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Objectives: To assess the use, and evaluate the usefulness, of non-interventional studies and routinely collected healthcare data in postmarketing assessments conducted by the European Medicines Agency (EMA).
Design: We reviewed and systematically assessed all referrals to the EMA made due to safety or efficacy concerns that were evaluated between...
Citations
... Taner (2013) lowered down the complications of cataract surgery using Six Sigma. Alkinaidri and Alsulami (2018) improved the delays in referral system of hospital using Lean Six Sigma. Molla et al. (2018) improved the timeliness of the discharge process of the hospital using Lean Six Sigma. ...
... They stated that multidisciplinary team approach along with Six Sigma training is the most crucial for successful implementation of Six Sigma. Alkinaidri and Alsulami [30] improved the delays in referral system of hospital using Lean Six Sigma approach. After the project, a little improvement in the response time of physicians to the referral system was achieved. ...
Purpose
The purpose of this paper is to investigate the utilization of Lean & Six Sigma quality initiatives in healthcare sector in India.
Methodology
The survey questionnaires were sent to 454 hospitals through registered postal in all the states of India. The survey questionnaire was designed to assess different quality initiatives; currently implemented in Indian hospitals, factors align with organization’s objectives, reasons for not implementing Lean & Six Sigma and contribution of Lean & Six Sigma projects in healthcare improvement projects etc. A separate section in the questionnaire provides the feedback on implementation of Lean & Six Sigma in various hospitals. The relationships between Lean & Six Sigma and healthcare performance have also been established in this paper.
Findings
It is found that 15 Nos. of hospitals have implemented the Lean tools while 14 Nos. have implemented the Six Sigma tools out of 109 collected responses. This shows the utilization of Lean & Six Sigma in Indian healthcare sector. The ‘Lack of knowledge’ and ‘Availability of resources’ are the major reasons for not implementing Lean & Six Sigma. It is also observed that 22% running projects were related to Lean & Six Sigma out of various improvement projects running in various hospitals.
Originality
There is lack of evidences of similar studies that determines the utilization of Lean & Six Sigma in Indian healthcare sector at the national level. This paper will provide important breakthrough to academicians and healthcare practitioners, who are involved in Lean & Six Sigma research.
Social implications
The present study will create awareness among healthcare practitioners across India for utilization of quality tools that will provide direct benefits to the society.
... Four of the studies were conducted in United States of America (11. 12, 35, 36), two were conducted in South Africa (14,37), while one study was done each in Italy, Taiwan, UK, Kenya, and Malawi (1,8,13,29,38). Six of the papers were retrospective cohort studies (12,15,35,37,39,40), four randomized control trials (RCT) (1,11,13,14), two mixed method involving qualitative and quantitative approaches (29,38) and one system simulation study (8). ...
... 12, 35, 36), two were conducted in South Africa (14,37), while one study was done each in Italy, Taiwan, UK, Kenya, and Malawi (1,8,13,29,38). Six of the papers were retrospective cohort studies (12,15,35,37,39,40), four randomized control trials (RCT) (1,11,13,14), two mixed method involving qualitative and quantitative approaches (29,38) and one system simulation study (8). ...
... These include resource allocation criteria (1,11,12,13,14,35,36). Three studies evaluated provision of patient referral including simulation optimization methods for solving patient referral problems in hospital environment, challenges facing implementation of referral system for quality health care services, and provision of referral services at primary care (8,29,38). ...
... Nowadays, patient referrals are a common practice in healthcare setting with aim to seek advice, specialty consultations for advance and complex cases [1]. Referral system supports the transfer from one level of the healthcare system to higher levels for patients attending a healthcare facility that has insufficient resources to the most appropriate specialist or facility with better level of services [2][3][4]. Healthcare organizations know that referrals are a critical especially with growing demand for specialty care. Pending or delaying referral requests is the most common barrier to a well-functioning referral system. ...
