Short discharge time from hospitals increases both bed availability and patients' and families' satisfaction. In this study, the Six Sigma process improvement methodology was applied to reduce patients' discharge time in a cancer treatment hospital. Data on the duration of all activities, from the physician signing the discharge form to the patient leaving the treatment room, were collected through patient shadowing. These data were analyzed using detailed process maps and cause-and-effect diagrams. Fragmented and unstandardized processes and procedures and a lack of communication among the stakeholders were among the leading causes of long discharge times. Categorizing patients by their needs enabled better design of the discharge processes. Discrete event simulation was utilized as a decision support tool to test the effect of the improvements under different scenarios. Simplified and standardized processes, improved communications, and system-wide management are among the proposed improvements, which reduced patient discharge time by 54% from 216 minutes. Cultivating the necessary ownership through stakeholder analysis is an essential ingredient of sustainable improvement efforts.

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Enterprise systems are viewed as large-scale software systems, which are usually assembled through a number of protocols inspired by political coalitions. This is due to the fact that incompatibilities emerge through the nature of subsystems can only be avoided in a wider and comprehensive context, which can only come to existence in the corporate/strategic level of enterprises. Cancer care systems consist of a number of such individual systems that require alignment of principles and goals subjected to changes due to emerging circumstances in order to keep up with substantial efficiency, and a certain level of sustainability. In this position paper, an agent-based system is proposed comprising a set of autonomous and collaborating agents running a mathematical model to health-check the current status of the entire system and to produce maintenance and alignment operations to corresponding parts of the system. It helps align the strategical values and principles with the lower level operations infiltrating into the entire enterprise system. This prototypical idea can be extended for more configuration and maintenance.

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