Competency of student nurses in the operating room Essay Example for Free

Competency of student nurses in the operating room Essay LEGEND: 4-Competent (Student performs consistently in an effective and efficient manner) 3-Progress Acceptable (performance is usually effective and efficient but not always) 2-Needs Improvement (progress in performance is too slow to judge satisfactorily; task performance is not done properly for majority of the time0 1-Progress Unacceptable (no progress in performance has been demonstrated and/ or performance is consistently ineffective and inefficient) CORE COMPETENCY SCORE REMARKS A. safe and quality nursing care 1. utilizes the nursing process in the care of OR client a. Obtains comprehensive client’s information by checking complete accomplishment of the preoperative checklist/ clients chart b. Identifies priority needs of the client at the Operating Room c. Provides needed nursing interventions based on identified needs d. Monitors client’s responses to surgery 2. Promotes safety and comfort of patients inside the OR a. Transports client safely from the unit to OR b. Transfer client safely from the stretcher to OR bed, OR bed to stretcher, stretcher to RR bed (e.g. use of side rails) c. Places properly grounding pad under the patient for electro-surgical equipment d. Monitor vital signs e. Provides physical comfort utilizing comfort devices/ techniques f. Provides needed blankets and sheets to prevent hypothermia and provide privacy g. Assist in proper and safe positioning of clients in preparation for surgery h. Observes the principles of strict surgical aseptic techniques within the work area at all times i. Observes universal precautions in handling body fluids 3. Performs the functions of the scrub nurse a. Drapes the operative field correctly b. Performs surgical scrub correctly c. Dons surgical gowns and gloves correctly d. Serves gowns, gloves and drapes aseptically e. Prepared surgical instruments, sponges, sutures and other supplies in functional agreement f. Hands instruments, sponges, sutures and other materials according to surgeon’s preference g. Performs surgical count accurately h. Performs after care of the surgical instruments 4. Performs the functions of the circulating nurse a. Prepared the surgical table and all needed equipment and supplies for surgery b. Assist the anesthesiologist in the induction of anesthesia c. Performs the surgical skin preparation of the client d. Checks with the scrub nurse the completeness of surgical sponges, needles and instruments e. Anticipates the needs of the surgical team f. Ensures intactness and functionality of all contraptions ( e.g. IVF; BT; IFC; NGT) g. Helps in the after care of all equipment and the OR as a whole h. Hand additional instruments and supplies aseptically as needed i. Check sheet integrity and sterility of OR packs i.1. Sets up the OR Room needed equipment i.2. Receives client for surgery/ endorses client post-operatively i.3. Assists in skin preparation and draping of client 5. Administer medications and other health therapeutics safely 6. Executes legal orders of the surgeon/ anesthesiologist accurately and timely 7. Evaluates patient’s response to interventions 8. Monitors patients progress during surgery and immediate post-op phase B. Management of resources and environment 1. Ensures availability, completeness and functionality of OR equipments 2. Observes protocols in unrestricted, semi-restricted and restricted areas in the OR 3. Performs proper disinfection and sterilization protocols 4. Observes proper disposal of hazardous and non hazardous wastes. Observes proper handling and up keeping of OR resources 5. Observes OR policies, procedures and protocols on infection control 6. Conducts inventory of OR resources 7. Awareness of the institutional evacuation and location plan both for fire, earthquake and other major emergencies. C. Health Education 1. Implements appropriate health education activities to client based on needs assessment of the intra-operative client 2. Reinforces pre-operative health teachings to client D. Legal Responsibility 1. Adheres to legal and institutional protocols regarding informed consent and other legal documents E. Ethico- Moral Responsibility 1. Respects the rights of the OR client 2. Accepts responsibility and accountability for own decision and actions as an OR nurse 3. Maintains privacy and confidentiality of client’s information 4. Adheres to the Code of Ethics for Nurses F. Personal and Professional Development 1. Performs OR functions and according to professional standards 2. Possesses positive attitude towards learning surgical and OR-related knowledge and skills G. Quality Improvement 1. Reports significant actual or potential observations regarding the surgical client 2. Reports positive or negative variances at the OR 3. Identifies and reports variances in sterility and other OR activities H. Research 1. Disseminates results of OR-related research findings to clinical group and other members of the OR team as appropriate I. Records Management 1. Maintain legible, accurate and updated documentation of patient care in the chart/ and OR dorms 2. Submits timely, complete an accurate surgical slips and Or write-ups for cases handled J. Communication 1. Utilizes therapeutic communication skills with patients, significant others and members of the health team 2. Establishes professional relationships with members of the surgical/ health team 3. Utilizes proper channel of communication 4. Observes complete and accurate endorsement procedures 5. Uses appropriate information mechanism to facilitate communication inside the OR and with other departments in the hospital K. Collaboration and Teamwork 1. Collaborates plan of care with other members of the health team

