Design And Provision Of Healthcare Services – Baker IDI Heart And Diabetes Institute

Baker IDI Heart and Diabetes Institute

Thus report will explicitly revolve around the designing and provision of a service. Specifically, the service is “Healthcare”. The company’s name is Baker IDI Heart and Diabetes Institute or simply Baker Institute. Notably, Baker Institute is a private medical research institute in Australia with its headquarters in Melbourne, Victoria. The institute was established in 1926 and has a good reputation especially on its efforts towards controlling cardiovascular diseases. The institute majorly conducts independent research on the implication of various complications such as diabetes and obesity among other cardiovascular conditions (Baker, 2012).

In addition, Baker Institute extends its healthcare services to extensive community based studies with a particular focus on the diagnosis, disease prevention and possible treatment of cardiovascular conditions and diabetes. The institute also has comprehensive clinical services that entail proper diagnosis and relevant medical advice. Most of the wide-scale research conducted by Baker Institute majorly targets these killer diseases. The institute is therefore very flexible and innovative in its response to the transforming healthcare and community needs of the contemporary society.

According to WHO (World Health Organisation), Australia’s ageing population is on the rise, and so is cardiovascular conditions such as heart diseases (WHO, 2010). The core mission of Baker Institute is to ensure a reduction in deaths and disabilities resulting from diabetes among other related disease conditions. Therefore, Baker Institute aim at addressing these contemporary health-related challenges and improving the health status of the Australian population.  

Currently, Baker Institute is best positioned address these health concerns. This is because the hospital has a team of diverse professionals such as cardiologists, physical activity experts and epidemiologists among others who are constantly researching on various prevention, care and treatment procedures of these disease conditions.

Baker Institute’s strategies stipulates five distinct programs that are subsequently listed in the table below.

Program	Role
Metabolism and inflammation	Under this program, Baker Institute aim at ascertaining the role of inflammation in the start and advancement of diabetes among other chronic conditions.
Atherothrombosis and Vascular	Under this program, Baker Institute analyses possible ways of identifying and treating the stipulated disease conditions.
Diabetic complications	Under this program, Baker Institute is conducting relevant research on how to successfully prevent the development of diabetes.
Behavioural and generational change	The institute also designs how various behavioural patterns can contained among diabetes and chronic patients.
Hypertension and Cardiac Disease	Under this program, Baker Institute is conducting thorough research on how chronic heart diseases can be reversed. The institute also studies the prevention and repair of structural damages to the patients’ hearts as a result of hypertension among other chronic conditions.

Table 1: Baker’s distinct programs

Source: Author

Baker Institute has both the internal and external shareholders. The table below shows a list of internal and external stakeholders of the Baker Institute.   

Internal shareholders	Responsibilities and expectation
The board of Advisors of Baker Institute	· The governing body of the institute · Overseeing the strategic development of the institute · Developing relevant policies and processes
The medical director of Baker Institute	· Responsible for overseeing various activities that are related to quality delivery of medical and clinical care · Managing the activities of hospital’s physicians    · Handling various medical patient complaints · Managing the Institute’s relation with the community · Monitoring the quality and relevance of medical and clinical care provided by the institute
Diverse medical specialists such as cardiologists and diabetes physicians among other bench-top scientists	· Responsible for the translation of the laboratory findings and to establish how to best prevent, treat and care for patients    · Conducted treatment among other therapeutic services to the clients
Hospital administrator	· Responsible for overall regulation of every facet of medical activities at the institute · Acting as the liaison among the Institute’s governing boards and other stakeholders · Responsible for the organisation, direction, control and coordination of medical services at the institute · Involved in the recruitment, hiring and evaluation of other hospital personnel
External Shareholders
Patients	· Are the primary reason why the Institute is in operation · Benefits from the competent personnel and the outcome of the variant research.
Local and international partners	· Facilitates the Institute’s research programs through pooling resources · Help the institute to maximise its impact on global healthcare provision
The Australian Government	· Subsidises certain important research programs that are pertinent to the Ageing population · Offers tax breaks to the Institute’s numerous important research activities · Ensures the rights political setting and goodwill to allow the Institute to conduct it activities
Non-profit organisations	· Local churches and charity organisations occasionally donate cash to fund the Institute’s diverse medical research

Table 2: Stakeholder Analysis

Source: Author

To effectively capture the Institute’s clients’ diverse needs, the organisation will apply varied techniques that will include the following:

• Patient interviews
• Survey questionnaires
• Focus groups

Interviews are relatively cheap and clear method of collecting important data and information from the respondents (National Center for Health Statistics, 2010). Through interviews, the aggregation of patients’ varied needs is made possible. For successful interviews, a number of issues must be made clear (King and Horrocks, 2010). First, the patients to be subjected to the interviews, when the interviews are to be undertaken and the medium of communication that include through telephone or face-to-face.

