Question: Community Medical Associates (CMA) is a large
Community Medical Associates (CMA) is a large health care system with 2 hospitals, 25 satellite health centers, and 56 outpatient clinics. CMA had 1.5 million outpatient visits and 60,000 inpatient admissions the previous year. Just a few years ago, CMA’s health care delivery system was having significant problems with quality of care. Long patient waiting times, uncoordinated clinical and patient information, and medical errors plagued the system. Doc- tors, nurses, lab technicians, managers, and medical students in training were very aggravated with the labyrinth of forms, databases, and communication links. Accounting and billing were in a situation of constant confusion and constantly correcting medical bills and insurance payments. The complexity of the CMA information and communication system overwhelmed its people. Prior to redesigning its systems, physicians were faced with a complex array of appointments and schedules in order to see patients in the hospital, centers, and clinics. For example, an elderly patient with shoulder pain would get an X-ray at the clinic but have to set up an appointment for a CAT scan in the hospital. Furthermore, the patient’s blood was sent to an off-site lab, and physician notes were transcribed from tape recorders. Radiology would read and interpret the X-rays and body scans in a consultant report. Past and present medication records were kept in the hospital and off-site pharmacies. Physicians would write paper prescriptions for each patient. Billing and patient insurance information was maintained in a separate database. The patient’s medical chart was part paper based and part electronic. The paper medical file could be stored at the hospital, centers, or clinics. Nurses handwrote their notes on each patient, but their notes were seldom input into the patient’s medical records or chart. “We must access one database for lab results, then log off and access another system for radiology, then log off and access the CMA pharmacy system to gain an integrated view of the patient’s health. If I can’t find the patient’s records within five minutes or so, I have to abandon my search and tell the patient to wait or make another appointment,†said one doctor. The doctor continued, “You have to abandon the patient because you have to move on to patients you truly can diagnose and help. If you don’t abandon the patient, you might make clinical decisions about the patient’s health without having a complete set of information. Not having all the medical information fast has a direct impact on quality of care and patient satisfaction.†
Today, CMA uses an integrated operating system that consolidates over 50 CMA databases into one. Health care providers in the CMA system now have access to these records through 7,000 computer terminals. Using many levels of security and some restricted databases, all patient information is accessible in less than two minutes. For example, sensitive categories of patient records such as psy- chiatric and AIDS problems were kept in super-restricted databases. It cost CMA $4.46 to retrieve and transport a single patient’s paper-based medical chart to the proper location, whereas the more complete and quickly updated electronic medical record costs $1.32 to electronically retrieve and transport once. A patient’s medical records are retrieved on average 1.4 times for outpatient services and 4.8 times for inpatient admissions. In addition, CMA has spent more money on database security, although it has not been able to place a dollar value on this. Electronic security audit trails show who logs on, when, how long he or she views a specific file, and what information has been viewed. The same doctor who made the previous comments two years ago now said, “The speed of the system is what I like. I can now make informed clinical decisions for my patients. Where it used to take several days and sometimes weeks to transcribe my patient medical notes, it now takes no more than 48 hours to see them pop up on the CMA sys- tem. Often my notes are up on the system the same day. I’d say we use about one-half the paper we used with the old system. I also find myself editing and correcting transcription errors in the database—so it is more accurate now.†The next phase in the development of CMA’s integrated system is to connect it to suppliers, outside labs and pharmacies, other hospitals, and to doctors’ home computers. Case Questions for Discussion: 1. Explain how CMA used the four principles of lean operating systems to improve performance. 2. Using the information from the case, sketch the original, paper-based value chain and compare it to a sketch of the modern, electronic value chain, which uses a common database. Explain how the performance of both systems might compare. 3. What is the total annual record retrieval cost savings with the old (paper-based) versus new (electronic) systems? 4. Does this CMA improvement initiative have any effect on sustainability? If so, how? If not, why? 5. Using lean principles, can you simultaneously improve speed and quality while reducing waste and costs? What are the trade-offs? Explain your reasoning.
> For the coffee maker sales data in problem 33, use the Exponential Smoothing Excel template with = 0.2 to compute the exponential smoothing forecasts for February through July.
