Blockchain-based solution for COVID-19 vaccine waste reduction.

Coronavirus 2019 (COVID-19) vaccines have been produced on a large scale since 2020. However, large-scale vaccine production has led to two forms of waste; namely, overproduction and underutilization. Most of today's systems and technologies used to manage waste data related to COVID-19 vaccines fall short of providing transparency, traceability, accountability, trust, and security features. In this paper, we address the problem of COVID-19 vaccines waste due to their overproduction and underutilization. We propose a blockchain-based solution that is composed of five phases: registration, commitment; production and delivery; consumption; and waste assessment. These phases make up the complete life cycle of a COVID-19 vaccine, and they are governed by several smart contracts to ensure accountability of all the actions taken by the involved entities and reduce any excessive waste caused by overproduction, overordering, or underconsumption. We ensure security, traceability, and data provenance by recording all actions through smart contracts in the form of events on an immutable ledger. We utilize decentralized storage such as the InterPlanetary File System (IPFS) to reduce the costs posed by large-sized file storage when stored on-chain. We present algorithms that describe the logic behind our developed smart contracts. We test and validate the functionalities of our proposed solution. We conduct security, cost, and scalability analyses to show that our solution is affordable, scalable, and secure. We compare our solution with the existing blockchain-based solutions to show its novelty and superiority. The smart contract code is made publicly available on GitHub.

The Impact of Healthcare 4.0 on the Healthcare Service Quality: A Systematic Literature Review.

Healthcare 4.0 is inspired by Industry 4.0 and its application has resulted in a paradigmatic shift in the field of healthcare. However, the impact of this digital revolution in the healthcare system on healthcare service quality is not known. The purpose of this study is to examine the impact of healthcare 4.0 on healthcare service quality. This study used the systematic literature review methodology suggested by Transfield et al. to critically examine 67 articles. The impact of healthcare 4.0 is analyzed in-depth in terms of the interpersonal, technical, environmental, and administrative aspect of healthcare service quality. This study will be useful to hospitals and other stakeholders to understand the impact of healthcare 4.0 on the service quality of health systems. Besides, this study critically analyses the existing literature and identifies research areas in this field and hence will be beneficial to researchers. Though there are few literature reviews in healthcare 4.0, this is the first study to examine the impact of Healthcare 4.0 on healthcare service quality.

Critical Success Factors for Successful Implementation of Healthcare 4.0: A Literature Review and Future Research Agenda.

The digitization of healthcare services is a major shift in the manner in which healthcare services are offered and managed in the modern era. The COVID-19 pandemic has speeded up the use of digital technologies in the healthcare sector. Healthcare 4.0 (H4.0) is much more than the adoption of digital tools, however; going beyond that, it is the digital transformation of healthcare. The successful implementation of H 4.0 presents a challenge as social and technical factors must be considered. This study, through a systematic literature review, expounds ten critical success factors for the successful implementation of H 4.0. Bibliometric analysis of existing articles is also carried out to understand the development of knowledge in this domain. H 4.0 is rapidly gaining prominence, and a comprehensive review of critical success factors in this area has yet to be conducted. Conducting such a review makes a valuable contribution to the body of knowledge in healthcare operations management. Furthermore, this study will also help healthcare practitioners and policymakers to develop strategies to manage the ten critical success factors while implementing H 4.0.

An assessment of quality costs within electronic adverse incident reporting and recording systems: a case study.

PURPOSE: There are three main objectives of the research presented in this paper: to examine the challenges of using an electronic adverse incident recording and reporting system; to assess the method of using a prevention appraisal and failure model; and to identify the benefits of using quality costs in conjunction with incident reporting systems. DESIGN/METHODOLOGY/APPROACH: Action diary, documentation and triangulation are used to obtain an understanding of the challenges and critical success factors in using quality costing within an adverse incident recording and reporting system. FINDINGS: The paper provides healthcare professionals with the critical success factors for developing quality costing into an electronic adverse incident recording and reporting system. This approach would provide clinicians, managers and directors with information on patient safety issues following the effective use of data from an electronic adverse incident reporting and recording system. ORIGINALITY/VALUE: This paper makes an attempt of using a prevention, appraisal and failure model (PAF) within a quality-costing framework in relation to improving patient safety within an electronic adverse incident reporting and recording system.

An exploratory study into the use of Lean Six Sigma to reduce medication errors in the Norwegian public healthcare context.

