PRODUCTIVITY IMPROVEMENT TOOLS AND TECHNIQUES
Question 1: What other productivity improvement tools and techniques could be used or considered to enhance existing improvement efforts, and what are the drawbacks
Magnetic resonance imaging
This technique uses medical images as a result of radiology to show the human anatomy pictures and the different physiological processes of the human body. MRI scanners utilize strong magnetic fields, magnetic field concentration gradients, and electromagnetic radio waves for the generation of images of the body organs. MRI techniques do not involve the use of X-rays or the utilization of ionizing radiation, which recognizes it from CT and PET outputs. X-ray is a clinical utilization of nuclear magnetic resonance (NMR). NMR can likewise be utilized for imaging in other NMR applications, for example, NMR spectroscopy.
While the dangers of ionizing radiation are presently all around controlled in most clinical settings, an MRI may, in any case, be viewed as a superior decision than a CT check. X-ray is broadly utilized in emergency clinics and centres for clinical determination and arranging and follow-up of sickness without presenting the body to radiation. An MRI may yield distinctive data contrasted and CT. Dangers and distress might be related to MRI examines. Contrasted and CT scans, MRI checks ordinarily take longer and are more energetic, and they, for the most part, need the subject to enter a restricted, binding cylinder. Also, individuals with some clinical inserts or other non-removable metal inside the body might be not able to experience an MRI assessment securely.
X-ray was initially called NMRI (nuclear magnetic resonance imaging), however “nuclear” was dropped to stay away from negative associations. Certain nuclear cores can ingest radio recurrence vitality when set in an outside magnetic field; the resultant advancing twist polarization can incite an RF signal in a radio recurrence loop and subsequently be detected. In clinical and look into MRI, hydrogen atoms are regularly used to create a visible polarization that is distinguished by reception apparatuses near the subject being examined. Hydrogen atoms usually are copious in people and other natural living beings, especially in water and fat. Thus, most MRI filters map the area of water and fat in the body. Beats of radio waves energize the nuclear turn vitality progress, and magnetic field gradients limit the polarization in space. By fluctuating the parameters of the beat succession, differences might be produced between tissues dependent on the unwinding properties of the hydrogen atoms in that.
Drawbacks
This is a costly method due to the technology involved in it and also requires skilled operators to handle the machine.
The machine can only capture a clear image of the patient being scanned only stays completely, which is difficult in most cases.
Researchers globally are not yet very familiar with this technological method of body imaging.
Reducing the Variance to Standard for Hospital Stays
Use of Right-Size Unit Capacity
Erroneously surveying the required size of a unit prompts a higher level of patients not being placed into their objective group, longer endure times to get patients of the ED, and greater unpredictability in dynamic. The right number of required beds can be computed for a given unit by breaking down authentic patient volumes by the administration. Specifically, medicine units tend to blend patients. For instance, medicine units acknowledge general medicine patients, notwithstanding the claim to fame patients for whom the unit is intended. To remedy this, emergency clinics can reduce the size of the claim to fame units and open a bigger general medicine unit. Albeit virtual and not located in one single unit or floor, this virtual unit can even now comprise of a few sizeable subunits. This methodology prompts less complicated patient arrangement and makes it simpler to co-find patients assigned to a given clinical group.
Guarantee Proper Patient Placement
Utilize an algorithmic way to deal with a quiet position to adjust load across units and limit the number of patients not being placed in their actual units.
Oversee/Forecast Spikes in Census
Use numerous information sources and sophisticated AI strategies to give a progressively exact and granular gauge. Additionally, breaking the day into valuable portions considers better strategic arranging.
Smooth Patient Flow from the Operating Room (OR)
Estimate the volume and case combine of medical procedures with the associated recuperation time per case and apply lean assembling methods combined with an enhancement motor to manufacture medical procedure layouts that stay away from spikes in the downstream enumeration.