> 1. Exhibit 19.21 shows the project work activities for designing custom jewelry using computer aided design (CAD). Draw the network diagram, determine the project completion time, critical path(s), activity slack times, and create a Gantt chart for the p
> The manufacturer of gas outdoor grills provides sales data for the last three years as follows: Use the Exponential Smoothing Excel template to develop single exponential smoothing models with ï¡ï€ = 0.2, 0.4, and 0.6. Co
> Five observations from a work measurement study are shown below. Continuous timing was not used, but the times in minutes for each work element were recorded individually. Assume a total allowance of 20 percent. Use the Work Measurement Excel template t
> Nine observations from a work measurement study using continuous timing are shown below. Allowances are determined as: personal five percent; fatigue five percent; delay fiver percent. Use the Work Measurement Excel template to determine the standard
> The deli at a Metro Supermarket experiences constant and continuous demand. Staffing is a problem for store managers but several of the employees suggested they buy more deli cutting machines and weighing scales and place them side-by-side. Currently, th
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> An automated car wash called Jet Express outside a large Texas city on the beltway is deciding whether to build and install one dedicated vehicle wash line or have two parallel wash lines. There are no other cash washes at this intersection and there wil
> Rework computational problem 36 (college textbook publisher) using the Break-Even template in MindTap and answer the following questions: Note that students must use Goal Seek or trial and error to find the breakeven quantities. a. What is the break-even
> Rework computational problem 34 (Worthington Machining) using the Break-Even Excel template in MindTap to answer the following questions: a. What is the break-even quantity between these two processes? b. If predicted demand for next year is 120,000 pane
> Samoset Fans, Inc. manufacturers its fan blades in-house. The owner, Betty Dice, doesn’t outsource any fan parts except fan motors—all other fans parts are made in-house. There current process and its equipment are getting old. Maintenance and repair cos
> Consider the following transportation problem data for Baker Industries (these data are available in the Excel worksheet Baker Industries on MindTap): Use the techniques explained in Supplement E: The Transportation Problem to address the following: a.
> Milford Lumber Company ships construction materials from three wood-processing plants to three retail stores. The shipping cost, monthly production capacities, and monthly demand for framing lumber are given below (these data are available in the Excel w
> Gordon Rivers, the city manager of Saratoga, Florida, pitched the proposed design schedule back at Jay Andrews. Jay Andrews is the project manager for Major Design Corporation (MDC). The city of Saratoga selected MDC for this project. As project manager,
> Cunningham Products is evaluating five possible locations to build a distribution center. Data estimated from the accounting department are provided below. The annual production is estimated to be 30,000 units. a. Use the Location Analysis Excel template
> For the David drugstore chain in Problem 39, suppose that after five years, half the customers from segment 1 are expected to move to segment 2. Where should the drugstore shift, assuming the same criteria are adopted? Use the Center of Gravity Excel t
> MegaMart, a large department store, has a very successful and profitable package wrapping department. The department uses two very complex bow-making machines that work inline to make the bows for the packages. Bow-making Machine #1 has a reliability of
> The Lemma Company manufactures and sells ten products. Managers find ways to reduce the setup and inventory-holding costs by one-half. What effect will this have on the EOQs for the ten products?
> Magnaplex, Inc. has a complex manufacturing process, with three operations that are performed in series. Because of the nature of the process, machines frequently fall out of adjustment and must be repaired. To keep the system going, two identical machin
> An electronic missile guidance system at Mguide, Inc. consists of: Components A, B, C, and D which have reliabilities of 0.98, 0.97, 0.91, and 0.95, respectively (see the following diagram). a. Use the Excel template Systems Reliability to compute the r
> Suppose that the design specifications for hydraulic cylinder are 10.00 0.10 centimeters, and that the Taguchi loss function is estimated to be L(x) = 1,400 (x – T)2. Use the Excel template Taguchi to answer the following questions: a. Determine the e
> For the situation in Problem 51, what are the economic design specifications if the cost of inspection and adjustment is $7.50?
