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A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective.

A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process.

Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process.

The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender.

The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings.

Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.

The purpose of the paper is to develop an integrated framework for performance management of healthcare services.

This study develops a performance management framework for healthcare services using a combined analytic hierarchy process (AHP) and logical framework (LOGFRAME). The framework is then applied to the intensive care units of three different hospitals in developing nations. Numerous focus group discussions were undertaken, involving experts from the specific area under investigation.

The study reveals that a combination of outcome, structure and process‐based critical success factors and a combined AHP and LOGFRAME‐based performance management framework helps manage performance of healthcare services.

The proposed framework could be practiced in hospital‐based healthcare services.

The conventional approaches to healthcare performance management are either outcome‐based or process‐based, which cannot reveal improvement measures appropriately in order to assure superior performance. Additionally, they lack planning, implementing and evaluating improvement projects that are identified from performance measurement. This study presents an integrated approach to performance measurement and implementing framework of improvement projects.

The purpose of this paper is to develop a comprehensive framework for improving intensive care unit performance.

The study introduces a quality management framework by combining cause and effect diagram and logical framework. An intensive care unit was identified for the study on the basis of its performance. The reasons for not achieving the desired performance were identified using a cause and effect diagram with the stakeholder involvement. A logical framework was developed using information from the cause and effect diagram and a detailed project plan was developed. The improvement projects were implemented and evaluated.

Stakeholders identified various intensive care unit issues. Managerial performance, organizational processes and insufficient staff were considered major issues. A logical framework was developed to plan an improvement project to resolve issues raised by clinicians and patients. Improved infrastructure, state‐of‐the‐art equipment, well maintained facilities, IT‐based communication, motivated doctors, nurses and support staff, improved patient care and improved drug availability were considered the main project outputs for improving performance. The proposed framework is currently being used as a continuous quality improvement tool, providing a planning, implementing, monitoring and evaluating framework for the quality improvement measures on a sustainable basis.

The combined cause and effect diagram and logical framework analysis is a novel and effective approach to improving intensive care performance. Similar approaches could be adopted in any intensive care unit.

The paper focuses on a uniform model that can be applied to most intensive care units.

The purpose of this study is to develop a performance measurement model for service operations using the analytic hierarchy process approach.

The study reviews current relevant literature on performance measurement and develops a model for performance measurement. The model is then applied to the intensive care units (ICUs) of three different hospitals in developing nations. Six focus group discussions were undertaken, involving experts from the specific area under investigation, in order to develop an understandable performance measurement model that was both quantitative and hierarchical.

A combination of outcome, structure and process‐based factors were used as a foundation for the model. The analyses of the links between them were used to reveal the relative importance of each and their associated sub factors. It was considered to be an effective quantitative tool by the stakeholders.

This research only applies the model to ICUs in healthcare services.

Performance measurement is an important area within the operations management field. Although numerous models are routinely being deployed both in practice and research, there is always room for improvement. The present study proposes a hierarchical quantitative approach, which considers both subjective and objective performance criteria.

This paper develops a hierarchical quantitative model for service performance measurement. It considers success factors with respect to outcomes, structure and processes with the involvement of the concerned stakeholders based upon the analytic hierarchy process approach. The unique model is applied to the ICUs of hospitals in order to demonstrate its effectiveness. The unique application provides a comparative international study of service performance measurement in ICUs of hospitals in three different countries.

There is an increasing need of a model for the process‐based performance measurement of multispecialty tertiary care hospitals for quality improvement. Analytic hierarchy process (AHP) is utilized in this study to evolve such a model. Each step in the model was derived by group‐discussions and brainstorming sessions among experienced clinicians and managers. This tool was applied to two tertiary care teaching hospitals in Barbados and India. The model enabled identification of specific areas where neither hospital performed very well, and helped to suggest recommendations to improve those areas. AHP is recommended as a valuable tool to measure the process‐based performance of multispecialty tertiary care hospitals.

The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance.

This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps – problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case‐study environment to three acute healthcare services (Operating Room utilisation, Accident and Emergency, and Intensive Care) in order to demonstrate its effectiveness.

The paper finds that LFA is an effective method of quality management of hospital‐based healthcare services.

This study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended.

The proposed model can be implemented in hospital‐based healthcare services in order to improve performance. It may also be applied to other services.

Quality improvement in healthcare services is a complex and multi‐dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services.

The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically.

This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, Accident and emergency, and Intensive care) in order to demonstrate its effectiveness.

The paper finds that LFA is an effective method of quality management of hospital‐based healthcare services.

This paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well.

In the paper the proposed model can be practised in hospital‐based healthcare services for improving performance.

The paper shows that quality improvement in healthcare services is a complex and multi‐dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies.

Process improvement initiatives, such as Lean, Six Sigma and Lean Six Sigma, typically have common characteristics that are carried through projects. Whilst a project’s performance is an important determinant of the successful implementation of continuous improvement (CI) initiatives, its failure can undermine the impact of any CI initiative on business performance. As a result, an understanding of the reasons of process improvement project failures is crucial. The purpose of this paper is to present the results of a pilot survey highlighting the most common reasons for process improvement project failures.

This paper presents a pilot survey of 42 Brazilian manufacturing specialists who have been involved in process improvement projects. The participants of this survey were Six Sigma Master Black Belts, Black Belts, Green Belts and Six Sigma champions from manufacturing companies in Brazil. The survey questionnaire was piloted with five experts in the field in order to ensure that the questions were valid and technically sound.

The execution of Six Sigma projects in organizations results in a moderate rate of project failures. These failures can cost organizations several millions of dollars especially within the context of larger organizations. The main reasons for project failure, as cited by the specialists include: resistance to change, lack of commitment and support from top management and incompetent teams.

The authors report the findings from a pilot survey having a limited sample size. Moreover, the data have been collected from one country and primarily from large manufacturing companies.

To the best of the authors’ knowledge, this is the first empirical study looking into the reasons for process improvement project failures. The authors argue that if the top reasons for such failures are understood, a framework can be developed in the future that can mitigate the chance of project failures during project execution. This could potentially lead to significant savings to the bottom-line of many organizations.

The purpose of this paper is to develop a benchmarking framework for assessing the performance of the distribution models adopted by the local branches of National Health Services (NHSs) for delivering health technologies to patients at a local level, and to derive prescriptions for enhancing design and optimal management of the distribution models.

The authors focussed the study on the distribution of absorbent devices for incontinence, adopting the analytic hierarchy process as a tool for developing the benchmarking framework. The authors applied the framework to the context of the Italian NHS with respect to the Lombard Local Health Authorities, assessing their performance in terms of operational efficiency and service quality.

The developed framework constitutes a novel contribution, and it allows for generating prescriptions. Through its application to the context studied the authors found that a “one-size-fits-all” distribution model cannot be proposed, as regards both efficiency and effectiveness, since process standardization does not provide benefits or savings in all contexts. Rather, a total landed cost approach in the evaluation of the distribution practices must be adopted.

This paper offers to managers and decision makers an innovative approach to the design of distribution models for health technologies. It provides policy makers with prescriptions to develop regulations fostering a comprehensive view of the factors for an optimal health technologies distribution at a local level.

Given the dearth of scientific publications focussed on the distribution at the local level of health technologies, this paper significantly contributes to the existing body of knowledge and it offers an innovative framework which can be proficiently replicated in manifold contexts.