Reengineering & Lean Management|My course tutor

Posted: February 28th, 2023

INSTRUCTIONS

Course related article: Students are to find an article that is related to one of the chapters being taught. Download it in the designated dropbox along with a full page explaining the relationship to the chapter materials and your thoughtful reflection on the article.

International Journal for Quality Research 15(3) 1007–1022

ISSN 1800-6450

1 Corresponding author: Nayara Nicole de Sene Pereira

Email: nayara_senne@hotmail.com

1007

Nayara Nicole de Sene

Pereira1

Evandro Eduardo

Broday

Article info:

Received 24.03.2020.

Accepted 15.07.2020.

UDC – 005.6

DOI – 10.24874/IJQR15.03-20

APPLICATION OF CONTROL CHARTS

FOR MONITORING THE WAIT ING TIME

IN A BASIC HEALTHCARE UNIT IN

BRAZIL

Abstract: Brazilian public healthcare service is highly

demanded. However, the system has been through a restrained

scenario, with a long waiting time to have a doctor’s

appointment and scans. This research aims to analyze the

waiting time in the services of a Basic Healthcare Unit (BHU)

in a small city in the state of Sao Paulo, Brazil, by using

statistical control charts. The field research relays on

Taguchi’s loss function smaller-the-better, in other words, the

shorter the waiting time for patients, better is the perception of

quality. A direct observation was carried out in order to

acquire the patients’ waiting time for a medical appointment

and to evaluate the quality of the service. The patient waiting

time was monitored with Control Chart for Individual

Measurements and Moving Range and then it was determined

the capability of the service by using the 𝐶𝑝𝑘 index. It was

concluded that the service is inefficient based on Process

Capability Index (𝐶𝑝𝑘=-0.15), being the average waiting time

for a doctor’s appointment around 121.88 minutes

(approximately 2 hours).

Keywords: Quality Management; Control Charts; Public

Health Service; Waiting Time.

1. Introduction

The Brazilian Constitution (1988) says that

access to healthcare is a right of all Brazilian

citizens, either through the National Health

Service, which is the public service offered by

the government, or through private

agreements with private companies.

According to Tieghi (2013), the National

Health Service serves 200 million people, of

which 152 million are exclusive users of this

system. Brazil has more than 6000 hospitals,

45000 Basic Healthcare Units (BHU) and

30300 family health teams.

It is evident, then, that public health services

are the most demanded by the population.

However, the system has flaws in its main

programs and, as a consequence, there are

crowded hospitals, lack of manpower, lack of

training for professionals and problems

related to National Health Service financing

(Rossi, 2015). Thus, preserving a free

universal health system is an obstacle for

Brazil, mainly due to its territorial extension

(Tieghi, 2013).

These flaws can also be evidenced through

research carried out by the Brazilian Institute

of Geography and Statistics (IBGE) (2015),

which points out that 40.4% of the population

cannot get care due to the absence of doctors

and dentists, 32.7% do not have access to a

BHU, 6.4% do not find specialized

professionals to attend, 5.9% waited a long

time and gave up, 2.3% due to unavailability

1008 N.N.S. Pereira, E.E. Broday

of equipment, 2.1% due to the health service

not working, 0.5% for not being able to pay

for the consultation and 9.7% for other

reasons.

Al-Shdaifat (2015) conducted a survey where

TQM (Total Quality Management) was

implemented in hospitals in Jordan. Results

showed that less than 60% of hospitals

implemented, being the main principle to be

implemented costumer focus. Kalaja et al.

(2016) conducted a study at the regional

public hospital in Durrës, Albania, and

reported that healthcare is on the rise in the

country, receiving the attention of researchers

and doctors, due to deficiencies that the sector

faces and the challenges to be overcome. This

situation is very similar to that faced by

Brazil, which also faces deficiencies in the

sector.

In this way, quality tools can help the

limitations of the health sector. Control charts

are an example of a quality tool used in this

sector. According to Fry et al. (2012), even

though these graphs have been developed to

assist manufacturing quality control, control

charts have been suggested for assessing

clinical outcomes. It can be shown that

Statistical Process Control (SPC) can bring

many benefits to the health sector, reducing

waste, reducing costs and making better use

of resources, in order to prioritize patient

satisfaction. In order to bring benefits to the

services, the use of quality methods is

increasing, concerned with the quality of

service and improvements, with the consumer

satisfaction as the main goal (Rosa and

Broday, 2018).

The present research sought to evaluate the

capability of the Health System, based on the

Cpk index, in a small city in the state of Sao

Paulo, Brazil. The patients’ waiting time was

monitored with Control Charts for Individual

Measurements and Moving Range using data

from the waiting time of patients collected in

a Basic Healthcare Unit.

2. Literature Revi

Chapter 6.

