Shared Flashcard Set

Details

healthcare management
n/a
73
Management
Undergraduate 3
05/08/2011

Additional Management Flashcards

 


 

Cards

Term
Lean Philosophy
Definition
  • Lean is the "one true path"
  • Lean is easy to implement
  • Goal is zero inventory
  • No "tradeoffs"
  • Make things only when the customer wants it
Term
7 Steps in Successful Lean Production
Definition
  1. Stabilize schedule
  2. Improve product design
  3. Reduce inventory
  4. Work with vendors
  5. Improve quality control
  6. Improve design flow process
  7. Establish kanban system
Term
Stabilize Schedule (Lean)
Definition
  • Level Schedule
  • Underutilize capacity
  • Establish freeze windows
Term
Improve Product Design (Lean)
Definition
  • Standardize product configuration
  • Standardize/reduce # of parts
  • Process design with product design
  • Design for manufacturibility

 

Term
Work with Vendors (Lean)
Definition
  • Fewer suppliers
  • Relationships are long term based on cooperation
  • Suppliers must strive to continuously improve
Term
Total Quality Control (Lean)
Definition
  • Jidoka - fix problem right when it occurs
  • Enforce compliance: quality first, output second
  • Housekeeping: sort, straighten, sweep, standardize, self-discipline
  • Kaizen
  • Automatic inspection/100% inspection
  • Misktake-proof the process
Term
Design Flow Process (Lean)
Definition
  • Link operations
  • Balance resource capacities
  • Re-layout for flow
  • Emphasize preventive maintenance
  • Reduce lot sizes
  • Reduce setup/changeover time
Term
Designing for Flow Requires...
Definition
  • "Info-based" flow
  • Minimal setups
  • Well characterized/understood process
  • Kaizen
Term
How to implement health systems into the lean production?
Definition
  • Consider product rather than process layouts -use "cellular production" or the use of semi-autonomous teams working on different tasks for the same goal
  • Use task overlapping to create within-cell pooling
  • Reduce batch sizes
  • Mistake-proof the process
  • Design jobs for multi-skilled employees
Term
Push System
Definition

An item is realseased for production at a specified time with an associated due date (controls throughput > WIP)

Term
Pull System
Definition

Explicitly limits the amount of work in the process (aka inventory/unfinished products) that can be in the system ( controls WIP > throughput)

Term
Kanban System
Definition

A system in which one station of work cannot start production without its succeeding station specifically requiring for production (a chain reaction)

 

  • Prevents buildup of inventory
  • Maintains discipline of pull production
  • Allows kanban to authorize movement of goods
Term
Control process vs. capable process (six sigma)
Definition
  • Control - a process is said to be in control if there are no special causes for variation and other there are only common causes for variation
  • Capale - a process is capable if it is within the specified design limit
Term
Deming's Main Idea
Definition

A system in control may have a lot of variation and only management has the power to reduce defects because only management has the power to change the process

Term
DMIAC (six sigma)
Definition
  • Define - define root causes
  • Measure - measure baseline metrics
  • Analyze - identify root causes
  • Improve - determine optimal solution
  • Control - sustain gains with reporting
Term
Champion (six sigma)
Definition
  • Defines strategic goals
  • Promotes six sigma
  • Establishes business targets
Term
Sponsor (six sigma)
Definition
  • Requestor of project
  • Defines project goals, objectives, and scope
  • Removes barriers and aligns resources
  • Key communicator of project progress
Term
Owner
Definition
  • Responsible for sustaining long-term gains
Term
Black Belt
Definition
  • Full time project leaders who are expert in Black Belt methodology
Term
Green Belts
Definition
  • Experts in their field of work that is related to the project
Term
Foundations Team
Definition
  • Participate in local communication
  • Problem analysis
  • Improvement of design and implementation
Term
Criticism of Six Sigma
Definition
  • Huge investment
  • A cultural change
  • Just a bunch of already used quality techniques repackaged into one system
  • Rewards systems and has measures that do not distinguish between "quality" and "luck"
  • Identifies random variation as "problems" and then tries to find a solution to these "problems"
Term
4 Main Six Sigma Objectives at Academic Medical Hospital
Definition
  1. Create a safer environment by reducing medical errors
  2. Become a "best place to care" reduced turnover
  3. Become a preferred place to care, gain market shares
  4. Reduce variability and process waste
Term
Moods Median Test
Definition
A non parametric test to compare samples and determine if they come from different populations.
Term
Process Flow Time[image]
Definition
The time that a unit spends in the system (usually we calculate the average). Short flow time = high level of operational excellence
Term
Theoretical Flow Time
Definition
Minimal amount of time required for processing a typical unit without any waiting
Term
Critical Path
Definition

The theoretical flow time of the longest path in a process flow chart

 

Used so management knows which activities on the path are "critical" or most variable and thus need most focus

Term
Levers for Decreasing Theoretical Flow Time
Definition

Reduce the work content of activities on the critical path

  • Eliminate non-value adding subactivities (work smarter)
  • Increase the speed
  • Reduce number of repeat activities
  • Change patient mixup
  • Design for efficiency 

