Process Improvement Research Articles

Effectiveness of a program director for osteopathic medical education to support osteopathic recognition at a training site with multiple programs

Abstract Context With the advent of the Single Accreditation System (SAS) within the Accreditation Council for Graduate Medical Education (ACGME), few programs have achieved Osteopathic Recognition (OR) status to date. OR is an accreditation that graduate medical education (GME) programs can achieve to distinctly acknowledge the additional focus on osteopathic training. There is an effort by national osteopathic organizations to determine barriers for programs to achieve OR and what innovative methods might help overcome them. In identifying its own barriers, a central Ohio hospital created a unique Program Director for Osteopathic Medical Education (PDOME) role to assist its 10 programs in achieving OR. Objectives The objectives of this study were to determine the effect that a PDOME role has through measures of the numbers of programs achieving OR and standards met, as well as the perceived ‘helpfulness’ of the role based on surveys of program leadership. Methods Upon initiation of the PDOME in July 2021, the PDOME assessed applications, citations, and curriculums of the 10 hospital programs with varied OR status to help determine curricular goals. Additional osteopathic activities, evaluation tools and faculty development were subsequently offered based on this information and needs assessments of the programs. A survey was sent to all programs at intervals of 12 and 18 months after role inception to be utilized as process improvement. Comparisons were made between surveys, as well as between the total number of programs with continued OR status and the total OR requirements achieved before and after PDOME. A chi-square test (or Fisher’s exact test when the ‘n’ was too small) was utilized for significance, and the p value was set at 0.05. Results After the PDOME, there was a significant increase in the number of OR standards met across programs (p<0.001). Although not significant, the number of programs achieving continued OR increased from 4 to 8 (p=0.168). Due to many positive responses in both surveys, there was no significance between surveys in the “helpfulness” of PDOME; however, there was a significant increase in the number of respondents from 13/67 (or 19.4 %) to 32/67 (or 47.8 %) (p<0.001), indicating increased engagement among respondents. Conclusions This study suggests that a PDOME role in medical education may be well received and may assist GME programs in achieving OR. Implementation of a similar role elsewhere could help programs overcome barriers and stir growth in OR programs nationwide.

Tools of Theory of Inventive Problem Solving Used for Process Improvement—A Systematic Literature Review

One of today’s great challenges is radical process improvement. TRIZ (theory of inventive problem solving) could help to resolve this. This study aims to answer the following research question: Which tool of TRIZ is best for process improvement? To answer this, a systematic literature review was conducted, and the gathered data were analyzed. The main focus was on the tools, the rate of improvement, the improved parameters, and the combination of tools. The results show that the technical contradiction with inventive principles should be easy to use and provide sufficient results. If the technical contradiction is not enough or the process is too complex, an algorithm or framework to use more advanced tools of TRIZ should be used. That should help to resolve the most challenging problems related to radical process improvement.

PV chart management innovation based on production balance ratio: a case study of Company S’s GaAs process improvement for compound semiconductors

PV chart management innovation based on production balance ratio: a case study of Company S’s GaAs process improvement for compound semiconductors

Facilitating collaboration with collaborative technology: Prerequisites and evidence from an explanatory mixed-methods study

Collaboration is widely recognized as essential for mitigating resource dependency and effectively fulfilling public responsibilities. Meanwhile, the use of information technology is expected to enhance communication and strengthen interactions among collaboration participants. Given the substantial annual investments in IT and collaboration initiatives, public managers need to understand how technology, particularly collaborative tools, can be leveraged to achieve better collaboration outcomes. This case study examines the use of collaborative technology in an intraorganizational collaboration context, employing a mixed-methods approach that begins with an experiment followed by semi-structured interviews. The findings reveal that the use of collaborative technology alone does not guarantee improvements in the collaboration process or performance. Achieving desired outcomes requires a supportive organizational and technological environment characterized by sustained leadership, thorough planning, active stakeholder engagement, robust communication mechanisms, and a commitment to continuous learning. Most importantly, genuine collaboration and engagement from all parties involved are key to success.