Reduce Delays in Admission from the ED
Ability to perceive into the ED and the inpatient units takes into account better dynamic and responsibility for doctors, RNs, transport staff and housekeeping. A synopsis perspective on ED action permits clients to rapidly see the number of patients hanging tight for a bed, normal loading up times, and so on. A unit see shows the quantity of occupied, messy and accessible beds.
Drawbacks
It requires enough time for the involved parties to adapt to the changes in improvement processes.
The changes to the standard way of doing things may not fit all of the employees or patients.
T newness of the hospitalist with the patient and the correspondence blunders that may happen during changes from outpatient to inpatient, and the other way around, between various doctors.
The Kaizen Method
The implementation costs of these methods are minimal. The Kaizen technique has a significant contribution to the reinforcement of the relationship between the organization manager and employees at Cleveland clinic since the achievements of the company are the results of the combined efforts of each employee (Kazi, 2019). Kaizen lies at the centre of lean. Kaizen is executed through practices that empower workers to propose thoughts for development and tackle issues.
This kaizen method as a technique of process improvement has brought together all the employees of the Cleveland Clinic which has, in turn, led to the advancement of the communication process and the reinforcement of the feeling of membership of the improvement process. The project team and Cleveland clinic management have motivated the whole company staff to implement the concept of performance-oriented organization. Kaizen has been used to achieve and overcome the company’s objectives of the improvement in surgery processes. The Kaizen method has increased productivity of the Cleveland clinic since now operations such as surgery can be done within a short period. The overall business performance of the Cleveland clinic has risen to a greater extend.
Drawbacks
Requires engaging of the involved members
The project team brought in representatives from each of the three shifts to contribute to finding solutions. Stanicki says that the team wanted to engage the people who were doing the work stating that the employees were the closest to it, and without their buy-in, he and his team would never make any progress. Leonard also said that workforce engagement is significant, and if they did not believe in it, it would not last for more than a couple of weeks.
A proper analysis needs to be done before implementing the process.
The project team decided to hold Kaizen events to analyze each sub-process after realizing the arising problems.
The method depends on the willingness of the involved members to cooperate.
If the Cleveland employees would not have assisted, then it would have been challenging to implement the kaizen project of process improvement.
Question 2: Discuss the use of risk management at the Cleveland Clinic and in particular, FMEA (Failure Mode and Effects Analysis). How could this approach enhance improvement efforts, and what are the drawbacks of such an approach?
FMEA, which is an inductive engineering technique of improvement process, has been used at Cleveland clinic by the PSI team to define the existing problems facing the members and patients of the hospital (Mikulak, McDermott, & Beauregard, 2017). The issues raised by the surgeons, such as the inability to start operating rooms on time and instruments that were not immediately available when requested were defined to know where to start from in the improvement process.
Identifying existing problems at the Cleveland Clinic
FMEA has been used to determine the existing challenges faced mostly by the surgery processing department, the workers and the patients and eliminate any known failure or potential failures, problems, and the various errors from the Cleveland clinic system. Design, process, and serviced the failures before reaching to the patients who are customers. Cleveland Clinic has made use of risk assessment to identify and evaluate risks to support decision-making regarding actions to ensure the safety of the employees and patients. Earlier on, Stanicki and the surgery processing department (SPD) realized that errors in its processes were negatively impacting the surgeons’ abilities to do their work. Stanicki came up with the conventional solution of purchasing more instruments or hire more employees, but he chose to institute new practices to manage the situation. He told the teams that they had the right resources but were not being adequately utilized. With this in mind, he turned to guidance from Cleveland Clinic’s PSI team to analyze the current practices and partner in process improvement efforts. He told the team that his staff was frequently running into cases of missing instruments, and also had a hard time adequately preparing tools in emergencies which were a risk to the patients and the doctors.
FMEA has been used to evaluate the different processes at Cleveland clinic
It has pointed out the areas of concern and at the same time, reduce development time and cost. FMEA was able to evaluate the following areas of interests and improvement from Cleveland clinic; delayed cases and even cancellations which would result in discomfort for patients, the clinic suffering financial loss due to inefficient resource utilization, high costs from delays originating in the SPD which were conservatively estimated at hundreds of thousands of dollars annually due to; lost time in the operating rooms and processing fees for incorrect instrument trays, patient dissatisfaction and cancellations, and overall loss of goodwill. These intangible costs were more challenging to estimate and were difficult to account for in strictly financial estimates of cost. Still, FMEA came with solutions for the reductions and proper utilization of the available resources.
