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MGT603: Systems Thinking

ASSESSMENT 3 BRIEF: (Word count: Up to 2000 words)

Assessment 3 is about uncovering the complexities in operations management generally, identifying key themes, intended and unintended consequences and proposing a holistic solution to the problem using a Systems Thinking lens.
The following scenario study provides you with a brief overview of a hypothetical problem. Be aware that the scenario provided may not cover every detail that you will need to address in the Written Report, in which case, you will need to conduct additional research, including further research on how emergency departments function in any hospital.

Scenario:

Consider yourself as part of a team responsible for managing the operations of an emergency department of a public hospital. The emergency department has received feedback from patients suggesting that the patient wait times need to be improved. The value stream map of the current operations is shown in the attached diagram.
The Value Stream Map is can be Found via the Assessment Link.
You have been tasked with improving patient turnaround time by reducing the current time to half. To complete the task you are required to identify the various System Archetypes that affect the operations of the hospital and the emergency department itself and based on the archetypes, develop a future State Value Stream Map of the emergency department.
It is recommended that you identify and critically analyse intended and unintended consequences, recommending holistic solutions that will optimise the operations of the emergency department without compromising the performance of other functions of the hospital.

Answer:

Individual Report

Executive Summary

With rising healthcare costs, it is critical to evaluate systems and practices that will result in increased organization efficiency and cost savings. The intensive care unit of the hospital is having capacity issues. Frequently, patients, particularly those with life-threatening conditions, are forced to wait longer than necessary, resulting in consumer discontent or unnecessarily heightened tension between management and the customer. To address this issue, operations management must conduct a comprehensive analysis and evaluation of the process flow, identifying and eliminating non-value-added services in order to provide the desired services. The current article examines a case study involving an emergency ward. It highlights how device archetypes may be utilized to significantly improve the emergency ward’s performance in order to accept more patients while also significantly improving the hospital’s overall workflow by significantly lowering wait times. Additionally, the report offers a value stream mapping technique for eliminating redundant work and streamlining hospital operations management. The report finishes with many recommendations to aid the hospital in streamlining their processes without jeopardizing service quality.

1. Introduction

In recent years, technological developments have posed a great challenge of medical institutions, posing a major danger each and every stakeholders involved with them, including patients, vendors, and physicians. For example, institutions are continually implementing and promoting the use of new advanced devices, necessitating the establishment of a strong understanding and their use among practitioners in order to prevent any type of exploitation. However, since these new technologies are anticipated to provide several advantages to their end customers, they also pose a number of obstacles to the physicians or doctors who are using them. Existing health systems have not yet been able to deal with the changes taking place in the sector in the outside world, and as a result, there are a variety of emerging challenges that are arising, which is compounding the magnitude of the issue (Taveras et al., 2013).

Furthermore, the contemporary healthcare system is indeed not adequately prepared to deal with individuals who require a variety of complicated treatments. In order to provide an accurate balance between the needs of customers and the objectives of facility owners and employees, the healthcare senior management must operate in a collaborative manner. As a result, hospitals must have a mechanism in place to verify that the services they provide are in line with the requirements and expectations of their patients.   It is indeed critical to maximize the utilization of the available resources to their greatest potential possible. When it comes to hospitals, amongst the most in-demand sections is the emergency room, which, despite the great demand, is not effectively managed. Because of this, healthcare administrators must put in place measures to close the supply gap, as well as to reduce the amount of time patient must wait. It is important that the emergency room prioritize acute and severe patients over all other patient as well as provide immediate medical treatment without sacrificing the quality of medical care delivered. Hospitals should train its administrative staff and physicians, particularly those working in the emergency room, in order to cope with the changing number of patients. Hospitals must have a well-planned framework for reorganizing patient care services. This could be addressed by addressing the concerns such as emergency room design and implementation, resource depletion, etc. System thinking is the best approach for institutions to manage their internal processes, including emergency wards. To use these system-wide techniques, healthcare professionals can collaborate to develop innovative solutions to challenges. More precisely, healthcare systems can use value stream mapping to visualize emergency department operations and workflows. It illustrates the full workflow process (Tapping, 2002, Jimmerson, 2017).