Gun Control in the United States Essay -- second amendment,firearm, we

The second amendment gives people the right to own a firearm. The founding fathers might have thought a gun was the best form of protection but many years have past since then and humans have evolved. Times are different and society is different. Technology has a big impact on people and how we think and all those variables can affect people with how they react in stressful situations. We have to consider the mental stability of those in possession of the weapons, it is important to keep the weapon away from loved ones or other people, and is the law protecting those in possession of the weapons or putting lives in more danger. The human mind is a complex place filled with a variety of thoughts and desires. One may hide the deepest thought in the unconscious without even knowing it or worse, their desires reside in the conscious waiting to be acted upon. With all circumstances no one from the outside knows what is going on in another ones mind even the person himself may not be completely be sure. My confidence in ones mental stability is low because these facts show the mystery of what is inside the human mind. â€Å"To elaborate on this, in a previous study in 2004 researchers discovered that around one in four adults have a mental health disorder and one in seventeen had a serious mental illness but how many of them keep going on with their lives thinking their feelings are normal? All people are given the right to bare arms that means all people even those with these disorders. Now the right to bare arms is the right of the people to protect themselves yet giving those with weak mental stability is a scary thought† (â€Å"Mental Health†). The laws should provide us with a mental state test before being given a weapons license. .. ...929.full>. "Eligibility Requirements." / Concealed Weapon License / Licensing / Divisions & Offices / Home. N.p., n.d. Web. 03 Mar. 2014. . "Florida Concealed Carry Permit Information." Florida Concealed Carry Permit Information. N.p., n.d. Web. 04 Mar. 2014. . "Guns and Violence." Current Issues: Macmillan Social Science Library. Detroit: Gale, 2010. Opposing Viewpoints in Context. Web. 16 Mar. 2014. "Gun Control." Opposing Viewpoints Online Collection. Detroit: Gale, 2013. Opposing Viewpoints in Context. Web. 16 Mar. 2014. "Mental Health." - Healthy People 2020. N.p., n.d. Web. 05 Mar. 2014. . Gun Control in the United States Essay -- second amendment,firearm, we The second amendment gives people the right to own a firearm. The founding fathers might have thought a gun was the best form of protection but many years have past since then and humans have evolved. Times are different and society is different. Technology has a big impact on people and how we think and all those variables can affect people with how they react in stressful situations. We have to consider the mental stability of those in possession of the weapons, it is important to keep the weapon away from loved ones or other people, and is the law protecting those in possession of the weapons or putting lives in more danger. The human mind is a complex place filled with a variety of thoughts and desires. One may hide the deepest thought in the unconscious without even knowing it or worse, their desires reside in the conscious waiting to be acted upon. With all circumstances no one from the outside knows what is going on in another ones mind even the person himself may not be completely be sure. My confidence in ones mental stability is low because these facts show the mystery of what is inside the human mind. â€Å"To elaborate on this, in a previous study in 2004 researchers discovered that around one in four adults have a mental health disorder and one in seventeen had a serious mental illness but how many of them keep going on with their lives thinking their feelings are normal? All people are given the right to bare arms that means all people even those with these disorders. Now the right to bare arms is the right of the people to protect themselves yet giving those with weak mental stability is a scary thought† (â€Å"Mental Health†). The laws should provide us with a mental state test before being given a weapons license. .. ...929.full>. "Eligibility Requirements." / Concealed Weapon License / Licensing / Divisions & Offices / Home. N.p., n.d. Web. 03 Mar. 2014. . "Florida Concealed Carry Permit Information." Florida Concealed Carry Permit Information. N.p., n.d. Web. 04 Mar. 2014. . "Guns and Violence." Current Issues: Macmillan Social Science Library. Detroit: Gale, 2010. Opposing Viewpoints in Context. Web. 16 Mar. 2014. "Gun Control." Opposing Viewpoints Online Collection. Detroit: Gale, 2013. Opposing Viewpoints in Context. Web. 16 Mar. 2014. "Mental Health." - Healthy People 2020. N.p., n.d. Web. 05 Mar. 2014. .

