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A study on the barriers that impact the adoption of Industry 4.0 in the context of Brazilian companies 巴西企业采用工业4.0的障碍研究
TQM Journal Pub Date : 2023-05-16 DOI: 10.1108/tqm-07-2022-0239
R. F. Cordeiro, L. Reis, J. Fernandes
{"title":"A study on the barriers that impact the adoption of Industry 4.0 in the context of Brazilian companies","authors":"R. F. Cordeiro, L. Reis, J. Fernandes","doi":"10.1108/tqm-07-2022-0239","DOIUrl":"https://doi.org/10.1108/tqm-07-2022-0239","url":null,"abstract":"PurposeThis research aims to evaluate the impact of barriers experienced by Brazilian companies in adopting Industry 4.0 (I4.0).Design/methodology/approachAs a methodological approach, the survey method was used, adopting the use of the questionnaire for data collection. From the feedback of 99 companies (with an index of 80%), quantitative analyzes of the data were carried out with the aid of factor analysis and linear regression to validate the proposed structural model.FindingsThe barriers construct does not impact the I4.0 adoption construct. Directly evaluating the effect of the variables that make up the barriers construct in the I4.0 adoption construct, it was observed that three barriers affect effectively the adoption of I4.0: technological infrastructure; financial constraint and lack of understanding of the benefits of I4.0.Research limitations/implicationsAs a limitation, the research was conducted only in the Brazilian context, requiring the development of future studies in other countries that can strengthen the findings of this research.Practical implicationsIn addition, the results achieved provide relevant insights into public policymakers and business managers, helping them to deeply understand the barriers that impact the adoption of I4.0. This facilitates the propagation of I4.0 concepts in the context of Brazilian companies and in the formulation of public policies adapted to each sector, allowing a more assertive action in the face of the types of barriers experienced by organizations during the adoption of I4.0.Social implicationsThe findings can help practitioners and policymakers to understand in detail this new industrial model and the difficulties that prevent its implementation.Originality/valueFrom an extensive literature review, no studies were identified that statistically validate which barriers effectively affect the adoption of I4.0. This research is a pioneer in proposing a structural model to analyze the barriers experienced by workers during the adoption of I4.0, exploring Brazilian companies, from different economic sectors and sizes. It is noteworthy that the literature still focuses efforts on manufacturing companies.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48196636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
How integrated store-service quality promotes omnichannel shoppers’ word-of-mouth behaviors: the moderating role of perceived relationship investment and the shopper’s perceived value 综合店铺服务质量如何促进全渠道购物者口碑行为:感知关系投资和购物者感知价值的调节作用
TQM Journal Pub Date : 2023-05-11 DOI: 10.1108/tqm-12-2022-0364
T. Natarajan, Deepak Ramanan Veera Raghavan
{"title":"How integrated store-service quality promotes omnichannel shoppers’ word-of-mouth behaviors: the moderating role of perceived relationship investment and the shopper’s perceived value","authors":"T. Natarajan, Deepak Ramanan Veera Raghavan","doi":"10.1108/tqm-12-2022-0364","DOIUrl":"https://doi.org/10.1108/tqm-12-2022-0364","url":null,"abstract":"PurposeThe post-purchase behavioral responses of omnichannel shoppers, who mainly rely on physical stores (acknowledged as a crucial channel in providing a seamless shopping experience and fulfilling the dynamic needs of the shoppers), are still understudied. The purpose of this paper is to examine how integrated store service quality (ISSQ) can contribute to a more optimal shopping experience (cognitive, affective and relational) and have a subsequent impact on shoppers’ psychological ownership toward the store, resulting in the generation of (face-to-face, online and social media) word of mouth (WOM).Design/methodology/approachThe research is descriptive, quantitative and cross-sectional investigation. A purposive sampling technique was used for selecting the study respondents. The data were collected from 786 Indian omnichannel shoppers using a validated self-administered questionnaire. The proposed conceptual model was tested using partial least squares structural equation modeling.FindingsThe results indicate that all three dimensions of omnichannel customer experience (cognitive, affective and relational) positively mediate the relationship between ISSQ and psychological ownership, subsequently impacting all three WOM behaviors of omnichannel shoppers (face-to-face, online store and social media). The