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First of all, in the scopes of this research paper it is important to rely to the background of the theory.  In the time frames after the World War II, the world markets have been dominated by the technologically advanced and high quality products, manufactured in USA. Afterwards, in the 1970-s, the oil shock has taken its place, the set of the economical advantages, having been associated with the cheap petroleum have been lost and the Asian and European recovered economical systems have become the strong competitors to the US manufacturers and to the US health care providers in particular. It is important to place an emphasis on the fact that after such new trend occurrence, US has lost its ability of insulating the industries from the customer oriented approaches, which have been developed by Asian and European manufacturers.

It is obvious that with the rapid development of the industries worldwide, the need of their qualitative and quantitative analysis and that of the possible mistake reduction has occurred. There has been a set of the quality methods, which have assisted US industries in order to reduce the defects and to minimize the costs, improve the quality of the products or services and finally for becoming more customer focused. While realizing the fact that the quality gap in such countries as Japan is in process of its minimization, US has started looking for the set of new approaches, directed for the customers’ satisfaction assuring and cost reduction. Also, these new approaches are expected to assist the product faster moving to the particular market. In the USA such approaches imply the following maxim: "better, cheaper, faster."(Bariani et al, 2004)

It is important to pay additional attention to the fact that the set of widely applied approaches and Quality Function Deployment are mainly developed for evaluation of what to be solved but at the same time, the ways how to solve some technological issue is not implied by this approach.

While referring to the Theory of Inventive Problem Solving (TRIZ), it is necessary to pay additional attention to the fact that there are laws  which are implied by this approach. Law of Increasing Ideality is one of them. That, in turn, means that the increasing degrees of ideality are evolved into the technical systems.  The ideality is defined as the quotient of the system's useful effects sum (Ui), divided by its harmful effects sum (Hj).

The entire set of the of the system functioning valuable results is included into the Useful effects. The following undesired inputs: footprint, cost, pollution, consumed energy danger, etc. are included into the harmful effects.

The ideal condition for the system is when there are not any harmful effects - only benefits.  From the design point of view, the engineers are expected to pursue lower cost of labour, greater benefits and minimize the energy and material consumption and to avoid the harmful side effects.

It is acceptable when, in the case of the increased harmful effects, the benefit results are improved by the trade off. At the same time, in accordance with the Law of Ideality, the designers are expected to eliminate completely or to solve the design contradictions or trade-offs.  The ideal expected outcome is when there is a beneficial function without machine itself.

TRIZ Process Step-By-Step

 As it has been discussed above, the acceptable theory of invention should be known to the inventors in the light of the following the general approach towards the problem solving. The first step of the TRIZ analysis implies the identification of the problem.  The founders of TRIZ analysis - Alla Zusman and Boris Zlotin have developed the "Innovative Situation Questionnaire “ for the studied system identification in the light of the following issues: resource requirements, operating environment, harmful effects, primary useful function and, finally – ideal result.

The second step is the problem formulating through the TRIZ Prism. That means that the problem is restated in the terms of physical contradictions. Those problems, which have the probability of occurrence, are identified. Also, the probability of situation when improvement of one characteristic being directed for the problem solving causes another problem, should be identified. Also, the identification of the possible conflicts, which may force the trade off, is carried out at this stage.

The third stage implies the search and evaluation of the previously well-solved problem. The fourth stage implies search for the analogies which may be furthermore adapted and applied for the particular case. Forty inventive principles have been extracted by Generich Altshuller from the world wide patents. These solutions are the hints, which may assist the engineer in the highly inventive solution to the problem search. The 40 Inventive Principles, outlined Generich Altshuller are the following: extraction, segmentation, nesting, asymmetry,local quality, combining. universality, counterweight, prior action, prior counter-action, cushion in advance, inversion, equipotentiality, dynamicity, spheroidality, periodic action, mechanical vibration, continuity of a useful action,, rushing through, convert harm into feedback, benefit, self-service, mediator, copying, hydraulic or pneumatic construction, mechanical system replacement, homogeneity, flexible membranes or thin films, porous material use, changing the colour, regenerating and rejecting parts, transformation of the chemical and physical states of an object, thermal expansion, phase transformation, use of strong oxidizers, inert environment and composite materials.

  1. Additional TRIZ Tools.

 Another issue to discuss in the scopes of this research paper is the Additional TRIZ Tools.  It is important to put an emphasis on the fact that even while taking into account the variety of engineering options, offered by TRIZ, it can be adapted in the different kinds of problem solving in other industries and in the health care, in particular.

The entire technique, which has been described above is not a complicated one, but the user should pre-formulate the problem in the standard engineering parameter terms. The exhaustive set of solutions is rarely offered by TRIZ, but at the same time, it is primarily applied for solving level two type problems. For more complicated problems, there are other approaches – such as ARIZ (Algorithm for Inventive Problem Solving), Anticipatory Failure Determination (AFD), Directed Product Evolution (DPE) and Su-Field Analysis.

