...S w 908D01 PAEDIATRIC ORTHOPAEDIC CLINIC AT THE CHILDREN'S HOSPITAL OF WESTERN ONTARIO Manpreet Hora wrote this case under the supervision of Professor Robert D. Klassen and Dr. Kellie Leitch solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. Ivey Management Services prohibits any form of reproduction, storage or transmittal without its written permission. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Management Services, c/o Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada, N6A 3K7; phone (519) 661-3208; fax (519) 661-3882; e-mail cases@ivey.uwo.ca. Copyright © 2008, Ivey Management Services Version: (A) 2010-01-13 Dr. Kellie Leitch glanced at the data on wait times collected from the patients in one of her clinics. As Chief of Paediatric1 Orthopaedic surgery at the Children’s Hospital of Western Ontario (CHWO), she was very concerned by the long times that the young patients (and their parents) were experiencing in the daily clinic. Long wait times tended to aggravate the already pent-up distress and concern that they were feeling, and parents were...
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...Case report: Paediatric Orthopaedic Clinic 1- What is capacity utilization at every step in the process? What is the direct resource utilization? Using the data provided in the case, we are able to compile all data necessary to compute the capacity utilization at the clinic. Activity | # of Staff | Available time | Activity time | Number of Patients | Time needed | Utilization10 | | | /Staff | Total | N | F | N | F | N | F | Total | | 1. Front Desk | | | | | | | | | | | | a. Registration | 3 | 180 | 540 | 5 | 5 | 32 | 48 | 160 | 240 | 400 | 74 % | b. Verification | 3 | 255 | 765 | 9 | 4 | 32 | 48 | 288 | 192 | 480 | 63 % | 2. Radiology Department | | | | | | | | | | | | a. X-ray imaging | 6 | 240 | 9603 | 11 | 11 | 32 | 40.8 | 352 | 448.8 | 800.8 | 83 % | b. Development of X-rat | -1 | 240 | 9604 | 7 | 7 | 32 | 40.8 | 224 | 285.6 | 509.6 | 53%8 | c. Diagnostic reading and comments | 3 | 240 | 4805 | 5 | 5 | 32 | 40.8 | 160 | 204 | 364 | 76% | 3. Hand-off X-ray to Clinic | | | | | | | | | | | | a. Collection of X-ray | 3 | 2556 | 7657 | 2 | 2 | 32 | 40.8 | 64 | 81.6 | 145.6 | 19% 9 | b. Filing/exam room prep | 1 | 255 | 255 | 2 | 2 | 32 | 48 | 64 | 96 | 160 | 63% | 4. Examination Room | | | | | | | | | | | | a. Surgeon | 1 | 255 | 255 | 7 | 4 | 32 | 14.4 | 224 | 57.6 | 281.6 | 110% | b. Resident | 1(2)2 | 255 | 255 | - | 7 | - | 33.6 | - | 235.2 | 235.2 | 92% | c. Cast technician...
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...Outpatient Orthopedic Clinic Thomas R. Rohleder, PhD Division of Health Care Policy and Research Mayo Clinic 200 First Street SW Rochester, Minnesota 55905 tel: 507-538-1532 Email: rohleder@mayo.edu Peter Lewkonia, MD Faculty of Medicine University of Calgary Calgary, Alberta Diane Bischak, PhD Haskayne School of Business University of Calgary Calgary, Alberta Paul Duffy, MD Faculty of Medicine University of Calgary Calgary, Alberta Rosa Hendijani Haskayne School of Business University of Calgary Calgary, Alberta July 2011 Abstract We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced. Keywords: Outpatient Clinic, Discrete Event Simulation, Process Improvement, Patient Waiting I. Introduction Visiting hospital outpatient clinics is a very common way for patients to access health care. These clinics typically schedule...