Accelerating spatial planning in Indonesia: Critical points and improvement initiatives for detailed spatial plan

The policy to accelerate the design of the Detailed Spatial Plan regulation document (RDTR) is a strategic step to enhance ease of doing business and promote sustainable development in Indonesia. Targeting 2036 RDTR sites nationwide, the initiative relies on various policy interventions and technical approaches. However, as of 8 January 2024, only 399 RDTRs (19.59%) were enacted after four years of implementation. This underperformance suggests the need to examine factors influencing the process, including issues at each stage of the RDTR design business process. While often overlooked due to its perceived irrelevance to the core substance of planning, analyzing the process is crucial to addressing operational and procedural challenges. This research identifies critical issues arising from the preparation to the enactment stage of RDTR regulations and proposes necessary policy changes. Using an explanatory approach, the study employs methods such as Analytic Hierarchy Process (AHP), post-review analysis, stakeholder analysis, business process evaluation, and scenario planning. Results show several impediments, including challenges related to commitment, technical and substantive issues, managerial coordination, policy frameworks, ICT support, and data availability. These findings serve as inputs for the development of business process improvement scenarios and reengineering schemes based on Business Process Management principles.

The WHY in Business Processes: Discovery of Causal Execution Dependencies

Abstract Unraveling the causal relationships among the execution of process activities is a crucial element in predicting the consequences of process interventions and making informed decisions regarding process improvements. Process discovery algorithms exploit time precedence as their main source of model derivation. Hence, a causal view can supplement process discovery, being a new perspective in which relations reflect genuine cause-effect dependencies among the tasks. This calls for faithful new techniques to discover the causal execution dependencies among the tasks in the process. To this end, our work offers a systematic approach to the unveiling of the causal business process by leveraging an existing causal discovery algorithm over activity timing. In addition, this work delves into a set of conditions under which process mining discovery algorithms generate a model that is incongruent with the causal business process model, and shows how the latter model can be methodologically employed for a sound analysis of the process. Our methodology searches for such discrepancies between the two models in the context of three causal patterns, and derives a new view in which these inconsistencies are annotated over the mined process model. We demonstrate our methodology employing two open process mining algorithms, the IBM Process Mining tool, and the LiNGAM causal discovery technique. We apply it to a synthesized dataset and two open benchmark datasets.

Using Mobile Phone Survey Paradata for Process Evaluations and Improvements: Best Practices and Lessons Learned from 9 Surveys in 7 Sites

Using Mobile Phone Survey Paradata for Process Evaluations and Improvements: Best Practices and Lessons Learned from 9 Surveys in 7 Sites

Comprehensive Analysis and Emission Reduction Pathway of GHG Emissions at a Wastewater Treatment Plant in Suzhou

Taking a sewage treatment plant in Suzhou City, Jiangsu Province, as an example, the greenhouse gas （GHG） emissions generated in the sewage treatment system were calculated using the carbon balance method and the emission factor method. The environmental impacts and economic aspects of different treatment units in wastewater treatment plants were analyzed using life cycle assessment, cost-benefit analysis, and data envelopment analysis models, and emission reduction pathways were proposed. The results indicated that the total GHG emissions （in terms of CO2） from a certain municipal wastewater treatment plant in Suzhou were 6 653.08 kg·（104 m3）-1, with direct and indirect GHG emissions accounting for 29.22% and 74%, respectively. The reuse of treated effluent achieved a reduction of 3.3% in emissions. The biological treatment phase and the sludge treatment phase were the main impact stages for GHG emissions at a certain wastewater treatment plant in Suzhou, where the high-power equipment, specifically the blowers used in the biological treatment phase, and the use of polymeric ferric sulfate agents in the sludge treatment phase were the primary factors contributing to GHG emissions. Life cycle assessment analysis revealed that electricity consumption, direct CO2 emissions, pollutant concentration in the effluent, and the use of chemical agents at wastewater treatment plants had negative impacts on global warming, atmospheric acidification, and eutrophication of water bodies. Calculations indicated that for every 10 000 m3 of wastewater treated, the sewage treatment plant achieved a net benefit of 13 630 RMB. However, from April to May 2023, the scale efficiency of the sewage treatment plant was less than 1. This indicates that during this period, the proportion of output increase was less than that of input increase, demonstrating an irrational structure of input-output. After June, through enhancing the overall operational load, advancing technical improvements, and management efforts, the optimization of scale efficiency was achieved. A sewage treatment plant in Suzhou could achieve the goal of being "green and low-carbon" by installing high-efficiency pumps and fans, utilizing solar photovoltaic and water source heat pump systems, and making process improvements.