Baker Institute’s Programs

Moreover, the interviewee is required to prepare a list of questions that will facilitate the collection of relevant data and information (Rowley, 2012). These questions must relate to the specified or perceived patient needs and give a special interview structure. After aggregating the targeted information, comprehensive analysis ensues to better comprehend and classify the patients based on specific attributes. Interview as a method of data collection will provide the interviewer with pertinent qualitative data that can be used to establish best solutions on how to satisfy all the needs of the Institute’s customers.      

Designing and distributing questionnaires to the patients will enable the institute to better understand the patients’ needs. This method of data collection is relatively cheap and effectively captures the diverse needs of the respondents (Harkness,et al., 2010). This is because most of the responses are subjective opinions of the patents with no second party to engage the patients.

Therefore, the questions listed in the survey will majorly focus on the quality of healthcare provided at the Institute. This will enable the organisation to obtain reasonably accurate responses that will facilitate subsequent customer satisfaction. Therefore, the quality of the questions must be taken seriously as this will largely determine the level of accuracy of the responses.

This can be made possible through the provision of various range level (for instance 1-5) that indicates the patients’ level of satisfaction, displeasure, affability and perceived level of distastefulness based on the speculated outcome that the patients will be required to act on. Notably, survey questions can significantly capture the needs of the patients based on the aggregated responses.

Characteristically, focus groups can comprise of 5-8 patients, both currently at the hospital or those that have been discharged (Krueger, 2014). The Institute will then bank on the communication between these individuals from which they will derive some qualitative data and evidences. Under this method, the organisation encourages the participants to engage in fruitful discussions on their perceived needs and factors they consider pertinent. The focus group leader is encouraged to ask open-ended questions to encourage the individuals to give more information on the subject. The possible result is a precise data and information on patients’ diverse needs (Stewart and Shamdasani, 2014).

2.3 Customer Needs Analysis (Kano Analysis)

To articulately capture the perceived patients’ needs, the report used survey questionnaires (Chaudha et al., 2012). Through this method, Baker Institute formulated a progressive 5-steps procedure subsequently stipulated below.

Customer Satisfaction

Figure 1: The survey questionnaire process

Source: Chaudha et al. (2012)

The primary goals and objectives of the survey include:

• To Providing Baker Institute with the requisite information on patients’ needs
• To avail tangible evidence of possible patients discontent and areas where the hospital can still register improvement.  
• To provide special insight on the design and provision of healthcare services by the institute.

The survey plan will include conducting the survey questionnaire at the hospital premises and visiting patients who have already been discharged. This will enable the Institute to reach to an expanded number of survey participants (Zare Mehrjerdi, 2010). The projected sample size is approximately 300 patients which will depend on the patients that shall be reached at the time of conducting the study. Notably, only present and past patients of Baker Institute will be allowed to participate in the study. This will help increase the level of accuracy of the anticipated outcome.

Relevant questionnaire based on the stipulated goals and objectives is developed and tested. Under this step, every study respondent will be required to respond to certain scores on the significance of and satisfaction with Baker Institute services.          

Below is a sample of the questionnaire that will be designed and tested.

1. How long have you been a client at Baker Institute?
2. Less than 1 year       B. 1-2 years       C. 2-3 years
3. 3-4 years                      E. More than 4 years
4. Do you plan to continue visiting Baker Institute in the future?
5. Yes                           B. No
6.  What motivates you to commit to Baker Institute?
7. Comprehensive patient care               B. Competent workforce  
8. Good relationship with the patients    D. Others_____ (Please specify)
9. In your opinion, what more should Baker Institute do to encourage attract more patients?
10. Improved personalised care                      B. Improve its technological applications  
11. Constant provision of quality healthcare   D. Improved patient-nurse relationships
12. Is Baker Institute your preferred hospital?
13. Yes          B. No

1. Please indicate your gender
2. Male      B. Female
3. Please indicate your age by ticking accordingly
4. 18- 25 years old     B. 26-35 years old       C. 36-45 years old
5. 46-55 years old      E. Over 55 years old

Under this part, the respondents will be kindly requested to give their subjective opinions based on various scores are on a scale of 1 to 5, where 1 implies you “Not very Important” , 2: “Somewhat Unimportant”, 3: “Somewhat Important”, 4: “Important” and 5: “Very Important”.

