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Executive Summary

System thinking in the modern world is an advanced approach in resolving organisational issues and performances. Businesses are growing by implementing various system thinking tools in their daily operations, thereby increasing their sustainability. In this report, a need for improving the current system of a hospital so as to minimise its patient turnaround time was outlined. The issues with the current operational flow were detected and recommendations for the same have been provided in the new proposed system thinking model. A few recommendations regarding the same were provided.

Introduction

System thinking in the modern world is a rapidly growing concept. Both profitability and sustainability of an organisation depend on the approach and innovation implemented in the business operations. Nowadays, the increasing amount of waiting time for the patients before diagnostics is a great concern. According to the data provided in the yearly report by Vitals, on average, a patient has to wait for 19 minutes and 19 seconds before they get to meet a physician. This is quite a serious issue for most hospital, especially in the case of an emergency where every second matter. In this report, a discussion on patient turnaround time in a hospital will be discussed. In addition to this, a discussion on a new framework to reduce the time is provided with a few changes in the existing system. The pros and cons of a new proposal are also discussed in the context of a hospital or any medical institution.

Identification and analysis of the System Archetypes Impeding performance

System archetypes are the concept of noticing behavioural patterns of processes in a business organisation. With the help of this approach, the organisation develops new thinking in order to resolve the issues and challenges it faces. These effective tools are used in gaining an insight into the main cause of delays (Andersen, et.al, 2014). The services of the emergency department can be analysed by the following system archetypes.

• Technophile archetypes provide a great number of methods that facilitates the service quality
• Care enterprise archetype helps in identifying the treatment areas that require great focus (WHO, 2019).

In the current scenario, the primary problem is the increased waiting time at the emergency ward for patients. This has large consequences for the hospital as there is some sort of danger that patients might move to other hospitals. In this case, the hospital might lose its competitive position in the market. Therefore, it is important to understand the factors contributing to the increased patient turnaround time. The first and foremost reason is the use of manual techniques instead of computers (WHO, 2019). Still, the record-keeping in the hospital is done through traditional methods. When the patients arrive in the hospital, they have to fill their personal detail in the form. This consumes on an average 9 minutes of a patient which is quite a large amount of time in case of emergency. The much amount of time is wasted in filling up the details of the patient. In addition to this, the registration window is crowded as there is a common window for normal and those who are in an emergency situation. This might be due to the shortage of staff in hospitals (WHO, 2019). The hospital is not investing in upgrading its modus operandi and this is the major threat for the growth of the organisation. Once the registration is done, the patient has to wait for the hospital’s confirmation regarding the availability of room or bed in the emergency ward. This is a technical weakness of the hospital as its staff is not trained well in information management. The complexities of the diseases are also increasing patient time. The nursing staff is required to collect all the preliminary information about the issue a patient is facing. A complex disease might increase this time and other patients might end up in waiting for a longer duration.

In addition to this, the hospital lacks the specialised team of doctors. This is also resulting in increased time as the normal doctors take time to understand the situation of the patient and provide the right treatment to them. They consult the specialised doctors from other hospitals which also increase the time taken up by a patient. Also, it is found that the hospital is focusing on reducing the operational cost and hence, the management is seeking more help and support from its limited staff. The members are already assigned with more than one duty so they are not able to cater the patients waiting for their turn. There is no team that specifically handle emergency situations.

Analysis of the Current state Value Stream Map of the emergency department based on System Archetype

Value stream mapping is the method that is used for operation flow evaluation in the industry. It is also critical in the healthcare sector. It helps in determining the process flow and operation management modelling of ED in the public health care industry. For the analysis of the current value stream map, the first stage is to identify relevant objectives/target (Mainz, et.al, 2015). The current VSM has many functions that involve several processes. The first and foremost is the registration of patients, wherein the patient or their relative register and make a booking for the patients. Furthermore, they have to wait for their turn in the waiting area. Once the number comes, the nurse examines and collect the basic information related to the patient. All the information is recorded and then forwarded to the doctor. While the patient is undergoing diagnosis by the doctor, the nurse arranges for medical supplier and the doctor treats the patient. Once the treatment gets completed, the patient can go home. This process is shown in the image provided below:-

The maximum amount of time of the emergency department can result in the death of the patient. This should be understood by the management of the hospital and they should make efforts to change the current system described above. The speed of carrying out operations and time management in the critical case can be improved significantly by managing the flow of information. The information passes through various sources, such as registration desk, nursing staff, doctors, and specialised surgeon. This flow of information can be reduced if these sources are reduced or direct access to information is provided each and every concerned person through an online data storage platform. Once the information reaches to the doctor directly, there are very fewer chances of miscommunication and misunderstanding between patient and doctor. The right treatment can be given to the patient in no time. This would effectively reduce the amount of time.

Recommended new State Value Stream Map with the desired reduction in patient turnaround time.

