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Article
Publication date: 1 February 2013

Mehmet Tolga Taner, Bulent Sezen and Kamal Atwat

This paper aims to compare two diagnostic performance measures, i.e. signal‐to‐noise ratio (S/N ratio) and partial area under receiver operating characteristic curves (pAUC). It…

Abstract

Purpose

This paper aims to compare two diagnostic performance measures, i.e. signal‐to‐noise ratio (S/N ratio) and partial area under receiver operating characteristic curves (pAUC). It proposes the use of S/N ratio rather than pAUC for establishing optimal cut‐off point for diagnostic biomarkers.

Design/methodology/approach

This paper discusses the properties, uses, advantages and shortcomings of the two performance measures, namely the partial area under receiver operating characteristic curve (pAUC) and Taguchi's signal‐to‐noise (S/N) ratio. The benefits of S/N ratio have been illustrated in a sample of four biomarkers, each having five cut‐off points. The S/N ratio is compared to the pAUC index. The SAS software is employed to calculate pAUC and AUC.

Findings

This paper shows that S/N ratio can be used as a measure of diagnostic accuracy. The cut‐off point with the highest S/N ratio is the optimal cut‐off point for the biomarker. The proposed method has the advantages of being easier, more practical and less costly than that of pAUC.

Practical implications

This paper includes implications for the development of a more practical, equally powerful and less costly means of measuring clinical accuracy thereby reducing the costs and risks resulting from wrong selection of cut‐off point can be decreased.

Originality/value

This paper supports suggestions in the recent literature to replace pAUC with a new, more meaningful index.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 30 September 2013

Mehmet Tolga Taner

The article's aim is to focus on the application of Six Sigma to minimise intraoperative and post-operative complications rates in a Turkish public hospital cataract surgery unit…

1280

Abstract

Purpose

The article's aim is to focus on the application of Six Sigma to minimise intraoperative and post-operative complications rates in a Turkish public hospital cataract surgery unit.

Design/methodology/approach

Implementing define-measure-analyse-improve and control (DMAIC) involves process mapping, fishbone diagrams and rigorous data-collection. Failure mode and effect analysis (FMEA), pareto diagrams, control charts and process capability analysis are applied to redress cataract surgery failure root causes.

Findings

Inefficient skills of assistant surgeons and technicians, low quality of IOLs used, wrong IOL placement, unsystematic sterilisation of surgery rooms and devices, and the unprioritising network system are found to be the critical drivers of intraoperative-operative and post-operative complications. Sigma level was increased from 2.60 to 3.75 subsequent to extensive training of assistant surgeons, ophthalmologists and technicians, better quality IOLs, systematic sterilisation and air-filtering, and the implementation of a more sophisticated network system.

Practical implications

This article shows that Six Sigma measurement and process improvement can become the impetus for cataract unit staff to rethink their process and reduce malpractices. Measuring, recording and reporting data regularly helps them to continuously monitor their overall process and deliver safer treatments.

Originality/value

This is the first Six Sigma ophthalmology study in Turkey.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 8
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 13 February 2007

Mehmet Tolga Taner and Bulent Sezen

The aim of this article is to show how Taguchi methods can be applied to health care to improve the quality of medical images. Quality is often integrated with the performance and…

Abstract

Purpose

The aim of this article is to show how Taguchi methods can be applied to health care to improve the quality of medical images. Quality is often integrated with the performance and parameters of the design of medical applications. Many imaging methods can be designed by setting the correct combination of parameters and estimating the contribution of individual quality influencing factors by means of incorporating parameter design and orthogonal arrays. The performance of any imaging equipment can be measured by signal‐to‐noise ratio. This inherent index can give a sense of how close the performance is to the ideal.

Design/methodology/approach

Data were collected from a database of 82 diagnostic thoracic computed tomography (CT) scans. Signal‐to‐noise ratios (S/N) were calculated.

Findings

Given the S/N's, the best CT level was found to be level 4.

Originality/value

To reduce bias resulting from the observer's readings, robust equipments should be designed incorporating Taguchi's experimental design. Further work is needed to establish imaging protocols and new hardware design.

Details

Leadership in Health Services, vol. 20 no. 1
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 6 February 2009

Mehmet Tolga Taner and Bulent Sezen

The aim of this paper is to propose a new, objective and consistent method for the calculation of the diagnostic efficiency in medical applications.

625

Abstract

Purpose

The aim of this paper is to propose a new, objective and consistent method for the calculation of the diagnostic efficiency in medical applications.

Design/methodology/approach

In this study, a hybrid method of Taguchi and DEA is proposed. This method reflects the diversity of inputs and outputs by incorporating the stepwise application of sensitivity, specificity, leveling threshold, and efficiency score. A hypothetical case study is given which involves eight readers of X‐ray films in clinical radiology.

