Dissertations / Theses on the topic 'Process improvement in healthcare'

Thesis (M.S.)--University of Toledo, 2008.<br>Typescript. "Submitted as partial fulfillments of the requirements for The Master of Science in Industrial Engineering." "A thesis entitled"--at head of title. Bibliography: leaves 69-70.

This thesis outlines the development of a standard methodology for performing a time and motion study in a lean healthcare environment. Time and motion studies have been used in healthcare environments in the past, however they have nearly all been exclusive to a particular healthcare enterprise. To develop the time and motion study methodology, a study was designed to examine how resident doctors spend their time. This study was performed in response to coming changes in the work hours for all residents. Once the methodology was developed, trial observations were conducted. The data from these observations was analyzed to determine the effectiveness of both the time and motion study methodology and its usefulness for process improvement activities.

Employee Engagement in a Cardiac Catheterization Lab by Rhonda J. Smith Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2016 This study adds to the existing body of knowledge on employee engagement and workplace climate in the catheter laboratory setting. The study goals were to discover the current state of workplace satisfaction and then to share the results with the staff to determine what to improve and how to guide them through the Lean process. This study was guided by Kanter's structural empowerment theory, which holds that structural factors inside the workplace have a greater impact on employee work feelings and behaviors than do the employees' own personal tendencies. It was also guided by the Lean model, which aims to transform an organization's culture via a customer-focused method to constantly produce improvement opportunities, remove waste, and create value. This project utilized a descriptive research design. The catheter laboratory staff were e-mailed a link to complete a staff engagement and workplace climate survey. The survey was based off of a prior staff satisfaction survey used by the organization for consistency, but was not validated in the process. This survey provided a means to establish employee attitudes on several aspects analyzed by a 7 point-Likert scale. Of the 19 staff members who received the survey, 11 completed it, yielding a 60% response rate. Overall, the staff indicated that they were satisfied with their job and enjoyed working in their department. The findings from this survey were shared with the catheter laboratory staff and they chose to work on improving teamwork with departments outside of cardiology. The results of this study reinforce existing literature that demonstrates that employees who are engaged in the workplace are happier and more productive. The concept of staff engagement has been linked to higher quality patient outcomes, greater financial viability, increased productivity, and higher employee satisfaction.

Most organizational change initiatives fail because managers lack effective change management strategies. The purpose of this single case study was to explore change management strategies that outpatient care facility managers used to positively affect process improvements. The population consisted of 6 managers who completed change initiatives at a military, outpatient medical facility in Texas and 6 of their team members. Data were collected using semistructured interviews and organization documents, then analyzed based on the conceptual framework of Lewin’s change theory. Rowley’s 4-step process for analysis—organizing; getting acquainted with; classifying; coding and interpreting; and presenting and writing up the data—was used to identify 4 major themes through data saturation. From the data analysis, the following strategy themes emerged: building effective teams, establishing the foundation for the change, communicating throughout the change process, and solidifying the change. Managers in the healthcare industry can use the findings of this study as a guide to improve the outcomes of their process improvement initiatives by implementing the strategies provided by the manager participants. Thus, the findings of this study may be used to affect positive social change to improve patients’ quality of healthcare and community healthcare outreach programs through increased efficiencies and reduced expenditures.

Solitamente i sistemi sanitari sono disegnati e ottimizzati considerando stabilità nel sistema e nel suo intorno. Nel 2020 ha messo a dura prova il sistema sanitario la comparsa dell’infezione da SARS-cov2, un virus altamente contagioso che in pochi mesi ha portato alla diffusione di una pandemia mondiale. In un contesto di pandemia, non è più possibile assumere una delle principali ipotesi che suppongono stabilità e profonda conoscenza della malattia. Per questo motivo, i sistemi di assistenza sanitaria hanno dovuto reinventare il loro modo di pianificare e gestire le loro operazioni. Infatti, i sistemi ospedalieri sono progettati per un carico medio di pazienti e non per epidemie che causano un forte afflusso di persone che spesso necessitano di cure intensive. Per questo motivo, quando il numero di casi cresce in modo esponenziale, un’emergenza sanitaria pubblica può trasformarsi in una crisi operativa. La pandemia è un evento dinamico a lungo termine che richiederà lo sviluppo di una strategia proattiva quasi costante e la risoluzione dei problemi che da essa emergono. In questi casi di instabilità, la progettazione e l'uso di strumenti di simulazione di eventi discreti è rilevante per valutare i cambiamenti nel layout, i modi di gestire i pazienti o per testare diverse politiche da implementare. A tal fine, sono state effettuate analisi dei dati raccolti in un database e successivamente è stato creato un modello di simulazione a partire da tali dati. L’obiettivo del progetto di ricerca a cui ho partecipato è quello di sviluppare un modello che possa aiutare a ridimensionare i processi sanitari per supportare il sovraccarico degli ospedali.

The world is facing the challenge of an increasingly growing and aging population which leads to increasing requirements on the healthcare system. This has led to higher financial pressure on operational managers to do more with less resources. Hospitals are characterised by rigid routines, strict hierarchical structures and lack of consistent definitions of value which creates challenges for improvement projects and implementation. To explore an alternative perspective of how to increase value in healthcare, the concept of secondary activities is introduced. Secondary activities are defined as activities that are indirectly related to healthcare and medical processes in hospitals. Presently, secondary activities are not prioritised in healthcare since the distinction has not been made before and therefore is the value-gain interesting to investigate. The purpose of this report is to investigate how to increase value in healthcare through improved secondary activities and the following research questions are used to fulfill the purpose: What are the challenges of defining value in healthcare? 2. What process improvement strategy is suitable for improving secondary activities? 3. What implementation strategy is suitable when improving secondary activities? The method used to conduct this study consisted of a literature study covering the fields of value creation, Lean in healthcare and change management in hospital management, followed by a case study at Norrtälje Sjukhus where the food process was investigated. Results of the study showed that the challenges of defining value in healthcare are the different mindsets between professions operating in hospitals and the required balance between ethical and financial aspects. II At Norrtälje Sjukhus, the assistant nurses valued time spent with patients. In order to free more time for them, secondary activities have great potential of increasing value through improvement projects. The combination of Lean and Biodesign based on comprehensive observations proved to be a suitable process improvement strategy for improving secondary activities. Moreover, secondary activities lag well behind primary activities regarding digitalisation which can increase the value of secondary activities through improved workflows. When value is defined as time spent with patients this process improvement strategy proved to be successful. Results of improving the food process in the case study showed that the total annual savings for the hospital were 3212 work hours which corresponds to 761 244 kr. Prerequisites for a successful implementation strategy are awareness of problems, needs and to have an improvement strategy that fits the situation. Introduction of changes should made together with the personnel and be incremental to minimise disturbances to other healthcare activities. A remaining challenge is the lack of responsibility and managerial competence in the regular hospital organisation that is needed for future, continuous and sustainable improvements for secondary activities.<br>Världen står inför en stor utmaning med en växande och åldrande befolkning vilket ställer högre krav på sjukvårdssystemet. Detta har lett till ökat finansiellt tryck på verksamhetsansvariga att prestera mer med mindre resurser. Sjukhus karaktäriseras ofta av oflexibla rutiner, strikt hierarkiska strukturer och inkonsekvent definition av värde vilket innebär utmaningar för förbättringsarbeten och implementation. Konceptet sekundära aktiviteter introduceras för att utforska ett alternativt perspektiv av hur man ökar värde i sjukvården. Sekundära aktiviteter definieras som indirekt sjukvårdsrelaterade aktiviteter som stöttar medicinska processer. I nuläget prioriteras inte sekundära aktiviteter i sjukvården eftersom denna särskiljning inte tidigare gjorts och därför blir den potentiella värdeökningen intressant att undersöka. Syftet med denna rapport är att undersöka hur värdet kan öka i sjukvården genom förbättring av sekundära aktiviteter. Följande forskningsfrågor bidrar till att uppfylla syftet med rapporten: 1. Vilka är utmaningarna med att definiera värde i sjukvården? 2. Vilken processförbättringsstrategi är lämpligast för att förbättra sekundära aktiviteter? 3. Vilken implementationsstrategi är lämpligast för att förbättra sekundära aktiviteter? Metoden som användes i denna studie bestod av en litteraturstudie som behandlade områdena värdeskapande, Lean i sjukvården och förändringsarbete inom sjukhusledningen, följt av en fallstudie på Norrtälje Sjukhus för att undersöka matprocessen. Resultat från studien visade att utmaningarna med att definiera värde inom sjukvården är skillnader mellan professioner och en avvägning mellan etiska och finansiella faktorer. Undersköterskorna på Norrtälje Sjukhus värderar tiden med patienterna högst. Sekundära aktiviteter har stor potential att öka i värde genom förbättringsarbeten för att kunna frigöra mer tid för undersköterskorna. IV Kombinationen av Lean och Biodesign baserat på omfattande observationer visade sig vara en lämplig processförbättringsstrategi för att förbättra sekundära aktiviteter. Sekundära aktiviteter ligger efter primära aktiviteter vad gäller digitalisering som kan öka värdet av sekundära aktiviteter genom förbättrat arbetsflöde. När värde definieras som tid spenderad med patienter är den här processförbättringsstrategin framgångsrik. När matprocessen förbättrades i fallstudien resulterade det i en årlig besparing för hela sjukhuset på 3212 arbetstimmar vilket motsvarar 761 244 kr. Förutsättningar för en framgångsrik implementationsstrategi är medvetenhet kring problemen, behoven samt att anpassa strategin efter situationen. Introduktion av förändringarna bör ske stegvis i samarbete med personalen för att minimera störningsmoment gentemot andra vårdaktiviteter. En kvarstående utmaning är bristen på ansvar och chefskompetens i sjukhusorganisationen för framtida, kontinuerliga och hållbara förbättringar av sekundära aktiviteter.