Item	Not very Important	Somewhat Unimportant	Somewhat Important	Important	Very Important
Highly motivated and competent staff
Comprehensive goals and objectives towards the provision of healthcare services
Good patient care
Massive investment on healthcare technologies
Comprehensive care program after discharge
The Institute still needs to improve on certain areas such as disease diagnosis
Improved condition of the rooms
More personalised care programs

Source: Author                       

The provided scale will assist the study respondents to respond based on rationality and subjective opinions (Zare Mehrjerdi, 2010). Based on the above survey questionnaire template, a trial run is conducted through actual distribution of the questionnaires. This will enable the organisation to explicitly ascertain the validity of the responses. The collected outcome from the targeted 300 respondents will then be summed (as shown in the table below) and subjected to a statistical analysis.          

	Musts	Wants	Extras
Cumulative Score	Greater than 1500	1000-1500	Less than 1000

The study will then be conducted based on the above stipulated questionnaire template.

The projected results are subsequently tabulated.  Moreover, the aggregated results (shown in the table below) will be subjected to a comprehensive statistical analysis.       

Item	Cumulative score	Average score
Highly motivated and competent staff	1550	4.0
Comprehensive goals and objectives towards the provision of healthcare services	1420	3.8
Good patient care	1550	4.0
Massive investment on healthcare technologies	1550	4.0
Comprehensive care program after discharge	1420	3.8
The Institute still needs to improve on certain areas such as disease diagnosis	1580	4.1
Improved condition of the rooms	1550	4.0
More personalised care programs	1550	3.8

Table 6: Results analysis

Source: Author

From the above outcomes, the survey questionnaire, Baker Institute can classify each patients’ needs and address them appropriately (Zare Mehrjerdi, 2010). These are briefly classified in the table below as musts, wants and Extras.    

         

Figure 2: Customer satisfaction

Source: Adapted by the author

The stipulated patient inherent desires and requirements at the institute are correlated to specified service design requirements using the QDF (Quality Function Deployment) technique (Sharif Ullah and Tamaki, 2011). The impotence (significance) rating is then aggregated from the average score established from the completed patient survey questionnaire. To ensure increased accuracy and uniformity in the whole process, the values are multiplied by a constant value of 2. The perceived relationships are recorded based on a logarithmic value system of between 1 and 9 where 1 depicts a weak connection while 9 represent a strong connection. See the table below for detailed analysis of the QDF form.  

Stakeholder Analysis

	A	B	C	D	E	F	G	H	I	J	K	L
1	Customer requirements	Importance ratio	Design Requirements
2	Competent staff	More donor funding	Air conditioned rooms	Improved diagnosis	Enhanced follow-up programs	Constant patient review	New healthcare technologies	Specialised staff training	Comprehensive emergency services
3	MUSTS	Good patient care	10	0	0	10	8	8	5	0	0	7
4	Increased investment in technology	8	0	10	0	0	0	0	10	8	0
5	Improved disease diagnosis	5	8	0	0	9	0	0	10	6	0
6	WANTS	Highly motivated and competent staff	8	8	0	0	9	0	0	0	6	8
7	Good-nurse patient relationships	9	6	0	0	0	9	5	0	0	0
8	EXTRAS	Improved conditions of the rooms	10	0	5	10	0	0	0	0	0	0
9	More personalised care programs	5	0	0	0	0	10	8	0	0	0
10				Academic background	Increased transparency	Room renovations	Modernised technologies	Check-ups after discharge	Close monitoring	Replace the obsolete ones	Increase competency	Quick and quality services
11		Absolute score		158	130	200	117	211	125	130	142	134

Table 7: Baker’s QFD

From the above table, academic backgrounds, room renovations, check-ups after discharge and increased competency have got highest numbers. It means that the items that received higher and more favourable ratings have the highest impact on the services that the institute will provide to its patients. For example, cell E4 assert that more donor funding will enable the purchase of more specialised and modern healthcare technologies. Also, cell F3 assert that air conditioned rooms is a requisite for good patient care. On the other hand, cell J5 implies that new healthcare technologies will results into improved disease diagnosis.      

