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Improving the efficiency and effectiveness of ward rounds on a Danish Haematology Department
( Birgitte Enslev Jensen ),( Pauline Found(dr) ),( Sharon Williams(dr) ),( Paul Walley(dr) ) 한국품질경영학회 2015 한국품질경영학회 학술대회 Vol.2015 No.2
Purpose: In hospitals, ward rounds aim to prioritise quality, patient experience, and patient safety, however, failures in care arising from the ward round can directly affect patient safety. The ward rounds are crucial for decision-making in the context of patient treatment processes and, in the course of a ward round; new tasks are identified and allocated to physicians and nurses. However, these tasks are not systematically managed in clinical practice and ward rounds are often lengthy in duration due to missing information, equipment or unavailability of key staff. This research aims to access whether ward rounds can be structured more efficiently and effectively from the perspective of patients and staff. Methodology/Approach: This mixed method approach examines the ward rounds conducted in three units within a haematology department. Having collected baseline measures (e.g. duration, average length of stay) improvement methods are employed to capture the value of the ward round described by patients and staff, to map the information, patient and equipment flows associated with a typical ward round, to identify non-value adding activities and present recommendations for improvement. Findings: All the staff aspired to a ward round of good quality but what good quality meant in this context was never articulated. Typically ward rounds would take from 9 am till 3 pm and, from the observations and interviews, it was apparent that the team spent a lot of time waiting for team members to arrive. There were no real standards as how to do the rounds and what should be ready, no consistent plan for the patients with the consequence that the length of stay on the ward was often extended. Whilst, in general patients and relatives were very satisfied with the ward round, the timing of them raised concerns and they would like to have known an approximate time when they would occur. In addition, the duration of the ward round was unpredictable. The improvements identified by the team, if implemented, would allow the ward round to be completed by noon with much more certainty on the time that the clinical team was due. Research Limitations/implications: This research provides an insight to how ward rounds are conducted within a Haematology Department. Recommendations are provided for those involved in ward rounds in relation to reducing the time the rounds take but maintaining quality and safety of patient care. Originality/Value: Much of the previous research on ward rounds has focused on the interactions between doctors and nurses. This research focuses on the operational process of the ward round and presents a structured approach to support multi-disciplinary teams with a strong focus on value from the patient□s perspective.
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Failure Demand: An evaluation of concept in UK Primary Care
( Paul Walley(dr) ),( Sharon Williams(dr) ),( Pauline Found(dr) ) 한국품질경영학회 2015 한국품질경영학회 학술대회 Vol.2015 No.2
Purpose - The purpose of this paper is to assess the characterisation of failure demand as service lean concept that assists in the analysis of waste during quality improvement activity. We assess whether the limited use of this concept is a missed opportunity to help understand improvement priorities given that a UK Government requirement for public services to report failure demand has been removed. Design/methodology/approach - The study looks at the existing literature across the public sector and then applies the concept of failure demand to the UK□s primary healthcare system. UK NHS demand data are analysed and the impact on patient care is elicited from patient interviews. Findings - The study highlighted the value of the concept, showing how the primary care system often generates failure demand partly because of existing demand and capacity management practices. This demand is deflected to other parts of the system with a considerable detrimental impact on the patient□s experience. Research implications - More research is now needed to fully understand how best to exploit the idea of failure demand as there are many barriers to its appropriate and successful application. Practical implications - The paper highlights three practical barriers: the lack of general understanding of demand within the healthcare system, the lack of understanding of systems improvement and the need to apply the concept for improvement not reporting purposes. Originality/value - The paper provides an objective and independent insight into the concept of failure demand that has not previously been seen in the academic literature.
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