Application of Fmea in the Context of Organizations Providing Integral Services of Local and Regional Interest in Romania

Failure Mode and Effects Analysis, FMEA, is a methodology frequently used in the commercial sector to investigate the numerous causes and repercussions that could result from a failure (defects that cause the object to lose its ability to perform functions). In this research paper, we will investigate why it is useful, as well as how this strategy could be used in the context of integrated services of local and regional importance. Organizations that provide services of local and regional importance will benefit if they can predict potential problems and failures of the management infrastructure. A process FMEA study shows discrepancies that impact product safety and quality.

The Feasibility of Using a Problem-Solving Methodology Used in Manufacturing in Public Interest Sectors

The pandemic affected in a variable way both the private and the public sectors. Organizations were forced to adapt due to the logistical problems that arose. Due to the rapid spread of COVID-19, one solution for organizations was for employees to work from home. This aspect led to the need for a specialized and access-protected environment to ensure the productive functioning of organizations. Due to the emergence of difficulties in terms of reporting and solving problems, it was necessary to identify a methodology and apply it. The methodology presented in the paper represents a basic method from Toyota by which a problem can be stated, adjusted and solved through a single A3 page. In this scientific work, we will apply the methodology in order to solve the problems of an organization.

Change management: a framework for adaptation of the change management model

Digital health change management projects have a high rate of failure which limits the realization of their potential benefits. While there are many change management models, there is limited evidence of one model being effective in all circumstances. We propose a framework for building on an organizations preferred change management model and adapting it based on the change desired and the organization. We use three change management scenarios (small, large, and rapid) from radiology to explore the application of the framework. Radiology was chosen to illustrate the framework because it has been digital longer than many medical specialties. Given the high number of upgrades and new digital platforms in Radiology, it could also serve as a testing ground for such a framework. © 2023 "IISE”.

Improving the resident assessment process: application of App-based e-training platform and lean thinking.

BACKGROUND: The assessment system for standardized resident training is crucial for developing competent doctors. However, it is complex, making it difficult to manage. The COVID-19 pandemic has also aggravated the difficulty of assessment. We, therefore, integrated lean thinking with App-based e-training platform to improve the assessment process through Define-Measure-Analyze-Improve-Control (DMAIC) cycles. This was designed to avoid unnecessary activities that generate waste. METHODS: Panels and online surveys were conducted in 2021-2022 to find the main issues that affect resident assessment and the root causes under the frame of waste. An online app was developed. Activities within the process were improved by brainstorming. Online surveys were used to improve the issues, satisfaction, and time spent on assessment using the app. RESULTS: A total of 290 clinical educators in 36 departments responded to the survey, and 153 clinical educators used the online app for assessment. Unplanned delay or cancellation was defined as the main issue. Eleven leading causes accounted for 87.5% of the issues. These were examiner time conflict, student time conflict, insufficient examiners, supervisor time conflict, grade statistics, insufficient exam assistants, reporting results, material archiving, unfamiliarity with the process, uncooperative patients, and feedback. The median rate of unplanned delay or cancellation was lower with use of the app (5% vs 0%, P < 0.001), and satisfaction increased (P < 0.001). The median time saved by the app across the whole assessment process was 60 (interquartile range 60-120) minutes. CONCLUSIONS: Lean thinking integrated with an App-based e-training platform could optimize the process of resident assessment. This could reduce waste and promote teaching and learning in medical education.

Global collaboration in teaching root cause analysis with healthcare professional students

Purpose - The purpose of this paper is to describe an example of how universities can develop unique synchronous educational opportunities to engage students in an online environment, especially since study abroad opportunities have slowed or halted due to the COVID-19 pandemic crisis.Design/methodology/approach - Two affiliated universities, in the United States and Scotland, selected a simulated root cause analysis (RCA) of a medical error for a collaborative activity.Findings - Together the students analyzed the event within assumed roles of healthcare professions in a systematic way using the "Swiss Cheese Model, " identified opportunities for improvement, debriefed using the Promoting Excellence and Reflective Learning in Simulation (PEARLS) method and submitted a reflective assignment. The RCA resulted in several process improvement suggestions and positive feedback from the participants.Research limitations/implications - The approach was for graduate students from two affiliated universities, in the United States and Scotland, to simulate a RCA of a medical error as a collaborative activity.Practical implications - This example using simulation of healthcare roles demonstrates the application of international collaboration, problem-solving models and methodologies and recognition of the similarities and differences between the United Kingdom and the United States approaches to patient safety. Especially with the ongoing COVID-19 pandemic, the students' ability to internationally collaborate can be limited without such unique opportunities.Social implications - The students were provided with a side-by-side comparison of the patient safety efforts in each country and written and didactic material about an RCA and the Swiss cheese model.Originality/value - Students come from different perspectives of health services administration, nursing and nursing leadership from Scotland and the United States to solve patient safety problems.