Academically based regional quality improvement hubs: Advancing Medicaid's quality strategy in the state of Ohio through state‐academic partnerships

AbstractIntroductionIn 2022, the Ohio Department of Medicaid (ODM) launched a Managed Care Population Health and Quality Strategy to improve healthcare quality and equity for Medicaid Managed Care enrollees. Aligned with national quality objectives, the strategy focuses on personalized care, service coordination for complex needs, reducing health disparities, and includes performance incentives for Managed Care Organizations (MCOs) and innovative provider payment models. While Ohio has made progress in quality improvement, challenges remain in addressing statewide health indicators and disparities and helping healthcare providers adapt to performance‐based models. This report outlines a new approach that builds on Ohio's partnership with six colleges of medicine (CoMs) to support provider organizations and engage stakeholders in quality improvement (QI).MethodsODM established Regional QI Hubs within Ohio's CoMs to advance population health initiatives using the Model for Improvement developed by the Associate in Process Improvement. These academically based hubs collaborate with local healthcare clinics, community partners, and payers on QI projects to enhance care, reduce disparities, and strengthen health systems. By engaging stakeholders in designing and testing change ideas using Plan‐Do‐Study‐Act cycles and electronic health record data feedback, QI Hubs further the goals of the learning health system.ResultsKey lessons highlight the benefits of engaging academic institutions to build internal QI capacity and promote health equity. The model required substantial capacity building and commitment on behalf of academic institutions and strengthening of regional partnerships. Collaboration between MCOs and health clinics is focused on standardizing processes to access services and implement best practices. Patient, family, and community engagement efforts aim to improve patient experience and address drivers of health equity. Each partner leverages resources and benefits from the collaboration.ConclusionsOhio's academically based Regional QI Hub Model offers a promising approach to advancing population health. Policymakers are encouraged to consider integrating academic expertise into state quality strategies.

A Sponsor's Best Practice and Operating Principles to Manage Data Monitoring Committees.

The use of data monitoring committees (DMC) to safeguard patients' safety in clinical trials has evolved over the last decades and has become increasingly common. To ensure well-operating and high-performing DMCs, pharmaceutical companies need to establish clearly defined operational processes while continuously seeking to optimize these and adapt to the needs of drug development. Although there are health authority guidelines on establishing and managing a DMC, the perspectives and experiences of sponsors are often underrepresented. This publication shares insights on a sponsor, Novo Nordisk (NN), regarding principles and practices for DMC establishment and management across varying trial types and therapeutic areas, including challenges and solutions. Highlighting NN's structured and successful approach to DMCs, it details clearly defined roles and responsibilities that ensure productive DMC meetings and high-quality data for the DMC. Additionally, NN's practices for clear, transparent, and trustful communication between the sponsor, the DMC, and the independent external statistical vendor are described. Processes for quality control, internal audits, and learnings from inspections and how these are incorporated for continuous improvement of the DMC process are discussed. While the processes and practices described are primarily designed for medium and large pharmaceutical companies, certain aspects may also be relevant and beneficial for smaller companies.

EL DESARROLLO DE LA LECTURA POR MEDIO DE LA PREVENCIÓN DE LAS DIFICULTADES DE APRENDIZAJE BASADAS EN EL LENGUAJE Y COMUNICACIÓN A TRAVÉS DE LA GAMIFICACIÓN

