Process Mapping Strategies to Prevent Subcutaneous Implantable Cardioverter-Defibrillator Infection

Background: Infection remains a major complication of cardiac implantable electronic devices (CIEDs) and can lead to significant morbidity and mortality. Extrathoracic devices that avoid epicardial or transvenous leads, such as the subcutaneous implantable cardioverter-defibrillator (S-ICD), can reduce the risk of serious infection-related complications, such as bloodstream infection and infective endocarditis. While the 2017 AHA/ACC/HRS guidelines include recommendations for S-ICD use for patients at high risk of infection, currently, there are no clinical trial data that address best practices for the prevention of S-ICD infections. Therefore, an expert panel was convened to develop consensus on these topics. Methods: An expert process mapping methodology was used to achieve consensus on the appropriate steps to minimize or prevent S-ICD infections. Two face-to-face meetings of high-volume S-ICD implanters and an infectious diseases specialist, with expertise on cardiovascular implantable electronic device infections, were conducted to develop consensus on useful strategies pre-, peri-, and post-implant to reduce S-ICD infection risk. Results: Expert panel consensus of recommended steps for patient preparation, S-ICD implantation, and post-operative management were developed to provide guidance in individual patient management. Conclusion: Achieving expert panel consensus by process mapping methodology for S-ICD infection prevention was attainable, and the results should be helpful to clinicians in adopting interventions to minimize risks of S-ICD infection.

Application of Process Mapping as an Improvement of an Integrated Management System in a Steel and Pipe Company in the Manaus Industrial Center

This academic work will demonstrate a project applied within a company of Steel, Tubes and Connections in the industrial pole of Manaus. The objective of this project is the unification, through an integrated communication system, of all sectors of the company. So that you no longer need to use other means of communication to connect the company and make it quick, automatic, and easy, in addition to being able to make decisions based on information in real time. For this purpose, process mapping was used, the improvement agent for the application of the study, these mappings were made using software called Bizagi.

Costs and optimisation options for monitoring of indirect dischargers

Monitoring of indirect and industrial dischargers, respectively, makes an important contribution to the safe and environmentally sound operation of wastewater systems. As a result of local framework conditions, there is a wide range of monitoring practices across Germany. In a benchmarking project, ten sewerage operators and monitoring bodies representing large German cities have collected data on their work and discussed their practices. The results show that the extent of monitoring is between 244 and 1,457 monitoring points per sewer network (given as 15th and 85th percentile). The median value of the specific expense is 689 EUR per monitoring point and year. In relation to the total wastewater fee volume, the median expense is 0.71%. The sub-process ‘sampling’ was examined more closely. By means of detailed process mapping and regression analyses, it can be shown that on-site activities and tours have the largest share of working time (total of 72%) and thus the greatest leverage in optimisation measures. Various examples are given.

QUALITY IMPROVEMENT INITIATIVE IN CSSD AT A MATERNITY CARE HOSPITAL USING THE PDCA CYCLE TO SUPPORT KAIZEN (CONTINUOUS IMPROVEMENT)

Background: The Central Sterile Supply Department (CSSD) is a service unit of the hospital responsible for providing guaranteed sterile equipment/ instruments to all the departments of hospital for immediate use in patients care. Method: During a 4-month period, in CSSD which caters two number of operation theatres and a 6 bedded Intensive care unit, a central laboratory and a blood bank a study was done, we used PDCA approach to PLAN i.e., identify and analyze the problem, within CSSD and to “DO” i.e., implement changes in CSSD from the inputs given by all the stakeholders involved viz. CSSD technicians, staff, nursing ofcers and the consultants. Subsequently PDCA approach was used to identify and analyze the problem, viable solutions were incorporated. Results : To identify the problem process mapping and interactive sessions with the staff and it was identied that the main problem was inadequate quality in the CSSD services. Our analysis also extracted that the Standard operating procedures were documented related to CSDD were found to be inadequate with regard to the machine maintenance, staff training. The “Do” stage is where we checked for possible solutions or changes. By carrying out a detailed process mapping of the CSSD work ow, an action was taken based on what was learned in the study and to incorporate what we have learned from the test into wider changes, to plan new improvements and start the cycle. Conclusions : The interesting application of PDCA cycle to improve Kaizen and the results achieved reinforces the usefulness of the Kaizen tools to improve business excellence. Using the same facilities, it was possible for efcient space utilization, better improvement in Knowledge of the manpower, identied few gaps in the material procurement and developed standard operating procedures to be followed which are on par to the national and international infection control guidelines which resulted in better working conditions and efcient output from the central sterile supply department.

