Search results

The healthcare system has been under pressure to provide timely and quality healthcare. The influx of patients in the emergency departments (EDs) is testing the capacity of the system to its limit. In order to increase EDs' capacity and performance, healthcare managers and practitioners are adopting process improvement (PI) approaches in their operations. Thus, this study aims to identify the main PI approaches implemented in EDs, as well as the benefits and barriers to implement these approaches.

The study is based on a rigorous systematic literature review of 115 papers. Furthermore, under the lens of thematic analysis, the authors present the descriptive and prescriptive findings.

The descriptive analysis found copious information related to PI approaches implemented in EDs, such as main PIs used in EDs, type of methodological procedures applied, as well as a set of barriers and benefits. Aiming to provide an in-depth analysis and prescriptive results, the authors carried out a thematic analysis that found underlying barriers (e.g. organisational, technical and behavioural) and benefits (e.g. for patients, the organisation and processes) of PI implementation in EDs.

The authors contribute to knowledge by providing a comprehensive review of the main PI methodologies applied in EDs, underscoring the most prominent ones. This study goes beyond descriptive studies that identify lists of barriers and benefits, and instead the authors categorize prescriptive elements that influence these barriers and benefits. Finally, this study raises discussions about the behavioural influence of patients and medical staff on the implementation of PI approaches.

The purpose of this paper is to present the findings of a theoretical calculation for the emergency evacuation of an auditorium facility managed by a university in Saudi Arabia.

The authors reviewed the published literature to identify the sources of fire incidence, guidelines for means of escape in assembly occupancies and human behavior in fire emergencies. The theoretical method of the SFPE handbook to estimate the required evacuation time was subsequently applied to a case study of an auditorium facility managed by a university located in Saudi Arabia. Finally, the authors developed recommendations for the performance-based fire safety evacuation of the auditorium facility under review.

The study showed that a total of 6 minutes 39 seconds is needed to evacuate the whole auditorium. However, reviewed literature for assembly occupancies requires between 4 minutes 30 seconds and 6 minutes 24 seconds for total evacuation. Though, the calculated evacuation time is close to generally acceptable limits. It was noted that overcrowding and bottlenecks may be formed in some of the exit routes.

This paper will stimulate and increase research and industry concern for performance-based design of assembly-type facilities. This will be of significant value to designers, engineers, facilities managers, and owners in ensuring the safety of occupants in assembly-type facilities.

The purpose of this paper is to explore and critically review the existing literature on applications of Lean Methodology (LM) and Discrete-Event Simulation (DES) to improve resource utilization and patient experience in outpatient clinics. In doing, it is aimed to identify how to implement LM in outpatient clinics and discuss the advantages of integrating both lean and simulation tools towards achieving the desired outpatient clinics outcomes.

A theoretical background of LM and DES to define a proper implementation approach is developed. The search strategy of available literature on LM and DES used to improve outpatient clinic operations is discussed. Bibliometric analysis to identify patterns in the literature including trends, associated frameworks, DES software used, and objective and solutions implemented are presented. Next, an analysis of the identified work offering critical insights to improve the implementation of LM and DES in outpatient clinics is presented.

Critical analysis of the literature on LM and DES reveals three main obstacles hindering the successful implementation of LM and DES. To address the obstacles, a framework that integrates DES with LM has been recommended and proposed. The paper provides an example of such a framework and identifies the role of LM and DES towards improving the performance of their implementation in outpatient clinics.

This study provides a critical review and analysis of the existing implementation of LM and DES. The current roadblocks hindering LM and DES from achieving their expected potential has been identified. In addition, this study demonstrates how LM with DES combined to achieve the desired outpatient clinic objectives.

Properly allocating an organization's activities within a building is vital to reducing the relational complexity arising from process–environment interactions. Multiple relationships are mapped, and certain interferences are only identified after these have been processed. The method/software employed for this task is Mapping Activity Environment Allocation (MAEA). However, data input and interpretation of results depend on the usability conditions of the organization's agents. This paper presents MAEA's usability test results.

Test sessions and interviews were carried out with seven agents registered at a University Hospital. Participants were instructed to think aloud during its use, and immediately afterward, responded to semi-structured interviews. Test sessions were audio recorded and screen captured.

