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.

Saudi Arabia’s sustainable housing limitations : the experts’ views

Purpose The purpose of this paper is to attempt to bridge the gap between sustainable housing and the use of smart technologies to improve the level of sustainability in the housing construction in Saudi Arabia, by discussing the barriers and enablers concerned with applying sustainability to housing construction in Saudi Arabia, which utilises smart technologies. Design/methodology/approach A Delphi method survey was employed, for which 25 individuals from three key stakeholder groups of the Saudi housing sector participated. They were asked about their degree of agreement (or disagreement) about the various barriers and enablers of applying sustainability to housing construction in Saudi Arabia, which utilises smart technologies. This research paper must be considered as an indicative study of selected experts that do not represent in any way the total population of Saudi Arabia. Findings Lack of public awareness has been identified as the most significant barrier in implementing sustainable housing development in Saudi Arabia, which utilises smart technologies. Raising awareness of the public to the benefits of sustainable housing and enlightening key project stakeholders in the design of sustainable housing are both essential in order to overcome the barriers discussed in this paper. In addition, it is important to adopt smart sustainable construction methods, exemplified by but not limited to, appropriate water preservation and wastewater treatment systems that are simultaneously smart and sustainable. Research limitations/implications This particular research has dealt with only barriers and enablers in the application of sustainability to housing in Saudi Arabia, which utilises smart technologies. For a more complete understanding, there is a need for further analysis of supplementary factors. Practical implications A study such as this, which identifies and prioritises barriers and enablers, could prove useful in guiding or encouraging the relevant ministry in Saudi Arabia to develop policies founded in the implementation of sustainability to the housing sector. Originality/value This research is a preliminary investigation into the implementation of sustainable housing development as it relates to Saudi Arabia.

Students with AD/HD-related behaviours : Saudi mainstream teachers' knowledge and attitude towards inclusion

This study investigated Saudi mainstream primary teachers' knowledge of AD/HD and their attitudes towards the inclusion of students with AD/HD-related behaviours. The study also explored the relationships among teachers' attitudes towards inclusion, knowledge of AD/HD, efficacy beliefs for teaching students with behavioural problems, and relevant background factors such as teacher age, training and experience, and class size. In the first phase of the study, more than 200 Saudi teachers completed a four-part self-report questionnaire while in the second, 8 teachers completed semi-structured interviews. Findings from both phases of the study indicated that although teachers' knowledge of AD/HD was somewhat limited, they generally held positive attitudes towards the inclusion of students with AD/HD-related behaviours in regular classrooms. Additional significant influences on teachers' attitudes included class size as well as teachers' training and self-efficacy beliefs.

An examination of Saudi high school teachers' ICT knowledge and implementation

This study investigated Saudi high school teachers' implementation of ICT in schools. The study also explored the relationship between the teachers' level of TPACK and their implementation of ICT. In the first phase of the study, more than 250 Saudi teachers from Al-Madinah administrative area filled in a four-part self reported questionnaire while in the second, 12 teachers completed semi-structured interviews. Findings from both phases of the study revealed that Saudi high school teachers demonstrated low level of effectiveness of ICT implementation. Among a number of barriers, Teachers' TPACK knowledge was found as the best predictor of the effectiveness of ICT implementation.

Factors influencing Saudi Arabian optometry candidates' career choices and institution of learning. Why do Saudi students choose to study optometry?

Optometry is a primary health-care profession (PHCP) and this study aimed to elucidate the factors influencing the choice of optometry as a career for Saudi students, the students' perceptions of optometry and the effect of gender. METHODS Two hundred and forty-seven students whose average age was 21.7 ± 1.5 (SD) years and who are currently enrolled in two colleges of optometry in Saudi Arabia--King Saud University (KSU) and Qassim University (QU)--completed self-administered questionnaires. The survey included questions concerning demography, career first choice, career perception and factors influencing career choices. RESULTS The response rate was 87.6 per cent and there were 161 male (64.9 per cent) students. Seventy-nine per cent of the participants were from KSU (males and females) and 20.6 per cent were from QU (only males). Seventy-three per cent come from Riyadh and 19 per cent are from Qassim province. Regarding the first choice for their careers, the females (92 per cent) were 0.4 times more likely (p = 0.012) to choose optometry than males (78.3 per cent). The males were significantly more likely to be influenced by the following factors: the Doctor of Optometry (OD) programs run at both universities, good salary and prospects (p < 0.05, for all). The women were significantly less likely to be influenced by another individual (p = 0.0004). Generally, more than two-thirds of the respondents viewed the desire to help others, professional prestige and the new OD programs as the three most influential factors in opting for a career in optometry. CONCLUSION Females were more likely to opt for a career in optometry and males were more likely to be influenced by the new OD programs, good salary and job prospects. Service provision to others in the community was a primary motivation to opt for a career in optometry among young Saudis.

