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Consider yourself as part of a team responsible for managing the operations of an emergency department of a public hospital. The emergency department has received feedback from patients suggesting that the patient wait times need to be improved. The value stream map of the current operations is shown in the attached diagram Value Stream Map
You have been tasked with improving patient turnaround time by reducing the current time to half. To complete the task you are required to identify the various System Archetypes that affect the operations of the hospital and the emergency department itself and based on the archetypes, develop a future State Value Stream Map of the emergency department.


It is recommended that you identify and critically analyse intended and unintended consequences, recommending holistic solutions that will optimise the operations of the emergency department without compromising the performance of other functions of the hospital.

System Archetypes

The aim of report is to implement a system archetype that will help to minimize the time while waiting for the emergency department. The report will describe the system archetypes that will affect the performance of the hospital (Mutale et al., 2016). System archetypes are basically referred to combination of strengthening and corresponding reaction. These contain two or more loops. The report will analyze the state value stream map of emergency department based on system archetypes that is currently used. The current state value stream that is developed for the department includes a lot of time and this leads to the increase in patient turnaround time (Iqbal et al., 2015). Thus it is important to reduce their turnaround time.

There are all total eight types of system archetypes, this includes limiting the success, instable the burden, fixing the fail, drifting the goals, underinvestment and growth, success to the successful, catastrophe of the commons and escalation. The report will address the existing system archetype used in hospitals emergency department. New recommendation for the state value stream map will be implemented in order to reduce the time.

System Archetypes 

System archetypes are referred to the behavior of a system. Systems that are represented with the use of circles of causality have same structure. One of the fundamental property possessed by the system archetypes is that nothing can affect the past. From the concept of system thinking it ca be stated that every action has some reaction in response. In the context of system dynamics this reaction is referred to as the feedback. Basically these feedbacks are divided into two parts- balancing feedback and reinforcing feedback. However, the feedback offered by the system is not immediate every time, sometimes the feedback gets delayed.

Thus, it becomes easy to draw any diagram set up with the help of circles of causality that includes feedbacks, actions and delays. Reinforcing feedback is also known as amplifying feedback and these is used to accelerate the given process. Whereas balancing feedback is also known as stabilizing feedback and works at if there is any objective state exists. The balancing process anticipates to decrease the gap between the existing state and the chosen state. There are total 8 types of system archetypes, this are as follows:

Fixes the fail: In order to address the problem, faced by the system, a solution gets generated rapidly and addresses the urgent problem (Abdullah & Shaikh, 2015). This also includes fixing up the set of unintentional consequences that are not understood at first but ends up adding one more symptom to the system.

Value Stream Map - Emergency Room

Burden shift: whenever a problem is determined it is being addressed based on sort term and on a fundamental solution. There is a side effect that is produced on fundamental solutions in case of short term solution. As the system encounters these problem, the attention gets shifted to short term solution or to their possible side effects.

Limits to success: whenever s system primarily gives effort it generate a positive performance. Moreover, with time it is observed that the determination reaches to a limit that slows down and with that the overall performance also gets affected irrespective of the energy applied (Hansen, 2018).

Drifting goals: while developing the system it is observed that a gap gets generated between the goal and the actual performance. The aim is to lower to goal and will affect the performance of the system.

Growth and underinvestment: there is a limit to invest on a particular system. Growth is accepted to reach a limit that is avoidable with investments. However, in respect to the investment a decision is made that stops the system to further invest on. These sometimes leads to performance degradation (Frank & Kordova, 2015).

Success to successful: more than two efforts are used to compete for the same finite resources. With the increase in effort, the larger allocation of the resources gets detriment.

Escalation: the parties and the stakeholders associated with the system takes mutual threatening actions that escalates the relation.

Tragedy faced by the commons: there are several parties enjoying the benefits of the resources made common and does not bothers about the effects they are creating on common resources. As a result this resources gets drained consequential in the system closure and all the activities of each party gets closed.

