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Al-Ain Hospital’s Waiting Line Management Essay

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Updated: Apr 9th, 2021

Introduction

Al Ain hospital prides for the first-class service it offers to its clients in the Al Ain region. It provides services to nationals of the Gulf countries and the Emirates as well as expatriates. It specializes in acute care and emergency. The hospital has 30 medical departments and divisions with 412 beds.

Use of Line management system

Understanding the use of line management techniques at Al Ain Hospital requires the linkage of operational performance to business drivers. There is growing awareness of the importance of linking customer care services to leadership, customer orientation and more operational issues such as benchmarking, quality control and service design, with their impact on business performance. The strength of the hospital lies in its operations, in the departments and divisions. Performance measurement and operations improvement are the drivers of the hospital with much emphasis on providing high quality services to clients.

Despite some major work in the performance measurement area, the hospital seemed reluctant to review critically and develop their performance measurement systems. The balanced scorecard, although a significant step forward for the hospital, had once led to a degree of complacency, and its Standard Business Units, have found measures to fit all four boxes.

Guarantees, complaints and service recovery

Organizational practice in the area of complaints and recovery has regressed into mere marketing ploys (Robson, 2002). Complaints procedures in some organizations had become mechanisms to pass on tokens or small payouts to disgruntled customers. Guarantees often seemed little more than the clients’ statutory rights, or an “opportunity” to purchase insurance so that, if the product or service fails, the hospital would not be in troubled with the problem (and so was unaware of the in-built problems of their products or services).

Service recovery appeared to be reactive, with staff carefully listening to, sympathizing with, and then paying off the customer but never sorting out the root problem. The key questions for the Al Ain hospital managers are;

  • How can we link complaints and failures to organizational improvement? How can organizational learning develop from mistakes?
  • How can organizations be proactive in finding and dealing with mistakes before their customers tell them (or more often don’t tell them)?
  • What are reasonable service guarantees and how can they be operationalized?
  • What evidence is there that complaints, guarantees or service recovery drive improvements within an organization?
  • How is learning best captured and applied?

Addressing these questions has gone a long way into enhancing the efficiency at the hospital and earning patients trust.

People, management

Despite some excellent additions to the literature in the HRM area operations, academics need to retrace their roots and focus on the design of jobs. The problem is not knowing that customers expect empathy, reliability and assurance but delivering it in a regular routine. We need to understand how all employees can deliver constant and consistent high levels of service, and how we can design jobs and motivate employees to respond to client needs effectively (Robson, 2002).

Conclusion

Therefore, it is worth noting that some work exists in the management of service capacity in terms of staff scheduling. Strategies for managing demand and supply in service operations have also been documented; however, there has been little advancement in managing long queues in hospitals yet this area is fundamental to the planning and control of service. Another issue, the subject of a preliminary investigation, is the relationship between capacity levels and the level of service quality delivered. Robson (2002) provides some conceptual models of intuitively derived relationships between resource utilization and service quality. It would be appropriate if organizations adopted these models in management of queues.

Analytical Hierarchy Processes at Aldar Property

Introduction

AHP belongs to the general family of Multiple Attribute Decision Making (MADM) methods. AHP was developed in 1970s by Thomas Saaty. It is based on mathematics and psychology. AHP is a ‘normative’ model of decision making. Opposed to a ‘descriptive’ model which allows describing the way a DM makes the decision, a normative model enables a DM to defend his decision over competing alternatives.

General Analysis of AHP at Aldar

Presenting and clarifying the underlying concepts of AHP for decision making process, Saaty (2009) submits that the measurement of ’concepts changes from one situation to another and they depend on a value system which varies from one person to another. Thus, their importance cannot be measured once and for all and has to be determined in terms of individual values. The most appropriate way to measure such attributes is by comparing their relative importance with respect to a higher goal. From the comparisons, one derives a series of priorities which are in reasonable values. Judgments come first, priorities second’.

In its use at Aldar Property, AHP refers to ‘alternatives’, ‘attributes’ and ‘goals’. In any problematic situation, ‘attributes’ are several. In the problem resolving process, a DM generates relevant attributes for each problem setting. The management stresses the certainty that attributes represent the desired purpose and have developed one way to acquire the attributes hierarchically from a super goal; goal hierarchy formulation at the company starts with the listing of overall performance objectives serving a brilliant goal.

The managers have noted such hierarchy to consist of at least three levels: focus or overall goal at the top, various criteria that define alternatives in the middle, and competing alternatives at the bottom. The current research uses a similar hierarchy of attributes and a brilliant goal of selection of optimal delay analysis system under given circumstances of a project. It is advised to control the main and sub attributes based on Miller’s contention that seven plus or minus two represents the greatest amount of information that an observer can produce about an object on the basis of an absolute judgment.

While the number of attributes depends on the nature of the problem, each attribute may have different units of measurement. These units may be quantitative or qualitative. Attribute ‘weights’ are the quantitative way to demonstrate the importance of each attribute relative to the others, which is usually supplied and assessed by an ordinal or principal scale. The current research questionnaire-survey has supplied a cardinal scale based on a five point Likert-type-scale to evaluate such relative importance of attributes.

AHP application at Aldar Property R& D Department

The research department has established its philosophical basis on Critical Realism. Ontologically, Critical Realism accommodates the existence of multiple subjective meanings within participants’ ‘personal’ and ‘social’ worlds. AHP features the recognition of multiple constructed realities in differences within perceptions, judgments, attitudes and practices amongst practitioners dealing with delay claims. The judgments and the like are intangible, and they have to be first measured before being used as variables.

