Operation Management and Quality
Part 1
Introduction
Lean management has been applied to various organizations where the management focuses on increasing their production at the lowest price hence maximizing their profits. Lean was introduced in Japan by a Toyota industry where they applied several principles that helped them reach their organizational goal of customer satisfaction as well as minimizing waste products (Wickramasinghe, 2014). Similarly, lean principles have helped other organizations such as hospitals in utilizing the concept that would help achieve the goal of providing equitable health care to the society. Lean principles focus on identifying the value, mapping the value stream, creating a value flow, establishing a value pull, and seeking perfection to implement the value of the product or services (Wickramasinghe, 2014). Therefore, lean application in a service industry is much different from the manufacturing industry thus creating a suitable criterion in applying lean in the healthcare system.
Identifying value in healthcare should be the first motive since value is the important attribute in the application of lean management. For instance, the management should ascertain the value of patients in the healthcare system. Patients are the crucial components of a hospital since they are the main customers of the health industry. The management should ensure the health practitioners have the knowledge of realizing the importance of patients in a hospital. For example, the management should focus on providing valuable services to the patients instead of focusing on providing services to a large number of patients (Karim&Arif-Uz-Zaman, 2013). The value of the service should matter not the value of the income generated.
The value of the service should be followed by a strategy that maps the importance of the services. The hospital management has the mandate to ensure a strategic planning that would help the health practitioners in achieving the goal of healthcare service delivery. The mapping of the value stream includes the steps that the management should use to overcome the challenge of poor service delivery (Wickramasinghe, 2014). For instance, the hospital officials should incorporate every role player in the implementation of a lean strategy. Employees, patients, and management involvement should be the strategy that would see the development and application of lean concepts in the healthcare system. Mapping should bring positive changes to the organization. The system would ensure a strategic planning criterion employed through the process of mapping the value of the services offered to the patients.
The system should allow the managers to experience a flow of services towards the implementation of lean concepts. The third lean principle is the creation of a flow that the employees and the services should be following (Womack, et al., 2005). For instance, the management should introduce new measures that would ensure that every employee or health practitioner in the organization follows the steps introduced by the management (Womack, et al., 2005). The flow is to help the management have minimal errors in the service delivery. Similarly, the flow of value should as well ensure that the hospital has less or no waste products. Less waste ensures that the organization has to maximize their profits as well as provide services to as many patients as possible.
The hospital management should follow a protocol of establishing a pull system that would implement the proposed flow of operations. Establishing a pull is the same as employing new tactics that help in implementing the service delivery in the healthcare system (Mazzocato, et al., 2010). For instance, the management has the mandate to lay down the steps that should be followed by their employees. The pull is an effort initiated by the management that should be used to implement the strategies in healthcare service delivery. Additionally, the last step in lean management is the use of the laid down strategies in perfecting the healthcare services (Mazzocato, et al., 2010). Perfection is improving the steps laid down by the management to implement in the effort of ensuring the services delivered to the patients are updated as well as tested. Therefore, the management has the role of ensuring that service delivery is much different from production manufacturing.
The process of transformation is where an organization operates to produce goods or services have different procedures. For instance, a car industry incorporates the inputs of raw materials to produce different models of cars. Stuart et al. (2002) claims that, the process of transforming the raw materials into finished goods differs depending on the nature of the outputs whether products or services. Therefore, the process of transforming health services includes changes of psychological or physiological nature of human behavior as a way of helping them achieve good health (Stuart, et al., 2002). Similarly, the system includes the process of giving information of the patient, the materials used, and the outcomes, which are the service rendered.
The transformation process of production includes the use or utilization of raw materials from their physical nature to the process of manufacturing which includes the changing of their state to produce finished goods or services. The finished products add value to the consumers making them more valuable and accessible in the market. The process of production adds value to the products that are needed by the consumers (Slack, 2015). For example, a car company manufactures different models of vehicles that add credibility to the lives of human beings. The consumers of cars have a new lifestyle after they purchase the cars.
