Emergency Department Bottleneck Proposal
Middletown Hospital is a 200-bed, not-for-profit-general hospital that has an emergency department with 20 emergency beds. The emergency department handles on an average 100 patients per day. The hospital’s CEO has authorized the Six Sigma Team (SST) to address complaints received from patients seeking treatment between 6:00 p.m. and 10:00 p.m. The complaints are centered on waiting times and poor service. During this time the data indicates that approximately 70% of the department’s admissions occur (University of Phoenix, 2009, Course Syllabus).
To address these complaints and improve performance of the emergency department the Six Sigma Team must understand process improvement proposals. The process must identify the reason of the bottleneck; identify the correct data collection method; the use of capacity planning; accurate analysis of the scheduling and controlling techniques; and identify a recommendation on staffing or alternative sources of care. Process Improvement Proposals
A process improvement proposal is a mechanism to define the opportunities needed to reduce the number of steps, interactions, decision points, reports, and the length of the defined practice (Langabeer, 2008). Three key areas need to be addressed when improving a current practice. According to Langabeer (2008), these areas include increasing capacity, reducing the use of resources, and reducing the amount of variation (p. 79). For example, if the emergency department is currently seeing patients at a rate of four per hour during normal business hours, and this rate drops to one per hour during the period listed a bottleneck will result. To address this issue the department needs to provide the resources necessary to avoid the problem. However, when the reason for the bottleneck is known the correction must include steps to preserve resources. These steps must address reducing the cost per patient, removing excessive steps, and exposures that are unnecessary. Because the data shows the bottleneck occurring after normal business hours the third key area is equally important for successful performance. This area involves the development of control tools. These tools will assist the department when variation occurs, these tools can include the development of contingency plans to use other hospital resources available after normal business hours; for example the use of clinical examination rooms for patient overflow. Process of Improvement Method
Edward Deming introduces a method known as the Deming Cycle to identify bottlenecks within organizational structures. The Deming Cycle comprised of a continuous process cycle that involve planning, implementation, assessment and decision-making. Deming postulated that “business processes should be analyzed and measured to identify sources of variations that cause products to deviate from customer requirement” (Arveson, 1998, para 1). Each step gives operation managers the feedback needed to determine if they are meeting current objectives. Arveson also suggest that this checklist will help reduce bottlenecks from happening while increasing productivity within every department. Comparing the Middleton Hospital use of Six Sigma methodology to Deming Cycle both methods can help reduce bottlenecks issues with waiting time that occurs during interval time of 6:00 p.m. to 10:00 p.m. Six Sigma methodology uses phases of defining a problem and provide an alternative solution to the problem. The next phase includes measuring the solution’s outcomes, analyzing the outcomes’ goals and effectiveness, improving any flaws that was identified in the improvement process, and controlling any costs or activities to contain cost and resource deficiency (National Association of Health Care Quality, 2009). The Six Sigma system addresses each problem measuring a quantitative solution to be addressed by upper management and delivered to department heads for implementation....
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