Value Creation to Patients and Reducing Waiting Time

This report discusses the need to reduce waiting time for patients in the emergency department and create value for them. It explores the current state value stream map and proposes a new map with a decentralization of responsibilities. The report also discusses the intended and unintended consequences of the modified system.

Running head: VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Value Creation to Patients and Reducing Waiting Time
Name of the Student:
Name of the University:
Author Note:

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Executive Summary:
It can be pointed out from the report that emergency department of the public hospitals should
stream their value chain streams to create value for the patients. They should also counsel and
mentor their employees to reduce the insecurity.

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Table of Contents
Executive Summary:........................................................................................................................1
Introduction/background:................................................................................................................2
Identification and analysis of the System Archetypes that may impede performance:...................2
Analysis of the current State Value Stream Map of the emergency department based on System
Archetypes:......................................................................................................................................3
Recommended new State Value Stream Map with desired reduction in patient turnaround time:. 4
Discussions on intended and unintended consequences of the modified system............................5
Recruitment of medical employees eligible for holding the positions of attending nurses:........5
Training of the existing medical staffs:.......................................................................................6
Technological up gradation:........................................................................................................6
Resentment among the attending nurses:....................................................................................6
Conclusion:......................................................................................................................................7
Recommendations:..........................................................................................................................7
Mentoring and counseling of the attending nurse:......................................................................7
Training of the medical staff:......................................................................................................7
References:......................................................................................................................................8
Appendices:.....................................................................................................................................9
.........................................................................................................................................................9

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Introduction/background:
The emergency departments of public hospitals have to manage a large number of
patients many of whom are in critical stages. This requirement to treat large numbers of patients
accurately put immense pressure on the staff involved in the department. The management of the
public hospitals in order to ensure that the treatment services proceed in ways so that each
patients can be treated systematically, forms value stream map. However, the pressure to treat
immense numbers of patients impedes the medical staff members of the emergency departments
to ensure value creation to each and every patient. The operations staff members of the
emergency departments in order to enable the medical deal with the issue have to restructure the
existing value stream map from time to time to meet the operational needs of the department
(Haghighinejad et al., 2016). The aim of the report would be to explore an issue faced by the
emergency department of an arbitrary hospital to point out that changes in its existing value map.
The main issue which the report would seek to manage by restructuring their existing value
stream map would be long waiting hours for which the patients (customers) have to wait (Shetty
et al, 2017). It would also be assumed that the emergency department has gained feedback from
patients which necessitates reduction of the waiting time of the patients, thus reducing their
suffering by giving them prompt treatment and creating value to them.
Identification and analysis of the System Archetypes that may impede performance:

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Analysis of the current State Value Stream Map of the emergency department based on
System Archetypes:
An analysis of the existing value stream chain of the emergency reveals the issue of lack
of streamlining of the patient admission, treatments and discharge of the patients. The value
stream map of the emergency can be divided into two broad categories, namely, flow of material
and flow of information. The process starts with a patients walking in who are registered at the
outpatient desk or counter. The patients then go to the waiting area from where they are taken to
the ER rooms. The availability and allocation of the rooms to patients are under the jurisdiction
of the attending nurse. The patients are examined by nurses to recognize their health issues and
their causes (Yarmohammadian et al. 2017). The medical supplies which the nurses require to
check the patients have to be allocated by the attending nurse. The next stage of patients’
treatment consists of doctors treating the patients once, using the supplies of medical goods
allocated by the attending nurse. It can again be pointed out that when the doctors issue departure
instruction to the patients showing strong signs of recovery, the departure documents once again
is issued by the attending desk. Thus, it is clear from the main issue dealt with in the case study,
prolonged waiting time which escalates the suffering of the patients stems of the extreme
centralization of the patient treatment in the hands of the attending nurse. It can also pointed out
that as per the established value stream chain, the intervention of attending nurse in every action
in the emergency department actually contributes to the waiting time of the patients, thus
increasing their suffering (Improta et al., 2018). Thus, the new value stream map which would
put forward before the management of the hospital would aim to reduce the waiting time of the
patients by decentralization the process of the emergency department.