Titel: Ett akut förbättringsarbete - En utvärderingsstudie av förändringsprocessen Akuten till Primärvården i Region Jönköpings län Kurs: Kandidatuppsats Civilekonomprogrammet, Controller 15 hp (2FE24E) Lärosäte: Linnéuniversitetet Växjö Författare: Cajsa Gollwitzer, Madeleine Hentzel &amp; Klara Olsson Handledare: Pia Nylinder Examinator: Elin Funck Bakgrund: Dagens hälso- och sjukvård står inför en rad olika utmaningar, där den största utmaningen är den långsiktiga finansieringen. Ett stort problem som återfinns i dagens hälso- och sjukvård är att befolkningen i alltför hög utsträckning söker fel vårdnivå och akutmottagningarna överbelastas med patienter utan akuta besvär. Det är ett problem som inte är långsiktigt hållbart i Sverige då sjukhusens akutsjukvård är betydligt dyrare än primärvård. I Region Jönköpings län startade 2016 en förändringsprocess för att lösa problemet genom att omfördela patientströmmar från akutmottagningen till primärvården. Syfte: Syftet med studien är att genomföra en processinriktad utvärdering av förändringsprocessen för delprojektet Akuten till primärvården. Genom att kartlägga arbetssättet ska vi identifiera styrkor och svagheter som sedan ska ligga till grund för att utforma förbättringsförslag på hur förändringsprocessen kan utvecklas för att uppnå målsättningen. Metod: Forskningen grundar sig i en kvalitativ enfallsstudie med inriktning på utvärderingsstudie. Semistrukturerade intervjuer tillsammans med insamlade dokument har legat till grund för det empiriska materialet. Slutsats: Förändringsprocessen för delprojektet Akuten till primärvården är uppdelad i tre delar; planering, genomförande och uppföljning. En utsedd projektgrupp arbetar med förändringsarbetet med hjälp av olika verktyg. För att utveckla förändringsarbetet måste projektgruppen utforma ett standardiserat arbetssätt som är accepterat av samtliga enheter som medverkar i processen. Rekommendationer för ett bättre förändringsarbete är att införa fler kommunikationskanaler, erbjuda utökat stöd samt öka kunskapen hos de som arbetar inom processen. Marknadsföring av primärvårdens kompetenser kan medföra en effektivare fördelning av patienströmmarna.<br>Title: An emergency improvement - An evaluation study of the improvement process ER to primary care in Region Jönköping County Course: Bachelor Thesis in Business Administration, Controller 15 hp (2FE24E) Institution: Linnaeus University Växjö Authors: Cajsa Gollwitzer, Madeleine Hentzel &amp; Klara Olsson Tutor: Pia Nylinder Examiner: Elin Funck Context: Today's healthcare is facing a lot of challenges where the biggest challenge is the issue of the long term funding. A big problem with the system today is that many non-acute patients are looking for help in the emergency rooms instead of getting proper help at the primary care. This does not benefit the financial state for Swedish hospitals where emergency care is significantly more expensive than primary care. In 2016, Region Jönköping took an initiative to improve the process by redistributing the non-acute patients from the emergency room back to primary care. Purpose: The purpose of the study is to implement a process-based evaluation of the improvement process ER to primary care. By charting their work, we will try to identify the strengths and weaknesses to provide suggestions of improvements in order to achieve the objectives of the project. Method: The research is based on a qualitative single case study focusing on evaluation studies. Empirical data has been collected through semi-structured interviews and documents. Conclusion: The improvement process ER to primary care is divided into three steps; planning, implementation and monitoring. A chosen team for the project use various tools in the work for improvement. In order to develop and improve this process, the project team has to design a standardized approach that is accepted by all the entities involved in it. Recommendations for such an improved process is to introduce multiple communication channels, provide increased support and expand the knowledge of those working in the process. By marketing the competence within the primary care, the distribution of the patients can get more efficient.

Dans chaque organisation, les processus métier sont aujourd’hui incontournables. Cette thèse vise à développer une méthode pour les améliorer. Dans le domaine de la santé, les organisations hospitalières déploient beaucoup d’efforts pour mettre leurs processus sous contrôle, notamment à cause de la très faible marge d’erreur admise. Les parcours des patients au sein des structures de santé constituent l’application qui a été choisie pour démontrer les apports de cette méthode. Elle a pour originalité d’exploiter les données de géolocalisation des patients à l’intérieur de ces structures. Baptisée DIAG, elle améliore les parcours de soins grâce à plusieurs sous-fonctions : (i) interpréter les données de géolocalisation pour la modélisation de processus, (ii) découvrir automatiquement les processus métier, (iii) évaluer la qualité et la performance des parcours et (iv) diagnostiquer automatiquement les problèmes de performance des processus. Cette thèse propose donc les contributions suivantes : la méthode DIAG elle-même qui, grâce à quatre différents états, extrait les informations des données de géolocalisation ; le méta-modèle DIAG qui a deux utilités : d’une part, interpréter les données de géolocalisation et donc passer des données brutes aux informations utilisables, et, d’autre part contribuer à vérifier l’alignement des données avec le domaine grâce à deux méthodes de diagnostic décrites plus bas ; deux algorithmes de découverte de processus qui utilisent la stabilité statistique des logs d’évènements ; une nouvelle approche de process mining utilisant SPC (Statistical Process Control) pour l’amélioration ; l’algorithme proDIST qui mesure les distances entre les modèles de processus ; deux méthodes de diagnostic automatique de processus pour détecter les causes des déviations structurelles dans des cas individuels et pour des processus communs. Le contexte de cette thèse confirme la nécessité de proposer de telles solutions. Une étude de cas dans le cadre de ce travail de recherche illustre l’applicabilité de la méthodologie DIAG et des fonctions et méthodes mentionnées<br>Business processes are everywhere and, as such, we must acknowledge them. Among all of them, hospital processes are of vital importance. Healthcare organizations invest huge amount of efforts into keeping these processes under control, as the allowed margin of error is so slight. This research work seeks to develop a methodology to endorse improvement of patient pathways inside healthcare organizations. It does so by using the indoor location data of patients. This methodology is called DIAG (Data state, Information state, Awareness, Governance). It is constructed of several different functions. The most important ones are as follows: (i) location data interpreting, (ii) automatic discovery of business process models, (iii) business process analyzing for evaluating the performance and quality of processes, and finally, (iv) automatic diagnosing of business processes. Along the former functions, the contribution of this thesis are: The DIAG methodology which, through four different states, extracts knowledge from location data; the DIAG meta-model which supports both the interpretation of location data (from raw data to usable information) and the alignment of the domain knowledge (which are used for the diagnosing methods); two process discovery algorithms which explore statistical stability in event logs, application of Statistical Process Control (SPC) for the “enhancement notation” of Process Mining; the ProDIST algorithm for measuring the distance between process models; two automatic process diagnosing methods to detect causes of structural deviations in individual cases and common processes. The state of the art in this dissertation endorses the necessity for proposing such solutions. A case study within this research work illustrates the applicability of the DIAG methodology and its mentioned functions and methods

