Process Improvement Initiatives Research Articles

How to Sustain Healthcare Process Improvement in Heterogenous Teams? Evidence from a Systems Dynamic Model

This research investigates how to sustain process improvement (PI) initiatives in healthcare. Despite the abundant knowledge on PI, we know very little on why and how PI sustains over time. This is particularly true in the context of heterogeneous frontline teams of physicians and nurses with different operational characteristics such as attrition rates, skill sets, training, and goals. Our study builds a model that simulates the mutual, dynamic interaction of these stakeholders with each other and with processes with different characteristics in the presence of endogenous management prioritization. We build confidence in the model by calibrating it to data from PI teams at several family medicine clinics at a large US Midwestern healthcare system. The computational experiments performed using data from these teams yield several important insights for theory and practice. First, we find that process metrics, which are leading metrics related to the day-to-day functioning of the units, and outcome metrics, which are lagging metrics often tied to the unit's bottom line, are both critical for the functioning of the PI teams. Emphasizing one over the other can reduce sustainability while a mixed case in which one group of employees is incentivized to leading and another group to lagging can create a regime that is more effective in many scenarios. Second, we find that management interventions that improve short-term PI gains generally also reduce the likelihood of long-run sustainment. Third, we find that attrition and turnover among the team members affect sustainability of PI initiatives and reducing turnover for one class of employee, which attends lagging metrics, facilitates sustainment while reducing it for the other class, which attends leading metrics, can hinder sustainment. We conclude by discussing these implications to the practice of PI among healthcare teams.

Integrating Lean Six Sigma and Industry 4.0: developing a design science research-based LSS4.0 framework for operational excellence

Acknowledging the potential benefits of integrating Industry 4.0 techniques into Lean Six Sigma-oriented process improvement initiatives, the current literature lacks a comprehensive guideline for the systematic incorporation of Industry 4.0 within Lean Six Sigma practices. To fill this gap, we have developed the LSS4.0 framework, employing a design science research approach. This framework serves as a structured integration model for Industry 4.0 and Lean Six Sigma, aimed at assisting organizations in their journey towards LSS4.0 implementation. Through iterative development and collaboration with experts in both Lean Six Sigma and Industry 4.0, the framework and its associated 14-step implementation process underwent evaluation using action research-based semi-structured interviews and demonstrations, featuring case studies from the automotive (F2) and mining (F3) industries. The outcomes demonstrated substantial operational enhancements, including reduced defects, improved on-time delivery, a 95% first-pass yield in F2, a 20% boost in energy efficiency, an increase in equipment effectiveness from 75 to 85% in mining operations, and a notable 30% decrease in unplanned downtime incidents, contributing to improved productivity and operational efficiency while reducing maintenance costs. This research significantly advances knowledge in Industry 4.0 and Lean Six Sigma, offering valuable insights and making a meaningful contribution to the broader field of quality management.

Organizational ambidexterity in young SMEs? The incompatibility of entrepreneurial orientation and process improvement

ABSTRACT Organizational ambidexterity describes firms’ ability to pursue exploration and exploitation strategies simultaneously. It is, however, unclear if young SMEs should seek to develop organizations with this ability or if they are better off focusing on just one strategy. To shed light on this matter, this paper investigates the interaction between entrepreneurial orientation (EO) (organic organizing) and process improvement (mechanistic organizing) in relation to firm growth in young SMEs (small and medium-sized enterprises). We hypothesize that both types of strategies can produce growth for young SMEs but that, due to their incompatibility, young SMEs do not have the resources needed to successfully pursue them both. We test these hypotheses on a sample of 257 young Danish SMEs. Our results confirm that both EO and process improvement have a positive effect on firm growth. The results further show that while process improvement has a considerable positive effect in low EO firms, for high EO firms, this effect is minimal. Thus, high EO firms may waste important resources by putting too much effort into process improvement initiatives.

Design and Implementation of an RFID System for Order Tracking in Smart Manufacturing: A Case Study of a Mechanical Factory

Six Sigma is a well-liked technique for raising productivity and quality of output in industrial processes and process improvement initiatives. In the Six Sigma methodology, abnormalities in the operational process are reviewed and examined using the Define, Measure, Analyze, Improve, and Control (DMAIC) cycle. Corrective action is then taken to reduce bottlenecks to enhance productivity, ensure stable product quality, and create a tightly connected production cycle. This study proposes the use of integrating statistical hypotheses into the DMAIC cycle of the Six Sigma method and proposes the use of Enterprise Resource Planning (ERP) modules to monitor production processes at a major mechanical processing company. Lean tools are also suggested by the author to be used in the analysis phase. The research results show a reduction in the rate of late product delivery to users from 6.28% to 0.02% per month. The lean tool application model, statistical hypotheses, and industry 4.0 system are integrated into the EPR system at the company's improvement department and are considered a model for manufacturing companies to refer to in implementing improvements for their products. Production processes in different companies.

