Healthcare service quality: a methodology for servicescape re-design using Taguchi approach

Application of tools and techniques of quality by design in pharmaceutical process

Purpose

The purpose of this article is to demonstrate the application of the tools and techniques of Quality by Design (QbD) approach in an Indian pharmaceutical drug product manufacturing company and to understand the challenges, managerial implications and lessons learned while implementing this initiative.

Design/methodology/approach

This work adopts the Action Research methodology for impurity reduction in a drug product manufacturing company in India by using the tools and techniques of QbD approach. Various QbD tools like Design of experiments, process capability evaluation and control charts were effectively utilized for the study.

Findings

As a part of QbD implementation in the organization, a specific drug product was identified and the impurity level in the product was studied. Significant variables impacting the impurity were identified and the optimum levels for the significant variables were identified through design of experiments. The solutions were implemented and the impurity levels were reduced significantly.

Research limitations/implications

Even though the article is based on a single case study related to tools and techniques of QbD in a single organization in India, the identified problem is a generic product quality related issue for any pharmaceutical drug product manufacturing company. Hence the findings of this research are applicable to pharmaceutical drug manufacturing industry in general.

Originality/value

This article illustrates the systematic usage of various tools and techniques of QbD methodology in a pharmaceutical drug product manufacturing company. The usage of Design of Experiments for process optimization and application of other tools and techniques are ready references for the practitioners and novice users in the field.

Exploring the effectiveness of VR-based product demonstrations featuring items of furniture

Purpose

This paper aims to present a case study of virtual-reality-based product demonstrations featuring items of furniture. The results will be of use in further design and development of virtual-reality-based product demonstration systems and could also support effective student learning.

Design/methodology/approach

A new method was introduced to guide the experiment by confirming orthogonal arrays. User interactions were then planned, and a furniture demonstration system was implemented. The experiment comprised two stages. In the evaluation stage, participants were invited to experience the virtual-reality (VR)-based furniture demonstration system and complete a user experience (UX) survey. Taguchi-style robust design methods were used to design orthogonal table experiments and planning and design operation methods were used to implement an experimental display system in order to obtain optimized combinations of control factors and levels. The second stage involved a confirmatory test for the optimized combinations. A pilot questionnaire was first applied to survey demonstration scenarios that are important to customers.

Findings

The author found in terms of furniture products, product interactive display through VR can achieve good user satisfaction through quality design planning. VR can better grasp the characteristics of products than paper catalogs and website catalogs. And VR can better grasp the characteristics of products than online videos. For “interactive inspection”, “function simulation”, “style customization” and “set-out customization” were the most valuable demonstration scenarios for customers. The results of the experiment confirmed that the “overall rating”, “hedonic appeal” and “practical quality” were the three most important optimized operating methods, constituting a benchmark of user satisfaction.

Originality/value

The author found that it is possible to design and build a VR-based furniture demonstration system with a good level of usability when a suitable quality design method is applied. The optimized user interaction indicators and implementation experience for the VR-based product demonstration presented in this study will be of use in further design and development of similar systems.

Application of Lean Six Sigma in conservative dentistry: an action research at an Indian dental college

Purpose

The article evaluates the obstacles, lessons learned and managerial implications of deploying Lean Six Sigma (LSS) in a dental college hospital in India.

Design/methodology/approach

The work adopts the action research (AR) methodology to establish a case study, which is carried out using the LSS define–measure–analyze–improve–control (DAMIC) approach in a dental college. It uses LSS tools to enhance the productivity and performance of the Conservative Dentistry Department of a dental college and to unravel the obstacles and success factors in applying it to the education and healthcare sector together.

Findings

The root cause for high turn-around time (TAT) is ascertained using LSS tools and techniques. The effective deployment of the solutions to the root causes of variation assists the dental college to reduce the TAT of the Conservative Dentistry process from an average of 63.9 min–36.5 min (i.e. 42.9% improvement), and the process Standard Deviation (SD) was reduced from 2.63 to 2 min. This, in turn, raises the sigma level from 0.48 to 3.23, a noteworthy successful story for this dental college.

Research limitations/implications

While the results and recommendations of this research are focused on a single case study, it is to be noted that the case study is carried out with new users of LSS tools and techniques, especially with the assistance of interns. This indicates the applicability of LSS in dental colleges; thus, the adopted modality can be further refined to fit India's education and hospital sector together.

Originality/value

This article explains the implementation of LSS from an aspiring user viewpoint to assist dental colleges and policymakers in improving competitiveness. In addition, the medical education sector can introduce an LSS course in the existing programme to leverage the potential of this methodology to bring synergy and collaborative research between data-based thinking and the medical field based on the findings of this study. The most important contribution of this article is the illustration of the design of experiments (DOE) in the dental college process.