The second chance project: A multi-level examination of secondary prevention practices for Saudi people following a recent cardiac event

The study examined the health-related behaviours of Saudi people following a recent cardiac event and identified the factors that influence these behaviours using McLeroy et al.'s (1988) Ecological Model of Health Behaviours as a guiding framework. The study was one of the first in Saudi Arabia to examine the health-related behaviours of Saudi people following a recent cardiac event. The study findings emphasise the importance of a program that integrates secondary prevention practices, educational approaches and targeted supportive services in cardiac care in Saudi Arabia.

Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: A prospective cohort study

The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30-day period, out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices-related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.

Effectiveness of in-office blood pressure measurement by eye care practitioners in early detection and management of hypertension

AIM To investigate the number of hypertensive patients, the optometrist is able to identify by routinely taking blood pressure (BP) measurements for patients in "at -risk" groups, and to sample patients' opinions regarding in -office BP measurement. Many of the optometrists in Saudi Arabia practice in optical stores. These stores are wide spread, easily accessible and seldom need appointments. The expanding role of the optometrist as a primary health care provider (PHCP) and the increasing global prevalence of hypertension, highlight the need for an integrated approach towards detecting and monitoring hypertension. METHODS Automated BP measurements were made twice (during the same session) at five selected optometry practices using a validated BP monitor (Omron M6) to assess the number of patients with high BP (HBP) - in at -risk groups -visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and how to obtain accurate BP readings. A protocol for BP measurement was distributed and retained in all participating clinics. The general attitude towards cardiovascular health of 480 patients aged 37.2 (依12.4)y and their opinion towards in-office BP measurement was assessed using a self -administered questionnaire. RESULTS A response rate of 83.6% was obtained for the survey. Ninety -three of the 443 patients (21.0% ) tested for BP in this study had HBP. Of these, (62 subjects) 67.7% were unaware of their HBP status. Thirty of the 105 subjects (28.6%) who had previously been diagnosed with HBP, still had HBP at the time of this study, and only 22 (73.3%) of these patients were on medication. Also, only 25% of the diagnosed hypertensive patients owned a BP monitor. CONCLUSION Taking BP measurements in optometry practices, we were able to identify one previously undiagnosed patient with HBP for every 8 adults tested. We also identified 30 of 105 previously diagnosed patients whose BP was poorly controlled, twenty-two of whom were on medication. The patients who participated in this study were positively disposed toward the routine measurement of BP by optometrists.

Measuring the multidimensions of symptoms in people with advanced stages of chronic kidney disease

Chronic kidney disease (CKD) is increasing globally and in Saudi Arabia it affects approximately 8% annual increment of dialysis population. It is associated with a high symptom burden. Previous studies have largely reported on the prevalence of symptoms only in the haemodialysis population. This study examined symptom burden across disease stages and treatment groups in advanced CKD, and their correlation with demographic and clinical factors. Using a cross-sectional design, a convenience sample of 436 patients with CKD was recruited from three hospitals in Saudi Arabia. The CKD Symptom Burden Index (CKD-SBI) was used to measure 32 CKD symptoms. Demographic and clinical data were also collected. Of the sample 75.5% were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5% were non-dialysis (CKD stage 4, n = 69; CKD stage 5, n = 38). Average symptom reported was 13.01 ± 7.67. Fatigue and pain were common and burdensome across all symptom dimensions.Approximately one-third of participants experienced sexual symptoms. Dialysis patients reported greater symptom burden, especially patients on haemodialysis. Haemodialysis treatment, older age and being female were independently associated with greater total symptom burden. In conclusion, symptom burden is high among advanced stages of CKD, particularly among those receiving dialysis. Although fatigue, pain and sexual dysfunction are key contributors to symptom burden in CKD, these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool to assess symptom burden, leading to the commencement of timely and appropriate interventions.

