Search results

This study aims to provide healthcare managers with a meaningful synthesis of state of the art knowledge on error proofing strategies. The purpose is to provide a foundation for understanding medical error prevention, to support the strategic deployment of error proofing strategies, and facilitate the development and implementation of new error proofing strategies.

A diverse panel of 40 healthcare professionals evaluated the 150 error proofing strategies presented in the AHRQ research monograph using classification systems developed by earlier researchers. Error proofing strategies were ranked based on effectiveness, cost, and ease of implementation as well as based on their aim/purpose, i.e. elimination, replacement, facilitation, detection, or mitigation of errors.

The findings of this study include prioritized lists of error proofing strategies from the AHRQ manual based on the preferred characteristics (i.e. effectiveness, cost, ease of implementation) and underlying principles (i.e. elimination, replacement, facilitation, detections mitigation of errors) associated with each strategy.

The results of this study should be considered in light of certain limitations. The sample size of 40 panelists from hospitals, medical practices, and other healthcare related companies in the Gulf Coast region of the USA prevents a stronger generalization of the findings to other groups or settings. Future studies that replicate this approach, but employ larger samples, are appropriate. Through the use of public forums and expanded sampling, it may be possible to further validate research findings in this paper and to expand and build on the results obtained in this study.

Using the error‐proofing strategies identified provides a starting point for researchers seeking to better understand the impact of error proofing on healthcare services, the quality of those services and the potential financial ramifications. Further, the results presented enhance the strategic deployment of error proofing strategies by bringing to light some of the important factors that healthcare managers should consider when implementing error proofing solutions. Most notably, healthcare managers are encouraged to implement effective solutions, rather than those that are merely inexpensive and/or easy to implement, which is more often the case.

This study provides a much‐needed forum for sharing error‐proofing strategies, their effectiveness, and their implementation.

Learning outcomes are as follows: students will discover the importance of process orientation in management; students will determine the root cause of the problem by applying root cause analysis technique; students will identify the failure modes, analyze their effect, score them on a scale and prioritize the corrective action to prevent the failures; students will analyze the processes and propose error-proof system/s; and students will analyze organizational culture and ethical issues.

Purpose: This case study is intended as a class-exercise, for students to discover the importance of process-orientation in management, analyze the ethical dilemma in health care and to apply quality management techniques, such as five-why, root cause analysis, failure mode and effect analysis (FMEA) and error-proofing, in the management of the health-care and service industry. Design/methodology/approach: A voluntary reporting of a case of “radiation overdose” in a hospital’s radio therapy treatment unit, which led to an ethical dilemma. Consequently, a study was conducted to establish the causes of the incident and to develop a fail-proof system, to avoid recurrence. Findings: After careful analysis of the process-flow and the root causes, 25 potential failure modes were detected and the team had assigned a risk priority number (RPN) for each potential incident, selected the top ten RPNs and developed an error-proofing system to prevent recurrence. Subsequently, the improvement process was carried out for all the 25 potential incidents and a new control mechanism was implemented. The question of ethical dilemma remained unresolved. Research limitations/implications: Ishikawa diagram, FMEA and Poka-Yoke techniques require a multi-disciplinary team with process knowledge in identifying the possible root causes for errors, potential risks and also the possible error-proofing method/s. Besides, these techniques need frank discussions and agreement among team members on the efforts for the development of action plan, implementation and control of the new processes. Practical implications: Students can take the case data to identify root cause analysis and the RPN (RPN = possibility of detection × probability of occurrence × severity), to redesign the protocols, through systematic identification of the deficiencies of the existing protocols. Further, they can recommend quality improvement projects. Faculty can navigate the case session orientation, emphasizing quality management or ethical practices, depending on the course for which the case is selected.

MBA or PG Diploma in Management – health-care management, hospital administration, operations management, services operations, total quality management (TQM) and ethics.

Teaching Notes are available for educators only.

CSS 9: Operations and Logistics.

The quality of haemodialysis process is a prime concern in renal care. This study, carried out at one of the leading Hospitals in Central India, providing kidney care and dialysis, aims to identify areas in the haemodialysis unit needing special attention, to improve process quality and ensure better patient welfare.

The failure mode and effects analysis (FMEA) approach included: deciding haemodialysis process requirements, identifying potential causes of process failure and quantifying associated risk with every cause. Suitable actions were then implemented to reduce the occurrence and improving the controls, thereby reducing risk. The study used primary data generated and monitored over the period: July‐December 2008.