Healthcare systems, driven by increased demand due to growth in chronic diseases and population, suffer from lack of staffing and facility resources. Many major hospitals have long waiting lists and have subsequently pushed their production close to maximum capacity due to the high demand for services. The consequences are lack of overview of the operations and lack of coordination between healthcare staff, which leads to treatment delays. Surgery planning or scheduling is an important part of production planning in hospitals, which is considered highly complex due to high variability and many decisions variables that need to be considered. Those responsible for surgery planning are often considered to lack the right tools to support them in evaluating the many different decision factors.   Simulation is a technology within the field of operations research which has been applied to aid with surgery planning problems and to look for process improvements. Many studies however use a simplified approach to the surgery planning, due to the complexities of the planning problem. Studies have further argued that surgery planning fails to consider downstream resources and the negative effects it has on utilization of those resources. This thesis is based on a case study at one of Sweden’s major hospitals and aims to explore how simulation could become a decision support to help with surgery planning and identifying what process improvements such a tool could be aimed at. The surgery planning decision making process is first analyzed using a hierarchical framework for hospitals’ production planning. The results were that the decision making process regarding patient flows needs to be improved by taking both a top-down and bottom-up strategy for better information flow and coordination. The study further concludes that improved coordination and information sharing are important factors to improve patient flow through the hospital, which could be supported by the usage of Discrete Event Simulation for decision making. The ideal decision support tool is however considered the simulation tool embedded with an online system to support bed management decisions which could increase patient throughput. Such a tool could help to decrease the demand for the hospital’s beds by discharging patients quicker. In addition, it could support the bottom-up strategy for coordination, while implementing a multi-method or hybrid simulation could further support the top-down part of the strategy.

Este trabalho apresenta conceitos relacionados ao pensamento enxuto, e mais especificamente, ao mapeamento de fluxo de valor (MFV), inseridos no contexto hospitalar, destacando exemplos encontrados na literatura e a análise de um caso prático conduzido pelo autor. Com a elaboração do trabalho, foi possível concluir que não existe um modelo de mapeamento de fluxo de valor padronizado para aplicações de lean em ambientes hospitalares. De maneira geral, a utilização do MFV em hospitais se dá através de adaptações da manufatura que não levam em conta todas as atividades que interferem no fluxo dos pacientes, como o fluxo de informações e de materiais. Para contornar esse problema, esta dissertação visa propor um novo modelo de MFV, voltado para ambientes hospitalares, que consiga contemplar em um único mapa todos os fluxos que interferem diretamente na duração do tratamento do paciente e sirva como modelo padrão para aplicações de lean em hospitais. Para isso, foi realizado um levantamento bibliográfico, que buscou identificar, no período de 2000 a 2013, os principais modelos de MFV atualmente empregados em implantações de lean healthcare e identificar as principais características e pontos positivos de cada um. Estes pontos positivos serviram como requisitos para a elaboração do novo modelo, passando a integrar um único mapa. Com a aplicação prática desse novo MFV, foi possível identificar os gargalos operacionais e inúmeros desperdícios que interferem no tratamento do paciente e que não poderiam ser identificados pelos outros modelos de mapeamento estudados. É possível concluir, com os resultados alcançados, que o modelo proposto atendeu aos objetivos definidos e demonstrou ser uma ferramenta valiosa para identificação de desperdícios em ambientes hospitalares.<br>This thesis presents lean thinking concepts focused on healthcare environments and more specifically on the value stream mapping (VSM). The research could concluded that there is no value stream map standardized for lean healthcare applications. In general, the use of VSM in hospitals are made by manufacturing adaptations that do not take into account all activities that interfere in the patient flow, such as information and material flow. To solve this problem, this research aims to propose a new VSM model for healthcare, which could contemplate all activities that directly affects the treatment time and also be a template for lean healthcare applications. Therefore, the focus in the literature review was to identify the main healthcare VSM models published between 2000 and 2013 and the key characteristics and strengths of each. These strengths were used as requirements for the new mapping model elaboration and were integrated in a single map. The practical application, conducted by the author, identified operational bottlenecks and numerous wastes that interfere in the patient\'s treatment that could not be identified by the other mapping models studied. In conclusion, the new VSM model proposed has achieve the defined goals and proved to be a valuable tool for identifying waste in hospital environments.

A field research-based statistical study was used to investigate successes and failures of Six Sigma methodologies based projects. Six Sigma methodologies require that projects be designed, planned, and implemented using techniques specifically designed to achieve desired benefits that are based on the method's key drivers for project success. This study addressed an identified gap in the literature that Six Sigma projects do not fail because of Six Sigma methodologies, but that the projects can fail because of deficient support processes. Six Sigma projects that do not achieve the desired benefits are often labeled as "fads". Research questions related to management support processes for Six Sigma projects addressed whether the project was properly scoped and if Six Sigma projects were conducted with the appropriate methodological framework. Field research data were collected using a 5-point, Likert self-administered survey, which was provided to a sample of 206 Six Sigma Black Belt practitioners and project participants. The survey data were analyzed using descriptive and inferential statistics to identify probable significance of the results. The general data results concluded that Six Sigma projects do not fail solely because of Six Sigma methodology; instead, failure was attributed to other unexamined reasons and factors. Successful Six Sigma projects, which are deployed to increase claims processing accuracy throughput for insurance companies and the Centers for Medicare & Medicaid Services, can trigger positive social change. Increased efficiencies should lead to improved cash flow for doctors and hospitals that will positively affect services offered, utilization processes, and their employees.

A crescente demanda por serviços de saúde, juntamente com a necessidade de proporcionar um cuidado com qualidade e com segurança, trazem desafios para as instituições que trabalham nessa área. Buscando-se soluções para esse problema, hospitais vêm aderindo a filosofia Lean Healthcare (LH), contudo é necessário ressaltar a dificuldade que essas aplicações podem ter, em longo prazo, por ser uma abordagem distinta da gestão tradicional e não levar em consideração a natureza complexa da saúde. Esse estudo buscou em desenvolver um Framework para análise e intervenção em Sistemas Complexos (SC), por meio da integração entre princípios de gestão de sistemas enxutos e princípios da ciência da complexidade. Para isso, lançou-se mão de métodos, como mapeamento de fluxo de valor, mapeamento de processos e Functional Resonance Analysis Method (FRAM). O Framework proposto estruturou-se em 6 etapas, sendo construído por meio da Design Science Research. O estudo aplicado ocorreu em um hospital universitário na análise do fluxo do paciente grave do Serviço de Emergência para a Unidade de Terapia Intensiva. Como resultado dessa aplicação, foi possível identificar 16 problemas nesse fluxo, propondo-se um plano de ação para um dos problemas e simulando os potenciais impactos por meio da utilização do FRAM. Concluiu-se que é possível unificar as visões de LH e de SC, gerandose uma visão aprofundada dos problemas enfrentados no cotidiano dos serviços da saúde, criando meios para intervenções mais seguras e que proporcionem maior qualidade no cuidado prestado ao paciente.<br>The increasing demand for healthcare, altogether with the necessity to provide quality and secure care, bring challenges for institutions in this domain. Pursuing solutions for this problem, hospitals are implementing Lean Healthcare (LH) philosophy, although, it is important to consider difficulties that this application might have in a long term. This is due to the fact LH differs from a tradition approach and does not take in consideration the complex nature of healthcare systems. This study sought to develop a Framework for analysis and intervention in Complex Systems (CS) through integration of principals from Lean Production Management and Complex Science. In this way, methods such as Value Stream Mapping, Process Mapping, and Functional Resonance Analysis Method (FRAM) were used. The proposed Framework had six stages, been based in Design Science Research. The Framework application took place in an university hospital, focusing in the critically ill patients flow from the emergency service to the intensive therapy unit. As a result, it was possible to identify 16 problems in the flow and an action plan was proposed for one problem using FRAM for potential impacts simulation. In conclusion, the integration of LH and CS was possible, generating a deeper understanding of day-by-day problems in healthcare, creating means for secure interventions and allowing more quality in patient care.