> A quality characteristic has a design specification (in cm.) of 0.200 0.02. If the actual process value of the quality characteristic is at the boundary of the tolerance on either side, the product will require a repair of $30. Use the Excel template T
> Assume the specifications for a television remote control part (in inches) are 5.00 ± 0.10, and the Taguchi loss function is estimated to be L(x) = 5,500 (x – T)2. Determine the estimated loss per part if the quality characteristic (i.e., actual process
> Assume the specifications for a part (in inches) are 5.00 ± 0.37, and the Taguchi loss function is estimated to be L(x) = 9,300 (x – T)2. Use the Excel template Taguchi to determine the estimated loss if the quality characteristic under study takes on a
> University Medical Center needs to move from its existing facility to a new and larger facility five miles away from its current location. Due to construction delays, however, much of the new equipment ordered for installation in the new hospital was del
> The Davis national drugstore chain prefers to operate one outlet in a town that has four major market segments. The number of potential customers in each segment along with the coordinates are as follows: Find the best location using the Center of Gravit
> Given the location information and volume of material movements from a supply point (warehouse) to several retail stores for Bourbon Hardware, find the optimal location for the supply point using the Center of Gravity Excel template.
> Does the EOQ increase or decrease if estimates of setup (order) costs include fixed, semi-variable, and pure variable costs while inventory-holding costs include only pure variable costs? Vice versa? What are the implications? Explain.
> Refer to the information provided in Question 36 to answer the following questions using the Break-Even Excel template. a. If demand is forecast to be 3,500 parts, should the firm make the part in-house or purchase it from a supplier? b. The marketing de
> Forbelt Corporation has a one-year contract to supply motors for all refrigerators produced by the Ice Age Corporation. Ice Age manufactures the refrigerators at four locations around the country: Boston, Dallas, Los Angeles, and St. Paul. Plans call for
> Arnoff Enterprises manufactures the central processing unit (CPU) for a line of personal computers. The CPUs are manufactured in Seattle, Columbus, and New York and shipped to warehouses in Pittsburgh, Mobile, Denver, Los Angeles, and Washington, DC for
> Assume the cost factors given in Problem 42 have not changed. A marketing representative of NEW-SPEC, a firm that specializes in providing manual inspection processes for other firms, approached Paris Manufacturing and offered to inspect parts for $19 ea
> A manager of Paris Manufacturing that produces computer hard drives is planning to lease a new automated inspection system. The manager believes the new system will be more accurate than the current manual inspection process. The firm has had problems wi
> Suzy’s Temporary Employee (STE) business, located in a big city, can do an on-line criminal background check in-house for $1.29 per search with a fixed cost of $29,000. A third party on-line security firm offered to do a similar security search for $8.00
> A hospital is evaluating whether to outsource or perform in-house a large set of blood and urine laboratory tests. The fixed cost of the laboratory equipment located in the hospital is $800,000 and the weighted average variable cost per test if performed
> A company is considering three vendors for purchasing a CRM system, Delphi Inc., CRM International, and Murray Analytics. The costs of the system are expected to depend on the length of time required to implement the system, which depends on such factor
> 1. Write a short paper (maximum of two pages) on how the four principles of lean operating systems are applied to diamond mining. 2. If you were to design a jewelry store based only upon the four principles of lean operating systems—elimination of waste,
> Suppose that in Problem 37, a forecasting study determines that he probabilities of demand volume are Low = 0.2, Medium = 0.2, and High = 0.6. Use the Excel template Decision Analysis to determine the expected value decision. How appropriate is it to u
> 1. Develop a staff schedule between the hours of 9 a.m. and 8 p.m. for week 8, which had 587 visits (see the worksheet Hudson Jeweler Demand Case Data in MindTap). Assume the maximum service rate is ten customers per hour per store employee. You will hav
> Edwards Machine Tools needs to purchase a new machine. The basic model is slower but costs less, while the advanced model is faster but costs more. Profitability will depend on future demand. The following table presents an estimate of profits over the n
> A firm is evaluating the alternative of manufacturing a part that is currently being outsourced from a supplier. The relevant information is provided below: For in-house manufacturing: Annual fixed cost = $80,000 Variable cost per part = $140 For purchas
> Marine International manufactures an aquarium pump and is trying to decide whether to produce the filter system in-house or sign an outsourcing contract with Bayfront Manufacturing to make the filter system. Marine’s expertise is producing the pumps the
> What might the competitive advantage be for each of the following companies? a. eBay b. Southwest Airlines c. Starbucks d. Apple e. Facebook f. Uber g. 3M h. Amazon i. Bentley automobiles j. Nordstrom
> Investigate the current technology available for laptop computers, cell phones, or tablets. Select two different models and compare their features and operational characteristics, as well as manufacturer’s support and service. Briefly explain how you mi
> Research radio frequency identification devices (RFID) and provide examples of how they are or might be used to improve productivity in operations.
> Identify and describe (maximum of one typed page) a service encounter where technology helps create and deliver the service in total or in part. What hard and soft technology most likely is involved?
> Describe at least one application of modern technology in each of these service industries: a. Financial services b. Public and government services c. Transportation services d. Educational services e. Hotel and motel services How does your example appli
> Bloomberg Businessweek published an article titled “This Economic Model Organized Asia for Decades. Now It’s Broken” (June 21, 2017; https://www.bloomberg.com/news/features/2017-06-21/this-economic-model-organized-asia-for-decades-now-it-s-broken). Res
> Find, describe, and draw an organization’s sup- ply chain and identify the types of inventory in it and, if possible, their purpose and how they are monitored and controlled. (The example could be a place you worked such as a call center, restaurant, fac
> Identify and describe a queueing system of interest to you. Draw a picture of the system.
> In what queueing situations might you apply only analytical models? Only simulation models? Can you think of a situation where you might apply both types of models to a real-world problem?
> What are the analogies between Little’s Law and a single server queueing model?
> Select a service process and draw the flowchart using no more than 10 process steps. The service process can be based on your work experience, such as in accounting or human resource management, or a familiar process such as a quick-service auto- mobile
> Identify one example of a resource with a very low average utilization rate and a second example with a very high average utilization rate. Consider both service and manufacturing organizations. Write a short (one page typed) paper that describes these s
> What types of jobs are best suited to apply learning curves? How would you determine this?
> Research and write a short paper (two pages maximum) on two examples of revenue management applications not in the text and explain how they help organizations.
> Briefly describe a business you are familiar with and explain how it might use each of the five ways to adjust its short-term capacity levels.
> How might a college or university with growing enrollment use the capacity expansion strategies in Exhibit 10.6? Discuss the pros and cons of each of these.
> Define useful capacity measures for a(n) a. brewery. b. airline. c. movie theater. d. pizza restaurant. e. amusement park.
> Provide some examples of short- and long-term capacity decisions different from Exhibit 10.1.
> Luke Steffie owns a balloon store and must fill balloons with helium and assemble them into certain configurations today for six major parties. His six customer jobs all need to use the same helium tank (that is, the single-re- source processor). Each jo
> Can you identify a focused factory in a service facility? Explain.
> Research and write a short paper (2 pages maximum) on organizations that have successfully used the focused factory concept.
> Provide and discuss some examples of economies and diseconomies of scale in a college environment.
> Search the Internet for some time-series data that relates to sustainability, for example, environmental emissions. What types of patterns do these data exhibit? Apply forecasting techniques in this chapter to forecast ten years into the future.
> Research and write a short paper (two pages maximum) that summarizes the capabilities of commercial software available for forecasting. How does such software compare with using Excel?
> Interview a current or previous employer about how he or she makes forecasts. Document in one page what you discovered, and describe it using the ideas discussed in this chapter.
> Looking back at the chapters you have studied so far, discuss how good forecasting can improve operations decisions in these areas.
> If a manager asked you whether to use time-series forecasting models or regression-based forecasting models, what would you tell him or her?
> Suppose that you were thinking about opening a new restaurant. How would you go about forecasting demand and sales?
> Discuss some forecasting issues that you encounter in your daily life. How do you make your forecasts?
> 1. Customer demand (weekly visits) at Hudson Jewelers is highly seasonal, as shown in the worksheet Hudson Jeweler Demand Case Data in MindTap (these data were used in Chapter 9 for forecasting). In the context of aggregate planning options (Section 14.2
> Research and write a short report (maximum of two typed pages) on green facility design making sure that you incorporate some of the key topics in this chapter.