Adopting proper checklists for work monitoring, providing training to enhance patient and staff awareness; led to reduced process errors, mitigating overall risks, eventually resulting in effective patient care.

The quantification of risk associated with every likely failure is subjective.

The findings have a great significance in relation to kidney patients' welfare. The process areas which may get compromised are highlighted so that they get due attention. Error proofing makes the process “robust”, reducing its vulnerability.

This study provides a microscopic error proofing approach to haemodialysis process using a proven engineering tool, FMEA, ensuring quality improvement. This approach can also be extended to cover other hospital activities.

To provide an advanced product definition methodology based on quality function deployment (QFD) principles to identify minimize the risks of project failures due to failure to align with the voice of the business. The methodology was developed by reviewing current design product definition and QFD tools and then applied to a number of industry‐based design projects in academia as well as an in‐depth case study at one industry organization. The tool has been well accepted for its ease and approach in both industry and academic environments and already used to help guide project management. The methodology has only been applied to limited projects in industry and advancements and improvements are still being made. A new simple but powerful tool based on QFD principles that can be readily applied to a number of current design projects; in addition, it demonstrates how the QFD method can be expanded to non‐traditional domains and systems. This paper not only identifies current product development issues but also explores a practical and proven solution to error‐proof the design process.

This paper aims to investigate the application of lean construction (LC) techniques in reducing accidents in construction projects.

A quantitative approach was used to collect the required data using a questionnaire survey and descriptive analysis was used to analyse the collected data. The LC techniques that were investigated in this paper are related to the tools of the last planner system (LPS), increased visualisation (IV), 5S, error-proofing, daily huddle meetings (DHMs), first-run studies (FRS), continuous improvement (Kaizen) and accident investigation (5Whys).

The overall results indicated that LC techniques are poorly implemented in construction projects in the Gaza Strip. The top three LC tools used to reduce the causes of accidents in the Gaza construction projects were 5Whys, 5S and LPS, while the highest three LC techniques applied to reduce the causes of accidents that were applicable were cleaning the workplace and removing materials and machines that are not required; conducting accident investigation and root cause analysis programmes; and using safety signs and labels on site.

There is a lack of information and published studies regarding the links between LC and safety, especially in the Middle East. This paper is limited to the perceptions and geographical boundaries; therefore, it cannot be generalised. However, it could form the basis for useful comparison in the future. Triangulation research method could also be used in future research to minimise the bias and validate the conclusions.

The findings of this paper will stress professionals and construction companies in Gaza to reconsider their behaviour towards using LC techniques. The findings of this paper will aid them to shift their attention and resources towards including LC techniques in their plans to reduce the causes of accidents on construction sites.

The findings of this paper will encourage professionals and construction companies in Gaza to reconsider their behaviour towards using LC techniques. The findings will also aid them to shift their attention and resources towards including LC techniques in their plans to reduce and/or avoid the causes of accidents on construction.

Because of the lack of published works that are specific to the Middle East, the authors believe that the originality lies in the paper’s serious attempt to explore the application level of the LC concept to safety in this part of the world. This paper contributes to a better understanding of the applicability of LC techniques in terms of accidents reduction. Findings from this paper provide a clear picture of the current status of using LC techniques to reduce accidents in the Gazan construction projects which drive them to investigate the main barriers and try to overcome them.

In order to improve working methods, this study proposes a method for the analysis of medication incidents and the systematic planning of error‐proofing (EP) countermeasures, in the hope that it might contribute to a reduction in medication incidents.

In order to simplify the process of planning EP countermeasures, the following approaches are employed in this study. Improvement elements are extracted in order to plan EP countermeasures. The improvement elements that caused the error‐factor are called improvement objects, and the authors designed the extraction set of improvement objects. The authors correlated the improvement objects with recommended EP solutions. Finally, these parameters are collated. Moreover, these tools are summarized as a procedure for analysis of such incidents and for the creation of appropriate EP countermeasures.

Using this approach, this paper suggests four steps to reduce medical incidents. The proposed procedure can facilitate the planning of EP countermeasures and can reduce the rate of medical incidents.

It can be surmised that the proposed method can serve as a useful means for planning EP countermeasures and reducing the number of medication incidents. On the other hand, there are various countermeasures which can be planned for one incident by applying the proposed method.

The relationship between Error factors and improvement objects were then clarified through utilizing maps. Furthermore, a list that clearly indicates which EP solutions should be adopted for the improvement objects were suggested. There is, therefore, a significant difference between the proposed and the conventional method, and this makes it possible to plan the EP countermeasures easily.

