Introduction/Background
Various organizations strategize to advance their overall performance of systems, enhance throughputs and reduce costs using system-thinking models (Hlubocky, Brummond & Clark, 2013). According to Villarreal (2012), the application of lean principles started in manufacturing companies before being adopted into other business sectors, like the healthcare emergency department. This paper critically analyzes system archetypes and reports on the application of the Value Stream Map (VSM) in the emergency department, which is recommendable for lowering the patient-wait time while enhancing patients’ throughput. The proposed VSM is capable of increasing the capacity of the healthcare office without the necessity of adding any equipment or people. Resultantly, the initiative, with its full capacity to lower patient-wait time for individuals with programmed schedules, will enhance the chance for patients with no formulated engagements to be served in the last moments thereby lowering the stress incurred by nurses and doctors.
System Archetype 1: Advancing the capacity of ED to adapt to the increased demand for Medicare
Figure 1: Underachieved system archetype
The figure 1 above reviews a scenario between the community and the emergency department, whereby ED reacts according the increasing demand of consumers for healthcare services. Demand for services policy typically considers the state of healthcare provision in urban and populated regions (Jimmerson, 2010). The system archetype pushes an intended consequence to develop for admissions to ED, which is speculated to cater the demands and needs of the society. Despite the fact, that only a smaller number of ex-ED patients desire post-emergency healthcare services according to Silbergleit (2004), the intended consequence policy stimulates the creation of more demands for the application of post-emergency health-care services. Nevertheless, these forms of services operate with limits and capacity considering the effectiveness of emergency department expansion. Therefore, this is an underachieved system archetype.
System Archetype 2: Enhancing prompt patients’ discharge from ED
Figure 2: Out-of-Control System Archetype
Currently, social and healthcare agencies seek to implement prompt and alternative processes to mitigate the out-of-control problem that seem to dominate beyond their capabilities. However, the most convenient mitigating step for hospitals’ healthcare managers is to research for a fix that operates within their own reach that enforces their missions and visions (Kapoor, 2017). To launch and fulfill this action, healthcare practitioners need to purpose for an implementation of a policy during early discharges of patients from the ED. Resultantly, this action leads to the formulation of another policy and issue-archetype, which is an out-of-control system archetype. This action poses an unintended consequence to prompt measures that will lead to effective control of ED capacity that will complement the original increase of patients’ demand for healthcare services. The consequence is speculated to have an opposite influence to the expected capacity of the healthcare department to providing services over societal boundaries (Khurum, Petersen & Gorschek, 2014). The percentage of patients discharged from ED will require a readmission, which means that new entrants in the hospital will be reduced considerably.
A value stream map (VSM) entails analyzing the current state of a series of events related to a particular service in order to create a plan to manage lean wastes. VSM critically focusses on areas of a service or product that add fundamental value to customers.
Analysis of System Archetypes
Figure 3: Current VSM
The mapping hurdle in the current VSM is due to insufficient understanding of the emergency department. The ED had little conception about the exact process of service delivery, enhancement and improvements, and if delivery was necessary or not. Patients were subject to extensive wait time from outpatient registration to when they were expected to leave the emergency room. Signifying that initial and prompt recognition of patients in the ED correlates with operations in a manufacturing industry, the VSM illustrates the necessity of paying attention to patients’ desires incorporating other supportive processes that allows prompt and timely patients’ checkout (Kunc, 2012). Attending nurses and physicians had their own presumed opinion of what problem archetype in the ED; however, the archetypes were helpful to define the future state of VSM. The current mapping scheme concentrated in the flow of patients thorough the facility that necessitated them to undergo a wait time and soon became a problem in the ED.
It is apparent that the process of patient service in the emergency department is a problem since patients are pushed to operate within the existing policy by scheduling and waiting in the ER from when an attending nurse has seen the patient. Patients schedule for ‘unknown’ duration of time, without any promising feedback, to receive the desired healthcare service. The considerable variation of patient wait time processes by attending nurses and physicians creates more problems on the ED (McBrien, 2016). The ideology that the maximum time variations in reflex to the average wait time is fundamental to facilitate more chances of making a backlog formed by severe superfluity. All this faults happened with little to no treatment information prior to scheduling and patient reception. Patients are constantly being pushed into the system in reference to a scheduled period set in advance. Therefore, patients are stranded in a system that provides them with no chance to exit the lane they found themselves in. This problem archetype can be worse if an attending physician in the ED has to depart the ER for some time.