[ES] La oportunidad en la atención es uno de los críticos de mayor relevancia en la satisfacción de los pacientes que acuden a los servicios de Urgencias. Por tal motivo, las instituciones prestadoras de servicio y las organizaciones gubernamentales deben propender conjuntamente por una atención cada vez más oportuna a costos operacionales razonables. En el caso de la Red Pública en Servicios de Urgencias de Barrannquilla, compuesta por 8 puntos de atención y 2 hospitales, la tendencia marca un continuo crecimiento de la oportunidad en la atención con una tasa de 3,08 minutos/semestre y una probabilidad del 93,13% de atender a los pacientes después de una espera mayor a 30 minutos. Lo anterior se constituye en un síntoma inequívoco de la incapacidad de la Red para satisfacer los estándares de oportunidad establecidos por el Ministerio de Salud, hecho que podría desencadenar el desarrollo de sintomatologías de mayor complejidad, el incremento de la probabilidad de mortalidad, el requerimiento de servicios clínicos más complejos (hospitalización y cuidados intensivos) y el aumento de los costos asociados al servicio. En consecuencia, la presente tesis doctoral presenta el rediseño de la Red Pública en Servicios de Urgencias anteriormente mencionada a fin de otorgar a la población diana un servicio eficiente y altamente oportuno donde tanto las instituciones prestadoras del servicio como los organismos gubernamentales converjan efectivamente. Para ello, fue necesaria la ejecución de 4 grandes fases a través de las cuales se consolidó una propuesta orientada al desarrollo efectivo y sostenible de las operaciones de la Red. Primero, se caracterizó la Red Pública de Servicios de Urgencias en Salud considerando su comportamiento actual en términos de demanda y oportunidad de la atención. Luego, a través de una revisión sistemática de la literatura, se identificaron los enfoques metodológicos que se han implementado para la mejora de la oportunidad y otros indicadores de rendimiento asociados al servicio de Urgencias. Posteriormente, se diseñó una metodología para la creación de redes de Urgencias eficientes y sostenibles la cual luego se validó en la Red Pública sudamericana a fin de disminuir la oportunidad de atención promedio en Urgencias y garantizar la distribución equitativa de los beneficios financieros derivados de la colaboración. Finalmente, se construyó un modelo multicriterio que permitió evaluar el rendimiento de los departamentos de Urgencia e impulsó la creación de estrategias de mejora focalizadas en incrementar su respuesta ante la demanda cambiante, los críticos de satisfacción y las condiciones de operación estipuladas en la ley. Los resultados de esta aplicación evidenciaron que los pacientes que acceden a la Red tienden a esperar en promedio 201,6 min con desviación de estándar de 81,6 min antes de ser atendidos por urgencia. Por otro lado, de acuerdo con la revisión de literatura, la combinación de técnicas de investigación de operaciones, ingeniería de la calidad y analítica de datos es ampliamente recomendada para abordar este problema. En ese sentido, una metodología basada en modelos colaterales de pago, simulación de procesos y lean seis sigma fue propuesta y validada generando un rediseño de Red cuya oportunidad de atención promedio podría disminuir entre 6,71 min y 9,08 min con beneficios financieros promedio de US$29,980/nodo. En último lugar, un modelo compuesto por 8 criterios y 35 sub-criterios fue diseñado para evaluar el rendimiento general de los departamentos de Urgencias. Los resultados del modelo evidenciaron el rol crítico de la infraestructura (Peso global = 21,5%) en el rendimiento de los departamentos de Urgencia y la naturaleza interactiva de la Seguridad del Paciente (C + R = 12,771).<br>[CA] L'oportunitat en l'atenció és un dels crítics de major rellevància en la satisfacció dels pacients que acudeixen als serveis d'Urgències. Per tal motiu, les institucions prestadores de servei i les organitzacions governamentals han de propendir conjuntament per una atenció cada vegada més oportuna a costos operacionals raonables. En el cas de la Xarxa Pública en Serveis d'Urgències de Barrannquilla, composta per 8 punts d'atenció i 2 hospitals, la tendència marca un continu creixement de l'oportunitat en l'atenció amb una taxa de 3,08 minuts / semestre i una probabilitat de l' 93,13% d'atendre els pacients després d'una espera major a 30 minuts. L'anterior es constitueix en un símptoma inequívoc de la incapacitat de la Xarxa per satisfer els estàndards d'oportunitat establerts pel Ministeri de Salut, fet que podria desencadenar el desenvolupament de simptomatologies de major complexitat, l'increment de la probabilitat de mortalitat, el requeriment de serveis clínics més complexos (hospitalització i cures intensives) i l'augment dels costos associats a el servei. En conseqüència, la present tesi doctoral presenta el redisseny de la Xarxa Pública en Serveis d'Urgències anteriorment esmentada a fi d'atorgar a la població diana un servei eficient i altament oportú on tant les institucions prestadores de el servei com els organismes governamentals convergeixin efectivament. Per a això, va ser necessària l'execució de 4 grans fases a través de les quals es va consolidar una proposta orientada a el desenvolupament efectiu i sostenible de les operacions de la Xarxa. Primer, es va caracteritzar la Xarxa Pública de Serveis d'Urgències en Salut considerant el seu comportament actual en termes de demanda i oportunitat de l'atenció. Després, a través d'una revisió sistemàtica de la literatura, es van identificar els enfocaments metodològics que s'han implementat per a la millora de l'oportunitat i altres indicadors de rendiment associats a el servei d'Urgències. Posteriorment, es va dissenyar una metodologia per a la creació de xarxes d'Urgències eficients i sostenibles la qual després es va validar a la Xarxa Pública sud-americana a fi de disminuir l'oportunitat d'atenció mitjana a Urgències i garantir la distribució equitativa dels beneficis financers derivats de la col´laboració. Finalment, es va construir un model multicriteri que va permetre avaluar el rendiment dels departaments d'Urgència i va impulsar la creació d'estratègies de millora focalitzades en incrementar la seva resposta davant la demanda canviant, els crítics de satisfacció i les condicions d'operació estipulades en la llei. Els resultats d'aquesta aplicació van evidenciar que els pacients que accedeixen a la Xarxa tendeixen a esperar de mitjana 201,6 min amb desviació d'estàndard de 81,6 min abans de ser atesos per urgència. D'altra banda, d'acord amb la revisió de literatura, la combinació de tècniques d'investigació d'operacions, enginyeria de la qualitat i analítica de dades és àmpliament recomanada per abordar aquest problema. En aquest sentit, una metodologia basada en models col´laterals de pagament, simulació de processos i llegeixin 6 sigma va ser proposada i validada generant un redisseny de Xarxa la oportunitat d'atenció mitjana podria disminuir entre 6,71 min i 9,08 min amb beneficis financers mitjana d'US $ 29,980 / node. En darrer lloc, un model compost per 8 criteris i 35 sub-criteris va ser dissenyat per avaluar el rendiment general dels departaments d'Urgències. Els resultats de el model evidenciar el paper crític de la infraestructura (Pes global = 21,5%) en el rendiment dels departaments d'Urgència i la naturalesa interactiva de la Seguretat de l'Pacient (C + R = 12,771).<br>[EN] Waiting time is one of the most critical measures in the satisfaction of patients admitted within emergency departments. Therefore, hospitals and governmental organizations should jointly aim to provide timely attention at reasonable costs. In the case of Barranquilla's Pubic Emergency Service Network, composed by 8 Points of care (POCs) and 2 hospitals, the trend evidences a continuous growing of the waiting time with a rate of 3,08 min/semester and a 93,13% likelihood of serving patients after waiting for more than 30 minutes. This is an unmistakable symptom of the network inability for satisfying the standards established by the Ministry of Health, which may trigger the development of more complex symptoms, increase in the death rate, requirement for more complex clinical services (hospitalization and intensive care unit) and increased service costs. This doctoral dissertation then illustrates the redesign of the aforementioned Public Emergency Service Network aiming at providing the target population with an efficient and highly timely service where both hospitals and governmental institutions effectively converge. It was then necessary to implement a 4-phase methodology consolidating a proposal oriented to the effective and sustainable development of network operations. First, the Public Emergency Service Network was characterized considering its current behavior in terms of demand and waiting time. A systematic literature review was then undertaken for identifying the methodological approaches that have been implementing for improving the waiting time and other performance indicators associated with the emergency care service. Following this, a methodology for the creation of efficient and sustainable emergency care networks was designed and later validated in the Southamerican Public network for lessening the average waiting time and ensuring the equitable distribution of profits derived from the collaboration. Ultimately, a multicriteria decision-making model was created for assessing the performance of the emergency departments and propelling the design of improvement strategies focused on bettering the response against the changing demand conditions, critical to satisfaction and operational conditions. The results evidenced that the patients accessing to the network tend to wait 201,6 min on average with a standard deviation of 81,6 min before being served by the emergency care unit. On the other hand, based on the reported literature, it is highly suggested to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for addressing this problem. In this sense, a methodology based on collateral payment models, Discrete-event simulation, and Lean Six Sigma was proposed and validated resulting in a redesigned network whose average waiting time may diminish between 6,71 min and 9,08 min with an average profit US$29,980/node. Lately, a model comprising of 8 criteria and 35 sub-criteria was designed for evaluating the overall performance of emergency departments. The model outcomes revealed the critical role of Infrastructure (Global weight = 21,5%) in ED performance and the interactive nature of Patient Safety (C + R = 12,771).<br>Ortíz Barrios, MÁ. (2020). Redesigning the Barranquilla's public emergency care network to improve the patient waiting time [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/156215<br>TESIS

Thesis (S.M.)--Massachusetts Institute of Technology, Sloan School of Management; and, Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1998.<br>Includes bibliographical references.<br>by Charlene Johnson.<br>S.M.

