Question 2: [45]

Read the case study and answer the questions that follow, drawing insights from the information provided, as well as using information from your text and other suitable sources.

Case Study

From a patients perspective, long patient waiting times at emergency wards (EW) are unacceptable. Studies have shown that the mean patient Length of Stay (LOS) at an EW correlates to increased morbidity and mortality (Sibbritt and Isbister 2006). At one of the EWs in Sweden, the LOS was increasing during 2005. An analysis revealed that about 16 000 patients were treated that year. The average LOS at the EW during the first six months was 2.7 hours. Furthermore, the variation in LOS was also significant. Nearly 10% of patients had a LOS of five hours or more, and almost 20% had a LOS of more than four hours.

To address the problem the owner of the emergency process at the EW the Manager of the surgical clinic decided to start an improvement project in the spring of 2006. The aim was to decrease the mean LOS by 20 minutes, thereby increasing patient satisfaction and safety, improving working environment and improving resource utilisation. A reason for this initiative was that LOS at EWs was a topic that appeared frequently in the national patient safety discourse. The project group consisted of interested co-workers at the EW and was led by two internal black belts.

A steering committee consisting of the medical and surgical clinical managers was established. The first line managers responsible for the different clinics in the emergency department followed the project. The daily operations of the EW are admittedly complex. About 16 000 cases pass through the department each year, and each patient is unique. Some patients must receive immediate treatment in the EW, while others treatment is less pressing. The inflow of patients varies from week to week, depending on such factors as the weather (e.g. slipperiness in the streets), epidemics (e.g. influenza) among the population and healthcare articles in newspapers.

The EW is also heavily dependent on a well-functioning collaboration with other units primarily the x-ray department and the laboratory unit to achieve an even flow through the department. The complex operations sometimes lead to an increased LOS, which is worrying, tiresome and potentially dangerous to the patients. A high inflow of patients also contributes to a stressful working environment. In addition, an increased LOS puts a higher demand on the resources at hand.

When there is an accumulation of patients due to different bottlenecks, the tail of the patient flow must be handled late at nights at a higher cost. The EW is organised under the surgical clinic; nurses and assistant nurses are employed at the EW whereas the doctors responsible for the EW come from the medical and the surgical departments following a scheme for emergency duty. There are two on-duty lines; the primary doctor on duty (usually a resident) works together with front line staff at the EW, whereas the secondary doctor (a senior physician) is on standby duty, always reachable by phone and obliged to appear within 20 minutes at the ward if called for.

2.1	Discuss how the Define, Measure, Analyse, Improve, and Control elements of the DMAIC roadmap could be used to improve the emergency process in the case study. Provide practical examples from your own experience or from a patients perspective to support your discussion.	(20)
2.2	Six Sigma is often referred to as Transactional Six Sigma within the service industry. Although Six Sigma projects have common key characteristics, there are some which differ in the service industry when compared to manufacturing. Provide a comparative analysis of these characteristics and their differences in relation to the above case study and your own work environment.	(25)