... This, in turn, makes timely access to specialty services more challenging, hence inefficiencies in quality of healthcare and suboptimal outcomes [5]. In order to overcome such barriers, a technical intervention is needed to streamline the referral process and reduce pending referrals in order to improve overall process effectiveness [4]. This study aims to assess whether escalation emails (technical intervention) would be practical at our facility to reduce the frequency of pending referral requests (accept, reject). ...
Referral system supports the directing of patient to an appropriate facility or specialty. Avoiding delay in referral requests decrease waiting lists and increase effectiveness of referral system, this leads to smooth referral process, and ease communication between all levels of the health system. This study uses Ministry of National Guard Health Affairs, Saudi Arabia to assess using escalation emails (technical intervention) as a way to improve quality of referral system. This solution was applied to identify the pending requests and escalate them to different departmental levels to speed the process. The intervention resulted in a trend of reduction in the percentage of requests either accepted or rejected; and thereby an improvement in the quality of referral system was achieved
... Likewise, research with a dynamic system simulation approach is still lacking or as far as the author knows, it does not even exist so that this research becomes important to fill in the gaps.. Test the average cost at a higher level of health facilities because of health referrals. [7] Statistics Improve the current referral system [8] Lean Six Sigma Measuring the level of referral from primary care to secondary care, evaluating referrals, and measuring the level of feedback from doctors secondary care. [9] A cross-sectional approach Evaluate the referral system in primary care in three regions in Ethiopia. ...
Indonesian National Health Insurance System (INHIS) is a government program that aims to provide health insurance to citizens by guaranteeing their health services. However, INHIS finances continued to experience a deficit since 2014. The purpose of this study was to find a solution so that the stock of funds remained stable. This is done by changing the patient's referral mechanism in INHIS. This is one solution so that the total health care costs do not increase. In this case the dynamic system simulation model is needed to find the relationship pattern between variables so that it can estimate the condition of INHIS funds. The decision variables in this study are the total health care costs and the stock of funds. From the simulation process, the results show that the proposed model can reduce the total health care costs by 44% and be able to maintain a stable supply of funds up to 40% of the sudden increase.
... SIPOC is a tool typically used in Define phase of DMAIC framework with the objective to identify process inputs and outputs. There are many advantages such as; it helps to scope the project, to identify the boundaries of the processes, to improve communications among the team members and also provide high level business requirements [28]- [30], [36]. The main disadvantage involved extensive discussion with the stakeholders. ...
Requirement Elicitation (RE) is the most important phase in software development life cycle. It is a complex process because it involves the communications between two group of people to get into understanding of what to be built and what need to be delivered from software perspective. The purpose of this paper is to introduce a hybrid framework which combine the RE techniques from analytical and synthetic category with Lean Six Sigma (LSS) method, aimed at improving RE process to produce a quality software requirement. A framework consists of three phases; design, implementation and analysis are proposed where an industry case study is demonstrated for validation. The new framework observed a significance acceptance by analysts where the new hybrid approach is easy to adopt though at absence of users at the early stage of requirement study. The result also shown that the entire RE process cycle time improved tremendously. The limitation of this paper because it only tested in one company and at a specific project. The main contribution of the paper is to provide new knowledge in combining the RE techniques with LSS at absence of end user.
... Last phase is to develop the monitoring plan. Recommended tools are effective communication, long term solutions such as web based monitoring systems or control charts, awareness and others [27]. ...
Providing quality requirements in Software Engineering is vital to ensure the product developed is able to deploy and function to meet the operational objectives. Software Requirement Engineering is the most complex process because it involves the integration of human, logics and process. Extracting or capturing what customers need and want is called Requirement Elicitation (RE) and it is the most crucial process in requirement engineering. If handled poorly, the cost of the failures would be very expensive. Most of the software projects that failed were due to poor requirements which occurred at RE phase. Thus, enhancing and optimizing the RE methods have been subject to a long research debate to ensure quality requirements are captured. Recently, Lean Six Sigma (LSS) had emerged as part of a continuous improvement in Software Development Life Cycles (SDLC). LSS is known for a systematic and structure business improvement successfully deployed in many fields of industry that contributes a significant gain not only in quality of products and services but also in operational costs and delivery. The objective of the research is to develop an integrated conceptual framework of LSS principles with Software Requirement Engineering methodology to optimize RE process. The article will produce conceptual framework as the comprehensive guidelines to capture quality software requirements.