Implementation of a hotline (“S-T-I-C-K”) to expedite management of occupational bloodborne pathogen exposures at an academic medical center: A Process Improvement Initiative

Previously, blood and body fluid exposures were managed by a visit to the University Employee Health Clinic during normal business hours and the Emergency Department after hours. We implemented the "S-T-I-C-K" program where health care personnel were evaluated immediately after exposure by a nurse-driven 24/7 hotline. Increasing accessibility to care and a simplified process for exposure management led to a significant decrease in Emergency Department utilization and time between the exposure and receipt of post-exposure prophylaxis.

Measuring and Analyzing the Process Capability of Productivity – An Applied Study in the Al-Tahady Factory for the Production of Filters

This study addressed concerns related to increased percentages of damaged and re-worked production, heightened demand for factory products, and lack of awareness of the approved Sigma (σ) level during manufacturing, and associated deviations in the manufacturing process. The primary research problem was to assess the manufacturing process's stability and capability to consistently produce conical filters that meet required specifications. The study followed a sample-based approach, where twenty samples, each containing four observations, were collected continuously over a period of seven days. For each sample, the mean (X ̅) and range (R) were calculated. The mean X-Double bar of 319.32 and the average range R-bar of 0.848 were obtained through data analysis. The main findings revealed that, on average, the manufacturing process was relatively close to the target value (X-Double bar = 319.32). However, the presence of several data points outside the control limits indicated potential variability in the process. The average range (R-bar = 0.848) highlighted certain variations in the manufacturing process, which might contribute to issues like damaged or re-worked production. The study identified the need for further investigation to determine the root causes of these variations, which could include machine malfunctions, material fluctuations, or operator errors. By addressing these concerns and reducing process variability, the factory can enhance product quality, decrease waste, and improve customer satisfaction. In conclusion, continuous process monitoring and improvement initiatives, such as Six Sigma, are essential for achieving greater process capability in conical filter manufacturing. This research contributes valuable insights into process performance and provides a basis for implementing corrective actions to ensure consistent product quality and meet customer demands.

Anesthesia Risk Alert Program: A Proactive Safety Initiative.

Analyzing adverse events data collected over a three-year period on all anesthetic cases, North American Partners in Anesthesia (NAPA), a nationwide anesthesia practice, found a correlation between certain high-risk clinical factors and a number of critical events. Seeking to reduce the incidence of critical adverse events associated with these high-risk factors, the quality team of the NAPA Anesthesia Patient Safety Institute (NAPSI) developed the Anesthesia Risk Alert (ARA) program, which guides clinicians in proactively applying targeted risk mitigation interventions in five specific clinical scenarios. NAPSI is NAPA's Patient Safety Organization (PSO). ARA promotes a proactive (Safety II) approach to patient safety. The protocol incorporates innovative collaboration techniques to improve clinical decision-making, along with recommendations by professional medical societies. ARA risk mitigation strategies also adapt decision tools from other industries, such as red team/blue team methodology. Following implementation training to approximately 6,000 NAPA clinicians, ongoing compliance is tracked for the program's two components: screening patients for the five high-risk clinical scenarios and performing the associated mitigation strategy when one or more risk factor is identified. Since launching the ARA program in 2019, clinician compliance consistently exceeds 95%. Simultaneously, available data indicate that the incidence of selected adverse events has decreased. ARA, developed as a process improvement initiative to reduce patient harm in several vulnerable perioperative patient populations, demonstrates how proactive safety strategies can improve clinical outcomes and create better perioperative cultures. At various sites, NAPA anesthesia clinicians reported that ARA's collaboration strategies were transformative behaviors that extended beyond the operating room. Other health care providers may customize the lessons learned from ARA with a Safety II approach.

Team Approach: Improving Orthopaedic Operating Room Efficiency.