This research plan is based on the prevention of learning difficulties, whose main objective is to provide all students with skills and abilities to progress in their learning. Recent research shows that about 10% of students have learning difficulties. It is worth mentioning that according to the Learning Disorders report, carried out by Sans, Boix, Colomé, López-Sala and Sanguinetti, (2012) and supported by the Program for International Student Assessment (PISA) of 2018 (analysis carried out by Schleicher in 2019), the main difficulties are related to reading, writing and numerical learning. From both investigations lies the importance of focusing the study on the prevention of difficulties in the field of communication and language. The main objective of this thesis is to analyze to what extent the initial reading acquisition process can be improved through the development of a series of skills. To achieve this objective, a quasi-experimental project has been carried out with comparison of groups and pre-test and post-test measures. The project has different students who are in the last cycle of kindergarten belonging to schools in the province of Alicante and there is a sample of approximately 150 participants. Next, it is worth highlighting that the program is carried out by the teachers of the centers and for this they have undergone prior training. The project has an innovative axis, where new technologies have been used with the aim of making students feel more motivated and involved in learning, thus promoting their development and connecting with their interests. The hypothesis proposed for this research plan is the following: The aim is to analyze whether, by applying an intervention program focused on the stimulation of linguistic skills at an early age, we can contribute to reducing language and communication learning difficulties. at the first educational levels. The results of this intervention plan have been obtained through various activities related to the learning of communication and language where the responses of the students have been collected to analyze them. In short, the results of the work allow us to confirm that the group that receives the intervention obtains improvements in the reading learning process.

Production of Indian cultured butter (makkhan) from buffalo creams with varied fat globule size: process improvement and quality assessment

Production of Indian cultured butter (makkhan) from buffalo creams with varied fat globule size: process improvement and quality assessment

CARABELA-COPD: a novel approach for the transformation and improvement of the healthcare process in COPD management in Spain

Introduction: Chronic obstructive pulmonary disease (COPD) is a serious global health problem that is ranked third among the leading causes of death worldwide. However, underdiagnosis remains common, especially in Spain. The CARABELA-COPD initiative aims to address these issues by optimizing processes across the diverse healthcare settings in Spain.Material and methods: CARABELA-COPD employs lean methodology and fosters partnership between scientific societies, industry, clinicians, and managers to improve COPD care. The methodology consists of 4 phases: Phase 1 involved experts analyzing COPD care models and unmet needs; Phase 2, validation and priorization of improvement areas in 7 pilot hospitals, selecting healthcare quality indicators (QIs) in a national meeting; Phase 3, cocreation and refinement of results from a regional perspective; and Phase 4 is ongoing, disseminating the results and implementing them locally.Results: Initial phases of the initiative have defined a generic patient journey for COPD management from a multidisciplinary approach, identified 7 improvement areas for optimal COPD care, developed 4 care models tailored to different settings, and established QIs that have been validated in national and regional meetings.Discussion: CARABELA-COPD is a novel practical approach to COPD management in Spain that acts as catalyst for a system transformation to boost overall system efficiency and enhance patient outcomes. It provides a clear framework for improvement, emphasizing interdisciplinary collaboration and communication. The ongoing implementation phase will require flexibility and constant evaluation to further enhance COPD care, ultimately improving patient quality of life and healthcare effectiveness.

Exploring Women’s Childbirth Experiences in Labor Induction versus Expectant Management: A Systematic Review and Meta-analysis

Background: Negative childbirth experiences impact the well-being of women and their families. With rising induction of labor (IOL) rates and the inconsistent evidence regarding its impact on childbirth experiences, we conducted a systematic review and meta-analysis to estimate the overall effect of IOL versus expectant management on women’s childbirth experiences, defined as a woman’s self-assessment of her lasting memories of the childbirth event. Methods: We searched databases (PubMed, Embase, Cochrane Library, Science Direct, ProQuest and EBSCO) for RCTs and observational studies from 1970 to September 2023. Inclusion criteria covered women aged 19 and older with live, singleton, cephalic pregnancies at 37 0/7 until 41 6/7 weeks gestation. Quality was assessed using the Jadad and Newcastle-Ottawa Scales. RevMan 5.4 software and random-effects meta-analysis were used, adhering to PRISMA guidelines. Results: Of the 1.467 screened articles, we included nine studies from five European countries. Six studies (2.376 women) used the Childbirth Experience Questionnaire (CEQ). Overall CEQ scores showed no significant IOL vs. expectant management differences (MD = 0.01 [95% CI -0.06, 0.08]; p=0.78; I2 = 65%). Subgroup analyses favored IOL in RCTs (MD = 0.07 [95% CI 0.02, 0.13]; p=0.006; I2 = 0%) and studies with ≥500 participants (MD = 0.09 [95% CI 0.02, 0.15]; p=0.006; I2 = 0%). Conversely, four studies (48.324 women) using the Childbirth Experience Visual Analogue Scale (VAS) favored expectant management (OR = 0.73 [95% CI 0.63, 0.85]; p<0.001; I2 = 86%). Conclusion: VAS assessments suggest a more positive childbirth experience with the expectant management group. Improvements in the IOL process, transfer to delivery, and pain relief administration may benefit the IOL group. In contrast, the overall CEQ scores did not significantly differ between groups. Clinical practice should consider individualized approaches that align with patient needs and medical contexts. Limitations, such as variability in study quality and data heterogeneity, should be acknowledged.