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Recommended new State Value Stream Map with desired reduction in patient turnaround
time:
The new value stream map of the emergency department would aim to reduce the waiting
time of the patients which decentralizing of the duties of the department. The new value stream
map would start with the patients walking in. The patients post arrival would be directly taken to
the emergency rooms where the nurses would examine them to recognize the cause(s) of their
sickness or suffering. The next step would consist of the doctors examining the patients and
confirming the causes of ailment pointed out to the nurses attending the patients. The nurses
would then acquire the medical supplies to treat the patients. The doctors would then treat the
patients. The patients who recover are issued dispatch instructions by the attending doctors and
the former would be discharged from the emergency department. The change in the existing
value stream map which would be introduced would be decentralization with the power of the
attending nurse being curbed to control the treatment of the patients. As per the new system, the
patients would be issued emergency rooms in which the nurses would examine them. The nurses
attending the patients would be empowered to register the rooms in the name of the particular
patients which in turn would be communicated to the attending nurse 1(looking after allocation
of rooms). Secondly, there would be a new office of an attending nurse who would be
responsible for the allocation of medical suppliers to doctors and nurses for treating patients
(attending nurse 2). The nurses and doctors would treat the patients (Johari, Ahmad & Abidin,
2018). The doctors would be issuing dispatching instructions to patients showing strong rates of
recovery. The third attending nurse or attending nurse 3 would be responsible for issuing
departure related documents prior to their departure. It can be pointed out that the this division of
the duties and responsibilities of the attending nurse among three personnel holding the positions

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
of attending nurses, each nurse looking after a specific needs of the patients,. It can be inferred
from the description that this division of the responsibilities of the attending nurse among three
personnel would streamline the entire treatment process. For example, attending nurse 1 would
be responsible for maintaining records of the rooms in the emergency department available for
admission of patients. Attending nurse 2 accordingly would be responsible for allocating medical
suppliers to patients. Similarly, the third attending nurse or attending nurse 3 would be
responsible for issuing dispatch instructions to the out-going patients. Thus, it is evident from the
analysis of the new value chain stream that the division of the responsibilities carried out one
attending among three attending nurses would reduce the waiting times of the patients, thus
reducing the suffering of the latter.
Discussions on intended and unintended consequences of the modified system.
The change proposed in the value chain stream namely, division of the responsibilities of
one attending into among three attending nurses of equal hierarchy would attract several
intended and unintended consequences. The following are the intended consequences of the
change in the value stream of the emergency department under study:
Recruitment of medical employees eligible for holding the positions of attending nurses:
The first intended consequence of the division of power in the emergency department
would require the management of the hospital recruit medical personnel eligible of holding the
position of the attending nurses. An analysis of the value stream provided shows that the
attending nurse has to carry out three main responsibilities namely, allocating rooms to the
patients, allocating medical suppliers to treat the patients and issuing discharge certificates to
outgoing patients. Thus, it can be established that the personnel eligible to hold the position of

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
the attending nurses should be experienced and skillful to play the roles of the attending nurses
efficiently.
Training of the existing medical staffs:
The hospital should provide training to the medical staff to treat patients more efficiently.
The training of the doctors and nurses would enable them treat patients more appropriately. It
can also be pointed out that well trained medical staff would be able to treat patients faster, thus
speeding up their recovery rates. This would also enable them to treat more patients, thus
reducing waiting time of the patients (issue).
Technological up gradation:
It can be pointed out that the third consequence which the modification of the value
stream would result in would be the requirement of the hospital to upgrade its technological
infrastructure. It can be pointed out that the hospital should upgrade its existing technology to
enable the attending nurses obtain real time data booked by patients undergoing treatments and
the number of rooms available for admission of patients (Holzinger, Röcker & Ziefle, 2015). The
attending nurse looking after dispatch would be able to view the amount of payment made by the
particular patients and check whether they have any outstanding payments. Thus, it can be
established that the up gradation of the system would enable the attending nurses exercise greater
level of real time control over the emergency department functions under their individual
responsibilities.
Resentment among the attending nurses:
It can also be pointed out that the attending nurses may resent this division of power as
per the newly suggested value stream chain. The nurses view this division of power as a threat to