Emergency laparotomies in the UK, and internationally, have a high risk of death, with accompanying evidence of suboptimal care. The emergency laparotomy pathway quality improvement care (ELPQuiC) bundle is a care bundle for patients undergoing emergency laparotomy, consisting of: initial assessment with early warning scores, early antibiotics, interval between decision and operation less than 6 hours, consultant-led intra-operative care, goal-directed fluid therapy and postoperative intensive care. The primary aim was to determine if implementation improved patient mortality after emergency laparotomy. Methods: The ELPQuiC bundle was implemented in four hospitals, using locally identified strategies to assess the impact on risk-adjusted mortality. Comparison of risk-adjusted 30-day mortality rates before and after care-bundle implementation was made using risk-adjusted cumulative sum (CUSUM) plots and a logistic regression model. Results: Risk-adjusted CUSUM plots showed an increase in the numbers of lives saved per 100 patients treated in all hospitals, from 6.47 in the baseline interval (299 patients included) to 12.44 after implementation (427 patients included) (P < 0.001). The overall risk-adjusted risk of death decreased from 15.6 to 9.6 per cent (risk ratio 0.614, 95 per cent confidence interval 0.451 to 0.836; P=0.002). There was an increase in the uptake of the ELPQuiC processes but no significant difference in the patient predicted risk of mortality profile as determined by the mean Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) risk (0.197 and 0.223 before and after implementation respectively; P=0.395). Conclusion: Use of the ELPQuiC bundle was associated with an increase in compliance to the majority of elements of the care bundle. Introduction of the ELPQuiC Bundle was associated with a significant reduction in the risk of death following emergency laparotomy.

In this thesis the software development process and in particular, the requirements management processes in a major software development company have been investigated. The current problems related to requirements quality and process performances have been identified. Process improvement measures have been proposed based on the suggestions found in the relevant literature. The current process and the improved version have been compared with respect to the process evaluation metrics proposed particularly for software process improvement.

The intent of this Project was to identify areas of improvement in Shell Todd Oil Services (STOS) Well, Reservoir and Facility Management (WRFM) practices, in order to meet full compliance with Shell global WRFM Standards by their next annual review in Q4 2014. A gap analysis was carried out to identify where improvement efforts must be focussed and measures to support optimisation, streamlining and alignment of processes have been recommended. The Shell Blade 27 – Well, Reservoir and Facility Management Guideline was used to obtain insight and understanding of the WRFM process and requirements. The STOS WRM Management Manual, WRFM Plans and Health-check outputs were used as supplementary documentation for the gap analysis. The Shell WRFM minimum requirements were used as the established benchmark against which STOS practices were measured using the asset assessment tool. Interviews were carried out to further highlight complexities and constraints at STOS to meet Shell criteria. The findings in this report provide evidence of issues that should be addressed for the continuous improvement of WRFM at STOS. These have been provided for the consideration of Shell Todd Oil Services Limited WRFM Steering Committee Chair.

This thesis presents a software engineering process improvement study. The literature on software process improvement is reviewed. Then the current design verification process at one of the Software Engineering Departments of the X Company, Ankara, T&uuml<br>rkiye (SED) is analyzed. Static software development process metrics have been calculated for the SED based on a recently proposed approach. Some improvement suggestions have been made based on the metric values calculated according to the proposals of that study. Besides, the author&#039<br>s improvement suggestions have been discussed with the senior staff at the department and then final version of the improvements has been gathered. Then, a discussion has been made comparing these two approaches. Finally, a new software design verification process model has been proposed. Some of the suggestions have already been applied and preliminary results have been obtained.

Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, in conjunction with the Leaders for Global Operations Program at MIT, 2017.<br>Thesis: S.M., Massachusetts Institute of Technology, Department of Mechanical Engineering, in conjunction with the Leaders for Global Operations Program at MIT, 2017.<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (pages 61-62).<br>This project addressed challenges within the weld inspection process in one factory at Caterpillar through the implementation of phased array ultrasonic testing. The chosen factory fabricates and machines large weldments for track-type tractors. The industry trend towards lighter weight, lower cost, higher performance structures requires greater confidence in weld quality than can currently be ensured with existing inspection methods in use at Caterpillar. Previous attempts to implement phased array technology in production factories at Caterpillar were unsuccessful due to the perceived costs of the technology, a lack of training, a lack of internal standards, and a lack of a change agent. The first step in the project began with understanding the current state of weld inspections. This was accomplished through factory visits, as well as interviews with -vendors and Caterpillar's non-destructive evaluation community. Statistical analysis of quality data was conducted to understand current welding and inspection performance. This revealed several problems with the process that led to inaccurate inspection results and unnecessary factory rework. Next, the project identified a pilot case to introduce the phased array technology. After acquiring the necessary phased array equipment, a robust, repeatable, cost effective process was developed where data is stored, and can be recalled and used to improve quality and future designs. Necessary fixtures were prototyped and tested to demonstrate the value of implementation. The implementation phase focused on training the operators to use the new equipment and procedures while still ensuring that the quality of parts released downstream was not compromised. The final phase of the implementation validated the quality of the inspection data and focused on improving the speed and safety of the phased array ultrasonic inspections. This project integrated phased array ultrasonic testing into a factory and provided a framework for Caterpillar to continue to develop and deploy this technology across the enterprise. By identifying and solving gaps in the technology rollout process in collaboration with Caterpillar's non-destructive evaluation community, this project created positive change in the culture and execution of how improvements are made to weld inspection processes.<br>by Luke B. Boote.<br>M.B.A.<br>S.M.

Many software development organizations today are keen on improving their software development processes in order to develop software products faster, cheaper or better. For that reason, Software Process Improvement (SPI) has received significant attention from the research community over the last few decades. Process maturity models have become widely known for benchmarking software processes against predefined practices and for identifying processes to be improved or implemented, whereas process improvement approaches were developed for guiding the actual process improvement process. However, despite a wide number of provided guidelines on how to standardize the processes and how to run process improvement efforts, only a few SPI initiatives have succeeded. About 70% of the SPI initiatives fail and a significant number do not even get started. Many studies argue that the success of the SPI initiatives is dependent on the organizational, social and managerial aspects of process improvement. Those aspects however are not sufficiently covered by the existing SPI approaches and models. The little knowledge on organizational, social and managerial aspects of SPI that is available is mostly scattered across the domain. Hence, there is lack of a holistic overview of the current SPI domain that provides sufficient coverage of organizational, social and managerial aspects of SPI. This thesis has explored the organizational, social and managerial aspects of SPI and placed them into the context of the SPI domain. Its main research result is Software Process Improvement Framework (SPIF). The framework provides an overview of the SPI domain and positions theories representing organizational, social and managerial aspects of SPI in the context of existing SPI approaches, models, methods and practices. SPIF is based on the existing theoretical framework for SPI environment proposed by Sami Zahran. The SPIF framework has been additionally complimented with four additional outcomes of this study. Those are: 1) a list of organizational, social and managerial factors facilitating SPI effort, 2) a list of contextual factors impacting process change, 3) a process model for guiding software method adoption, and 4) a checklist representing the properties of successful and sustainable SPI projects. The research was based on a strong industrial cooperation. As many as thirty software development organizations were involved in this research. Methodologically, the research was conducted in line with the inductive reasoning, which guided the research into building the knowledge from empirical studies. However, at some stages of this research, literature studies were incorporated. The main research methods of this study are action research and case studies, whereas data collection methods are primarily structured interviews, participatory observations and surveys. The thesis concludes that implementing a recommended software development processes or practices using well defined SPI approaches is not enough. In order to implement successful and lasting process improvement, organizations also need to consider organizational, social and managerial aspects of SPI. The SPIF framework and other results of this thesis may significantly benefit software development organizations that plan to conduct software process change, or have already done it. These organizations may use SPIF for getting an overview of the process improvement process and the theories, methods and tools that should support it. The other results of this thesis can be used for: 1) incorporating organizational, social and managerial aspects in process changes, 2) for adapting process improvements in various organizational contexts, 3) for guiding adoptions of new software development methods, and finally 4) for evaluating and improving process improvement efforts.<br><p>QC 20140213</p>