Participants found the software easy to use and pointed out valuable implications for professional and academic use. In addition to relationship, priority and parallelism data, customized visualizations were created, including organizational charts, flowcharts and activity flow routes on the floor plan.

MAEA's simplicity allows non-designers to conduct evidence-based assessments and decisions. It allows designers to test their proposals during the programming and outline proposal stages.

A more detailed definition of design requirements from the beginning increases the conditions to successfully achieve project goals.

The ability to map the allocation of activity-spaces in the pre-design phase of building architecture allows for early identification of interactions, aiding in the development of more robust project requirements during programming.

This paper aims to shed light on a current and important theme that has been gaining increasing importance for governments, society and companies: the greening of agricultural companies in developing countries. The research objective is to classify a Brazilian cotton seed processing company in the evolutionary stages of environmental management: reactive, preventive or proactive.

A case study was conducted in a Brazilian cotton seed processing company.

The main results are: the studied company is positioned in the preventive stage of environmental management; this company is investing in operational green practices; environmental management in this company is motivated by various factors aiming at an increased competitive advantage. Finally, it can be concluded that this company is looking for green opportunities towards the proactive environmental management stage.

This paper explores a scarce theme: green issues in the cotton seed processing industry.

Using computer simulation, this paper seeks to model the emergency care process in a hospital and evaluate the effects of some proposed changes to improve patient wait times in the process.

The paper is based upon a case study conducted at the hospital and uses historical data provided by the hospital to simulate the emergency care process.

The simulation results demonstrate that the changes proposed can shorten patient wait times in the emergency care process. The proposed changes involve adding another payment station and a new short‐stay ward in the process. Based upon the results, the paper supports the implementation of the changes proposed.

A couple of limitations are recognized in this paper. First, the simulation does not consider varying the capacity of resources and locations involved in the emergency care process. Second, the simulation does not consider patients by clinical disciplines in which they are treated.

The simulation results show that computer simulation can be an effective decision support tool in modelling the emergency care process and evaluating the effects of changes in the process. The results would be helpful to those who are considering reengineering and improving emergency care or other similar processes in hospitals.

Based upon a case study using real‐world data, this paper extends the line of studies on computer simulation in healthcare by considering not only patient wait times in the emergency care process but also some ways to improve patient wait times and their effects on the process.

There is a need to provide more effective learning experiences for higher education (HE) students in transdisciplinary contexts such as disasters and emergency management. While much has been written on the value of simulation exercises (SEs) for emergency management practitioners, research has focussed less on their value for HE students. The purpose of this paper is to identify how a practitioner-oriented framework for the design and use of SEs in emergency management is relevant to the HE context and how this framework may need to be adapted to support effective learning by HE students.

An interpretive approach based on a qualitative content analysis of 16 semi-structured interviews with emergency management practitioners and educators is used to enable an in-depth understanding of the social phenomena to be obtained.

The paper highlights that a framework for the design and use of SEs for emergency management practitioners is potentially valuable in the HE context but should be applied in a nuanced way.

The paper is based on a small number of interviews and future studies could usefully analyse a wider set of perspectives (e.g. students), using a variety of alternative methods (e.g. surveys), to further test and/or enrich the framework.

Insights from the paper can inform the design and use of SEs in the HE context with a view to supporting more effective learning that better prepares students to operate during disaster events when they enter the emergency management workforce.

This is the first paper that has investigated the value of a practitioner-oriented framework for the design and use of disaster SEs in the HE context. In so doing, the paper has highlighted how the dimensions of the framework apply in the HE context and has revealed other issues that need to be addressed to support effective learning by HE students.

This paper seeks to explain how negotiation simulation exercises can be used to develop management insights and theory in the areas of business continuity and international security.

An extended multi‐cultural communication model for disaster and emergency management simulation exercises and a nine‐stage international security negotiation simulation exercise are outlined.