customer’s perceived value with the store and their perceived retailer relationship investment significantly moderated the relationship between ISSQ and different WOM behaviors (face-to-face, online store and social media). This research also demonstrated the direct impact of ISSQ on WOM and the indirect impact through different customer experience dimensions and psychological ownership.Research limitations/implicationsThe sample used in the study was not probabilistic and, therefore, presents limitations for the possibility of generalizing the results. The study was performed in a cross-sectional methodology in the Indian context; there is a need for longitudinal investigation.Originality/valueThis study addresses the need to investigate different dimensions of omnichannel customer experience that might influence various post-purchase behavioral responses. This study is the first to show that ISSQ might affect omnichannel shoppers' online, offline and social media word-of-mouth behaviors through different customer experience dimensions and the customer’s sense of belongingness to the store. The moderating effect of customer perceived value with the retailer and their perception of retailers’ investment in a relationship on proposed hypotheses was also tested to give managerial recommendations.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48396833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Current status of Hoshin Kanri 星心Kanri的现状
TQM Journal Pub Date : 2023-05-08 DOI: 10.1108/tqm-07-2022-0216
Richard A. Wilson, E. Cudney, R. J. Marley
{"title":"Current status of Hoshin Kanri","authors":"Richard A. Wilson, E. Cudney, R. J. Marley","doi":"10.1108/tqm-07-2022-0216","DOIUrl":"https://doi.org/10.1108/tqm-07-2022-0216","url":null,"abstract":"PurposeThe purpose of this research is to provide an introduction into Hoshin Kanri and how it has been used with other methodologies and frameworks. Additionally, factors that impact successful Hoshin Kanri implementation and future research opportunities are explored.Design/methodology/approachA systematic literature review was conducted to determine the methodologies and frameworks that have previously been explored and identify factors that lead to successful Hoshin Kanri implementation as it relates in the Western world.FindingsEven though Hoshin Kanri has been used to a limited extent for decades in the West, there is still relatively little published research on the topic. In the period reviewed most published research was performed in the UK or USA. In addition, most years had less than two publications (the exception being five in 2020).Research limitations/implicationsThis literature review was primarily focused on the manufacturing sector, publications from 1990–2021, and available in English.Practical implicationsCurrent practitioners may use the research in this review to improve their current Hoshin Kanri practices using the techniques mentioned as a means of continuous improvement or to build a new framework for their own needs.Originality/valueThis paper makes an important contribution to the study of Hoshin Kanri as it provides: (1) an updated literature review regarding the study and application of Hoshin Kanri, (2) a qualitative analysis of alternative methodologies and frameworks to traditional Hoshin Kanri and (3) success factors when considering implementation of Hoshin Kanri within an organization and researchers with potential ideas for future research.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46413734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Achieving operational resilience through kaizen practice: a case in a commercial livestock farm in Nigeria 通过改善实践实现运营弹性:以尼日利亚商业畜牧场为例
TQM Journal Pub Date : 2023-05-08 DOI: 10.1108/tqm-01-2023-0013
D. Ufua, M. Itai, Ajay Mahaputra Kumar, Mamdouh Abdulaziz Saleh Al-Faryan
{"title":"Achieving operational resilience through kaizen practice: a case in a commercial livestock farm in Nigeria","authors":"D. Ufua, M. Itai, Ajay Mahaputra Kumar, Mamdouh Abdulaziz Saleh Al-Faryan","doi":"10.1108/tqm-01-2023-0013","DOIUrl":"https://doi.org/10.1108/tqm-01-2023-0013","url":null,"abstract":"PurposeThis study is focused on achieving operational resilience through the practices of kaizen across the operational structure. The research is based on a case study of a commercial livestock farm in Nigeria. The study views the practice of kaizen from the perspective of the commitment of the members of the case study organisation who are directly involved with the operations of the organisation.Design/methodology/approachThe study applies a qualitative approach to explore the topic, engaging members of the case study organisation in the research to gather relevant data on the implementation of kaizen practices and the drive to attain resilience in the case study organisation. Semi-structured