MGT603: Improving Hospital Efficiency with System Thinking Analysis

This report analyzes the patient wait times in a public hospital's emergency department using a systems thinking approach. It identifies the problem of long wait times and applies system archetypes to understand the underlying issues. The report includes an analysis of the current state value stream map, highlighting inefficiencies in the patient flow. A new, simplified value stream map is proposed to reduce patient turnaround time. The report discusses the intended and unintended consequences of the modified system, offering recommendations for improving patient experience and overall hospital efficiency. The analysis emphasizes the importance of front-line scheduling, organizational culture, and policy adjustments to address the root causes of the long wait times and improve healthcare outcomes.

Running head: SYSTEM THINKING
System thinking
Name of the student:
Name of the university:
Author note:

Executive Summary
This paper has presented the methods which the public hospital can follow in order to reduce
the patient wait time. As per the case study, the hospital is encountering with significant
issues due to long wait time of the patients. A value stream map has been suggested for the
hospital to improve their existing process and reduce the wait time.
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Table of Contents
Introduction:...............................................................................................................................4
Identification and analysis of the System Archetypes that may impede performance:.............4
Analysis of the current State Value Stream Map of the emergency department based on
System Archetypes:....................................................................................................................6
Recommended new State Value Stream Map with desired reduction in patient turnaround
time:............................................................................................................................................7
Discussions on intended and unintended consequences of the modified system:.....................8
Recommendation:......................................................................................................................9
Conclusion:..............................................................................................................................10
References:...............................................................................................................................11
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Introduction:
With the diversifying demand of the customers, the hospitals need to be restructured.
There lies the significance of system thinking approach which is the key of running the
healthcare organisations systematically by mitigating all the issues. Roberts et al., (2016)
commented that it is the problem based approach which can help in analysing the problem
and its associated system and takes proper care in order to improve the same for the sake of
giving high quality of service to the patient and keeps them satisfied.
As per the case study, the emergency department of a public hospital is acquiring
major feedback regarding the wait time of the patients. Thus, the high authority of the
hospital has asked the operation management team to improve the current process and the
turnaround time of the patients. In addition, the senior management of the public hospital has
also asked the operation management team to modify the existing value stream map in terms
amplifying the internal functionality of the emergency department. Present paper will
highlight the system archetypes that can help in improving the performance of the emergency
department. The existing value stream map of the hospital and a new map will be suggested
in order to reduce the patient turnaround time. Recommendation will also be provided for the
hospital to improve the experience of the patients by reducing the wait time of the patients.
Identification and analysis of the System Archetypes that may impede
performance:
The healthcare organisations are experiencing massive change as the need of the
people is diversifying in a rapid manner. This is acting as the driving force behind the
healthcare organisations to improve their new system and implement new system in order to
improve the experience among the patients. Ginter, Duncan & Swayne (2018) observed that
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the system archetypes can be considered as the certain pattern of behaviour which is emerged
from the underlying structure of a firm. This is used in the healthcare organisations in order
to evaluate the existing system which is causing the problem. As discussed by Carroll &
Richardson (2016) the system archetypes are the most effective diagnostic tool in order to
understand the specific set of behaviour which can hamper the performance of an
organisation.
Fixing a Problem is one of the most significant types of system archetypes which can
impede the performance of the emergency department of the organisation. It is imperative to
note here that balancing loop, balancing structure with delay, indecision, drifting goals,
escalation, fixes that fail, shifting the burden and addiction are the different types of
system which can have both positive and negative impact on the performance of a firm.
Thomas (2017) put stress on the fact that balancing loop with delay is one of the biggest
issues of system archetypes which can lower the responsiveness of a system which eventually
hampers its performance. In addition to that, this type of system archetypes hampers the
ability of a department of an organisation respond fast to an issue.
Indecision is another major type of system archetypes which can also impede the
performance of a department. This system hampers confidence level of a department to take
necessary decision and thus manage the internal functionality in an effective manner. At the
same time, this can also affect the quality of service of the public hospital. However
Protzman, Mayzell & Kerpchar (2018) comtended by saying that drifting goals is also a
major type of system archetypes which plays a major role in terms of enabling the
emergency department of the healthcare organisations to analyse the gap between the goal
and actual performance. Still, D’Andreamatteo et al., (2015) argued by throwing light on the
fact that this system archetypes is closely associated with the decision related to lower the
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goal which in turn can hamper the performance of emergency department. This eventually
leads to decline of the performance of the system.