2. Main Discussion

2.1 Identification and analysis of the System Archetypes that may impede performance

System archetypes aids in recognizing behavioral traits in the sequence of events over time. System thinkers utilize these archetypes to discover behavior patterns indicated by the system’s flow (Braun & William, 2002; Verderber, 2010). These archetypes represent the activities or procedures that occur during the course of the system flows. Furthermore, it give an outline as to how these systems act in different contexts or circumstances. Ten distinct system prototypes are classified into four classes: machine tools, brainstorming tools, architectural thinking tools, and dynamic thinking tools. However, in order to identify the most suitable system archetype that could be effectively used by urgent wards in hospitals, it is important to understand how different agencies or members of the team within the emergency hospital perform or react in a particular scenario. Prior to this, the department must ascertain the relationships and behaviors of different departments inside the business (Kleissl-Muir, Raymond & Rahman, 2019). Hospitals in this region use value stream maps to analyze behavioral patterns in the crisis department’s system flows. To identify the most suitable archetype for institutions to utilize, it is imperative to understand their current system:

1. Shifting the burden: The hospital’s current approach depends on patient shifting, which is unsustainable in light of the growing population. Transferring people from one hospital to another can only impair the hospital’s overall performance. If 10 patients in a severe situation arrive at the hospital at the very same time, transferring them from one emergency department (ed to the other without first determining whether they require admission to the emergency department will merely shift the responsibility from one department to some other, rather than disbursing it reasonably across levels.

2. Limits to growth: The hospital’s existing system employs the limits to growth archetype in such a way that perhaps the number of doctors and nurses is inadequate to overcome the escalating inflow of patients, ultimately influencing delivery time. Hospitals must formulate strategies to ensure that patients receive the care they deserve in the quickest time possible. There must be a uniform waiting period beyond that no patient should always be kept waiting.

2.2 Analysis of the current State Value Stream Map of the emergency department based on System Archetypes

The hospital’s preexisting value stream map was evaluated to ascertain the services it presently provides and to identify ways that may be enhanced to improve responsiveness and handle a number of patients (ASQ, 2021). As per the established value system, every time the person attends a hospital, he or she is needed to undertake an application form and provide all pertinent information. This unfortunately, wastes time and resources for those who requires urgent attention and help. The individual is then transferred to the awaiting zone to receive his turn. This waiting period is usually indefinite, and individuals in need of emergency quality and treatment frequently suffer injury. Finally, when the physician’s turn comes, he or she would be immediately transported to the emergency department, where the doctor examines the patient and awaits the findings in the reception zone. Only when the results are confirmed is a doctor appointed to the individual for the final determination. The patient is then discharged from hospital. This unequivocally illustrates that a person seeking medical care in an emergency must await for extended amount of time, which frequently results in aggravation and unnecessary tension between the administrative personnel and the visitor.

The present model (Meadows, 2009) is based on patient movement between departments, consequently impeding the hospital’s overall performance. The patient who visits the hospital is continually transferred from one level to another; from the waiting zone to the registration zone, then back to the waiting zone to be transferred to the emergency ward, and then back to the waiting zone to see a doctor. The waiting routine goes from one department to the next until he is ultimately asked to leave. The hospital administration team must work on this attribute in order to address concerns about inefficient patient handling and management. The hospital’s current value stream map is depicted in the following figure:

Figure 1: Existing Value Stream Map

2.3 Recommended new State Value Stream Map with desired reduction in patient turnaround time

YSM is a strategy for deciphering process flows. It aids in the discovery of non-value-adding gray processes. Numerous emergency departments operations rely on interaction across the value stream’s diverse participants (Lucidcharts, 2021). This strategy can be effectively utilized to decrease wasteful procedures, eliminate redundancy, standardize process flows, and deliver competitive health services (Kamma, 2010). The hospital’s present value stream map was insufficient due to a lack of information sharing between departments, resulting in increasing wait times. Improvisation is used in the following areas of the hospital:

1. Inadequate communication between nurses and emergency room personnel

2. Documents in duplicate

3. Laboratory work and a process flow diagram are missing

4. The ergonomics of the department

5. Inadequate administration

The hospital administration should follow the following upgraded method of the value stream in order to minimize waiting times as well as provide higher-quality care in the shortest amount of effort possible (Meadows, 2009).

Figure 2 Value stream mapping symbol

Figure 3 Existing value streaming map

The symbols employed in value stream are critical to the map’s development. The system symbol depicts the processes that take place in specific station or area within the institution and highlights capacity restrictions. Among other things, the data box symbol carries the information on the processing times, high reliability, and change over the years. The stream value distribution map should really be adequate to enable hospital administrators to improve the utilization of health facilities, both in the emergency room and elsewhere. To begin, facts about just the workflow sequence and length of time it takes for each process with the support of the management team. Then, delivery times and non-value-added procedures were defined. Additionally, a proprietary value stream methodology was established in order to minimize any non-value-added assets and further reduce waiting lists. Thus, establishing a process map and gaining a thorough understanding of both internal and external customer requirements will benefit in enhancing performance. Furthermore, expanding the hospital’s infrastructure would enable it to handle a bigger volume of customers simultaneously. To avoid the deterioration of objectives, progress must be congruent with the hospitals’ strategic objectives.

