System Thinking for Managers of Royal Commission Health Service Program - Essay Example

SYSTEM THINKING FOR MANAGERS System Thinking for Managers Introduction Royal Commission Health Service Program (RCHSP) in Jubail, Saudi Arabia, is one of the main Health Programs in the Eastern region of Saudi Arabia that was established to provide Jubail Industrial community with integrated comprehensive quality health services. The senior managers in Royal Commission in the new born program are expected to be role models in health administration and care delivery for industrial communities in the Kingdom .This program includes Royal Commission Hospital and utilities, medical centers distributed around the city and three medical staff housing unit areas. Operation and Maintenance department, one of RCHSP units, maintain RCHSP utilities, including medical staff housing units and also execute internal projects with limited budget. Therefore, Operation and Maintenance department has a vital role to play in ensuring that the Health system in the City runs smoothly without any hitches. Recently, many problems appeared in maintenance department. Several claims from medical staff about the poor services provided by the department indicated Maintenance managements’ inability for handling their work order requests and satisfy their end users and which also, does not reflect Royal Commission reputation. Meantime, the current management continuously looks for solutions to improve maintenance response by investigating the root cause of the problem of Pending Work Order Requests. Their focus is to make job request process move smoothly and thus obtain satisfaction from the Royal Commission senior management and end users. This study will analyze the Pending work order requests and suggests viable solutions by using Methodologies of System Dynamic Modeling.  Problem Analysis (Pending Work Order Requests) Definitions and Boundaries: Work order is a document issued from the end user to the maintenance department in order to obtain maintenance service. These services may include civil, electrical and mechanical works. This document can be submitted either through printed work order request forms or through RCHSP Maintenance Program on intranet. End users include all RCHSP administrative staff in the hospital and Medical Units, medical staff housing units. Moreover, maintenance departments maintain all hospital utilities and systems such as Medical and Non-Medical Gas System, Power generators, Water Supply, Central HVAC System among others. When the end users have submitted their requests through work order forms or through Facility Management system (FMIS), they are received by the maintenance planner who is responsible for receiving and sending work order to the suitable division maintenance head. The maintenance head contacts the end user and make a site visit and then send the technician to fix and close the work order. Finally, the maintenance planner updates the status of the work order request in the system. Problem Description: The main problem related to pending work orders slower incoming work orders than response to end user complaints. The work orders were steadily increasing with time while it was taking longer than expected to fix End users complaints. There were many work order requests not being closed leading to: Patient and hospital visitors’ dissatisfaction. Resentment of RCHSP Program Director. Holding several planed internal projects and delaying in issuing new services. Declining in health services quality. Low morale and performance for the Medical staff that living in RCHSP housing units especially nurses. The Rich Picture: It is very important to create the rich picture in order to understand the complexity of the ‘messy’ situation (Armson 2011). Figure 1.0 below, illustrates general perspective about the problem. Figure 1: The Rich Picture Analysis of the Problem The following factors have contributed to the problem: Insufficient stock in Warehouse to cover the work order’s needs The relationship between maintenance department and warehouse is essential for reducing the number of pending work orders as shown in figures 2 & 3. Failure to provide maintenance consumable materials on time contributes to delayed close work orders. Poor warehouse management probably caused this imbalance between the amount of materials required and current available stock. In addition, slow procurement process, inadequate follow up and coordination also contributed to the delay and increased numbers of pending work order requests. Figure 2: feedback loop between the departments Maintenance, Warehouse and Procurement Figure 3: Slow procurement effect on the problem Unskilled Contractor Technicians Unskilled labor could cause many work headache to the maintenance department and it is definitely, primary contribute in delaying work order process due to his inability to fix the problem properly on time which in fact, required to make rework job and consume more time, resources and paper works on account of another job request and eventually, increase the number of pending work order requests. Figure 4: Pending work orders and unskilled technicians’ CLD Figure 5: stock-and-flow diagram for the impact of unskilled technicians on the problem New Management, Different Demands RCHSP has seen several management changes in the senior level over the past years and this played a major role in re-priority. The work and frequent change in attitudes leading to different expectations and demands in organization and drained maintenances’ time and resources, which impacted the stock in Warehouse and confused the maintenance