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...- Free Term Papers, Essays and Research Documents The Research Paper Factory Join Search Browse Saved Papers Home Page » Business and Management Paediatric Orthopaedic Clinic In: Business and Management Paediatric Orthopaedic Clinic Case report: Paediatric Orthopaedic Clinic 1- What is capacity utilization at every step in the process? What is the direct resource utilization? Using the data provided in the case, we are able to compile all data necessary to compute the capacity utilization at the clinic. Activity | # of Staff | Available time | Activity time | Number of Patients | Time needed | Utilization10 | | | /Staff | Total | N | F | N | F | N | F | Total | | 1. Front Desk | | | | | | | | | | | | a. Registration | 3 | 180 | 540 | 5 | 5 | 32 | 48 | 160 | 240 | 400 | 74 % | b. Verification | 3 | 255 | 765 | 9 | 4 | 32 | 48 | 288 | 192 | 480 | 63 % | 2. Radiology Department | | | | | | | | | | | | a. X-ray imaging | 6 | 240 | 9603 | 11 | 11 | 32 | 40.8 | 352 | 448.8 | 800.8 | 83 % | b. Development of X-rat | -1 | 240 | 9604 | 7 | 7 | 32 | 40.8 | 224 | 285.6 | 509.6 | 53%8 | c. Diagnostic reading and comments | 3 | 240 | 4805 | 5 | 5 | 32 | 40.8 | 160 | 204 | 364 | 76% | 3. Hand-off X-ray to Clinic | | | | | | | | | | | | a. Collection of X-ray | 3 | 2556 | 7657 | 2 | 2 | 32 | 40.8 | 64 | 81.6 | 145.6 | 19% 9 | b. Filing/exam room prep | 1 | 255 | 255 | 2 | 2 | 32 |...
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...Background Information Paediatric Orthopaedic Clinic is part of he Children’s Hospital of Western Ontario, located in London, Ontario. The clinic was one treatment center of CHWO that was jointly managed with the Division of Surgery and was used for children who had experienced a severe or complex bone trauma. Specialized care was given as part of a referral process from family doctors, walk-in clinics, and urgent care clinics throughout the CHWO system. Overall, the clinic is open for three half-day sessions per week. Hours of operation were from 8:30am-1:00pm, Monday through Wednesday. During the remainder of the week, the facilities were used by other sub-specialties of surgery. Staffing for the clinic consists of one surgeon, two senior resident students, three clerks and four registered nurses. Patient flow for the clinic was approximately 80 patients per day, with 60 percent being for follow-up appointments. The process at the clinic can be broken down into several steps. First, at the front-desk, patients must register and verify all necessary medical and identification documents with three nurses and three clerks. Registration ends promptly at 11:30am, while verification continues until 12:45pm. Next, patients are taken to the radiology department where there is six imaging rooms and six technicians on staff. In this step, patients take two types of generic x-rays: upper extremity or lower extremity. Depending on the type of x-ray, extra time must be allotted...
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...Dr. Kellie Leitch glanced at the data on wait times colle cted from the patients in one of her clinics. As Chief of Paediatric 1 Orthopaedic surgery at the Children’s Ho spital of Western Ontario (CHWO), she was very concerned by the long times that the young patie nts (and their parents) were experiencing in the daily clinic. Long wait times tended to aggr avate the already pent-up distress a nd concern that they were feeling, and parents were unders tandably irritated at missing significant time at work. Currently, on an average, patients were spending roughly two hours in the clinic. Patient health was not Dr. Leitch’s only concern. Clin ical staff had increasingly complained about being over-extended, yet budgetary pressure s to reduce the cost of service continued to mount. She was not convinced that all staff was being effectively utiliz ed, and there was an unresolved request from the Radiology department for more adva nced equipment. Dr. Leitch also served on several government task forces. From these, she knew that federal and provincial policy-makers were increasingly concerned with the economic impact that health-care wait times had on national economic productivity. In a moment of weakness, Dr. Leitch recently had volunt eered her clinic to hospita l management as a “test case” to demonstrate that patient care could be done in a more timely fa shion, without increasing costs. An objective of reducing wait times by 20 per cent was...
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...The industry and organization’s products and services I am doing my internship in Tender Care Rehab Center. It’s situated in very convenient location of Mississauga. Tender care is a multispecialty physiotherapy center starts from acupuncture, chiropractor, massage therapy and physiotherapy. It includes electrotherapy department (TENS, Ultrasound, Contrast bath) and exercise therapy department (Treadmill, Bike, CPM and dumbbell, pulley). Clinic also deals with orthotics and prosthesis. Tender care also provide free transportation service for their physically disable patients. The clinic treats the patients like orthopaedic, neurological, geriatrics and paediatrics, burns cases. Tender care mostly deals with the motor vehicle accident cases that include multiple fractures. Our supervisor Mrs. Saloni bookseller is registered physiotherapist. She has finished her graduation from India. She has come to Canada before 4 years and she has fulfilled the requirement to practice physiotherapy in Canada. She manages this clinic from last 2 years. Best thing about her is she always takes each case uniquely and provides the best rehabilitation programme for the same. She always challenge the patients to effort more which gives the quick results. There are two assistants who manage all the documentation work regarding to the insurance and appointments for the massage therapy and acupuncture. Provide a detailed description of your job, including responsibilities, role with...