There is little information existing about the spread of lean among Jordanian construction companies. Building on a report by Diekmann et al. (2004), this paper aims to perform a similar investigation among first-grade Jordanian construction companies to assess the extent of implementation of lean techniques.

For this purpose, a quantitative approach to measuring contractors’ conformance to lean practices was adopted. A survey of 61 contractors was conducted using both e-mails and personally delivered surveys that were completed on the spot. The results were analysed, and a practice value index, which indicates the level of implementation, was figured out for lean practices. In addition, an analysis of variance was conducted to determine whether there were differences among respondents from different construction fields.

The survey indicated that some procedures used by Jordanian contractors were consistent with lean construction practices. However, there was no proof that lean concepts were used on a company-wide basis. Furthermore, the survey revealed that the Jordanian construction industry lacks a “continuous improvement“ mentality, suffers from the absence of error proofing devices and provides minimal training at several levels of the organisation.

The outcomes of the study are valuable for contractors and developers of management practices, as it will encourage them to adopt lean construction holistically and identify features that are not exploited in the Jordanian construction industry.

Introduces a set of JIT house of matrices (collectively called here JIT quality matrices (JQM) and a matrix‐based procedure to analyse the results of strategic planning and implementation. Discusses the application of this matrix‐based approach to quantify and rank a set of chosen JIT tactics (called quality characteristics) at various points during its (JIT) implementation. The JQM and the matrix‐based procedure together define a measure of merits (a rating system) to prioritize a set of chosen JIT tactics. The rating system is derived from the same principles on which quality function deployment (QFD) was based. By providing the manufacturing and strategic development teams with a dynamic rating system, it has been possible to measure the progress and strategize a new line of JIT tactics, whenever the company′s situation or priority changes. With JQM, it is possible to realize an incorporation of continuous improvements (CPI) into the JIT implementation process. Inclusion of CPI is an inherent part of this procedure requiring no additional effort. The benefit of integrating CPI with JQM is manifested by its ability to reconfigure the chosen implementation strategies dynamically. The procedure allows the strategic team, at the start (based on its rating), to select an optimal mix of JIT tactics. Later, anytime during its implementation cycle, the team can monitor the process dynamically by analysing a quality characteristics trade‐off to see whether a mid‐course correction or change in the line of JIT tactics is necessary. This enables the planning team to sustain a series of successful planning activities throughout the strategic implementation process. This also prevents the manufacturing and strategic teams from unknowingly making any possible implementation mistakes.

It has not been enough to include “quality dimensions” into a product or a service and expect the outcome to be world‐class. Total value signifies a set of multidimensional measures towards realizing a competitive product (goods or services) that the customers would like and are willing to pay a premium price for. A “quality dimensions” set is one of its (total value) multidimensional measures. Such multidimensional value considerations would be vital for a company in maintaining a competitive edge in today’s global and rapidly changing marketplace. The first question is why a “quality dimensions” set has not been enough? The second question is what are those multidimensional sets of measures that make‐up this total value content? The last question is how to determine a cumulative total value‐index that accounts for these sets of measures so that an organization could use this total value‐index to optimize its product realization process and thereby control its (an organization’s) degree of competitiveness. The paper attempts to answer these questions.

The various quality improvement (QI) frameworks and maturity models described in the health services literature consider some aspects of QI while excluding others. This paper aims to present a concerted attempt to create a quality improvement maturity model (QIMM) derived from holistic principles underlying the successful implementation of system-wide QI programmes.

A hybrid methodology involving a systematic review (Phase 1) of over 270 empirical research articles and books developed the basis for the proposed QIMM. It was followed by expert interviews to refine the core constructs and ground the proposed QIMM in contemporary QI practice (Phase 2). The experts included academics in two academic conferences and 59 QI managers from the New Zealand health-care system. In-depth interviews were conducted with QI managers to ascertain their views on the QIMM and its applicability in their respective health organisations (HOs).

The QIMM consists of four dimensions of organisational maturity, namely, strategic, process, supply chain and philosophical maturity. These dimensions progress through six stages, namely, identification, ad-hoc, formal, process-driven, optimised enterprise and finally a way of life. The application of the QIMM by the QI managers revealed that the scope of QI and the breadth of the principles adopted by the QI managers and their HOs in New Zealand is limited.

The importance of QI in health systems cannot be overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality.

This paper contributes new knowledge by presenting a maturity model with an integrated set of quality principles for HOs and their extended supply networks.