 2.4 Discussion on Intended and unintended consequences of the modified system

Not only will the modified process map will help the hospital in reducing wait times, but it would also enhance response time. The new system will facilitate the facility to handle a greater number of patients than previously possible based on current slots (Arnold  & Wade, 2015). The subsequent effects should be expected: 

The subsequent effects should be expected: 

1. Providing patients with cost-effective, superior treatments.

2. Maximum waiting times will be significantly reduced.

3. Advance care planning would have had a clear grasp on the maximum number of patients that can be comfortably accommodated in a single day. This will aid the management in implementing measures to accommodate the increasing patient intake. The administration should prioritize reducing wait times at “non-value-added” locations. The infrastructure is sound and well-maintained, and the hospital now has a plan for future growth in terms of manpower and other required resources.

5. FIFO will assist in efficiently addressing the problems of current patients and accommodating new ones without placing undue strain on the hospital at many levels. 

The following unexpected consequences may occur: 

1. In certain locations, waiting is an unavoidable feature of life.

2. Each day, a certain percentage of clients is seen through appointment scheduling. Administration must have a strategy in place to cope with unexpected patients.

3. Conclusion

Average waiting times in the healthcare business, particularly in an emergency department, are usually associated with physical and psychological suffering. Additional processing time results in unneeded recurring tests and treatments that were not required initially, causing costly hardship for both the consumer and the health-care provider. As a result, applying continuous improvement to healthcare work processes improves emergency rooms in particular by decreasing wait times, increasing the efficacy and quality of patient treatment, and enhancing the proper operation of the hospital. Patient process flow may be continuously improved in the future by increasing the number of qualified staff, eliminating unnecessary movement, and enhancing job and service efficiency, among other things.

 4. Recommendations

The following steps must be done in order to establish an archetypal structure for the hospital’s emergency department in order to improve the patient experience:  

1. The hospital should be aware of and document its potential constraints, as well as the steps that must be taken in order to improve and advance within the hospital’s area of operations. 

2. It is important to thoroughly review any quick solutions that have been implemented in the past to assess their true impact on the hospital’s earnings. 3.  It is necessary for the hospital to develop and create a transparent transformation strategy that will drive success in accordance with the institution’s established objectives. Every six months, the hospital’s performance must be examined and designated as a success or failure. 

4. The hospital must combine resources whenever possible in order to avoid waste and overspending on services.

References

Arnold, R. D., & Wade, J. P. (2015). A definition of systems thinking: A systems approach. Procedia computer science44, 669-678.

ASQ, (2021). WHAT IS VALUE STREAM MAPPING (VSM)? Available from < https://asq.org/quality-resources/lean/value-stream-mapping>. [Retrieved from 10 August 2021]. 

Braun, W. (2002). The system archetypes. System2002, 27.

Jimmerson, C. (2017). Value stream mapping for healthcare made easy. Crc Press.

Kamma, T. K. (2010). Framework for lean thinking approach to healthcare organizations: Value stream mapping to reduce patient waiting time. Southern Illinois University at Carbondale.

Kleissl-Muir, S., Raymond, A., & Rahman, M. A. (2019). Analysis of patient-related violence in a regional emergency department in Victoria, Australia. Australasian emergency care22(2), 126-131.

Lucidcharts, (2021). The basics of documenting and analyzing your as-is process. Available from < https://asq.org/quality-resources/lean/value-stream-mapping>. [Retrieved from 10 August 2021]. 

Meadows, D.H.. (2009). Thinking in Systems: A Primer. Chelsea Green Press.

Tapping, D. (2002). Value stream management: Eight steps to planning, mapping, and sustaining lean improvements. CRC Press.

Taveras, E. M., Gillman, M. W., Kleinman, K. P., Rich-Edwards, J. W., & Rifas-Shiman, S. L. (2013). Reducing racial/ethnic disparities in childhood obesity: the role of early life risk factors. JAMA pediatrics167(8), 731-738.

Verderber, S. (2010). Innovations in hospital architecture. Routledge.

Womack, J.P. and Jones, D.T., 1994. From lean production to the lean enterprise. Harvard business review72(2), pp.93-103.

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