Flow Processes Improvement:

Reengineering & Lean Management

Chapter 6: Flow Process Improvement

Yasar A. Ozcan

1

1

Outline

Reengineering vs. Other Methods

Lean Management

Work Design in Health Care Organizations

Work Design

Job Design

Work Measurement-Standard Times

Stopwatch Time Studies

Standard and Predetermined Times

Work Measurement Using Work Sampling

Determination of Sample Size

Development of Random Observations Schedule

Training Observers

Work Simplification

Work Distribution Chart

Flow Chart & Flow Process Chart

Value Stream Map

Spaghetti Diagram

Worker Compensation

Yasar A. Ozcan

Chapter 6: Flow Process Improvement

2

Introduction

Organizational Performance is a major concern for health care managers

Performance is usually measured financially by looking at profits, market share, reimbursement, but also can be measured by market share compared to other institutions or healthcare systems.

Performance is usually classified as:

Those who perform adequately with no imminent risk in their finances or market share

Those whose performance is marginally adequate

Those whose performance is less than less than expected

Yasar A. Ozcan

Chapter 6: Quantitatve Methods in Health Care Management

3

How do you improve institutional Performance?

4

Chapter 6: Quantitatve Methods in Health Care Management

Yasar A. Ozcan

Improve Finances (Restructuring, downsizing/Layoffs, mergers)

What problems are created by restructuring /downsizing?

Will this impact Quality of care?

Pareto Principle “While improving a part of the organization, one should not make other parts of the organization worse off”

Improved Productivity (automation, implement process improvements, cross training staff, etc.)

Improve Quality of Care

Value = Quality/Cost (Increase value by Improving Quality and by reducing cost)

TQM/CQI

To improve both performance and quality one can use TQM (Total Quality Management) and CQI (Continuous Quality Improvement)

This should be a Long-term goal

Make incremental changes (often over 5 to 6 years)

Requires management commitment to quality

Q. Why TQM and CQI end up in failure?

Management’s commitment can become diluted

Responsibility is only assigned to a limited number of people

Chapter 6: Quantitatve Methods in Health Care Management

Yasar A. Ozcan

5

Reengineering & Lean Management vs. Other Methods

Healthcare managers have often sought organizational change, restructuring, and downsizing. Although those methods may improve the financial base of the organization or productivity at least temporarily by “cutting the fat,” namely by reducing the staff across the board, yet they create other problems. In particular, reducing staff can lead to major problems in the quality of care.

Two other contemporary and popular methods that aim to improve both performance and the quality are total quality management (TQM) and continuous quality improvement (CQI) which are geared to make incremental changes over time.

Yasar A. Ozcan

Chapter 6: Flow Process Improvement

6

Reengineering and Lean management

What is Reengineering and Lean Management?

Yasar A. Ozcan

Chapter 6: Quantitatve Methods in Health Care Management

7

Flow Process Improvement via Reengineering and Lean Management

Reengineering and Lean Management methods are process improvement methodologies intended to overcome the difficulty in realizing TQM/CQI performance over a long duration, as well as the myopic conduct of organizational change, restructuring and downsizing.

To improve the system flow process, healthcare managers must be able to understand work-design, jobs, job measurement, process activities, and reward systems – all well known concepts of industrial engineering. With that knowledge, they can recognize the bottlenecks in the old system, identify unnecessary and repetitive tasks, and eliminate them in the reengineered system of care.

Yasar A. Ozcan

8

Chapter 6: Flow Process Improvement

Reengineering

Reengineering in the early 1990 aimed to improve:

Quality

Cost

Service

Speed

Chapter 6: Quantitatve Methods in Health Care Management

Yasar A. Ozcan

9

Reengineering

What should Reengineering do?

Eliminate Delays in healthcare delivery

Eliminate duplication in healthcare delivery/Eliminate unnecessary tasks

Implement automation or IT

Retrain employees to provide a comprehensive and undisruptive care

This will help reduce cost and speed up recovery

Yasar A. Ozcan

Chapter 6: Quantitatve Methods in Health Care Management

10

Example of Comprehensive and undisruptive care

Example is patient focused or patient centered care. Hospital offering patient-focused cardiac care for a patient recuperating from a heart attack or bypass surgery.

Nurses are trained to perform EKGs and Draw blood, so fewer staff are involved in the patient’s care

Patients are given one on one education about heart disease and cardiac rehab.

Families receive education about their health

Yasar A. Ozcan

Chapter 6: Quantitatve Methods in Health Care Management

11

Final Thought: Why reengineering Fails

12

Chapter 6: Quantitatve Methods in Health Care Management

Yasar A. Ozcan

One reason such efforts fail is that leaders assume that reengineering is no more than cos

 

SOLUTION

Quantitative methods are important tools for health care managers to analyze and evaluate the performance of health care organizations, make informed decisions, and optimize resource allocation. In health care management, quantitative methods are used to collect, analyze, and interpret data to identify patterns, trends, and relationships that can inform decision-making. Some of the quantitative methods commonly used in health care management include Statistical analysis: Statistical analysis is used to analyze and interpret data to identify patterns and relationships. Statistical methods such as regression analysis, ANOVA, t-tests, and correlation analysis can be used to analyze data collected from surveys, medical records, and other sources.

1.