Findings

The selected pairs of sensitivity and specificity yielded two efficient readers. After super efficiency analysis, Reader 6 is found to be the most efficient reader.

Originality/value

The paper presents a new, objective and consistent method for the calculation of the diagnostic efficiency in medical applications.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 1
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 19 June 2007

Mehmet Tolga Taner, Bülent Sezen and Jiju Antony

Delays, measurement and medical errors and variability often undermine the delivery of safe, effective patient care. However, it is possible to minimize them by applying…

12236

Abstract

Purpose

Delays, measurement and medical errors and variability often undermine the delivery of safe, effective patient care. However, it is possible to minimize them by applying six‐sigma. This methodology aims to focus on the root causes of healthcare problems, analyses them by flowcharts and fishbone diagrams and produces near‐perfect healthcare services.

Design/methodology/approach

Five case studies in healthcare are designed to show the performance improvement accomplished by six sigma. The DMAIC (Define‐Measure‐ Analyse‐Improve‐Control), i.e. a road‐map for problem solving and service/process improvement, is implemented.

Findings

The findings in this paper show that the healthcare organization has a greater ability to address challenges across the system. Resource utilization has been maximized. Fewer redundancies, waste and rework have been observed. Bottle‐necks related to scheduling have diminished. Working conditions have improved for healthcare personnel. Increased patient and physician satisfaction as well as cost savings have been achieved. These will enable the healthcare organization to increase its market share in the long run.

Originality/value

The application of six sigma in healthcare services is relatively new topic and very little research has been performed in this area. The paper will be extremely valuable to researchers and practitioners who are currently engaged in six sigma research.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 27 April 2012

Mehmet Tolga Taner, Bulent Sezen and Kamal M. Atwat

This paper aims to apply the Six Sigma methodology to improve workflow by eliminating the causes of failure in the medical imaging department of a private Turkish hospital.

1899

Abstract

Purpose

This paper aims to apply the Six Sigma methodology to improve workflow by eliminating the causes of failure in the medical imaging department of a private Turkish hospital.

Design/methodology/approach

Implementation of the design, measure, analyse, improve and control (DMAIC) improvement cycle, workflow chart, fishbone diagrams and Pareto charts were employed, together with rigorous data collection in the department. The identification of root causes of repeat sessions and delays was followed by failure, mode and effect analysis, hazard analysis and decision tree analysis.

Findings

The most frequent causes of failure were malfunction of the RIS/PACS system and improper positioning of patients. Subsequent to extensive training of professionals, the sigma level was increased from 3.5 to 4.2.

Research limitations/implications

The data were collected over only four months.

Practical implications

Six Sigma's data measurement and process improvement methodology is the impetus for health care organisations to rethink their workflow and reduce malpractice. It involves measuring, recording and reporting data on a regular basis. This enables the administration to monitor workflow continuously.

Social implications

The improvements in the workflow under study, made by determining the failures and potential risks associated with radiologic care, will have a positive impact on society in terms of patient safety. Having eliminated repeat examinations, the risk of being exposed to more radiation was also minimised.

Originality/value

This paper supports the need to apply Six Sigma and present an evaluation of the process in an imaging department.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 May 2009

Mehmet Tolga Taner and Bulent Sezen

The purpose of this study is to show how the principles of Six Sigma can be applied to the high turnover problem of doctors in medical emergency services and paramedic backup.

2319

Abstract

Purpose

The purpose of this study is to show how the principles of Six Sigma can be applied to the high turnover problem of doctors in medical emergency services and paramedic backup.

Design/methodology/approach

Six Sigma's define‐measure‐analyse‐improve‐control (DMAIC) is applied for reducing the turnover rate of doctors in an organisation operating in emergency services. Variables of the model are determined. Explanatory factor analysis, multiple regression, analysis of variance (ANOVA) and Gage R&R are employed for the analysis.

Findings

Personal burnout/stress and dissatisfaction from salary were found to be the “vital few” variables. The organisation took a new approach by improving its initiatives to doctors' working conditions. Sigma level of the process is increased. New policy and process changes have been found to effectively decrease the incidence of turnover intentions. The improved process is gained, standardised and institutionalised.

Originality/value

This study is one of the few papers in the literature that elaborates the turnover problem of doctors working in the emergency and paramedic backup services.

Details

International Journal of Health Care Quality Assurance, vol. 22 no. 3
Type: Research Article
ISSN: 0952-6862

Keywords

Content available
Article
Publication date: 4 February 2014

Keith Hurst

832

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 1
Type: Research Article
ISSN: 0952-6862

Content available
Article
Publication date: 4 February 2014

91

Abstract

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 1
Type: Research Article
ISSN: 0952-6862

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