| Přispěvatelé: |
Spies, D.C., Niesing, C.M., Kruger, D., 11311738 - Bester, Petra (Supervisor), 12681644 - Niesing, Christina Maria (Supervisor), 20576404 - Kruger, Danél (Supervisor) |
| Popis: |
MBA, North-West University, Potchefstroom Campus, 2019 Background: Operating theatres are dedicated venues within hospitals designed for safe surgical interventions and account for a large portion of their revenue and expenditure. Within the public health system in South Africa, there is a high demand from patients seeking medical treatment through surgical procedures, especially orthopaedic procedures. Hence optimal scheduling of operating theatres geared towards efficiency and production is essential in the management of hospitals. Problem statement: Surgery of elective patients is a challenge in public hospitals amid staff shortages, long waiting times, cancellation by patients on short notice, limited post-operative recovery beds, and orthopaedic wards. The challenge is even more pronounced when there is no software program use to schedule orthopaedic surgeries. The researcher was requested by the Chief Executive Officer of a level three public hospital in the North West Province, South Africa, to explore and describe how orthopaedic theatres function in this hospital in order to propose how orthopaedic surgery scheduling with lean management principles could improve orthopaedic theatres' efficiency and production. The hospital is a level three public hospital servicing the Dr Kenneth Kaunda District and other districts within the North West Province. Due to its good performance with orthopaedic theatre surgeries it attracts patients from other provinces and some African countries. Aim and objectives: The aim was to gain a better understanding of the current scheduling system for orthopaedic theatres at a level three public hospital in the Dr Kenneth Kaunda District, North West. The first objective was to explore and describe how orthopaedic theatres and the current scheduling system function. Secondly, a lean management framework for orthopaedic theatre scheduling was proposed. Methods: The research followed a qualitative single-case embedded design, with the two units of the orthopaedic operating theatres, theatres 1, and 3. The setting was the orthopaedic, administration, finance, pharmacy, and X-ray departments of a level three public hospital in the Dr Kenneth Kaunda District, North West. The literature reviews studied lean management in the healthcare environment, globally and in South Africa and Lean Six Sigma and 5S were found to be the most suitable lean management frameworks. The data was collected from multiple sources of evidence listed as 36 archival documents, eighteen (18n) semi-structured interviews and 250 pages of reflective notes. The research concluded with a proposed lean management framework developed from the typical activity flow for a patient from diagnosis, through surgery to discharge and was based on multiple objective programming, reactive and simulation models. Five steps in the workflow were highlighted and applied to lean management principles. This framework addresses orthopaedic scheduling aiming to reduce waiting lists, cancellation of elective patients, and to improve efficiency and production. Recommendations: It is recommended that the hospital invest in a central computerised network, linking departments, and application of scheduling software for operating theatres. Text messages could be sent to patients' phones from a centralised scheduling system. It is also recommended to have dedicated orthopaedic theatre staff, especially an anaesthetist, nursing staff, and a porter available on orthopaedic surgery days. Adopting such a lean management framework will help improve scheduling in the orthopaedic operating surgeries, theatre efficiency, as well as production. Masters |