Proposal and Implementation of a Model for Organizational Redesign and Its Influence on Digital Transformation in the Public Sector

This paper reviewed the literature on the topics of organizational redesign, digital transformation, strategic planning, process management, administrative simplification, continuous improvement, redesign and automation, and also considered the activities developed to implement organizational redesign in the quarantine declared by the Peruvian state as a result of COVID 19, with the purpose of proposing a method for organizational redesign towards digital transformation in public entities, with a strategic and operational approach. For the implementation of the strategic approach, the institutions that functionally depend on the Ministry of Education were involved, considering the current situation in relation to the operational and territorial capacities of each region, to develop the strategic and process design. Likewise, for the implementation of the operational approach, the results of the virtual course on process management for administrative simplification 2 were used, involving several institutions that proposed and implemented improvements towards the digitization of processes, promoting digital transformation. The results of the present work consider the effective time of the administrative procedures and the cost of implementation. The effective time of the procedures was reflected in a reduction of 11% and 52% in the reduction of the cost of the procedures. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment.

Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners' awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.

From music industry to content industry: a story of Sun Eater Records

Learning outcomes: At the end of this study, students should analyze the re-orientation of innovation music business model strategy to create a new market using the Blue Ocean Strategy of Sun-Eater Records Company. Furthermore, they should be able to implement the business model transformation in the music industry in this digital media era based on data and technological capability. Students should analyze the digital content strategy that is relatable and relevant to music customers/users through content creation. Finally, they need to create the content strategy applicable to promotion and marketing innovatively in the music business. Case overview/synopsis: This study analyzes how a Jakarta-based independent music company, Sun Eater Records, changed its strategy in response to the Covid-19 pandemic. The adverse effect of the pandemic on this company included a massive drop in sales of products and revenues from tours, festivals and outdoor music performances. Music industry stakeholders were confused and frustrated because of the restriction and the implementation of the social distancing policy, as most of their business models depended on live music showcases and selling records. The protagonist of this study, Kukuh Rizal Arfianto, is the director and co-founder of Sun Eater Records. Kukuh’s experience during the pandemic is used to capture the dilemma faced by the music industry players in Indonesia. This agile businessman transformed this music company by embracing digitalization. Inspired by the business models of Disney and 88 Rising (Music Management), Sun Eater Records developed various derivatives digital products. The company did not only sell music through digital content, it also developed several complementary products with music as their main theme. These innovative creations include mini-documentary, virtual concerts, compilation albums serial, digital comics, and Covid-19 Campaigns. The company is quite active in leveraging digitalization to survive in this business compared to other industry players. This study provides communication and design students opportunities to analyze how to draft an effective content strategy in the industry, in this case, the music industry. Complexity academic level: This case is designed mainly for Management, Innovation, and Digital Communication course at the Bachelor's level program. Supplementary materials: Teaching notes are available for educators only. Subject code: CSS 11: Strategy. © 2022, Emerald Publishing Limited.

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review.

Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean-Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications.

Proposed Improvement of the Mining Cycle to Increase Productivity in a Mining Company in La Libertad Region, 2020

The main objective of this research was to determine the impact of the proposed improvement of the mining cycle on the productivity of a mining company in the La Libertad Region during 2020. The study was carried out considering the protocols established in the Covid-19 pandemic. In the first section, the problems of this industrial sector were highlighted, as well as the causes that led to low productivity in the mining cycle of the company. In the second section, the research methodology was reflected and engineering tools such as time study, management indicators system, and COLPA were applied. In the third section, the results obtained after the proposal of the engineering tools were shown, these results were positive for the company since a benefit was obtained/cost of S/136.54, which generated an economic saving for the company of S/1 694 591. In addition, productivity in the mining cycle increased from 0.172 Ozs. Au/worker-day to 0.250 Ozs. Au/worker-day. Finally, the results obtained were compared, showing that the improvement proposal increased productivity in the mining company. The contributions in this study will serve for future research related to these variables and the industrial sector. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Business Process Improvement in Distributor Company to Increase The Timeliness of Delivery

Pandemic Covid-19 has had an impact not only on health aspects but also on the economy of Indonesia, both from demand and supply. Problems in Indonesia's government, such as the lack of medical equipment and supporting facilities in handling Covid-19 pandemics, have triggered the need for a sudden (urgent/emergency). On the other hand, there are still many distributor companies that have no experience in handling emergencies. One of the impacts is the delivery of goods that are not on time /late. To solve the problem, this study aims to get a process business in a distributor company with more effective and efficient processes by involving intercompany to increase the timeliness of delivery to customers. We propose using BPR (Business Process Reengineering) and simulation to model and analyze the current process and redesign the repair process. The results were obtained, with the average procurement of goods decreased by 46%. © 2022 IEEE.