Application of system archetypes

System archetypes are used for the purpose of understanding the dynamics and analyze a specific set of behaviors (Spicar, 2014). This are used as a diagnostic tool. The objective behind developing a system archetype is that in situation of undesirable results or horizontal effects can be plotted in the form of mutual behavior model. The information of system archetypes provides a guidelines for determining the archetype type and after it is identified an approach intervention is included.

However, for proactive perspective system archetypes the planning part becomes important. There are several strategies that are tested with the use of archetypes to analyze the potential drawbacks and addresses them in the time of planning new stages and areas where they can be easily tackled. Apart from these system archetypes provides a language that helps to communicate among the members of a particular organization. However, there are some unintended consequences in system archetypes and these can be translated to the realized consequences (Spricar, 2014).

Application of System Archetypes

Value stream map – emergency room

In the value stream map there are several entities, this includes patient hospital records, attending nurse, attending physician and the insurance company. This are the main stakeholders associated with the hospital’s emergency room. In the scenario it is observed that the patient has to wait for a long time period to get the treatment done. First the registration is done for every patient who comes for a treatment in the emergency room (Bures & Racz, 2016). After the registration the history of the patients is transferred to attending physician by the nurse. These helps the physician to provide proper medicine to the patients. Once the patient gets registered and gets enrolled with a number they are sent to the waiting room and after that from their attending nurse takes the charge and shifts the patient to ER room. Patients are transferred to ER room only after the nurse checks for the available room.

After that the patient is being examined by nurse and a physician (Pejic Zoroja & Merkac-Skok, 2014). After the patient is being examined by the nurse he is taken to the doctor. Once the doctor completes his examination process, the nurse bring the required medical supplies. The physician supplies the medical requirements to the doctor, the doctor starts the treatment. Doctor treats the patients accordingly and with that prescribed medicines and reports are prepared for the patients. After all these procedures the patients can leave the hospital. However, in each step there are several sub steps that gets executed simultaneously.

Before leaving the hospital, the patient needs to submit a copy of the report to the hospital records department. The record contains treatment information related to each patient and also the diagnosis prescribed too each patient. These is a very long procedures and involves a long time of the patient. As shown in the picture in each step the patient needs to wait. Thus, this becomes very much difficult to follow the queue. Thus it becomes essential to develop a new system archetype that will help in reducing the time (Jarvie, 2014).

Recommendation for new state value stream map 

In order to reduce the time in getting the treatment it becomes necessary to shorten the procedures each steps. However while developing the system it becomes necessary to keep in mind that minimizing the time should not sacrifice with the service provided to the patients. The patients should get registered at time of entry and at that time there should be an attending nurse who will diagnosis the patient on an initial level and will transfer the records to the physicians. After that once the room gets clear the nurse should assist the patient to the ER room without wasting time (Tyagi et al., 2015).

The nurse should understand the problems and should schedule the patients accordingly. Emergency rooms are basically for the purpose to provide instant service to the needful. After these the patients needed to be diagnosed by the doctor for further treatment. Once the doctor diagnoses the patient, the information is sent to the physician and according to the information medicines are being prepared and supplied to the patients. Once the patient gets prescribed with the medicine and the database gets stored in the system, the patient can leave the hospital premises. The records of the patients can be sent while the papers are sent to the physicians for medicine (Nallusamy, 2016).

This will save the patient’s time and also will decrease the effort and time needed to implement the task in two different phase. With the implementation of these state value stream map the time will be saved and can be done effectively. Moreover the patient will also get satisfied with the service provided by the hospital.

Intended and unintended consequences of new state value stream map

Unintended consequences are referred to the outcomes that are not predicted and are brought intentionally. However, there are three types of unintended consequences this includes unexpected benefits unexpected drawbacks and perverse result (Lacerda, Xambre & Alvelos, 2016). With the implementation of new state value stream map the unintended consequences that are likely to be faced by the hospital includes the unexpected benefits, like the increase in customer satisfaction or with the implementation of these new map the efforts made by the people associated with the organization can be reduced.

