Ozcan: Chapter 6 Reengineering (Overview) Dr. Joan Burtner, Certified Quality Engineer Associate...
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Transcript of Ozcan: Chapter 6 Reengineering (Overview) Dr. Joan Burtner, Certified Quality Engineer Associate...
Ozcan: Chapter 6 Reengineering Ozcan: Chapter 6 Reengineering (Overview)(Overview)
Dr. Joan Burtner, Certified Quality Engineer
Associate Professor of
Industrial Engineering and Industrial Management
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 2
Chapter 6 Topics
Work Design in Health Care Organizations Work Design Job Design
Work Measurement-Standard Times Stopwatch Time Studies Standard and Predetermined Times
Work Measurement Using Work Sampling Determination of Sample Size
Work Simplification Flow Chart Work Distribution Chart Flow Process Chart
Worker Compensation
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 3
What is Reengineering (Ozcan Interpretation)?
Reengineering is a methodology intended to overcome the difficulty in realizing TQM/CQI performance over a long duration, as well as the myopic conduct of organizational change, restructuring and downsizing.
To reengineer the system, healthcare managers must be able to understand work-design, jobs, job measurement, process activities, and reward systems – all well known concepts of industrial engineering. With that knowledge, they can recognize the bottlenecks in the old system, identify unnecessary and repetitive tasks, and eliminate them.
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 4
Importance of Work Design
Human resources (manpower) represents over 40% of healthcare facility budgets
Human resource management issues Productivity and satisfaction of staff involves an
understanding of the work environment Work must be designed so that employees are
happy, organizational productivity is high, and costs are minimized
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 5
Work Design- A Systems Perspective
Work Design
WorkMeasurement•Time Study•Predetermined Standard•Work Sampling
Job Design•Who?•How?
•Where?
Job Simplification
WorkerCompensation
•Time Based•Output Based•Incentive Plans
ExternalFactors
Source: Ozcan Figure 6.1
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 6
Frederick Winslow Taylor
Developed scientific management approach
Focused on time studies Asserted that conflicts between labor and
management occurred because management had no idea how long jobs actually took
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 7
Socio-technical School Approach
Efficiency School(Technical Focus)
Behavioral School(Human Focus)
Socio-technical School
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 8
How can jobs be improved? – Behavioral School
Job enlargement-- give workers a larger portion of the total task (horizontal loading-- additional work at same level of skill and responsibility)
Job enrichment-- increasing responsibility for planning and coordinating tasks (vertical loading)
Job rotation-- workers periodically exchange jobs (limited applicability in healthcare)
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 9
Work Measurement Using Time Standards
Time standards are important in establishing productivity measures, determining staffing level and schedules, estimating labor costs, budgeting, and designing incentive systems
A time standard represents the amount of time needed for the average worker to do a specific job working under typical conditions
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 10
Standard Time Development
The amount of time it should take a qualifiedworker to complete a specified task, working at a sustainable rate, using given methods and equipment, raw materials, and workplacearrangements is called a standard time.
Standard time can be developed through:•Stop-watch studies•Historical times•Predetermined data•Work sampling
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 11
Stopwatch Time Studies
Take time over a number of trials (cycles) Workers should be educated regarding the process
to avoid suspicion and avoid the Hawthorne Effect Number of cycles to time (i.e., sample size)
variability in observed times desired accuracy desired level of confidence for the estimate
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 12
Desired Confidence Z-value 90 1.65 95 1.96 98 2.33 99 2.58
Determining Sample Size
Accuracy desired may be explained by the percentage of the mean of the observed time. For instance, the goalmay be to achieve an estimate within 10 percent of theactual mean. The sample size is then determined by:
where:z = number of std. dev.
needed for desired confidence
s = sample std. dev.a = desired accuracyx = sample mean
2
*
*
xa
szn
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 13
An Alternative Formula
Desired accuracy may be expressed as an amount (e.g.,within one minute of the true mean). The formula for sample size becomes:
wheree = Accuracy or
maximum error acceptable
To make an initial estimate of sample size, you shouldtake a small number of observations and then compute the mean and std. dev. to use in the formula for n.
2*
e
szn
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 14
Example 6.1
414.414.6*10.
1.2*96.12
orn
A heath care analyst wishes to estimate the time required to perform a certain job. A preliminary stopwatch study yielded a mean of 6.4 minutes and a standard deviation of 2.1 min. The desired confidence level is 95 percent. How manyobservations will be needed (including those already taken)if the desired maximum error is:
a) +/- 10 percent?b) one-half minute?
a)
b) 688.675.
1.2*96.12
orn
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 15
Determining the Standard TimeDetermining the Standard Time – Normal Time – Normal Time
Observed Time-- average of observed times OT = xi/n
Normal Time-- observed time adjusted for worker performance NT = OT * PR (where PR = performance standard measured
for the entire job) NT = (Ej*PRj) (where PR is measured element by element)
PR equals 1 for the average worker; PR< 1 is for a slower worker
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 16
Allowance Factor
Standard time equals normal time multiplied by an allowance factor ST = NT * AF
Allowance Factor accounts for personal delays, unavoidable delays,
and/or rest breaks AFjob = 1+A, where A= allowance percentage based
on job time AFday = 1/(1-A), where A = allowance percentage
based on work day
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 17
Table 6.1 Typical Allowance Percentages for Varying Healthcare Delivery Working Conditions
Allowance Level Percent
1. Basic-low (personal, fatigue, standing) 11
2. Basic-moderate (basic-low and mental strain) 12
3. Basic-high (basic-moderate and slightly uncomfortable heat/cold or humidity
14
4. Medium-low (basic high and awkward position) 16
5. Medium-moderate (medium-low and lifting requirements up to 20 lbs.) 19
6. Medium-high (medium-moderate and loud noise) 21
7. Extensive-low (medium-high and tedious nature of work) 23
8. Extensive-medium (extensive-low and with complex mental strain) 26
9. Extensive-high (extensive-medium and lifting requirement up to 30 lbs.) 28
Source: Adapted from B.W. Niebel, 1988.