The cost of surgical care accounts for almost one-third of all health care spending in the United States. Within health care spending, the operating room (OR) is one of the largest health care costs during a perioperative episode of care. Efficiency in the OR has been associated with increased productivity, safety, and quality of care. However, multiple sources of delays can contribute to inefficiency, and improving efficiency in the OR requires a systematic approach to identify and address each issue. We report on the case of a process improvement initiative implemented in a large academic institution to improve OR efficiency in outpatient orthopaedic cases, and we discuss the lessons learned through this program. Optimizing workflow in the OR requires a multidisciplinary team approach consisting of clinician leaders with common goals and open discussion regarding the needs of each team member, including circulating nurses, surgical nurses/technologists, and anesthesiologists. Our experience highlights the importance of practical, clinician-driven changes that are supported by administrative engagement, resources for staffing and equipment, and institutional flexibility, which are required to implement systemic changes to address and improve efficiency in the OR.

АЛГОРИТМ ВИМІРЮВАННЯ ПОДІБНОСТІ МІТОК ДІЯЛЬНОСТЕЙ НА ОСНОВІ NLP У БАЗІ ДАНИХ МОДЕЛЕЙ БІЗНЕС-ПРОЦЕСІВ

Business process modeling is an important part of organizational management since it enables companies to obtain insights into their operational workflows and find opportunities for development. However, evaluating and quantifying the similarity of multiple business process models can be difficult because these models frequently differ greatly in terms of structure and nomenclature. This study offers an approach that uses natural language processing techniques to evaluate the similarity of business process models in order to address this issue. The algorithm uses the activity labels given in the business process models as input to produce textual descriptions of the associated business processes. The algorithm includes various preprocessing stages to guarantee that the textual descriptions are correct and consistent. First, single words are retrieved and transformed to lower case from the resulting textual descriptions. After that, all non-alphabetic and stop words are removed from the retrieved words. The remaining words are then stemmed, which includes reducing them to their base form. The algorithm evaluates the similarity of distinct business process models using similarity measures, including Jaccard, Sorensen – Dice, overlap, and simple matching coefficients, after the textual descriptions have been prepared and preprocessed. These metrics provide a more detailed understanding of the similarities and differences across various business process models, which can then be used to influence decision-making and business process improvement initiatives. The software implementation of the proposed algorithm demonstrates its usage for similarity measurement in a database of business process models. Experiments show that the developed algorithm is 31% faster than a search based on the SQL LIKE clause and allows finding 18% more similar models in the business process model database.

How to develop standardized work for business processes in the transactional office environment

Standardised Work (STW) is one of the most effective but least utilized Lean tools for business process improvement initiatives in the transactional office environment known as the ‘Lean office’. The STW not only establishes a baseline for continuous improvement initiatives but also facilitates them by giving indications of key improvement opportunities in the present best practice. The STW is a thorough document in which the process workflow is broken into a number of consecutive work elements whose processing times are labelled according to their nature and required resources. Developing the STW for business processes in the manufacturing environment is quite common; however, it is quite rare and limited in the transactional office environment. This is primarily caused by the business-office processes’ complexity or underestimating their influence on overall business success. In this study, we position and highlight the importance of the STW in the Lean office programme and propose a pragmatic and tractable framework for developing the STW for business-office processes through the use of a pilot process. The proposed STW framework was implemented successfully in the pharma industry. Finally, the paper is concluded by discussing the possible obstacles and providing future research directions.

The importance of theory at the Information Systems Journal

The importance of theory at the <i>Information Systems Journal</i>

Interval-Valued Intuitionistic Fuzzy-Analytic Hierarchy Process for Evaluating the Wastes in a Pharmaceutical Company

Pharmaceutical manufacturing is a sector where good manufacturing practices (GMP) practices are applied and any process change will be completed with long processes. In this study, all production steps of a pharmaceutical production facility in Turkey, from raw material to finished product, were examined. Wastes determined using current state VSM were evaluated by IVIFAHP. The study's findings and the operational enhancements demonstrate that using VSM and IVIFAHP is a successful technique for these firms to enhance their processes and hence address their existing difficulties. By offering empirical proof of the application of VSM in Turkey, this paper contributes and can be used as a reference by managers and engineers to carry out particular process improvement initiatives in their organizations that are comparable to the ones described.

