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Operations Management In Healthcare Strategy And Practice 1st Edition Corinne M. Karuppan , Nancy E. Dunlap,Michael R. Waldrum - Solutions
2. Evaluate the performance of basic queuing systems and compute their costs
1. Identify queuing characteristics and classify queuing models accordingly
7. Look at the dashboard (Figure 7.12). Can you think of other indicators for the competitive priority of delivery?
6. In your work environment, select a process that is dysfunctional, develop a 5w2h framework, and make a case for action.
5. In your work environment, select a process that is dysfunctional. Depict it using a swimlane diagram, analyze it using a process activity chart, and propose an improvement. Develop a general process chart to show the magnitude of the improvement.
4. Box 7.5 describes the switch from a “job shop” to a “focused factory” model. Can you recommend this process transformation for another situation in healthcare? If so, which one and why?
3. In Box 7.3, what would you consider to be “buffers”?
2. Box 7.1 describes a process change aimed at decreasing the suicide rate in the psychiatry unit at Johns Hopkins. Was Johns Hopkins right in focusing on the system rather than the individuals? Why or why not?
1. Search online for a process improvement in nursing homes and answer the following questions:a. What were the problems before the process redesign?b. Who took the initiative to recommend the redesign?c. What tools were used?d. What were the results of the redesign?
10. A very satisfied patient has made a sizeable donation to the plastic surgery clinic at BPH. The funds will be used to remodel the outdated facility so that the new layout will support the work flow. After talking with the staff and making observations on her own, the office manager developed
9. The following diagram is the existing layout of the nursing management office. Based on the data regarding traffic and distance, propose a new layout that will minimize the load–distance. What is the total load–distance of your layout?
8. The following is the current layout of a large storage area with items placed in rooms 1, 2, or 3 depending on their types. Based on the data regarding traffic and distance:a. Fnd the load–distance for the current layout.b. Redesign the layout to minimize load–distance. What is the total
7. Employees at BPH’s Health Plans division process 200 claims during a 400-minute day. Based on the following precedence relationships, do the following:a. Draw the precedence diagram.b. Compute the desired cycle time.c. Compute the theoretical minimum number of process steps.d. Balance the
6. These are the tasks necessary for the final assembly of a hospital bed, the time needed to perform each task, and the operations that must be completed prior to subsequent operations. The time available is 300 minutes per day, and the required output rate is 25 beds per day.a. Construct a
5. The billing department at BPH is redesigning the layout of its office to manage bottlenecks better. You are responsible for assigning each employee involved in this process to a set of tasks. One major goal is to achieve equal work groupings, that is, balance the line. The work elements to be
3. Develop a process activity chart for problem 1.a. Categorize activities as value-added, non–value-added, and business–value-added.b. Compute the efficiency of this process.4. Develop a process activity chart for problem 2.a. Categorize activities as value-added, non–value-added, and
• Echo staff charges for exam (2 minutes).a. Develop a basic flowchart.b. Develop a value stream map.c. What improvements would you recommend? Why?
• Echo staff moves to control area (1 minute).
• Echo staff writes down exam information (3 minutes).
• Patient changes and is dismissed (2 minutes).
• Echo staff performs exam (23 minutes).
• Patient changes (2 minutes).
• Echo staff gets a blanket and brings it to the room (1 minute).
• Echo staff takes patient to procedure room (1 minute).
• Echo staff goes to procedure room and enters demographic patient data into machine (3 minutes).
• Echo staff checks paperwork and enters order (3 minutes).
• Patient sits in waiting area (11 minutes).
• Patient is sent to third floor for exam (3 minutes).
• Patient goes to registration booth and is registered (3 minutes).
• Patient sits in waiting area (1 minute).
• Patient checks in (1 minute).
2. These are the steps for a patient to receive an echocardiogram:
• File clerk returns records to storage location (5 minutes).a. Develop a basic flowchart.b. Develop a swimlane diagram.
• Staff member makes copies of records and gives them to patient (20 minutes).
• File clerk collects the records (3 minutes).
• Storage clerk reviews the request (2 minutes).
• File clerk places a request to have records pulled (2 minutes).
• File clerk goes to record storage location (5 minutes).
• File clerk finds the location of each requested file (5 minutes).
• File clerk checks all communication methods (10 minutes).
• Staff member requests paper medical records from file clerk through e-mail, call, instant messaging, or paper note (10 minutes)
• Staff member pulls list of patients with appointments to pick up their records (1 minute).
1. These are the steps for patients’ paper records requests and recovery at one of BPH’s clinics:
15. What is a cellular layout? What is its primary advantage?
14. What is the meaning of the X and of each of the five vowels in Muther’s grid?
13. What is the purpose of block diagramming?
12. What is the purpose of line balancing?
11. Differentiate between functional and product layouts in terms of process type, demand, volume, and organization of resources.
