Birgitte Enslev Jensen, Pauline Anne Found, Sharon J. Williams and Paul Walley
Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended…
Abstract
Purpose
Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended due to missing information or equipment or staff unavailability. This research aims to assess whether ward rounds can be structured more efficiently and effectively from the perspective of patients and staff.
Design/methodology/approach
This mixed-method approach examines the ward rounds conducted in three units within a haematology department of a major Danish hospital. Baseline measures were collected to capture the value of the ward round described by patients and staff. The information on patient and equipment flows associated with a typical ward round was mapped with recommendations for improvement.
Findings
Staff aspired to deliver a good-quality ward round, but what this meant was never articulated and there were no established standards. The duration of the ward round was unpredictable and could take 6 hours to complete. Improvements identified by the team allow the ward rounds to be completed by mid-day with much more certainty.
Research limitations/implications
This research provides an insight as to how ward rounds are conducted within a Danish haematology department.
Practical implications
The research has implications for those involved in ward rounds to reduce the time taken whilst maintaining quality and safety of patient care.
Social implications
This research has implications for patients and their families who wish to spend time with consultants.
Originality/value
Previous research has focused on the interactions between doctors and nurses. This research focuses on the operational process of the ward round and presents a structured approach to support multi-disciplinary teams with a focus on value from the patient’s perspective.
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Paul Walley, Pauline Found and Sharon Williams
The purpose of this paper is to assess failure demand as a lean concept that assists in waste analysis during quality improvement activity. The authors assess whether the…
Abstract
Purpose
The purpose of this paper is to assess failure demand as a lean concept that assists in waste analysis during quality improvement activity. The authors assess whether the concept’s limited use is a missed opportunity to help us understand improvement priorities, given that a UK Government requirement for public service managers to report failure demand has been removed.
Design/methodology/approach
The authors look at the literature across the public sector and then apply the failure demand concept to the UK’s primary healthcare system. The UK National Health Service (NHS) demand data are analysed and the impact on patient care is elicited from patient interviews.
Findings
The study highlighted the concept’s value, showing how primary care systems often generate failure demand partly owing to existing demand and capacity management practices. This demand is deflected to other systems, such as the accident and emergency department, with a considerable detrimental impact on patient experience.
Research limitations/implications
More research is needed to fully understand how best to exploit the failure demand concept within wider healthcare as there are many potential barriers to its appropriate and successful application.
Practical implications
The authors highlight three practical barriers to using failure demand: first, demand within the healthcare system is poorly understood; second, systems improvement understanding is limited; and third, need to apply the concept for improvement and not just for reporting purposes.
Originality/value
The authors provide an objective and independent insight into failure demand that has not previously been seen in the academic literature, specifically in relation to primary healthcare.
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Kate Silvester, Paul Harriman, Paul Walley and Glen Burley
– The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.
Abstract
Purpose
The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.
Design/methodology/approach
The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays’ root causes in the entire emergency care system were investigated. Event time-lines that disrupted patient flow and patient mortality statistics were compared.
Findings
Data showed that patient mortality increases at times when accident and emergency (A&E) department staff were struggling to admit patients. Four delays influenced mortality: first, volume increase and mixed admissions; second, process delays; third, unplanned hospital capacity adjustments and finally, long-term capacity restructuring downstream.
Research limitations/implications
This is an observational study that uses process control data to find times when mortality increases coincide with other events. It captures contextual background to whole system issues that affect patient mortality.
Practical implications
Managers must consider cost-decisions and flow in the whole system. Localised, cost-focused decisions can have a detrimental effect on patient care. Attention must also be paid to mortality reports as existing data-presentation methods do not allow correlation analysis.
Originality/value
Previous studies correlate A&E overcrowding and mortality. This method allows the whole system to be studied and increased mortality root causes to be understood.
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Harboro Rubber Company is a small manufacturing business which has managed a successful strategic change in a short space of time. The plan involved moving the company from an…
Abstract
Harboro Rubber Company is a small manufacturing business which has managed a successful strategic change in a short space of time. The plan involved moving the company from an uncompetitive, loss‐making position to one where the company is enjoying growth and profitability. The distinguishing feature of the changes is the extent to which strategic decisions have been influenced by lower level employees who previously had no say in how the business was managed. Critical success factors which made the transition so successful are identified, the most important being the avoidance of programmatic change.
Recent research shows that, despite a number of companies claimingsuccess for their total quality (TQ) programmes, most programmes arefailing to achieve their objectives because…
Abstract
Recent research shows that, despite a number of companies claiming success for their total quality (TQ) programmes, most programmes are failing to achieve their objectives because of a number of implementation failings. Describes the TQ programme in the UK sales region of Hewlett‐Packard (HP UKSR) which, after a slow start, is being implemented with a high degree of success. A sample of the company′s employees completed a questionnaire requiring their motivation for TQ training. This revealed that they had attended the training course because of management pressure and the identification of one specific work‐related problem, which could potentially be solved using TQ techniques. In general, employees were not motivated by factors such as the company′s competitive environment. Recommends that TQ training programmes emphasize the company′s objectives of the programme, and guide participants in the selection of TQ projects. Sees the role of facilitators as important in order to achieve participation in TQ in the long term, since training possibly provides only short‐term motivation.