Transitioning among improvement processes in members involved
FMEA is necessary when the intention is to move a process of one service to another. The workers of the Cleveland clinic were required to transform to new ways of doing things such as decontamination whereby the carts containing used surgical instrument entered the SPD area were scanned into an electronic database and decontaminated automatically contrast to their traditional methods, prepping and packing after decontamination, sterilization, case cart assembly, delivery and Sterile Storage after sterilization.
An effective way to identify the means of improving areas where there is a decline in performance such as an employee or customer dissatisfaction
FMEA was able to identify the following areas of concerns and improvement from Cleveland clinic, delayed cases, and even cancellations would result in discomfort for patients. The clinic also suffered financial loss due to inefficient resource utilization. Costs from delays originating in the SPD were conservatively estimated at hundreds of thousands of dollars annually. The estimate included lost time in the operating rooms and processing fees for incorrect instrument trays. In addition to revenue loss, costs also resulted from patient dissatisfaction and cancellations, and overall loss of goodwill; these intangible costs were more challenging to estimate and were difficult to account for in strictly financial estimates of cost.
Drawbacks of FMEA use at the Cleveland Clinic
If the team forgets to list some basic failure modes, then the ways will be ignored. The project team at Cleveland Clinic might have left some of the failure modes required for the techniques needed for the improvement process.
FMEA may not prioritize failure modes according to their risk. This means that it will not be able to eliminate the required specific failure modes and may need other actions outside of the FMEA procedures and the project team conducting it.
Too many details make the analysis seem a much-involving task. The Cleveland Clinic employees, at some point, viewed the FMEA as much demanding, but they later adapted to the process. This problem can be solved by breaking the analysis into manageable segments.
FMEA should regularly receive updates since new potential failure modes arise at different circumstances. From the Cleveland Clinic, we have seen how unplanned problems such as the workers being affected by inefficiencies inside and outside the department at several levels. There was a challenge in sorting and cart assembly due to complexity of instruments made, the large number and complexity of the instruments made correct sorting and cart assembly a challenge, lack of versatility within the workforce and problems with coverage, overflow in the process that led to considerable emotional impact among the employees etc. Corresponding control plans were then developed.
Question 3: Explain the reasons why a total Lean implementation is difficult to achieve for this type of organization, illustrate your answer using the Cleveland Clinic case study. Then discuss the advantages and disadvantages of adopting a tailor-made approach to process improvement such as that adopted at the Cleveland Clinic
Reasons why a total Lean implementation is difficult to achieve for Cleveland Clinic organization
Scope and lack of strategic plans among Cleveland employees
Lack of enough discussions of strategies in level thinking in Cleveland’s lean management system. It is essential to have necessary discussions among the Cleveland clinic members, management and the project team of how to apply a sequence of different management tools and techniques required for improvement processes among the management, is one of the factors behind difficultness in achieving this implementation (Keeley, et al., 2013). In Cleveland Clinic, Stanicki and Leonard determined that there were probably inefficiencies across all of the sub-processes that were affecting the staff and impacting the number of missing instruments and delays in the processes due to lack of adequate strategies. The use of policy operation and other strategy formation should be implemented by Cleveland Clinic management.
Human aspects
Lean production is as a result of rational thinking and therefore, the workers and management of the Cleveland clinic to undergo proper training to be equipped with the required techniques of implementing the improvement processes. The workers should be motivated, empowered and respected in what they do (Krumholz, 1982). We experienced a case of considerable emotional impact among the Cleveland clinic employees, which resulted from an overflow in the process. Again, workers in each procedure throughout the value stream were isolated in their respective areas, which created a lack of versatility within the workforce. This should not be the case.
