Executive Summary

The hospitals are unable to provide efficient service and facilities for the treatment of the patient because of the emergency room which is present in the respective hospital. This report has divulged the key understanding on the system thinking and how current state value stream up and recommend new value stream up will strengthen the work program of the health care centre. It is considered that to enhance the facilities as well as service, the management department of the hospital must implement strategic tools and techniques to manage huge number of people in efficient manner.

Introduction 

With the increasing complexities in hospitals and different working phase, patients have been facing various issues of waiting in the health care centre.  The reason behind this delay in the service is that emergency room is active for 24*7. This also leads to create shortage of resources which are needed for the treatment of the patients. All these points combined leads to formation of retarded system and process of the hospital. This report emphasis on the evaluation of Public Sector Hospital. The respective hospital is situated in Australia. This report also gives preference on the development of Value Stream Mapping.

Main Discussion 

Identification and analysis of the System Archetypes that might impede performance

In recent times, there are various hospitals in Australia that has been experiencing difficulty in managing emergency department due to increase in waiting times for health care seekers. This has led to the use of system archetypes that has an impending impact on performance of hospitals. It has been used to identify the policies, norms and consequences that has resulted in degradation in performance of patient care services. According to Dolanskyet al. (2020), analysis of system archetypes that has been impeding the performance shows that it has been due to both internal and external factors. External factors are out of control of the hospitals and it involves fact that there has been increase in ageing patient population (Adams, &Mun, 2015). They need frequent health services of emergency Departments and at times it exceeds the minimum care needs that can be provided by the healthcare centres. System archetypes of limited beds and fact that ageing patients when admitted remains in it, even without requirement of acute care led to decrease of working capacity. It also leads to development of backlog for other healthcare seekers waiting for services of emergency departments (Davidson &Venning, 2011). 

System Archetypes also involves shortage of human resources as there has been a shortage of number of healthcare givers in emergency department of healthcare centres. Moreover, another archetype involves lack of ED healthcare givers in public hospitals having accessibility to treat the chronic patients. Lack of infrastructure can be another reason to be delayed or decrease of overall performance of emergency departments of hospitals. There are also few cases where there is lower number of nurses who are skilled enough to perform their duties and hence, ED doctors have to perform by themselves. Lack of proper medical investigation elongates the length of stay at hospital’s emergency unit (Altman Huang &Breland, 2018). 

The diagram has presented the emergency department patient throughput phase. There are overall three phases that has been depicted in the diagram. This involves the access phase, evaluation and management phase along with last one which is the disposition phase (Kwamie van Dijk &Agyepong, 2014) In the access phase, it has been seen that at first the healthcare seeker identifies the need of visiting the hospital and then get transported to Emergency Department. In the third stage, arrival at the ED takes place followed by filling the forms and getting the registration done. In the fifth stage, triage takes followed by placing the heath service seekers in treatment room. 

Figure 1: Emergency Department Throughput Phase

In the second stage of Evaluation and Management, initial physician assessment and evaluation is done of the health care seeker followed by diagnostic and management orders. In the third stage with help of nurse and ED health care givers diagnostics and management process gets started. In the fourth stage, assessment of diagnostics and response to management takes place. In the last stage, the care giving process is complete. In the disposition phase, disposition site of care order is completed. According to Mutale et al. (2016), this involves looking after the admit, discharge and transfer process followed by disposition coordination. In the last stage, the health care seeker leaves the Emergency Department. When there has been no need of emergency care identified, the genera; physician is gives the order of evaluation of health along with completing the care giving process (Narayanamurthy&Gurumurthy, 2018)

Analysis of current State Value Stream Map of emergency department based on System Archetypes

The current state of the Value Stream Map indicates the fact that at first the patient has been sent for registration process after completion of formalities at the reception. At the reception, entire patient profile is taken for checking and making it to enter into the registry book of the hospital. According to Peters (2014), during this time only, the insurance history of the health service is checked and verified. Accordingly, the insurance process gets initiated. There can be two cases that can appear in this and that is either the health service seeker is in such stage in which operation need to be done on emergency basis and then the patient needs to be transferred back to the emergency room. On other hand, another option or alternative can be that if the health service seeker needs to be shifted in emergency department due to certain need of ventilation (Pfannstiel&Rasche, 2019 )

Figure 2: Current VMS 

(Source: Created by Author)

In both the cases, after certain number of days stay, the health service seeker is transferred to the general ward after the physician validate that the health service seeker is out of danger. After validation, the health service seeker for some days is kept at the general ward and after getting required treatment is received. It has been observed that there are various areas in which the identified system archetypes has been found to be present impeding overall system performance.  System Archetypes occurs when there has been lack of medical staffs present in in the initial diagnosis phase when the health care seekers are not attended properly (White, 2015). This can be due to the lack of skilled nurse at the Emergency Department. 

The problem can be solved by the system archetypes of fixing the tail and in this way, solution to the problem can be identified through addressing symptoms of a problem. The symptoms involve lack of human resources, nurses, medical staffs and care givers that increases turnaround time for health care seekers. In the next stage, there occurs shifting the problem and fundamental solution is proposed. 