Move some of the work content off the critical path

Term
Capacity
Definition
Maximum output in a specified period of time (measured in units per unit time)
Term
Throughput
Definition
Rate at which a system generates new inputs
Term
System Capacity
Definition

Minimum capacity of any step or key resource for the process (aka the capacity of the bottleneck)

 

Capacity = (1/unit load) x batch size x availibility x number of resources

Term
Bottleneck
Definition
The process in a chain of processes such that if its capacity becomes limited, the capacity of the chain as a whole is limited
Term
Levers for Managing Capacity
Definition
  • Focus on the bottleneck
  • Increase capacity of the bottleneck (1. decrease work content at bottleneck; 2. reduce necessary batch sizes; 3. increase # of bottleneck resources; 4. increase schedule availibility)
  • Increase the net availibility by managing resource downtime and setup times
  • Decrease resource idleness
  • Manage supply and demand to limit strain on the bottleneck
Term
Actual Throughput/Flow rate
Definition

The number of units that flow through a specific point of the process per unit time

 

Governed by demand

 

Long Run -

average inflow rate = average outflow rate

Term
Capacity Utilization
Definition

Fraction of time resource is busy

 

Throughput rate/capacity

or

Input rate (units/hour)/possible output rate (units/hour)

 

Stable system - utilization rate < or = 1

Term

"Product" Layout

 

Time -

Quality -

Inventory -

Scheduling -

Flexibility -

Demand changes -

Product mix -

New products -

Definition
  • "Patient focused" care
  • Service line production
  • However, lack of pooling makes large variation aka difficult

Time -Shorter lead times

Quality -Faster feedback

Inventory -Lower WIP

Scheduling -Well defined

Flexibility -Less flexible

Demand changes -Less easy to absorb

Product mix - Limited and fixed

New products - More difficult to introduce

Term

"Process" Layout

Time -

Quality -

Inventory -

Scheduling -

Flexibility -

Demand changes -

Product mix -

New products -

Definition
  • Departmentalized - all personnel of one type are grouped together

Time - longer lead time

Quality -slower feedback

Inventory -High WIP

Scheduling -Difficult

Flexibility - More flexible

Demand changes -Relatively easy to absorb

Product mix - can be large and variable

New products -can incoroporate new products easily

Term
Pooling
Definition

The adding together of multiple sources of variability that makes the whole less variable (effectively)

 

Example - tossing a coin 5 times in comparison to 50

Term
Pros of Service Lines
Definition
  • Reduced points of coordination between team members
  • Increased teamwork
  • Increased expertise in treating specific diagnosis
  • Shorter response times
Term
Cons of Service Lines
Definition
  • Integrality
  • Loss of flexibility
Term
Measuring Capacity
Definition
  • Ti = average time between arrivals
  • Tp = average processing time of a job
  • c = number of parallel servers
  • Arrival rate (measures throughput rate)= 1/Ti
  • Service rate (measures capacity) = c/Tp
  • Ri < Rp - adequate capacity
  • Utilization rate = Tp/(c x Ti)
Term
Little's Law
Definition

Inventory = Throughput x Flow Time

 

Flow time - time it takes for a unit to go through the system

 

Throughput - the rate of arrivals

Term
Six Sigma Equation
Definition

Q x A = E

 

Q - quality of solution

 

A - acceptance of major stakeholders

 

E - effectiveness of process

Term
Characteristics of Manufacturing
Definition
  • Labor costs - 10%
  • Manufacturing costs - 40%
  • Production not near customers
  • High degree of automation
  • Variation is reduced
Term
Characteristics of Healthcare
Definition
  • Labor costs - 65 to 75%
  • Material costs < 15%
  • Production always in close proximity to customer
  • Industry wide shortage of critical skills
  • Limited automation to replace labor
  • Must accept variation as much of it cannot be removed
Term
How to Overcome Resistance to Change Initiatives
Definition
  • Position initial projects to be based around patient care quality and not cost
  • Pick the right sponsor and team
  • Start out with a low budget project and show results to major stakeholders
  • Always manage scope and expectations
  • Involve key stakeholders from the beginning
Term
Activities of NP's
Definition
  • Diagnose patients for acute and chronic conditions
  • Order and perform diagnostic tests
  • Order prescriptions
  • Counsel patients
  • Manage patients overall care
Term
Requirements to become CRNA
Definition
  • Have a Bachelor of Science in Nursing degree
  • Be a registered nurse for 1 year
  • Go to nursing school for anesthesia (24 to 36 months)
  • Pass certification exam after graduation
Term
Queuing Approach by Vericourt and Jennings
Definition

In order to provide care in a timely fashion, hospitals set up a threshold time T, and any patients waiting after T is unacceptable (needy patients get priority)

 

Physician groups in hospitals should decide what T is

 

Realize that compliance cannot be fully governed

 