Abstract WP26: Multidisciplinary Case Reviews Reduce "Door-to" Times

Background: Rapid reperfusion is critical for positive outcomes in stroke patients. To improve patient outcomes, the organization reduced program goals for all door-to metrics. To reach the aggressive new goals, a door-to task force led by the Stroke Program Coordinator was created. The multidisciplinary task force meets monthly and consists of members from Pre-Hospital, ED, Stroke, CT, and Neurointerventional Radiology (NIR). Interventions: Door-to data is shared monthly and case reviews on all door-to fall-outs are performed. The task force reviews door-to-CT, door-to-thrombolytics, and door-to-puncture metrics. An RCA is conducted on each case that exceeds our time goals looking for areas for improvement. Each case is evaluated from initial EMS contact through initiation of treatment; with all members of the multidisciplinary team participating. A trend in prolonged door-to-puncture was seen; so further investigation into the causes for the delays was done by the task force. This led to several improvement initiatives that addressed each of the delays. Education was completed for ED, CT, and NIR staff on the significance of a rapid initial evaluation and transport to NIR. An outside hospital (OSH) transfer notification process was created for OSH transfers eligible for thrombectomy. A direct-to-angio process was also developed to allow transport from CT to the NIR suite without stopping in an ED room. Results: The combination of these initiatives had a positive impact on door-to-puncture times. When comparing 2021 data to year-to-date 2022 post-implementation data, a reduction in door-to-puncture has been seen. Median time for door-to-puncture in 2021 was 60 minutes. This time has reduced to 48 minutes for the January through June 2022 timeframe. Conclusion: A multidisciplinary door-to task force reduces door-to-puncture times by keeping constant focus on door-to metrics and by creating a shared accountability for the process. With the door-to task force, real-time case reviews can be completed to allow for rapid identification of areas of opportunities and initiation of process improvement initiatives to reduce door-to times.

The Creation of a Critical Care Admission Pressure Injury Prevention Cart to Reduce Hospital-Acquired Pressure Injuries

The goal of this process improvement initiative is to reduce hospital-acquired pressure injuries related to Covid-19 with Critical Care patients. Critically ill and ventilated patients require prone position therapy and prolonged ventilator times place the patient at risk for hospital acquired conditions and pressure injuries. The Critical Care team created a Critical Care Admission Pressure Injury Prevention Cart that contains preventative dressings for all pressure areas at risk. The Critical Care Admission Pressure Injury Prevention Cart has significantly reduced the pressure injury rate. With the emergence of the pandemic and additional surges, pressure injuries continued to be on the rise due to prone position therapy. The Critical Care team worked with the system and developed prone position protocols, which included preventative dressings for all areas at risk. Prior to the implementation of the admission cart, Critical Care ended fiscal year 2022, quarter one, with fifty-three hospital acquired pressure injuries. Last December and early January 2022 there was another surge of Covid-19. The Critical Care team implemented the admission cart in January 2022. From January 2022 through September 2022, there has been an 98% reduction. The cart has been successful for Critical Care, and Baptist Hospital implemented the cart in all high acuity areas. This cart was a multidisciplinary practice, which consists of nursing, the wound and skin team, respiratory care, and leadership working together towards the goal of patient safety and pressure injury prevention.

Creating conditions for effective knowledge brokering: a qualitative case study

BackgroundProcess improvement in healthcare is informed by knowledge from the private sector. Skilled individuals may aid the adoption of this knowledge by frontline care delivery workers through knowledge brokering. However, the effectiveness of those who broker knowledge is limited when the context they work within proves unreceptive to their efforts. We therefore need greater insight into the contextual conditions that support individuals to broker process improvement knowledge to the frontline of care delivery, and how policy makers and organizations might generate such conditions.MethodsOur research took place in a healthcare system within an Australian State. We undertook a qualitative, embedded single case study over the four year period of a process improvement intervention encompassing 57 semi-structured interviews (with knowledge brokers, policy makers, and executive sponsors), 12 focus groups, and 137 h of observation, which included the frontline implementation of actual process improvement initiatives, where knowledge brokering took place.ResultsWe identified four phases of the process improvement intervention that moved towards a more mature collaboration within which knowledge brokering by improvement advisors began to emerge as effective. In the first phase knowledge brokering was not established. In the second phase, whilst knowledge brokering had been initiated, the knowledge being brokered lacked legitimacy amongst frontline practitioners, resulting in resistance. Only in the fourth and final phase of the intervention did the collective experience of policy makers result in reflections on how they might engender a more receptive context for knowledge brokering.ConclusionWe highlight a number of suggested actions that policy makers might consider, if they wish to engender contextual conditions that support knowledge brokering. Policy makers might consider: ensuring they respect local context and experience, by pulling good ideas upward, rather than imposing foreign knowledge from on high; facilitating the lateral diffusion of knowledge by building cultural linkages between people and organizations; strengthening collaboration, not competition, so that trans-organisational flow of ideas might be encouraged; being friend, not foe, to healthcare organizations on their knowledge integration journey. In sum, we suggest that top-down approaches to facilitating the diffusion and adoption of new ideas ought to be reconsidered.