A Six Sigma DMAIC methodology as a support tool for Health Technology Assessment of two antibiotics

Health Technology Assessment (HTA) and Six Sigma (SS) have largely proved their reliability in the healthcare context. The former focuses on the assessment of health technologies to be introduced in a healthcare system. The latter deals with the improvement of the quality of services, reducing errors and variability in the healthcare processes. Both the approaches demand a detailed analysis, evidence-based decisions, and efficient control plans. In this paper, the SS is applied as a support tool for HTA of two antibiotics with the final aim of assessing their clinical and organizational impact in terms of postoperative Length Of Stay (LOS) for patients undergoing tongue cancer surgery. More specifically, the SS has been implemented through its main tool, namely the DMAIC (Define, Measure, Analyse, Improve, Control) cycle. Moreover, within the DMAIC cycle, a modelling approach based on a multiple linear regression analysis technique is introduced, in the Control phase, to add complementary information and confirm the results obtained by the statistical analysis performed within the other phases of the SS DMAIC. The obtained results show that the proposed methodology is effective to determine the clinical and organizational impact of each of the examined antibiotics, when LOS is taken as a measure of performance, and guide the decision-making process. Furthermore, our study provides a systematic procedure which, properly combining different and well-assessed tools available in the literature, demonstrated to be a useful guidance for choosing the right treatment based on the available data in the specific circumstance.

Does ethical leadership boost nurses' patient-oriented organizational citizenship behaviours? A cross-sectional study

AIMS

To examine the relationships between perceived ethical leadership, perceived interactional justice climate, and patient-oriented organizational citizenship behaviour.

DESIGN

A cross-sectional non-experimental design was employed.

METHODS

The convenience sampling was adopted. Data were collected in July and August 2018. A total of 738 nurses were recruited from eight Chinese hospitals. The survey included instrument scales of ethical leadership, interactional justice climate, and patient-oriented organizational citizenship behaviour. SPSS version 22 was used to compute means, standard deviations, and intercorrelations. The partial least squares structural equation modelling was chosen to estimate the path coefficients of the relationships.

RESULTS

Relationships among perceived ethical leadership, perceived interactional justice climate, and organizational citizenship behaviours were statistically significant. Perceived interactional justice climate mediated the relationship between perceived ethical leadership and nurses' organizational citizenship behaviours.

CONCLUSIONS

Ethical leadership is related to interactional justice climate, which, in turn, increases nurses' organizational citizenship behaviour. Nurse leaders are encouraged to exhibit ethical behaviours and to create justice climate. Ethical leadership scale can be used to select, train, and evaluate the nurse supervisors and managers.

IMPACT

Hospital administrators are encouraged to recruit and promote those with both moral compass and leadership potential to nursing leadership positions. Nursing managers should create a justice climate in their hospitals. Hospital administrators could use ethical leadership scale to develop ethical leadership training programmes.

V, Madhavan V, Gurumurthy A. Development of Lean Six Sigma training module: evidence from an emerging economy

Purpose

Nowadays, firms are keen on improving the quality culture in the organizations. The proven success of Lean and Six Sigma has given rise to the synergetic Lean Six Sigma (LSS) approach that has been catching fire in the past one decade. However, there exists a gap between the understanding and implementation of LSS in the organizations, especially in the emerging economies. Taking this as a valuable opportunity, the purpose of this paper is to present a development of LSS training module.

Design/methodology/approach

This study starts with a literature review of LSS to reinforce the understanding of the research subject in scope of manufacturing sector. Then, an online questionnaire was designed and used to collect responses from 181 companies located in the Indian sub-continent. Subsequently, the results obtained from the survey were analyzed using COARSE approach.

Findings

This study reveals two key findings and associated contributions. First, it was found that the overall awareness of LSS within the responded manufacturing firms is about 70.4 percent. Second, there is no single standard training module that exists in any of the sampled firms to cater to their quality programs. Hence, in order to improve the LSS awareness which could subsequently help managers as a resource for creating an efficient workplace, this paper presents a structured LSS training framework.

Research limitations/implications

Although this paper presents the importance of LSS and associated awareness level among the responded firms, more empirical evidence is required to generalize the model findings. Second, this study is scoped to firms that work out of the Indian sub-continent, and this provides a future opportunity to expand the scope of this research toward a global study for a comparison between emerging and developed economies. Third, this study is limited to manufacturing firms and hence paves an opportunity to research on a similar theme in services context as well.

Practical implications

Before embarking on an LSS journey, an organization can use the LSS training module proposed in this study to assess the employee awareness on LSS. Furthermore, organizations that already have a mature LSS practice can incorporate the LSS training module for periodic evaluation of the employees for effective change management.

Originality/value

The training module presented in this paper is the original contribution by the authors. This is no association to any single identifiable organization or associated funding. The direct practical implication of its application in real time is the value that managers could derive from the proposed LSS training framework.