Abstract:The performance gap between hospital spending and outcomes is indicative of inefficient care delivery. Operational failures-breakdowns in internal supply chains that prevent work from being completed-contribute to inefficiency by consuming 10% of nurses' time (Hendrich et al. 2008, Tucker 2004. This paper seeks to identify organizational factors associated with operational failures, with a goal of providing insight into effective strategies for removal. We observed nurses on medical/ surgical units at two hospitals, shadowed support staff who provided materials, and interviewed employees about their internal supply chain's performance. These activities created a database of 120 operational failures and the organizational factors that contributed to them. We found that employees believed their department's performance was satisfactory, but poorly trained employees in other departments caused the failures. However, only 14% of the operational failures arose from errors or training. They stemmed instead from multiple organizationally-driven factors: insufficient workspace (29%), poor process design (23%), and a lack of integration in the internal supply chains (23%). Our findings thus suggest that employees are unlikely to discern the role that their department's routines play in operational failures, which hinders solution efforts. Furthermore, in contrast to the "Pareto Principle" which advocates addressing "large" problems that contribute a disproportionate share of the cumulative negative impact of problems, the failures and causes were dispersed over a wide range of factors. Thus, removing failures will require deliberate crossfunctional efforts to redesign workspaces and processes so they are better integrated with patients' needs.

Using POSH, this paper examines what consumers and practitioners value about health services; it also illustrates how brilliance can be theorized into health service management research and practice.

To the best of the authors' knowledge this is the first comprehensive report applying lean flows to pathology laboratory remodelling and one of the few applications of Lean Systems Thinking between departments and between separate health services organisations.

No abstract

Objectives:To (1) assess whether according to healthcare providers, the creation of an ethics service responds to a need; (2) assess the importance of an ethics service for healthcare providers; (3) determine what ethics services should be offered and the preferred formats of delivery; and (4) identify key issues to be initially dealt with by the ethics service.Design:A survey of healthcare providers in Québec’s Centre Local de Services Communautaires (CLSC), healthcare institutions dedicated to community health and social services.Findings:96 (95%) respondents agreed that an ethics service was needed, and on average the ethics service project was judged to be very important. Preferred formats for ethics consultation and education were identified, as well as key concerns such as the need of respect for the patient as a person, elder abuse and ethical issues in home care.Conclusion:This survey is helping in the implementation of an ethics service and can guide others in similar healthcare institutions.