This thesis concerns healthcare management and specifically addresses the problems of operating room planning and waiting list management. The operating room department is one of the most expensive areas within the healthcare system which necessitates many expensive resources such as staff, equipment and medicine. The planning of operating rooms is a complex task involving many dependencies and conflicting factors and hence careful operating room planning is critical to attain high productivity. One part of the planning process is to determine a Master Surgery Schedule (MSS). An MSS is a cyclic timetable that specifies the allocation of the surgical groups into different blocks of operating room time. Using an optimization-based approach, this thesis investigates whether the MSS can be adapted to better meet the varying surgery demand. Secondly, an extended optimization-based approach, including post-operative beds, is presented in which different policies related to priority rules are simulated to demonstrate their affect on the average waiting time. The problem of meeting the uncertainty in demand of patient arrival, as well as surgery duration, is then incorporated. With a combination of simulation and optimization techniques, different policies in reserving operating room capacity for emergency cases together with a policy to increase staff in stand-by, are demonstrated. The results show that, by adopting a certain policy, the average patient waiting time and surgery cancellations are decreased while operating room utilization is increased. Furthermore, the thesis focuses on how different aspects of surgery pre-conditions affect different performance measures related to operating room planning. The emergency surgery cases are omitted and the studies are delimited to concern the elective healthcare process only. With a proposed simulation model, an experimental tool is offered, in which a number of analyses related to the process of elective surgeries can be conducted. The hypothesis is that, sufficiently good estimates of future surgery demand can be assessed at the referral stage. Based on this assumption, an experiment is conducted to explore how different policies of managing incoming referrals affect patient waiting times. Related to this study, possibility of using data mining techniques to find indicators that can help to estimate future surgery demand is also investigated. Finally, in parallel, an agent-based simulation approach is investigated to address these types of problems. An agent-based approach would probably be relevant to consider when multiple planners are considered. In a survey, a framework for describing applications of agent based simulation is provided.

This study investigates software development process improvement approaches. In particular, the static process evaluation methodology proposed by S. G&uuml<br>ceglioglu is applied on the requirements analysis and validation process applied in Project X in MYCOMPANY and an improved process is proposed. That methodology is an extension of the ISO/IEC 9126 approach for software quality assessment, and is based on evaluating a set of well-defined metrics on the static model of software development processes. The improved process proposed for Project X is evaluated using G&uuml<br>ceglioglu&rsquo<br>s methodology. The applied and improved process measurement results compared to determine if the improved process is successful or not.

Thesis (M.S.)--Florida State University, 2009.<br>Advisor: Zhiyong Liang, Florida State University, College of Engineering, Dept. of Industrial and Manufacturing Engineering. Title and description from dissertation home page (viewed on Nov. 17, 2009). Document formatted into pages; contains ix, 57 pages. Includes bibliographical references.

This thesis is a study on improving the software requirements management processes of embedded software department of a company. The literature on software process improvement and requirements engineering is reviewed. After determining the problems related to the current requirements management processes of the department, an improved process is proposed addressing these problems. The static process descriptions and the models of the current and improved requirements management processes are formed. A recently proposed pre-enactment model for measuring process quality is used for measuring the quality of the current and improved requirements management processes. Finally, the results of the process quality measurements are compared and evaluated.

Thesis (M.S. in Software Engineering)--Naval Postgraduate School, June 2003.<br>Thesis advisor(s): Mikhail Auguston, Christopher D. Miles. Includes bibliographical references (p. 59-61). Also available online.

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1993, and Thesis (M.S.)--Massachusetts Institute of Technology, Sloan School of Management, 1993.<br>Includes bibliographical references (leaves 118-120).<br>by Steven Hofstetter.<br>M.S.

Practice and law around informed consent in healthcare have undergone a revolution for the better over recent decades. However the way we obtain informed consent remains problematic and is imbued with irreducible but not ineliminable uncertainty. The reasons for this uncertainty are varied. The uncertainty is partly due to the conceptual opacity of important core concepts. The complexity of communication in clinical encounters is another. The role of autonomy, and the changing nature of the clinician patient relationship, have also contributed to this uncertainty remaining. This thesis is not a panacea for these difficulties. However there have been two quite profound revolutions in healthcare over the last decade or so, namely, the introduction of evidence-based medicine into clinical decision making, and the institutionalization of clinical governance and the application of quality improvement philosophy. I have examined ways in which these two “movements” can help in reducing some of the uncertainty in the practice of informed consent.

Quality improvement (QI) has become an important issue in healthcare settings. A central question for many healthcare systems is how to manage improvement initiatives adequately. All county councils and regions managing healthcare in Sweden have started to work with QI at an organizational system level, to varied extents. The Kalmar county council improvement initiative constitutes the empirical basis of this thesis. The aim of the thesis is to provide knowledge about different aspects of a county-wide improvement initiative, and a broader understanding of factors and strategies that affect participation, management and outcomes. The overall study design is based on a case study. The first two studies illuminate the practice-based (micro level), bottom-up perspective. Inductively five different areas (categories) were identified. Factors influencing participation in improvement initiatives provided the basis for the next study. The result showed that different staff categories were attracted by different initiatives. The next two studies illuminate the top-down (macro/meso) management perspective. Managers’ views of how patients can participate were investigated and a content analysis of the written answers was made. Four main areas (categories) were identified. A survey study investigated all of the county council managers’ experiences of the whole improvement initiative. Overall the managers thought that the improvement work was worth the effort. To evaluate the Breakthrough Collaborative program, a survey was developed and tested. This survey was used to investigate process and outcome of the BC program. The majority of the respondents were satisfied with their work, but wanted more time for teams to meet and work. To find out if an improvement program can affect outcome and contribute to sustainable changes, interviews were made with project applicants (n=202). Almost half (48%) of the projects were funded, and of those 51% were sustained. Of the rejected (not funded) projects, 28% were accomplished and sustained anyway. The results in this thesis cannot show that the “golden mean” exists, or that a single best way to manage changes and improvements in a healthcare organization has been found, but the way QI initiatives are organized does affect participation and outcomes. The intention, from the management topdown system level, encouraging staff and units and letting practice-based ideas develop at all system levels, can stimulate and facilitate improvement work.<br>Kvalitetsutveckling och förbättringsarbete har blivit en viktig del av hälso- och sjukvården. En viktig fråga för landsting och regioner är hur kvalitetsutveckling skall drivas och styras. Syftet med detta arbete är att bidra till ökad kunskap om kvalitetsarbete i en hälso- och sjukvårdsorganisation, hur förbättringsinitiativ kan bedrivas och ledas, samt vilka faktorer som bidrar till ett framgångsrikt förbättringsarbete. Arbetet utgår empiriskt från en satsning på kvalitet och förbättringsarbete i landstinget i Kalmar län och är genomförd som en fallstudie (case). Resultatet speglar vad ett landstings satsning på förbättringsarbete utifrån mikro-, macro- och mesonivå kan ge. De första två delstudierna speglar det praktikbaserade förbättringsarbetet utifrån ett praktikbaserat perspektiv. En innehållsanalys av projekten som ansökt om ekonomisk ersättning gjordes. Fem kategorier utformades, och projekten betonade områden som patientsäkerhet, förbättrad tillgänglighet och effektivitet. Studie II kartlade deltagande i förbättringsarbete utifrån två olika initiativ. Resultatet visade att de olika initiativen attraherade olika personalkategorier, men kunde samtidigt utesluta andra grupper. Chefernas åsikter om och erfarenheter av landstingets satsning undersöktes i studie III och IV. Cheferna var överlag positiva och nöjda med arbetet. Förbättringsprogrammen följdes med frågeformuläret Swedish Improvement Measurement Questionnaire (SIMQ) som testats och utvärderats. Resultatet visade att deltagarna är nöjda med arbetet med sin förbättringsidé, men att metodiken kan upplevas som svår. Dessutom efterlyste deltagarna mer tid för förbättringsarbete i vardagen. Till sist analyserades de projekt som sökt pengar för att driva förbättringsarbete. Nästan hälften av alla projekt (48%) hade fått ekonomisk ersättning, och av dessa hade fler än hälften (51%) uppnått sitt mål och infört en bestående förbättring. Den här avhandlingen påvisar vikten av att ledningen uppmärksammar, möjliggör och stimulerar förbättringsarbete. Genom att erbjuda flera olika sätt att bedriva förbättringsarbete ökar möjligheten för allas medverkan.

