System Thinking: Emergency Department Value Stream Analysis

This report analyzes the application of system thinking principles within a hospital's emergency department. It begins with an executive summary, followed by an introduction that emphasizes the critical need for efficient emergency services. The report identifies and scrutinizes relevant system archetypes, including limitations to growth, eroding goals, and escalation, to understand the root causes of inefficiencies. A detailed comparison is made between the existing value stream map and a proposed new version, highlighting the potential for reduced waiting times and optimized operations. The consequences of implementing the new value stream map, both positive and negative, are thoroughly assessed. The report concludes with recommendations focused on reducing the burden on the EHR system, promoting automation, and prioritizing patient needs to enhance overall efficiency and patient satisfaction. The study uses relevant literature to support the arguments and findings, providing a comprehensive analysis of the emergency department's processes.

Running head: SYSTEM THINKING
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Name of the Student
Name of the university
Author note

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Executive Summary
The following report discusses on a situation based on an emergency services of a particular
department of a hospital considering the organization’s archetype. The paper includes the
Value Stream Map of the hospital that exists at present and recommends new version of the
Value Stream Map that takes less time and optimizes the entire operations of the hospital.
The report also analyses the various consequences of the optimization of the emergency
department operations. Lastly, the discussion is concluded by suggesting ideas that would
help make the process better than before.

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Table of Contents
Introduction................................................................................................................................3
Background................................................................................................................................3
Discussion..................................................................................................................................3
Identification of System Archetype and its analysis..............................................................3
Limitation to the growth process........................................................................................4
Eroding goals.....................................................................................................................4
Escalation...........................................................................................................................5
Existing Value Stream Map...................................................................................................5
New version of Value stream Map.........................................................................................6
Consequence of the New Value Stream Map:.......................................................................8
Conclusion..................................................................................................................................8
Recommendations......................................................................................................................8
References................................................................................................................................10

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Introduction
The emergency cases in hospitals need to be addressed immediately and in case of
delays lead to severe problems as hazardous as causing death. The report relates to the
identification and the scrutiny of the System Archetype that is an essential part of
performance. The value stream map that exists at present in the emergency department of the
hospital is the analyzing subject in this paper. A new value stream map has been suggested
that could make the hospital department more efficient by decreasing the time of response
and optimizing the operations (Begun & Thygeson, 2015). The report concludes by
suggesting some reforms that might help in changing the present scenario.
Background
The emergency department of the hospital deals in receiving feedback from the
patients that includes certain suggestions on their waiting time and asking for improvements
in the same case. The main concern is that when the patients require emergency treatment,
the waiting hours are long due to mismanagement. The process being followed by the
emergency department needs to be reviewed as it is complicated at present and requires
optimization (Stevens & Price, 2015). A value stream map has been suggested in the report
that is a lot optimized compared to the one that exists.
Discussion
Identification of System Archetype and its analysis
The following section of the paper identifies the system archetype that was the cause
for the disruptions in the performance of the process and analyzes the same (Bureš & Racz,
2016). The system archetype includes the limitations in the growth process, the goals being
eroded, grievance of the public, escalations, failure, accident and adversaries.

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Limitation to the growth process
The hindrance to the growth of the hospital is a major concern of the system
archetype and refers to the scrutiny of rules that are a probable cause for the degradation of
the services and loss of resource. The mismanagement of the authorities and the individuals
included in making the process lengthy and time-consuming are one among the various
challenges (Marco-Ruiz et al., 2015). The growth in the business cannot be carried on in a
dynamic way succumbing to the defaults. This archetype includes making use of the dynamic
theory that is related to maintaining a balance in the operations essential for the firm’s
growth. In order to accomplish the balance it is required that in providing similar efforts, the
return rate is reduced in a broader sense. The proper diagnosis of the growth pillars is the
main aspect of the seven action steps and this in turn will help in doubling the time of the
performance (Mathews & Long, 2015). Yet another positive aspect of this is that the firm will
be able to identify its potentials and successfully maintain the required balance (Saltman et
al., 2015). The changes opted for require good understanding so that it proves to be beneficial
for the hospital’s growth and effective implementation of the restructured strategy.
Eroding goals
The eroding goals of the hospital is one of the major outlook of the system archetype
that is found to be revolving around the various functions with regard to the shifts happening
in the environment of dynamic tension between the symptoms. The aspect focuses on the
dynamic nature that relates to proper future forecasting that have been determined in the past
(Ward et al., 2017). This is an important aspect considered in the case because the various
circumstances set at the beginning of the process require eroding that is related to the
obstructions endured in the entire project.