Source: adapted by the author

	A	B	C	D	E	F	G	H	I	J	K
1	Function	Failure Mode	Effect of Failure	S	Causes/Failure Mechanism	O	RPN	Recommended Action	Action Result
2	S	O	RPN
3	Institute administration	Ineffective strategies and unfavourable work conditions	Employee turnover and patients shifting to other healthcare centres	5	Undefined values and directions	5	15	The institute administrator should clearly define the company’s mission, vision and long-term strategies on how improve operations	4	2	4
4	Service delivery	Not conducting conclusive research on disease diagnosis	Most of the patients will receive wrong disease diagnosis	4	Incompetent staff and defective medical equipment	4	20	The institute should hire competent and experienced medical practitioners. Should direct massive investments towards new equipment	5	1	5
5	Donors and international partners	Withholding certain incentives and financial assistance	Limits the operation of the company	5	Fraudulent activities at the institute			The institute should directly engage its international partners and donors and assure them of increased value on their investment	5	1	5
6	Working conditions	Personnel got infected by some contagious diseases	Delay in buying the right medical gears such as quality hand gloves and lab coats	5	The institute administrator is complacent	4	18	Procure relevant equipment and improve the work conditions	4	1	4
7	Patient satisfaction	Reducing patient satisfaction	Shift to other health institutes within Melbourne	4	Reduced personalised care and slow disease diagnosis	3	12	Enhance its service provision in the specified areas.	4	2	6

Table 8: Design Risk Analysis (FMEA)

Source: Author

Below is a brief description of what can be derived from the table above.

Comment: Number 5: The institute’s administrator should clearly define the organisation’s mission, vision and long-term strategies.

Comment: Number 5: Undefined values is the primary cause of administrative anomalies.

Comment: Number 3: Low administrative performance can be detrimental  

Comment: Number 4: Competent staff results in improved and quality service delivery      

Identifying the Components

Baker Institute’s major sections of service include:

• First medical equipment and other relevant accessories suppliers
• Baker Institute that comprise of a team of medical specialists, scientists and public health experts
• The hospital medical team such as cardiologists and diabetes physicians among other bench-top scientistsare focussed on bringing their knowledge and expertise to ensure full diagnosis and treatment of chronic conditions.
• Institute administrator ensure smooth running of all administrative processes at the institute. Also involved in the recruitment of hospital personnel.    
• Local and international donors provides financial and material support to the hospital’s course.
• Government: Baker Institute cooperates with the Australian government to provide viable health solutions to the country’s ageing population.
• Developing the Supplier Selection Criteria

Under this part, First medical equipment and other relevant accessories suppliers is scrutinised based on the following criteria.

• The projected price of the medical equipment supplies
• The projected delivery price of the equipment
• The probable time and location of the delivery of the equipment
• The location of medical equipment suppliers
• The return policy on the supply of medical equipment supplied
• The perceived quality of the medical equipment
• The market reputation of the contracted medical equipment supplier
• The expanded range of medical supply materials
• Environmental impact of disposing the medial equipment     
• Constructing and Using a Supplier Selection System

The subsequent supplier table is tabulated based on the significance ratio as shown below.

Less significant	Significant	Very significant
1-2	3.4	5

	Significance ratio	Sydney Medical suppliers	Melbourne MS	Jovren Suppliers international
The projected price of the medical equipment supplies	5	5	4	3
The projected delivery price of the equipment	4	5	5	5
The probable time and location of the delivery of the equipment	4	4	4	5
The location of medical equipment suppliers	3	5	5	3
The return policy on the supply of medical equipment supplied	2	2	3	5
The perceived quality of the medical equipment	4	5	5	5
The market reputation of the contracted medical equipment supplier	5	5	5	5
The expanded range of medical supply materials	2	3	4	4
Environmental impact of disposing the medial equipment	2	5	4	3
The projected price of the medical equipment supplies	4	2	5	5
Total		146	155	146

Table 9: Supplier Selection System

4.4. Conclusion: Report on the results of supplier selection process  

From the table above, Melbourne MS Company recorded the highest number at 155. Therefore, Baker Institute will settle on Melbourne MS Company to supply most of its medical equipment (Harju, 2010). The significance ratio will help Bake Institute to make this important decision. The table further shows that the projected price of the medical equipment and quality of the machines recorded the highest weight of 5. Besides, the price of delivering the medical equipment, the projected delivery time and return policy on the equipment recorded a weight of 4.   