PURPOSE: Medication errors are a significant cause of injury in Norwegian hospitals. The purpose of this study is to explore how Lean Six Sigma (LSS) has been used in the Norwegian public health-care context to reduce medication errors. DESIGN/METHODOLOGY/APPROACH: A mixed method approach was used to gather data from participants working in the four regions served by the Norway health authorities. A survey questionnaire was distributed to 38 health-care practitioners and semi-structured interviews were conducted with 12 health-care practitioners. FINDINGS: The study finds that the implementation of LSS in the Norwegian public health-care context is still in its infancy. This is amidst several challenges faced by Norwegian hospitals such as the lack of top-management support, lack of LSS training and coaching and a lack of awareness around the benefits of LSS in health care. RESEARCH LIMITATIONS/IMPLICATIONS: Because of the large geographical area, it was difficult to reach participants from all health regions in Norway. However, the study managed to assess the current status of LSS implementation through the participants' perspectives. This is a fruitful area for future research whereby an action research methodology could be used. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first empirical study into the use of LSS methodology in reducing medication errors. In addition, this study is valuable for health-care practitioners and professionals as a guideline to achieve the optimal benefit of LSS implementation to reduce medication errors.

Can Lean Six Sigma be used to reduce medication errors in the health-care sector?

Purpose The purpose of this paper is to present the implementation of Lean Six Sigma (LSS) to reduce medication errors, by using four case examples. The paper will also suggest appropriate Lean and Sigma tools to improve the medication process. Design/methodology/approach The authors critically analyze four case examples that used LSS projects, to demonstrate the approach, benefits, success factors and lessons learnt. Findings LSS is a powerful process improvement methodology that could be applied by health-care sectors to reduce medication errors, increase patient safety and reduce operational costs. Common Lean and Six Sigma tools play a significant role in improving and sustaining the medication process. Practical implications It is necessary for the project team to select the most appropriate LSS tools to address medication process problems. Adoption of a LSS roadmap could help health-care organizations in the successful implementation of LSS. Originality/value The paper is valuable for health-care professionals seeking to reduce errors in the medication process or other processes that need to be improved.

Improving patient safety and quality: what are the challenges and gaps in introducing an integrated electronic adverse incident and recording system within health care industry?

PURPOSE: The purpose of this paper is to present the challenges and gaps in using an electronic adverse incident recording and reporting system from a commercial supplier to an acute health care setting. DESIGN/METHODOLOGY/APPROACH: The paper used action diary, documentation and triangulation to obtain an understanding of the challenges and gaps. FINDINGS: The paper provides health care with further understanding of the complexity, challenges and gaps of using an electronic adverse incident recording system to improve patient safety. ORIGINALITY/VALUE: This paper explains the important views of clinicians and managers in relation to improving patient safety by using an electronic adverse incident management system.

Comparing public and private hospital care service quality in Turkey.

PURPOSE: The aim of this article is to examine the differences in service quality between public and private hospitals in Turkey. DESIGN/METHODOLOGY/APPROACH: This study applies the principles behind the SERVQUAL model and compares Turkey's public and private hospital care service quality. The study sample contains a total of 200 outpatients. Through the identification of 40 service quality indicators and the use of a Likert-type scale, two questionnaires containing 80-items was developed. The former measured patients' expectations prior to admission to public and private hospital service quality. The latter measured patient perceptions of provided service quality. FINDINGS: The results indicate that inpatients in the private hospitals were more satisfied with service quality than those in the public hospitals. The results also suggest that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive services than their counterparts in the public hospitals. Finally, the results show that satisfaction with doctors and reasonable costs is the biggest determinants of service quality in the public hospitals. ORIGINALITY/VALUE: Consequently, SERVQUAL, as a standard instrument for measuring functional service quality, is reliable and valid in a hospital environment.

Applying Taguchi methods to health care.

PURPOSE: The aim of this article is to show how Taguchi methods can be applied to health care. DESIGN/METHODOLOGY/APPROACH: The quadratic loss function is at the heart of Taguchi methods. It is a powerful motivator for a quality strategy and can be used to adequately model the loss to society in health care. It also establishes a relationship between cost and variability. Therefore, it can be integrated with the performance and parameters of the design of medical applications. Signal-to-noise ratios give a sense of how close is the performance to the ideal. By maximizing the signal-to-noise ratio, quality-engineering activities can be aimed at identifying near-optimum levels of factors and making quality equal to zero. FINDINGS: This article shows that, when the patients' requirements are consistently met, lower losses can provide an impetus to improve patient satisfaction. ORIGINALITY/VALUE: The article outlines areas in health care where Taguchi methods can easily be applied.

Determining positivity of alcohol abuse by Taguchi methods.