Figure 4: Future VSM
Prior to the observation of the current state VSM and critically analyzing the problem archetypes, the foremost step and reaction is to formulate a mapping scheme that will replace the current system. However, there should be a recognition of the variation is emergency department demands and typical manufacturing organizations. Since many attending nurses and physicians are in the best position to address medical services, a continuous connection between patients and healthcare providers is therapeutically anticipated. Therefore, involving a significant number of attending doctors to enhance a smooth backlog formed by extended processes and variation is a fundamental beginning for an outstanding patients’ flow (Meudt, Metternich & Abele, 2017). Unfortunately, this can lead to poor delivery of healthcare services if practitioners do not implement correct mitigating measures to problem archetypes.
The theoretical framework of archetype solution should be identified in reference to an underachievement through a consideration of the problem archetype (Cox, Hill & Lack, 2012). In order to formulate a remedy to the archetype related to community demands of emergency services and the capacity of emergency departments to meet the demand, a new VSM is necessary. The fundamental purpose of this system thinking methodology is to unblock any constraint related to the capacity of emergency department to hold future patients. Moreover, the initiative is facilitated through the implementation of an ED expansion policy. The application of system thinking lens requires maximum acknowledgement and understanding of both the health practitioners and other post-hospital services. In an event whereby the implementation of system thinking necessitate the involvement of the government, hospital need to attain the speculated measure of a particular of a particular political level.
Current State Value Stream Map
On the other hand, the solution on the reduction of patient wait time that applies the out-pf-control theory, emergency departments need to evaluate their archetype. The implementation of a solution to reduce the patient wait time also incorporates the reduction of readmissions which is parallel to early discharges (Denton, 2013). However, the mitigating approach towards this problem is challenging and difficult in relation to boundary fulfillments. The application of the proposed model necessitates critically evaluation of individuals to be discharged earlier than other. Moreover, this action also entails both physical and technical approach to supporting the community by post-hospital services.
In the ED, approximately 50% of attending patients are delivered with services and follow-up information upon pre-scheduling with a specific nurse or doctor. The remaining 50% are reportedly walk-up instance with minor health issues with could be handled by any attending physician. It is presumed that most of ER patients have minor health issues, which will necessitate the attendance of physicians randomly to enhance prompt service delivery to meeting the increased demand of services by community and to reduce the patient-wait time significantly (Oberhausen, Minoufekr & Plapper, 2017). Individuals with pre-programmed appointments will have to wait for a shorter time since they will be placed in the front lanes of FIFO. The more chances a patient is caught in behind a significant number of patients in a statistical cycle, the more time will be consumed hence reducing the backlog system because the proposed VSM is set disallow the addition of more patients once a significant number of patients has not been served. The enhance flexibility and capacity of the proposed system also allows late patients to be served effectively since attending physicians will have enough time to cater for the increasing demand of service provision.
The future system incorporates an effective scheduling strategy that allows a steady movement of incoming patients from the reception to the lab and checkout. The ED is dealing with human beings and not hardware; hence, the recommended WIP amount in a line cannot be obtained financially but according to the measure of wait-time (Sawhney, Kannan & Li, 2009). The future scheduling system starts with the formulation of the overall ED capacity of the hospital before proceeding to the wait time. Early, the VSM has no assigned timeslots for patients to see the doctor; fortunately, the new VSM has a checkout time with an average of 15 minutes.
Based on the system thinking principles, there are consequences to the implementation of the modified system. The first consequence is the intended one that stimulates the creation of more demands for applications in the post ED. The lean applications will define forms of issues that require pre-scheduling with the desired doctor in reference to patients who can be served with any physician (Siegel & Bigelow 2018). This intended consequence has to be addressed to the scheduling sector to considering programing activities carefully. The second consequence is unintended one that leads to the formulation of an out-of-control archetype. This consequence prompts advance measures to use the capacity of ED to serve the interests of an increasing demand of healthcare services in the community.