Strategic Management Practices and Survival Rates Of Small and Medium Sized Enterprises Start-Ups In Taita Taveta County, Kenya.

This study investigated the influence of strategic management practices on the survival rates of small and medium-sized enterprise (SME) start-ups in Taita Taveta County, Kenya. The study focused on five key strategic management practices: strategic planning quality, leadership effectiveness, strategic innovation, strategic market orientation, and access to financing. Specifically, it examined how these practices impacted SME survival indicators such as business longevity, financial stability, and market presence. A descriptive research design was adopted, and data were collected using structured questionnaires distributed to SME owners and managers within the county. The sample included both established and relatively new SMEs operating across various sectors. The findings revealed that strategic planning quality, characterized by goal setting, resource allocation, and risk assessment, significantly influenced SME sustainability. Leadership effectiveness, particularly in decision-making and adaptability, was found to enhance organizational resilience. Strategic innovation through product and process improvements, as well as technology adoption, also contributed positively to SME growth. Strategic market orientation, emphasizing customer focus, market responsiveness, and competitor analysis, improved market positioning and survival. Furthermore, access to financing, including credit availability and cost of funding, emerged as a critical determinant of SME longevity. The study concluded that the adoption of comprehensive strategic management practices significantly enhanced the survival and competitiveness of SME start-ups. The findings underscored the need for SME stakeholders to prioritize strategic approaches in operations to address challenges and ensure long-term success. Recommendations were provided to policy-makers and practitioners to support SME development through targeted interventions.

FDI spillover effect on the green productivity of Vietnam manufacturing firms: the role of absorptive capacity

ABSTRACT This study examines the contribution of absorptive capacity to the relationship between FDI spillover effects and firm-level green total factor productivity (GTFP) using the Malmquist-Luenberger productivity index approach combined with a threshold regression model. Using firm-level data from annual enterprise surveys in Vietnam’s manufacturing and processing industries from 2013 to 2019, the study found that absorptive capacity had an important mediating role in amplifying the beneficial effects of FDI spillover. The magnitude of horizontal FDI spillover varies with absorptive capacity in medium high technology (MHT) sectors, while negative effects are observed in medium low technology (MLT) and low technology (LT) sectors. Firms with HT, MLT, and LT sectors have positive backward effects on productivity if their absorptive capacity exceeds a particular threshold. Furthermore, our findings point to specific factors that may be crucial in improving absorptive capacity, such as internal research and development, process improvement, and export.

A need for greater awareness: a mixed methods study of patient and healthcare professional perspectives on the diagnosis journey for haemophagocytic lymphohistiocytosis (HLH)