Analysis of the current State Value Stream Map of the emergency
department based on System Archetypes:
Value stream map is defined as the visual depiction of the process, which is followed
in an organisation in order to deliver products or services. Shanks (2016) shaded light on the
fact that with the assistance of Value stream map, it becomes easy for the healthcare
organisations to ensure smooth communication in between each of the department which is
very much needed to provide the patients with high quality of services. As per the case study,
the emergency department of an organisation is facing major issues related to longer
turnaround time which is causing the patients to wait for longer period time to get treatment.
Now, it is imperative to analyse the value stream map of the hospital which is actually
causing such issue.
According to the given value stream map, the patients have to go through multiple
processes in order to access the treatment. Initially, the patients have to register themselves
by furnishing personal details, nature of injury. Them the registration department assigns the
nurses based on the statistics of the patients. Them the patients are asked to go to the waiting
area. Then the patients go to the ER room where the nurse checks the previous health record
of the patients’ and take necessary treatment related decision accordingly. It is important to
note in this context that sometimes, the patients have to wait in the ER area due to the
availability of the rooms. This creates a negative vive among the patients (Lee, 2019). After
that the nurse examines the patients in accordance with the statistics of patients. After this
longer process, the patients are finally examined by the doctors.
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This is not the closing of the process. After the doctor’s examination, the patients
have to wait in order to get medical supplies by the nurses, on the basis of which the doctors
treat the patients and give departing instruction to the patients. Based on the value stream
map of the hospital, it can be said that the patients have to wait for longer period of time and
go through multiple processes to be treated by the doctors. This is creating a negative issue
among the patients and leading them to raise concern regarding the functionality of
emergency department (Dai & Tayur, 2019). This issue among the patients has created
urgency among the higher authority to modify the existing system in order to lower the
turnaround time of the patients.
Recommended new State Value Stream Map with desired reduction in
patient turnaround time:
Mahadevan (2015) commented that in order to provide the patients with positive
experience of visiting the hospital, it is imperative for the higher authority of the public
hospital to take necessary initiative in order to change their existing system. It is suggested
for the public hospital to change their complicated value stream mapping and change it into a
simple one to reduce the wait time of the patients. The value stream map which the public
hospital should follow has been suggested below:
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Data base
Registrati
on Evaluation
Treatment
Check-in
W
ait W
ait
Patient
discharge

Figure 1: Proposed value stream map for the public hospital
(Source: As created by the author)
As observed by Anderson, Nasr & Rayburn (2018) this value stream map would play
a crucial role for the public hospital to reduce the wait time of the patients. According to this
map, when the patients arrive at the hospital, they have to register themselves first in the
registration counter. Then the patients have to wait at the lobby near to the registration
counter in order to be called for the evaluation process. At the time of the registration
process, the duty nurse will have to check all the documents of patients and evaluate the past
record.
By this time, the patients will get registration number from the registration counter.
Then comes the evaluation process in which the public hospital have to check the body
weight, blood pressure, blood test, urine test and checking the development of foetus for the
pregnant women. After undergoing the entire evaluation process, the patients will have to
wait for the treatment process. After completing the treatment process, the hospital will
discharge patients. This is a much more simple process which can reduce the wait time of the
patients and thus mitigate any kind of negative vive among them. Based on the observation of
Mahadevan (2015) it can be said that this is the way, through which high quality of service
can be provide to the patients by ensuring smooth flow of between all the processes without
any kind of overlapping.