Some hospitals turn away patients in order to keep their T level up

Term
Benefits of Simulations
Definition
  • Relatively straightforward and generally easier to understand
  • It can answer "what-if" types of questions without actually changing or building a real system
  • Generally safer and cheaper to experiment than a real system
Term
Limitations on Simulation
Definition
  • Expensive and time consuming to develop
  • Does not give optimal or exact solutions to the problem
Term
Enterprise Resourse Systems
Definition
  • Multifunctional in scope, tracking a range of activities from financial results, procurement, sales, operations
  • Integrated in nature
  • Modular in structure
Term
Implementation of ERP Systems
Definition
  • 30,000 companies worldwide
  • Costs a fortune for companies (billions of dollars for large companies)
  • Takes many years to complete: 1 to 4 years
Term
Success Elements for ERP Implementation
Definition
  • Senior management was thoroughly involved
  • Cross functional implementation team
  • Teams spent great detail in how implementation was going to be carried out
  • Clear guidelines were laid out on performance measurement
  • Established clear guidelines on how to use outside consultants
  • Developed detailed plans for training users
Term
Different Branches of ERP in Health Services Organizations
Definition
  • Financial
  • Human resources
  • Resource utilization
  • Materials management
  • Facilities and project management
  • Office automation
Term
Financial Information Systems (ERP)
Definition
payroll, accounts payable, patient accounting, cost accounting, general ledger, budgeting, internal auditing, forecasting, planning financial investments
Term
Human Resources (ERP)
Definition
  • Employee information
  • Position control
  • Labor analysis reports
  • Inventory of skills
  • Information for labor cost allocation
  • Productivity information
  • Compare compensation with competitors
Term
Resource Utilization Systems (ERP)
Definition
  • Patient scheduling
  • Clinic use
  • Emergency department use
  • Ambulatory surgery centers
Term
Resource Systems (ERP)
Definition
  • Connect with clinical decision making systems to flag procedures that precede or require other procedures
  • Connect with inventory systems to automatically order needed supplies for scheduled procedure
  • Connect with HR to assess personnel need, allocate personnel
  • Connect with patient database to remind patient to show up
Term
Materials Management (ERP)
Definition
  • Requisitions for suppliers checked against budget
  • Electronic data interchage with suppliers
  • Bar codes, RFID chips
  • Food services management
Term
Facilities and project management
Definition
  • Maintenance of buildings
  • Manage new projects or renovations
Term
Why Adopt Enterprise Systems?
Definition
  • Simplify and standardize IT systems
  • Have access to accurate information for better interaction and communication with patients, health professionals, and suppliers
  • Improve the availibility and quality of data
  • Will result in lower inventory, shorter delivery cycles etc
  • May contain decision support capabilities
Term
Service Oriented Architecture
Definition
  • Loose coupling of services with operating systems
  • Allows different applications to exchange data with one another.
  • Systems package functionality as interoperable services
Term
Electronic Medical Records
Definition
  • Provide data about diagnostic and treament events retrievable electronically.
  • Real time data entry and retrieval
  • Link scheduling, billing, referrals
  • Data can be interchanged with other agencies
  • Allow real time access by providers/patients for information
Term
Clinical Decision Support Systems
Definition
  • Passive - present information culled from other systems about patient and medical science
  • Active - patient specific information from clinical databasem and rule-based inference engine; combines them to generate specific suggestions
Term
RFID Tags
Definition
  • Transponder which receives radio signals and in response sends out a radio signal
  • Antennae, small chip, and stores small amount of data
  • Programmed at manufacture or installation
  • Powered by the electromagnetic field generated by antennas
Term
Benefits of RFID Tags (over barcode)
Definition
  • Unique identifier
  • Read many at once
  • No line of sight required
  • Easy to conceal
  • Works well in harsh environment
Term
RFID Limitations
Definition
  • Can be very sensitive and calibrating the antennae can be tricky
  • Can be expensive
  • Don't get instand feedback of a bad scan (sometimes no way to tell)
Term
RFID Tag Medical  Uses
Definition
  • Inserted into catheters to notify when it has been in use for 72 hours
  • Prescription disbursement and dosage
  • System logons
  • Key asset tracking
Term
Unstructured Care Problem
Definition
  • Iterative - compromised of multiple cycles
  • Recursive - each step based on the outcomes of the former
  • Customized
  • Uncertain
Term
Structured Care Problem
Definition
  • Problems are well known
  • Unitary - only one problem (one disease etc)
  • Known solutions (linear - protocol exercised without variation; standardized; certain - solution works)
Term
QuickMedx's Value Propostions
Definition
  • Rapit throughput rate
  • Minimal queue time
  • Low cost
  • One stop shopping
  • Let the customer do the initial triage
Term
Risks of QuickMedx
Definition
  • Cannot treat all diseases (what do they do if a patient comes in and needs immediate treatment?)
  • More volume, more risk
  • Little price elasticity
  • NP's becoming bored
  • Patient flow is unpredictable
  • Management team not proven for growth
  • Criticisms by physician groups over quality of care
  • Uninsured patients expected PCP type service and consuming service time
  • No significant barriers to entry
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