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...equipment. Output may be a physical product or a service. A metric used to measure the rate at which potential output levels are being met or used. Displayed as a percentage, capacity utilization levels give insight into the overall slack that is in the economy or a firm at a given point in time. Using the data provided in the case, we are able to compile all data necessary to compute the capacity utilization at the clinic. 1. Front Desk = a. Registration b. Verification 2. Radiology Department = a. X-ray imaging b. Development of X-rat c. Diagnostic reading and comments 3. Hand-off X-ray to Clinic = a. Collection of X-ray b. Filing/exam room prep 4. Examination Room = a. Surgeon b. Resident c. Cast technician The activity utilization at every step in the process is as follows: 1- It’s an automatic activity 2- There are two senior resident students, but in a current time only one of them is working 3-4-5 The current available time (in total) for these activities is: a. = 1440; b. 1440; c. = 720. But since Paediatric Orthopaedic Clinic use these activities only 2/3 of the total time they are available we have these numbers: a. = 960; b. 960; c. = 480 6-7- This activity is performed by the same staff as in 1- b. 8- It’s an automatic process 9- This activity is performed by the same staff as in 1- b. We can add that the utilization of this part of staff, three nurses is: 1.b + 3.a = 62 % + 19 % = 81 % 10- Utilization for every step in the process...
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...Admission At the Admitting Department, the patient will be required to provide personal information and sign consent forms before being taken to the hospital unit or ward. If the individual is critically ill, then, this information is usually obtained from a family member. Specialist clinics Specialist clinics provide planned, non-admitted services for people who need the focus of an acute setting to ensure the best outcomes. Specialist clinics provide an interface between primary care services and acute inpatient services, with access to: • medical, nursing, midwifery and allied health professionals for assessment, diagnosis and treatment • ongoing specialist management of chronic and complex conditions in collaboration with community providers...
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...An update on Calcaneal Apophysitis (Sever’s disease) Often children between the ages of eight and thirteen attend the podiatry clinic with heel pain. One differential diagnosis is calcaneal apophysitis or otherwise known as sever’s disease. Calcaneal apophysitis is the inflammation of a calcaneal growth plate causing pain in the heel posteriorly, it is classified as a non-articular Osteochondrosis at an impact site (O’Gradaigh & Crisp, 2012). The calcaneus in a child under sixteen years contains a growth plate posteriorly. This is the section where the Achilles tendon inserts on the calcaneus. Around sixteen years of age, the growth plate ossifies onto the calcaneum. Sever’s disease is the disturbance or micro trauma in this growth area. Calcaneal apophysitis is more common in individuals who participate in active sport. It is a traction apophysitis of the Achilles tendon insertion at the calcaneus and is one of the most common causes of heel pain in children (Micheli & Ireland, 1987). The condition can occur in both sexes and usually resolves once bone growth has ceased. Children are usually in an active growth spurt during which time the Calcaneal apophysitis (Ogden et al, 2004) causes pain. It is thought that the long bones growth exceeds the musculature growth (posterior muscle compartment), causing pulling on the calcaneal muscle attachment. However Michelli & Ireland (1987) suggest the exact aetiology is undetermined and that it is thought to be a repetitive...
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...largest and fastest-growing industries. Consuming over 10 percent of gross domestic product (GDP) of most developed nations, health care can form an enormous part of a country's economy. For purpose of finance and management, the health care industry is typically divided into several areas. As a basic framework for defining the sector, the United Nations International Standard Industrial Classification (ISIC) categorizes the health care industry as generally consisting of: 1. Hospital activities 2. Medical and dental practice activities 3. "Other human health activities". This third class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, or other allied health professions, e.g. in the field of optometry, hydrotherapy, medical massage, yoga therapy, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractic, acupuncture, etc. The Global Industry Classification Standard and the Industry Classification Benchmark further distinguish the industry as two main groups: 1. Health care equipment and services, and...