... Between 2014 and 2015, the number of referrals requested of and accepted by secondary healthcare providers increased by 13.6% and 11.5%%, respectively, illustrating the necessity of improving the referral system in Saudi Arabia (Alkinaidri & Alsulami, 2018). In 2018, Alkinaidri and Alsulami (2018) identified the following issues in the Saudi health referral system: delays in responding to referral requests, incomplete referral documents, lack of internal communication consultants, and lack of follow up by coordinators. ...
... Between 2014 and 2015, the number of referrals requested of and accepted by secondary healthcare providers increased by 13.6% and 11.5%%, respectively, illustrating the necessity of improving the referral system in Saudi Arabia (Alkinaidri & Alsulami, 2018). In 2018, Alkinaidri and Alsulami (2018) identified the following issues in the Saudi health referral system: delays in responding to referral requests, incomplete referral documents, lack of internal communication consultants, and lack of follow up by coordinators. Therefore, the researchers applied Lean Six Sigma principles to the referral system in King Abdullah Medical City in Makkah. ...
... Therefore, the researchers applied Lean Six Sigma principles to the referral system in King Abdullah Medical City in Makkah. The results included a decrease from 28.1% to 21.5% in delayed responses to referral requests, reducing inappropriate referrals and improved compliance with response-time policies (Alkinaidri & Alsulami, 2018) Quality of primary care ...
INTRODUCTION: The referral system authorizes and transfers the responsibility for healthcare services from one provider to another. A key component of the system is the communication between primary-care and specialist providers. Poor communication between them is detrimental to and can cause significant issues with coordination of effective care. OBJECTIVE: The purpose of this review was to evaluate current healthcare referral systems, focusing on the communication among providers, and to suggest practices that could make the Saudi healthcare referral system more effective. DESIGN: This systematic review identified published studies of the quality of the healthcare referral system in Saudi Arabia and other countries using two databases, Medline and PubMed. Data were summarized and extracted into two tables. RESULTS: The review included 12 studies that met its selection criteria. These studies were conducted in various regions of Saudi Arabia, but mostly the west and north. The 12 studies included 181,192 participants, with numbers of participants ranging from 21 to 138,484. The present review found that more than 50% of the referral documents and feedback reports in these studies had incomplete patient information. Implementation of electronic referrals (e-referrals) in several countries, including Australia, New Zealand and the United States, improved their referral systems, particularly by solving the problem of incomplete referral documents. In addition, the present review found that in some specialist clinics, referral cases contributed to increased workloads. One study reported on implementation of Lean Six Sigma principles in a military hospital in western Saudi Arabia, which reduced the number of referrals delayed, inappropriate referrals and the response time to referrals (7%). E-referrals and Lean Six Sigma principles may be applicable in Saudi Arabia as solutions to referral and response-time problems. CONCLUSIONS: An increase in healthcare referrals in Saudi Arabia has caused an increase in missing essential information in referral letters and feedback reports as well as overcrowding in specialist clinics. The results of the present review suggested that implementing e-referral and Lean Six Sigma principles may improve the quality of Saudi Arabia’s healthcare referral system.
In today's competitive conditions, businesses that produce goods or services frequently benefit from process improvement and similar methods to achieve their goals. Being process-oriented means giving importance to the creation of quality, not quality control. The Hospital Appointment system is the admission of patients to polyclinics at certain time periods. The purpose of the appointment system for the patients is to organize and spread the time of the patients' arrival at the hospital outpatient clinics. In general, to solve the waiting problem in hospitals, health services are provided by distributing patients to certain time periods. However, due to the insufficient capacity of the hospital, the patients' demand for health services cannot be met, and therefore the appointment problem continues. Patients spend days on the internet and on the phone to get an appointment from some medical units. In this context, the aim of the study is to make improvements and evaluate the results by evaluating the problems experienced in the process of making an appointment in health services in terms of quality, time, technique, and customer satisfaction.
