In this paper, we present a state-of-the-art survey on the vehicle routing problem with multiple depots (MDVRP). Our review considered papers published between 1988 and 2014, in which several variants of the model are studied: time windows, split delivery, heterogeneous fleet, periodic deliveries, and pickup and delivery. The review also classifies the approaches according to the single or multiple objectives that are optimized. Some lines for further research are presented as well.
This paper focuses on the issue of longer appointment lead-time in the obstetrics outpatient department of a maternal-child hospital in Colombia. Because of extended appointment lead-time, women with high-risk pregnancy could develop severe complications in their health status and put their babies at risk. This problem was detected through a project selection process explained in this article and to solve it, Six Sigma methodology has been used. First, the process was defined through a SIPOC diagram to identify its input and output variables. Second, six sigma performance indicators were calculated to establish the process baseline. Then, a fishbone diagram was used to determine the possible causes of the problem. These causes were validated with the aid of correlation analysis and other statistical tools. Later, improvement strategies were designed to reduce appointment lead-time in this department. Project results evidenced that average appointment lead-time reduced from 6,89 days to 4,08 days and the deviation standard dropped from 1,57 days to 1,24 days. In this way, the hospital will serve pregnant women faster, which represents a risk reduction of perinatal and maternal mortality.
Six Sigma y Manufactura Esbelta son enfoques de mejora de la calidad y productividad que han sido implementados con gran éxito en grandes empresas a nivel mundial, en el ámbito de la manufactura y los servicios. Pero en la actualidad investigadores y expertos en el tema han encontrado hallazgos que evidencian dificultades en la implementación de este tipo de enfoques en pequeñas y medianas empresas (PYMES). Por esta razón, el presente artículo propone una metodología para la implementación de un enfoque integrado, comúnmente llamado Lean Six Sigma (LSS), el que se adapta a las necesidades y características de las PYMES. La metodología está compuesta de cuatro fases: donde la primera establece los factores claves en los cuales las PYMES deben prepararse para implementar LSS; en segundo lugar se plantea la identificación de focos de mejora y definición de un portafolio de proyectos; en tercer lugar, la ejecución de los proyectos priorizados; y por último, la evaluación de los resultados obtenidos. La metodología fue validada en una PYME dedicada a la fabricación de muebles de madera, donde la ejecución de los dos primeros proyectos LSS generaron importantes ahorros en costos de mala calidad, disminuciones en las devoluciones de productos, además de lograrse la implementación de buenas prácticas en la gestión de los procesos.
This paper presents an ANP technique applied to identify and prioritize Six Sigma projects for healthcare providers whose results allow selecting the project that ensures the maximum financial benefits for the healthcare company. First, the Six Sigma evaluation model is determined, then the criteria weights are established by ANP (Analytic Network Process) and finally, results from ANP and ANP-DEMATEL (Decision Making Trial and Evaluation Laboratory) are compared. The results show a better decision making performance for ANP-DEMATEL. An empirical case from healthcare sector is presented, showing the effectiveness of the proposed technique.
In hospital services, operations efficiency and healthcare quality are two critical factors since both define the financial sustainability of the hospitals as well as patient health, safety and satisfaction. For this reason, it is necessary to explore different strategies for the improvement of quality and efficiency indicators in the provision of healthcare services. Specifically, this paper focuses on the application of Six Sigma methodology as an important option to solve this problematic. This methodology begins with the identification of improving opportunities that are aligned with the organization goals. Then, a portfolio of potential improvement projects is created. Later, these projects are prioritized with basis on multicriteria decision making techniques, with the purpose of choosing the project with the highest impact on the organization quality and efficiency. Finally, the selected project is developed through DMAIC cycle. An application case related to the process of obstetric outpatient in a maternal-child hospital located in the city of Barranquilla (Colombia) is presented to prove the validity of the proposed approach. The results show that the average lead time in the obstetric outpatient service in which pregnant women are monitored, was reduced from about 7 days/appointment to approximately 4 days/appointment.
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