Lean Six Sigma in Hrm

1 Lean Six Sigma in the Service Industry Alessandro Laureani University of Strathclyde United Kingdom 1. Introduction The business improvement methodology known as Lean Six Sigma is rooted in the manufacturing industry, where it developed over the past few decades, reaching widespread adoption worldwide.However, according to the World Economic Outlook Database, published in April 2011, by the International Monetary Fund (IMF, 2011), the distribution of PPP (Purchase Power Parity) GDP, in 2010, among various industry sectors in the main worldwide economies, reflected a decline in the industrial sector, with the service sector now representing three-quarters of the US economy and more than half of the European economies. PPP GDP 2010 Agriculture Industry Service European Union 5. 7% 30. 7% 63. 6% United States 1. 2% 22. 2% 76. 7% China . 6% 46. 8% 43. 6% India 16. 1% 28. 6% 55. 3% Table 1. PPP GDP Sector Comparison 2010. In light of the increasing importance of the service sector, the objective of this chapter is to discuss whether the business improvement methodology known as Lean Six Sigma is applicable to the service industry as well, and illustrate some case study applications. 2. What is Lean Six Sigma? Lean Six Sigma is a business improvement methodology that aims to maximize shareholders’ value by improving quality, speed, customer satisfaction, and costs.It achieves this by merging tools and principles from both Lean and Six Sigma. It has been widely adopted widely in manufacturing and service industries, and its success in some famous organizations (e. g. GE and Motorola) has created a copycat phenomenon, with many organizations across the world willing to replicate the success. www. intechopen. com 4 Advanced Topics in Applied Operations Management Lean and Six Sigma have followed independent paths since the 1980s, when the terms were first hard-coded and defined.  Control Key and Word – Text and Graphics.The first applications of Lean w ere recorded in the Michigan plants of Ford in 1913, and were then developed to perfection in Japan (within the Toyota Production System), while Six Sigma saw the light in the United States (within the Motorola Research Centre). Lean is a process-improvement methodology, used to deliver products and services better, faster, and at a lower cost. Womack and Jones (1996) defined it as: †¦ a way to specify value, line up value-creating actions in the best sequence, conduct those activities without interruption whenever someone requests them, and perform them more and more effectively.In short, lean thinking is lean because it provides a way to do more and more with less and less—less human effort, less human equipment, less time, and less space—while coming closer and closer to providing customers with exactly what they want. (Womack and Jones, 1996:p. ) Six Sigma is a data-driven process improvement methodology used to achieve stable and predictable process results, reducing process variation and defects. Snee (1999) defined it as: ‘a business strategy that seeks to identify and eliminate causes of errors or defects or failures in business processes by focusing on outputs that are critical to customers’.While both Lean and Six Sigma have been used for many years, they were not integrated until the late 1990s and early 2000s (George, 2002; George, 2003). Today, Lean Six Sigma is recognized as: ‘a business strategy and methodology that increases process performance resulting in enhanced customer satisfaction and improved bottom line results’ (Snee, 2010). Lean Six Sigma uses tools from both toolboxes, in order to get the best from the two methodologies, increasing speed while also increasing accuracy. The benefits of Lean SixSigma in the industrial world (both in manufacturing and services) have been highlighted extensively in the literature and include the following: 1. 2. 3. 4. 5. 6. Ensuring services/products conform to what the customer needs (‘voice of the customer’). Removing non-value adding steps (waste) in critical business processes. Reducing the cost of poor quality. Reducing the incidence of defective products/transactions. Shortening the cycle time. Delivering the correct product/service at the right time in the right place. Antony, 2005a; Antony, 2005b) Examples of real benefits in various sectors are illustrated in Table 2. One of the key aspects differentiating Lean Six Sigma from previous quality initiatives is the organization and structure of the quality implementation functions. In quality initiatives prior to Lean Six Sigma, the management of quality was relegated largely to the production floor and/or, in larger organizations, to some statisticians in the quality department.Instead, Lean Six Sigma introduces a formal organizational infrastructure for different quality implementation roles, borrowing terminology from the world of martial arts to define hierarchy an d career paths (Snee, 2004; Antony, Kumar & Madu, 2005c; Antony, Kumar & Tiwarid, 2005d; Pande, Neuman & Cavanagh, 2000; Harry & Schroeder, 1999; Adams, Gupta & Wilson, 2003). www. intechopen. com Lean Six Sigma in the Service Industry 5 Table 2. Benefits of Six Sigma in Service Organizations (Antony, Kumar & Cho, 2007). 