Service industry and manufacturing industry have different terminologies in their businesses. For instance, service industry provides services while manufacturing companies provide goods and products. The products or goods are tangible compared to the services. Similarly, the products from manufacturing industries can be stored, unlike the services that could not be stored as inventory. Additionally, customers have a direct contact in service industry unlike in manufacturing industry where the consumers have no direct contact with the production company (Slack, 2015). For instance, a patient receiving medical attention is present at the hospital while someone buying a car does not have a direct contact with the production company. Furthermore, a service industry has an instant response from the consumer since the customers could comment on the value of services rendered. However, manufacturing company could not have instant response since the product might take time before reaching to the consumers.
Conclusion
The healthcare system is faced by the challenge of not accommodating the ongoing high number of ENT patient. Taking the strategy of lean management which was introduced by Toyota industry could help in improving the management of healthcare industry. The operations of managing the healthcare system should as well employ the lean principles which could help in maximizing their productivity and minimizing the wastes. Therefore, the healthcare system should adopt the technique seen in the operation management in an effort of reducing the health disparities in the ENT surgery.
Part 2
Introduction
ENT surgery is a method applied to the treatment of ear, nose, and throat diagnosis to patients preferably children. The treatment incorporates almost more than 40% of the total surgeries performed in most hospitals (Shi, et al., 2015). The evidence collected from the hospitals as well as the information contained from the waiting lists shows that ENT surgery is not taken seriously since it comprises of few doctors and medical specialists. For instance, ENT Surgeons in Ireland have a ratio of one doctor to 120000 patients (Shi et al., 2015). Therefore, the process of providing equitable health services to ENT patients has been having issues meaning that the ENT surgery has a long waiting list. The problem involves poor allocation of ENT health practitioners. The government should ensure that ENT surgeons are increased as well as well remunerated and provide enough resources that would help in minimizing the risks of ENT surgery.
Overloaded Waiting List
The waiting list is the time taken before implementing a curing procedure to a patient. For instance, ENT surgery patients have been experiencing the problem of having an overloaded waiting list since the health practitioners allocated to the ENT service are never enough to handle the emergent cases of ENT diagnosis. The cause of the long waiting list in the ENT surgery department is the lack of enough health practitioners in the health department. Every hospital has their targeted number of patients they tend to attend on a daily basis (James & Hockings, 2012). For the ENT surgery department, there is usually a shortage of doctors or specialists who have been allocated to a certain region by the healthcare department. The healthcare service department assumes that ENT surgery patients would never overflow or else outdo the number of doctors.
Some hospitals have been reported to provide a long waiting list of patients of ENT surgery that leads to some of the patients losing hopes of being treated (James & Hockings, 2012). The health practitioners have the right to suggest the best treatment to the ENT patients. The outpatient wait list is recommended whenever the patient is sent to a referral hospital. The patient is required to attend to a specialist for further consultancy as he or she awaits the doctor’s appointment (James & Hockings, 2012). The results obtained from the referral specialist would determine the urgency of the appointment. For instance, the first category of the urgency is known as the urgent. The specialist recommends an outpatient wait list of fewer than 30 days. The recommendation requires the Patient to receive medical attention within the first 30 days after the referral. Additionally, the second category comprises of semi-urgent which is a recommendation of seeing a doctor within the next 90 days. The specialist advises the ENT patient to visit a doctor for the speculated time depending on the urgency of the subject matter from the patient. The third category in the referral outpatient wait list is the non-urgent category. Patients with lesser risks diseases along ENT are categorized as non-urgent (Shi, et al., 2015). The doctor refers them to a specialist who sees the importance of placing their outpatient wait list within 365 days. The duration might seem long depending on the urgency of the disease. Therefore, the specialist analyzes the urgency of every category and places the ENT patients accordingly. The results of the specialists analyzing and categorizing the patients by their urgency have led to the emergence of overloaded wait lists where patients of the third category are not taken care of since their urgency does not concern the safety of the health practitioners.
