A new value stream mapping approach for healthcare environments

Hospitals worldwide are giving a growing emphasis to the application of lean concepts in the healthcare sector, commonly known as ‘lean healthcare’. A fundamental tool that allows such implementations is the value stream mapping (VSM). The problem is that VSM models used in implementations of lean healthcare are simple adaptations of the original VSM model, which was initially directed towards manufacturing and may not always represent important support activities for the patient flow that directly impact treatment time. Within this context, this paper presents a new VSM approach for healthcare environments. This new VSM model, specifically designed for healthcare environments, contemplates all activities that directly affect the treatment time. In addition, the present paper also presents an action research in a Brazilian hospital where the proposed VSM model is compared to other VSM models found in the literature. The results shown that the proposed VSM model was able to identify some operational bottlenecks and wastes that interfere in the patient’s treatment that could not be identified by other mapping models studied.     

Application of discriminant analysis-based model for prediction of risk of low back disorders due to workplace design in industrial jobs

The occupational exposure limits of different risk factors for development of low back disorders (LBDs) have not yet been established. One of the main problems in setting such guidelines is the limited understanding of how different risk factors for LBDs interact in causing injury, since the nature and mechanism of these disorders are relatively unknown phenomena. Industrial ergonomists' role becomes further complicated because the potential risk factors that may contribute towards the onset of LBDs interact in a complex manner, which makes it difficult to discriminate in detail among the jobs that place workers at high or low risk of LBDs. The purpose of this paper was to develop a comparative study between predictions based on the neural network-based model proposed by Zurada, Karwowski & Marras (1997) and a linear discriminant analysis model, for making predictions about industrial jobs according to their potential risk of low back disorders due to workplace design. The results obtained through applying the discriminant analysis-based model proved that it is as effective as the neural network-based model. Moreover, the discriminant analysis-based model proved to be more advantageous regarding cost and time savings for future data gathering.     

Contractual Integration of Physician and Hospital Services in the U.S.

Using a binary-choice, probabilistic model, this study analyzes data covering the institutional and market characteristics of 759 hospitals in 81 metropolitan statistical are as in the United States to understand why many of them have chosen to contractually integrate with physician and physician group practices. The results support the theory that the contractual integration of physician and hospital services in the U.S. during the 1990s occurred in response to market pressures to circumvent the transaction costs of monitoring physician utilization of hospital resources. They also support the views of Robinson (1997) and Shortell (1997) that the nature of the coordination, the governance structure, and the part to which market mechanisms play are largely determined by the demands for coordination from the market served by the hospital, the capabilities of the hospital to pull physicians into integration arrangements, and the historical context and constraints binding the hospital's decision making. This revised version was published online in July 2006 with corrections to the Cover Date.     

Table of Contents Volume 8 2004

Volume Content

Table of Contents Volume 8 2004