Background
Wait times are considered as most prevalent aspect of health care services, which might cause delayed access to care services, can increase discomfort among patients and can lower the perceived quality of care. More specifically, the emergency departments of hospitals seem to have the issue of overcrowding which is lowering their capacity and causing more waiting time for patients (Abo-Hamad, Crowe & Arisha, 2012). It has been highlighted in previous studies that wait time in emergency department fluctuate across hospitals and normally patients have to wait for more than an hour (Bushell, Mobley & Shelest, 2002). Likewise, the wait time could further increase at night time at during weekends, when number of patients is more. In order to lower the waiting times in emergency department of hospitals, the lean thinking approach has been considered as highly relevant, as it can enable to identify the waste time, value adding and non-value adding activities as well as bottlenecks which might hinder the performance of care delivery services (Minitab, 2018). The lean thinking and system thinking approach is highly common in manufacturing sector for lowering waste and improving the quality of products (Lummus, Vokurka & Rodeghiero, 2006). However, it has emerged in all sectors, including healthcare industry, whereby quality of care can be improved through implication of system tools.
The present report is also focused on implying the system thinking approach for reducing the wait time for patients in emergency department. The report has firstly identified the system archetypes which are considered as highly suitable for studying the behavioral patterns of the system and it has enabled the identification of activities which might be causing increased waiting time. Secondly, the two identified system archetypes (shifting the burden and fixes that fail) are being used to carry out analysis of current value stream map of the emergency department of hospital. Thirdly, new value stream map is being recommended for the hospital which is being followed by discussion of consequences of the new value stream map. The report is being concluded and suggestions are made for hospital.
Identification and analysis of the System Archetypes that may impede performance
Each system is formed by several components and there exist some defined behavioral pattern among the system components. Such behavior and patterns are termed as system archetypes (Grove et al., 2010). It has been highlighted by Jimmerson (2017) that there exists causality within the system and in order to identify issues within a system, the investigation of system archetypes is needed. The value stream map of hospital shows that there are many interlinked patterns within the treatment process and thus investigation through system archetypes can enable to identify issues which are causing delayed treatment (Henrique et al., 2016). The two system archetypes are identified in the context of value stream map of emergency department, which are given below;
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