3. Lean Six Sigma and the service industryThe service industry has its own special characteristics, which differentiate it from manufacturing and make it harder to apply Lean Six Sigma tools, which can be summarized in the following main areas (Kotler, 1997; Regan 1963; Zeithmal, Parasur and Berry 1985): Intangibility: Although services can be consumed and perceived, they cannot be measured easily and objectively, like manufacturing products. An objective measurement is a critical aspect of Six Sigma, which requires data-driven decisions to eliminate defects and reduce variation.The lack of objective metrics is usually addressed in service organizations through the use of proxy metrics (e. g. customer survey). Perishability: Services cannot be inventoried, but are instead delivered simultaneously in response to the demand for them. As a consequence, services processes contain far too much ‘work-in-process’ and work can spend more than 90% of its time waiting to be executed (George, 2003). Inseparability: Delivery and consumption of service is simultaneous.This adds complexity to service processes, unknown to manufacturing. Having customers waiting in line or on the phone involves some emotional management, not present in a manufacturing process. Variability: Each service is a unique event dependent on so many changing conditions, which cannot be reproduced exactly. As a result of this, the variability in service processes is much higher than in manufacturing processes, leading to very different customer experiences. www. intechopen. com 6 Advanced Topics in Applied Operations ManagementOwing to these inherent differences, it has b een harder for service organizations, such as financial companies, health-care providers, retail and hospitality organizations, to apply Lean Six Sigma to their own reality. However, there are also great opportunities in the service organizations (George 2003): – – Empirical data has shown the cost of services are inflated by 30–80% of waste. Service functions have little or no history of using data to make decisions. It is often difficult to retrieve data and many key decision-makers may not be as ‘numerically literate’ as some of their manufacturing counterparts.Approximately 30–50% of the cost in a service organization is caused by costs related to slow speed, or carrying out work again to satisfy customer needs. In the last few years, successful applications in service organizations have come to fruition and we will illustrate three possible applications: in a call centre, in human resources, and finally in a healthcare provider. 4. Case study 1: Lean Six Sigma in a call centre (Laureani et al, 2010a) The two major types of call centres are outbound centres and inbound centres. The most common are inbound call centre operations.Almost everyone in their daily life has had to call one of those centres for a variety of reasons. Outbound centres are used more in areas such as marketing, sales and credit collection. In these instances, it is the call centre operators who establish contact with the user. Although there are some differences between outbound and inbound call centres, they each have certain potential benefits and challenges, with regard to the implementation of Lean Six Sigma. Benefits Some of the benefits that Lean Six Sigma can deliver in a call centre are (Jacowski, 2008; Gettys, 2009): . 2. 3. 4. 5. Streamlining the operations of the call centre: Lean strategy helps in eliminating waste and other non-value added activities from the process. Decreasing the number of lost calls: Six Sigma’s root-cau se analysis and hypothesistesting techniques can assist in determining how much time to spend on different type of calls, thus providing a guide to the operators. Better use of resources (both human resources and technology), thus leading to a reduction in the cost of running such centres.Unveiling the ‘hidden factory’: establishing the root causes of why customers call in the first place can help in uncovering trouble further along the process, providing benefits that go further than the call centre itself, improving customer service and support. Reducing employee turnover: call centres are usually characterized by high employee turnover, owing to the highly stressful work environment. A more streamlined operation would assist in reducing operators’ stress, particularly in an inbound centre. ChallengesSpecific challenges of applying Lean Six Sigma in a call centre environment (Piercy & Rich, 2009): www. intechopen. com 7 Lean Six Sigma in the Service Industry 1. 2. 3. The relentless pace of the activity (often 24/7) makes it more difficult for key staff to find the time to become involved in projects and Lean Six Sigma training. The realization of an appropriate measurement system analysis (MSA) (Wheeler & Lyday, 1990) is difficult because of the inherent subjectivity and interpretation of some call types, failing reproducibility tests of different call centre operators.High employee turnover, that normally characterizes call centres, makes it more difficult for the programme to remain in the organization. Strengths Weaknesses ? ? Root cause analysis can determine major reasons for customers’ calls, helping to unveil problems further along the value stream map of the company Lean Six Sigma deployment requires significant investment in training, that may be difficult from a time perspective in a fastpaced environment such as a call centre Opportunities Threats ? ? ? ? ? Decrease number of lost calls Reduce waiting time for calls in t he queue Improve employee productivity (i. . number of calls dealt with by the hour) ? Lack of metrics Lack of support from process owner Preconceived ideas Table 3. SWOT Analysis for the Use of Lean Six Sigma in a Call Centre. Overall, the opportunities far outweigh the challenges. Call centres nowadays are more than just operations: they are the first, and sometimes a unique, point of contact that a company may have with its customers. Their efficient and effective running, and their timely resolution of customers’ queries, all go a long way