Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization’s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
2016). Studying the reasons for delay and cost overrun in construction projects: The case of Iran.Abstract: Undesirable delays in construction projects impose excessive costs and precipitate exacerbated durations. Investigating Iran, a developing Middle Eastern country, this paper focuses on the reasons for construction project delays. We conducted several interviews with owners, contractors, consultants, industry experts and regulatory bodies to accurately ascertain specific delay factors. Based on the results of our industry surveys, a statistical model was developed to quantitatively determine each delay factor's importance in construction project management. The statistical model categorises the delay factors under four major classes and determines the most significant delay factors in each class: owner defects, contractor defects, consultant defects and law, regulation and other general defects. The most significant delay factors in the owner defects category are lack of attention to inflation and inefficient budgeting schedule. In the contractor defects category, the most significant delay factors are inaccurate budgeting and resource planning, weak cash flow and inaccurate pricing and bidding. As for the consultant defects delay factors such as inaccurate first draft and inaccuracies in technical documents have the most contribution to the defects. On the other hand, outdated standard mandatory items in cost lists, outdated mandatory terms in contracts and weak governmental budgeting are the most important delay factors in the law, regulation and other general defects. Moreover, regression models demonstrate that a significant difference exists between the initial and final project duration and cost. According to the models, the average delay per year is 5.9 months and the overall cost overrun is 15.4%. Our findings can be useful in at least two ways: first, resolving the root causes of particularly important delay factors would significantly streamline project performance and second, the regression models could assist project managers and companies with revising initial timelines and estimated costs. This study does not consider all types of construction projects in Iran: the scope is limited to certain types of private and publicly funded projects as will be described. The data for this study has been gathered through a detailed questionnaire survey.Hamed Samarghandi et al. 52/PENERBIT UNIVERSITI SAINS MALAYSIAan important role as a major driving force in the growth of several other sectors in the economy, including but not limited to mining and natural resources extraction, transportation and logistics, insurance, consultation and management, and even education and training (Assaf and Al-Hejji, 2006). According to the statistics provided by the Central Bank of Iran, the construction sector has annually absorbed more than USD 13 billion in direct private investments between 2002 and 2014.Unfortunately, construction project delays are very common in Iran. Potentially profitable projects are regrettably tu...
Executive SummaryAs instructors continue developing useful learning tools for their classrooms, games have become one popular alternative. This paper explains an inventory simulation game, two methods for evaluating whether students learn from playing the game, and the results from two experiments evaluating student learning.An effective game will help students understand concepts more quickly and remember them better than from a lecture. The game used here is a simulation of an inventory system, where student teams place orders for an item on a monthly basis (based on limited knowledge of prior demand), and then the instructor informs them what the demand is for that month. There are holding costs for items not sold and shortage costs if they run out of items. The students then place their order for the next month.To evaluate student learning, two methods were used: a before-and-after questionnaire, and playing the game twice. Both methods allowed for an initial benchmark to be established, followed by a measure of how much students improved. For the questionnaire, answers were scored and a paired-comparison t-test was calculated to assess learning. When the game was played twice, a few things were calculated regarding student performance, including the change in student profits.Most results point to the conclusion that students learned from the game. Basic inventory knowledge increased, students gained an appreciation for the complexity of inventory issues and of decision making in general, and students enjoyed the game and thought it was a worthwhile learning experience. It was evident that many students grasped the larger strategic issues and were beginning to apply them more broadly. Although not all changes were statistically significant, most did improve, suggesting that students developed a deeper hands-on understanding of the issues.The current study is confirmatory in the general use of simulation games, although it adds to existing literature in that little exists on operations management and information systems games and their assessment. Also, this study involves two independent assessments of the same game, two different instruments, and two different universities.
Purpose-The purpose of this paper is to provide details on a study to determine the wait time and service time for various emergency department (ED) patient care processes and to apply the science of plan-do-study-act (PDSA) cycles to improve patient flow. Design/methodology/approach-The paper used direct observation to collect patient flow data on 1,728 patients at multiple ED sites in Saskatchewan, Canada. It calculated wait times and services associated with important care processes and then tested, measured and implemented ideas to reduce wait time. Findings-On an average, patients spend nearly five hours in the ED with about one-half of the visit devoted to waiting for the next required service to take place. Waiting for an inpatient bed, specialist consultation or physician reassessment comprised relatively long wait times. Through the use of visual reminders and standard process worksheets, quality improvement teams were able to achieve large reductions in physician reassessment waiting time. These improvements required minimal materials cost and no additional staff. Research limitations/implications-The case study featured EDs within a particular Canadian province, so may not be generalizeable to other settings. We only sampled a fraction of ED patients at each facility. Practical implications-Admitted patients waiting for a hospital bed represent a key contributor to ED congestion. PDSA cycles are a valuable approach to achieving quality improvement in health care. Originality/value-The paper fulfils an identified need by breaking down an ED patient's waiting time into several high-level processes. It also applies improvement science to ED patient flow.
We apply decision analysis to an important decision in the sport of curling. In particular, we examine the choice between taking a single point or blanking an end in the latter stages of a curling game. There are benefits and drawbacks associated with each alternative. Taking a single point provides the team with an additional point but transfers the last-shot advantage to the opposition. Blanking an end foregoes an additional point but retains the last-shot advantage. Based on the observation of world-class competitions, North American curlers will always attempt to blank an end, while their European counterparts have been known to opt for the single point. We develop a decision tree to conceptualize the choices. Then, we use data from over 900 national championship curling games to empirically determine the expected values of each alternative. Our results indicate that blanking the end is the better alternative.
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