Current Problematic Process Map
The problem facing the healthcare system in the ENT surgery department could be avoided by placing a mapping process in the system. A process mapping is a system used to analyze any problem facing a department as well as laying down a solution that would help the organization resolve their challenges (Johnson, et al., 2012). The process mapping incorporates the ideas laid down and discussed by the general practitioners as well as the healthcare management to ascertain the solution affecting their organization. Similarly, the idea of process mapping could be used to indicate the problem as it is used to implement the roles and requirements of every team player in an organization. The stages found in the process mapping include first understanding the problem facing the healthcare system and second examining the problem affecting the implementation of health policies as well as the problems facing the health practitioners. The problem of having an overloaded waiting list could be caused by several mistakes such as multiple handoffs, duplication of procedures, and waste contributed by the health practitioners. Therefore, analyzing the challenge facing ENT surgery department where they have a long waiting list could be the first step in finding the possible solution. The causes of the problem of overloaded waiting list are that the nurses or the surgery doctors responsible are minimal compared to the patients of ENT. For example, the percentage of ENT surgery patients represents more than 30% of all annual surgeries in the United States (Johnson, et al., 2012).
Similarly, there are less than 10% of ENT doctors in the health sector working for the U.S government (Johnson, et al., 2012). Furthermore, the causes of the delays in healthcare delivery in the ENT surgery department might be caused by the handoffs found in the healthcare facilities. A study conducted at a hospital indicated that the annual assessments of ENT surgery was less that 300 and was lesser compared to other assessments done to other operations (Toussaint, 2013). Some examples of handoffs in a hospital include activities from one health practitioner to another. For instance, a patient sent from one health practitioner to another in an effort of finding a cure to his or her disease.
The process mapping should articulate the constraints and bottlenecks facing the organization. Considering the principles of management, reality of the organization should focus on the problem facing the healthcare system as a way of helping the managers be accountable for their activities. Healthcare bottlenecks are the problems facing the process of service delivery from one department to another causing delays or misinterpretation where the patients are forced to wait for service delivery. For example, doctors were seen neglecting assessments of the ENT patients by directing them to obtain other documents instead of offering the service (Johnson, et al., 2012). Additionally, bottlenecks in the ENT surgery are caused by the constraints that would result to a long and delayed waiting list. The health department has been analyzing the causes of the constraints bringing delays to the healthcare hence, discussing the constraints and their possible solutions.
There are two types of bottlenecks in the mapping process. One is process bottlenecks, and the other is functional bottlenecks. The bottlenecks have the longest and take much time before being accomplished. Similarly, the bottleneck constraints are those activities that take time before bringing the last step in health service delivery. For instance, a patient may be sent to a certain department in the same hospital facility to obtain an x-ray. Similar cases were seen developing at a certain hospital where nurses and general practitioners sent the ENT patients to obtain x-ray services from other institutions (Toussaint, 2013). The process of x-ray would take time since the department would require obtaining specific pictures and results and the results take time before being released. Therefore, the patient would not get a full medical report on the same day as planned since the x-ray department failed to accomplish their duty on time.
The other constraint is known as functional bottleneck. As the name suggests, it’s functional and is the delays caused by the services offered in the healthcare system. The process of providing ENT surgery services to the public has been met by several challenges including the functional constraints where patients are forced to wait for particular services that would determine their health status. For example, one service would lead to another before the ENT surgery is determined. Radiology, pathology, screening, and imaging processes follow one another in an effort of determining the need and the purpose of the ENT surgery (Toussaint, 2013). Therefore, the patient is required to obtain the long process which takes much time as they are placed in different departments so as to bring the solutions to his or her doctor since the number of ENT specialists does not accommodate the increased number of ENT patients. Paediatric Airway Surgery (PAS) an ENT condition found mostly in infants has never had enough specialists. The available PAS doctors are said to be less than 100 representing a big population hence, not having a proportional ratio (Toussaint, 2013). The functional bottlenecks are the slowest processes in the ENT service delivery. The patients could not get emergency surgery since the constraints and bottlenecks cause’s delays that bring the long list of waiting, patients.