Sydney Medical suppliers and Melbourne MS Companies recorded very close tallies apart from the projected damage on the environment. Also, Jovren Suppliers International charges its medical equipment expensively compared to other two companies. The lowest score recorded under Jovren Suppliers is 3 which is relatively low. Also, the price of delivery charged by Sydney MS Company is much less compared to Melbourne’s with a significance ratio of 4. On the projected environment effect Sydney recorded a 2 with a significance ratio o4 4 while Melbourne recorded 4.                  

Capturing Customer Needs

 The following processes significantly contributes the operations of Baker Institute.

NO.	Process	Process details
1	Receiving the patients	The hospital’s medical specialists then subject the patient to intense medical examination or therapy to ascertain or diagnose the disease and recommend various treatment procedures. Laboratory specialists takes various samples from the patient for purposes of analysis
2	Analysing the outcome of the patient lab analysis	The results are properly analysed to accurately determine or diagnose the condition the patient might be suffering from. The results are forwarded to relevant medical experts who are tasked with providing and recommending diverse treatment options.
3	Providing personalised care	Depending on the outcome from the above lab analysis, the patients are subjected to an intense personalised care program. This enables the institution to keenly watch their response to the recommended treatment procedures.
4	Risk analysis	Wide-ranging risk analysis is carried out to ascertain the projected impact of the recommended medical procedures or treatment options
5	Patient’s past medical records	Past medical reports and data will enable the Institute to conduct proper diagnosis and recommendation of proper treatment options
6	Patient approval	The Institute is obliged to seek patients’ approval or the consent of a guardian or any other interested party before conducting a treatment procedure
7	Designing and approving relevant medical procedures and equipment	This include ensuring that the medical procedures or treatment options are the most relevant and strictly based on the outcome lab analysis.
8	Conducting the relevant medical procedures	Relevant medical procedures are conducted based on the patients’ conditions and outcome of the lab analysis
9	Patient discharge	After conducting every relevant procedures or recommending various treatment options, the patients are then discharged from the institute.
10	Follow-up program	A patient follow-up program after discharge helps the Institute to manage the patients better. This prevents possible reoccurrence or worsening of the disease condition. The primary objective of this process is to limit or avoid possible cases of readmission.

 Table 10: Baker’s processes

According to De Vries and Reneau (2010), the statistical process control (SPC) charts are some of the most effective tools that are used in visualizing and pin-pointing various statistical inconsistencies in a particular process performance by an institution. Research by Qiu (2013) further stipulates that statistical process control (SPC) charts details important data and information on the effectiveness of various processes (Chang and Yadama, 2010). This is specifically possible through graphical representation of such data and information based on the processes performance. Through statistical process control (SPC) charts, the organisation can ascertain the accuracy of a particular procedure.

Some of the primary components of statistical process control (SPC) charts include the control line (CL) which is used in the identification of the average of the processes and the upper control limit (UCL) that majorly categorises the tolerable deviation areas (Suhairi and Gaol, 2013). Others include the lower control unit (LCL) which is also used to classify tolerable deviation areas, the upper specification limit (USL) and the lower specification limit (LSL) (Qiu, 2013).

In addition, attribute (discrete) and variable (continuous) data are the two major data sets that are used to facilitate the processes analysis.  Attribute data refers to the special quality features that are hard to represent numerically and can be represented using p-charts, np-charts, u-charts and c-charts.

This chart is used in plotting the fraction of such items that are considered defective. P-charts enables the accurate counting of such non-conforming items as a proportion of the provided sample size. Specifically, the chart is majorly used in monitoring various processes by giving the precise number of items that are considered “defective”. The identified variations are analysed to ensure and ascertain the level of conformity. The chart makes it possible to establish whether the sequence of values that are plotted do resemble any uncontrolled procedure, and a possibility of restoring such processes to full performance.

This chart is used to plot the established number of defective items that have been identified by the p-chart. The chart constantly monitors fixed sample sizes per day and conduct a thorough analysis of the statistical patterns. For example, is one of the medical processes at Baker Institute is established to be beyond the stipulated control limit, hospital’s management is immediately alerted for corrective actions.

This chart is used to plot various defective items that can be derived from a constant sample size. For example, if 3 defects are established in 1 of the medical equipment within a fixed sample size of 5, the c-chart will be used to register 2 defects per day. This chart is majorly important in the monitoring processes of medical equipment functions among other processes.                        

