Case: \"Process Improvement in Stanford Hospital\'s Operating Room\" by Stefanos
ID: 369043 • Letter: C
Question
Case: "Process Improvement in Stanford Hospital's Operating Room" by Stefanos Zenios et al. (in your Harvard Business School Press coursepack) Read the case. Submit a report and a YAWL model file addressing the following questions: I. Summarize the existing instrument provisioning process at Stanford Hospital. Identify its purpose and performance objectives and how it relates to organizational goals (in other words: “What is the process meant to achieve?"). Cite evidence from the case to support your analysis. Approximately 1 to 2 pages (10%) 2. Identify those parts of the process that you believe cause the major problems. State why you believe they cause problems and what problems you believe they cause. Provide arguments and/or evidence from the case for this. Ensure that you clearly justify what the major problems to the process are. Do not focus on a single issue, there are many present in this case. Also, do not try to attempt to list all problems. Recognize that some problems are more severe or more fundamental or more critical than others. You should attempt to find a few major root causes of the many problem symptoms. You may find the material for the classes on process analysis and improvement useful, but you are not be limited to that material only Rank or prioritize the problems/root causes by their severity or importance and briefly justify your rank order. Cite evidence from the report to support your analysis and to support your ranking/prioritization. Your answer should be more than a simple list of things the case already mentions but demonstrate some analysis/deeper thinking Approximately 2 to 3 pages (15%) 3. Recommend the most important changes to the process that addresses the problems of the instrument provisioning process. Describe each recommended change, state which problem it addresses and describe how it solves the problem. Each change recommendation should directly address one or more of the identified root causes in the previous question. Change recommendations should be realistic and implementable in a reasonable time and with reasonable resources. Change recommendations should be detailed and specific. Not all change recommendations will necessarily show up in the process flow model (Q4). S organizational, or concern the information change recommendations are described and justified well. flow in the process. This is perfectly fine as long as the This step is critical to the success of your paper. If you do not recommend the proper changes it will difficult for your new process to be logical. To do this you have to ensure you properly identify theExplanation / Answer
Summary
According to Rickey’s experience at the Stanford Hospital and Clinics, the institution was experiencing a problem with the process of instrumentation that had caused a lack of solidarity and teamwork within the institution. It, therefore, prompted the recruitment of material flow committee to address the hospitals limited resources, and that is why the selected team had to come up with the best instruments that would be first utilized.
In 2002, a turnaround had to be reached, and it marked the initial steps for SHC vision. At this point, there was a need to initiate a culture of continuous improvement within the organization, however, challenging it might seem because of the skepticism that was prevalent. Most of the employees lacked confidence essentially because of the experience and perceptions towards the external consultants. There was the regular hiring of firms to make recommendations, but these commendations were rarely implemented. As a result, there was an infrequent success and increased frustrations. Because of all these troubles, culture had to be shifted and driven from within the organization.
The criteria have helped to establish an OR, which generated a third of the hospital revenue and increased the hospitals efficiency in an impact that has been established as significant. The improvement of the OR was primarily driven by the changes in the local market, an increase in surgical volumes and the decreased staff and physician.
Challenges to the Process Flow
Market changes is a major problem because it puts some revenue stream from the OR in danger, for instance, competing health care providers wanted to build a new facility in the Bay area, and this prompts the revenue to be spent on unplanned activities. The fact that surgeons who are operating in the SHC are operating in suites that were built more than forty years can easily get drawn to the state of the art facilities away from the SHC.
Another problem with the process is the adoption of robotics by surgeons. The adoption of this technology for microsurgical techniques at an increasing rate has made the procedure to consume a lot of time in the OR because of the complexity of the process. According to hospital administrators, it had also led to the increase in surgery demand which has shot up by 18% and the hospital leadership knows that if the surgeons become dissatisfied with their access time to OR, they would probably move to other hospitals that are in competition with the SHC.
The process also faces instrumentation challenges because, in 2004, there were already complaints about instrumentation issues in OR. The issues ranged from the shortage of the essential instruments to an intolerable length of time that is needed to complete sterile processing to the stressed communication between sterile processing staff and the OR. The lack of coordination between employees can be a big problem because the organization cannot move forward when there is no teamwork.
The process flow also faces a major problem with the sterilization procedure that requires all the instruments to be sterilized, processed and taken to the right surgeon for the correct case at the right time. Every step in the process has added complications to the entire objective. There are several steps which have to be followed so that instruments can be sterilized and this process consumes a lot of time. At some point, it has led to OR staff to circumvent the process through sharing instruments between suites. Sometimes instruments can go missing leading to a nurse or a technician looking for another surgical and borrow other instruments during the process of surgery. Sometimes instruments were flash sterilized, and this causes a lot of worries because the process does not offer an effective control of infection when compared to the complete procedure of sterile processing.
Management is also another major challenge to the process because initially, SHC was an academic medical center and it did not have a single individual who was responsible for the whole organization. The whole institution was managed by two different administrators, for instance; the SHC CEO managed the hospital facilities and staff while the Dean managed the residents, faculty, and the medical center. Despite the hospital incurring costs of operation, it had very limited amount of control on physicians. A physician was not considered an employee of the hospital which gave them the chance to practice in various facilities at any given time. In case a prominent physician had to live because of the restrictions that the administration has imposed then the center would lose a medical expertise, physicians, revenue stream and also patients.
Recommendations
There is need to focus on the organizational dynamics and culture because the key obstacle to the excellence of the OR was the SHC culture. The silos that were established hampers the flow of information across all the job functions. There is a high value put on experience and seniority that often stifled new ideas from members who are new to the team and the hierarchy of authority also slows idea flow reaching the top of the organization quickly. The morale of workers needs to be boosted because low morale results into a high turnover that in the end leads to the loss of the scholarly capital. Perhaps the best way to go is to hold all the operational changes until a culture of change is embraced within the organization.
Redesigning the current process flow is also another significant aspect that the SHS has to focus on because apart from the cultural issues, the OR process seemed unstructured and it only required heroic efforts of technicians and nurses on the daily basis to ensure that supplies and instruments were kept in the right place at the correct time. The center was confused about the particular roles of clinical against the non-clinical personnel. Some OR personnel were also complaining about the issue of employing external consultants to fill the gap. For that reason, the SHC administrators need to redesign the existing process so that they can reallocate labor resources to reduce the errors of instrumentation and improve the efficiency of the OR.
There is also the need to outsource the entire provision of instrumentation process because there was a working model for the option at the SHC outside the OR in the supply management for the medical floors. At this place, a distributor had the ability to offer a just in time supplies delivery to the appropriate floor according to the required system of inventory. The existing provision of instrumentation entailed complex procedures, however, exploring the viability of this option needed SHC to make up its mind whether the provision of instrumentation was a major competency. Nonetheless, there was also need to assess the downside risks required for outsourcing the vigorous function.
HSC also needs to invest in education to enhance the accuracy of handling instrumentation throughout all the OR levels including all other employees, surgeons, and nurses because this might have a significant effect on efficiency by tumbling the amount items lost, broken and also hidden for later use. Implementation of technology will ensure the IT systems are available through which employees can use the online tools to facilitate in assembling instruments that are complicated. The training will also allow the assemblers of instruments and the sterile processing employees to fill in for one another based on the workload. Moreover, the high employees’ turnover might mean that the additional investment would be lost to the hospital and acquired by the next institution that the employee worked for which essentially helps the competition.