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Escalation
The way the management of the emergency department functions is tested as it is
related to the issue of the improper and time-consuming services to the patients. It works as a
vital aspect that is associated with the decrease in the entire value of the firm for the clients.
A better understanding regarding the dynamic theory relating to the escalations that is
associated to a single party and therefore be associated with the perception of the other
parties (McDermott & Venditti, 2015). This is the reason behind the associated threat linked
to the hypothesis that needs to be performed maintaining the balance in order to form the
reinforcements.
Existing Value Stream Map
The value stream map is dependent on the system archetype, is found to be wastage of
time in the beginning, and is associated with numerous errors in the organization’s
operations. There have been regular complaints on the longer waiting time before receiving
the treatment. This proves that there is a need of a new value stream map that could
effectively replace the old one (Jimmerson, 2017). At present, the value stream map starts by
filling up the insurance forms by the patients that is followed by getting them registered as
outpatients. The process is long enough as it involves the patients to be taken to the waiting
area, the nurse notes down the information of the patients and then patient is assisted. After
the information is obtained, the nurse prepares the emergency room and this consumes a lot
of time and meanwhile the patient is kept waiting. The doctor in the emergency room checks
the patient’s medical history and other important details, and while analysing the reports the
statistics are considered, accordingly equipments are provided for the treatment, and finally
services are supplied (Václavík et al., 2016). Lastly, the patient is provided with the

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treatment, tests are conducted but the test results take a long time to be generated, and thus
the overall time required is high. After the successful initiation the nurse takes up the entire
responsibility of keeping the family of the patient updated with the details of the tests and
corresponding results (Henrique et al., 2016). The patient is discharged from the hospital
after his treatment is completed. Once the patient is discharged, then the information related
to the patient is forwarded to the insurance company. The complete process runs
simultaneously with the internal process.
New version of Value stream Map
The new version consists of the system archetype to shift the burden. The archetype
helps develop the main aspect of the new value stream map and the entire change can be
implemented with high level of flexibility and will decrease the expenditure. The process will
help managing the emergency department properly (Jackson, 2016). It will provide in
increasing the long-term productivity by inculcating optimization in the whole process and
reducing workload. The new value stream map will aid the functions and the symptomatic
solutions can be implemented simultaneously with the fundamental ones with respect to the
problem solving techniques (Clancy, 2018).

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Fig 1: New Value Stream Map
Source: Created by Author
The new version of the value stream map can help cutting the long wait hours and there is a
possibility that the time taken is half that of the time consumed previously. The existing
common archetype is a major issue and is an outcome of the numerous tasks allocated to the
nurse. This map will be effective in shifting the burden of work especially of the nurses in the
emergency department. A new entity can be introduced in the process by making use of this
archetype (Haron & Ramlan, 2015). If the EHR is successfully implemented then the project
will eliminate various issues and help manage different processes. The EHR will replace the
manual processes with automation.

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Consequence of the New Value Stream Map:
There are positive and negative effects of the new value stream map on the various
operations of the emergency department (Bal, Ceylon & Taçoğlu, 2017). The positive impact
is that it will reduce the waiting time due the system automation services. The excess time
required to do some manual tasks will be eliminated and thus achieving the set goal will
become easier (Hung et al., 2015). The negative effect of the new value stream map is that
the hospital will have to endure extra cost for the functional process, as the implementation
requires adding a new entity.
Conclusion
The working of the hospitals is linked to the way the system model is adapted. In
order to accomplish the objectives that have been set, data modeling tools are used expecting
that the complete functioning will be enhanced. Optimization of the value stream map will
help in reducing the waiting time. The shifting of burden is the main concept used in
developing the new value stream map. This reduces the burden by distributing the workload.
The EHR system has been included in the new value stream map that helps implementing
automation in the different processes of the emergency department.
Recommendations
 The excessive burden on the EHR system needs to be reduced. New ideas should be
explored and the team must include it in the process of documentation.
 The hospital needs to stress on using automation in its operations that will be effective
in collecting the informations.
 Data entry process must not be linked with entering the data and the individuals
concerned should be allowed to enter their own data that in turn will help to produce
customized reports.

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 Reimbursement of the implemented changes for developing innovations in the EHRs
should be motivated.
 The hospital management should prioritize the patient’s needs and understanding the
value of time in case of health should implement the new value stream map that is
effective to reduce waiting time.
.

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References
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simulation to improve efficiency of emergency departments. International Journal of
Healthcare Management, 10(3), 196-206.
Begun, J. W., & Thygeson, M. (2015). Managing complex healthcare
organizations. Handbook of healthcare management. Northampton: Edward Elgar, 1-
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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.
Clancy, T. (2018). Systems thinking: Three system archetypes every manager should
know. IEEE Engineering Management Review, 46(2), 32-41.
Haron, S. H. A., & Ramlan, R. (2015). Patient process flow improvement: value stream
mapping. Journal of Management Research, 7(2), 495.
Henrique, D. B., Rentes, A. F., Godinho Filho, M., & Esposto, K. F. (2016). A new value
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Hung, S. H., Wang, P. C., Lin, H. C., Chen, H. Y., & Su, C. T. (2015). Integration of value
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engineering, 6(3), 377-398.
Jackson, T. L. (2016). Mapping clinical value streams. Productivity Press.

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Jimmerson, C. (2017). Value stream mapping for healthcare made easy. Productivity Press.
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Václavík, T., Langerwisch, F., Cotter, M., Fick, J., Häuser, I., Hotes, S., ... & Seppelt, R.
(2016). Investigating potential transferability of place-based research in land system
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Ward, P. R., Rokkas, P., Cenko, C., Pulvirenti, M., Dean, N., Carney, A. S., & Meyer, S.
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