Executive Summary

The problems faced by every organization can be deciphered with the help of tools. System thinking is one such objective tool to evaluate the issues being faced by the organization. The system thinking tool also assists the management to take decisions which will ameliorate the problem. System archetypes are required to be assessed with the help of Value mapping systems. The complex form of the system archetype of Hillston Public hospital causes an inordinate delay for the patients of the Emergency Department to get the doctor's advice. 

The lengthy procedures and intricate administrative actions required to be undergone by the patients is extensive. This has caused increased turn-around time for the patients. In order to reduce the time elapsed in providing the necessary attention to the Emergency patients, the management tried the Value Stream Mapping (VSM). The system archetype of the Hillston Public Hospital has been effectively described in the task. The inherent problems of the system are duly unearthed, and the proper resolution solutions for the same have been suggested. The VSM also includes proposals to reduce the turn-around time of the patients in the ED. The author has also diligently invoked the analysis and retributive measures to be adopted by the hospital to enhance a better quality of service to the patients. 

1. Introduction 

The integration of the system with the more extensive system as well as other systems, within the larger system, causes the procedure to be complicated in totality. The system thinking clarifies the interlinked systems and brings out a model which enables a clear understanding of the tasks undertaken (Petticrew et al. 2019). Emergency department of every hospital should be a priority sector. The research at hand deals with the system archetypes, which impede the activities of the vital ED department of the Public Hospital. The VSM of the Hillston Public Hospital is also an integral aspect of the research. The means and ways to improve the value stream map by incorporating slight changes have also been catered to in the task. 

2. Discussion

2.1 Different system ArchetypesA conglomeration of behavioural patterns accomplishing one task in a manner resembling the other task performances is called a system archetype (Dutta et al. 2018). The behavioural patterns are so common that they are sometimes misunderstood as part of the system. Hillston Public hospital to improve the emergency department patient services can employ many system thinking patterns to accomplish the same (Chang et al. 2018). The varied methods of system thinking, which could be used to improve upon the condition of the emergency department patients are as laid down: 

The tragedy of the commons

The system which incorporates the sharing of resources by all the individuals of the system thinking that they are working for the common goal, but on the contrary, the result is not the achievement of common goal but the satisfaction of self-interest only. According to Moodley (2016), the motive of achieving the benefit to all users is not attained by the tragedy of the commons system. In this system pattern, the quantity of service produced is vast, but the quality of service and the result is compromised. Thereby, the output of all the functions so performed is reduced. It has also been argued that in order to reach a finite result; which is actually a common good, infinite resources will be required. As illustrated by Eckerberg (2017), in the Hillston Public hospital practise of such a system archetype has resulted in long queues and extensive waiting for the patients even in the Emergency department.

Success to the successful 

This type of system architecture is implemented when the system is aware that not all users are the same, and the capabilities differ. The success of the successful system enables a causality driven concept of working, thereby improving the functional ability of the employees. Employees tend to refrain from performing any task of system archetype behavioural patterns which do not induce any quality in the system (Clancy, 2018). A healthcare system always needs to keep the causality aspect at the forefront of all the actions taken. The implementation of this system pattern in the Hillston Public Hospital will invoke the emphasis on the result-oriented jobs rather than system archetype jobs.  

The Emergency Department will have a reduced turn-around time for patients and will also improve the quality of treatment dealt with patients (Kaushik et al. 2018). This type of system can be implemented by rearranging of the sequence of tasks undertaken and also removing the redundant and overlapping tasks altogether. Incorporation of an efficient and robust management advisor in congruence with the update of the systems will enable the Hillston public hospital to reduce the waiting time faced by patients and allow a faster turn-around time. The initiation of the system will allow the hospital to omit recurring and unobvious operations and focus the available workforce towards beneficial utilization, thereby inducing a better quality of service to the patients. 

2.2. Value Stream Map (VSM) of Hillston Public Hospital

Value stream mapping is the visual tool utilized to understand the procedures and the time lags in-between methods to estimate the pace at which the patients are being treated at a hospital (Ramaswamy et al. 2017). The system archetype of “Tragedy of commons” in vogue at Hillston Public hospital when perused by the VSM clearly states that the patient turn-around time is very long and the reason as seen vividly is the overutilization of available workforce for the archetype jobs. As per the VSM, the workforce available is utilized in recurring and formality oriented tasks which are not directly linked to patient welfare thereby increasing the time taken for the patient to see the doctor (Kirmi, 2017). The VSM also implicates that the repositioning of the infrastructure and arrangement of the same as per patient benefit would reduce the time by a lot. 

Figure 1: Current value map for Hillston Public hospital

(Source: Kirmi, 2017)

As per the VSM, the patients who arrive at the hospital do need to undergo a lot many procedures which are incoherent and delay the time elapsed by the patient for visiting the physician. The Emergency department of a public hospital has the requirement of the entirety of the vitals and details of the patient for the physician to assess the condition of the patient (Davies et al. 2018). The same was not thoroughly done, and the patient, therefore, has to suffer a humongous time waiting for the physician's consultation. The necessity imbibed by this system archetype accrues the patients lag time for insurance inquiry, registration, examination procedures, checking of medical history, vital statistics and personal information. All these stages are time taking, and the lag time in-between the stages are waiting time. As per the VSM, the value-added time towards the patients' consultation was very little, whereas the Lead time, which has elapsed in completing the procedure is much more. If the system could have been more interactive rather than stage-based, the delay time could be curtailed, whereas the value-added time will also be shortened. 