process, caused more pending work requests. Figure 6: tracking processes of hiring new management. Figure 7: CLD for variable management and pending work orders. Lock of Periodic Preventive Maintenance (PPM) Not forcing consolidated preventive maintenance concepts led to underestimation of the future consequences for worn-out RCHSP buildings and equipment at maintenance department. Lack of preventive maintenance resulted in decline in building life expectancy and increased the operation cost, which led to faults multiplicity and dramatically increased the number of pending work order requests. Figure 8 & 9 show relation between making PPM and declining in pending work orders requests. Figure 8: CLD shows the relation between PPM and the problem Figure 9: PPM Stock-and-Flow Diagram Methodological approach The proposed study will use System Dynamic (SD) methodology in order to model the Pending Work Order Requests problem in RCHSP. System Dynamic (SD) methodology is a mathematical modeling technique allows understanding the relation between several components inside system and discussing complex problem. Also, it illustrates how the system parts behave over the time and how these relations could affect the entire system. It enables one to ascertain the dynamic patterns that underpin a system (Vlachos et al, 2006). Modeling It is very important to model the system by using stock-and-flow diagrams and Casual Loop Diagram and this will illustrate the system key components and allow understand the level of complexity in the system and the action can be taken to improve the current situation. In order to resolve the current problem and come up with a solution that might help to fix the problem of pending work orders requests in RCHSP, the system components should be distributed in parts in order to understand the process and behavior of each part in relation to the problem. Stock-and-Flow Diagrams Since there are several factors contributing to increasing pending work order requests, the study in stock-and-flow diagrams will focus only on process of three direct key elements: unskilled technician, insufficient stock in warehouse and variable management directions. Other factors might be considered as indirect factors leading to emergent of the problem and these will also be included in Casual Loop Diagram as part of the solution. Unskilled Technicians Model The relation between unskilled technicians and pending work order can be illustrated as shown in figure 10 below: Figure 10: Stock-and-Flow Diagram shows feedback loop in the maintenance department. This model uses a stock-and-flow diagram to describe the process. It is clear that unskilled technician factor in the maintenance department contributes to increasing the pending work order requests by creating more open rework requests and loading the work order process by consuming time, resource and efforts. Over time, maintenance capability and response pace declines and increase the end users claims. Unskilled technician could make serious damages and cost if maintenance department ignores this factor. The model indicates to those unskilled technicians as the “flow” and the input for defects of fixing and installation “stock” results in the end user to reopen the work request and call for fixing his problem again. Insufficient stock in Warehouse Model Another factor that increases the complexity of the problem is the insufficient stock of spare parts and consumable materials in Warehouse as shown in figure 11. Figure 11: Stock-and-Flow Diagram for the work order request processes Majority of maintenance claims require spare parts. It is the responsibility of the warehouse to ensure availability of materials when they are needed. The process starts in the stock-and-flow diagram with End users ‘ issuing claims throw Maintenance Facility Management System(FMIS) and then, the work orders are received by FMIS Controller in planning and Controlling Department. After that, Maintenance Planner coordinates issuing material request from store incase work needs spare parts. Incase the spare parts are not available in store, the store keeper raises purchase order and submit it to the procurement department. Finally, the procurement officer makes the purchase and supply process in order to provide the required materials. Variable Management Direction The following stock-and-flow diagram shows many stages starting with assigning new management on site to make essential decisions in order improve the nurses housing condition. The management has the authority to use more resources and reprioritize work order requests from their perspective to solve the issue immediately, which consumes more and more of the available stock solving the virtual problems only. Figure 12: Stock-and-Flow Diagram shows feedback loop in the maintenance department. With the current long-term purchasing process, the hidden impacts therefore, expand until they blow up and result in more pending work order requests. Low staff efficiency becomes inevitable because of the need to fix several issues in their units. This makes them to lose their attention in work and reduces the quality of Health service provided to the patients. Finally, senior management of Royal Commission drives the Current RCHSP administrative for improvement processes in order to achieve patient protection and reputation of the organization. Insights and Solutions Casual Loop Diagram (Putting everything together): Causal loop diagrams provide “... a framework for seeing interrelationships rather than things, for seeing patterns of change rather than static snapshots” (Senge 1990 P68). In order to raise the department efficiency and solve the problem of pending work order requests, feedback loops will help to eliminate the residual problems in the system as illustrated in the figure 13: Figure 13: Casual Loop Diagram (CLD) shows the main key factors that contribute in the problem. The CLD shows the current relations and behaviors: 1- The existing RCHSP buildings have limit capacity, but overstress them by accommodating more staff in housing units. This caused more faults in units such as appliances breakdown, plumbing works and HVAC problem. This is also what happened in hospital and medical centres. Expanding the office spaces in order to accommodate more staff also contributes to increased faults and add load to the maintenance department, causing increased pending work order requests. 