personal interviews and workshops were used for data collection. The study adopts systems theory to explore the topic, identifying and engaging relevant stakeholders.FindingsParts of the findings relating to kaizen are the issues with the livestock production process, aggressive leadership and the issue of livestock mortality in the case study organisation. These were discussed based on extant literature. The study affirms the importance of organisational members' commitment and adequate leadership support to achieve sustainable kaizen practices. The study highlights the need to align kaizen practices with relevant organisational practices, such as reward systems and contextual requirements for its implementation in an operational process. The study suggests that further study can focus on the dynamics of the legal system on the implementation of kaizen, especially from a developing economic background like Nigeria, where this study was conducted.Originality/valueThe study projects learning about the spatial factors that can affect the practices of kaizen in critical sectors like livestock management.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48957677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Analyzing patient satisfaction in a rural wound care center 某农村创伤护理中心患者满意度分析
TQM Journal Pub Date : 2023-05-01 DOI: 10.1108/tqm-08-2022-0273
E. Cudney, Clair A. Reynolds Kueny, S. Murray
{"title":"Analyzing patient satisfaction in a rural wound care center","authors":"E. Cudney, Clair A. Reynolds Kueny, S. Murray","doi":"10.1108/tqm-08-2022-0273","DOIUrl":"https://doi.org/10.1108/tqm-08-2022-0273","url":null,"abstract":"PurposeAs healthcare continues to become more expensive and complex, considering the voice of the patient in the design and operation of healthcare practices is important. Wound care and rural healthcare scenarios pose additional complexities for providers and patients. This study sought to identify key determinants of patient service quality in wound care.Design/methodology/approachPatients at the wound care/ostomy clinic (WOC) in a rural hospital were surveyed using the Kano model. The Kano model enables the categorization of quality attributes based on the attributes' contribution to the subject's overall satisfaction (and dissatisfaction). Chi-square goodness-of-fit testing, multinomial analysis and power analysis were then used to determine the Kano categories for each satisfaction-related attribute.FindingsThe analyses resulted in 14 one-dimensional attributes and 3 indeterminable attributes. For the one-dimensional attributes, customer satisfaction is directly proportional to the level of performance for that attribute. The one-dimensional attributes included providing correct care on the first, provision of necessary supplies for care, appropriately qualified medical staff and confidence in care provided by medical staff, among others. Understanding the attributes important to the patient drive patient-centered care, which improves positive patient outcomes and recovery. These attributes can then be used by healthcare professionals to design patient-centric processes and services. This research provides a framework for incorporating the voice of the patient into healthcare services.Research limitations/implicationsWhile the research methodology can be used in other healthcare settings, the findings are not generalizable to other wound care clinics. This research was conducted in one small, rural hospital. In addition, the sample size was small due to the size of the wound clinic; therefore, an analysis of the differences between demographics could not be performed.Practical implicationsConsidering the perspectives of rural wound care patients is important, as the patients are an under-served population with unique challenges related to patient care. The research findings detail rural patients' expectations during wound care treatments, which enable the clinic to focus on improving patient satisfaction. This research contributes to understanding the factors that are important to patient satisfaction in wound care. Further, the methodology presented can be applied to other healthcare settings.Originality/valueWhile studies exist using the Kano model in healthcare and the literature is sparse in rural healthcare, this is the first case study using the Kano model in wound care to understand patient preferences.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47125888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Statistical validation of critical aspects of the Net Promoter Score 净推荐值关键方面的统计验证
TQM Journal Pub Date : 2023-04-25 DOI: 10.1108/tqm-05-2022-0170
M. Cazzaro, P. Chiodini