The VSM of the system practised at the public hospital the patients are required to wait unduly to complete all the formalities and the essential aspect is that the waiting in queue is a mandatory step before each step thereby increasing the turn-around time for the patients. This prolonged wait may cause grave risk to the patient’s health and in some conditions may also be fatal to the patient. The quality of the services provided is therefore bizarre, and the user satisfaction levels are also below standards (Krishnaraj, 2019). Thus, the lead time as described in the VSM, which is the time elapsed in passing on the information and material is the key factor where the negative impact on patient satisfaction is cropping up. Therefore, it is evident through the value stream mapping of the tragedy of the commons system followed in the Hillston Public Hospital is inefficient and should be revamped for better patient care and quality healthcare. 

2.3. Suggested VSMAs discussed earlier, the proper system which could turn the hospitals' image would be the success of a successful system. The prolonged lead time as experienced in the VSM earlier can be curtailed with the improvement of system think time and system re-alignment. A proper system of processing the jobs and a correct procedure of the same will enable the hospital system to reduce turn-around time for all patients, including ED patients (Sweet, 2020). The Hillston Public Hospital can imbibe three minor changes that will reduce the lead time in the VSM Chart immensely, thereby facilitating a speedy turn-around time for the patients of the ED. The stipulated changes are:

The positioning of a Pre-triage Zone

In this area, patients do not have to wait as a hospital representative will assess only by visual assessment, whether the patient requires immediate attention or not. This brief and accurate assessment will enable the patient to be directly conveyed in the care area. As stated by Loriston (2018), the preliminary job of every hospital is to ensure complete patient fulfilment. The visual discretion of the representative of the hospital will be upon the type of injury or accident wherein the response of the patient will also be assessed to ensure speedy treatment initiation. Implementing this will increase a value-added task, thereby ensuring lesser lead time and swift turn-around time for the patient in the ED.

Figure 2: Suggested VSM(Source: Self-Created, 2020)

Reforming Triage zone

As per the revised VSM, the patients requiring urgent medical support will be taken to the tri-age care zone where the representatives of the hospital will do all the checks like vitals, records, history and RM. The tri-age care will be equipped with all the adequate tools required for the assessment to be as good as practicable. The positioning of the hospital staff conducting the tests will not be on desks rather a free-flowing workflow culture will be utilized where the hospital staff will move to the patient rather than the patient being moved from room to room (Chen et al. 2020). The tri-age zone will also be containing the reception desk where the attendees of the patient can inform whether or not they require express emergency treatment for the patient through RN and MD testing, RN and MLP testing and final assessment which will then be conducted there only.

Treatment zone

The definitive treatment of the patient could be initiated within 25 minutes of visiting the hospital, unlike the delayed treatment start procedure followed earlier. The implementation of VSM in the hospital enabled the time lag to shorten and the arrangement of the staff in order to be able to execute the tasks quickly and without time lag (Shitu et al. 2020). The final treatment to the patient is given based on RN and MD testing and final assessment. After initial treatment was initiated, the physician can consult the other evaluations and tests to ascertain if the patient is needed to be admitted, discharged, or transferred to other department or facilities. Therefore the humongous turn-around time of patients in the Hillston Public Hospital has been drastically reduced by the proper usage of VSM amalgamated with the change of system archetype that is Success to Successful system.

2.4. Outcome of the new modified system

The implementation of the changed system archetypes and the improvement of the working environment in favour of the patients may bring out some intentional and a few unintentional outcomes. The outcomes that can be envisaged are as follows:

Deliberate outcomes

The deliberate change brought upon the system and the change of the working environment of the staff may hinder the overall productiveness of the Hillston Public Hospital. The intentional scrounging of the staff may pose a delay in the patient turn-around time. To mitigate these risks and to avert the same realistic management techniques need to be applied. Even the quality of treatment dealt out to patients through the new system may be lousy because the human tendency to serve self before others is a perennial part of every human being even the hospital staff. This may lead to a deteriorating condition of ED patients (Mortensen & Rasmussen, 2017). The staff may tend to use unsuitable equipment in a bid to reduce the time lag. Inordinate delays caused to fulfil personal gains may cause the system to suffer and hamper the quality of healthcare to ED patients. 

Inadvertent consequences

Implementation of a new system amongst the staff may cause inadvertent consequences. The arrival of multiple emergency cases at the same point of time may cause even the new system to be delayed.  In order to assess the value of users, it is essential that a proper system mapping be done. A new system, however useful it might be will always create confusion and a state of perplexity amongst old patients (Magnusson et al. 2020). Even the convergence of multiple Emergency patients at the same time can leave the representative hospital assessor with a befuddling situation, thereby increasing the time elapse.

3. ConclusionIn conclusion, it can be stated that the requirement of a value mapping system is very much essential to emerging a hospital like the Hillston Public Hospital into a more conducive healthcare facility, especially for ED patients. In order to turn the Hillston public hospital with reduced time to turn-about patients, the Success to Successful layout must be followed.  

4. RecommendationsThe implementation of the system thinking is not the only aspect that needs change. The following elements may also be looked into: 

Patient-centred care: The patient-centred care will ensure individual attention to the patients.Training of staff: Training the staff to the newly adopted system and better equipment will reduce turn-around time.

Managing medical care ethics: The Hospital should be dedicated to patient care and provide the patients with a more caring atmosphere to ensure quick healing and complete convalescence.