Patient Interviews

On the other hand, variable data are also referred to as continuous data that results from various measurements and are represented using IMR-charts, x-charts, x bar-charts, R-charts, c bar and s-charts.   

This charts applies measured data to analyse various patterns derived from value measurement and comparison of uncontrolled procedures. X-Charts are mostly useful when monitoring large sample sizes that may sometimes be tiresome and involving.

The charts are used to conduct in-depth analysis of processes. For instance, x-charts can be used to aggregate and plot average outcomes from particular subgroups (Ou, Wu, and Tsung, 2012). Through this charts, Baker Institute can articulately interpret and comprehend how its various medical facets are performing and identify possible areas of improvement.            

C-Chart is the most appropriate way of monitoring and analysing the processes of medical equipment functions at Baker Institute (De Vries and Reneau, 2010). The hospital administrator will sample 5 medical equipment on a daily basis to recognise the number of defects. Attribute type of data is therefore predominantly used in the construction of the SPC chart.

Through C-Charts, the administrator will be able to carefully monitor the decimal data of the procedures and count possible number of defects in the equipment rather than the percentage of the defects (El-Midany et al., 2010). In this particular case, the sample size is fixed at 5.

Some of the common elements of C-Chart include: C as the possible number of defects, C bar as the average number of the defects detected. Also, UCL = C bar +3 (C bar) (1/2) while LCL = C bar – 3 (C bar) (1/2) (El-Midany et al., 2010). The table below indicates various specifications.

Day	Number of defects	Sample size	C bar	UCL	LCL
K	C	5	8.5	17.24	-0.2264
Mon	4	5	8.5	17.24	-0.2264
Tues	6	5	8.5	17.24	-0.2264
Wed	9	5	8.5	17.24	-0.2264
Thurs	15	5	8.5	17.24	-0.2264
Fri	11	5	8.5	17.24	-0.2264
Mon	6	5	8.5	17.24	-0.2264
Tues	5	5	8.5	17.24	-0.2264
Wed	6	5	8.5	17.24	-0.2264
Thurs	10	5	8.5	17.24	-0.2264
Fri	12	5	8.5	17.24	-0.2264
Mon	8	5	8.5	17.24	-0.2264
Tues	10	5	8.517	17.24	-0.2264

 K = 12

N = 4

6.1. Identifying the Problems and Problem Solving Tools

Some of the problems that the medical practitioners and patients may face when dealing with the medical equipment to perform varied procedures include:

• Defective equipment
• Expensive equipment and medical procedures
• Unavailability of the medical equipment in the local markets
• Unclear diagnosis of diseases
• Patients may be too impatient to know their health conditions or to receive proper treatment
• Employee turnover is also a possible challenge especially if the working conditions are not conducive enough.   

Some of the problem solving techniques that can be used to mitigate the above challenges include:

• Gantt chart
• Cheek sheet
• Serious brainstorming
• Process flow chart
• Why-why diagram

The appropriate methods selected in this report to help in solving the above problems include (Aarikka-Stenroos and Jaakkola, 2012):

• Why-why diagram
• Brainstorming
• Check-sheet

Why-why diagram

This diagram will help Baker Institute establish some of the fundamental causes of the identified problems (Van Aken et al., 2012). The diagram below is a depiction of a why-why diagram that Baker Institute can effectively and solve some of the problems.         

 

Figure 3: Why-why diagram

Survey Questionnaires

Source: Adapted by the author

This method involve identifying specific problems and allowing a group of medical practitioners to discuss and ascertain the primary problems and possible solutions (Jonassen, 2010). For example, on the cost of medical procedures to patients, the group can brainstorm and involve the government, private institutions and donors to subsidise such costs.

Check sheet will enable the company to establish the primary or major reason behind the stipulated problems. The table 11 below is a sample of check sheet that the company can use (Jonassen, 2010).

Root Cause	Occurrence	Absolute	Accumulative %
Defective equipment	45	47.4	47.4
Expensive equipment and medical procedures	16	16.7	64.2
Unavailability of the medical equipment in the local markets	10	10.6	74.7
Unclear diagnosis of diseases	5	5.4	79.4
Patients may be too impatient to know their health conditions or to receive proper treatment	2	2.2	81.5
Employee turnover is also a possible challenge especially if the working conditions are not conducive enough.	7	7.5	88.9
Expensive equipment and medical procedures	10	10.6	100
95	100	100

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