{"title":"Statistical validation of critical aspects of the Net Promoter Score","authors":"M. Cazzaro, P. Chiodini","doi":"10.1108/tqm-05-2022-0170","DOIUrl":"https://doi.org/10.1108/tqm-05-2022-0170","url":null,"abstract":"PurposeAlthough the Net Promoter Score (NPS) index is simple, NPS has weaknesses that make NPS's interpretation misleading. The main criticism is that identical index values can correspond to different levels of customer loyalty. This makes difficult to determine whether the company is improving/deteriorating in two different years. The authors describe the application of statistical tools to establish whether identical values may/may not be considered similar under statistical hypotheses.Design/methodology/approachEqual NPSs with a “similar” component composition should have a two-way table satisfying marginal homogeneity hypothesis. The authors compare the marginals using a cumulative marginal logit model that assumes a proportional odds structure: the model has the same effect for each logit. Marginal homogeneity corresponds to null effect. If the marginal homogeneity hypothesis is rejected, the cumulative odds ratio becomes a tool for measuring the proportionality between the odds.FindingsThe authors propose an algorithm that helps managers in their decision-making process. The authors' methodology provides a statistical tool to recognize customer base compositions. The authors suggest a statistical test of the marginal distribution homogeneity of the table representing the index compositions at two times. Through the calculation of cumulative odds ratios, the authors discriminate against the hypothesis of equality of the NPS.Originality/valueThe authors' contribution provides a statistical alternative that can be easily implemented by business operators to fill the known shortcomings of the index in the customer satisfaction's context. This paper confirms that although a single number summarizes and communicates a complex situation very quickly, the number is ambiguous and unreliable if not accompanied by other tools.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43679828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The critical success factors of the highly competitive organizations; a systematic literature review 竞争激烈的组织的关键成功因素;系统的文献综述
TQM Journal Pub Date : 2023-04-24 DOI: 10.1108/tqm-11-2022-0333
Alaa M. Ubaid
{"title":"The critical success factors of the highly competitive organizations; a systematic literature review","authors":"Alaa M. Ubaid","doi":"10.1108/tqm-11-2022-0333","DOIUrl":"https://doi.org/10.1108/tqm-11-2022-0333","url":null,"abstract":"PurposeThe current research aims to analyze the literature to determine its strengths and weaknesses and extract the required information, which will be used to identify the characteristics of the highly competitive organization (HCO), define it and identify the HCO's critical success factors (CSFs). Finally, the future research agenda will be proposed.Design/methodology/approachA multiple stages research methodology was used to fulfill the research objectives. The research started with the systematic literature review (SLR). Then, focus group discussions and Pareto analysis were used to fulfill research objectives.FindingsEleven points were identified in the research to represent the characteristics of the HCO. Then, the HCO was defined based on the elements of these points. Moreover, the vital few CSFs to successfully implement many research scopes were identified. Then, the CSFs of the HCO was generated based on these vital few CSFs.Research limitations/implicationsThe main limitation of the current research is the literature sample size. A larger sample selection could enrich the generated lists with many other CSFs.Practical implicationsMany implications points were highlighted in this research which showed the importance of the current research for academic and practical audiences.Originality/valueThe SLR process showed that the reviewed literature lacked a consolidated list of the HCO characteristics and a clear definition of the HCO. Moreover, the reviewed literature lacked a unified list of the HCO CSFs. Therefore, the current research approach is novel and original.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48316391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare 平衡跷跷板-领导者对设计和医疗保健传统质量改进的看法
TQM Journal Pub Date : 2023-04-18 DOI: 10.1108/tqm-07-2022-0219
Jonas Boström, Helene Hillborg, J. Lilja
