BACKGROUND፡ Considering various researches were carried out to implement Lean techniques in healthcare centers, this study has tried to investigate how lean principles could be prioritized in the Emergency Department (ED) by comparing physicians and nurses viewpoints.METHODOLOGY: In the first stage, relevant Lean techniques and several criteria to evaluate the ED performance were selected by reviewing the literature. Then, weight factors for each criterion were calculated using the Entropy method, and Lean techniques were compared and ranked via a questionnaire by which the physicians' and nurses' opinions were obtained separately. In the last stage, the final ranking of Lean techniques was done using VIKOR and SAW methods as two powerful means of Multi-Criteria Decision-Making (MCDM).RESULTS: Theory of Constraints (TOC) was selected as the most appropriate principle from the physicians' viewpoints by both decision-making methods. However, according to the nurses' opinions, Jiduka was the best approach by the VIKOR method, while with the SAW method, 5S was chosen as the most practical Lean technique.CONCLUSION: This study has illustrated that although all Lean techniques are useable for ED, these techniques' prioritization has a key role in choosing the more suitable Lean approach. Moreover, it provides a chance for the emergency wards to keep down different costs and improve staff and patient satisfaction and the quality of treatment simultaneously.
Background and Objectives: Two of the most important policies for dealing with the negative effects of high rates of no-show patients and appointment cancellations include double-booking and walk-in admission policies. This study aimed to compare these policies to identify their differences and their effects as well as the best circumstances for using each one. Methods: The main approach used in this study was discrete-event simulation using the Arena software application. Moreover, the average waiting time (considering patients' lateness) and the number of missed patients (considering no-show and cancelled patients) were accounted for in the performance evaluation criteria for both of the selected policies. Results: When the patients' arrival rate was high, the double-booking system resulted in higher productivity, while when it was low, the walk-in admission policy was the best policy for patient admission. The successful appointment rates of the current system, the walk-in admission system, and the double-booking system were 61.18%, 89.45%, and 93.24%, respectively. Conclusions: Although both double-booking and walk-in policies reduced the negative effects of cancelled and no-show patients, they had significantly different results in different situations. In general, there is no best system for appointment scheduling, and the choice of the superior system depends on the demand rate and its fluctuations.
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