United Arab Emirates

The United Arab Emirates (UAE) is part of the geographic region known as the Middle East. With a land mass of 82,000 square kilometres, predominantly desert and mountains it is bordered by Oman, Saudi Arabia and the Arabian Gulf. The UAE is strategically located due to its proximity to other oil rich Middle Eastern countries such as Kuwait, Iraq, Iran, and Saudi Arabia. The UAE was formed from a federation of seven emirates (Abu Dhabi, Dubai, Sharjah, Ras Al Khaimah, Ajman, Fujuriah, and Um Al Quain) in December 1971 (Ras Al Khaimah did not join the federation until 1972) (Heard-bey, 2004, 370). Abu Dhabi is the political capital, and the richest emirate; while Dubai is the commercial centre. The majority of the population of the various Emirates live along the coast line as sources of fresh water often heavily influenced the site of different settlements. Unlike some near neighbours (Iran and Iraq) the UAE has not undergone any significant political instability since it was formed in 1971. Due to this early British influences the UAE has had very strong political and economic ties with first Britain, and, more recently, the United States of America (Rugh, 2007). Until the economic production of oil in the early 1960’s the different Emirates had survived on a mixture of primary industry (dates), farming (goats and camels), pearling and subsidies from Britain (Davidson 2005, 3; Hvit, 2007, 565) Along with near neighbours Kuwait, Bahrain, Oman, Qatar and Saudi Arabia, the UAE is part of the Gulf Cooperation Council (GCC), a trading bloc. (Hellyer, 2001, 166-168).

Printmaking as an expanding field in contemporary art practice : a case study of Japan, Australia and Thailand

This thesis proposes that contemporary printmaking, at its most significant, marks the present through reconstructing pasts and anticipating futures. It argues this through examples in the field, occurring in contexts beyond the Euramerican (Europe and North America). The arguments revolve around how the practice of a number of significant artists in Japan, Australia and Thailand has generated conceptual and formal innovations in printmaking that transcend local histories and conventions, whilst paradoxically, also building upon them and creating new meanings. The arguments do not portray the relations between contemporary and traditional art as necessarily antagonistic but rather, as productively dialectical. Furthermore, the case studies demonstrate that, in the 1980s and 1990s particularly, the studio practice of these printmakers was informed by other visual arts disciplines and reflected postmodern concerns. Departures from convention witnessed in these countries within the Asia-Pacific region shifted the field of the print into a heterogeneous and hybrid realm. The practitioners concerned (especially in Thailand) produced work that was more readily equated with performance and installation art than with printmaking per se. In Japan, the incursion of photography interrupted the decorative cast of printmaking and delivered it from a straightforward, craft-based aesthetic. In Australia, fixed notions of national identity were challenged by print practitioners through deliberate cultural rapprochements and technical contradictions (speaking across old and new languages).However time-honoured print methods were not jettisoned by any case study artists. Their re-alignment of the fundamental attributes of printmaking, in line with materialist formalism, is a core consideration of my arguments. The artists selected for in-depth analysis from these three countries are all innovators whose geographical circumstances and creative praxis drew on local traditions whilst absorbing international trends. In their radical revisionism, they acknowledged the specificity of history and place, conditions of contingency and forces of globalisation. The transformational nature of their work during the late twentieth century connects it to the postmodern ethos and to a broader artistic and cultural nexus than has hitherto been recognised in literature on the print. Emerging from former guild-based practices, they ambitiously conceived their work to be part of a continually evolving visual arts vocabulary. I argue in this thesis that artists from the Asia-Pacific region have historically broken with the hermetic and Euramerican focus that has generally characterised the field. Inadequate documentation and access to print activity outside the dominant centres of critical discourse imply that readings of postmodernism have been too limited in their scope of inquiry. Other locations offer complexities of artistic practice where re-alignments of customary boundaries are often the norm. By addressing innovative activity in Japan, Australia and Thailand, this thesis exposes the need for a more inclusive theoretical framework and wider global reach than currently exists for ‘printmaking’.

Indig-curious : what are the challenges for non Aboriginal theatre practitioners in accessing and interpreting Aboriginal themes?

How do non-Indigenous theatre practitioners, especially actors, access and incorporate Aboriginal themes in the plays they create or perform in? Will it ever be acceptable for a non-Aboriginal actor to play an Aboriginal role? In literature there are clear protocols for writing Aboriginal characters and themes. In the visual arts and in dance, non-Indigenous practitioners might 'reference' Aboriginal themes, but what about in theatre performance? This research embodies one cultural dilemma in a creative project and exegesis: exploring the complex issues which emerge when an Aboriginal playwright is commissioned to write an 'Aboriginal themed' play for two non-Aboriginal actors.