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
their individual influences. They may try to resist the change by not cooperating with the medical
staff, thus in turn increasing the waiting time of the patients.
Conclusion:
It can be concluded from the above analysis that the need to reduce the waiting time of
the patients are one of the most pressing business needs of the emergency departments of the
hospital. The operational departments of the hospitals should bring about changes in the value
stream chain in order to minimize the waiting time of patients. Thus would reduce the suffering
of later and create value for them. The change suggested in the case of the emergency
department would be dividing the power enjoyed by the office of a single attending nurse into
three attending nurses, each looking after a specific area of patient treatment namely, allocation
of rooms, allocation of medical supplies and allocation of the outgoing certificates. It has also
been pointed out that this change would attract certain consequences, some which are accepted
while others are not. The accepted consequences would be recruitment of the new nurse in
charge and technological advancements. The unwanted consequences would be conflict posed by
the present nurse in charge. This would lead to two recommendations which would be mentioned
in the next section.
Recommendations:
The following are the two recommendations which can be suggested to the management
of the hospital to deal with the issue of conflicting attending nurses:

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Mentoring and counseling of the attending nurse:
The management of the hospital should mentor and counsel the defiant attending nurses.
The latter should be informed that the aim of the change would be maximizing patient value by
reducing waiting time and not challenging the powers of the latter.
Training of the medical staff:
The medical staff would be trained. This would enhance their efficiency.
References:
Haghighinejad, H. A., Kharazmi, E., Hatam, N., Yousefi, S., Hesami, S. A., Danaei, M., &
Askarian, M. (2016). Using queuing theory and simulation modelling to reduce waiting
times in an Iranian emergency department. International journal of community based
nursing and midwifery, 4(1), 11.
Holzinger, A., Röcker, C., & Ziefle, M. (2015). From smart health to smart hospitals. In Smart
health (pp. 1-20). Springer, Cham.
Improta, G., Romano, M., Di Cicco, M. V., Ferraro, A., Borrelli, A., Verdoliva, C., ... &
Cesarelli, M. (2018). Lean thinking to improve emergency department throughput at
AORN Cardarelli hospital. BMC health services research, 18(1), 914.
Johari, N. S. K., Ahmad, N., & Abidin, N. Z. (2018). A SIMULATION-BASED DEA
FRAMEWORK TO IMPROVE CUSTOMER’S WAITING TIME AT VEHICLE
INSPECTION CENTRE. Journal of Technology Management and Business, 5(2).
Shetty, A. L., Teh, C., Vukasovic, M., Joyce, S., Vaghasiya, M. R., & Forero, R. (2017). Impact
of emergency department discharge stream short stay unit performance and hospital bed

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
occupancy rates on access and patient flowmeasures: a single site study. Emergency
Medicine Australasia, 29(4), 407-414.
Yarmohammadian, M. H., Rezaei, F., Haghshenas, A., & Tavakoli, N. (2017). Overcrowding in
emergency departments: a review of strategies to decrease future challenges. Journal of
research in medical sciences: the official journal of Isfahan University of Medical
Sciences, 22.

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VALUE CREATION TO PATIENTS AND REDUCING WAITING TIME
Patients regsireted ER rooms
allocated
Nurses check
apottients
Doctors tretya
patients
Patients are
discharged
Attending nurse 1 Attending nurse 2 Attending nurse
3
Approves rooms Allocates medical supplies
Allocates dispatch
certificates
Appendices:
New value stream chain: