Gajanan G. Hegde

Engineering changes and time delays: A field investigation

Abstract We report on a field investigation on the impact of engineering change orders (ECOs) on completion time of jobs in repetitive manufacturing settings. The study provides concrete evidence of the detrimental impact of ECOs and of the practice of padding lead times. In addition, the analysis quantifies the impact and interaction of various other time drivers. The paper emphasizes that factors such as ECOs and raw material discrepancies must be better managed to improve shop response time.

Site selection for a ‘sure service terminal’

Abstract This paper reports a use of the AHP in solving a facility location problem faced by a large multinational corporation. The problem is that of deciding where to locate service terminals for the spare parts division. The AHP was introduced and successfully used to solve the problem. A distinct feature noticed by the authors is that the managers developed a sense of ownership in the findings of the study because the AHP facilitates their involvement at every level. Consequently the findings and conclusions were readily implemented in their business plan.

Development and Evaluation of Educational Materials for Pre-hospital and Emergency Department Personnel on the Care of Patients with Autism Spectrum Disorder

With the rising prevalence of patients with autism spectrum disorder (ASD), there has been an increase in the acute presentation of these individuals to the general health care system. Emergency medical services and emergency department personnel commonly address the health care needs of patients with ASD at times of crisis. Unfortunately, there is little education provided to front-line emergency medical technicians, paramedics and emergency nurses on the characteristics of ASD and how these characteristics can create challenges for individuals with ASD and their health care providers in the pre-hospital and emergency department settings. This paper describes the development of educational materials on ASD and the results of training of emergency medical services and emergency department personnel.

LIFE CYCLE COST: A MODEL AND APPLICATIONS

Abstract This research is an effort in understanding and modeling benefits of the interaction between the design and engineering stage, and field service support. We first present a model which estimates discounted and undiscounted life cycle cost of a durable product We incorporate the production costs and demand effects, and take into account the interaction between design engineering parameters and field service support functions. The demand side explicitly models the nonlinearities that exist in cost structure experienced by users of durable products. Implications for choosing alternative design configurations and advantages of including field failure data in making decisions at the early stages of product development are discussed.

Feasibility of integrating a clinical decision support tool into an existing computerized physician order entry system to increase seasonal influenza vaccination in the emergency department

While emergency department (ED) seasonal influenza vaccination programs are feasible, reported implementation barriers include added staffing requirements to identify eligible patients and getting busy ED personnel to order and provide vaccination. We present a prospective, observational trial of integrating a clinical decision support tool into an existing ED computerized physician order entry (CPOE) system to increase ED seasonal influenza vaccination without added staffing resources, the operational barriers identified to program implementation, the revenue generated and data on opportunities for future quality improvement. Compared to the comparable pre-protocol period, ED influenza vaccination rose by 17.5% with a resultant profit margin of 34.5%.

Engineering costs and customer costs in designing product support

Product support encompasses activities undertaken by durable goods producers to ensure their customers the continued use of the product. Examples of product support elements include after the sale activities such as providing repair services and warranty programs, as well as all the activities undertaken at the design and production stage to improve the reliability of products before they reach the market. The implications of incorporating customer costs while designing product support packages are the concern of this study. We study how the parameters of support package impact the costs incurred by customers and provide insights about selecting appropriate levels of product support. We show that the engineering orientation of maximizing the products availability ignores market characteristics, and results in a mismatch between the corporations support package and the customers needs. The research is intended to be a step in understanding the interaction between design engineering parameters and customers costs.

Impacts of supplier hubris on inventory decisions and green manufacturing endeavors

The paper studies the impact of a green supplier’s overconfidence on inventory decisions in a supply chain consisting of a supplier facing effort-dependent stochastic demand and a rational retailer. The overconfident supplier may overestimate the product demand due to carbon-reduction green efforts or underestimate the variability of the stochastic demand. We characterize these two kinds of overconfidence as ability-based and precision-based overconfidence, for which we develop optimal models for three supply chain systems: integrated, vendor managed inventory, and retailer managed inventory. Extensive comparative studies are conducted to highlight the impacts of suppliers overconfidence on the inventory decisions and on different green-supply chain performance measures. We find that, under certain conditions, suppliers overconfidence prompts the supplier to exert more efforts on green manufacturing, and enhances the profits of the retailer and of the entire supply chain. Managerial insights are provided for various scenarios and propositions.

Incentives for overhead cost reduction: Setup time and lot size considerations

Abstract This paper addresses incentive issues arising in the integration of production control and process improvement on the shop floor. High overhead rate estimates identified by an activity based costing (ABC) system can result in a decision to increase lot sizes, thereby reducing setup related overhead costs. We integrate ABC and EOQ analyses to establish the circumstances under which increasing the lot size becomes a viable alternative. However, while increasing the lot size may be important for short-term competitiveness, long-term control of setup related overhead costs can be achieved only by decreasing setup time. We address the role of incentive systems in simultaneously implementing both short-term and long-term strategies. In particular, we focus on how the choice of performance measures can result in conflicts between production personnel who may be concerned with short-term cost reduction and engineering personnel who are responsible for reducing setup time. Finally, we discuss the value of group incentive systems in mitigating such conflicts.

Incorporating Screening, Brief Intervention, and Referral to Treatment Into Emergency Nursing Workflow Using An Existing Computerized Physician Order Entry/Clinical Decision Support System

INTRODUCTION The objective of this study was to evaluate whether screening, brief intervention, and referral to treatment (SBIRT) could be incorporated into the emergency nursing workflow using a computerized physician order entry/clinical decision support system. We report demographic and operational factors associated with failure to initiate the protocol and revenue collection from SBIRT. METHODS We conducted a retrospective, observational cohort analysis of a protocol adding SBIRT to the emergency nursing workflow of a single, tertiary care urban emergency department for all adult patient visits in 2012. Emergency nurses prescreened for unhealthy alcohol or drug use during triage assessment and, when positive, administered SBIRT during treatment area care, all documented in the computerized physician order entry/clinical decision support system. Using multivariable logistic regression, we report demographic and operational factors associated with failure to initiate the protocol. From October 2012, we submitted charges for brief interventions and analyzed collection results. RESULTS The inclusion criteria were met for 47,693 visits. Of these, 39,758 (83.4%) received triage protocol initiation. Variables associated with decreased odds of protocol initiation were younger age (odds ratio [OR] for rising age, 1.044; 95% confidence interval [CI], 1.042-1.045), arrival by ambulance (OR, 0.37; 95% CI, 0.35-0.40), and higher triage acuity (OR, 0.08; 95% CI, 0.07-0.09). Of visits with protocol initiation, 21.4% were documented as positive for at-risk alcohol and/or drug use. However, brief interventions were only administered during 971 visits. During the billing period,

Perceptions of Participating Emergency Nurses Regarding an ED Seasonal Influenza Vaccination Program

3617.53 was collected on charges of