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System Thinking Assignment 2nd Answer

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Assessing Value Stream Map and Factors Causing Increased Patient Wait Times in HospitalsExecutive Summary

In this report, the assessment of the current value stream map of the hospital was done, wherein the processes are evaluated and causing an increment in the patient waiting time. There are many factors that were determined and a new system was proposed that would reduce the patient waiting time up to 20 minutes. Certain recommendation regarding the interventions and system augmentations have been provided in the report.


The requirement for improving the patient turnaround time is high. It is defined as the average time a patient has to wait in the emergency department before he/she gets to see the doctor and gets the treatment. According to the Vitals, on an average, a patient has to wait for nineteen minutes before get finally receive the treatment. In this report, the concerns regarding the increased turnaround time of a hospital are discussed and the reason for the cause are also elucidated. In addition to this, the current value stream map is also elaborated and the problem is highlighted in it. Based on the review, a new and improved value stream map is proposed that would surely be decreasing the time taken up by the doctors to provide treatment to the doctors. In addition to this, some intended, as well as unintended consequences, are enlisted in the report with some recommendations for the hospital.

Evaluating System Archetypes Impeding Performance

System Archetype is the study of current patterns of operations undertaken by the organization. These are first studied and coined by Donella Meadows, Jay Forrester, and Dennis Meadows in the year 1960s and 70s. By making use of these archetypes, innovation and thinking can be improved significantly and business-related issues can be resolved in no time and that too very easily (Kreitzer,, 2019). The management of the hospital can employ these archetypes and understand the patterns that take place within the hospital. This amount of knowledge would help them in understanding the sources that are increasing the waiting time for the patient in the emergency department. There are a few system archetypes that are discussed here that has the potential to impede the performance level of the company (Iqbal,, 2018).

Fixed that Fail:This is usually executed or implanted for addressing the urgent problems faced by the organisation. The complete attention is provided to fix the issue while ignoring the other operations in progress (Lin, et, al, 2017).

Limit to Success:The factors that are improved for improving the performance would result in generating the better performances. However, this would result in a diversion of attention from one operation to another (Lin, et, al, 2017).

Growth and Underinvestment:The approaches for improvement and growth are ignored due to lack of funds and underinvestment done by the management. This might be due to the poor performance of the department in the past.

Escalation: The escalation and tension between two systems resulted from the threatening actions of the concerning parties.

Shifting the Burden:The burden of a particular system gets shifted to another system for either shorter or longer duration. This might reduce the performance of the latter system as it has an only limited amount of resources.

Drifting Goals:The increasing gap between the goals and actual performance would eventually reduce the performance of the emergency department system and increase the patient turnaround time.

The Success to Successful: It is usually seen that the most effective efforts during the treatment get the bigger part in the resource allocation. This reduces the number of resources available to the other departments. The emergency department is one such department that is facing the issue of lack of resources.

The Tragedy of the Commons: The commons resources are not given proper attention by the multiple parties who can be benefitted directly from those resources. This aggravates to the shutdown of all the processes or operations forming the system. The hospital might not be giving significant importance to the medical services that are there in the inventory rather, it is hiring external agencies to provide them. This increases the patient time (Lin, et, al, 2017).

Addressing each of these issues can reasonably reduce the

Current State Value Stream Map of the Emergency Department

For understanding the major cause of the increased turnaround time of the patient, it is important to get into the grass root level of the problem. The major source of delays is required to be identified and rectified later on. In order to evaluate the present Value Stream Map, it is necessary to first visualise the process that takes place as soon as the patient arrives in the hospital. The first and foremost step is the identification of the patient and his medical history. All the information are required to be filled in the registration form. There is always a long queue on the registration desk as there is no separate window for an emergency department. This might consume nearly 10 minutes of a patient. Once the form is submitted, the patient is provided with a token number and is asked to wait until his turn comes. This might take nearly 5-6 minutes of time. Once the token number is announced, the patient has to go to the diagnosis room where the head nurse collects the basic information, such as medical history, illness details, and other health related data (Fan, et al, 2015). These are noted down in the notepad. This might take 8-10 minutes of the patient's time. Once all these are done, the patient finally gets to see the doctor. The overall process takes nearly 25 minutes on an average of the patient. In case of an emergency, every second is important. This large amount of time might cause some serious issues to the patient. Hence, it is required to be reduced at the earliest (Fan, et al, 2015).  

System Thinking

In addition to this, the hospital lacks the expert physicians. They are required to be called from other sister institution in case of a serious emergency. Furthermore, the medical services for emergency departments are usually present in a lesser amount. In the case of the massacre, the hospital would not be able to cater to the demand of the medical needs of the patient. Hence, the present system needs some serious augmentation (Iqbal,, 2018). The poor communication and directions from the management are also causing the turnaround time to keep increasing and causing serious troubles to the patient. There is a strong requirement for reducing the mediators from the current system along with the processes that are irrelevantly increasing the time. The immediate data is required to have come to the doctor who can fathom the issues of misconceptions and miscommunication between the specialists just as the patient. This procedure can help in the decrease of the holding up time and the crisis cases can likewise be dealt with suitably inside a shorter period.