2- The diagram indicates direct relationship between unskilled technicians and pending work orders. Unskilled technicians could cause many problems to a department. Actually, it is one of key reasons behind accumulated work order requests on maintenance planner’s desk. 3- The last important issue that causes this problem is the unbalance stock in Warehouse. The CLD illustrates that there are relations between procurement process, Management variable decisions and stock in Warehouse. 4- Finally, the CLD shows that there is direct relationship between pending work orders and department efficiency. Proposed Solutions In order to make the system to work efficiently and solve the existing problem, the system needs to activate the roles of several components to eliminate pending work orders. First, applying the Periodic Preventive Maintenance (PPM) plan will be beneficial to the system by confronting the future risks of overloading the existing facilities and increasing the life span as well as saving operations cost. Second, unskilled technicians’ problem can be solved if the current management are convinced of the importance of training staff and have allocated a part of their budget and time on this matter .There is a feedback loop between the “apply training plans” and “reduce number of unskilled technicians” in maintenance department, which leads to reduction and elimination of pending work orders. This is considered as positive feedback. According to Kauffman, feedback is considered positive or negative depending on what it does to changes in the system (Kauffman 1980 p24). The CLD relates training to higher department efficiency. Third, Casual Loop Diagram demonstrates that the pending work orders can be avoided if there are clear channels between Maintenance, Warehouse and Procurement Departments. Figure 14: Casual Loop Diagram (CLD) shows feedback loops for the proposed solutions . Evaluation of the Methodology One of the key reasons that contribute to the failure of finding proper solutions to the pending work orders problem is unclear roots, which caused the problem. This can be solved by System Dynamic methodology. Lack of understanding of the relationship between several components and the other problem‘s dimensions and potential consequences must be considered by any manger when taking essential decisions. Blaming the maintenance department and changing the current management will not solve the problem, but will contribute to more complexity as the System Dynamic methodology indicates. This methodology provides broader understanding of the problem. Using Stock-and-Flow Diagram enables us to track the system behavior and identify the gaps in the current system, for instance, slow pace of procurement process and different directions of the management and how they contribute in system complexity. The analysis demonstrates that the unskilled technicians play a major role in causing the problem and the system provide to us with some insights and solutions that will help to reduce the number of pending work orders. The solutions and insights of this issue can be described as follows: A. First, some solutions can be applied by the Operation and Maintenance Director to reduce the impact of unskilled technicians such as: 1- Implementing orientation training programs for maintenance staff to improve their skills. 2- Retaining skilled technicians in RCHSP and renewing their contracts before expiry because they are familiar with most of the maintenance problems and they have the ability to repair them with less time and more quality without any additional costs. 3- Updating the current Periodic Preventive plans and employing the supervision role in order to monitor any variations that could occur. B. Second, insights and solutions related to RCHSP Director in order to present a desirable solution such as: 1- Creation of a clear vision and strategic plan and discussing them with all parties in open meeting and giving them the chance to generate more effective ideas and recommendations. 2- Gathering Departments related to current affair and creating a committee responsible to prioritize the pending work orders and sort out in categories. 3- Making the end users aware of the daily progress of the issue. 4- Allocating a budget for outsourced renovation projects to rehabilitate the current facilities. 5- Updating the purchasing process and procedure to imply more flexible processes in order to keep pace with the aspirations of the future management of Royal Commission. Conclusion Therefore, System Dynamic Model is suitable to deal with any potential problems in the organization. It is very viable tool that can help the decision makers to understand the relations between several components in complex systems and also shows how the system behaves. It also determines if the system is capable of adapting to future changes. Read More