Structure-Oriented versus Process-Oriented Approach to Enhance Efficiency for Emergency Room Operations: What Lessons Can We Learn?:

Dynamic Layout Design Optimization to Improve Patient Flow in Outpatient Clinics Using Genetic Algorithms

Evolutionary algorithms, such as genetic algorithms have been used in various optimization problems. In this paper, we propose to apply this algorithm to obtain the layout design/redesign in order to improve the patient flow in an outpatient clinic. Layout designs are planned considering long-term requirements whereas the layout keeps modifying as per short-term demands. Over a period of time, the layout often does not remain efficient. Therefore, there is a need for such a model that helps in decision making on layout redesigns, and it must also optimize workflow by incorporating the flow constraints. In this study, we propose to minimize the waiting times by obtaining optimal and sub-optimal layout designs. A genetic algorithm is implemented to redesign the layouts based on the changing dynamics of patient demand, clinical pathways and services offered. The workflow is simulated with current layout and optimized layouts, and the results in terms of waiting time and cycle time are compared. The study shows that when layout design or redesign incorporate the workflow and pathways along with associated constraints, improves waiting time and cycle time of patients in the outpatient clinic. The distance between the departments/locations is translated to travelling time and overall travel distance/time is minimized by rearranging the allocations of departments to the location through genetic algorithms.

Business process improvement methods in healthcare: a comparative study

PURPOSE

According to the literature concerned with this study, less than satisfactory outcomes have been achieved through implementing business process improvements methods (BPIMs) in industries, in general, and in healthcare, in particular. The existing methods used need to be enhanced in order to create more effective outcomes. There has also been a lack of studies documenting gaps or shortfalls in implementing BPIMs, to be presented to the BPI research community. Therefore, researchers of this paper have attempted to fill gaps between theory and practice. On the contrary, there is also a need to link practical outcomes in the healthcare domain with those of the BPI research community. The purpose of this paper is to review popular BPIMs, techniques and tools applied in the healthcare domain; it seeks to examine and highlight their significant roles, clarify their pros and cons, and find opportunities to enhance their impact on the achievement of more sustainable improvements in the healthcare domain.

DESIGN/METHODOLOGY/APPROACH

This study has been carried out by using a methodology combining an in-depth literature review with a comparison framework, which is called as the "Framework for Comparing Business Process Improvement Methods." The framework is composed of seven dimensions and has been adapted from four recognized, related frameworks. In addition to the in-depth review of related literature and the adapted comparison framework, researchers have conducted several interviews with healthcare BPI practitioners in different hospitals, to attain their opinions of BPI methods and tools used in their practices.

FINDINGS

The main results have indicated that significant improvements have been achieved by implementing BPIMs in the healthcare domain according to related literature. However, there were some shortfalls in the existing methods that need to be resolved. The most important of these has been the shortfall in representing and analyzing targeted domain knowledge during improvement phases. The tool currently used for representing the domain, specifically flowcharts, is very abstract and does not present the domain in a clear form. The flowchart tool also fails to clearly present the separation of concerns between business processes and the information systems processes that support a business in a given domain.

PRACTICAL IMPLICATIONS

The findings of this study can be useful for BPI practitioners and researchers, mainly within the healthcare domain. The findings can help these groups to understand BPIMs shortfalls and encourage them to consider how BPIMs can be potentially improved.

ORIGINALITY/VALUE

This researchers of this paper have proposed a comparison framework for highlighting popular BPIMs in the healthcare domain, along with their uses and shortfalls. In addition, they have conducted a deep literature review based on the practical results obtained from different healthcare institutions implementing unique BPIMs around the world. There has also been valuable interview feedback attained from BPI leaders of specific hospitals in Saudi Arabia. This combination is expected to contribute to knowledge of BPIMs from both theoretical and practical points of view.

Emergency Nurses' Perceptions of Efficiency and Design: Examining ED Structure, Process, and Outcomes

INTRODUCTION

Due to increasing demands, it is imperative for emergency departments to improve efficiency, while providing safe and effective care. Efficient and quality healthcare delivery are impacted by interactions among the emergency department's physical structure, processes, and outcomes. Examining the interrelationship between these three components is essential for assessing quality of care in the ED setting. Studies simultaneously investigating all three aspects of this model are rare.

OBJECTIVES

To study examined emergency nurses' perceptions of efficiency and satisfaction with the design of a newly constructed academic emergency department through analysis of these three assessment factors.

METHODS

Data were collected using observational techniques, physical measurements of walking, and staff questionnaires. Correlation analysis was employed to investigate the relationships among specific structure, process, and outcome factors. Hierarchical linear regression was conducted to understand which structure and process variables in particular were related to the dependent variable, perceptions of efficiency and staff satisfaction with design.

RESULTS

Outcomes revealed that all of the structure and process factors examined in this emergency department including unit configuration, technology, lighting, visibility, patient room layout, storage, walkability, staff stress, data access, and teamwork were significantly associated with perceptions of efficiency and staff satisfaction with design.

DISCUSSION

The findings suggest that the structure of the built environment can shape healthcare processes occurring within it and ultimately improve the delivery of efficient care, thus increasing both patient and staff satisfaction. As such, the designed environment has a critical impact on enhancing performance, productivity, and staff satisfaction.

The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs

As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.

The impact of redesigning care processes on quality of care: a systematic review

BACKGROUND

This literature review evaluates the current state of knowledge about the impact of process redesign on the quality of healthcare.

METHODS

Pubmed, CINAHL, Web of Science and Business Premier Source were searched for relevant studies published in the last ten years [2004-2014]. To be included, studies had to be original research, published in English with a before-and-after study design, and be focused on changes in healthcare processes and quality of care. Studies that met the inclusion criteria were independently assessed for excellence in reporting by three reviewers using the SQUIRE checklist. Data was extracted using a framework developed for this review.

RESULTS

Reporting adequacy varied across the studies. Process redesign interventions were diverse, and none of the studies described their effects on all dimensions of quality defined by the Institute of Medicine.

CONCLUSIONS

The results of this systematic literature review suggests that process redesign interventions have positive effects on certain aspects of quality. However, the full impact cannot be determined on the basis of the literature. A wide range of outcome measures were used, and research methods were limited. This review demonstrates the need for further investigation of the impact of redesign interventions on the quality of healthcare.