{"title":"Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare","authors":"Jonas Boström, Helene Hillborg, J. Lilja","doi":"10.1108/tqm-07-2022-0219","DOIUrl":"https://doi.org/10.1108/tqm-07-2022-0219","url":null,"abstract":"PurposeThe purpose of this paper is to explore and describe the perspectives and reasoning of senior development leaders in healthcare organizations, when reflecting on design as theory and practice in relation to more traditional methods and tools for improving quality and support innovation.Design/methodology/approachThe paper is based on a qualitative interview design with five development and innovation leaders from separate healthcare regions in Sweden. They have, to varying degrees, applied design theory and practice for quality improvement and innovation in their organizations. The interview transcript was analysed using a content analysis together with an interpretive approach.FindingsThe major findings are to be found in the balancing act for leadership and organizations in healthcare when it comes to introducing and combining different theories and practices for improving quality and support innovation. The balance is between the change in power dynamics and pushing traditional boundaries in a complex healthcare world.Practical implicationsThe narratives from the leaders' experience of applying design theory and practice for improving healthcare quality can help us create readiness and knowledge about how we prevent and/or facilitate planning and implementing design theories, practices, methods and tools in a healthcare context.Originality/valueThe study provides a unique insight when it captures and illustrates five different organizations' experiences when applying design for developing healthcare quality.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44560161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Defining lean experts' roles and behavioral competencies during lean adoption: a case study of Groupe PSA 定义精益专家在精益采用过程中的角色和行为能力:Groupe PSA案例研究
TQM Journal Pub Date : 2023-04-18 DOI: 10.1108/tqm-01-2023-0011
F. Magnani, A. Siadat, E. Caillaud, Olivier Gaudichau
{"title":"Defining lean experts' roles and behavioral competencies during lean adoption: a case study of Groupe PSA","authors":"F. Magnani, A. Siadat, E. Caillaud, Olivier Gaudichau","doi":"10.1108/tqm-01-2023-0011","DOIUrl":"https://doi.org/10.1108/tqm-01-2023-0011","url":null,"abstract":"PurposePrevious research has managed to clearly define lean technical competencies. However, the behavioral competencies remain underestimated, and the roles of lean experts are not clearly stated: are they teachers, facilitators or technical experts? The present paper investigates lean behavioral competencies and their relationship to lean experts' roles.Design/methodology/approachThis article serves as an exploratory study built on interviews, observations and focus groups conducted during a three-year longitudinal study accompanied by a three-year follow-up. The case takes place in an international automotive company in partnership with Toyota in which lean adoption was part of a consistent strategy over a period of 20 years.FindingsThe study clarifies lean behavioral competencies related to organizational efficiency (nominal management, improvement management and respect for people) and relational efficiency (problem resolution, competencies development and systemic interactions). The study helped create a typology of lean experts' roles related to the maturity level of the environment in which they intervened. Moreover, Lean experts' roles in congruence with the environment seem to positively influence the creation of emerging human relationships that are beneficial to process improvement and competencies development.Originality/valueThis paper is the first to clarify behavioral competencies with respect to lean experts' roles and to study the temporality of the introduction of lean practices. The findings recommend that researchers better acknowledge the influence of lean behavioral competencies during lean adoption and their relationship to contextual factors and organizational performance. A practical methodology is proposed to measure the necessary behavioral adjustments of lean experts or employees.","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49429859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project 改进病房和ICU泌尿外科患者的VTE预防:六西格玛DMAIC方法改进项目
TQM Journal Pub Date : 2023-04-11 DOI: 10.1108/tqm-09-2022-0281
Hesham Metwalli Mousli, I. El Sayed, Adel Zaki, Sherif Abdelmonem
{"title":"Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project","authors":"Hesham Metwalli Mousli, I. El Sayed, Adel Zaki, Sherif Abdelmonem","doi":"10.1108/tqm-09-2022-0281","DOIUrl":"https://doi.org/10.1108/tqm-09-2022-0281","url":null,"abstract":"PurposeThis study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.Design/methodology/approachThe authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.FindingsDMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.Research limitations/implicationsThe project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.Practical implicationsSeveral recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement ini","PeriodicalId":40009,"journal":{"name":"TQM Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45679893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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