Systems Thinking Assignment: Improving Patient Turnaround Time With System Archetypes

Question

Task:
Context:
There are two approaches towards improving systems, short-term approaches that normally addresses the symptoms and rarely help understand and address the cause of the problem, and long-term approaches, which allow managers to address the real cause(s) of the problem. In this assessment, students will try to solve a practical problem by using Systems Thinking tools called System Archetypes combined with value stream mapping.

Instructions:
The systems thinking assignment is about uncovering the complexities in operations management generally, identifying key themes, intended and unintended consequences and proposing a holistic solution to the problem using a Systems Thinking lens. The following scenario study provides you with a brief overview of a hypothetical problem. Be aware that the scenario provided may not cover every detail that you will need to address in the Written Report, in which case, you will need to conduct additional research, including further research on how emergency departments function in any hospital.

Scenario
Overview:
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.

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.

Answer

Executive Summary
The Emergency Department (ED) is amongst the most critical sections inside the healthcare system, yet it faces a number of challenges, including delays, excessive traffic flow, as well as patient safety. Because of this, the primary goal of this report on systems thinking assignment should be to reduce patient wait times so that each emergency situation may receive care. Patients with mild ailments took up a lot of room while health care workers were diagnosing and healing them, causing the emergency department to become congested. As a result, the focus of this study will be on identifying the most practical solution to the problem. The primary objective would be to limit the amount of time patients spend throughout the emergency room, in order to speed up the process of registering, diagnosing, and treating patients.

Introduction/Background
Every participant in the medical system, from patients to vendors to physicians, is exposed to a high level of risk because of the complexity of these institutions (Dai, 2015). This is due to recent technological advancements, which have made healthcare more complicated in past few years. As an example, hospitals are always pushing the use of more technological gadgets, and professionals need to be aware of their proper use to avoid any form of misuse. However, while these cutting-edge technologies are expected to provide significant advantages to their end users, they also present numerous obstacles for clinicians or doctors who use these tools. There are a number of new emerging difficulties that are escalating the severity of the current scenario since the healthcare systems in place have not been able to keep up with external sector developments.
For one thing, the current healthcare system isn't capable of handling complicated patients. This means that the healthcare leadership team must endeavour to produce a correct balance between the demands of consumers and the aims of hospital owners and employees. As a result, hospitals must implement a system to verify that the services they provide are in line with the wants and requirements of their patients (Dai, 2015). It is also critical to make the most of given resources to their utmost extent. An section of the hospital that receives a lot of attention yet isn't well-managed is the emergency room. In order to reduce waiting times and solve the demand-supply mismatch, healthcare managers must take action. Severe & critical patients are given top priority in the emergency room, and the quality of treatment delivered should never be compromised in the name of speed. In order to deal with the increasing number of patients, healthcare facilities should train its administrative personnel and nurses, particularly in the hospital emergency room. In order for hospitals to provide the best possible care to their patients, they must have a well-thought-out plan in place for doing so. Addressing challenges such as insufficient emergency ward resources and facility design and management can help achieve this goal as well. In order to deal with the complexity of their internal systems, hospitals should use system thinking, which is the best strategy to take (Abdoli et al., 2016). This includes the emergency rooms themselves. Health care participants may work together using such system-wide methods in order to push beyond the constraints and come up with unique solutions to various challenges. Healthcare systems may use the value stream mapping approach to visualise various processes and workflows, such as those in the emergency room and elsewhere. Workflow diagram depicts the full procedure.

Main Discussion
Identification and analysis of the System Archetypes that may impede performance
In the course of things, system archetypes assist to detect behavioural patterns. Such archetypes are used by system theorists to identify patterns of behaviour in the system's flux. Such archetypes depict the occurrences or activities that are performed in the workflow. There are also brief descriptions as to how these things operate in different contexts or events. Brainstorming tools, computer-based tools, structural thinking tools, as well as dynamic thinking tools all seem to be examples of system archetypes (Jocson, 2021). It would be important, therefore, to know how various departments or members of the team with in crisis ward operate or behave in a given circumstance in order to determine the most acceptable system archetype for usage in the hospital's emergency departments. When the hospital's management department obtains patient feedback on how to reduce waiting times, they need a system archetype to help them figure out how to do it. First, the department must figure out how other departments interact with one another. Value stream maps are used by hospitals in this region to identify the behavioural patterns of the emergency department's process flows (Joshi et al., 2020). It is essential to evaluate the current system in order to choose the best archetype for hospitals:

1. Patient Hopping: Shifting patients around the hospital isn't an efficient way to deal with the growing population. The hospital's overall performance will be negatively impacted if patients are transferred across departments. The burden will be unfairly distributed across departments rather than evenly distributed across 20 patients in a serious condition who arrive at the hospital simultaneously. This can be avoided by simply moving patients through one emergency department to another without even considering whether they need to be hospitalised in to the urgent care.

2. Limitations: According to current hospital systems, there aren't enough nurses as well as physicians on hand to keep up with a rising number of patients, resulting in a longer response times. Hospitals must take steps to ensure that patients receive the treatment they want from the shortest amount of time feasible. Response time must be regulated so that no patient is made to wait longer than they need to be.

Analysis of the current State Value Stream Map of the emergency department based on System Archetypes
Value stream mapping was used to evaluate the hospital's current services as well as to point out areas which need to be addressed to increase cycle times and accommodate a high number of patients (Michalski, 2019). Patients are required to fill out a patient registration form when they arrive at a hospital, according to the current procedure. However, it requires a significant amount of time from the patients to accomplish this goal. Patients are then advised to transfer to a waiting area and wait for their turn. Patients who need urgent treatment and attention are prone to be affected by this lengthy delay. After this, the patient is immediately taken to the emergency department, where a nurse checks the person in question. Afterwards, the patient is returned to the waiting area where he or she awaits the results of the tests and an appointment with a doctor. Nurses provide test findings to patients after they have been thoroughly examined by a doctor, and they must wait for the doctor's final decision. The patient is discharged from the hospital at this point. A patient who attends a hospital during an urgent situation is forced to wait for a long period of time, something that frequently results in dissatisfaction and avoidable confrontation between the administration staff and the patient.

System performance is hampered by the use of two archetypes throughout the current value stream map. Because of these staffing shortages, the hospital's patient load isn't growing at a rate that can keep up with the demand. In addition, the hospital's emergency department does not have the required management process in place to ensure prompt treatment for patients who require urgent or emergency care. The emergency department isn't necessary for every patient in the hospital. As a result, no one should have to wait for their turn to visit the doctor. Patients are more likely to leave the hospital if they have to wait a long period for an appointment. A separate department which handles appointments should be established by the hospital administration in order to minimise patient wait times.

This model also depends on patients being moved through one department to the other, which hinders the overall efficiency of the hospital (Nagi & Altarazi, 2017). When a patient goes to a hospital, they are constantly shuffled between different levels; from waiting area to registration area, then back into the reception area to see a specialist, then back into the waiting area repeatedly. Waiting goes on for a long time at each department before the patient is eventually asked to leave. Efforts should be made to improve this quality in order to deal with problems related to patient care and management. The following image depicts the hospital's current value stream map:

Recommended new State Value Stream Map with desired reduction in patient turnaround time
Delays and long waits can be eliminated by updating the value stream map. The hospital needs to be able to handle the present challenges it faces. In light of said hospital's new position as a high-quality healthcare provider, their value mapping was already modified to reflect this. The updated map's implementation in the facility's emergency department is certain to improve patient care (Nyenke, 2021).

The accompanying revised value stream map may be used by the hospital management in order to reduce patient waiting times and deliver better quality services there in shortest amount of time feasible. Waiting is only present on the new value stream map at the places where it is unavoidable. This map shows that people will be granted a consultation before they arrive at the hospital. There would be a time gap between the appointment times assigned to various patients, as the administrative department will see to it (Rohac & Januska, 2015). On their very first visit, individuals will be asked to fill out an application form after having their appointment time checked. Waiting areas will be established for those who have completed this form. Afterwards, they won't have to wait any longer because all the workers they wanted to meet would be accessible to serve them. Afterwards, the nurse will assess the patient and, if necessary, refer them to a specialist. As according to their medical history, this same doctor would determine whether or not he should continue medication or be allowed to depart. The patient could finally receive treatment once the nurse tells him or her to do so after the wait for the specialist to come up with an adequate remedy. The medical supplies and the insurance provider are also integrated in the same flow, greatly streamlining the process.