The critical friendship group approach and the case study research approach can be used to provide insights into business continuity planning. Complex simulation exercises, underpinned by scenario planning, are useful with respect to providing training and educational support vis‐à‐vis crisis/disaster/emergency planning. A more focused approach to teaching the subject of negotiation, which takes into account the business‐international relations dimension and security in particular, will enable business and management students to link more firmly real world events with company‐government relations. This will contribute to the development of management theory and ensure that business continuity managers, employed by private sector and public sector organisations, utilise more fully simulation exercises than is the case at present.

Research needs to be undertaken into how academics and practitioners can work together in order to develop management simulation models that are methodologically different from those that exist at present, and which facilitate the theory building process.

By working closely with simulation designers, academics will be able to produce interdisciplinary/multidisciplinary crisis/disaster/emergency simulation exercises.

A nine‐stage negotiation simulation exercise is outlined which will allow management/business studies students to place business continuity planning within an international security context.

Facilitated by a decision support system tool, the purpose of this paper is to find the “best” allocated number of surgeons and medicine doctors that reduce patients' non‐value‐added time (NVAT) and total time in the system (TTS).

Interview and observation are first conducted in order to get general insights about (and to understand) the emergency ward of Sahlgrenska Hospital in Gothenburg (Sweden) and its value stream (flow). Then, time‐related data are collected by conducting time measurements empirically and through the triage database. The statistics of the collected empirical data represent the initial state of the system and are utilised as the input of ARENA^® simulation. A simulation scenario is designed by constructing a 3×3 table (= nine combinations) that contains a varying number of surgeons and medicine doctors allocated in the emergency ward. For each combination, 1,000 replications apply (=10 runs @ 100 replications). “Runs” are the cycles or how many times the simulation is executed, while “replications” refer to how many times a computer (automatically) repeats the simulation in a single execution. The simulation length of a single replication was set at 24 hours due to the fact that an emergency ward was always open. The selected feasible solution is the “best” combination of surgeons and medicine doctors that reduces the existing NVAT and TTS while ensuring that the resource utilisation is at a “reasonable” level (and did not exceed 100 per cent).

The simulation output indicates that the emergency ward may achieve considerable reduction in a patients' NVAT and total patients' time in the system by assigning three medicine doctors and three surgeons. This combination leads to (in average) 13 per cent reduction of NVAT while maintaining the TTS at approximately the same level.

An expanded simulation model with a higher level of complexity and ability to accommodate, e.g. cost of care, flow/layout reconfiguration would be greatly needed and is of interest. It would also be relevant to add greater flexibility by assigning more parameters in the simulation model (other than medicine doctor and surgeon).

Simulation can be considered as a valuable decision‐support tool in the adoption of lean in healthcare due to its flexibility in the sense that it is able to show the output (outcome) of various scenarios before any actual change is made. The results of our study present another side of the adoption of lean thinking besides layoff.

After the occurrence of a disaster, emergency supplies should arrive at disaster area in the shortest possible time. Therefore, it is of pivotal importance to speed up the preparation and scheduling process. In other words, only when the preparation process and scheduling process coordinate well, could the emergency supplies arrive at disaster area in time. Consequently, the purpose of this paper is to explore a method that can strengthen the coordination in various kinds of situations.

The paper first elaborates the preparation and scheduling process of emergency supplies in disasters. Then, it establishes a workflow simulation system of the emergency supplies preparation and scheduling based on Petri Net. Afterward, the paper proposes a simplified simulation system of emergency supplies preparation and scheduling which can be employed in actual emergency response. Finally, the paper takes China Lushan Earthquake for a case study.

By employing the simulation system proposed by this paper, decision makers can simulate the whole emergency supplies preparation and scheduling process, which can help them find a method that can optimize the current process. Specifically, by analyzing the simulation results, the government can obtain conclusions as follows. First, whether the preparation and scheduling process of emergency supplies can speed up or not. Second, which part of the process should be improved to realize the acceleration. Third, the workload of the staffs and experts. Fourth, whether it is necessary to add staffs or experts to work in parallel.

This paper proposes a system that can coordinate the preparation process and scheduling process of emergency supplies in disaster. Then, it employs the Petri Net based workflow model to do simulation. The simulation results show that the system designed is reasonable and can be used in practical decision making on the preparation and scheduling of emergency supplies.