10. What are common objectives of layouts?
9. What is the purpose of a general process chart?
8. List five design principles and explain them.
7. What are the five sections of a business case for process improvement?
6. From a value standpoint, what is the efficiency of a process?
5. What are business–value-added activities? Give some examples.
4. What is a process activity chart? What are the symbols used in the chart to categorize process steps?
3. What is the purpose of a 5w2h framework? Describe each of the 5 Ws and the 2 Hs.
2. What are the modeling tools explained in this chapter? Explain each one.
1. Describe the modeling, analysis, and design phases briefly.
6. Develop general process charts to evaluate the extent of improvement accomplished through redesign
5. Design product, functional, or hybrid layouts based on process characteristics
4. Propose approaches to reduce hand offs and to simplify processes
3. Develop a process activity chart to identify value-added and non–value-added steps in a process
2. Develop a 5w2h (who, what, when, where, why, how, and how much)framework to develop a basic understanding of a process
1. Model a process using well-known visual tools: basic flowcharts, swimlane diagrams, and value stream maps
3. Describe a way to poka-yoke your morning routine so that you wake up on time and remember to take your cell phone to work.
2. Go to http://archive.ahrq.gov/professionals/quality-patient-safety/patient-safetyresources/resources/mistakeproof/mistake8.html. Explain why barcoding of specimens or drugs can be considered a method of poka-yoke. Name one mistake that can come with barcoding.
1. Draw the actual value stream for one of the following processes:a. Making a cup of coffee using a regular coffeemakerb. Brushing your teeth and flossingc. Washing your car Time the various steps and identify and label the types of waste that can be eliminated.
10. Give an example of a just-in-time system. Explain why it is beneficial.
9. What are the various roles of people involved in Six Sigma projects?
8. What are the steps in Six Sigma?
7. What is poka-yoke? Name three examples of its use in healthcare.
6. What is a root cause and how do you identify it? Give an example.
5. Explain why culture is an important consideration when both Lean and Six Sigma are used in an organization.
4. What are the differences between push and pull systems?
3. Why is flow important in Lean?
2. List the Lean principles and explain how each one is used to examine/improve a process.
1. Name the eight types of waste (Lean methodology) and give an example of each in healthcare.
8. Elucidate how culture is important for organizations that adopt Lean or Six Sigma methodologies
7. Describe the steps in DMAIC (define, measure, analyze, improve, control)
6. Explain the basis for Six Sigma
5. Understand the importance of flow in Lean
4. Investigate the root cause of a problem
3. Learn how to map the value stream
2. List the five Lean principles and explain briefly how each is used to examine a process
1. Describe the types of waste found in healthcare processes
4. In healthcare, it is not uncommon to see Individual X-MR control charts. Research what these charts display and identify some healthcare indicators for which they are appropriate.
3. SPC knowledge by itself is insufficient to bring about quality. Inability to apply this knowledge is a major obstacle to quality achievement and is the result of numerical illiteracy. “Numerical illiteracy is not a failure with arithmetic, but it is instead a failure to know how to use the
2. Do a literature search and explain the “crowding” phenomenon in the ED.
1. Find an article describing the reorganization of an emergency department. Explain the scope of their efforts to redesign processes and how these efforts contributed to higher efficiency and higher patient satisfaction.
15. Use the BPH data set (CBC-Stats) for October. Filter the data to extract the tests for CBC-d (Column A). From October 1st to October 20th, randomly select samples of 5 total lab turnaround times (Column J) each day. Using the 20 samples (one for each day), construct an chart and conduct a run
14. Use the BPH ED data set (LWBS & LWBT) for May. The proportion of admissions relative to the total number of visits is provided for each day (Column BF). Construct the appropriate p-chart. Is the process in control? Why or why not?
13. Use the supplemental BPH ED data set (LWBS & LWBT) for April. The proportion of LWBS + LWBT patients relative to the total number of visits is provided for each day (Column Q). Construct the appropriate p-chart. Is the process in control? Why or why not? Hint: convert percentages (LWBS + LWBT
12. Based on the following scenarios, determine the type of data (attribute versus variable) involved and identify the appropriate control chart.
11. You have been asked to determine whether the sound level at night is acceptable in cancer patient rooms. Using a digital sound-pressure-level meter, you collect data in 12 patient rooms, every day, for 20 days. Recommended sound levels are 35 dB ± 10 dB. Is the process in control? Why or why
10. Dr. Barari wants to reduce the waiting times in her office. Six random observations of times spent between arrival and exam were made over a period of 17 days.a. Develop the appropriate chart(s) and determine whether the process is in controlb. If patient surveys indicate that they are willing
9. One of BPH’s clinics is concerned about the number of patient records that get misplaced. They decide to record the number of misplaced patient records over a period of 15 weeks. The number of patients seen for whom the records were needed is indicated. Develop the appropriate control chart(s)
8. The head of the surgery department is concerned about the incidence of patient readmissions after being discharged from the hospital. In several cases, a patient had to be readmitted multiple times. The following data are available for the past 11 months. Develop the appropriate control chart
7. Nosocomial infections result from treatment in a hospital. At BPH, the following incidences of nosocomial infection that appeared within 30 days after discharge were recorded for the first half of June. The number of patients discharged did not fluctuate much from day to day and can be assumed
6. The dietitian at BPH has warned that the meals served at the cafeteria contain too much sodium. For the past 10 days, she has sampled four batches of the “entrée du jour” and recorded the sodium content per serving. Based on the data that follows, construct the and R charts.a. Is the
5. Following are the average times spent in the ED and standard deviations for samples of 25 patients seen in the ED in February. Develop the appropriate and s-charts. Is the process in control? Why or why not?
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