Application of lean management after audit of Medical Records Department in a COVID19 dedicated center during the COVID pandemic.

Background: The Medical Record (MR) contains the information which is needed to plan, provide, and evaluate the care given to the individual. It also serves as a pivotal tool for communicating information to all the health personnel who manage the patient, and it contributes to the continuity of patient care. There is an unmet need of identifying and correcting the issues faced with MR and Medical Records Departments (MRDs) so that higher efficiency can be achieved. This study was conducted to study the deficiencies and discrepancies found in MRD files during COVID management and to correlate the deficiencies with the facilities available and the workflow. Later Lean Management (LM) was applied to ensure compliance and efficiency in the system. Methods: An observational study was done on the audit of COVID 19 patient files and facilities in the care centres. Process mapping was done. The data for LM were collected by brainstorming, observation, interview, and workflow review of several processes, values, number of wastes, and suggestions were documented the MRD staff. Results: Area available was 400 m2 which is adequate against the norm of 350 m2. The existing staff of 30 was adequate as per norms. Deficiencies were observed in physical examination, history, radiology, and laboratory reports. The findings showed that the MRD units had 13 current processes, 26 wastes, and 10 values were identified. In addition, they were offered a total of 25 comments on eliminating the waste. Conclusion: Staff and equipment were adequate. Recommendations include regular staff training and usage of electronic medical records, focus on deficiency check by specific MRD staff on regular basis monitored by the administration and supported by the medical audit committee. The study also recommends that suggestions applied after LM should be implemented in letter and spirit and a repeat study of LM is advisable after regular intervals to maintain the quality standards and to maintain or further improve the efficiency.

DigiYatra – a digital experience for air travelers

Learning outcomes: Students will learn technology strategies specific to airports. Students will understand the reason for the success of Bengaluru International Airport. Students will learn to apply management models in airport settings. Students will improve their understanding of airport business, airport-related technologies, specifically in the Indian settings. Case overview/Synopsis: DigiYatra is a revolutionary initiative by the Government of India to digitalize all the airports in India, making your face your boarding pass. Bengaluru International Airport Limited (BIAL) is at the forefront of this initiative. As one of the early public–private partnership airports, BIAL has seen many challenges over time but could succeed in all its endeavour. The case discusses the journey of DigiYatra, which BIAL has taken through the eyes of the Chairman, Hari Marar. The case goes through several layers like initial planning, creating the team, implementation challenges, technology strategy adopted and how they tackled Covid lockdown challenges to complete the project's initial phase. Complexity academic level: Post graduate students. Supplementary materials: Teaching notes are available for educators only. Subject code: CSS 11: Strategy. © 2022, Emerald Publishing Limited.

How Industrial Internet of Things Enables Engineers to Work Remotely

Industrial Internet of Things (IIoT) has enabled many new avenues for industrial engineers to perform their jobs. There used to be a need for an engineer to monitor, analyze, and improve a process manually. The inherent benefit of IIoT applications in industrial settings no longer requires in-person contact. Through the use of sensors, actuators, and data communication networks, businesses can now automate the data collection process to achieve KPIs. With this digital revolution comes the ability to access the data and improve the process from anywhere in the world. While IIoT brings many advantages that may improve a process improvement team's efficiency, it is not without some drawbacks such as security and cost. This paper will explore how IIoT enables remote improvements and how the COVID-19 pandemic has made remote work a fiscal possibility for many businesses. © IEOM Society International.

BPMN-Based Simulation Analysis of the COVID-19 Impact on Emergency Departments: A Case Study in Italy

The COVID-19 outbreak, which has been recognized as a pandemic in March 2020, has brought the need to timely face an extraordinary demand of health-related resources and medical assistance. The objective of this work is to analyze the structural and procedural changes that have been enacted in an emergency department (ED), according to guidelines provided by national authorities. Specifically, guidelines deal with how to manage the access of COVID-19 patients, ensure the isolation of suspected cases, execute a proper triage, and identify the appropriate treatment path for all patients. The paper describes a process modeling and simulation-based approach to analyze the treatment of patients accessing the ED of an Italian hospital. The approach makes use of the Business Process Model and Notation standard to specify ED treatment processes before and during the pandemic, so to evaluate different scenarios and effectively support process improvement activities by use of simulation-based what-if analysis. © 2021 IEEE.

