Diagnosing patient flow issues in the emergency department: an Australasian hospital case study.

PURPOSE: This study investigates how a hospital can increase the flow of patients through its emergency department by using benchmarking and process improvement techniques borrowed from the manufacturing sector. DESIGN/METHODOLOGY/APPROACH: An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors. FINDINGS: High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management's commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident. RESEARCH LIMITATIONS/IMPLICATIONS: This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays. PRACTICAL IMPLICATIONS: This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow. ORIGINALITY/VALUE: This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department's value stream maturity.

Squaring the circle of healthcare supplies.

PURPOSE: The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement. DESIGN/METHODOLOGY/APPROACH: A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case. FINDINGS: The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information. RESEARCH LIMITATIONS/IMPLICATIONS: The small number of cases limits the generalisability of the findings at this time. PRACTICAL IMPLICATIONS: Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems. ORIGINALITY/VALUE: Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high-leverage solutions, supports the transfer of appropriate best practices even between organisations in dissimilar business and economic settings.