to establishing the company’s brand and image. Project selection is a critical component of success.Not all projects may be suitable candidates for the application of Lean Six Sigma, and this needs to be kept in mind in assessing the operation of a call centre. Also, different tools and techniques may be more suited to a specific project, depending on the nature and characteristics of the process it is trying to address. Projects that better lend themselves to Lean Six Sigma share, inter alia, the following characteristics: ? The focus of the project is on a process that is either not in statistical control (unstable) or outside customer specifications (incapable).As already mentioned in the introduction, Six Sigma techniques focus on reducing the variation in a process, making them the ideal tools for tackling an incapable but stable process, whereas Lean tools focus more on the elimination of waste and would be the first port of call for streamlining an unstable process. Priority should be given to unstable processes, using Lean tools to eliminate the waste and simplify the process. Once it has stabilized, more advanced statistical tools from the Six Sigma toolbox, can be used to reduce variation and make the process capable. ww. intechopen. com 8 ? ? ? Advanced Topics in Applied Operations Management The root reason(s) for this has not been identified yet. It is important to start work on the project wit h an open mind and without any prejudice. Data and hard facts should guide the project along its path. Quantitative metrics of the process are available. A lack of measures and failing to realize a complete measurement system analysis (MSA) (Wheeler & Lyday, 1990) can seriously jeopardize any improvement effort. The process owner is supportive and willing to provide data and resources.This is critical for the ongoing success of the project; the process owner’s role is discussed in detail in the Control Phase section. Potential areas of focus for Six Sigma projects in call centres (Gettys, 2009): ? ? ? ? Lost call ratio out of total calls for an inbound call centre; Customer waiting/holding times for an inbound call centre; First-call resolution; Calls back inflating call volumes. Call centres are increasingly important for many businesses and are struggling consistently with the pressure of delivering a better service at a lower cost.Lean Six Sigma can improve the operation o f a call centre through an increase in first-call resolution (that reduces the failure created by failing to answer the query in the first place), a reduction in call centre operator turnover (leveraging on training and experience), and streamlining the underlying processes, eliminating unnecessary operations. Given the large scale of many call-centre operations, even a relatively small improvement in the sigma value of the process can dramatically reduce the defect rate, increase customer satisfaction and deliver financial benefits to the bottom line (Rosenberg, 2005).By focusing on eliminating waste, identifying the real value-adding activities and using the DMAIC tools for problem-solving, it is possible to achieve significant improvements in the cost and customer service provided (Swank, 2003). 5. Case study 2: Lean Six Sigma in HR administration (Laureani & Antony, 2010b) In the late 1980s, when Motorola implemented Six Sigma originally, obtaining astonishing results, the compa ny was then faced with the dilemma of how to reward its employees for these successes (Gupta, 2005).This was the first time Six Sigma and HR practices came into contact, and a more accurate definition of HR practices was needed. If, in the past, the term HR was related only to administrative functions (e. g. payroll, timekeeping, etc. ), the term has increased substantially, in the last few decades, to include the acquisition and application of skills and strategies to maximize the return on investment from an organization’s human capital (Milmore et al, 2007). HR management is the strategic approach to the management of all people that contribute to the achievement of the objectives of the business (Armstrong, 2006).As such it includes, but it is not limited to, personnel administration. In effect it includes all steps where an employee and an organization come into contact, with the potential of adding value to the organization (Ulrich, 1996). www. intechopen. com Lean Six Sigma in the Service Industry 9 As such, and merging terminology from Lean and HR, we define the following seven points as the Human Capital Value Stream Map: 1. 2. 3. 4. 5. 6. 7. Attraction Selection Orientation (or induction) Reward Development Management Separation Fig. 1. Human Capital Value Stream Map.The Human Capital Value Stream Map is a Lean technique that identifies the flow of information or material required in delivering a product or service to a customer (Womack & Jones, 1996). Human capital is the accumulated skills and experience of the human force in an organization (Becker, 1993). The Human Capital Value Stream Map is the flow of human capital required for an organization to deliver its products or service to customers; the objectives of which are briefly described below: ? ? ? ? ? ? ? Attract: to establish a proper employer’s brand that attracts the right calibre of individual.Select: to select the best possible candidate for the job. Orient: to ensure new employees are properly trained and integrated into the organization. Reward: to ensure compensation packages are appropriate and in line with the market. Develop: to distinguish talent and ensure career progression. Manage: to supervise and administer the day-to-day jobs. Separation: to track reasons for voluntary leavers and maintain a constructive relationship. It is possible to apply Lean Six Sigma tools to each step of the Human Capital Value Stream Map, in order to eliminate waste in the HR process Wyper & Harrison, 2000). For each step in the Human Capital Value Stream Map it is necessary to establish proper quantitative metrics that allow objective assessment and control of the process step (Sullivan, 2003). This makes use of the more quantitative statistical tools from the Six Sigma toolbox possible. Establishing HR metrics can be controversial, with different parts of the organization having different objectives (Jamrog & Overholt, 2005), but the answer to these simple ques tions may help to focus on the real value each step can provide. 