ABSTRACT Objectives Our aim was to better understand and raise awareness of the diagnosis journey and quantify any barriers for timely diagnosis of haemophagocytic lymphohistiocytosis (HLH), to support patients’ struggle with diagnosis and reduce time to diagnosis. Methods Patients diagnosed with, or caregivers for those diagnosed with primary or secondary HLH and physicians involved in the treatment of HLH were recruited. Quantitative interviews were undertaken with patients/caregivers to quantify key elements of the diagnosis journey, followed by qualitative interviews with participants. Interviews took place between March–May 2021. Results Thirty-three patients/caregivers and nine physicians took part in this mixed methods study. Lack of physician awareness of HLH was a common frustration for patients/caregivers, causing delayed diagnosis. All physicians indicated bone-marrow testing is a key step in the diagnosis process, and some patients/caregivers had frustrations around testing. Emergency care doctors, although not usually involved in the diagnosis process, were among the most-seen specialists by patients/caregivers. Patients/caregivers suggested potential improvements in available information, such as providing information on treatment options and condition management. Discussion Patients/caregivers and physicians agreed on the need to raise overall awareness of HLH signs/symptoms among priority groups of physicians to recognise how signs/symptoms can progress and develop. Improvements in the testing process and communication would directly impact the speed of diagnosis and support patients/caregivers during the diagnostic journey, respectively. Conclusion Raising awareness of key issues, such as signs/symptoms, tests and diagnostic procedures, and improved communication and support for patients/caregivers, are key to speeding up HLH diagnosis and improving outcomes.

Change-driven process management: exploring a new process paradigm adaptable to societal changes

PurposeProcess management principles are challenging owing to the increasing need for sustainable operations. The demand for rapid deliveries implies accelerated changes and increased flexibility. Therefore, this study aims to facilitate process improvements based on change-driven needs.Design/methodology/approachThe research is conducted using holistic multiple case studies of eight Swedish organisations (with employees from Sweden, France and Germany), representing the automotive, energy, medical technology, healthcare, telecom and social services sectors.FindingsA process management model with four change-driven phases is presented. The model fulfils demands for both speed and quality in process changes, providing specific guidance on working methods for (1) control and stability, (2) creativity and stability, (3) creativity and change and (4) control and change.Research limitations/implicationsThis research is limited to eight organisations in Sweden, France, and Germany that participate in the automotive, energy, medical technology, healthcare, telecom and social services sectors. Future research should explore broader international contexts.Practical implicationsThe proposed model helps decision-makers adapt process management to evolving business and operational needs; thus, leaders can make grounded decisions on when and how to change operations based on changing internal and external requirements.Originality/valueThis study challenges the current process management paradigm with new knowledge of how process management can be adapted to new business opportunities.

Best practices for seamless integration of Robotic Process Automation (RPA) and cloud technologies

Transformative technology such as Robotic Process Automation (RPA) and Cloud Integration is the platform to achieve streamlining of operations, enhance employee productivity, and drive innovation for your business. While RPA automates repetitive, rule based work, cloud computing is the scalable, flexible and decentralized infrastructure for storing and processing of data, and collaboration. With RPA integrated with cloud platforms, organizations gain several advantages including accessibility, low cost and real time collaboration. Choosing the right cloud provider that supports RPA workloads, ensuring data flow seamlessly between RPA bots and cloud systems, and using cloud based RPA tools that can scale and that add flexibility, are the best practices for RPA and Cloud integration. It is also important to enforce robust security protocols, data governance as well as comply with risks. Integration is successful when RPA links with cloud native apps and services with as little disruption to work as possible and as much automation effect as possible. It is therefore recommended that performance monitoring, testing and continuous improvement of automation process should be given priority. Through the implementation of these best practices, organizations can attain near full potential RPA and cloud integration for operation efficiency, better customer experience and faster digital transformation. In this paper we explore the key strategies, challenges and solutions to ensure success with the integration of RPA into cloud technologies to help businesses looking to optimize the use of automation and cloud capabilities in unison.

Data analytics in business process improvement: Enhancing decision-making and operational efficiency in financial institutions

This review paper examines the pivotal role of data analytics in enhancing decision-making and operational efficiency within financial institutions. The research highlights how data analytics tools and techniques optimize business processes, streamline operations, and improve resource allocation. Key areas such as risk assessment, customer segmentation, and fraud detection are explored to demonstrate the practical applications of data-driven decision-making. Additionally, the paper discusses the challenges financial institutions face in implementing data analytics, including issues related to data quality, system integration, and resistance to change. The paper concludes with recommendations for financial institutions to leverage data analytics effectively and suggests avenues for future research, particularly in emerging trends like artificial intelligence and machine learning.