> How might sustainability issues be incorporated into the design of facilities and workplaces? Provide examples and explain your reasoning.
> List the ergonomic features of your automobile’s interior and discuss any improvements that you can identify.
> What is the role of ergonomics in job design? What factors do you think are the most important?
> Research and write a short paper (1-page maximum) on the advantages and disadvantages of virtual teams in today’s digital environment.
> What do you think of Cargill Kitchen Solutions’ 20-minute job rotation approach? Would you want to work in such an environment, or one in which you performed the same tasks all day. Why?
> Do you think the following jobs require standard times? Explain your reasoning. • Carpet installers • Software programmers • Cable T.V. installers • Hotel maids • Bank tellers • Airline flight attendants • Dentists • Medical Doctors • Restaurant reserv
> How is assembly line efficiency related to unit cost? Explain.
> What type of layout is typically used in a home kitchen? Can you suggest an alternative layout that might have some different advantages?
> Many company cafeterias are changing from the traditional cafeteria (process) layout to a product layout in which food items are arranged into stations (salads, Italian, cold sandwiches, roast beef and ham, etc.). What types of layouts are these? Discus
> The process of obtaining a mortgage for a house or condominium is more complex than most people think. It starts with an application that contains all pertinent information about the borrower that the lender will need. The bank or mortgage company then i
> Visit a manufacturer or service organization and critique their facility design. What are the advantages and disadvantages? How does the layout affect process flows, customer service, efficiency, and cost? Describe the basic types of materials-handling s
> Research and write a short paper illustrating how an organization uses one of the following types of facility layouts: • Product layout • Process layout • Cellular layout • Fixed position layout
> Describe the layout of a typical fast-food franchise such as McDonald's. What type of layout is it? How does it support productivity? Do different franchises (e.g., Burger King or Wendy's) have different types of layouts? Why?
> Discuss the type of facility layout that would be most appropriate for: a. printing books, b. performing hospital laboratory tests, c. manufacturing home furniture, d. a hospital, e. a photography studio, and f. a library.
> What are the advantages and disadvantages of each of the major types of layout patterns? Provide one example of each type of layout for goods-producing and service-providing firms.
> Identify several sources of errors as a student or in your personal life. Develop some poka-yokes that might prevent them.
> Develop a value stream map for the process you flowcharted in Question #27 to identify the value-added and non-value-added activities. How can you estimate costs and/or revenue for the process steps?
> Draw a flowchart for a process of interest to you, such as a quick oil-change service, a factory process you might have worked in, ordering a pizza, renting a car or truck, buying products on the Internet, or applying for an automobile loan. Identify the
> What sustainability issues are present in the example restaurant order fulfillment process example (Exhibits 7.6 and 7.7)? What other restaurant processes need to include sustainability criteria in their design and day-to-day management?
> Discuss how sustainability might be incorporated into a process or value chain improvement initiative. Try to find an example and summarize it in a manner similar to that in the box feature on Alfa Laval.
> The BOM, current inventory, and lead time (in months) for the in-line skates in Rocker Industries (A) case is shown in Exhibit 14.37. Using the chase demand strategy, you developed in Rocker Industries (A), develop a complete MRP week-by-week schedule us
> Design a process for one of the following activities: a. Preparing for an exam b. Writing a term paper c. Planning a vacation
> Provide some examples of customer- and provider-routed services that you have encountered that are different from those described in this chapter. Can you identify any improvements to these processes?
> Use the product-process matrix to explain the implications for Boeing in changing from a project focus to more of a flow shop process as explained in the box "Rethinking Airplane Manufacturing Processes. Limit your discussion to one typed page.
> List some common processes that you perform as a student. How can you use the knowledge from this chapter, such as identifying bottlenecks, to improve them?
> What type of process – project, job shop, flow shop, and continuous flow – would most likely be used to produce the following? a. Gasoline b. Air-conditioners c. Specialized machine tools d. Ships e. Producing many flavors of ice cream