As Saaty (2009) argued, what is most significant is that intangible can only be measured through expert judgment and only relative to the goals of concern in a situation. The AHP is a tool that supports the relative measurements of such intangibles. It allows for differences in opinion to develop a best construct. On the other hand, the main character of AHP lies in its ability to take into account essentially emotional ‘factors’ or ‘attributes’ in a decision making process. Thus, AHP fits into the role in deriving measurements out of such subjective and qualitative data for decision making (selection of the optimum delay analysis method. It helps to resolve conflicts in judgments and combine different perspectives of different practitioners to choose the best of a set of Alternatives.

Conclusion

Finally, AHP enables a Decision Maker (DM) to combine quantitative and qualitative data. AHP supports mixed and multiple methods in data collection and analysis despite its over reliance on mathematical manipulation. To this extent AHP is utilized in research from the Critical Realism perspective. Accordingly, AHP’s role in using both quantitative and qualitative data collection and analysis is expected to result in the phenomenon of apportioning liabilities in delay claims resolution being seen from different perspectives illuminated with mixed methods. This places the AHP’s performance in full harmony with the philosophical position of this research design which promotes the use of mixed or multiple methods.

Total Quality Management at Al-Noor Hospital

Introduction

“TQM uses process techniques, such as nominal groups, brainstorming, and consensus forming to facilitate communication and decision making” (Saaty, 2009). TQM has arrived on the health services scene or at least in parts of the health services system. The Joint Commission on the Accreditation of Healthcare Organizations, for example, has incorporated TQM concepts in its Agenda for Change. Consulting organizations have developed programs to educate health services managers, physicians, and other health personnel on TQM. Al-Noor Hospital is one of the health facilities that have increasingly implemented TQM.

The hospital has succeeded in problem solving and planning to use TQM as others have failed. The increasing use of TQM is an exciting development, but TQM application lags in the process of providing health services in the public sector, specifically public health agencies. TQM offers public health organizations a unique opportunity to adopt a powerful tool for strengthening management. It also presents a fundamental challenge to public health administrators.

Standards and Assessment

Standards in the practice of public health traditionally emphasized (a) health outcomes, (b) flexibility to allow communities to establish and quantify their own objectives, and (c) the role of government as a residual guarantor that is responsible for assuring that prevention services are provided through community agencies, concepts that are reflected in the Model Standards published in 1985.

The recent development and availability of the Assessment Protocol for Excellence in Public Health (APEX-PH) provides a methodology for systematically assessing departmental operations relative to meeting standards. APEX-PH provides agency leaders a clear, comprehensive, and flexible protocol for assessing organizational and community resources and needs. The workbook format helps agency leaders to meet national health promotion and disease prevention objectives at the community level.

The availability of Model Standards and APEXPH provides Al-Noor Hospital with a rational method to assess its potentials and goals for health outcomes. Guided by community health objectives and assessment findings, managers can formulate a hospital-community health plan that serves to direct work within programmatic areas. The health objectives should be broad and multidimensional in order to define the direction of an agency’s strategy.

The organizational assessment process provides a framework for developing and maintaining the capacity to carry out a community health plan. To assure that program objectives are met, health departments traditionally have depended on a system of performance standards and quality assurance methods. While these efforts are necessary, they are not sufficient to meet the challenges now facing public health agencies. TQM offers a means to improve on-going processes. It also enhances the facility’s performance within a changing environment.

TQM Strengths at the Hospital

TQM focuses on work processes, applying analytical and behavioral techniques to improve those processes within an organization. For example, a group of nursing and laboratory personnel may select a process for improvement, such as untimely deliveries of laboratory test results to a prenatal clinic. Using a series of flow diagrams, they may be able to identify the steps involved in the process and the factors that may be contributing to delays. Based on this understanding, the hospital identifies and steps up to improve the timeliness of the test results, monitoring the results to try to achieve continuous improvement.

In such a program, TQM presents a fundamental challenge to the use of internal performance standards to achieve public health objectives (Saaty, 2009). While the use of performance standards is a starting point for TQM, continuous quality management goes beyond conforming to control standards. TQM includes systematic review of the work performed by the organization, with emphasis on the horizontal integration of services across program areas. Attention can is given to identifying and reducing variations in the work performance of medical staff and non-medical staff. Improvement is based on both outcome and process. The hospital constantly improves its problem-solving capacity, using performance standards as leverage in the improvement process.

APEX-PH and TQM at Al-Noor

Whereas Model Standards and APEX-PH focus on strategic health outcome objectives and community stakeholders as the ultimate health department customers, TQM examines each component in the process used to achieve the hospital’s health goals. The clients in TQM include the many users of the hospital’s output, including health providers within the organization itself (Saaty, 2009).

The criterion is not whether or not the work meets some management performance standard per se, but whether the user (often a part of a different profession, or a group of employees with the hospital, or a host of other public and private health service agencies) is satisfied with the timeliness and usefulness of the service being provided by or within the public health agency. The managerial problem is not to assure adherence to prescribed standards. It has to use energy in facilitating and assuring continuous improvement in the many interrelated processes that are the work of the department.

Conclusion

The TQM model focuses on the system, emphasizing collective managerial responsibility, not simply legal or professional mandates. The management understands that it is the primary source of problems, and by focusing on their system they provide opportunities for improving their services. TQM focuses on the work process, not on the individual worker. The objective is not to rely solely on legal or professional authority, but to challenge the interdisciplinary work group involved assuming ownership of that process and responsibility for its continuous improvement.

References

Robson, C. (2002). Real world Research, Blackwell Publishing, Oxford.

Saaty, T. (2009). The Analytical Hierarchical Process, Wiley, New York.

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