Citigroup Has Not Displayed Environmental Adaptability in China
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Operations Management
Introduction
Process has been used in manufacturing for many years for raw materials to be routed through a series of machines to become a finished part. Processes were eventually expanded to involve management to capture all aspects of the flow of goods and materials (Schmenner, 1998). Today operations management (OM) involves looking at organizational processes. Chase et al; (2006), defines operations management as the design, operation, and improvement of the systems that create and deliver the firm’s primary products and services. Hospitals provide services for the patient through patient care and technology. They are expected to deliver safe patient care, and have policies and procedures to ensure that hospital employees follow evidence based practice to prevent injury and death to a patient. Operations management is an effective way for managers to plan work, control quality, and ensure productivity of hospital employees under their supervision (Chase, 2006). Managers also view first hand the productivity and patient flow on their unit’s. Managers also assess the nursing staff for any concern that is preventing them from being efficient with their routines, and by patient rounding to evaluate and solve patient concerns. Through these observations and assessments there was a concern about patient flow on the unit when a patients acuity level changes and has to be transferred to a monitored unit. This was a growing issue within the hospital because of the lack of available beds within the hospital. Solutions had to be made on how to solve this issue to increase patient safety in XYZ hospital.
XYZ hospital has an outstanding reputation for being an excellent hospital and has an inpatient occupancy level close to 90%-100%, which is a critical bed status. XYZ is a non-profit hospital which is located in an area that maximizes their market share from the surrounding communities to provide patient care services.
Health care organizations are increasingly facing challenges for being efficient and effective when it comes to patient flow within their hospital systems. Hospitals lose revenue if their emergency department (ER) cannot handle the volume of patients arriving to the ER and have to close their doors. This action results in diverting ambulances to other hospitals and the facility not to be efficient. The other patient flow problems is the waiting time for patients in the ER to obtain a inpatient bed, operating room schedules and delays, length of stay, and lack of a discharge times for patient to leave. These all have created an unsafe environment for the patient which is not effective for patient care. This can be viewed at a systems level, where the problems are a consequence of conventional and historical healthcare processes that need to be revised, and is reflective of a large-scale dilemma affecting many acute care institutions and the industry as a whole (Zimmerman, 2004).
First our hospital hired and outside company to evaluate the daily operations for patient flow within the hospital. They interviewed each manager from all the units regarding their observations for activities regarding patient flow on their units. The company compiled an executive summary for the Vice President with recommendations for process improvements regarding patient flow within the hospital. Unfortunately this was not communicated to the front line management what the recommendations were. However, a committee was formed, short and long term goals were generated and implemented throughout the hospital. Bed management’s department was increased to handle the patient flow and assign beds. Post- op patients were assigned times to arrival on inpatient surgical units. A short term committee of managers and bed management was formed with the ER department to see why patients were “batched”. It was found out that ER doctors sent out patients in “batches” as they were assigned beds. This was due to them charting on their patient’s at one sitting and this caused a delay in patients being delivered to the unit which caused a “batching of patients to units”. Prolonging the holding time (keeping the patient in limbo) between locations for care can be dangerous, particularly when patients are placed in ad hoc care situations (Zimmerman, 2004). This caused nurses to be “slammed” with multiple admissions and not to be efficient once again which caused overtime pay. These admissions caused nurses to be less effective also and which increase potential for patient error. The short term solution was to create admission nurses in the ER, which did not solve the patient flow problem, but assisted the staff RN. The committee was told that the doctors were not going to change their practice. In regards for patients who had to be transferred to a monitored bed, the patient had to wait until a bed was created on the assigned unit before they could be transferred. This delay could be more than 2 hours. This created great concern for patient safety because proper treatment could not be given on a medical floor. Since then, a SWAT nurse team has been created to meet the higher level of care for the patient on a medical/surgical units, variances are generated for delayed transfers, and medical/surgical