الفهرس 
Just-in-time lean operation philosophyOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
This study aimed mainly to evaluate the effectiveness of the current
flow of patient processes and value stream activities performed in
hospital ED operation setting. This purpose could be attained by
determining if patient length of stay in the emergency department is
prolonged by waiting time and service delays that can be avoided by an
efficient design of the service delivery process. Therefore, this study
targeted identifying the inefficiencies and major bottlenecks interrupting
current process flow at the ED and its ancillary departments in the studied
EDs, and exploring possible sources of waste embedded in the structural
elements of ED service operation which considered the main causes of
patient processing delays.
The research approach utilized to study the research problem is a mixed
model research. The core assumption of the mixed model form of inquiry
is that the combination of quantitative and qualitative approaches provides
a more complete understanding of a research problem.
The targeted research population settings of this research include the
Emergency departments of three public hospitals providing health care
services to the community in Menoufia governorate. Two of the ED setting
chosen, the university hospital and the instructional hospitals, are
considered treasury hospitals with substantially larger capacity serving the
population of the governorate. The third chosen were the central hospital
of emergencies at Quessna. The research approached two different
populations; a-Care receivers seeking health services from the Emergency
department and b-Main providers of healthcare service in the emergency
department operation setting.
Primary data was collected using a triangulation methodology. Three
different methods of data collection were utilized. Unstructured observation and Personal in-depth interviews were used in order to stand
on the nature of operation at the emergency department , to observe
waiting time and service delays, and to understand the functionability and
the employment of the elements of producing service at the emergency
department.
The third data collection method utilized is the survey to finalize the
results and reach a decision of proving or disproving the hypotheses. Two
different questionnaire instruments were designed to collect data from care
providers and care receivers. Questionnaires directed to patients were
designed to ask about the time spent at the ED and their experience with
the operational elements at the ED. For care providers, physicians and
nurses drawn out in the sample were first informed about the research
problem, then they were handed the questionnaire to be answered and
collected. Also, the questionnaire designed for care providers contained
two sections asking about their overall evaluation of the patient flow at the
ED and their evaluation about each structural element of operation in
particular. In order to accomplish the objectives of the present study,
collected data were analyzed by statistical techniques such as descriptive
statistics , correlation analysis, linear regression, ANOVA, Mann-Whitney
test, Kruskal-Wallis test and two independent sample t-test.
By investigating the significance of the relationship between the time
intervals spent between core service delivery processes and total patient
length of stay in the Emergency department, the research results proved
that there is a significant relationship between total time that patient spent
in the ED and the length of the waiting times intervening core patient
processing time in the emergency department. It was also found that, for
each patient type of severity, certain time intervals length were more
significantly, strongly , and directly correlated to the length of the total.