Discussion on Intended and unintended consequences of the modified system
Using the new value stream map, this same hospital would be able to reduce wait times while simultaneously speeding up service. As per the spots available, the revised approach will allow the facility to manage a greater number of patients.

The anticipated consequences can be:
1. Patients' wait times will be greatly decreased.
2. There would be a clear grasp of how many patients each unit can manage on a given day.
3. Administration may then use this information to better plan for the anticipated surge of patients.
4. When it comes to staffing or other necessary resources, there is a well-structured as well as controlled system in place at the hospital.

The unintended consequences could be:
1. Waiting times are unavoidable in some places.
2. Only a certain number of people can be seen each day when reservations are made.
3. Random patients must be taken care of by administration at some point.
4. This system is supposed to work for a given number of patients only, it may be redesigned when the hospital grows even further (Romero & Arce, 2017).

Conclusion
To address the issue throughout the hospital, systems thinking methodology was used. It included real system prime examples and also was applicable to any matter at hand. It was affecting the patients' perceptions of the health centre since the patients started facing delays in such a crisis unit that exclusively dealt with emergencies. The value stream map was used to assess the progress of systems in an organisation, and if it can be successfully fixed with a genuine systematic method, problems may be reduced. The guide has effectively implemented a solution to the delay of a superb opportunity for said patients as well as ensured a great health care workplace for everyone. As a result, their major focus ought to be on reducing patient waiting times in an attempt to provide aid to each emergency situation. There was a lot of room taken up by people with mild ailments while the physicians and nurses were evaluating and healing them. Because of this, this study will explore the best possible solution to the problem. The primary objective would be to reduce the time patients take in the urgent care, hence minimising the time among clinical documentation, assessment, and medication.

Recommendations
• The aforementioned value stream map should be modified when the hospital's workflow changes to keep up with the times.
• It is imperative that the hospital's infrastructure and staff are used in the most efficient manner possible.
• Leadership must be equipped to make changes to the program if the proposed map has unforeseen consequences.

References
Abdoli, S., Kara, S., & Kornfeld, B. (2016). Application of Dynamic Value Stream Mapping in Warehousing Context. Modern Applied Science, 11(1), 76. https://doi.org/10.5539/mas.v11n1p76
Dai, T. (2015). Incentives in U.S. Healthcare Operations. Decision Sciences, 46(2), 455–463. https://doi.org/10.1111/deci.12136 Jocson, Engr. J. C. (2021). Application of Lean Methodology to Increase Productivity through Value Stream Mapping. Engineering and Technology Journal, 06(09). https://doi.org/10.47191/etj/v6i9.04
Joshi, H., Goyal, B., & Tomar, P. (2020). Application of Value Stream Mapping in Induction Motors Making Industry to Develop Current State Map and Identify Wastes. Industrial Engineering Journal, 13(6). https://doi.org/10.26488/iej.13.6.1235
Michalski, K. (2019). Product analysis using value stream mapping. Multidisciplinary Aspects of Production Engineering, 2(1), 467–475. https://doi.org/10.2478/mape-2019-0047
Nagi, A., & Altarazi, S. (2017). Integration of value stream map and strategic layout planning into DMAIC approach to improve carpeting process. Systems thinking assignment Journal of Industrial Engineering and Management, 10(1), 74. https://doi.org/10.3926/jiem.2040
Nyenke, O. K. W. (2021). Value Stream Mapping: A Tool for Waste Reduction. International Journal of Innovative Research and Development, 10(6). https://doi.org/10.24940/ijird/2021/v10/i6/jun21009
Rohac, T., & Januska, M. (2015). Value Stream Mapping Demonstration on Real Case Study. Procedia Engineering, 100, 520–529. https://doi.org/10.1016/j.proeng.2015.01.399

Romero, L. F., & Arce, A. (2017). Applying Value Stream Mapping in Manufacturing: A Systematic Literature Review. IFAC-PapersOnLine, 50(1), 1075–1086. https://doi.org/10.1016/j.ifacol.2017.08.385