A High-reliability Organization Mindset.

In 2020, the US Department of Veterans Affairs Connecticut Healthcare System began its journey to becoming a high-reliability organization as part of Veterans Affairs efforts to become an enterprise-wide high-reliability organization through the Veterans Health Administration. The initiative was launched to create safe enterprise-wide health care systems and environments with robust continuous process improvements as a method for providing patients with safer and higher quality care. In this article, the authors describe a continuous process improvement initiative aimed at implementing system-wide initiatives along the journey to becoming a high-reliability organization. The initiatives are described from the perspectives of individuals representing staff from the frontline to executive leadership. The authors believe that the processes, strategies, and example initiatives described can be readily adopted and implemented in other health care organizations along the journey to high reliability.

61 Designing and Developing A Digital Equity Dashboard For the Emergency Department

Nationally, disparities in diagnosis, treatment, and health outcomes of racial minorities are well documented in the emergency department (ED). While EDs may conduct regular quality and process improvement initiatives, it is rare to provide daily mechanisms for administrators, clinical staff, and trainees to examine clinical data stratified by demographic details (ie race, ethnicity, age, language, sex). A web-based solution would provide an up-to-date summary of patient care, and allow users to identify opportunities for improvement.

Interventions in the diagnosis and adoption of pacemaker therapy in sinus node dysfunction patients: Results from the IMPROVE Brady study

AimsIMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients. Methods/Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant.A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001). ConclusionsA process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.

Advanced Triage Protocol: The Role of an Automated Lactate Order in Expediting Rapid Identification of Patients at Risk of Sepsis in the Emergency Department.

OBJECTIVES:We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level.DESIGN:Prospective cohort study.SETTING:Seven hundred-bed tertiary care hospital with ≅65,000 patient visits/yr.PATIENTS:Patients presenting to emergency department (ED) triage who met the following criteria: greater than or equal to two of the three systemic inflammatory response syndrome criteria assessable in triage, a chief complaint suggestive of infection, emergency severity index 2 or 3, and ambulatory to ED.INTERVENTIONS:A computer-generated lactate order was created, staff education and resources increased, and point-of-care lactate testing was introduced.MEASUREMENTS AND MAIN RESULTS:Primary endpoints include the following: percent of patients having a lactate level drawn, percent of lactate samples resulting before room placement, and time intervals from triage to lactate blood draw and to lactate result. Secondary endpoints were percentage of patients admitted to the hospital, percentage admitted to the ICU, and in-hospital mortality. Six thousand nine hundred six patients were included: 226 historic controls (HCs) and 6,680 intervention group patients. The mean serum lactate level was 1.77 ± 1.18 mmol/L. The percentage of patients having a lactate resulted increased from 27.4% in the HC period to 79.6%. The percentage of these lactate results available while the patient was still in the waiting room increased from 0.4% during the HC period to 33.7% during Phase 5 (p < 0.0001). In the intervention period, time from triage to lactate result decreased (78.1–63.4 min; p < 0.0001) and time to treatment room decreased (59.3–39.6 min; p < 0.0001).CONCLUSIONS:Implementation of a computerized lactate order using readily available data obtained during ED triage, combined with point-of-care lactate testing, improves time to lactate blood draw and lactate result in patients at risk for severe sepsis. Initial lactate levels correlated with admission to the hospital, admission to the ICU, and in-hospital mortality.

Administrative structures: Options for achieving success in perioperative medicine.

Without the appropriate administrative structure, even well-thought-out strategic plans or detailed process improvement initiatives will fail. Developing a strong foundation for governance and leadership is a critical element of any high-functioning organization, and it applies just as well in the perioperative setting. Yet, perioperative patient care teams and operating room (OR) management structures can be very complex, due to relationships both within the OR and between the OR and other departments. Frequently, reliable management of the perioperative process is lacking. We aim to provide an overview of the structural and elemental components and roles of perioperative management teams, as well as the administrative structure that guides them, since effective perioperative care teams and OR leaders are of paramount importance for any successful hospital.