A way of improving the process mapping is teaming up with the patients. Customers should be part of the development of an organization. Therefore, the management should be listening to patients’ views in matters of the delivery of ENT health service. An additional reason behind the long waiting list in the ENT surgery department is the amount of batching where the doctors and health practitioners contain a long list of information of the ENT patients waiting to be processed. The National Health Service (NHS) had recorded that a large geographical area only had eight general practitioners assigned to accommodate more than 12000 patients per year (Toussaint, 2013). For instance, a patient visits a certain hospital seeking for ENT services. The patient sees a doctor who fills a form that is placed on top of other files of similar patients. The doctor as well piles the files and sends them to another doctor who would analyze the files. Therefore, the doctor sends the files in batches. The batches reach to a subsequent doctor or health practitioner who will as well take another significant time before accomplishing the task (Toussaint, 2013). Therefore, his or her results would be sent back to the first doctor in batches. The batch sending of incomplete files would make the patients wait for an amount of time before their files are analyzed. Consequently, the process of batching queues the files that result in delays in the process of ENT healthcare service delivery.
Defects of ENT Surgery
The problem facing the ENT surgery department regionally or even worldwide is the high risk of the increasing level of waiting list. The service delivery has been facing challenges internal or external, and the government has not applied the effort of implementing strategies that would ease the problem. The major defect of the ENT surgery is the lack of resources preferably funds (Siciliani& Hurst, 2005). The ENT surgery department is the least funded department in the healthcare services in the country. Similarly, the department has not yet received any boost of improvements as seen in other departments such as neurosurgery, anesthesia, and others like craniofacial. These departments have been boosted as people have benefited from their improvements but the ENT surgery department has been lagging behind.
Another problem facing the ENT surgery department is the lack of enough staff or doctors representing the ENT services. For instance, the number of ENT patients is much higher than the number of ENT health practitioners in the country (Toussaint, 2013). Similarly, the rise of ENT complications would soon cause over flooding in the hospitals of the patients seeking services. The authority has not participated in the recruitment of enough staff that would cater for the rising number of ENT surgery patients. Furthermore, the ENT surgeons are always reported to be busy with other things. Surgeons always have a busy schedule, but sometimes the schedule does not incorporate the practices of ENT services (Fagan, 2012). For instance, a surgeon could be helping other departments in other activities instead of participating in helping the ENT patients.
Communication breakdown has been a challenge to the ENT surgery department. The staffs and the patients lack one formal channel of communication where the patients are forced to revolve around the whole health facility n search for actual ENT services. For instance, a patient seeking for ENT health services would be sent from one department to another in need of other services such as x-rays but the doctor sending the patient would not disclose where the other department is found in the health facility (Cullis, Jones, &Propper, 2000). Therefore, the process of finding and obtaining the x-ray services would slow down the process of being treated the ENT diagnosis.
The rate at which emergency patients are treated is very low. Patients who need immediate medical response have been neglected since the services offered does not incorporate emergency procedures that would help the patients (Ryan, et al., 2000). For example, children have been reported to be the most affected population having ENT complication. Children in need of emergent medical care would not receive treatment because the services rendered in the healthcare are not capable of providing immediate effective health services. Similarly, reports have claimed that healthcare facilities do not have equitable and substantial resources to cater for the demand in the rising number of ENT patients. For instance, some hospitals have minimal or are sharing treatment equipment used in treating ENT. Additionally, the hospitals have failed to purchase types of equipment that would suit the number of ENT surgery patients (Ryan, et al., 2000).
The implementation of ENT surgery service delivery in rural areas has been affected by various external factors in the globe. Infrastructures, isolation, lack of enough resources, and poor technology development, are some of the factors affecting the implementation of ENT surgery in various rural areas (Gupta & Denton, 2008). However, most patients are forced to move to other urban areas in search of the healthcare service even though the rural accounts for one-fourth of the overall population. Therefore, the delivery of ENT surgery in the rural areas would be a challenge to the globe if some new measures would not be strategically implemented. Similarly, the life in the rural areas is below the poverty line with a per capita amounting to $7500 compared to that of urban places (Gupta & Denton, 2008). However, the people living in the rural areas would not accommodate for the increased costs of ENT treatments. Furthermore, rural areas do not have enough number of ENT physicians working under the wing of ENT surgery hence, making it hard for the betterment of ENT treatment.