After these, it comes to the unexpected drawbacks (Venkatram, et al., 2014). This includes occurrence of an activity that was not desired. That is apart from the expected drawbacks there will be a sudden occurrence of an activity. With the implementation of new map if suddenly the whole system gets messed up or the physician prescribes wrong medicine to the wrong person it will cause an adverse effect. Intended consequences are referred to the cases where someone intentionally tries to harm an organization or a particular human being (Martin & Osterling, 2014). The intender consequence of the new developed map is in case anyone leaks the private data of the patients or the data gets transferred or shared with other institutions intentionally.

Recommendation

The developed new State Value Stream Map of the emergency room will help the hospital to manage the patients well. Moreover it is recommended to the hospital to set the patients based on the priorities. The new value stream map will improve the efficiency of each staff associated with the emergency room as their responsibility increases (Roshani & Zaharee, 2015). The developed system will also reduce the time. This will reduce turnaround time and will help organization to manage every patients well. Moreover with the help of implementing an emergency number will help the organization to manage the system well. Moreover the physician is advised to be efficient and effective so that they can manage the work properly.

Conclusion

From the above report it can be concluded that it is important to implement new value stream map for reducing turnaround time. The system archetypes and their behaviour are described in the report. System archetypes are used to determine the behaviour of the system. The report has determined the application of system archetypes. Apart from these the report has addressed the already existing value stream map and a new system is developed for better service towards the patients. With the newly developed system the patients will get better facility.

References 

Abdullah, M. A., & Shaikh, B. T. (2015). Review of HIV response in Pakistan using a system thinking framework. Global health action, 8(1), 25820.

Bureš, V., & Racz, F. (2016). Application of system archetypes in practice: an underutilised pathway to better managerial performance. Journal of Business Economics and Management, 17(6), 1081-1096.

Frank, M., & Kordova, S. K. (2015). Four Layers Approach for Developing System Thinking Assessment Tool for Industrial and Systems Engineers. Ind Eng Manage, 4(178), 2169-0316.

Hansen, P. K. (2018). Do Norwegian Textbooks for Compulsory Education Promote Geological System Thinking?.

Iqbal, A. M., Khan, A. S., Bashir, F., & Senin, A. A. (2015). Evaluating national innovation system of malaysia based on university-industry research collaboration: A system thinking approach. Asian Social Science, 11(13), 45.

Lacerda, A. P., Xambre, A. R., & Alvelos, H. M. (2016). Applying Value Stream Mapping to eliminate waste: a case study of an original equipment manufacturer for the automotive industry. International Journal of Production Research, 54(6), 1708-1720.

Martin, K., & Osterling, M. (2014). Value stream mapping: how to visualize work and align leadership for organizational transformation. New York, NY: McGraw-Hill.

Mutale, W., Balabanova, D., Chintu, N., Mwanamwenge, M. T., & Ayles, H. (2016). Application of system thinking concepts in health system strengthening in low?income settings: a proposed conceptual framework for the evaluation of a complex health system intervention: the case of the BHOMA intervention in Z ambia. Journal of evaluation in clinical practice, 22(1), 112-121.

Nallusamy, S. (2016). Lean manufacturing implementation in a gear shaft manufacturing company using value stream mapping. In International Journal of Engineering Research in Africa (Vol. 21, pp. 231-237). Trans Tech Publications.

Pejic Bach, M., Zoroja, J., & Merkac-Skok, M. (2014). Social responsibility in tourism: system archetypes approach. Kybernetes, 43(3/4), 587-600.

Rohani, J. M., & Zahraee, S. M. (2015). Production line analysis via value stream mapping: a lean manufacturing process of color industry. Procedia Manufacturing, 2, 6-10.

Špicar, R. (2014). System dynamics archetypes in capacity planning. Procedia Engineering, 69, 1350-1355.

Tyagi, S., Choudhary, A., Cai, X., & Yang, K. (2015). Value stream mapping to reduce the lead-time of a product development process. International Journal of Production Economics, 160, 202-212.

Venkataraman, K., Ramnath, B. V., Kumar, V. M., & Elanchezhian, C. (2014). Application of value stream mapping for reduction of cycle time in a machining process. Procedia Materials Science, 6, 1187-1196.

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