Discussions on intended and unintended consequences of the modified
system:
Value stream mapping is one of the most significant aspects of appropriate
management and information system which play a critical role in supporting the basic process
of an organisation. This is the most effective tool, which helps in exploring any kind of issue
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in the organisations and take strong action in order to mitigate the same in order to amplify
the same. In the context of healthcare organisations, the inclusion of comprehensive value
stream mapping makes it easy for the doctors to perceive the flow of the patients and take
necessary action to make sure that individual patient has been treated carefully. In addition,
value stream mapping also helps in tracking the room which is available for treating the
patients. However, Gopee & Galloway (2017) counter argued by saying that value stream
mapping is a technical tool which only deals with the physical process. By executing the
suggested value stream mapping, the emergency department of the public hospital might face
issues in the way of treating those patients who are suffering from chronic disease. As the
same time, in the proposed mapping there is no documentation process. Ginter et al. (2018)
stated that this can make it difficult for the doctors to check the previous medical records of
the patients which can hamper the consistency of the process.
Recommendation:
Dobrzykowski & Tarafdar (2015) observed that in order to provide better care to the
patients, it is imperative to reduce their wait time. This is the way, through which better
health outcome can be acquired for the patient with massive heart attack or stroke, in which
every singular moment is equally important for survival. Thus, it is recommended for the
public hospital to refurbish the front-line scheduling process.
The emergency department of the hospital should schedule the patients before one
day, which can help the hospital to deal with larger rush of the patients. As stated by Delias et
al., (2015) this can help the hospital to get the patients properly without any kind of
overlapping. At the same time, the internal organisational culture of the hospital must also be
modified by considering reduced wait time as a part of it. The higher authority of the hospital
must prioritise the wait time and make necessary policy in order to address the issues which
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are causing the patients to wait for longer period time (Wirtz, 2019). It is suggested for the
higher authority to evaluate the work flow of the hospital and take necessary action in order
to ensure smooth flow of work. The emergency department of the hospital must also make
the schedule of the patients as per their preferences. The hospital can launch online booking
system and allow the patients and their family members to make the appointment online as
per their convenient time.
Conclusion:
Based on the discussion, it can be concluded by saying that modification of the value
stream mapping is very much needed for the hospital to reduce the wait time of the patients.
The proposed value stream mapping would help the hospital to ensure smooth flow of all the
processes and thus offer the patients with high quality of healthcare service.
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References:
Anderson, S., Nasr, L., & Rayburn, S. W. (2018). Transformative service research and
service design: synergistic effects in healthcare. The Service Industries Journal, 38(1-
2), 99-113.
Carroll, N., & Richardson, I. (2016). Aligning healthcare innovation and software
requirements through design thinking. In Proceedings of the international workshop
on software engineering in healthcare systems, 8(3), pp. 1-7.
D’Andreamatteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: a
comprehensive review. Health policy, 119(9), 1197-1209.
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Research. Manufacturing & Service Operations Management, 7(2), 89-120.
Delias, P., Doumpos, M., Grigoroudis, E., Manolitzas, P., & Matsatsinis, N. (2015).
Supporting healthcare management decisions via robust clustering of event
logs. Knowledge-Based Systems, 84, 203-213.
Dobrzykowski, D. D., & Tarafdar, M. (2015). Understanding information exchange in
healthcare operations: Evidence from hospitals and patients. Journal of Operations
Management, 36(3), 201-214.
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health
care organizations. John Wiley & Sons.
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health
care organizations. John Wiley & Sons.
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Gopee, N., & Galloway, J. (2017). Leadership and management in healthcare. Sage.
Lee, D. (2019). A model for designing healthcare service based on the patient
experience. International Journal of Healthcare Management, 12(3), 180-188.
Mahadevan, B. (2015). Operations management: Theory and practice. Pearson Education.
Protzman, C., Mayzell, G., & Kerpchar, J. (2018). Leveraging lean in healthcare:
Transforming your enterprise into a high quality patient care delivery system.
Productivity Press.
Roberts, J. P., Fisher, T. R., Trowbridge, M. J., & Bent, C. (2016). A design thinking
framework for healthcare management and innovation. Elsevier.
Shanks, N. H. (Ed.). (2016). Introduction to health care management. Jones & Bartlett
Publishers.
Thomas, P. (2017). Integrating Primary Healthcare: leading, managing, facilitating. CRC
Press.
Wirtz, J. (2019). Cost-effective service excellence in healthcare. Springer.
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