1. 2. 3.What is the expected deliverable of the step? What are the relevant metrics and key performance indicators of the step? What are the opportunities for defects in the step? www. intechopen. com 10 Advanced Topics in Applied Operations Management For recruitment, for example, the answers to the above questions may be as follows. 1. 2. 3. Hire, in the shortest possible time, new members of staff to fulfil a certain job. The number of days to fill a vacancy (also define the acceptable norm for the organization). Any job remaining vacant for longer than the acceptable norm.Similar thought processes can be performed for other steps: having set metrics for each step of the Human Capital Value Stream Map, an organization is now in the position to apply Six Sigma DMAIC to it. Six Sigma can be used to improve administrative processes, such as HR processes. Implementing the Six Sigma DMAIC breakthrough methodology in HR f ollows the same path as implementing it in any other part of the organization. However, there are some specific key learning points and challenges for the HR area, such as: ? ? ?Difficulty in establishing an appropriate measurement system analysis and metrics; Data collection can be extremely difficult, as the project team is dealing with very sensitive issues; and Difficulty in performing any pilot or design of experiment. Any of these is going to impact on the behaviour of staff, making it difficult to measure its results accurately. As a result, projects may last longer than the standard four to six months and the wider use of tools such as brainstorming and ‘Kaizen’ workshops with domain experts may be necessary (Lee et al, 2008).Examples of potential Six Sigma projects in the HR function are: ? ? ? ? ? ? reduction of employees’ turnover reduction in time and cost to hire a new employee reduction in training costs reduction in cost of managing employeesâ€⠄¢ separation reduction in administrative defects (payroll, benefits, sick pay, etc. ) reduction in queries from the employee population to the HR department. Every area of an organization needs to perform better, faster and more cheaply, to keep the company ahead of the competition, and be able to satisfy ever-increasing customer expectations.HR is no exception: more cost-effective and streamlined HR processes will create value for the organization, instead of just being a support act for management (Gupta, 2005). 6. Case study 3: Lean Six Sigma in health-care delivery Health care is a complex business, having to balance continuously the need for medical care and attention to financial data. It offers pocket of excellence, with outstanding advances in technology and treatment, together with inefficiencies and errors (Taner et al, 2007). Everywhere in the world, the financial pressures on health care have increased steadily in the last decade.While an ageing population and technolog ical investments are often cited as culprits for these financial pressures, unnecessary operational inefficiency is another source www. intechopen. com Lean Six Sigma in the Service Industry 11 of cost increases, largely under the control of health-care professionals (de Koning et al, 2006). Lean Six Sigma projects so far in the health-care literature have focused on direct care delivery, administrative support and financial administration (Antony et al, 2006), with projects executed in the following processes (Taner et al, 2007): ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? increasing capacity in X-ray rooms reducing avoidable emergency admissions improving day case performance improving accuracy of clinical coding improving patient satisfaction in Accident and Emergency (A&E) reducing turn-around time in preparing medical reports reducing bottle necks in emergency departments reducing cycle time in various inpatient and outpatient diagnostic areas reducing number of m edical errors and hence enhancing patient safety reducing patient falls reducing errors from high-risk medication educing medication ordering and administration errors improving active management of personnel costs increasing productivity of health-care personnel increasing accuracy of laboratory results increasing accuracy of billing processes and thereby reducing the number of billing errors improving bed availability across various departments in hospitals reducing number of postoperative wound infections and related problems improving MRI exam scheduling reducing lost MRI films improving turn-around time for pharmacy orders improving nurse or pharmacy technician recruitment mproving operating theatre throughput increasing surgical capacity reducing length of stay in A&E reducing A&E diversions improving revenue cycle reducing inventory levels improving patient registration accuracy improving employee retention The focus has been on the improvement of clinical processes to identi fy and eliminate waste from