Task-shifting to optimize outpatient neurological care in Zambia

Objective To investigate opportunities for task shifting to decongest an outpatient neurology clinic in Zambia by describing current patient flow through the clinic and potential nodes for intervention using process mapping. Background Zambia has a population of approximately 18 million people with 4 full-time adult neurologists, as of 2018, who all practice at the University Teaching Hospital (UTH), the main tertiary care center in the country. As a result of this provider-to-patient ratio, the outpatient neurology clinic is overcrowded and overbooked. Task-shifting programs have shown to improve efficiency, access and quality of care through the use of less specialized healthcare workers in low- and middle-income countries (LMIC). Methods We evaluated patient flow in the UTH neurology outpatient clinic through the development and analysis of a process map. The characteristics of the clinic population between 2014 and 2018 were retrospectively reviewed from the clinic register. Between July and August 2018, we prospectively collected appointment lag times and time each patient spent waiting at various points in the clinic process. We conducted interviews with clinic staff and neurologists to generate a detailed process map of current pathways to care within the clinic. We then devised task-shifting strategies to help reduce patient wait times based on the overview of clinic process mapping and patient demographics. Results From 2014 to 2018, there were 4701 outpatients seen in the neurology clinic. The most common neurological diagnoses were epilepsy (39.2%), headache (21.5%) and cerebrovascular disease (16.7%). During prospective data collection, patients waited an average of 57.8 (SD 73.4) days to be seen by a neurologist. The average wait time from arrival in the clinic to departure was 4.0 (SD 2.5) h. The process map and interviews with clinic staff revealed long waiting times due to a paucity of providers. Nurses and clerks represent an influential stakeholder group, but are not actively involved in any activity to reduce wait times. A large proportion of follow-up patients were stable and seen solely to obtain medication refills. Conclusions Epilepsy, headache, and stroke make up the largest percentage of outpatient neurological illness in Zambia. Targeting stable patients in these diagnostic categories for a task-shifting intervention may lead to substantially decreased patient wait times. Potential interventions include shifting clinical follow-ups and medication refills to less specialized healthcare workers.

Methodology for optimizing the stock control of an electronic segment company

Inventory control management is considered a fundamental tool for the management of a company, since it allows processes to be managed efficiently. With less resources and more savings. This study aims to: identify and model the inventory control processes that already exist in the company, analyze the inventory that already exists in the company, describe the methodology for inventory control and propose actions of the methodology that allow corrections of inventory activities already identified. The goal is to propose a methodology for optimizing stock control that is able to define how much and when to buy products. The materials and methods applied in the execution of the work were divided into the following four stages: data collection, process mapping, analysis of improvement opportunities, research design, as well as guidelines for the application of the case study and implementation of the proposal for improvements. The results achieved allowed for the implementation of the methodology, where a 30% reduction in the problems of non-attendance was allowed. Also as a contribution were the goals to be achieved as positive factors such as lean inventory, improvements to efficient customer service, increased capital turnover and increased company profits.

MAPEAMENTO DE PROCESSO E PENSAMENTO ENXUTO: UM ESTUDO BIBLIOMÉTRICO

Este artigo analisa as características das publicações relacionadas aos temas mapeamento de processo e pensamento enxuto. A pesquisa foi realizada na base de dados Web of Science, procurando examinar sete áreas temáticas, intituladas: autores; áreas de pesquisa; anos de publicação; organizações; países/regiões; agências financiadoras; e fontes de publicações. Além disso, foi realizado um comparativo entre autores com os maiores números de publicações com os artigos mais citados no período analisado, para verificar a relação entre eles. Durante o período de 2010 até 2019, foram tratados 198 artigos ao todo e, de acordo com os resultados deste estudo, o número de publicações cresceu de forma significativa em boa parte do período estipulado, porém publicações relacionadas à temática do pensamento enxuto apresentaram um declínio em 2019. Ademais, são apresentadas todas as agências financiadoras de pesquisas relacionadas aos temas, sendo de maior destaque as norte-americanas, o que justifica a liderança dos Estados Unidos das Américas no ranking dos países que mais publicam sobre process mapping e lean thinking. Constatou-se, ainda, que a maioria dos autores que se destacaram em quantidade de publicações, não possuem seus trabalhos entre os mais citados, isso é, os artigos de maior impacto nas temáticas pesquisadas.

Process Mapping as a Tool for Integrating Human Factors into Work System Design

This thesis explores the utility of a production system development process (PSDP) map as a tool for identifying process improvement opportunities with a focus of integrating human factors (HF) into work system design. In this university-industry action research collaboration with a Canada-based electronics manufacturer, 91 meeting events involving 31 personnel took place. The creation and application of the PSDP map led to process improvement ideas with an implementation plan over 14 sub-projects, as well as evidence of organizational change towards applications of proactive HF in design. Results showed that critical issues of PSDP mapping initiatives include data collection methods, scoping, level of detail, style, content and implementation. It was concluded that a process mapping approach to work system design is an effective method for identifying process improvement opportunities with consideration for human capabilities, though further research is required for implementing and sustaining process improvement changes.

Process Mapping as a Tool for Integrating Human Factors into Work System Design

This thesis explores the utility of a production system development process (PSDP) map as a tool for identifying process improvement opportunities with a focus of integrating human factors (HF) into work system design. In this university-industry action research collaboration with a Canada-based electronics manufacturer, 91 meeting events involving 31 personnel took place. The creation and application of the PSDP map led to process improvement ideas with an implementation plan over 14 sub-projects, as well as evidence of organizational change towards applications of proactive HF in design. Results showed that critical issues of PSDP mapping initiatives include data collection methods, scoping, level of detail, style, content and implementation. It was concluded that a process mapping approach to work system design is an effective method for identifying process improvement opportunities with consideration for human capabilities, though further research is required for implementing and sustaining process improvement changes.