Integrated lean six sigma approach for patient flow improvement in hospital emergency department

This research aims to develop an Integrated Lean Six Sigma approach to investigate and resolve the patient flow problems in hospital emergency departments. It was proposed that the voice of the customer and the voice of the process should be considered simultaneously to investigate the current process of patient flow. Statistical analysis, visual process mapping with A3 problem solving sheet, and cause and effect diagrams have been used to identify the major patient flow issues. This research found that engaged frontline workers, long-term leadership obligation, an understanding of patients' requirements and the implementation of a systematic integration of lean strategies could continuously improve patient flow, health care service and growth in the emergency departments.

Integrated Lean Six Sigma approach for patient flow improvement in hospital emergency department

Because of increased competition between healthcare providers, higher customer expectations, stringent checks on insurance payments and new government regulations, it has become vital for healthcare organisations to enhance the quality of the care they provide, to increase efficiency, and to improve the cost effectiveness of their services. Consequently, a number of quality management concepts and tools are employed in the healthcare domain to achieve the most efficient ways of using time, manpower, space and other resources. Emergency departments are designed to provide a high-quality medical service with immediate availability of resources to those in need of emergency care. The challenge of maintaining a smooth flow of patients in emergency departments is a global problem. This study attempts to improve the patient flow in emergency departments by considering Lean techniques and Six Sigma methodology in a comprehensive conceptual framework. The proposed research will develop a systematic approach through integration of Lean techniques with Six Sigma methodology to improve patient flow in emergency departments. The results reported in this paper are based on a standard questionnaire survey of 350 patients in the Emergency Department of Aseer Central Hospital in Saudi Arabia. The results of the study led us to determine the most significant variables affecting patient satisfaction with patient flow, including waiting time during patient treatment in the emergency department; effectiveness of the system when dealing with the patient’s complaints; and the layout of the emergency department. The proposed model will be developed within a performance evaluation metric based on these critical variables, to be evaluated in future work within fuzzy logic for continuous quality improvement.

Modern energy access to all in rural India: An integrated implementation strategy

Expanding energy access to the rural population of India presents a critical challenge for its government. The presence of 364 million people without access to electricity and 726 million who rely on biomass for cooking indicate both the failure of past policies and programs, and the need for a radical redesign of the current system. We propose an integrated implementation framework with recommendations for adopting business principles with innovative institutional, regulatory, financing and delivery mechanisms. The framework entails establishment of rural energy access authorities and energy access funds, both at the national and regional levels, to be empowered with enabling regulatory policies, capital resources and the support of multi-stakeholder partnership. These institutions are expected to design, lead, manage and monitor the rural energy interventions. At the other end, trained entrepreneurs would be expected to establish bioenergy-based micro-enterprises that will produce and distribute energy carriers to rural households at an affordable cost. The ESCOs will function as intermediaries between these enterprises and the international carbon market both in aggregating carbon credits and in trading them under CDM. If implemented, such a program could address the challenges of rural energy empowerment by creating access to modern energy carriers and climate change mitigation. (C) 2011 Elsevier Ltd. All rights reserved.

Medically unexplained symptoms: The need for effective communication and an integrated care strategy

Much is already known about medically unexplained symptoms (MUS) in terms of incidence, presentation and current treatment. What needs to be urgently addressed is a strategy for dealing with patients and their conditions, particularly when they do not fall neatly into medical frameworks or pathologies where the syndrome can be easily explained. This article will consider the provision of health and social care support for patients with MUS within an interprofessional education context. The author will contend that a sensitive and valued service for this large client group is dependent upon services without professional boundaries and practitioners with a clinical interest that can work together and agree an appropriate way forward in terms of care, support and strategic service provision. The article will support the idea that clear guidelines through the National Institute for Health and Care Excellence can offer clear clinical direction for practitioners working in primary and secondary care settings to work together interprofessionally to ensure a seamless and sensitive service for people with this condition.

Integrated communications strategy for mylabel

Integrated Communication Strategy for MyLabel Following paper presents Integrated Communication Strategy for Continente’s private label brand of cosmetics MyLabel. The main purpose of the project is to position MyLabel as venture brand which will gain strong market position in order to compete with the manufacturer brands. Therefore, based on the created brand equity model for the venture cosmetic brand, MyLabel will be approached from the branding perspective in order to improve perceived quality and consecutively, build brand recognition and credibility. In this respect, integrated communication strategy includes some of the branding tactics and marketing communication mix. Thereafter, MyLabel will be transformed into the sub-brand MyBeauty, which can exploit opportunities given by the new market image of retailers’ brands and gain special, unique position in the market.