the patient pathways, to enable staff to examine their own workplace, and to increase quality, safety and efficiency in processes (e. g. Fillingham, 2007; Silvester et al, 2004; Radnor and Boaden, 2008).The barriers specific to the deployment of Lean Six Sigma in health care, in addition to the ones commonly present in other industries, are: ? Measurement: it is often difficult to identify processes, which can be measured in terms of defects (Lanham and Maxson-Cooper, 2003). www. intechopen. com 12 ? Advanced Topics in Applied Operations Management Psychology of the workforce: in the health-care industry it is particularly important to not use jargonistic business language, as this has a high chance of being rejected or accepted with cynicism by medical professionalsThe application of Lean Six Sigma in health care is still in its early stages. Therefore early successes in simple projects will pave the way for tackling more complicated initiatives in the f uture, initiating a positive circle of improvement, bringing clinical change on a broad scale. Appropriately implemented, Lean Six Sigma can produce benefits in terms of better operational efficiency, cost-effectiveness and higher process quality (Taner et al, 2007), as the case studies presented in this paper illustrate.The spiralling costs of health care means that unless health-care processes become more efficient, a decreasing proportion of citizens in industrialized societies will be able to afford high-quality health care (de Koning et al, 2006). Continuous process improvement is needed to ensure health-care processes are efficient, cost-effective and of high quality. The five case study applications we have examined in this paper provide examples of how Lean Six Sigma can help to improve health-care processes.The adoption of similar programs in other hospitals across the health-care sector will help the delivery of high quality health care to an increasing population. 7. Conc lusion Lean Six Sigma is now accepted widely as a business strategy to improve business profitability and achieve service excellence, and its use in service organizations is growing quickly. However, there are a number of barriers to the implementation of Lean Six Sigma in services, such as the innate characteristics of services, as well as the manufacturing origins of Lean Six Sigma that have conditioned service managers to consider them as physical products only.On the other hand, as shown in the case studies, there are a number of advantages for the use of Lean Six Sigma in services (Eisenhower, 1999). Overall, the applications so far have showed the benefits (such as lowering operational costs, improving processes quality, increasing efficiency) to outweigh the costs associated with its implementation. 8. References Adams, C. , Gupta, P. & Wilson, C. (2003) Six Sigma deployment. Burlington, MA, Butterworth-Heinemann. Antony, J. (2005a) Assessing the status of six sigma in the UK service organizations. Proceedings of the Second National Conference on Six Sigma, Wroclaw, pp. -12. Antony, J. (2005b) Six Sigma for service processes. Business Process Management Journal, 12(2), 234-248. Antony, J. , Antony, F. & Taner, T. (2006), The secret of success. Public Service Review: Trade and Industry, 10, 12-14. Antony, J. , Kumar, M. & Cho, B. R. (2007) Six Sigma in services organizations: benefits, challenges and difficulties, common myths, empirical observations success factors. International Journal of Quality Reliability Management, 24(3), 294–311. www. intechopen. com Lean Six Sigma in the Service Industry 13 Antony, J. , Kumar, M. & Madu, C. N. 2005) Six Sigma in small and medium sized UK manufacturing enterprises: some empirical observations. International Journal of Quality & Reliability Management, 22(8), 860-874. Antony, J. , Kumar, M. & Tiwari, M. K. (2005) An application of Six Sigma methodology to reduce the engine overheating problem in an automot ive company. IMechE – Part B, 219(B8), 633-646. Armstrong, M. (2006) A handbook of human resource management practice. London, Kogan Page. Becker, G. S. (1993) Human capital: a theoretical and empirical analysis, with special reference to education. Chicago, University of Chicago Press. e Koning, H. , Verver, J. P. S. , Van den Heuvel, J. , Bisgaard, S. & Does, R. J. M. M. (2006) Lean Six Sigma in health care. Journal for Healthcare Quality, 28(2), 4-11. Eisenhower, E. C. (1999) The implementation challenges of Six Sigma in service business, International Journal of Applied Quality Management, 2(1), 1-24 Fillingham, D. (2007) ‘Can lean save lives? Leadership in Health Services, 20(4), 231-41. George, M. L. (2003) Lean Six Sigma for service: how to use Lean speed and Six Sigma quality to improve services and transactions. New York, McGraw-Hill. George, M. 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(1985), Problems and strategies in services marketing, Journal of Marketing, 49 (Spring), 33-46. www. intechopen. com Advanced Topics in Applied Operations Management Edited by Mr. Yair Holtzman ISBN 978-953-51-0345-5 Hard cover, 200 pages Publisher InTech Published online 16, March, 2012 Published in print edition March, 2012 The chapters in Advanced Topics in Applied Operations Management creatively demonstrate a valuable connection among operations strategy, operations management, operations research, and various departments, systems, and practices throughout an organization.The authors show how mathematical tools and process improvements can be applied effectively in unique measures to other functions. The book provides examples that illustrate the challenges confronting firms competing in today's demanding environment b ridging the gap between theory and practice by analyzing real situations. How to reference In order to correctly reference this scholarly work, feel free to copy and paste the following: Alessandro Laureani (2012). Lean Six Sigma in the Service Industry, Advanced Topics in Applied Operations Management, Mr.Yair Holtzman (Ed. ), ISBN: 978-953-51-0345-5, InTech, Available from: http://www. intechopen. com/books/advanced-topics-in-applied-operations-managem ent/lean-six-sigma-in-theservice-industry InTech Europe University Campus STeP Ri Slavka Krautzeka 83/A 51000 Rijeka, Croatia Phone: +385 (51) 770 447 Fax: +385 (51) 686 166 www. intechopen. com InTech China Unit 405, Office Block, Hotel Equatorial Shanghai No. 65, Yan An Road (West), Shanghai, 200040, China Phone: +86-21-62489820 Fax: +86-21-62489821