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...NATIONAL HEALTH INSURANCE SCHEME TIONAL H NA E H INSUR LT A A OPERATIONAL GUIDELINES REVISED OCTOBER, 2012 National Health Insurance Scheme P.O.W. Mafemi Crescent Off Solomon Lar Way, Utako P. M. B 400, Garki Abuja, Nigeria Tel: 234-1-4130026-7 Fax: 234-1-4130028 Email: info@nhis.gov.ng Website: www.nhis.gov.ng All rights reserved. No part of this publication may be reproduced, transmitted, transcribed, stored in a retrieval system or translated into any language or computer language, in any form or by any means electronic, mechanical, magnetic, chemical, thermal, manual or otherwise, without the prior consent in writing of the National Health Insurance Scheme. 1 CH E S EME NC © National Health Insurance Scheme ISBN 978 2397 24 5 REVISED October 2012 2 TABLE OF CONTENTS Foreword Acknowledgement Introduction Definition of Key Terms SECTION ONE (PROGRAMMES) * Introduction * Formal Sector Social Health Insurance Programme * Definition * Roles and responsibilities of Healthcare Facility under the Formal Sector Social Health Insurance Programme * Roles and responsibilities of HMO under the Formal Sector Social Health Insurance Programme * Roles and responsibilities of NHIS under the Formal Sector Social Health Insurance Programme * Organization of Health Services * Guidelines For Public Sector And Organized Private Sector * Membership * Contributions * Waiting Period * Scope of Coverage * Registration of Employers and Employees * Rights and Privileges of...
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...Flow at an Outpatient Orthopedic Clinic Thomas R. Rohleder, PhD Division of Health Care Policy and Research Mayo Clinic 200 First Street SW Rochester, Minnesota 55905 tel: 507-538-1532 Email: rohleder@mayo.edu Peter Lewkonia, MD Faculty of Medicine University of Calgary Calgary, Alberta Diane Bischak, PhD Haskayne School of Business University of Calgary Calgary, Alberta Paul Duffy, MD Faculty of Medicine University of Calgary Calgary, Alberta Rosa Hendijani Haskayne School of Business University of Calgary Calgary, Alberta July 2011 Abstract We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced. Keywords: Outpatient Clinic, Discrete Event Simulation, Process Improvement, Patient Waiting I. Introduction Visiting hospital outpatient clinics is a very common way for patients...
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...CHAPTER ONE 1.1 Background to the Study Health is central to the development of any human society, thus an adequate healthy society can improve the social status of the people (Akanbi, 2014). Though healthcare is a vital service, however, it is often treated from symptoms rather than the causes of the poor health. WHO (1948) affirms that, health is a state of complete physical, mental and social well-being and not mere absence of disease and infirmity. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. In recent years, much evidence has been accumulated which shows just how important the planning of physical, social, and economic environment in which we live and work is to our health. Conversely, physical planning systems are the methods used by the public sector to influence the distribution of activities in spaces of various scales (Andreas and Bas, 2002). Also, it is a process intended to promote sustainable development and is defined as goingbeyond traditional land use planning to bring together and integrate policies for the development and use of land with other policies and programmes which influence the nature of places and how they function.In the developing countries, a substantial and growing population lives in or around metropolitan areas and megacities (Adesina,2007). The urban sector of any country is never static. It changes with time, in fact as the days and years go by, the urban landscape is altered...
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...(Last updated April 2010) Königinstraße 5 80539 München Tel.: (089)2888-0 http://munich.usconsulate.gov DOCTORS AND MEDICAL SERVICES – MUNICH The U.S. Consulate General Munich, Germany, assumes no responsibility or liability for the professional ability or reputation of, or the quality of services provided by, the following persons or clinics. Inclusion on this list is in no way an endorsement by the Department of State or the U.S. Consulate. Names are listed alphabetically, and the order in which they appear has no other significance. The information in the list on professional credentials, areas of expertise and language ability are provided directly by the physicians. You may receive additional information about individuals by contacting the local medical association (or its equivalent) or the local licensing authorities. NOTE: Medical service in Germany is of a high standard. Charges for private patients can be approximately the same as those assessed in the United States but vary from physician to physician. University professors are likely to charge higher fees than other doctors on the list. These fees, however, in view of the physicians’ standing in the medical community are not considered excessive. Tourists should be prepared to pay in cash when they visit a doctor. For hospital admittance, except in emergency cases, a deposit is usually required to cover a five day stay. All cities, town and rural areas in Bavaria will have University, City...
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