios of 15.85%, 15.65%, and 15.56% from 2020 to 2022, with waste waiting accounting for a breakdown time and operating time ratio of ±40%. The study employs Lean Six Sigma to analyze and mitigate waste during HRC production, aiming to augment product value, production efficiency, and cost reduction. Through Value Stream Mapping and Process Activity Mapping, 44.93% of Necessary Not Value- Added Activities (NNVA). In the next stage, critical wastes including waste defects, overproduction, and waiting are selected using the Waste Assessment Model. The Analysis stage employs fishbone diagrams and Failure Mode and Effect Analysis to determine root causes and assess risk. Proposed improvements include toolbox meetings, maintenance scheduling, check sheets, a work roll replacement algorithm, and sensor adjustments, projected to raise sigma values significantly for waste defects, overproduction, and waiting.

Reducing Wall Shelf Product Defects Using the DMAIC Method in Furniture Industry Companies

The object of research is a place of business that produces household needs and wood-based industries. One of the products it produces is a minimalist wall shelf. In the period January –December 2021 minimalist wall shelf products are the products with the most defects. Manufacturing companies in this study have a product defect tolerance limit of 5% of the total production, but minimalist wall shelf products have a defect of 5.64%. This study aims to determine the types of defects that occur in wall shelf products, identify the causes of defects minimalist wall shelves and provide suggestions for improvements to reduce the number of future defects. In this research the method used is DMAIC. In the minimalist wall shelf production process, 4 types of defects were found. Based on the Pareto diagram, it was determined that the type of lacquer defect was not suitable to be the most dominant type of defect, namely 80.1%, it was also found that the DPMO value and sigma value on minimalist wall shelves were 14,100 and 3.69. Based on the analysis of the fishbone diagram method and Failure Mode and Effect Analysis (FMEA), it is known that the main root cause of product defects is a dirty, dusty and windy environment with an RPN (Risk Priority Number) value of 448. Analysis was carried out using the 5W + 1H approach to find improvements to overcome the problems that occur, obtained suggestions for improvements for the company, namely making work area picket schedules, making closed work areas, daily and monthly check sheetforms for maintenance of work tools, making varnish process work instructions, making training schedules for operators and submitting additional goods forms.

Advancing health equity in improving breast cancer screening with the use of a mobile mammography bus in marginalised population: quality improvement project

BackgroundBreast cancer, the second leading cause of cancer-related deaths in women in the USA, is effectively treated through early detection and screening. This quality improvement (QI) project aimed to improve...