Lack of contingency plans
There are still misunderstandings of the contingency plans that should be applied to lean thinking among Cleveland employees. The lack of adequate plans during the implementation of the improvement process led to workers being isolated in each section throughout the value stream, which created a shortage of versatility within the workforce and problems with coverage. Also, there were reported instances of inefficiencies in the floor layout, which took a physical toll due to long transit times for repetitive tasks.
Coping with variability
Another most essential part of the difficulty when it comes to lean implementation is the challenge of lean production systems and the supply chains to cope with variability, which is a vital aspect of lean management. The workers were affected by inefficiencies inside and outside the department at several levels due to lack of experience with the improvement process (Abrahamse, 2007). The lean managers must seek to find ways to manage variability by utilizing the available assets more effectively than in original systems to add value to the patients and the workers. Various lean approaches, as a method of process improvements, such as mixed model scheduling and level scheduling, has to be developed by the hospital management and the project team to achieve this. However, in instances of demand variability, the approaches mentioned above have sought to control demand, as the original lean founders came from a well stable demand environments companies or workplaces. This high-volume and repetitive demand character of the Lean implementation increases the duration through which employees ought to adopt the implementation of the lean improvement process.
Advantages of using a tailor-made approach to process improvement.
It is easily adaptable.
Before the improvement processes begin, employees and patients are consulted to give out the problems facing them and then requested to participate in coming up with the solutions. The employees, patients and management feel that they were engaged therefore have a role in implementing the improvement process (Kliegel, & Bürki, 2012). The kaizen project team had to halt their events and bring in representatives from each of the three shifts to contribute to finding solutions. Stanicki says that they wanted to engage the people who were doing the work since they were the closest to it and without their buy-in he and his team would never make any progress. Leonard complements his statement agreed who says that workforce engagement is significant for if they did not believe in it, it would not last for more than a couple of weeks.
Highly efficient.
Cleveland clinic employees enjoy working in a situation whereby they are expected to show improvements in the issues they raised, unlike if they would be just instructed to follow some instructions for process improvement. They are more likely to stay in the company longer and to some extent, satisfy their patients while fixing problems. For instance, in only one week, the team redesigned the process layout of the decontamination area. It was able to reduce the cart breakdown time (which was identified as the biggest driver of process lead time) by 63%. The team also reduced the walking time, which was identified as an inefficient part of the cycle time, by 56%.
It is specific.
Tailor-made is as a result of collected views of the actual issues affecting the employees, management and patients, to come up with long-lasting solutions. Therefore, it addresses the real problems facing the Cleveland clinic system.
Responsibilities are evenly distributed
Each member feels actively involved therefore, the need to contribute to the improvement process. At Cleveland Clinic, we see that the new workflow assigned one individual as a material handler who would sort through the instruments from the decontamination process and supply the prep & pack operators, who would be assigned to specific instrument stations (Hoekman et al., 2015)
The following drawbacks can also accompany the approach;
- Individuals may tailor their own solutions
If the tailor-made approach is not appropriate (no structure or uniform process), the members involved may develop their versions, thus reducing the efficiencies that were supposed to be gained from the process.
- Difficult in reaching decisions
Sometimes it becomes difficult to fit each individual’s demands, and therefore it may take a while for all the team members to come to a joint agreement.
- Inefficiencies at times
The willing to participate in improvement programs may not have the capacity or capability to contribute to the programs effectively. Also, there might be confusing at times if the program is not well structured. We have seen how the workforce and coverage problems were versatile among the workers at Cleveland. There was process overflow which created a considerable emotional impact. It said that there were inefficiencies in the floor layout due to transit times for repetitive tasks. The use of a tailor-made approach also allows for the inclusion of only the necessary features. One does not have to worry about unnecessary features that add costs and complexity. Decide what is needed and design the features to match the requirements. The scheduling of a patient in the MRI proved to be a problem in Cleveland clinic, and it took a lot of time before patients were able to get their MRI even with the many devices distributed in the clinic. The long wait had an impact on the patients, both psychologically and physically as they awaited their diagnosis.
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