TRIZ with QFD(Quality Function Deployment)

 While taking into account the fact that TRIZ is designed for helping the developers and engineers in new technologies inventing and technical contradictions solving, its practical application in the New Product Development (in the case of the health care establishments, the new health care services are considered the “ new product”). While combining the new product with the Quality Function Deployment (QFD), the health care establishment needs to manage to determine the core requirements of its patients (clients) and after that, to solve effectively the technical problems, which may occur in the health care services providing and in their documentation, in particular.

With the help of TRIZ it is also possible to identify the levels of performance for achieving the best level of the quality.  In the table 1, the cases when the TRIZ and QFD may complement each other in the light of the health care services providing.

Table 1. Simultaneous using TRIZ and QFD

Phase  of Development

QFD Deployment

Benefit of TRIZ and QFD

Market Research

7 Tools of healthcare service planning

Practical application of the Directed Product Evolution (DPE), while using the concept methods in order to   demonstrate to the patients what the new health care service will be like.

R&D

Technology Deployment

 For engineering contradictions and contradictions and bottlenecks solving in documentation  process

 

Quality Deployment

 For eliminating the Quality contradictions. The quality standards both for the health care services and their documentation forms are set by the Ministry of Health of a particular country.  

 

 

Assists in  Quality Planning Table target values determining

Design

Function Deployment

Applying the Su-Field Analysis and DPE for the new functions to attract the customer identification.

 

Reliability Deployment

Using the Anticipatory Failure Determination for the services’ failure modes identification and their prevention.

 

Cost Deployment

Use TRIZ for the costs lowering while avoiding the trade offs.

Practical application 

Process Deployment

Design constraints removing in accordance with the people and process limitations.

 The last issue to discuss in the scopes of this section is the software, used for the TRIZ practical implementation in the health care establishments. TRIZ is built on database which, in turn, consists of thousands principles, patents, contradictions, operators, etc, the engineers may achieve the desired result within the limited time frames.

In the scopes of this paper it is important to outline the most popular types of software, Applied for TRIZ analysis (table 2).

Table 2: The most popular types of software, applied for TRIZ analysis

Name of software

Purpose of its practical application

Improver

existing design improvement

system performance improvement

system quality improvement

manufacturing cost improvement

patent application improvement

product feature improvement

Ideator

ARIZ assists in the system creation abstract models: contradiction formulation and ideal situation envisioning, in particular

Idealization is the process, which tends to bring the system close to ideal. 

Innovation Mini-Guide includes nearly 100 technical applications of chemical, physical effects.

Eliminator

The Idealization Appetizer is developed for assistance in finding innovative solutions of problems while avoiding the trade-offs or drawbacks.

 2. ROOT CAUSE ANALYSIS

1. Background of the Root cause analysis.

First of all, in the scopes of this chapter it is important to pay attention to the fact that the root cause analysis (RCA) is the problem solving technique, which is mainly applied for the causes of problems or faults being the reason of the operating events (in our case the failures in the medical documentation) identification.  One of the main features of such analysis is that it is tending to find the solutions for the problems, while applying the root causes identification and correction, but not just their symptoms addressing. According to the RCA approach, the recurrence complete prevention may be achieved by focusing of the correction process on causes. At the same time the adherents of RCA recognize the fact that there is not always the possibility of complete reoccurrence prevention while applying the corrective actions only. There can be a set of the effective approaches (measures or techniques), which are directed for the root causes of a problem addressing. That is why it is possible, to consider the RCA as the iterative process, which in majority of cases is applied as the continuous improvement approach.

Usually, RCA is used as the identifying cause reactive method. It reveals the problems and solves them. The analysis process is carried out after the occurrence of a particular event. The value of the RCA is a pro-active method – its insights. That is why it is possible to apply RCA for forecasting the probable events or for their prediction even before their occurrence. While taking into account the fact that in the practice the events follow one after another, the RCA is considered as a completely separate process to Incident Management..

At the same time, it is incompetent to say that the root cause analysis is a sharply defined and single methodology due to the fact that there is a set of different procedures, tools, philosophies and processes for the RCA performing. It is possible to outline a set of broadly defined approaches or "schools” by their field of origin or basic approach: production-based, safety-based, process-based, systems-based and failure-based.

While referring to the Safety-based RCA, it is derived from the accident and occupational safety and health analysis areas. The Production-based RCA is related to the quality control of manufacturing (in our case of the health care services providing and their documenting).

The Process-based RCA is mainly grounded on the production-based RCA, but its scopes are extended to the process of health care service providing. The Failure-based RCA takes into account the failure analysis practice and it is mainly applied in the engineering process and in the maintenance. Finally, the Systems-based RCA has occurred as the preceding schools amalgamation along with the approaches, borrowed from the following scientific areas: risk management, change management and system analysis.

There is still a set of the common and integrative principles for them. That is why the next step of the research is identification of the set of general principles applied for the RCA performance. 

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