Process of Recommendation
The first step in implementing a change that would see the improvement of the ENT service delivery is the change in the management. The ENT department in the country should incorporate a strategic managerial procedure and team that understands the needs of the population as well as the needs of the healthcare department in the delivery of ENT healthcare services. Change in management should start at the top healthcare ministry whereby capable managers should install strategies that would help the ENT department to develop (Min &Yih, 2010). For instance, change of management helped in benefiting the effective implementation of ENT surgery in a children’s hospital in the U.S.
Another attribute that would help the development of ENT service delivery is the increase in the number of employees. For a long time, the ENT department has not been having enough general practitioners specialized in the ENT department hence, creating a slow movement of the ENT service delivery (Gupta & Denton, 2008). Similarly, the rural areas have been outnumbered where the managers do not place enough ENT health practitioners who would take care of the ENT patients in the rural areas. Increasing the number of employees especially the specialized ENT nurses in the country would help curb the problem of having an overloaded waiting list of ENT patients (Mark, 2003). Additionally, the number of untreated patients would as well decrease. Increasing the number of ENT health consultants specialized in pediatric otolaryngologist would help cater for a large number of patients at the minimum time possible. Therefore, the additional staff would help in a better implementation of ENT surgery services in the country increasing the credibility of the health sector.
The Department of ENT surgery and service delivery should introduce a strategy that would ask for more funding in the department in creating awareness of the ENT sicknesses. The government has the mandate to fund the ENT department to introduce measures that aim at catering for their servicing and operations (Gupta & Denton, 2008). Similarly, the government and the healthcare ministry should introduce new technology in the healthcare system that would cater for the ongoing challenges of ENT diagnosis. Technology development should be the aim of the department in maintaining as well as acquiring new machinery and pieces of equipment used in the treatment of ENT (Dexter et al., 1999). Therefore, the doctors should not have an excuse of lacking enough resources in the reduction of ENT overloaded waiting list.
The system recording and keeping of patient’s information should be made electronic. For instance, acquiring of the computer system in keeping health records should be implemented to incorporate the problem of manual recording as well as easing the workload of general practitioners in the healthcare system. The challenge of keeping and accessing health records have led to the increase of the overloaded waiting list in the ENT healthcare delivery. Additionally, MacCormick, Collecutt, and Parry (2003), suggests a system that should be adapted to the newly developed system of telehealth system that accommodates the use of telephones to refer the patients to other referral hospitals offering similar services. The service operates where the patients are required to obtain a certain service in his or her treatment process hence; the specialized doctor would use the platform of giving the information to the required patient.
The process of accessing a hospital with the ENT surgery services in the country has become a challenge where patients tend to travel long distances in search for such facilities. For instance, the government has minimal numbers of health facilities in the rural areas where the patients from the rural areas do not have access to the facilities (Hanning & Lundstrom, 1998). Therefore, the department should increase the numbers of hospitals and health facilities in rural areas as a way of helping every patient to access health services near their homes. The task would decrease the number of patients traveling to far places in search for the ENT surgery services. Similarly, the overloaded waiting lists would decrease, and the service delivery would be equitable.
Conclusion
The state of providing ENT surgery services in the globe has faced major drawbacks where the health department has failed by experiencing an increasing in the number of an overloaded waiting list. The waiting list is the number of untreated patients waiting for the health services caused by the lack of enough resources, poor management, the minimal number of physicians, and lack of developed technology. However, the ENT health department has suggested the course in making the department a better one that would cater and provide services to the country at large. Therefore, the recommendations proposed would include the change in management system where capable managerial representatives would take the lead in implementing new strategies that would help in making the ENT department a better ministry.
Reflection
The research conducted in the ENT surgery department and the services rendered to the patients have made the readers and the author understand the challenges facing the delivery of the health services. For instance, I have understood that the healthcare management should implement new ways that would reduce the health disparities present in the ENT surgery as well as avoiding the overloaded waiting lists. Similarly, the study has helped in articulating the responsibilities of the healthcare management and the overall government as well as the incorporation of health practitioners in the fight against the lack of service delivery in the ENT treatment. Applying the teachings of lean principles in the healthcare system has shown how a manager is supposed to implement the strategies seen in the Toyota industry. Doctors and nurses should have the responsibilities of managing their time and apply techniques that would help the patients acquire the required health services.
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