PURPOSE: Aims to establish the critical score and screening accuracy of the CAGE Questionnaire in three treatment settings--primary health care, walk-in (triage) clinic and the emergency room. DESIGN/METHODOLOGY/APPROACH: Taguchi methods are applied to three screens of the CAGE questionnaire. FINDINGS: Analysis of the sensitivity and specificity data of three CAGE screens by leveling factor (p'), signal-to-noise ratios (S/N, SS/N) and their dependent relation resulted in critical CAGE scores of 1, 1 and 2; and high screening accuracy levels of 98.44, 97.20 and 94.92 percent, respectively. The illustrated method yielded excellent (> or = 95 percent) screening accuracy values for primary health care, emergency room and walk-in clinic patients. ORIGINALITY/VALUE: To reduce misclassification rates of alcohol abuse, screening systems should concentrate first on developing ways to standardize protocols. Further work is needed to establish high screening accuracy in other clinical settings, and particularly in those at risk of alcohol abuse in the general population.

Can Six Sigma be the "cure" for our "ailing" NHS?

PURPOSE: The purpose of this research is to analyse whether Six Sigma business strategy can be used to improve the financial and operational performance of the NHS. The paper will also look at some of the major challenges and barriers in the implementation of this powerful process improvement strategy within the healthcare sector. DESIGN/METHODOLOGY/APPROACH: This paper discusses whether Six Sigma DMAIC methodology can be a useful and disciplined approach to tackle process- and quality-related problems in the NHS. FINDINGS: The paper presents some key findings from other researchers in the field, followed by some comments on whether Six Sigma is a useful approach to be considered by the NHS for cost reduction and defect reduction strategies. ORIGINALITY/VALUE: The paper illustrates the point that Six Sigma is not confined just to manufacturing industry, rather it is equally applicable to service industry, especially the healthcare and financial sectors. The application of Six Sigma in the UK health sector is relatively new and the purpose of the paper is to increase the awareness of this powerful business strategy in healthcare discipline.

A simple, semi-prescriptive self-assessment model for TQM.

This article presents a simple, semi-prescriptive self-assessment model for use in industry as part of a continuous improvement program such as Total Quality Management (TQM). The process by which the model was constructed started with a review of the available literature in order to research TQM success factors. Next, postal surveys were conducted by sending questionnaires to the winning organisations of the Baldrige and European Quality Awards and to a preselected group of enterprising UK organisations. From the analysis of this data, the self-assessment model was constructed to help organisations in their quest for excellence. This work confirmed the findings from the literature, that there are key factors that contribute to the successful implementation of TQM and these have different levels of importance. These key factors, in order of importance, are: effective leadership, the impact of other quality-related programs, measurement systems, organisational culture, education and training, the use of teams, efficient communications, active empowerment of the workforce, and a systems infrastructure to support the business and customer-focused processes. This analysis, in turn, enabled the design of a self-assessment model that can be applied within any business setting. Further work should include the testing and review of this model to ascertain its suitability and effectiveness within industry today.

Reassessment of the CAGE questionnaire by ROC/Taguchi methods.

OBJECTIVES: The clinical assessment efficiency of the CAGE questionnaire for alcohol abuse based on diagnostic accuracy has not been fully established to date because of the varied and inconclusive gold standards used as diagnostic criteria. CAGE has also been highlighted to miss almost half of the risk-drinkers due to the use of inadequetly set criteria for the positive recognition of alcohol abuse. This study aims to establish the diagnostic accuracy of CAGE at different treatment settings. METHODS: A hybrid of the receiver operating characteristic (ROC) and the Taguchi method was used, as this approach proved to evaluate the diagnostic performance and accuracy in hypothetical clinical settings. Data were used from three cross-clinical treatment settings, i.e., general medicine outpatients, medical inpatients, and psychiatric inpatients, and analyzed by means of a step-wise application of managable number of statistical indices such as the area under the ROC curve (AUC), leveling factor (p'), and signal-to-noise ratios (S/N; standardized S/N [SS/N]). RESULTS: The selected settings yielded similar AUCs but portrayed different trade-offs on the ROC curves signaling the presence of different critical CAGE scores. Analysis of the sensitivity and specificity data of i, ii, iii by p', S/N, SS/N and their dependent relation resulted in the critical CAGE scores of 1,1, and 2; and high diagnostic accuracy levels of 76.84 percent, 86 percent, and 76.84 percent, respectively. CONCLUSIONS: By setting these critical CAGE scores as the minimum detection levels of alcohol abuse, early intervention before the onset of serious alcohol-related problems is possible. This will decrease the health-care costs of the patient and, in addition, reduce the psychological and social burdens inherent to alcohol abuse both on the patient and society. Having its critical scores reliably identified and diagnostic accuracy fully determined, CAGE can now improve the detection rate of problem drinking individuals substantially.