Managing a lean six sigma project in a remote environment

As a result of the COVID-19 pandemic, organizations are forced to operate in a remote environment with several restrictions on travel, group meetings, and in-person interactions. This is especially difficult for lean six sigma projects where observing the process and interacting with the workers is essential to understanding and improving the process. The Army's Lean Six Sigma methodology includes five phases: Define, Measure, Analyze, Improve, Control;each of these phases includes interaction between the project and process team. This paper focuses on the application of Lean Six Sigma methodology at Tobyhanna Army Depot to help reduce overruns and repair cycle time within the sheet metal cost center. At the initiation of the project, the process incurred over 4000 hours of overruns, a situation in which it takes longer to repair an asset than the standard hours allocated for the repair. Additionally, the average repair cycle time, amount of time required to repair an individual asset, exceeded customer expectations by almost 4 days. The paper discusses how the lean six sigma team executed tradition tools for each phase, like process mapping, data analysis, communication plans, and brainstorming in a remote environment. © 2021 IISE Annual Conference and Expo 2021. All rights reserved.

Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support-A Pilot Study.

Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and non-user friendly, resulting in missed training opportunities, specific training license expiration, and underutilized training slots which resulted in lost time for both the trainers and trainees. A pilot study was undertaken to review the process for accessing mandatory training with a focus on the mandatory training program of Basic Life Support (BLS). This was chosen due to its importance in patient resuscitation and its requirement in the hospital achieving Joint Commission International (JCI) accreditation. A pre- and post-team-based intervention design was used with Lean Six Sigma (LSS) methodology employed to redesign the process of booking, scheduling, and delivery of BLS training leading to staff individual BLS certification for a period of two years. The redesign of the BLS training program resulted in a new blended delivery method, and the initiation of a pilot project led to a 50% increase in the volume of BLS classes and a time saving of 154 h 30 min for staff and 48 h 14 min for BLS instructors. The success of the BLS process access pilot has functioned as a platform for the redesign of other mandatory education programs and will be of interest to hospitals with mandatory training requirements that are already facing healthcare challenges and demands on staff time.

Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty.

The importance of telemedicine technologies around the world has been growing for many years, and it turned out to be a particularly important issue for conducting some medical procedures during the SARS-CoV-2 pandemic. It is necessary to create interdisciplinary teams to design and implement improved procedures using telemedicine tools. The aim of the article is to develop original, improved posthospital patient care process after total hip arthroplasty (THA) with the use of telemedicine technologies. In the study, a literature review and empirical research were used. The conducted research resulted in the designing an original posthospital patient care process after THA that uses telematics technologies. Due to the use of analyzed telemedicine technologies, the designed patient care process brings a possibility to increase the patient's safety by monitoring life parameters, allowing for regular, remote contact with specialists and to be supervised remotely. All this may contribute to shortening the convalescence time, reducing the risk of complications, as well as reducing treatment costs. The designed model is ready for further clinical research with the participation of medical staff, patients after THA and patient caregivers.

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review.

The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions.

Implementation of point-of-care blood gas testing at a large community hospital: Cost analysis, sepsis bundle compliance, and employee engagement.

INTRODUCTION/BACKGROUND: Point-of-care testing (POCT) platforms support patient-centered approaches to health care delivery and may improve patient care. We evaluated implementation of a POCT platform at a large, acute care hospital in the Midwestern United States. METHODS: We used lactate testing as part of a sepsis bundle protocol to evaluate compliance and mortality outcomes. Respiratory team members were surveyed to assess perception of efficiency, ease of use, timely patient care, and overall engagement with the POCT system. Annualized cost per test of a benchtop analyzer and a POCT platform were compared across 3 years for each platform. RESULTS: Lactate testing volume increased from 61% to 91%, which was associated with improved sepsis bundle protocol compliance. Employees reported high levels of engagement, improvements in efficiency and time savings, and better patient care with POCT. Average cost per test was $10.02 for the benchtop system and $6.21 for the POCT platform. POCT saved our institution $88,476 annually in labor costs. DISCUSSION: Combined with a robust training program emphasizing the use of lactate testing in the context of the overall clinical picture, POCT enabled adherence to the sepsis bundle protocol and may have contributed to lower mortality. Additionally, the COVID-19 pandemic has provided us with unanticipated benefits of using POCT; it has enhanced our ability to deal with stringent infectious disease protocols, saving time and minimizing patient and staff exposure. CONCLUSIONS: Implementation of a POCT platform was associated with improved compliance to our sepsis protocol, reduced sepsis mortality, high employee engagement, and cost savings.