There can also be lack of infrastructure for diagnosing whether the health service seeker requires emergency services or not. This leads to delay and often inappropriate diagnosis. There has also been results of increased impact of a certain situation for the patient in absence of fast and proper first aid services. Absence of proper checking of the insurance papers can also delay the health care services as payment options for the services gets blocked. There are also health care services that has to be provided in the emergency department and at times, due to shortage of beds it cannot be provided. In the opinion of Wilkinson et al. (2018), it leads to increase in treatment time and backlog of patients develops. In addition to this, there may lack of proper infrastructure and skilled surgery specialists leading to increase in delay. This also deteriorates the performance of health care givers and hospitals on an overall basis. These are the system archetypes that is present in the current value stream map. 

Recommendation of new State Value Stream Map with desired reduction in patient turnaround time 

There are certain areas of improvement that has to be done in the hospital emergency department sector management. This will improve the performance of the ED in giving care to the health service seekers. This has been recommended with the help of new State Value Stream Map that has been designed so as to decrease the turnaround time of patients. It involves simultaneous functionality of the flow of information of patient data for the registration process along with verification of the medical history and insurance. Insurance verification is done by a group of members kept for the purpose it decreases the turnaround time for the medical service seekers (York et al. 2019). 

Figure 3: Recommended VMS

(Source: Created by Author)

The system archetypes will be so developed that there will be availability of surgery specialists looking after the health service seekers. There will be increase in the workforce as it will increase the availability of services and one to one ratio will be followed. It will not lead to congestion of health care services for the emergency department patient. There will be increase in the infrastructure facilities as the nurse will be able to examine the various immediate tests required prior to conducting the medical examination. After treatment the patients will be discharged with proper care and paper work. There are various waiting areas within the healthcare centres that has to be eliminated so that the material and information flow get quickened up. 

It has been observed that there is a flow of information in between healthcare service seekers about the insurance coverage that they will be getting. Simultaneously patient history has been matched with patient registered data and then they are made to go to the waiting area. The patient history is given to the attending nurse and the information has been conveyed through help of statistics. The healthcare seeker is moved to the available emergency room and the diagnosis is treated. There is also availability of supply needs to the doctor and nurse.  It has been observed that the availability of more than one nurse will help in decrease of turnaround time for the patients. 

Discussion on intended and unintended consequences of modified system 

There are various intended and unintended consequences of the modified system that has been made in the present Value Stream Map will help in increase of the overall performance of the hospital in emergency situation. It has been observed that increase in availability of nurse will help in easing the job of medical practitioners and health care professionals in the emergency unit and surgical operation unit. This leads to fast treatment after completion of the surgery or making the health service seeker go through emergency ventilation. there are six junctions in which the health service seeker has to go through wait stage. 

Figure 4: System Archetypes 

Improvement in the waiting stage will lead to increase of the performance efficiency and decrease of the turnaround time. There has been waiting stage identified in between the go to waiting area and shift to emergency room. The incorporation of information retrieval system in this area will led to increase in data gathering strategy about the health service seeker. This will increase the diagnosis process and the medical history of the patient can be submitted to the concerned specialist doctor in the department There is also waiting stage in between patient being shifted to emergency room and examination of the patient by nurse. 

The delivery of medical statistics at a fast rate will help in retrieval of the report by the nurse and can be aided with information. This will decrease the diagnosis time of doctor being attended for the purpose and simultaneously increase the efficiency of wait I time. It has been observed that there is considerable delay due to lack of available infrastructure and equipment in between the doctor going to operate on the patient, medical supplies give to it. The modification made in the process will help in availability of various medical tools and infrastructure at an effective rate. This helps in increase of the efficiency of the effectivity of the surgery performance and decreases the turnaround time. The attending physician need to be available and it has been seen quite often that there is a lack of availability of the physician. In such a case, the modifications will help in making the number of physicians present in a large amount and 1:1 ratio can be made. Availability of more doctors will ensure that there are more individuals to attend the emergency sector beds. This decreases the occupancy time of the bed. 

Conclusion 

In the light of the above discussion, it is revealed that healthcare system is efficient to handle number of people in effective way. There is an urgent need to intensify the quality as well as management of the hospital as it is customer-oriented organization. This will facilitate to charm more people for the treatment as well as diagnosis of disease. Although the task of implementation of this system is difficult task because of the complexity of it. But after implementation of new system in the hospital and healthcare sector the quality of its service is strengthens. For intensify the entire process of the hospital several approaches are impactful such as value stream mapping. With the advancement in the technology, the service standard of hospital is intensified.

Recommendations 

There are few recommendations for future improvement in the service as well as facilities of the hospital and healthcare sector which are as follows:

• By establishing value stream mapping the management process in the hospital or healthcare sector is strengthen. 
• The system can diminish the gap occurrence and problem that take place in the medical process. 
• There is a need of check on an on-going basis to ensure the efficiency of system. 
• In order to give intensified service to the patient, the hospital and healthcare sector requires to implement techniques which enable to effective time management. 
• By implementing latest technology in various process of the hospital, the information and data are stored adequately. 
• This system helps to strength the service quality of the hospital which leads to formulate good image or reputation among the public. 
• The patient is sent to the ED room after the nurse attends for the primary health care service of diagnosis and first aid. The attending nurse along with presence of ED medical professional will take care of the situation thereafter. There has to be increase in healthcare professionals in ED To improve the turnaround time.