New State Value Stream Map

In this section, a new State value Stream Map has been proposed that would provide a better option to cater to the issues faced by the current emergency department of the hospital. In order to compete with other hospitals in the market, the hospital is required to implement certain interventions in order to improve the current system (Acaroglu, 2017). First and foremost, the management should carry out brainstorming to determine the processes that are consuming time and resources of the hospital and are not providing any relevant output. Such redundancies are required to be reduced at the earliest. In the current system, the basic diagnosis carried out by the head nurse is a redundant process and it should be eliminated. Only the doctor should be collecting the health related data in order to provide relevant treatment to the patients. Another issue identified in the hospital is related to the registration and shortage of medical services in the inventory of the hospital (Kreitzer,, 2019). The online registration process and the mobile queue can help in improving the issues and reduce the waiting time up to 8-9 minutes.

System Thinking

The aforementioned system can be able to reduce the waiting time up to 20 minutes. The reason being the patient after getting the token number would directly get to see the doctor. The process of examination done by the head nurse is removed. In addition to this, the online booking of appointment can also be initiated by the hospital. In addition to this, to improve patient satisfaction, skilled staff and doctors can also be hired. Furthermore, customer support services can also be provided to tackle the queries of patients (Iqbal,, 2018).  

Intended and Unintended Consequences

The aforementioned framework has certain pros and unintended consequences. These are enlisted below:-

Intended outcomes

  • The adjusted framework will help in encouraging the orderly just as the arranged progression of the data immediately.
  • To handle and deal with the unpredictable issues and the crises, the specialised staff of the representatives will be contracted (Acaroglu, 2017).
  • The effective management of time in the medicinal services settings and powerful techniques can pace up theprocesses in the hospital and its framework
  • The successful and convenient conveyance of the administrations will help keep up the altruism of the emergency department in the organisation.
  • The patients will be fulfilled more and the administration arrangements of the medical clinic will likewise be improved (Acaroglu, 2017).

Unintended results

  • There can be poor patient satisfaction because of the abnormal state of the development of strategic approaches and their impact on the nature of the administrations given by it.
  • There might be the shirking of some important procedures because of the annihilation of unremarkable in the finding procedure of emergency cases (Matheson,, 2017).
  • There will be a prerequisite of the preparation and improvement programs for the workers of such emergency clinic which may prompt expanding costs.
  • The notoriety of the organization may affect contrarily because of the switch effect of such adjustment in the current structure (Kreitzer,, 2019).


It is concluded from the following report that hospitals should have a well-established and well-equipped emergency department. This would significantly improve the brand image of the hospital and patient satisfaction. It was identified that time management, lack of resources in the emergency department, shortage of manpower, outsourcing delays, and poor efficiency of processes. These are required to be handled at the earliest in order to provide immediate help to the patient. In addition to this, the proficiency of the administrations gets decreased because of the reason for holding up the time taken before the determination of the patients of crisis cases. To lessen the wastage of time just as the assets, the human services industry is required to utilize the TQM forms in their current frameworks and these frameworks ought to likewise be altered for further improvement. The report has given the suggestions on the results of the new improved framework for such medicinal services part.


In relation to the aforementioned issue discussed in the report, here are some recommendations that would be very effective in reducing the waiting time for the people who visit the emergency department:-

  • The information of the patient should be gathered directly into the system while having a telephonic conversation (, 2017)
  • Only the trained and expert staff should be recruited for the emergency system. This would improve the service quality and pace of carrying out an operation in case of an emergency.
  • The online booking can also be an option for reducing the queue length from the registration desk. People can book their bed anytime and from anywhere.
  • In peak season, the hospital should provide the patients and their relatives some comfortable reception area so that they don't face issues while waiting for their turn (Kreitzer,, 2019).
  • The notification regarding the appointment data and schedule should be provided through messages. This would help the patient to visit only that particular time slot rather than waiting for their turn in the hospital (, 2017).
  • Resource allocation should be proper between all the departments. The hospital should try to bridge the gap between patient and doctor by increasing the number of experts (Kreitzer,, 2019).


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  • (2017). Healing Troubled Institutions Through Systems Thinking - The Systems Thinker. Retrieved 17 August 2019, from
  • Kreitzer, M. J., Carter, K., Coffey, D. S., Goldblatt, E., Grus, C. L., Keskinocak, P., ...&Valachovic, R. W. (2019). Utilizing a Systems and Design Thinking Approach for Improving Well-Being within Health Professions' Education and Health Care.  NAM Perspectives.
  • Matheson, A., Bourke, C., Verhoeven, A., Khan, M. I., Nkunda, D., Dahar, Z., & Ellison-Loschmann, L. (2018). Lowering hospital walls to achieve health equity.  bmj,  362, k3597.
  • Meesala, A., & Paul, J. (2018). Service quality, consumer satisfaction and loyalty in hospitals: Thinking for the future.  Journal of Retailing and Consumer Services,  40, 261-269.
  • Spector, N., Blegen, M. A., Silvestre, J., Barnsteiner, J., Lynn, M. R., Ulrich, B., ...& Alexander, M. (2015). Transition to practice study in hospital settings.  Journal of Nursing Regulation,  5(4), 24-38.
  • Fan, S., Lau, R. Y., & Zhao, J. L. (2015). Demystifying big data analytics for business intelligence through the lens of the marketing mix. Big Data Research, 2(1), 28-32.
  • Iqbal, R., Doctor, F., More, B., Mahmud, S., &Yousuf, U. (2018). Big data analytics: Computational intelligence techniques and application areas. Technological Forecasting and Social Change.
  • Lin, J., Naim, M. M., Purvis, L., & Gosling, J. (2017). The extension and exploitation of the inventory and order based production control system archetype from 1982 to 2015. International Journal of Production Economics, 194, 135-152.
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