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Application of "Value Engineering" to Rationalize the Cost of Cataract Surgery in Eye Clinic at Tata Main Hospital

S.P. Jakhanwal, G.B. Singh

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Topics

Function Phase

Objective: To assess its major function, cost and “relative worth”; and to determine functions which are being performed and those which must be performed by the item or system under study.

In “VE”, function is best expressed using two words; a “verb” and its “noun” object. Functions of items or systems may be divided into two types : Basic , and Secondary . While a Primary function answers the question “What does it do?”, a Secondary function answers the question, “What else does it do?”. For example, whereas the Basic function of exterior paint is “protect surface”, then a Secondary function is “improve appearance”.

A) Determining Functions:

Function of Hospital stay:

Component Verb Noun
i) Pre-operative Stay Prepare Patient
ii) Stay on operation day Operate Patient
iii) Post operative stay Examine Patient
Dressing Patient

Functions were further analysed at different stages:

Pre-operative Preparation of patient:

  • Eye lashes are trimmed
  • Face wash with soap
  • Hair is tied and secured
  • Antibiotic drops started
  • Two tablets of Diamox is given 1 hour before operation
  • Dilating drops started 1 hr before operation and instilled twice at 15 min interval
  • Patient is sent to O.T.

Operation of Patient:

  • Retrobulbar/Peribulbar block is given 10-15 min before operation.
  • Operation is performed
  • Patient is sent to ward ambulatory with pad and bandage
  • Patient is given normal diet

Post operative Stay:

1st Postoperative day: Pad and Bandage is opened

  • Wound inspected
  • Local Eye drops (Steroid + Antibiotic + Mydriatic) are applied as per requirement and rebandaged
  • Patient is discharged and asked to remove bandage and wear dark glasses at home
  • Advised to continue drops and ointments prescribed and to report at OPD for follow-up.

B) Determining Functional Relationship:

In “VE” the designation of function as basic or secondary depends upon the indenture level. A function which exists to support the method of performing the Basic function is a Secondary function. This is best assessed with application of Function Analysis System Technique (FAST). It is a diagramming technique which reveals the relationship, and interrelationship of all known functions.Steps of developing “FAST” Diagram:

  • Diagram to have a critical Path of Function from left to right between two Scopelines
  • On the Critical Path, Higher Order Function (HOF), Basic and Secondary functions are listed from left to right in that order.
  • HOF is placed outside the left Scopeline
  • Basic function is placed immediate right to the left Scopeline
  • All other functions (Secondary, and others) lie to the right of Basic function
  • To determine whether the functions are arranged properly, two basic logic test questions must be met : “How?” and “Why?”. The functional answer of “How?” should lie immediate Left, and answer of “Why?” on Right of the function.

!http://www.indmedica.com/journals/images/jaha/013_002_fast1.gif (Fast 1)!

The “FAST” Diagram helped the team to identify the “HOF”, Basic and Secondary functions and their inter-relationship; and to establish scope of this “VE” study.

C). Determining Functional Worth:

“Worth” is the least expensive way to barely perform a function without considering where or how the function is used.

“Cost-Worth” Analysis of Functions:

Table 1 Showing Hospital Stay has high “worth” for Operation Function,

While Hospital Stay Is “worth” less for Pre and Post Op Functions

Component Function Cost “C” in Rs. Worth “W” In Rs. Basic of worth Value (C-W)
a. Pre-op Stay Prepare 100 Hospital Stay 100  
b. Oper. Day Stay Operate Patient 200 200 Hospital Stay 0
c. Post-op Stay Examination and Dressing of Patients 100 0 Hospital Stay 100
d. Post-op Stay on Sunday (Operated on Saturday) Do 300 0 Hospital Stay 300

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