Is There Any Evidence for Cannibalism in Dinosaurs

A few years ago, a paper published in the distinguished scientific journal Nature bore an arresting title: Cannibalism in the Madagascan Dinosaur Majungatholus atopus. In it, researchers described their discovery of various Majungatholus bones bearing Majungatholus-sized bite marks, the only logical explanation being that this 20-foot-long, one-ton theropod preyed on other members of the same species, either for fun or because it was especially hungry. (Since then, Majungatholus has had its name changed to the slightly less impressive Majungasaurus, but it was still the apex predator of late Cretaceous Madagascar.) As you might have expected, the media went wild. Its hard to resist a press release with the words dinosaur and cannibal in the title, and Majungasaurus was soon vilified worldwide as a heartless, amoral predator of friends, family,  children, and random strangers. It was only a matter of time before The History Channel featured a pair of Majungasaurus in an episode of its long-extinct series Jurassic Fight Club, where the ominous music and portentous narration made the offending dinosaur seem like the Mesozoic equivalent of Hannibal Lecter (I ate his liver with some fava beans and a nice Chianti!) Notably, Majungasaurus, aka Majungatholus, is one of the few dinosaurs  for which we have indisputable evidence of cannibalism. The only other genus that even comes close is Coelophysis, an early theropod that congregated by the thousands in the southwestern U.S.  It was once believed that some adult Coelophysis fossils contained the partially digested remains of juveniles, but it now appears that these were actually small, prehistoric, yet uncannily dinosaur-like crocodiles like Hesperosuchus. So Coelophysis (for now) has been cleared of all charges, while Majungasaurus has been pronounced guilty beyond a reasonable doubt. But why should we even care? Most  Creatures Will Be Cannibals Given the Right Circumstances The question that should have been asked upon the publication of that Nature paper wasnt Why on earth would a dinosaur be a cannibal?, but rather, Why should dinosaurs be different from any other animal? The fact is that thousands of modern species, ranging from fish to insects to primates, engage in cannibalism, not as a flawed moral choice but as a hardwired response to stressful environmental conditions. For example: Even before theyre born, sand tiger sharks will cannibalize each other in the mothers womb, the biggest baby shark (with the biggest teeth) devouring its unfortunate siblings.Male lions  and other predators will  kill and eat the cubs of their rivals, in order to establish dominance in the pack and ensure the survival of their own bloodline.No less an authority than Jane Goodall noted that chimps in the wild will occasionally kill and eat their own young, or the young of other adults in the community. This limited definition of cannibalism applies only to animals that deliberately slaughter, and then eat, other members of their own species. But we can vastly expand the definition by including predators that opportunistically consume their packmates carcasses--you can bet that an Africa hyena wouldnt turn up its nose at the body of a two-days-dead comrade, and the same rule doubtless applied to your average Tyrannosaurus Rex or Velociraptor. Of course, the reason cannibalism evokes such strong feelings in the first place is that even supposedly civilized human beings have been known to engage in this activity. But again, we have to draw a crucial distinction: its one thing for Hannibal Lecter to premeditate the murder and consumption of his  victims, but quite another for, say, members of the Donner Party to cook and eat already-dead travelers to ensure their own survival. This (some would say dubious) moral distinction doesnt apply to animals--and if you cant hold a chimpanzee to account for its actions, you certainly cant blame a much more dim-witted creature like Majungasaurus. Why Isnt There More Evidence of Dinosaur Cannibalism? At this point you may be asking: if dinosaurs were like modern animals, killing and eating their own young and the young of their rivals and gobbling down already-dead members of their own species, why havent we discovered more fossil evidence? Well, consider this: trillions of meat-eating dinosaurs hunted and killed trillions of plant-eating dinosaurs during the course of the Mesozoic Era, and weve only unearthed a handful of fossils that memorialize the act of predation (say, a Triceratops femur bearing a T. Rex bite mark). Since cannibalism was presumably less common than the active hunting of other species, its no surprise that the evidence thus far is limited to Majungasaurus--but dont be surprised if additional cannibal dinosaurs are discovered soon.