Approved for public release; distribution is unlimited.<br>The purpose of this study is to streamline the contract closeout process through the application of continuous process improvement techniques. A methodology for the identification of procedures involved in the process and problem areas in the process was developed. Available literature was reviewed and personal interviews were conducted to develop a model of the contract closeout process and to identify problems in the contract closeout process. Continuous Process Improvement procedures were applied to the contract model and the problems identified to eliminate the problems and increase the efficiency of the process. Recommendations included: increasing the priority placed on the close out of U. S. Government contracts, development of an automated system for the close out of U. S. Government contracts, development of a training program in the contract closeout process, improvement of communications between organizations involved in the contract closeout process, and application of continuous process improvement procedures to reduce the time required to close out U. S. Government contracts..

Radio Frequency Identification (RFID) technology has been widely adopted by different industries for various purposes. While implementing a RFID system for personnel tracking in an industrial environment, such as a hospital, the tracking accuracy is not always satisfactory due to incorrect placement of RFID hardware, coarse system configuration or environment. This thesis proposes comprehensive optimization methods for improving the tracking accuracy of a RFID system for personnel tracking. The improvement is achieved from four perspectives including RFID data cleaning, experimental design, data fusion and simulation modeling. This research is based on a case study carried out in a local community hospital where a RFID system for personnel tracking has been implemented. Through applying the optimization methods, the tracking accuracy of the RFID system has been improved to 87.33%. The thesis provides a guideline for the hospital and other similar application environment to implement improvement methods on a RFID tracking system.

<p>Reports of software a development projects that miss schedule, exceeds budget and deliver products with poor quality are abundant in the literature. Both researchers and the industry are seeking methods to counter these trends and improve software quality.</p><p>Software Process Improvement is a systematic approach to improve the capabilities and performance of software organizations. One basic idea is to assess the organizations’ current practice and improve their software process on the basis of the competencies and experiences of the practitioners working in the organization. A major challenge is to create strategies and mechanisms for managing relevant and updated knowledge about software development and maintenance. Insights from the field of knowledge management are therefore potentially useful in software process improvement efforts to facilitate the creation, modification, and sharing of software processes in any organization.</p><p>In the work presented in this thesis, we have made an overview of empirical studies on the effect of knowledge management in software engineering. We have categorized these studies according to a framework and we report findings on the major concepts that have been investigated empirically, as well as the research methods applied within the field. We have also investigated two main strategies for knowledge management, codification and personalization, through the application of four concrete methods in a software process improvement setting: Mentoring, Rational Unified Process, Process Workshops and Post Mortem Analysis.</p><p>We have classified the work in this thesis within three main themes:</p><p>RT1: Previous research on knowledge management in software engineering.</p><p>RT2: Application of knowledge management to improve the software process through codification of knowledge.</p><p>RT3: Application of knowledge management to improve the software process through personalization of knowledge.</p><p>The main contributions are:</p><p>C1: An overview of the research literature on empirical studies of knowledge management in software engineering.</p><p>C2: A method for tailoring the Rational Unified Process to the development process of a software consulting company.</p><p>C3: Improvements of the Process Workshops method by contextualization.</p><p>C4: Improvement of the root-cause analysis phase of the lightweight Post Mortem Analysis for more effective project retrospectives.</p><p>C5: Proposed methods to increase the learning effect of mentor programs in software engineering.</p>

si bien existen anteriores investigaciones que ponen de evidencia la existencia de relación entre la selección de proveedores y la mejora de procesos de negocio (business process improvement - bpi), estas dan poca información acerca del nivel de la misma.<br/>la presente tesis contribuye al cuerpo de conocimientos en ambos campos, mediante la identificación y examen de las relaciones existentes entre los dos tópicos a partir del modelo conceptual desarrollado, el cual explica dichas interrelaciones, y mediante la aportación de los resultados del estudio empírico del modelo, a diferentes niveles operativos, realizado sobre una muestra de grandes empresas que operan en diferentes sectores industriales de londres (reino unido).<br/>en general, los datos confirman el modelo de investigación propuesto. los resultados del estudio demuestran que niveles más altos de calidad, servicio, organización y relación así como niveles más bajos de tiempo de ciclo de los proveedores contribuyen significativamente a los proceso de negocio de iniciativa de mejora y enfoque al cliente del comprador. además, se deduce también que los factores de selección de proveedores, relación y tiempo de ciclo, tienen más impacto sobre un comprador que tenga un enfoque a iniciativa de mejora; y que organización y tiempo de ciclo son factores que tienen más relación con el enfoque al cliente del comprador que otras variables de selección de proveedores.<br/>en el desarrollo de la tesis, empezamos revisando la literatura relevante y desarrollando el modelo de investigación conceptual. describimos los factores claves de selección de proveedor y de la mejora de procesos de negocio (bpi), profundizamos en las interrelaciones entre estas variables y planteamos una serie de hipótesis testeables sobre dichas relaciones. a continuación, discutimos cuestiones metodológicas relativas al desarrollo y validación de la medida de los constructos así como sobre la recogida de datos y procedimientos de análisis. seguidamente, presentamos y discutimos los resultados de nuestros tests que implican modelos de regresión lineal; y concluimos considerando las implicaciones de la tesis en la investigación y en la "práctica" de la selección de proveedores y bpi, y proporcionando también líneas de investigación futura en el campo.<br>while prior research provides considerable evidence for the existence of relationship between supplier selection and business process improvement (bpi), it yields little insight into the level of the relationship. <br/>by examining the level of the relationship between supplier selection and bpi practices, the present study contributes to the body of knowledge in both fields through identifying and examining the linkages between two topics based on a developed conceptual model, which explicates the interrelationships between supplier selection and bpi constructs, and providing the results of an empirical test of the model at different divisional levels of large firms operating in different industries in the london (united kingdom). <br/>in general, the data support the proposed research model. the results of the study show that higher levels of quality, service, organization and relationship as well as lower levels of cycle time pertinent to the suppliers significantly contribute to the buyers' process improvement initiative and customer focus. additionally, relationship and cycle time have more relations to improvement initiative and organization and cycle time have more impacts on customer focus than other supplier selection constructs.<br/>we begin by reviewing the relevant literature and developing the conceptual research model. we describe key supplier selection and bpi constructs, elaborate on the interrelationships among these variables and pose a series of testable hypotheses regarding the linkages between supplier selection and bpi constructs. next, we discuss methodological issues related to developing and validating the measures of constructs as well as data collection and analysis procedures. thereafter, we present and discuss the results of our substantive tests that involve linear regression models. we conclude by considering the implications for both research and practice and provide recommendations for broadening the scope of future research of supplier selection and bpi.

This thesis discusses and demonstrates the benefits of simulating and optimising a manufacturing control system in order to improve flow of production material through a system with high variety low volume output requirements. The need for and factors affecting synchronous flow are also discussed along with the consequences of poor flow and various solutions for overcoming it. A study into and comparison of various planning and control methodologies designed to promote flow of material through a manufacturing system was carried out to identify a suitable system to model. The research objectives are; • Identify the best system to model that will promote flow, • Identify the potential failure mechanisms within that system that exist and have not been yet resolved, • Produce a model that can fully resolve or reduce the probability of the identified failure mechanisms having an effect. This research led to an investigation into the main elements of a Drum-Buffer-Rope (DBR) environment in order to generate a comprehensive description of the requirements for DBR implementation and operation and attempt to improve the limitations that have been identified via the research literature. These requirements have been grouped into three areas, i.e.: a. plant layout and kanban controls, b. planning and control, and c. DBR infrastructure. A DBR model was developed combined with Genetic Algorithms with the aim of maximising the throughput level for an individual product mix. The results of the experiments have identified new knowledge on how DBR processes facilitate and impede material flow synchronisation within high variety/low volume manufacturing environments. The research results were limited to the assumptions made and constraints of the model, this research has highlighted that as such a model becomes more complex it also becomes more volatile and more difficult to control, leading to the conclusions that more research is required by extending the complexity of the model by adding more product mix and system variability to compare results with the results of this research. After which it will be expected that the model will be useful to enable a quick system response to large variations in product demand within the mixed model manufacturing industry.