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 18
Allowance Factor Computations
Compute the allowance factor if: The allowance is 20 percent of job time. The allowance is 20 percent of work day.
A) AF = 1 + A = 1.20, or 120%
B) AF = 1/(1-A) = 1/(1-.2) = 1.25 = 125%
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 19
What are the problems with time studies?
Subjective performance ratings and allowances
Only observable jobs can be studied Highly costly -- best for repetitive tasks Disrupts worker routine May cause worker resentment
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 20
Other Methods
Historical/Standard Elemental Times Firms collect data on standard job elements Put these data together to determine job times Less costly and disruptive Limited applications in healthcare
Predetermined Standards Obtained from trade publications Need no performance of allowance factor Operations are not interrupted
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 212121
Technique for estimating the proportion of time that a worker or machine spends on various activities
Observers make brief observations of a worker or a machine at random intervals over a period of time and simply note the nature of the activity
Purpose: To estimate percentage of unproductive or idle time for
repetitive jobs To estimate the percentage of time spent on various tasks
for non-repetitive jobs
Work Measurement Using Work Sampling
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 222222
Work Sampling Steps
1) 1) Determine the sample size
2) Train the observers,
3) Develop random sample schedule
4) Take observations, and re-compute the
desired sample size several times if initial
estimates are not reliable
5) Determine the estimated proportion of time
spent on specified activity
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 23
Estimating Required Sample Size
CI = confidence interval,e = error,z = number of standard deviations needed to achieve desired confidence, sample proportion (number of occurrences divided by sample size), n = sample size.
epCI ˆ
nppze /))ˆ1(*ˆ(
)ˆ1(ˆ)/( 2 ppezn
The goal of work sampling is to obtain an estimate that provides a specified confidence not differing from the true value by more than a specified error
p̂
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 24
Advantages of Work Sampling
Observations less susceptible to short term fluctuations
Little or no work disruption Workers are less resentful Less costly and time-consuming Many studies can be conducted
simultaneously Useful for non-repetitive tasks
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 25
Disadvantages of Work Sampling
Less detail on elements/tasks of a job Workers may alter patterns Often no record of method used by worker Observers may fail to adhere to random
observation schedule Not useful for short, repetitive tasks Much time required to move from observation
area to observation area to ensure randomness
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 26
Work Simplification
Work Simplification-- process of changing work methods: Eliminate unnecessary parts of work Combine and rearrange parts of work Simplify work when possible
Work Simplification Tools Flow Chart Work Distribution Chart Flow Process Chart Layout Chart
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 27
Process
Decision
Start/Terminate
Preparation
DocumentManual
Operation
Figure 6.4 Commonly Used Flow Chart Symbols
Off page connector
On page connector
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 28
PatientEntry
Figure 6.5 Flow Chart for Emergency Room Specimen Processing
Triage:need blood?
Nurse draws blood
MD orderslab
IS orderentry
Label &package
Verification
Lab
Accession &analysis
IS doubleentry
MD terminateslab order
(end)
PatientEntry
Triage:need blood?
Nurse draws blood
MD orderslab
IS entry label & package Lab
Accession &analysis
Results arrive in ER
(end)
Initial Process After Improvement
Yes
endNoendNo
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 29
The Work Distribution Chart
Shows what a department does to identify each of its major activities and to pinpoint the contribution of each employee to those activities
Spotting Trouble Which activities consume the most time? Are tasks evenly distributed? Is there under-specialization? Are employees assigned too many unrelated
tasks? Are talents utilized efficiently?
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 30
Flow Process Chart
Records a procedure in a graphic form, using a sort of shorthand to simplify and unify the record Ensures every significant detail of the work
process in its proper sequence is recorded Highlights inconsistencies and redundancies
Can eliminate, combine, change (sequence, place, person), or improve activities
Operation
Move
Inspect
Delay
Store
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 31
PPaattiieenntt EEnnttrryy Triage
RN draws blood Specimen waits for MD order Order entry
Label and package Sent to lab Accessioning process
Lab analysis VVeerriiffiiccaattiioonn bbyy llaabb//IISS eennttrryy SSeenntt ttoo EERR MMDD tteerrmmiinnaatteess llaabb oorrddeerr
OPERATION MOVE INSPECT DELAY
Figure 6.3 Flow Process Chart for Emergency Room Specimen Processing
Ozcan Ch. 6ISE 491 Fall 2009 Dr. Burtner Slide 32
Worker Compensation
Compensation schemes: Time based-- most common in healthcare Output based-- more difficult to operationalize, yet
pay is related to efforts Incentive Systems
Profit sharing plans-- receive % of profits Gain sharing plans-- receive a % of the value (i.e.,
cost savings) realized through increases in productivity