An integrated information strategy for ecommerce for export : enhancing networking in an international business context

Companies using electronic commerce to facilitate their export activities (EC4X) need information and support at all stages of their export development and eCommerce adoption. This need is especially pressing for small and medium enterprises (SMEs). This paper reports the findings of a study of EC4X information and support needs among a sample of Australian companies. Evidence from SMEs, business associations and the Victorian state government suggests that governments need to develop a strategy for cost-effective on-line EC4X material that incorporates both generic and specific information. On-line provision of information is an effective way to meet the needs of SMEs and is increasingly the preferred channel for government bodies seeking to promote EC4X capability. However, personal contacts and networks are still an essential part of international business. Thus, an effective government strategy will support the business networking and personal contacts so important to help SMEs develop both eCommerce and export activities.

The British Virgin Islands national integrated development strategy

Includes bibliography

The British Virgin Islands national integrated development strategy

Includes bibliography

Integrated testing strategy (ITS) for bioaccumulation assessment under REACH

REACH (registration, evaluation, authorisation and restriction of chemicals) regulation requires that all the chemicals produced or imported in Europe above 1 tonne/year are registered. To register a chemical, physicochemical, toxicological and ecotoxicological information needs to be reported in a dossier. REACH promotes the use of alternative methods to replace, refine and reduce the use of animal (eco)toxicity testing. Within the EU OSIRIS project, integrated testing strategies (ITSs) have been developed for the rational use of non-animal testing approaches in chemical hazard assessment. Here we present an ITS for evaluating the bioaccumulation potential of organic chemicals. The scheme includes the use of all available data (also the non-optimal ones), waiving schemes, analysis of physicochemical properties related to the end point and alternative methods (both in silico and in vitro). In vivo methods are used only as last resort. Using the ITS, in vivo testing could be waived for about 67% of the examined compounds, but bioaccumulation potential could be estimated on the basis of non-animal methods. The presented ITS is freely available through a web tool.

Optimizing the aquatic toxicity assessment under REACH through an integrated testing strategy (ITS).

To satisfy REACH requirements a high number of data on chemical of interest should be supplied to the European Chemicals Agency. To organize the various kinds of information and help the registrants to choose the best strategy to obtain the needed information limiting at the minimum the use of animal testing, integrated testing strategies (ITSs) schemes can be used. The present work deals with regulatory data requirements for assessing the hazards of chemicals to the aquatic pelagic environment. We present an ITS scheme for organizing and using the complex existing data available for aquatic toxicity assessment. An ITS to optimize the choice of the correct prediction strategy for aquatic pelagic toxicity is described. All existing information (like physico-chemical information), and all the alternative methods (like in silico, in vitro or the acute-to-chronic ratio) are considered. Moreover the weight of evidence approach to combine the available data is included.

Office of Space Science integrated technology strategy.

Shipping list no.: 95-0006-P.

Exploring the role of lean thinking in sustainable business practice

A large and growing body of literature has explored corporate environmental sustainability initiatives and their impacts locally, regionally and internationally. While the initiatives provide examples of environmental stewardship and cleaner production, a large proportion of the organisations considered in this literature have ‘sustainable practice’, ‘environmental stewardship’ or similar goals as add-ons to their core business strategy. Furthermore, there is limited evidence of organizations embracing and internalising sustainability principles throughout their activities, products or services. Many challenges and barriers impede outcomes as whole system design or holistic approach to address environmental issues, with some evidence to suggest that targeted initiatives could be useful in making progress. ‘Lean management’ and other lean thinking strategies are often put forward as part of such targeted approaches. Within this context, the authors have drawn on current literature to undertake a review of lean thinking practices and how these influence sustainable business practice, considering the balance of environmental and economic aspects of triple bottom line in sustainability. The review methodology comprised firstly identifying theoretical constructs to be studied, developing criteria for categorising the literature, evaluating the findings within each category and considering the implications of the findings for areas for future research. The evaluation revealed two main areas of consideration: - a) lean manufacturing tools and environmental performance, and; - b) integrated lean and green models and approaches. However the review highlighted the ad hoc use of lean thinking within corporate sustainability initiatives, and established a knowledge gap in the form of a system for being able to consider different categories of environmental impacts in different industries and choose best lean tools or models for a particular problem in a way to ensure holistic exploration. The findings included a specific typology of lean tools for different environmental impacts, drawing from multiple case studies. Within this research context, this paper presents the findings of the review; namely the emerging consensus on the relationships between lean thinking and sustainable business practice. The paper begins with an overview of the current literature regarding lean thinking and its documented role in sustainable business practice. The paper then includes an analysis of lean and green paradigms in different industries; and describes the typology of lean tools used to reduce specific environmental impacts and, integrated lean and green models and approaches. The paper intends to encourage industrial practitioners to consider the merits and potential risks with using specific lean tools to reduce context-specific environmental impacts. It also aims to highlight the potential for further investigation with regard to comparing different industries and conceptualising a generalizable system for ensuring lean thinking initiatives build towards sustainable business practice.