PurposeThe purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.Design/methodology/approachA survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.FindingsThe results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.Research limitations/implicationsThe research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.Originality/valueThis research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.
Emergency departments (EDs) have been becoming increasingly congested due to the combined impacts of growing demand, access block and increased clinical capability of the EDs. This congestion has known to have adverse impacts on the performance of the healthcare services. Attempts to overcome with this challenge have focussed largely on the demand management and the application of system wide process targets such as the "four-hour rule" intended to deal with access blocks. In addition, EDs have introduced various strategies such as "fast tracking", "enhanced triage" and new models of care such as introducing nurse practitioners aimed at improving throughput. However, most of these practices require additional resources. Some researchers attempted to optimise the resources using various optimisation models to ensure best utilisation of resources to improve patient flow. However, not all modelling approaches are suitable for all situations and there is no critical review of optimisation models used in hospital EDs. The aim of this article is to review various analytical models utilised to optimise ED resources for improved patient flow and highlight benefits and limitations of these models. A range of modelling techniques including agent-based modelling and simulation, discrete-event simulation, queuing models, simulation optimisation and mathematical modelling have been reviewed. The analysis revealed that every modelling approach and optimisation technique has some advantages and disadvantages and their application is also guided by the objectives. The complexity, interrelationships and variability of ED-related variables make the application of standard modelling techniques difficult. However, these models can be used to identify sources of flow obstruction and to identify areas where investments in additional resources are likely to have most benefit.
Supplier selection, one of the most important issues of a company, must be systematically considered from the decision makers' perspectives. For this reason, the supplier selection process were evaluated by researchers for many years in a large framework comprised of various experimental and analytical techniques and successful applications were done in various sectors. In this paper, supplier selection is considered a multicriteria decision problem and a model is proposed by using Analytical Hierarchy Process (AHP). The evaluation criteria are developed and used successfully in the proposed model. A detailed step-by-step implementation method is presented in this paper and a case study based on an apparel manufacturing organisation is conducted to prove the validity of the method.
The quality of machined parts and the productivity of machining that leads to economic sustainability. These factors are also vital for machinability improvement for materials, as well as, for economically sustainable manufacturing. Due to their poor machinability titanium alloys (Ti-alloys) are categorised as difficult-to-machine materials. For the same reason products made of Ti-alloys are highly expensive and are used only in strategic and sophisticated industries. A series of real-life experimental investigations was carried out to reveal the economic optimal zones of machining parameters that can produce the best possible surface roughness in machining Ti-6Al-4V alloy, using the coated carbide cutting tools, in shortest period of operation time. As the output of the research, for using the coated carbide tools for machining the investigated Ti-alloy, optimal zones of cutting speed, feed rate and depth of cut have been proposed and presented in graphical format. The current research revealed that all three groups (with nose radius Nr = 0.4, 0.8, and 1.2 mm) of coated carbide tools are capable to produce best surface finish, ranging between Ra = 0.5 - 1.0 µm, with cutting speed starting at V = 60 m/min and beyond at least up to V = 250 m/min while keeping the feed rate and depth of cut as constants as f = 0.1 mm/rev and d = 0.5 mm. The data on the graphs may help researchers, engineers and manufacturers to select optimal economic cutting speed, feed rate and depth of cut to achieve a certain level of surface roughness of machined components as assigned by the product designer on the part drawing. This reduces the production cost substantially, reduces number of defect products and improves product quality for machined parts.
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