New State Value Stream Map
Conclusion
The emergency department system is extensive and complex. The identifiable complexities in ED call for the application and improvement of the current VSM. The implementation of system thinking lens has historically been evident in the manufacturing sector before advancing its reach to other businesses like emergency healthcare department (Villarreal, 2012). Pressure on financial evaluation is forcing the ED to consider different initiative of minimizing costs and enhancing efficiency. The emergency department office is distinctive of considerable healthcare facilities that are widely known by medical practitioners; however, nurses and doctors have thrashed to enhance plans of enhancing performance of healthcare provision. Operating in collaboration with hospital staffs, the surveillance of the current VSM was possible to facilitate the proposal of a future map that will add value based on patients’ standpoint and patient wait-time. This paper has critically identified the system archetypes that impede the performance at emergency departments and also apply the VSM to recommendable lower the patient wait-time and enhance patients’ throughput. The proposed map is capable of increasing the ED’s capacity without necessitating the addition of more people or equipment. As a result, the initiative will enhance effective service of patient with no formulated engagement during the last moments thus lowering the stress incurred by health practitioners.
Patients may accept pre-programmed appointments and wait longer if a practitioner calls them during the last moments to be served by a specific physician previously desired. For the new system, there are recommendable issues that must be addressed. These are:
- Availability of ‘lane passible’ to facilitate the handling of acute issues arriving without creating more work-arounds and steps to reach the targeted practitioner
- All the in-processed inventories should be delivered daily
- The baseline of the system considers the exact time of patients meeting with the physician, which averages at 15 minute in a cycle. Hence, acute cases should be address accurately.
References
Cox, C., Hill, M., & Lack, V. (2012). Advanced practice in healthcare. London: Routledge.
Denton, B. (2013). Handbook of healthcare operations management. New York: Springer.
Hlubocky, J., Brummond, P., & Clark, J. (2013). Pharmacy practice model change: Lean thinking provides a place to start. American Journal Of Health-System Pharmacy, 70(10), 845-847. doi: 10.2146/ajhp120528
Jimmerson, C. (2010). Value stream mapping for healthcare made easy. New York: Productivity Press.
Kapoor, D. (2017). Re: Patients willing to wait: arrival time, wait time and patient satisfaction in an ambulatory urology clinic. Urology Practice, 4(4), 355. doi: 10.1016/j.urpr.2017.02.009
Khurum, M., Petersen, K., & Gorschek, T. (2014). Extending value stream mapping through waste definition beyond customer perspective. Journal Of Software: Evolution And Process, 26(12), 1074-1105. doi: 10.1002/smr.1647
Kunc, M. (2012). Teaching strategic thinking using system dynamics: Lessons from a strategic development course. System Dynamics Review, 28(1), 28-45. doi: 10.1002/sdr.471
McBrien, B. (2016). Fight bite injury: emergency department assessment and management. Emergency Nurse, 24(7), 34-37. doi: 10.7748/en.2016.e1611
Meudt, T., Metternich, J., & Abele, E. (2017). Value stream mapping 4.0: Holistic examination of value stream and information logistics in production. CIRP Annals, 66(1), 413-416. doi: 10.1016/j.cirp.2017.04.005
Oberhausen, C., Minoufekr, M., & Plapper, P. (2017). Standardized value stream management method to visualize, analyze and optimize cross-enterprise value stream data. International Journal Of Standardization Research, 15(2), 25-36. doi: 10.4018/ijsr.2017070102
Sawhney, R., Kannan, S., & Li, X. (2009). Developing a value stream map to evaluate breakdown maintenance operations. International Journal Of Industrial And Systems Engineering, 4(3), 229. doi: 10.1504/ijise.2009.023539
Siegel, M., & Bigelow, S. (2018). Palliative care symptom management in the emergency department: The ABC’s of symptom management for the emergency physician. The Journal Of Emergency Medicine, 54(1), 25-32. doi: 10.1016/j.jemermed.2017.08.004
Silbergleit, R. (2004). Effect of shift work on performance in the emergency department: Relationship between time of day and emergency department quality markers. Academic Emergency Medicine, 11(5), 483-483. doi: 10.1197/j.aem.2004.02.375
Villarreal, B. (2012). The transportation value stream map (TVSM). European J. Of Industrial Engineering, 6(2), 216. doi: 10.1504/ejie.2012.04560
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