4.0 Challenges of Operations ManagementThe challenges that hinder healthcare provider’s delivery system fail to align its operational performance measures include.4.1 Curb Core Operating CostsHealth care providers continue to seek different approaches to rein in the costs of their core operations, manage care variations from different service points and reduce utilization through standardization. Even high-end and performing organizations continue to obtain additional cost containment by taking a systems approach that is sometimes transparent and rigorous (Mosquera, 2014).4.11 Control Measures4.12 Advancing Roles of Advanced Care ProvidersAdvanced-care providers commonly referred as registered nurses (RNs) are always a beacon of hope for hospitals providers struggling with reimbursements and trying to reduce patient re-admissions. This means having enough registered nurses staff always help monitor admission checks and facilitate a clear communication pathway, giving room to physicians to take care of the more pressing and life threatening cases (James Ellis and Aaron Razavi, 2012).4.13 Developing Outpatient CentresDifferent centres in the healthcare from care centres, satellite emergency departments to ambulatory surgery centres all incur less operating costs than an emergency room in the hospital while providing financially impressive returns. The American Hospital Association (2006-2009) satellite emergency departments grew 25% and with hospitals operating them in at least in 16 states.Outpatient centres in the healthcare system promote health systems’ market share, allowing the hospital to offset uncompensated emergency room visits and continue to provide residents of rural communities, emergency care access close and proximal to them, with the end-product being the hospital branding its name (James Ellis and Aaron Razavi, 2012). 4.2 Lack of Proper Training and CommunicationFailure to proper training and development exposure always lead to hospitals having problems which subsequently lead to poor data quality during data registration, cause confusion, delays, time wasting and poor services standards (Weber, 2016).5.0 Lean Principles in the Healthcare Supply ChainLean can be described as a way of doing more with less. In healthcare supply chain it breaks down to meeting patients’ needs without compromising quality. This involves combination of less staff effort, equipment and space to increase on quality value at the same time minimize on waste simultaneously (Jones, James P. Womack and Daniel T., 1996). The five principles of a lean system include (Do, 2017):1. Define value from the standpoint of the targeted patient2. Map the value by eliminating steps that do not add value.3. Create a flow by having a sequence that allows the product to flow smoothly towards the patient.4. Establish a pull by letting patients have a pull value from the absolute upstream activity.5. Pursuit perfection by beginning the process again until a state of perfection is met. This means no waste after perfection is achieved (Catia M. L. Machado, 2014).Figure 3: Showing five lean principles In healthcare service, the patient always seeks for a cure or pain relief and that is what defines spot on value in healthcare. The process to achieve this vital goal is known as patient flow in healthcare. It not only relates to physical goods like pharmaceuticals, drugs, health aids and medical devices but also to all phases of their treatment from doctor’s referral to full recovery (Vries, F. and R. Huijsman, 2011).In order to practice these principles, many tools are used clearly indicated in shown in Figure 3. Popular tools include i. Kaizen blitz also referred as rapid improvement event, ii. Value stream mapping and iii. The six S’s i.e. (Sort, Straighten, Shine, Standardise, Sustain, Safety – also referred as 5S’s They are occasionally used to reorganize the working place. Rapid Improvement Event is normally a five-day workshop whose aim is to trace problems in the existing processes and suggests precise and quick changes (Fillingham, 2007). The three flow phases include i. A preparation period, ii. Followed by the event and iii. A three to four-week follow up period to implement the changes. Value Stream mapping key role is to eliminate wasteful activities by the active participation of all appropriate key players along the patient.Figure 4: House of Quality from Lean Principles (Gabriela S. Spagnol, Li Li Min, David Newbold, 2013) 5.1 Case StudyAccording to detailed articles, the key pioneers in using lean healthcare in United States of America included Virginia Mason in Seattle and Thedacare in Wisconsin (Institute for Healthcare Improvement, 2005). An example was in Virginia Mason Medical Center after 2 years of lean implementation (in 2002) a decrease in expenditures was recorded i.e. lead time (down 65%), (53% down in inventory), setup time (down 82%), people and product distance (decrease of 44% and 72%, respectively). These achievements were based on six different areas of focus: i. Being patient-centric as the key and number one driver for all processesii. Creation of an environment where people feel and comfortable to change and improvement, this also included the adoption of a no-layoff policyiii. The implementation of the organization wide defect alert referred as “The Patient Safety Alert System”iv. Encouragement of innovation and quickly trying new ideas or models of new ideas.v. Primary creation of a prosperous economic organization by waste elimination and vi. Leadership that is accountable (Kenney, 2011). On ThedaCare’s lean history, it centred its weekly meetings popularly referred to as Event Week in three tenets: i. Respect for people, ii. Experience teaching and iii. Primary focussing on top class performance (Toussaint, J., R.A. Gerard and E. Adams , 2010).6.0 General FindingsOperation performance measurement system should always be built with reference to the company’s strategy and vision (Kaplan, R. S. & Norton, D. P, 1996). Therefore performance indicators should be relatively simple and easy to measure to meet the company’s strategy and vision. The three interesting findings to be concluded include (World Health Organization, WHO, 2011).In the area of leadership, management and governance the below need to be adopted:i. Offer full support to the creation of well constituted and effective Boards of Governance structures that should aid in providing and developing effective ways of regulating governance.ii. Balance top and bottom level initiatives at organizational stage leveliii. Clearly understand with the aim to identify those elements of governance structure that are considered ineffectiveiv. Properly develop spot on governance between networks and organizations.v. Clearly understand and conceptualise quality leadership as well as management developmentvi. Be accommodative of trade-off between community orientation, health care and financial responsibilityIn the area of quality assurance that involve constellation of different stakeholders and a wide scope of tools and equipment such as certification and re-certification; quality standard checks; organization accreditation and re-accreditation as well as clinical guidelines the below need to be adopted:i. Accommodate managers’ involvement in the design of accreditation mechanisms with the aim to enhance their effectiveness in the process.ii. Develop safety learning tool kits to aim curb the risk that arise when they aren’t put in place.iii. Clearly define hospital information and requirements needs for reporting.iv. Properly constitute and develop at the same time implement peer review systems.v. Be supportive of effective governance.