Dans le monde des affaires d'aujourd'hui, les besoins des clients changent plus rapidement que jamais et le nombre de concurrents augmente chaque seconde. De plus, la capacité à gérer les changements et l'imprévisibilité sont devenus un facteur crucial pour que les entreprises gagnent en valeur et restent compétitives [Oracle 2013]. Il en résulte que les entreprises sont aujourd'hui confrontées non seulement à la gestion de processus métier structurés, mais également à des processus de plus en plus non structurés. Dans un processus métier structuré commun, tout ce qui concerne le processus peut être prédéterminé au moment de la conception, tel que les activités, la séquence d'exécution des activités, etc. Cependant, dans une structure non structurée, les activités ne peuvent pas être définies précisément au préalable, ainsi que la séquence à exécuter. Pour rester compétitives, répondre aux demandes du marché en constante évolution et améliorer l'efficacité opérationnelle de leurs processus d'affaires, les organisations ont besoin d'une approche de processus novatrice qui peut les aider à gérer les changements, la dynamique et l'imprévisibilité. Dans ce contexte, le concept de Case Management est proposé. Différent du Business Process Management (BPM) qui standardise et automatise les processus métier structurés, CM surmonte les limites de l'approche BPM et fournit une infrastructure pour gérer les changements, la dynamique et l'imprévisibilité dans les processus métier non structurés. Le CM procède en grande partie en fonction de l'évolution des circonstances, et les décisions sont prises à la volée. BPM nécessite un haut niveau de prévisibilité; considérant que le CM a un niveau de prévisibilité moindre mais un niveau d'adaptabilité et de flexibilité plus élevé. Avec l'approche CM, les entreprises sont en mesure de gérer leurs processus métier non structurés de manière plus souple et plus flexible.Cependant, pour ce nouveau domaine, il manque des méthodes de soutien et des outils logiciels. Les principales préoccupations sont: (1) la modélisation de cas (la construction de modéles de cas); (2) la découverte de modèles (l'établissement de modèles de cas à partir de données brutes); (3) l'analyse de modèles (l'analyse de modèles à la fois statiques et dynamiques, par exemple, la dérivation de propriétés avant la mise en place du cas); (4) amélioration du modèle (réduction des coûts, optimisation de la performance opérationnelle, etc.); et (5) la promulgation du modèle (l'exécution d'un scénario avec des case workers dans la boucle). Après un examen approfondi de la littérature, nous avons constaté que seulement quelques efforts ont été faits dans (1) et (5), et aucune contribution notable n'a été faite dans d'autres aspects.Ceci présente notre approche CM qui fournit aux assistants un support complet dans tout le cycle de vie du CM: de l'établissement de modèles de cas à partir de données brutes jusqu'à l'optimisation des modèles de cas. Process Tree est notre choix pour formaliser le modèle découvert, et CMMN (Case Management Model and Notation, une spécification de modèlisation de cas est choisie comme formalisme pour la présentation et la construction de modèles de cas.) En outre, nous adoptons le langage HiLLS. L'analyse de modèle dynamique est permise par le formalisme DEVS, l'analyse de modèle statique est fournie par des méthodes formelles. Quand à la mise en oeuvre de modèle, elle est permise par la mise en ?uvre d'une spécification orientée objet du cas. Nous proposons principalement deux modules: un module concernant la découverte du modèle de cas à partir des historiques d'événements, et un autre module concernant l'amélioration et l'optimisation du modèle de cas<br>In today's business world, customer requirements change more rapidly than ever before, and new competitors are increasing every second. Moreover, the ability of managing changes and unpredictability has become a crucial factor for enterprises to make more value and stay competitive [Oracle 2013]. This results in a fact that nowadays enterprises are challenged with not only managing structured business processes, but also more and more unstructured ones. In a common structured business process, everything regarding the process can be predetermined at design time, such as activities, the execution sequence of activities, and so on. However, in an unstructured one the activities cannot be defined precisely beforehand, as well as the sequence to execute. To stay competitive, meet the ever-changing market demands and improve their business process operational efficiency, organizations need a novel process approach that can help them manage changes, dynamics and unpredictability. Under this context, the concept of Case Management is proposed. Different from Business Process Management (BPM) which standardizes and automates structured business processes, CM overcomes the BPM approach limitations and provides an infrastructure for managing changes, dynamics and unpredictability in unstructured business processes. CM proceeds largely depending on evolving circumstances, and decisions are made on the fly. BPM requires a high level of predictability; whereas CM has a lower level of predictability but a higher level of adaptability and flexibility. With CM approach, enterprises are able to manage their unstructured business processes in a more adaptive and flexible manner.However, for this new area it lacks supporting methods and software tools. Major concerns are: (1) case modeling (the construction of case models); (2) model discovery (the establishment of case models from raw data); (3) model analysis (the analysis of models in both static and dynamic manners, e.g., the derivation of properties before the case is enacted); (4) model improvement (the reduction of cost, the optimization of operational performance, etc.); and (5) model enactment (the execution of a case scenario with case workers in the loop). After a thorough literature review we found that only a few efforts have been done in (1) and (5), and no noticeable contribution has been done in other aspects.This these presents our CM approach that provides case workers full supports in the whole lifecycle of CM: from establishing case models from raw data to optimizing case models. Process Tree is our choice to formalize the discovered model, and CMMN (Case Management Model and Notation, a case modeling specification is selected as the formalism for presenting and constructing case models. In addition, we adopt the HiLLS (High Level Language for Systems Specification) formalism to conciliate usability, simulation ability and formal analysis capabilities together. Dynamic model analysis is enabled by DEVS formalism, static model analysis is provided by formal methods, and model enactment is given by the implementation of an object-oriented specification of the case. We propose mainly two modules in this these: one module concerning the discovery of the case model from historical event logs, and another module concerning the improvement and the optimization of the case model

IQE (Europe) Ltd. manufactures group III/V compound semiconductor material structures, using the Metal Organic Vapour Phase Epitaxy process. The manufactured ranges of semi-conducting materials are relative to discrete or multi-compound use of Gallium Arsenide or Indium Phosphide [III/V]. For MOVPE to compete in large-scale markets, the manufacturing process requires transformation into a reliable, repeatable production process. This need is identified within the process scrap percentage of the process when benchmarked against the more mature Si-CVD process. With this wide-ranging product base and different material systems, flexible processes and systems are essential. The negative impact however, of this demanded flexibility is a complex system, resulting in instability. Minor fluctuations in time, flow, pressure, temperature, or composition in the manufacturing process, will lead to characteristic differences in the produced material [product], when comparing the prescribed run to the actual run. The product profile changes very rapidly, correspondingly the failure profile of the process is equally as dynamic, it is essential therefore that the analysis and projected activities and actions can be identified and consolidated in a timely manner. This project evaluates the process used by IQEE to manufacture III/V compound semi-conducting material structures and uses the business performance to identify the process drivers. One year's [1997] business and process information is used for a single iteration of the improvement cycle. These drivers are then utilised as operators and offer the critical weaknesses in the process related to performance blockages. Some of the techniques utilised in the process evaluation and cause derivation; are original contributions specifically derived for use with a multi-platform complex process with multiple cause and effect operators. A double reporting FMEA contributes a differing rank for like machines running differing products, offering a machine specific failure profile. A novel composite of P-diagram and process flow techniques enables determination of activity influences confirming the key failure mechanism as previously identified by the business risk analysis. This project concludes by nominating the key failure mechanism accounting for 41% of the approximate 50% scrap figure identified again within the business risk analysis. The effects attributed to this failure mechanism are 2- dimensionally analysed utilising an original double operating FMEA, plotting effect to effect for the individual causes, offering a prioritised list of failure categories. The highest priority failure mode is addressed by an equipment design exercise, resulting in an overall 10% sales potential recontribution.