Looking at all the factors contributing to the increased waiting time in the hospital, it can be said that the current system needs serious interventions. In order to minimise the unnecessary time consumed by processes that are redundant, the hospital management should remove them or make certain changes in them (Silsand&Ellingsen, 2014). The flow of information should be smooth and fast. The new value stream map will be having more access to information as the data would be stored online and all the stakeholders would be having direct access (Gijo& Antony, 2014). In addition to this, the online registration of the patient can help not only the hospital in improving its operation but patients also as they won’t have to wait for a long period for their turn. In addition to this, one stage needs to be removed from the existing system i.e., an examination by the nursing staff. In case of emergency, every second is important and only doctors should be allowed to handle such cases (Mainz, et.al, 2015).

In addition to this, the hospital should implement the TQM approaches in order to carry out all of its operations. It has been seen that people are not aware of such approaches and hence, they are reluctant to employ these techniques. This would reduce the errors in gathering and storing data and improves service quality. It will likewise help in streamlining the various approaches to convey the potential qualities to every one of the patients by treating every one of them in the constrained period time, conceivable (Swallmeh, et. al., 2014). The new worth stream guide of the crisis office contains the least, least or disposes of the pointless progression of data which aids in decreasing the long hanging tight time for every one of the patients before they get the compelling treatment. With the assistance of viably executing and actualizing this arrangement, the crisis office can deal with the tasks successfully without influencing the exhibition of different divisions in the emergency clinic (Coulter, et.al, 2014).

The improvement of the value stream map of the adjusted framework encourages in accelerating the operation. The performance of the framework isn't hampered and the turnaround time of the patient is decreased to a specific degree. It very well may be seen that with the ability and particular medical expert, the smooth and fast preparing can be accomplished. It has added to the decreased turnaround time by making robust procedures.

Discussions on intended and unintended consequences of the modified system

The modified system would have some positive as well as some negative consequences. The intended consequences are the desired results that are expected from the modification in the present system. On the other hand, the unintended consequence would be regarding the side-effects or major drawbacks of the system. Both intended and unintended consequences are enlisted below:-

Intended Consequences

• Stringent policies regarding time management and robust strategies for improving the pace of the operations (CUNLIFF, 2017)
• Hiring specialised staff for handling emergency situations and complex diseases
• Management of information in a systematic and planned way (Coulter, et.al, 2014).
• Improved version of healthcare facilities that results in patient satisfaction
• Time effective management and delivery of services resulting in the reputation of the hospital (Gijo& Antony, 2014).

Unintended Consequences

• The higher level of growth would reduce the quality of service provided by the hospital and this would result in poor patient satisfaction
• The time reduction would eliminate some of the processes and this might result in the deletion of some important services for the patient
• The modification would require some sort of training for the employees and this would be a burden on the budget of the employees (Coulter, et.al, 2014).
• The negative impact may be irreversible for the hospital and may hinder the whole functioning of the hospital.

Conclusion

It has been seen that each and every hospital ought to become familiar with the significance of the emergency cases and hence improve their emergency department. The greatest measure of time taken by the emergency division of the hospital that won't just influence the soundness of the considerable number of patients yet it will likewise bring about the diminished degree of efficiency. It should be seen that implementing TQM can help the organisation in upgrading the existing system. Also, recommendations regarding the consequences of the modified system are also provided in this section.

Recommendation

For the effective implementation of the strategies to reduce the patient waiting time, there are certain recommendations.

• The registration and information gathering should be done either online or on the phone so that the patient does not have to wait (CUNLIFF, 2017)
• Only specialised staff should be allowed to handle emergency cases (WHO, 2019).
• The secured data storage system should be used for storing medical history and other data (Andersen, et.al, 2014).
• The doctors should be provided access to the medical data of the patient through cloud computing technology (WHO, 2019).
• For those who don’t understand the online registration process, an extra window should be provided for registration only for emergency cases. In addition to this, an emergency unit should be formed to cater only the emergency cases.

References

• Andersen, H., Røvik, K. A., &Ingebrigtsen, T. (2014). Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews.  BMJ open,  4(1), e003873.
• Coulter, A., Locock, L., Ziebland, S., & Calabrese, J. (2014). Collecting data on patient experience is not enough: they must be used to improve care.  Bmj,  348, g2225.
• Gijo, E. V., & Antony, J. (2014). Reducing patient waiting time in outpatient department using lean six sigma methodology.  Quality and Reliability Engineering International,  30(8), 1481-1491.
• Mainz, J., Kristensen, S., & Bartels, P. (2015). Quality improvement and accountability in the Danish health care system.  International Journal for Quality in Health Care,  27(6), 523-527.
• CUNLIFF, E. (2017). Healing Troubled Institutions Through Systems Thinking - The Systems Thinker. Retrieved 17 August 2019, from https://thesystemsthinker.com/healing-troubled-institutions-through-systems-thinking/

• Silsand, L., &Ellingsen, G. (2014). Generification by translation: designing generic systems in context of the local.  Journal of the Association for Information systems,  15(4), 3.
• Swallmeh, E., Tobail, A., Abo-Hamad, W., Gray, J., &Arisha, A. (2014). Integrating simulation modelling and value stream mapping for leaner capacity planning of an emergency department.